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Ave Maria 2013 Employee Benefits Summary . Plans at a Glance. Enrollment Elections. Basic Coverage Provided to All Eligible Employees, Employer-Paid Benefits Core Dental Basic Life / AD&D Long Term Disability Short Term Disability Adoption. Optional / Contributory Coverage,

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enrollment elections
Plans at a GlanceEnrollment Elections

Basic Coverage Provided to All Eligible Employees,

Employer-Paid Benefits

Core Dental

Basic Life / AD&D

Long Term Disability

Short Term Disability

Adoption

Optional / Contributory Coverage,

Employee-Paid Benefits

Core Medical - Employer contributes to expense

Medical Plan1 - Employer contributes to expense

Medical Plan 2 - Employer contributes to expense

Enhanced Dental - Employer contributes to expense

Vision - Employer contributes to expense

Optional Employee/Spouse/Dependent Life

Flexible Spending Account

Various AFLAC products

delta dental
Delta Dental

ENHANCED

CORE

PPO Premier Non-

Dentist Dentist Network

Deductible

$50 Single / $150 family per benefit year

(the deductible does not apply to

diagnostic, Preventive or Orthodontic Services)

Class 1 Benefits

Preventive 100% 100% 100%

Class II Benefits

Basic Services 75% 75% 75%

Class III Benefits

Major 50% 50% 50%

Class IV Benefits

Orthodontic 50% 50% 50%

Maximum Payment

Annual Maximum $1,200 per Calendar Year

Orthodontic Lifetime Maximum $1,500 per person

PPO Premier Non-Network

DentistDentistDentist

N/A

100% 100 % 100%

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

$1000 per calendar year

N/A

delta dental ppo pricing example
Delta Dental PPO Pricing Example

Delta Dental PPO dentistDelta Dental Premier dentistNon participating dentist

To whom will check be sent? The dentist The dentist You

How is payment calculated Payment is based on the Payment is based on the Payment is based on the

amount in Delta Dental’s billed fee or Delta Dental’s billed fee or Delta Dental

PPO Fee Schedule, Maximum Approved Fee, Nonparticipating Dentist

whichever is less. whichever is less. Fee, whichever is less.

Things to Consider Participating Dentists : Participating Dentists: Non participating Dentists

Will fill out and submit claim forms Will fill out and submit claim forms Can charge you the

Cannot balance bill you Cannot balance bill you difference between their

will only charge you for your will only charge you for your fee and the amount Delta

copayment and deductible. copayment and deductible. Dental pays. May ask you to pay full amount up front. May require you to submit claim forms.

Payment Example Dentist’s billed fee $120 Dentist’s billed fee $120 Dentist’s billed Fee $120 PPO Fee Schedule amount $67 Maximum Approved Fee $102 Nonparticipating Fee $77

Delta Dental pays 75%

Delta Dental pays 75% of the Delta Dental pays 75% of the of nonparticipating

PPO Fee Schedule amount: $50.25 PPO Fee Schedule amount $76.5 Dentist’s fee $57.75

You Pay: $16.75 You Pay: $26.50 You Pay: $62.25

Delta Dental PPO dentist cannot charge Delta Dental Premier dentist cannot Because dentist does not

you the $53 difference between Delta charge you the $18 difference between participate, you are re-

Dental PPO Fee Schedule amount and Delta Dental’s Maximum Approved Fee responsible for the

his/her billed fee. You only pay your and his/her billed fee. You only pay difference between Delta

copayment. your copayment. Dental’s payment and the

dentist’s billed fee.

vsp vision benefits summary
VSP Vision Benefits Summary

In NetworkOut-of-Network

Vision Exam$10 co-pay Up to $45

Frames$130 Allowance; 20% of the Up to $70

amount over your allowance

Prescription Glasses

Standard Plastic Lenses: $25 co-pay

Single Vision Up to $30

Lined Bifocal Up to $50

Lined Trifocal Up to $65

Standard Polycarbonate Up to $55

(for dependent children)

Lens Options:

Standard Progressive Plastics $55 co-pay Contact VSP if you are seeking

Premium Progressive Plastics $95-$105 co-pay an out of network provider for

Custom Progressive Plastics $150-$175 co-pay coverage amounts.

Contact Lenses

(instead of Glasses) $130 allowance

Up to a $60 co-pay for your Up to $105

contact lens exam (fitting and

evaluation)

Laser Vision Correction 15% off retail price or 5% off N/A

promotional price

Frequency

Examinations Once every 12 months

Frames Once every 24 months

Lenses or Contacts (in lieu of plastic lenses) Once every 12 months

life and ad d insurance
Life and AD&D Insurance

Basic Life / AD&D (Cigna)

Basic Life

The Basic Life benefit is payable to your beneficiary should you die from most causes. The amount of

coverage is : 1 x annual earnings to a maximum of $500,000. Amounts of Basic Life coverage in excess if

$400,000 are subject to Evidence of Insurability rules.

Accidental Death and Dismemberment

The amount of AD&D coverage is: an additional 1 x base annual earnings to a maximum of $500,000.

Benefit Reduction Schedule

Benefit amount reduces to 65% at age 70, and 50% at age 75

voluntary life insurance
Voluntary Life Insurance

Voluntary or Optional Life (Cigna)

You have the opportunity to purchase additional Life insurance coverage under an

optional program. This coverage is available for you, your spouse, and children at

group rates. Amounts of coverage beyond the “guaranteed issue amount”, as well

as subsequent purchases or coverage increases, are subject to Evidence of

Insurability (EOI) rules.

Employee: 1, 2, 3, 4, or 5 x base annual earnings to a maximum of $200,000

Guaranteed Issue amount = $200,000 (upon initial first eligibility)

Spouse: $10,000

Child(ren): $5,000 per child

Birth to 14 days: $500

15 days to 6 months: $2,000

6 months to 19 years $5,000

Any employee who currently participates in Voluntary Life, with Unum, and has a life volume over and above $200,000 will be “grandfathered” at that amount under the new Cigna Plan.

disability insurance
Disability Insurance

The plan provides eligible employees with short and long-term disability income benefits, and pays the full

cost of this coverage. In the event you become disabled from a non work-related injury or sickness,

disability income benefits are provided as a source of income. You are not eligible to receive short-term

disability benefits if you are receiving workers’ compensation benefits.

Short Term Disability (Verus Health)

Benefit

A short-term, non-occupational, illness or injury, although not necessarily serious, can still prevent you

from working for a period of time. Should this happen, the Short Term Disability plan (STD) will replace a

portion of your lost income. The amount of coverage is:

66.67% of Weekly Earnings

Maximum Weekly Benefit = $750

Benefits become payable on the:

1st Calendar Day for Accident

8th Calendar Day for Sickness

For a duration up to 26 Weeks

Long Term Disability (Cigna)

Benefit

Long Term Disability is designed to continue to replace a portion of your income after your short term

disability benefits are exhausted. It pays a benefit each month, for as long as you remain totally or partially

disabled (or your normal Social Security retirement age, if earlier). The amount of the insurance is:

60% of Monthly Earnings

Maximum Monthly Benefit = $10,000

Elimination Period = 180 days

medical delta dental vsp vision plan 1 plan 2 core plan enhanced core

Medical, Enhanced Dental and Vision deductions are taken out on a pre-tax basis

Single $118.82 $51.40 $10.06 $16.46 $0 $1.45

EE +1 $241.73 $106.85 $24.15 $30.60 $0 $2.90

Family $346.80 $149.90 $29.18 $51.61 $0 $4.32

If you choose to waive medical or dental, your opt-out benefit will be $15.00 per person per

pay for medical and $2.50 per person per pay for dental

Bi-weekly Cost for each $1,000 of Employee Voluntary Life Insurance Coverage

Age <30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+

Rate $.02 $.03 $.04 $.06 $.10 $.15 $.23 $.37 $.67 $.96 $2.05

Spouse and Children – Flat $1.11 per family regardless of the number of children

You must submit Evidence of Insurability on any amount of core life insurance over $400,000. If you waived Voluntary Life at your initial

eligibility period you are considered a Late Entrant and are also subject to Evidence of Insurability. In addition, all subsequent requests for

increased amounts of coverage will always require Evidence of Insurability. Payroll deductions will not begin until approval from the insurance

company for amounts of coverage subject to Evidence of Insurability rules.

MedicalDelta DentalVSPVision

Plan 1Plan 2Core PlanEnhanced Core

Contribution Schedule

additional information
Additional Information
  • Ave Maria Human Resources Website
    • www.avemariahr.org(Employee Orientation → Open Enrollment 2013)
  • Verus Health Website
    • www.verushealth.com(Member & Provider Login)
    • Contact Verus Health for user name and password information
  • Due to changes in dental and vision plans, all employees are required to complete enrollment for 2013