2019-2020-mica-employee-benefit-guide_v4

Eligible Dependents Include: • Married Spouses • Domestic Partners • Dependent children to age 26 Children are eligible until the end of the calendar year that they turn 26 Life Chan

Employee

Benefits Guide 2019/2020

Welcome! 2

Plan Year 2

Eligibility 3

Life Changing Events 3

Medical Benefits 4

Medical Plan Option 1: Basic PPO (90/70) 4

Medical Plan Option 2: Premium PPO (100/80) 6

Pharmacy Benefit 8

Tools & Resources for Your Medical Plans 9

Dental Benefits 13

Dental Plan Comparison 13

DHMO Dental Plan Features 14

PPO Dental Plan Features 19

Employee Benefits and Contributions: Dental and Medical Insurance 21

Retirement 22

Core Benefits 23

Group Life and AD&D 23

Short Term Disability 25

Long Term Disability 27

Employee Assistant Program (EAP) and Health Advocate 30

Voluntary Benefits 31

Supplemental Life Insurance 31

Voluntary Benefit: Vision Insurance 32

Employee Benefits and Contributions: Vision Insurance 35

Voluntary Benefit: The Hartford Plans 36

Voluntary Benefit: Flexible Spending Account (FSA) 52

Contacts 58

Additional Benefits 59

Important Notices 61

Newborns’ and Mothers’ Health Protection Act Notice 61

Notice of Health Information Privacy Practices 61

Women’s Health and Cancer Rights Act Notice 61

Special Enrollment Notice 62

Children’s Health Insurance Program 63

New Health Insurance Marketplace Coverage Options 66

Important Notice About Your Prescription Drug Coverage and Medicare 69

It is important that you take the time to review all of the plan options available to you Consider each benefit and the associated cost carefully and choose the benefits package that will best meet you and your family’s needs throughout the year

Plan Year

MICA’s benefit plan year runs from June 1 st through May 31 st of the following calendar year to correspond with the fiscal year Open enrollment is held in April each year, which allows you the opportunity to change your benefits for the upcoming plan year If you miss the open enrollment period, you will not be able to make changes to your benefits until the next open enrollment, unless you have a life status change

All new employees’ coverage begins on the first day of the month following or coinciding with your hire date Enrollment is required through the Benelogic Online Open Enrollment System

at www.mica.benelogic.com within 31 days of your start date Be sure to enroll in your benefits on time If you miss the enrollment period, you will not have an opportunity to make changes to your benefits until the next open enrollment period

Exceptions: You may enroll or make changes to the 403(b) Retirement Plan and/or Commuter Benefits throughout the year

The College has a right to change these benefits at its discretion Changes may be approved by the Board of

Trustees (or its Executive Committee), The President or Vice-President and Treasurer of the Institute, or by

another official to whom one of these has delegated the amendment power If you have any questions about

these or any benefits at Maryland Institute College of Art, call the Human Resources Dept

This benefits summary describes the highlights of our benefits Your specific rights to benefits under the plan

are governed solely, and in every respect, by the official documents and not the information in this summary If

there is any discrepancy between the descriptions of the programs as contained in this brochure and the official

plan documents, the language of the official plan document shall prevail as accurate Please refer to the plan

specific documents for detailed plan information

You are eligible for benefits if you are a regular full-time or part-time MICA employee Full time

employees are those who work 30 or more hours a week and full-time contract faculty Eligibility and cost sharing is dependent upon full-time and part-time definition

Coverage begins on the first day of the month following or coinciding with your hire date

Eligible Dependents Include:

• Married Spouses

• Domestic Partners

• Dependent children to age 26 (Children are eligible until the end of the calendar year that they turn 26)

Life Changing Events

You can make changes to your medical, dental, vision, and Flexible Spending Account elections during the year only if you have an IRS approved “qualified status change.” You must make a change within 31 days of the event If you experience a life status change, keep in mind that the benefits changes you make must relate to the life status change For example, you may add or drop dependents if these changes are related to your life status change, but you cannot change plan types

You can change your benefits within 31 days if you experience one of the following life changes:

• Marriage, divorce, or legal separation

• Birth or adoption of child

• Death of a covered dependent

• Job status change (Full-time to Part-time or vice versa)

• Your spouse becomes eligible for medical benefits through new employment

• Your spouse becomes unemployed and loses benefit coverage

• A significant change in your spouse’s health coverage attributable to your spouse’s employment

• Ineligibility of your covered dependents due to:

o Marriage

o Change in dependent status

• Loss of other coverage due to circumstances not listed (detailed explanation required)

If you experience a life status change, written notification for the purpose of modifying your plan is required to be submitted to the Human Resources department within 31 days of the status change MICA may require additional documentation to ensure that requested changes become effective on the first day

of the following month of the life status change, not the date of the life status change (except for birth or adoption.)

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Medical Benefits

MICA has partnered with CareFirst, our health plan administrator, to provide you and your family national access to high quality healthcare providers nationwide You can choose between two medical plans Both plans covers a broad range of healthcare services and supplies, including prescriptions, office visits, and hospitalizations The plans differ when it comes to how they share costs with you Please refer to the summary below for details on each medical plan option

Medical Plan Option 1: Basic PPO (90/70)

Medical Plan Option 1: Basic PPO (90/70) Continued

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Medical Plan Option 2: Premium PPO (100/80)

Medical Plan Option 2: Premium PPO (100/80) Continued

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Pharmacy Benefit

MICA has partnered with CareFirst, our health plan administrator, to provide you and your family access

to pharmacy benefits The pharmacy benefits are included with either of the two medical plans and are the same for both plans Below is a high level benefit highlight of the pharmacy benefit

Tools & Resources for Your Medical Plans

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Dental Benefits

Good dental health is important to your overall well-begin At the same time, we all need

different levels of dental treatment That is why MICA offers two types of dental plans for our

employees to choose from: DHMO and a PPO plan Below please find the plan comparison

between these two plans Please note the different networks and cost sharing- especially

when accessing an out of network providers, as dentists can balance bill you

To locate a provider, please visit: www.unitedconcordia.com or call Customer Service at

1-800-332-0366 (FFS) or 1-866-357-3304 (DHMO)

Dental Plan Comparison

Calendar Year Maximum (per person) 1

[Excludes Class I & Orthodontic Services for PPO] None $1500 (Out-of-Network) $2000 (In-Network) Calendar Year Deductible (per person)

Excludes Class I & Orthodontic Services for PPO] None $50 (Out-of-Network) $25 (In-Network) Maximum Calendar Year Deductible (per family)

Excludes Class I & Orthodontic Services for PPO] None $150 (Out-of-Network) $75 (In-Network)

Orthodontic Maximum (Lifetime)

[Orthodontic Maximum is separate from Calendar Year

$2000 (In-Network)

$1500 (Out-of-Network) Implant Benefits Available

[Subject to PPO Calendar Year Deductible and Maximum] No Yes

* Applies when using any non-participating provider under this plan

Network Notes:

 DHMO – IN-NETWORK ONLY “CONCORDIA PLUS” DHMO network. Network is regional in scope Providers may close to new plan participants/patients You may choose to be assigned to open providers in Maryland or any bordering state

 PPO – IN and OUT-OF-NETWORK COVERAGE “ELITE PLUS” PPO network. Participating providers may close to new patients whenever they choose It is recommended that you check with the provider office to make sure they are accepting new patients under the PPO plan if you intend to move to this coverage based on a specific provider’s participation In-network providers may not balance-bill members Out-of-

network providers are paid according to 90 th percentile allowances and may balance bill

 Find network providers on-line at www.unitedconcordia.com or by calling Customer Service at 1-800-332-0366 (FFS) or 1-866-357-3304 (DHMO)

All services listed on this benefit summary are subject to the contract, Schedules of Benefits, and the Exclusions and Limitations

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DHMO Dental Plan Features

The DHMO dental plan provides you with a “schedule of benefits.” The schedule lists the American Dental Association (ADA), Codes, and a fee associated with each procedure Under the DHMO dental plan, you know exactly what the charge will be for any given procedure Under the DHMO, you are required to select a Primary Dentist for your dental needs from the Concordia Plus Provider Directory and you do NOT have out-of-network benefits Please note, you may be limited in your provider selection by providers that are currently accepting new patients

This schedule of benefits provides a listing of procedures covered by your plan For procedures the require a copayment, the amount to be paid is shown in the column titled “Member Pays $” Other items to consider when selecting this benefit:

1 You must use a United Concordia Primary Dental Office (PDO) Treatment by an out-of- network dentist is not covered, except as described in the Certificate of Coverage

2 Only listed procedures are covered For services not listed (not covered), you are responsible for the full fee charged by the dentist

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PPO Dental Plan Features

The PPO dental plan allows you and your dependents the freedom of a larger network of

participating dentists Under the PPO dental plan, you can select a dentist at the time of service

The PPO dental plan allows you the freedom of using in and out-of-network benefits Under the

PPO dental plan, there are both deductible and co-insurance requirements, as well as a

calendar year maximum

All Other X-rays

Cleanings & Fluoride Treatments

Sealants

Palliative Treatment

Class II – Basic Services

Basic Restorative (Fillings)

Class III – Major Services

Inlays, Onlays, Crowns

Prosthetics (Bridges, Dentures)

Implants

Orthodontics to ANY AGE

Included Plan Features

Preventive Incentive ® Class I services do not count toward your annual program

maximum Pregnancy Benefit • Covers 1 additional cleaning during pregnancy • Covers 1 additional periodontal maintenance

Maximums & Deductibles (applies to the combination of services received from network and non-network dentists)

Calendar Year Deductible (per person/per family) Excludes Class I & $25/$75

Orthodontics

$50/$150 Excludes Class I &

Orthodontics Calendar Year Maximum (per person) Excludes Class I & $2,000

Orthodontics

$1,500 Excludes Class I &

Orthodontics

Representative listing of covered services – certificate of coverage provides a detailed description of benefits

1 Dependents covered to age 26

2 Reimbursement is based on our schedule of maximum allowable charges (MACs) Network dentists agree to accept our allowances as payment

in full for covered services Non-network dentists may bill the member for any difference between our allowance and their fee (also known as balance billing) United Concordia Dental’s standard exclusions and limitations apply

3 Posterior Composite Restorations are covered as standard (no Alternate Benefit Provision applied)

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Employee Benefits and Contributions: Medical and Dental Insurance

Effective: 06/01/2019-05/31/2020

CareFirst- Medical: Full Time Employees

CareFirst- Medical: Part Time Employees

United Concordia- Dental: Full Time Employees

United Concordia- Dental: Part Time Employees

Premium PPO Monthly Cost Per Pay Cost

Individual $101.83 $47.00 Individual/Child $416.00 $192.00 Individual/Adult $546.00 $252.00 Individual/Children $615.33 $284.00 Family $684.66 $316.00

Basic PPO Monthly Cost

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Retirement

MICA’s retirement annuity plan (403b) is referred to as a “Defined Contribution Plan” which gives all full-time employees the opportunity to participate in the plan when you are benefit eligible, (new employees first of the month following or coinciding with your hire date.) You participate by making contributions into the plan and receiving matching dollars each pay cycle Once you are a participant in the plan, you can make contribution changes at any time during the year You are immediately vested into the retirement plan, which means you are eligible for 100% of the college’s contributions For each 1% contribution made by you the employee, MICA will contribute 1 ½%, up to 9% You may choose to make traditional 403(b) pre-tax contributions and/or Roth 403(b) post-tax contributions Each year the Federal Regulations change regarding the annual maximum contribution an individual can contribute If you are over the age of 50, you are allowed to contribute an additional amount each year The minimum contribution is 1% of your income to participate in the retirement plan The maximum match by the College is 9% (see chart below.)

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Core Benefits

Along with the many benefits the MICA provides you, core benefits are provided at no

cost MICA pays the full cost of these benefits for you These benefits include Group

Life and Accidental Death & Dismemberment (AD&D), Short Term Disability, Long

Term Disability, and the Health Advocate Please find the highlights of each of these

benefits below

Group Life and AD&D

MICA provides you with life insurance and accidental death and dismemberment

(AD&D) coverage through Aetna in the coverage amount of one times your annual

salary, a minimum of $50,000, maximum of $250,000, during your employment at

MICA You qualify if you are an active full-time employee working at least: staff (30

hrs.) or faculty (20 hrs.) You must designate a beneficiary for this coverage See

Human Resources to update your beneficiary at any time

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Short Term Disability

For Staff Employees:

Your eligibility in the short term disability plan is based on your length of service with the College and dependent upon proof of disability from your physician Eligibility is based on the following schedule:

• Less than 1 year of continuous service - You are not eligible during this period (See The Hartford Individual Short Term Disability in the Voluntary Benefits section for information on coverage available during this period.) Should you need to take medical leave and have exhausted all of your accrued leave, you may request a non-paid leave of absence

• 1 year of continuous service or more -Eligibility begins on the first day of the month after you have completed one year of full time employment Once your claim has been reviewed and approved by the Claim Administrator, then your benefit is paid at 60% of full regular pay through the short term disability plan You may use your accrued leave time to supplement the remaining 40% of your regular pay

Once your claim has been reviewed and approved by the Claim Administrator, the College will pay your short term disability as follows:

For Faculty Employees:

Like, Staff Employees, your eligibility in the short term disability plan is based on your length of service with the College and dependent upon proof of disability from your physician Eligibility is based on the following schedule:

• Less than 1 year of continuous service - You are not eligible during this period (See The Hartford Individual Short Term Disability in the Voluntary Benefits section for information on coverage available during this period.) Should you need to take medical leave and have exhausted all of your accrued leave, you may request a non-paid leave of absence

• 1 year of continuous service or more - Eligibility begins on the first day of the month after you have completed one year of full time employment Once your claim has been reviewed and approved by the Claim Administrator, after you utilize all sick time, then your benefit is paid

at 100% of full regular pay through the short term disability plan

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If you are on short term disability leave you will continue the status of "Active

Employee," which allows you to continue in the benefit programs During short term disability leave, you will continue to receive service time without interruption If you become disabled due

to a covered sickness or off-the-job injury, contact the Human Resources department to make a claim for short term disability

Long Term Disability

MICA provides you with Long Term Disability coverage through Aetna

For Staff Employees:

You qualify for long term disability if you are a full time staff employee working at least 30 hours

or more per week Coverage will begin on the first of the month if you are actively at work Once your claim has been reviewed and approved by the Claim Administrator, the College will pay your long term disability as follows:

For Faculty Employees:

You qualify for long term disability if you are a full time faculty employee working at least 20 hours or more per week Coverage will begin on the first of the month if you are actively at work Once your claim has been reviewed and approved by the Claim Administrator, the College will pay your long term disability as follows:

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Long Term Disability

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Employee Assistant Program (EAP) and Health Advocate

We all experience times when we need a little help with life’s challenges MICA understands the importance of balancing Work and Family issues, and you have been provided an Employee Assistance Program benefit through Health Advocate at no cost to you This benefit provides your and your extended family members with access to confidential counseling and referral services 24 hours a day, 7 days a week You can talk to a licensed EAP counselor, through telephone or by email, who will help you learn coping skills for stress, depression, parenting issues, substance abuse, and other temporary setbacks A Work/Life specialist can help you locate support resources, from childcare and eldercare to legal help

If you need help obtaining answers involving your medical, hospital, dental, mental health, medication, Flexible Spending Account, Hartford plans, or Medicare, Health Advocate is here to help Health Advocate is a free benefit available to you, your dependents, parents, and parents- in-law 24/7 Health Advocate can help resolve medical billing problems, claims processing issues, and other insurance-related concerns All conversations are confidential

Voluntary Benefits

MICA provides employees the option to elect voluntary benefits Voluntary benefits are

employee benefits paid for by the employee rather than the employer Through payroll

deductions, employees may elect to enroll in Aetna’s Supplemental Life, EyeMed’s Vision,

Hartford’s Accident, Hartford’s Critical Illness, Hartford’s Hospital Indemnity, and/or

Hartford’s Individual Short Term Disability Please refer to the benefits highlights for each of

these voluntary benefits

Supplemental Life Insurance

You may purchase, as part of MICA’s benefit program, an additional amount of life insurance

for yourself, your spouse/partner, and/or your dependents You qualify if you are an active

full-time employee working at least: staff (30 hrs.) or faculty (20 hrs.).Please see the below chart

for information on these policies

Your Summary of Group Life and AD&D Ultra ® Benefits: Supplemental Life Coverage

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Voluntary Benefit: Vision Insurance

Eligible employees may sign up for vision coverage, which allows participants to get an

examination and lenses every 12 months and frames every 12 months Participants have the option of receiving care from a network provider or out-of- network provider; however, if you use

an out-of-network provider you will incur higher out-of-pocket expenses For additional

information please visit www.eyemed.com

2019/2020 MICA Employee Benefits

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