The words you are searching are inside this book. To get more targeted content, please make full-text search by clicking here.
Discover the best professional documents and content resources in AnyFlip Document Base.
Search
Published by , 2018-02-04 23:25:49

AAU_Benefits_Guide_CA_2018_Final

AAU_Benefits_Guide_CA_2018_Final

2018 BENEFITS GUIDE

CALIFORNIA EMPLOYEES



Welcome to Your Benefits Guide

This guide is intended as a quick reference of the benefits available to you
through Academy of Art University. It is important that you take the time to
understand your options, ask questions, and make your choices accordingly.

The details of the benefit plans described in this guide are contained in the official plan and policy documents, including
insurance contracts. This guide is only meant to highlight major points of each plan and does not contain all the policy
provisions, limitations and exclusions that are included in the official plan documents and Summary Plan Descriptions (SPD).
If there is ever a question about any of these plans or policies, or if there is a conflict between the information contained in
this benefits guide and the official plan documents, the plan documents will govern.

TABLE OF CONTENTS

Your Benefits at Academy of Art University .......................................................................................................... 2
The Difference Card - Gap Medical Coverage...................................................................................................... 3
Medical Plan Choices............................................................................................................................................ 4
Dental Plan ............................................................................................................................................................ 8
Vision Plan............................................................................................................................................................. 9
Your Monthly Contributions.................................................................................................................................. 10
Flexible ­Spending Accounts ............................................................................................................................... 11
Basic Life/AD&D Insurance ................................................................................................................................ 14
Voluntary Life and AD&D..................................................................................................................................... 14
Long Term Disability............................................................................................................................................. 14
Travel Assistance Program.................................................................................................................................. 15
Employee Assistance Program (EAP)................................................................................................................. 15
401(k) Retirement Plan........................................................................................................................................ 15
Commuter Program............................................................................................................................................. 16
The Advocacy Group (TAG)................................................................................................................................ 16
Contact Information............................................................................................................................................. 17
Required Notices ................................................................................................................................................ 18

1

Your Benefits at Academy of Art University

At Academy of Art University, we believe our employees are our most valued asset, and our Human Resources team strives to
offer a comprehensive and competitive benefits program designed to protect the health and welfare of you and your loved ones.
With the help of outside consultants and data resources, we continually examine the value of our benefit plans to be sure we are
keeping pace with market trends and innovative approaches to health care and the financial well being of our staff.

While health care is an important component of any benefits program, Academy of Art University also offers a wide array of other
benefit options. This guide provides an overview of the benefits program, followed by descriptions of the primary features of each
benefit type. Please use this guide as an easy tool to help you make your benefit choices, and consult each carrier’s Summary
Plan Description, or booklet, for more in-depth descriptions of coverage. Remember too that your coverage needs may change
from year to year as your family situation changes. During each annual Open Enrollment—held each Fall of each year for a
January 1 effective date—you should reevaluate your benefit elections and determine whether they still meet your needs.

WHO IS ELIGIBLE

All full-time employees are eligible for benefits. You may enroll your eligible dependents for Medical, Dental, and Vision. Your
eligible dependents include:

•• Your spouse or registered domestic partner*
•• Your children up to age 26, including children of your registered domestic partner*
•• Any dependent child who is incapable of self-support due to a mental or physical disability

*Refer to Academy of Art University’s Domestic Partner policy for details.

TERMINATION OF COVERAGE

Your coverage ends on the last day of the month in which your active full-time service ends. For the Health Care and
Dependent Care FSA, please refer to page 11. For Life insurance, AD&D and Disability coverage, your coverage ends on the
day your active full-time service ends.

MAKING CHANGES

Any changes you make to your medical plan choices during open enrollment will be effective for the plan period January 1
through December 31, unless you have a change in family status (a qualifying event). Because many of your benefits are
available on a pre-tax basis, the IRS requires you to have a change in family status in order to make changes during the year.
Qualifying events include:

•• Marriage or divorce,
•• Birth, adoption or custody change of an eligible dependent,
•• A domestic partner becoming a spouse(marriage). Once enrolled as a spouse,

imputed income is no longer applicable,
•• The loss of coverage due to the death of a spouse or registered domestic partner,
•• Beginning or ending of a spouse’s or registered domestic partner’s employment,
•• Unpaid leave of absence by you, your spouse or registered domestic partner,
•• A change in employment (either yours, your spouse’s or registered domestic partner’s) from part-time to full-time or

full-time to part-time,
•• An increase in the cost of health care coverage for you or your spouse or registered domestic partner because of

your spouse’s or registered domestic partner’s employment,
•• An increase in the cost of, or reduction in your Academy of Art University health care benefits,
•• Becoming eligible for or losing coverage under a Medicaid or State plan (i.e., Medi-Cal).

If you have a qualifying event at a time other than open enrollment, you may change your Academy of Art University benefits by
notifying Human Resources within 30 days of the event. The change in your benefits must be consistent with the change in your family
status. For example, if you have a new baby, you can enroll the child as a dependent under your medical plan, but you may not remove
another dependent who is already covered. Remember that newly eligible dependents, including newborns, spouses and registered
domestic partners, can only be added to your plans within 30 days of first becoming eligible unless they are covered elsewhere.

2

The Difference Card - Gap Medical Coverage

At Academy of Art University, we recognize that the cost of health care increases with each passing year. Our goal has
always been to offer you the most comprehensive, cost-effective and competitive benefits package possible. Academy of Art
University will continue to support our employees by contributing directly towards your out-of-pocket costs, which includes
co-pays, co-insurance, and deductibles through The Difference Card. Those with the following medical plans will be issued a
Benefit Card by The Difference Card:

•• Anthem Blue Cross HMO

•• Anthem Blue Cross Solution PPO Plan

•• Kaiser HMO

Your enrollment in The Difference Card is automatic. The Difference Card is used to bridge the gap between what your
medical plan covers (the “Anthem Blue Cross” or “Kaiser” benefits column in the following benefit tables) and what you are
responsible for paying (the “You Pay” column). Academy of Art University has chosen to actively fund this difference (see the
“AAU Pays Through The Difference Card” column) to help lower health care costs for our employees. The Difference Card
does not supplement the Anthem Blue Cross plan offered to out-of-state employees. If you move out-of-state your coverage
under our California plans will be terminated and you will have 60 days from the date that plan is terminated to submit any
eligible claims. See the out-of-state Benefit Guide for more details about the benefits offered to non-California employees.

THE DIFFERENCE CARD – ID CARDS

Once you are enrolled, you will receive a benefits card (you will not be receiving a new card if you are currently enrolled). This
benefits card also acts as a credit card when paying for a portion of your doctor’s office visit copays. This credit card is not
tied to your credit history in any way.

Both you and your spouse/domestic partner will receive your own personalized Difference Card MasterCard. Dependent
children enrolled under your plan will be linked to both parents’ cards.

THE DIFFERENCE CARD – HOW IT WORKS

As an example, if you enroll in the Anthem Blue Cross HMO and you are visiting your primary care physician, you will
present your Anthem Blue Cross ID card and you will be charged $30 for your visit. You will then use The Difference Card to
pay $25 of that copay and you are responsible for the remaining $5. If your doctor’s office does not accept credit cards, you
will need to pay the entire copay and then submit the receipt along with the reimbursement form to The Difference Card at
the following address for reimbursement:

The Difference Card Phone: 888-343-2110
Attn: Claims FAX (914) 220-0901
245 Main Street, Suite 605
White Plains, NY 10601

For deductible and coinsurance claims, you will need to present your Anthem Blue Cross or Kaiser ID card to the hospital/
medical facility at time of service. Once the claim has been processed by Anthem Blue Cross or Kaiser, you will receive an
Explanation of Benefits (EOB) from Anthem or Kaiser showing the amount you owe. You will submit that EOB along with
the reimbursement form to The Difference Card at the claims address shown above. Alternatively, you may also upload the
documentation to www.differencecard.com or register your personal email address with the Difference Card so that you can
email the documentation to Difference Card for reimbursement.

Note that the Difference Card DOES NOT apply to prescription drug claims. You simply pay the appropriate copays when
picking up your prescriptions. The Difference Card also DOES NOT modify any benefits you receive under the dental or
vision plans. Please send an email to [email protected] if you lose your card and need a replacement.

Via Direct Deposit, your claims reimbursements are deposited directly into your bank account. To sign up for Direct Deposit, login
to the participant portal on www.differencecard.com and click on the “My Account” link in the black navigation bar at the top of the
page. Click on the purple Difference Card image. Click on the “My Accounts” tab and then the “Reimbursements Settings” link.
Select Direct Deposit as your Reimbursement Method. Enter your banking information on the Direct Deposit screen.

3

Medical Plan Choices

Academy of Art University offers California employees a choice of four medical plans—Kaiser HMO, Anthem Blue Cross
HMO, Anthem Blue Cross Solution PPO, or Anthem Blue Cross PPO. Please note: A Primary Care Physician (PCP)
designation is required when you enroll. To find an HMO PCP, visit www.anthem.com/ca and go to the menu in the top
left corner. Select “Find a Doctor” and, select “Search as a Guest” if you are not already an Anthem BC member. The network
you should use when providing your search criteria is the Blue Cross HMO (CACare) - Large Group”.

Please refer to the comparison chart below and on the following pages to compare your medical plan options.

Anthem Blue Cross HMO – (CaliforniaCare) Large Group Network

BENEFITS ANTHEM BLUE CROSS AAU PAYS THROUGH YOU PAY
Calendar Year Deductible BENEFITS THE DIFFERENCE
Coinsurance CARD None
$2,000 per member (See out of pocket
Office Visit Copay $2,000 per member maximum)
Chiropractic Services* $5 for PCP;
20% $0 $20 for Specialist

$30 copay for Primary Care $25 for PCP; $5
Physician (PCP); $45 copay for $25 for Specialist
Specialist
$25
$30 copay per visit

Acupuncture** $30 copay per visit $25 $5

Well Child Care No charge $0 $0

Adult Physicals No charge $0 $0

Hospitalization 20% (after deductible is met) $1,750 $250 copay plus 20% of
charges per admission

Emergency Room $150 copay per visit $50 $100 copay per visit
(Copay waived if admitted; (waived if admitted)
but deductible and 20%
coinsurance will apply)

Prescriptions (Retail $0 for preventive $0 You are responsible for the
Pharmacies - 30 day immunizations administered by copays
supply) retail pharmacy
$0 for generic and
single source brand oral
contraceptives
$10 copay Tier 1
$25 copay Tier 2
$40 copay Tier 3
20% to $150 maximum Tier 4

Mail Order Prescriptions $0 for generic and $0 You are responsible for the
(90 day supply) single source brand oral copays
contraceptives $2,000 Individual
Calendar Year Out-of- $10 copay Tier 1 $2,500 Family $1,500 Individual
Pocket Maximum (includes $50 copay Tier 2 Not applicable $4,500 Family
deductible) $80 copay Tier 3 Not applicable
Lifetime Maximum 20% to $300 maximum Tier 4

$3,500 Individual
$7,000 Family

Not applicable

Website www.anthem.com/ca www.differencecard.com

Note: After the Difference Card all copays and coinsurance are the member’s responsibility.
* Limited to a 60-day period of care; additional visits available when approved by your PCP.

4 ** Acupuncture is only covered when it is considered medically necessary. Please refer to the Anthem Blue Cross EOC for further details.

Medical Plan Choices (cont’d)

Kaiser HMO

BENEFITS KAISER BENEFITS AAU PAYS THROUGH THE YOU PAY
DIFFERENCE CARD
Calendar Year $2,500 Individual None
Deductible $5,000 Family $2,500 Individual (See out of pocket maximum)
Coinsurance 30% $5,000 Family
Office Visit
Copay $40 copay 30%
Chiropractic
Services Not covered – discount $15 $25
programs available
Acupuncture Not covered - discount N/A N/A
programs available
Well Child Care No charge N/A N/A
Adult Physicals No charge
$0 $0
Hospitalization 30% (after deductible is met) $0
$0 $500 copay per admission
Emergency 30% (after deductible is met)
Room 30% coinsurance except for the $100 copay (waived if admitted)
$10 copay Generic $500 copay per admission
Prescriptions $30 copay Brand
(Retail Any additional Deductible and
Pharmacies - 30 Coinsurance Charges
day supply)
$0 You are responsible for the
copays

Mail Order $20 copay Generic $0 You are responsible for the
Prescriptions $60 copay Brand copays
(90 day supply)

Calendar Year $5,000 Individual $3,500 Individual $1,500 Individual
Out-of-Pocket $10,000 Family $7,000 Family $3,000 Family
Maximum
(includes Not applicable Not applicable Not applicable
deductible) www.kp.org www.differencecard.com

Lifetime
Maximum

Website

Note: After the Difference Card, all copays and coinsurance are the member’s responsibility.

5

Medical Plan Choices (cont’d)

To find a participating provider, visit www.anthem.com/ca and select the Blue Cross PPO (Prudent Buyer) Large Group network.

Anthem Blue Cross Solution PPO – (Prudent Buyer) Large Group Network

BENEFITS ANTHEM BLUE CROSS AAU PAYS THROUGH THE YOU PAY
BENEFITS DIFFERENCE CARD
Calendar Year
Deductible In-Network: $3,500 Individual In-Network: $1,000 Individual In-Network: $2,500 Individual
Out-of-Network: $7,000 Family $2,000 Family $5,000 Family
$7,000 Individual Out-of-Network: $4,500 Individual Out-of-Network: $2,500 Individual
$14,000 Family $9,000 Family (no cross application)
In-Network: $5,000 Family
Coinsurance In-Network: 35% In-Network: 15% Out-of-Network:
Office Visit Out-of-Network: 10% In-Network: 20%
Copay Out-of-Network: 50% Out-of-Network: 40%
In-Network: $25 In-Network:
Chiropractic In-Network: $35 Out-of-Network: 10% Out-of-Network: $10
Services* 40%
Out-of-Network: 50%
Acupuncture** 20%
In-Network: 35% 40% up to $25 per
Well Child Care visit maximum
Out-of-Network: 50% to $25 per In-Network: 15%
Adult Physicals
visit max Out-of-Network: 10%
Hospitalization
Discount program also available
Emergency
Room In-Network: 35% In-Network: 15% In-Network: 20%

Out-of-Network: 50% Out-of-Network: 10% Out-of-Network: 40%

Discount program also available

In-Network: No charge In-Network: $0 In-Network: $0
Out-of-Network: 10%
Out-of-Network: 50% Out-of-Network: 40%
In-Network: $0
In-Network: No charge Out-of-Network: 10% In-Network: $0

Out-of-Network: 50% In-Network: 15% Out-of-Network: 40%
Out-of-Network: 10%
In-Network: 35% In-Network: 20%
Out-of-Network: $500 deductible Out-of-Network: $500 deductible
+ 50% + 40%

$150 copay per visit + 35% $50 copay + 15% $100 copay + 20% (deductible
waived if admitted)

Prescriptions $10 copay Tier 1 $0 You are responsible for the copays
$35 copay Tier 2
(Retail Pharmacies - $50 copay Tier 3
30 day supply) 30% to $150 maximum Tier 4
($250/member deductible applies to
Tier 2, 3 and 4 prescriptions)

Mail Order $10 copay Tier 1 $0 You are responsible for the copays
Prescriptions $70 copay Tier 2
$100 copay Tier 3 In-Network:
(90 day supply) 30% to $300 maximum Tier 4 Out-of-Network:
($250/member deductible applies to
Calendar Year Tier 2, 3 and 4 prescriptions)
Out-of-Pocket
Maximum In-Network: $6,350 Individual $2,221 Individual In-Network: $4,129 Individual
Out-of-Network: $12,700 Family $4,442 Family Out-of-Network: $8,258 Family
(includes deductible) $12,000 Individual $5,500 Individual $6,500 Individual
$24,000 Family $11,000 Family $13,000 Family

Lifetime Not applicable Not applicable Not applicable
Maximum www.anthem.com/ca www.differencecard.com

Website

Note: All copays and coinsurance are the member’s responsibility.

* 24 visits/calendar year; additional visits may be authorized.

6 ** Limited to $30 maximum per visit; 12 visits per plan year maximum.

Medical Plan Choices (cont’d)

To find a participating provider, visit www.anthem.com/ca and select the Blue Cross PPO (Prudent Buyer) Large Group network.

Anthem Blue Cross PPO – (Prudent Buyer) Large Group Network

BENEFITS ANTHEM BLUE CROSS BENEFITS
Calendar Year Deductible
$250 Individual
Coinsurance $500 Family
Office Visit Copay (All providers)
Chiropractic Services*
In-Network: 10%
Acupuncture** Out-of-Network: 30%

Well Child Care In-Network: 10%
Adult Physicals Out-of-Network: 30%
Hospitalization
Emergency Room In-Network: 10%
Prescriptions Out-of-Network: 30%
Discount program also available
(Retail Pharmacies - 30 day supply)
In-Network: 10%
Out-of-Network: 30%
Discount program also available

In-Network: No charge
Out-of-Network: 30%

In-Network: No charge
Out-of-Network: 30%

In-Network: 10%
Out-of-Network: $500 deductible + 30%

$100 deductible per visit + 30%

$10 copay Tier 1
$25 copay Tier 2
$40 copay Tier 3
20% to $150 maximum Tier 4
($250/member deductible applies to Tier 2, 3 and 4 prescriptions)

Mail Order Prescriptions $10 copay Tier 1
$50 copay Tier 2
(90 day supply) $80 copay Tier 3
20% to $300 maximum Tier 4
($250/member deductible applies to Tier 2, 3 and 4 prescriptions)

Calendar Year Out-of-Pocket Maximum In-Network: $2,000 Individual
Out-of-Network: $4,000 Family
(Excludes deductible) $6,000 Individual
Not applicable $12,000 Family
Lifetime Maximum www.anthem.com/ca
Website

Note: All copays and coinsurance are the member’s responsibility. Difference Card does not apply.
* Limited to 24 visits per calendar year, additional visits may be authorized.
** Limited to $30 maximum per visit; 12 visits per plan year maximum.

7

Dental Plan

Academy of Art University offers employees the choice of two dental plans through MetLife. With either plan, you are not
required to choose a PPO network dentist. If you do choose a PPO network dentist, you will have lower out-of-pocket costs
because MetLife negotiates lower fees with network dentists and passes the savings along to you. You can find a list of
participating dentists at www.metlife.com/dental. Once on the website, select “Find a participating dentist” and select the “PDP
Plus” network as your network type. When you use a non-network dentist, MetLife will pay according to usual and customary
allowances of the 90th percentile and you will be responsible for the balance beyond what MetLife pays the dentist.

Please consult the chart below for a summary of our two PPO plan options: the Core plan and the Enhanced plan.

During open enrollment, you may change from the Core Plan to the Enhanced Plan or vice versa without penalty. Such
changes will not be allowed during the rest of the year unless you experience a qualifying event.

If you did not enroll in either dental plan when you were initially benefit eligible and voluntarily elect to enroll on
a later date, your benefits will be limited to Preventive Care for your first year of coverage. After the first year of
coverage, you will be entitled to access all levels of service shown below.

The coinsurance percentages represent your financial responsibility.

MetLife Dental PPO – PDP Plus Network

THE CORE PLAN THE ENHANCED PLAN

BENEFITS IN-NETWORK NON-NETWORK IN-NETWORK AND

DENTIST DENTIST NON-NETWORK DENTISTS

Calendar Year Deductible $50 Individual $50 Individual
Calendar Year Maximum $150 Family $150 Family
Waived for Preventive Care Waived for Preventive Care

$1,000 Individual $1,500 Individual

Preventive & Diagnostic Services No charge* 20% No charge*

(Limit 2 cleanings per year)

Basic Services 20% 40% 20%
60%
(Fillings, extractions, periodontics, etc.) 50% 50%
Not covered Not covered
Major Services

(Crowns, bridges, dentures, etc)

Orthodontics

Website www.metlife.com/dental

* The benefits paid by MetLife to your dentist for preventive care are applied to your calendar year maximum even if you owe nothing. You will be
responsible for the cost of preventive & diagnostic services if you have already exhausted your maximum benefit for the year at the time of service.

** You will not receive a dental ID Card. However, a group dental card is supplied in the MetLife Dental Benefits summary.

8

Vision Plan

Academy of Art University offers you vision care coverage through Blue View Vision. With Blue View Vision you can receive
vision care services from any provider you choose. However, you will receive the highest level of coverage when you use
network providers. Most eligible services accessed from network providers are covered at 100% up to the plan’s allowance
for a specific service. Vision care accessed from out-of-network providers is covered at lower levels.

The copays represent your financial responsibility.

Blue View Vision*

BENEFIT FREQUENCY IN-NETWORK OUT-OF-NETWORK

Examination Every 12 months
Lenses Every 12 months
Frames Every 24 months
Contacts (In lieu of lenses and frames) Every 12 months

PLAN PROVISIONS $20 copay Up to $49
Examination
Single Lens $20 copay Up to $35
Bifocal Lens
Trifocal Lens $20 copay Up to $49
Basic Progressive
Contacts $20 copay Up to $74

Frames $65 copay Additional cost not covered

Laser Vision Care Covered up to $80 plan allowance plus Up to $64
15% discount thereafter ($200 for non-elective contacts)

Covered up to $100 plan allowance plus Up to $45
20% discount thereafter

Discounts may be available, contact member services

Website www.anthem.com/ca

* Blue View Vision uses the EyeMed network. Medical and Vision coverage are bundled. You can not elect medical without also enrolling in
vision and vice versa. Also, the coverage tier you elect for medical will be the same coverage tier you elect for vision. For example, if you select
Employee+Family for medical, you will also be enrolled in Employee+Family for vision.

9

Your Monthly Contributions

Kaiser Employee Only..................................................................................$ 85.00
– HMO Plan Employee + Spouse/Domestic Partner............................................$ 818.00
Employee + Child(ren).....................................................................$ 478.00
Employee + Family...........................................................................$ 1,159.00

Employee Only..................................................................................$ 85.00
Anthem Blue Cross Employee + Spouse/Domestic Partner............................................$ 698.86
– HMO Plan Employee + Child(ren).....................................................................$ 564.00
Employee + Family...........................................................................$ 1,294.36

Employee Only..................................................................................$ 162.00
Employee + Spouse/Domestic Partner............................................$ 894.90
Anthem Blue Cross Employee + Child(ren).....................................................................$ 741.00
– Solutions Plan Employee + Family...........................................................................$ 1,613.16

Employee Only..................................................................................$ 1,630.00
Employee + Spouse/Domestic Partner............................................$ 4,133.60
Employee + Child(ren).....................................................................$ 3,691.00
Anthem Blue Cross Employee + Family...........................................................................$ 6,677.32
– PPO Plan




MetLife Dental Core Plan EnhancedPlan
Employee Only.................................................................................. $ 11.00 $ 37.48
Employee + Spouse/Domestic Partner............................................ $ 59.00 $ 112.10
Employee + Child(ren) .................................................................... $ 54.00 $ 103.46
Employee + Family........................................................................... $ 101.00 $ 176.12

Blue View Vision* Employee Only.................................................................................. $ 4.84
Employee + Spouse/Domestic Partner............................................ $ 8.48
Employee + Child(ren) .................................................................... $ 9.22
Employee + Family........................................................................... $ 14.06


The costs for employee coverage for the medical, vision and dental plans are primarily paid for by Academy of Art University.

* Medical and Vision coverage are bundled. You can not elect medical without also enrolling in vision and vice versa. Also,
the coverage tier you elect for medical will be the same coverage tier you elect for vision. For example, if you select
Employee+Family for medical, you will also be enrolled in Employee+Family for vision.

Academy of Art University pays the premium for Life/AD&D and Long Term Disability, as well as the administrative fees for the
Flexible Spending Accounts, Commuter Program and 401(k) plan.

10

Flexible S­ pending Accounts

Flexible Spending Accounts (FSAs) are an easy and convenient way for you and your family to save up to 35% on out-of-pocket
health and dependent care expenses. By participating in this plan, you set aside a portion of your income, tax-free, to help pay
for eligible healthcare, childcare and elder care expenses incurred during the calendar year. The Difference Card is the Academy
of Art University’s FSA Administrator. Please note, your FSA contributions are loaded directly onto your Difference Card.
There are two types of FSAs:
1. The Health Care FSA is used to pay for your out-of-pocket health care expenses for you and your eligible dependents.
2. The Dependent Care FSA is used to pay for eligible day-care expenses for children or dependent elders.
Here is how the accounts work:

•• You decide how much to contribute:
–– Up to $2,650 a year in the Health Care FSA*
–– Up to $5,000 a year in the Dependent Care FSA**
–– The minimum contribution to each account is $25 a year

•• The amount you decide to contribute is deducted from your pay in equal installments through the plan year.
•• You pay no federal income tax or FICA taxes on your contributions.
•• When you have an eligible expense, you may either use your Difference Card, which also acts as a credit card, to pay

for the expense or submit a claim form and a receipt of payment to the Difference Card for reimbursement. Please
note: If you have medical coverage with Academy of Art University, the Difference Card needs only to be swiped
ONCE to utilize the FSA as well as your plan’s insurance (as indicated in the Difference Card section).

* Any contributions you have made with a previous employer in 2018 do not count toward the annual maximum
** Any contributions you have made with a previous employer in 2018 do count toward the annual maximum

HEALTH CARE SPENDING ACCOUNT

You can contribute up to $2,650 per year to the Health Care Spending Account to pay for out-of-pocket health care expenses
for you and your eligible family members even if you are not covered under Academy of Art University health plans.
Eligible out-of-pocket expenses include:

•• Deductibles, co-pays and coinsurance amounts for medical, dental, and vision expenses
•• Eyeglasses, contact lenses, and prescription sunglasses not covered by the vision plan
•• Orthodontia expenses not covered by a dental plan
•• Some physician-prescribed weight-loss programs
•• Expenses not covered by Academy of Art University medical plans but considered eligible by the IRS.

EXPENSES NOT ELIGIBLE

Expenses not eligible for the Health Care FSA include services that the IRS does not allow as federal income tax deductions,
including cosmetic surgery, massage therapy, and supplements, such as vitamins that can be purchased over the counter
as well as all other over-the-counter medications unless you have a doctor’s prescription. The full list of eligible health care
expenses is available at http://www.irs.gov/publications/p502 or at https://fsastore.com/FSA-Eligibility-List.aspx.

FSA STORE

As an additional resource, you can visit the FSA Store at http://differencecard.com/fsaextras to use your flexible spending
account to buy eligible products. Many products have a discount and shipping is free for orders which are $50 or more.

11

Flexible S­ pending Accounts (cont’d)

DEPENDENT CARE SPENDING ACCOUNT

You can contribute up to $5,000 a year to the Dependent Care FSA to pay for eligible child or elder care expenses required so
that you (or you and your spouse if you are married) can work outside your home. Your spouse must be working or attending
school full-time to qualify for Dependent Care Expenses. See the chart on the next page for contribution limits.

Eligible expenses include: •• Summer day camp
•• Baby-sitting and day care •• Family day care
•• Preschool and nursery school •• Elder care
•• Before and after-school care

You may be required to submit evidence that an expense is a qualifying dependent care expense if required by your FSA
Administrator, the Difference Card. Ineligible dependent care expenses include private school tuition, placement fees (for
getting  a baby-sitter), transportation costs, and registration fees. The full list of eligible dependent care expenses is available
at  http://www.irs.gov/publications/p503.

It is recommended that you consult with your tax advisor to determine whether the federal child care tax credit may be more
beneficial than participation in the Dependent Care FSA.

AMOUNT YOU CAN CONTRIBUTE TO THE DEPENDENT CARE FSA

IF YOU ARE: YOU CAN CONTRIBUTE UP TO:

Single $5,000

Married, file a joint tax return, and your spouse isn’t eligible $5,000
to ­contribute to a Dependent Care FSA
$5,000 (you and your spouse combined)
Married, file a joint tax return, and your spouse is eligible to
contribute to a Dependent Care FSA Any amount up to the lower of your or your spouse’s
annual earnings
Married, and either you or your spouse earns less than $2,500
$5,000 per year $2,400 for one dependent or $4,800 for two or more ­dependents

Married and file a separate tax return

Married and your spouse is disabled or a full-time student

TAX SAVINGS

FSAs help reduce your taxes. You don’t pay federal income tax or FICA taxes on your contributions. Your tax savings depend
on the amount you decide to contribute and your tax bracket (the percentage of income you pay in federal income tax).
This table shows the savings if you are in a 15, 25, or 35 percent federal income tax bracket. Your savings will be greater if
you are in a higher tax bracket.

TAX SAVINGS FOR THE FOLLOWING TAX BRACKETS

Amount You Contribute 15% 25% 35%

$200 $ 45 $ 65 $ 70
$500 $ 113 $ 163 $ 175
$1,000 $ 226 $ 326 $ 350
$1,500 $ 340 $ 490 $ 525
$2,000 $ 453 $ 653 $ 700
$5,000 $1,132 $1,632 $1,750

Tax savings - federal income tax plus .765% in FICA taxes. Figures in table are rounded and assume you pay FICA taxes on your
entire income for the 15% and 25% tax brackets, but not for the 35% bracket.

12

Flexible S­ pending Accounts (cont’d)

USE IT OR LOSE IT

Plan your expenses carefully. You forfeit any unused balances. You will have until February 28, 2019 to submit claims for
expenses incurred in the current plan year (ends December 31). You can obtain claim forms from the Difference Card. Please
refer to the contact information section.

FLEXIBLE SPENDING ACCOUNT (FSA) RULES

These rules apply to both the Health Care FSA and Dependent Care FSA.
1. Expenses must be incurred during the plan year which takes place January 1 through December 31. There are exceptions

if you terminate your employment with Academy of Art University mid-year. See below for details.
2. Claims can be filed until February 28, 2019 for reimbursement (see below for additional information should you terminate

your employment mid-year).
3. You may enroll in one or both accounts. However, the accounts are separate. You may not use funds from your Health

Care FSA to pay for dependent care expenses and vice versa.
4. You must designate how much money you wish to contribute annually to each account at the beginning of the Plan Year.
5. You may change your annual contributions only if you experience a qualifying “change in family status,” such as marriage,

divorce, addition or loss of a dependent, or a change in your spouse’s employment (for a list of qualifying events, please
see page 2).
6. It is important to carefully review your estimated expenses, since any unused funds remaining in each account at the end
of the plan year must be forfeited—referred to as the “Use It or Lose It Rule.”
7. Items paid through the FSA cannot be claimed on your income taxes.
8. You must re-enroll each plan year. Your elections will not carry over from year to year.

FLEXIBLE SPENDING ACCOUNT RULES WHEN YOU TERMINATE YOUR
EMPLOYMENT MID-YEAR

1. Your expenses must be incurred during the period of the plan year in which you are an active Academy of Art University
employee (from January 1 until the date you terminate your employment). Once you terminate your employment, you can
only submit a claim incurred after the date your employment terminates by electing COBRA and contributing to your FSA
on an after tax basis. Dependent Care FSA’s can not be continued after your employment termination date.

2. Claims incurred prior to the date your employment terminated must be filed for reimbursement within 60 days of your date
of termination.

DIRECT DEPOSIT THROUGH THE DIFFERENCE CARD

Your FSA claims reimbursements can be deposited directly into your bank account. To sign up for Direct Deposit, login to the
participant portal on www.differencecard.com and click on the “My Account” link in the black navigation bar at the top of the
page. Click on the purple Difference Card image. Click on the “My Accounts” tab and then the “Reimbursements Settings”
link. Select Direct Deposit as your Reimbursement Method. Enter your banking information on the Direct Deposit screen.

13

Basic Life/AD&D Insurance

Life insurance coverage provides you and your family with important financial security. Academy of Art University provides
an employer-paid Basic Life & AD&D benefit of $15,000. This policy is underwritten by Anthem Blue Cross Life and Health
Insurance Company.
If you should die in an accident, your Accidental Death and Dismemberment (AD&D) policy provides you with an additional benefit
equal to your life policy. This benefit is provided to you without evidence of insurability and is paid for by Academy of Art University.
Life/AD&D benefits will reduce by 35% at age 65 and by 50% at age 70.

Voluntary Life and AD&D

Academy of Art University currently provides all eligible employees with a University-paid Life and Accident benefit of $15,000
as stated above. You also have the opportunity to purchase additional Life and Accident coverage for yourself and your
dependents through Cigna.

•• Employees* may elect coverage in increments of $10,000 up to the lesser of 5X annual salary or $300,000.
Guaranteed issue** is $200,000.

•• Spouses/Domestic Partners may elect coverage in increments of $5,000 up to the lesser of 50% of employee’s
coverage or $150,000. Guaranteed issue is $30,000.

•• You may elect a $10,000 Life/AD&D benefit for your children (up to age 26).
•• Please note the following election guidelines:
•• You can not purchase Life and Accident coverage for your dependents without enrolling yourself.
•• In order to elect Voluntary AD&D, you must first elect Voluntary Life. For children, Life and AD&D is bundled and

cannot be elected separately.
Once you are enrolled, you will have the opportunity to increase your benefit by up to $20,000 (up to the guarantee issue)
during future open enrollments without having to complete a medical questionnaire. If you waive coverage when you are first
eligible and later change your mind, you will be required to complete a medical questionnaire when applying for coverage.
Cigna can turn you down if, based on medical underwriting, they consider you to be uninsurable due to a medical condition.
If you previously enrolled your Spouse/Domestic Partner, you can also increase their benefit during open enrollment by
$5,000 without having to complete a medical questionnaire (up to the guarantee issue limit).
* If both you and your spouse or Domestic Partner are employees of the Academy of Art University, you may not enroll one
another as your dependent under the Voluntary Life and AD&D plan if you are also enrolling as an employee.
** Guaranteed issue is the amount of coverage you or your dependent is eligible for without being subject to a
Medical examination.

Long Term Disability

Academy of Art University provides an employer-paid Long Term Disability or (LTD) coverage which is an income replacement
policy and is designed to provide you with a benefit when you are disabled and unable to work. After 180 days of disability,
the LTD program pays a monthly benefit equal to 60% of your monthly salary to a maximum monthly benefit of $5,000.
Disability is defined as your inability to perform the duties of the occupation for which you were trained, and benefits are
payable as long as you remain disabled from that occupation, up to your normal retirement age. The LTD program is insured
through Cigna.

14

Travel Assistance Program

The Cigna Secure Travel Program is an added benefit for employees covered under Cigna’s Voluntary Life/AD&D or Long
Term Disability policies at no cost to you. It gives you 24-hour, toll-free access to emergency assistance when you travel away
from home on vacation or business. These benefits and services are also available for your dependents, whether or not they
are traveling with you. For easy access in case of an emergency, pick up a service description and keep it with your travel
documents or luggage. For a complete description of services as well as detailed contact information for inquiries and claim
submissions, call (888) 226-4567 or email [email protected]

Employee Assistance Program (EAP)

The Employee Assistance Program (EAP) offers, at no cost to you, services designed to help you and your family members
meet the challenges of personal, family and work life. Confidential help is available over the phone, in person and online. The
EAP is administered through Cigna’s Life Assistance Program.
If you or a member of your household is faced with emotional worries, stress, relationship issues, substance abuse,
depression, or other personal or professional problems, you can call the EAP 24 hours a day for consultation, assessment,
and referral. You are eligible for up to three face-to-face counseling visits per member per year.
In addition, the program offers a wide range of resources to help you balance your work and life demands, including child care
searches, prenatal and parenting information, adoption assistance, resources for seniors, financial and legal assistance referrals,
and other education resources. These services include printed materials, online searches and telephone consultation.
To access the EAP, please call Cigna’s Life Assistance Program at (800) 538-3543 or www.cignabehavioral.com/CGI and
identify yourself as an Academy of Art University employee.

401(k) Retirement Plan

Employees may elect to participate in the 401(k) Retirement Savings Plan which features some of the most prominent
investment managers in the country. The 401(k) Retirement Savings Plan offers varied investment options via the Digital
Retirement Services website www.drs401k.com to assist employees in the planning of their personal retirement fund.

•• In 2018, employees can contribute up to $18,500 of annual earnings on a pre-tax basis ($24,500 for anyone age 50
and older in 2018). These limits may increase due to cost of living adjustments.

•• You must be 21 years of age at the date of entry.
•• You must complete 60 days of service to become eligible. Once you are eligible, you have the option of enrolling the

1st of the following month.
•• Academy of Art University provides a discretionary match of 50% up to the first 6% of compensation contributed

to the plan. If matching contributions are made, they will be funded annually. You are eligible for the Academy’s
contribution once you have been employed for one year, have worked 1,000 hours within your first year of
employment or within any following calendar year, and are employed on the last day of the plan year. If you have
terminated employment prior to the last day of the plan year, you must have 500 hours of service during the plan year.
•• Beneficiaries need to be entered online at www.drs401k.com.

15

Commuter Program

The Academy of Art University Commuter Program is administered by Commuter Check Direct. By participating in this program,
you can set aside pre-tax dollars to pay for the transit and parking costs associated with your commute to and from work.
The transit portion of the Commuter Program allows you to set aside pre-tax contributions to pay for bus passes, transit
passes and/or commuter check vouchers. You may choose to have a reloadable Smart Card, a reloadable Commuter Check
Card Prepaid MasterCard, a pass or commuter funds deposited directly onto a valid commuter transit card. If a physical pass
is ordered, it will be delivered to your home.
The parking portion of the Commuter Program allows you to set aside pre-tax contributions to pay for commuter parking
expenses. You may choose to place orders for one of the following options: send automated monthly payments electronically
directly to the parking vendor (Monthly Direct Pay), a reloadable Commuter Check Card Prepaid MasterCard, Commuter
Check for Parking Vouchers, or a Parking Cash Reimbursement.
The IRS allows employees to make a monthly pretax contribution of up to $260 for both transit and parking. If your commuting
expenses require you to spend more than the allowable pre-tax contribution, you may still participate in the program. Any
monthly orders in excess of your account balance or above the IRS maximum will need to be charged onto a personal credit
card. You may choose to change the amount of your contribution on a month-to-month basis, however, orders and changes
to existing orders must be placed by the 25th of the month (example, if an order is placed by May 25th, the funds will be
available by July 1).
To enroll or make changes, please register by visiting https://www.commutercheckdirect.com. From the landing page, select
“New User Signup” from the Employee Login area. To register you will need Academy of Art University’s Company ID (1539),
your first and last name and your home zip code. Note, the name you use must match what is in Academy of Art University’s
system (example, if you are in the Academy’s system as “James”, you must use that name when registering vs. “Jim”).
You can contact Commuter Check Direct with any questions by calling (888) 235-9223 or emailing them at
[email protected] Our group number is 1539.
If you are no longer working for the Academy, you have until the end of the month in which your employment
terminates to use all available funds. Otherwise, you forfeit your available funds.

The Advocacy Group (TAG)

Academy of Art University Employee Benefits Support Services is available to you and your covered family members to assist
with benefits-related questions and issues. You can ask about your coverage, eligibility, ID cards, claims, how to login to carrier
websites, request forms and help in finding you the right resources to resolve issues.
Available: 8:00am - 4:30pm PST
Contact: 888-732-1635
email: [email protected]

16

Contact Information

INSURANCE COMPANY GROUP CUSTOMER SERVICE # WEBSITE
NUMBER

Medical Plans 39603 (800) 464-4000 www.kp.org
• Kaiser HMO 175221H001 (800) 227-3613 www.anthem.com/ca
• Anthem Blue Cross HMO 175221M007 (800) 477-2226 www.anthem.com/ca
• Anthem Blue Cross Solutions PPO 175221M001 (800) 477-2226 www.anthem.com/ca
• Anthem Blue Cross PPO (800) 700-2541 www.anthem.com/ca
• Anthem Blue Cross Pharmacy N/A (866) 297-1013 www.anthem.com/ca
• Express Scripts Rx mail order www.differencecard.com
142850 (888) 343-2110
(through Anthem) www.metlife.com/dental
• Difference Card - Gap Medical 1752210003 (800) 942-0854
www.anthem.com/ca
Coverage N/A (866) 723-0515
Dental Plan www.differencecard.com
• MetLife PPO 1298 (888) 343-2110
Vision Plan www.drs401k.com
• Blue View LK964307 (888) 377-4015
Flexible Spending Accounts FLX966279 (800) 563-7166, option 4 or
• Difference Card [email protected]
401(k) Plan Life
• Digital Retirement Solutions OK967818 (800) 362-4462
• Pension Architects
Long Term Disability AD&D (800) 362-4462
• Cigna N/A
Voluntary Life and AD&D (800) 538-3543 www.cignabehavioral.com/CGI
• Cigna 1539
(888) 235-9223 www.commutercheckdirect.com
Employee Assistance Program N/A [email protected]
• Cigna Life Assistance Program
Commuter Program (888) 732-1635
• Commuter Check Direct [email protected]

The Advocacy Group (TAG)

This guide is intended as a quick reference, not a comprehensive description. There are some limitations and exclusions to these benefits that
can be found in the official plan document. The official plan document will govern in case of any discrepancies.

17

Required Notices

DOMESTIC PARTNER COVERAGE

Academy of Art University extends coverage to same gender and opposite gender registered Domestic Partners (registered
DPs) and their dependents who meet the requirement of the policies for:

•• Medical/Vision
•• Dental
•• Optional Life/AD&D
•• Dependent Life
•• EAP
Important points to note in most cases when signing up a domestic partner for coverage:
•• The Federal government does not recognize Domestic Partnerships and therefore your registered DP will be treated

differently in regard to certain Federal taxes and benefit protections.
•• In general, you may not pay for your registered DP’s insurance premiums with pre-tax dollars, unless your registered

DP meets the IRS definition of a Qualifying Relative.
•• The amount of premiums paid by your Employer for your registered DP will be included in the total wages reported on

your Form W-2 for Federal income tax purposes, unless you certify to your Employer that your registered DP meets
the Internal Revenue Service (“IRS”) definition of a Qualifying Relative.
•• If your registered DP meets the IRS definition of a Qualifying Relative, complete the Certification of Section 152
Qualifying Relative Status (form available from HR) and return this form to HR. If your registered DP meets the IRS
definition of a Qualifying Relative, the amount of premiums paid by your Employer for your registered DP will not be
included on your Form W-2.
•• Unless your registered DP meets the IRS definition of a Qualifying Relative, you may not receive reimbursement
under the Health Flexible Spending Account for your registered DP’s expenses.
Certain states do not tax certain registered DP benefits. If your registered DP relationship is recognized by state law, please
notify Academy of Art University so that the appropriate state tax treatment is applied to your registered DP coverage.

WOMEN’S HEALTH & CANCER RIGHTS ACT

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and
Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy related benefits, coverage will be provided in a
manner determined in consultation with the attending physician and the patient, for:

•• All stages of reconstruction of the breast on which the mastectomy was performed;
•• Surgery and reconstruction of the breast to produce a symmetrical appearance;
•• Prostheses; and
•• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical
benefits provided under the medical plan.
Contact the Academy of Art University Human Resources Office for more information.

18

Required Notices (cont’d)

DESIGNATION OF PRIMARY CARE PROVIDER

The Anthem Blue Cross HMO generally requires the designation of a primary care provider. You have the right to designate
any primary care provider who participates in the Anthem HMO network and who is available to accept you or your family
members. To find an HMO PCP, visit www.anthem.com/ca and select the Blue Cross HMO (CACare) Large Group network
or call (800) 227-3613.
For children, you may designate a pediatrician as the primary care provider.
You do not need prior authorization from Anthem Blue Cross or from any other person (including a primary care provider)
in order to obtain access to obstetrical or gynecological care from a health care professional in the Anthem HMO network
who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain
procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures
for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact
Anthem Blue Cross at (800) 227-3613.

19






Click to View FlipBook Version
Previous Book
RPT SAINS F5 2018 smkpr
Next Book
Collagen Retinol Serum Reviews