2013 BENEFIT GUIDE

2013 BENEFIT GUIDE January 1, 2013— December 31, 2013

ANNUAL HEALTH CARE UPDATE

Medicare Part D Prescription Drug Coverage

If you have Medicare or will become eligible for Medicare, a new Federal law gives you more choices about your prescription drug coverage. Please see pages 29-30 for more details.

MEMORANDUM Linda Height

Vice President Finance and Administration

Welcome to Lawrence Tech’s 2013 Benefits Open Enrollment! Lawrence Tech continues to be committed to offering our eligible employees and their family members comprehensive and affordable health care coverage. We, like most other employers, continue to struggle with the high cost of health care. The cost of health care continues to rise at a much higher rate than inflation. Nationally, the forecast is that health care costs will increase at double‐digit rates in 2013. In Michigan, the average increase is 12% plus 1% tax on healthcare claims dollars. Lawrence Tech researched many alternative plan designs with our current insurance carriers as well as plans offered by other medical carriers. With guidance from our benefits consultant, Gallagher, and our Benefits Committee, we determined that the products provided by Alliance Health and Life (AHL) and Blue Care Network HMO (BCN) are not competitive and would result in a 30% increase to our employees and the university. Additionally, the current life and disability insurance provider would result in 33% and 21% increased premiums, respectfully. After a comprehensive review, we have made the following changes regarding insurance providers: Benefits Coverage — 2013

• The current AHL EPO, AHL PPO and BCN HMO plans will terminate on 12/31/2012. • Effective 01/01/2013, the new medical plan providers will be BCN Healthy Blue Living HMO and BCBSM PPO. • The life and disability insurance provider will change from Standard to The Hartford.

After negotiations with our new providers, LTU’s 2013 costs will actually decrease by approximately 15%. Because of this, employees who remain in a similar plan to their current plan will actually see a decrease in their premiums. Overall, the University will continue to pay 75% of the medical premium costs while employees will pay 25%. As a strong advocate for preventive health care, the University is excited about the move to Healthy Blue Living (HBL HMO), which not only enhances employees’ involvement in living a healthy lifestyle, but also rewards those who commit to making better health choices. This is not only smart, it’s economical. When you enroll in the HBL HMO plan, you will need to complete the online BCN Health Assessment and meet other requirements to continue to be eligible for lower out‐of‐pocket costs. Both medical plans offered include deductibles, co‐payment and co‐insurance costs. The vision and dental plans may also include these out‐of‐pocket costs. To help you defray these costs, we encourage the use of the health care flexible spending account (FSA). The FSAs provide you a way to pay for some of these expenses with tax‐free dollars. Because you bypass payroll withholding taxes, you save money. Basic life and disability for 2013 continue to be offered to all eligible employees at no cost. Other optional benefits for legal services/identity theft shield plan and auto and homeowners insurance discount program continue to be available. Open Enrollment To continue our “green” sustainability commitment to the University, you will not receive paper enrollment materials. During the week of October 22nd, you will receive an email that will contain links to all of your open enrollment materials (i.e. 2013 Open Enrollment Newsletter, Benefits Guide, Enrollment/Change Forms). All open enrollment materials may be found on Lawrence Tech’s Human Resources website at: http://www.ltu.edu/human_resources/benefit_forms.asp. The newsletter will provide you with high level information on all plan offerings. For detailed information, please be sure to read the Benefits Guide in its entirety as it contains important information on your benefits to help you make informed decisions regarding your health care participation for the 2013 plan year. Because there are new insurance providers, all employees must complete and return the Benefits Election/Change Summary Form #3075 and new insurance enrollment/ change forms. For complete details, please review the Benefits Enrollment Instructions located in this booklet. Return your forms to the Office of Human Resources no later than November 2, 2012. As always, Lawrence Tech shares your concerns about rising health care costs and continuously seeks to assure the continuance of affordable, quality health care options. Please contact the Office of Human Resources at x2150, or via email at [email protected] if you have any questions regarding your benefits.

TABLE OF CONTENTSTABLE OF CONTENTS

Benefits Enrollment Instructions ...................................................................................................................................................... 1‐2 Access to Benefits Information ........................................................................................................................................................... 3 Insurance Providers ............................................................................................................................................................................ 4 Employees Responsibilities ................................................................................................................................................................. 5 Special Enrollment Period ................................................................................................................................................................... 6 Paying for Benefits ............................................................................................................................................................................. 7 Monthly Health Insurance Rates ......................................................................................................................................................... 8 Medical Insurance Options ............................................................................................................................................................. 9‐12 Medical Plan Comparisons ................................................................................................................................................................ 13 Vision Insurance ................................................................................................................................................................................. 14 Dental Insurance ................................................................................................................................................................................ 15 Wavier of Insurance Coverage .......................................................................................................................................................... 16 Life Insurance Plan ............................................................................................................................................................................. 17 Employee Assistance Program and Travel Assistance Program......................................................................................................... 18 Reimbursement Accounts ............................................................................................................................................................. 19‐22 LegalShield/Identity Theft Shield ....................................................................................................................................................... 23 Other Voluntary Benefits .................................................................................................................................................................. 24 Health Care Terms ............................................................................................................................................................................. 25 Federal Laws ............................................................................................................................................................................... 26‐27 HIPAA Notice of Privacy Practices ..................................................................................................................................................... 28 Medicare Part D Notice of Creditable Coverage .......................................................................................................................... 29‐30 BCN—Health Blue Living Schedule of Benefits ............................................................................................................................ 31‐32 Simply Blue PPO Schedule of Benefits ......................................................................................................................................... 33‐38 Blue Preferred Rx .......................................................................................................................................................................... 39‐40

Please note: This is not a contract. You and your provider should contact the insurance carrier for full benefits description and applicable restrictions (if any) before services are provided. See your plan certificates for clarification.

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BENEFITS ENROLLMENT BENEFITS ENROLLMENT INSTRUCTIONSINSTRUCTIONS

Newly Hired or New Benefit Eligible Employee

All new employees must complete the 2013 Benefits Election/Change Summary‐Form 3075 and applicable benefit enrollment form(s) located on the HR web site at http://www.ltu.edu/human_resources/benefit_forms.asp. All benefit forms must be received by the Office of Human Resources within 30 days of eligibility. Failure to submit elections within the 30‐day deadline will result in no insurance coverage for the entire plan year. The coverage effective date is the 1st of the month following 30 days of hire.

Qualifying Status Change Event/Special Enrollment Period

If you have a qualifying “status change” event during the year, you may be allowed to make changes to your benefits mid‐year. See page 5, Special Enrollment Period for a list of qualifying status change events. Complete and return the Benefits Election/Change Summary– Form 3075 and applicable enrollment/changes forms to the Office of Human Resources within 30 days of the event.

Benefits Open Enrollment

During the benefit open enrollment period, current eligible employees may switch, add, adjust or cancel insurance and/or add or remove spouse or dependent(s) from insurances. See Benefits Open Enrollment Instructions to complete your 2013 elections.

In this 2013 Benefits Guide, we’ll help you understand Lawrence Technological University’s benefit programs and how to ensure proper selection for your 2013 benefits coverage. Generally, there are three times when you can enroll in or may be able to change your benefits: 1) as a newly hired or benefit eligible employee, 2) after experiencing a qualifying status change, or 3) during open enrollment. Follow the procedures below to complete your enrollment. Access the benefit forms and materials online at http://www.ltu.edu/human_resources/benefit_forms.asp.

(Back to Table of Contents)

Summary of Benefits and Coverage (SBC)‐ under healthcare reform all plans must distribute new summary of benefits including coverage examples and a glossary of terms. We are working with BCBSM and BCN to complete this requirement. Once this information is available we will distribute to all employees.

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BENEFITS ENROLLMENT BENEFITS ENROLLMENT INSTRUCTIONSINSTRUCTIONS


You can elect benefits in 3 steps:

Review your Benefits Open Enrollment material... Be sure to:

• Read this guide to learn what’s happening for 2013. • Review your current benefits and dependent/

beneficiary information online at www.ltu.edu/bannerweb.

• Access additional information about all of LTU’s benefit plans at http://www.ltu.edu/human_resources/open_enrollment.asp.

All employees need to complete Benefit Forms for 2013… All employees must complete the 2013 Benefits Election/Change Summary Form #3075.

All employees must complete The Hartford (Life Insurance) Enrollment Form.

All AHL EPO, AHL PPO and BCN HMO members must enroll in either BCN Healthy Blue Living HMO or BCBSM Simply Blue PPO or complete the Waiver of Coverage Certification of Other Coverage form. In addition, you need to make elections if:

• You want to submit a change to your dental, vision or legal plans. Changes include cancel coverage or add/remove spouse or dependent.

• You want a 2013 FSA Health Care and/or Dependent Care plan. IF YOU DO NOT MAKE AN ELECTION FOR 2013 DURING THE BENEFITS OPEN ENROLLMENT PERIOD, YOU WILL NOT HAVE A FSA ACCOUNT.

• You want to waive medical, dental and/or vision coverage for 2013, you must submit the Waiver of Insurance Certification of Other Coverage form. If you are currently waiving insurance coverage and do not elect coverage for 2013, your current “waive insurance” election will automatically continue for 2013.

Make your 2013 benefits plan elections: Submit all signed forms to Human Resources by November 2, 2012. You have two ways to enroll or make changes to your benefits plan elections – paper or online. Paper. Download the benefit forms from the HR web site at http://www.ltu.edu/human_resources/benefit_forms.asp. Complete and return the following benefits enrollment/change forms:

• 2013 Benefits Election/Change Summary – Form #3075 • The Hartford (Life Insurance) Enrollment Form • BCBSM/BCN Enrollment Change of Status (Note: BCN Healthy Blue Living

HMO enrollment must include Primary Care Physician Name, Code and Location information.)

• Waiver of Insurance – Certification of Other Coverage • 2013 FSA Health/Dependent Care Form (Note: The 2013 FSA maximum

contribution limit for health care is $2,500 and dependent care is $5,000.)

• Dental, vision and/legal plan forms if making changes Online. Login to Bannerweb to complete your benefits open enrollment changes. Step 1 Access Bannerweb at http://www.ltu.edu/bannerweb.

Step 2 Click Login to Secure Area

Step 3 Click Employee Services

Step 4 Click Benefits and Deductions

Step 5 Click Start Open Enrollment and follow instructions

Step 6 Click Complete to update your change(s)

Step 7 Click Calculate Cost

Step 8 Print, sign and return Calculate Cost page to HR

Step 9 Download, complete and return benefits enrollment/change forms: • The Hartford (Life Insurance) Enrollment Form • BCBSM/BCN Enrollment Change of Status (Note: BCN Healthy Blue

Living HMO enrollment must include Primary Care Physician Name, Code and Location information.)

• Waiver of Insurance – Certification of Other Coverage • 2013 FSA Health/Dependent Care Form (Note: The 2013 FSA

maximum contribution limit for health care is $2,500 and dependent care is $5,000.)

• Dental, vision and/legal plan forms if making changes

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ACCESS TO BENEFITS ACCESS TO BENEFITS INFORMATIONINFORMATION

Faculty and staff have access to benefits information 24 hours a day, seven days a week. By logging onto BannerWeb at www.ltu.edu/bannerweb, employees may view their benefits information from home or office, anytime or anywhere. For additional information or assistance, participates may also contact the Office of Human Resources as follows:

Office Location Lawrence Technological University Office of Human Resources Business Services Building 21000 West Ten Mile Road Southfield, MI 48075

Office of Human Resources Deshawn Johnson, Director Starlett Sinclair, Manager, Benefits & HRIS Lorana Stewart, Human Resources Generalist II Radesha Williams, Human Resources/Payroll Representative

Office Hours Monday – Friday 8:00 am to 4:30 pm

Phone 248.204.2150 or 248.204.2151

Email Benefits staff will answer your benefits questions by email. Address your questions to [email protected]

Office of Human Resources website http://www.ltu.edu/human_resources

Limitations

Lawrence Tech in its sole discretion may modify, amend, or terminate the benefits provided in this handbook with respect to any individual receiving benefits, including active employees, retirees, and their spouses, partners, and dependents. Although Lawrence Tech has elected to provide these benefits in a calendar year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual right to continued benefits beyond the time Lawrence Tech modifies, amends, or terminates the benefit. Anyone seeking or accepting of the benefits provided will be deemed to have accepted the terms of the benefits programs and Lawrence Tech’s right to modify, amend or terminate them.

Notice of Non‐Discrimination Policy

Lawrence Technological University adheres and conforms to all applicable federal, state and local civil rights regulations, statutes and ordinances. No person, student, faculty or staff member will knowingly be discriminated against relative to the above statutes. Lawrence Technological University is an Equal Opportunity Employer.


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INSURANCE PROVIDERSINSURANCE PROVIDERS

You can access your insurance customer service to request a physician provider directory, medical membership ID cards, or to locate a network provider via phone or internet as follows:

Benefit Customer Service Number Hours Available Internet

Lawrence Technological University Office of Human Resources

248.204.2150 or 248.204.2151 Fax: 248.204.2118

Monday – Friday: 8:00 am ‐ 4:30 pm

www.ltu.edu/human_resources Email: [email protected]

ADN Dental 888.236.1100 or 248.901.3705

Monday – Friday: 8:00 am ‐ 5:00 pm EST

www.adndental.com

Blue Cross Blue Shield of MI 800.637.2227 Monday – Friday: 8:00 am ‐ 5:00 pm

www.bcbsm.org

Blue Care Network 800.662.6667 Monday – Friday: 8:00 am ‐ 5:00 pm

www.MIBCN.com

EyeMed Vision Care/ECPA 866.939.3633 Monday – Saturday: 8:00 am ‐ 11:00 pm

Sunday: 11:00 am ‐ 8:00 pm www.eyemedvisioncare.com

Gallagher Benefit Services Nicole Lee, Benefits Consultant

Benefit Questions 248.502.1129


[email protected]

Liberty Mutual Insurance Group (Home/Auto)

800.648.7944, ext 55124

Monday – Friday: 8:30 am ‐ 5:00 pm Weekend and evening hours by

appointment

www.libertymutual.com/shallanthalman Email:

[email protected]

Informed Rx Rx Inquires/Verification:

800.282.3232 24 hours www.informedrx.com

The LegalShield Plan/Identity Theft Shield

248.376.2858 Monday – Friday: 8:00 am ‐ 5:00 pm

Email: [email protected]

TIAA‐CREF Retirement Plan 800.842.2776 Monday – Friday:

8:00 am ‐ 10:00 pm Saturday: 9:00 am ‐ 6:00 pm

www.tiaa‐cref.org

The Hartford Life Insurance 800.523.2233 Monday – Friday: 8:00 am ‐ 5:00 pm

www.thehartford.com

The Hartford/AbilityAssist Employee Assistant Program

800.964.3577 24 hours www.guidanceresources.com

The Hartford/Travel Assist 800.243.6108 24 hours www.thehartford.com/

employee benefits

WageWorks Flexible Spending Account (Health and Dependent Care)

877.924.3967 Fax: 877.353.9236


www.wageworks.com Email: [email protected]


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EMPLOYEES RESPONSIBILITIESEMPLOYEES RESPONSIBILITIES

Enrollment Deadlines It is important that employees review their benefits information, make their benefits selections, and enroll within 30 days of eligibility. Failure to submit elections within the 30‐day deadline will result in no insurance coverage for the entire year. (Note: For benefits open enrollment, all changes to benefits must be submitted no later than November 2, 2012.)

Review Plan Limitations and Restrictions

The information provided in this Guide is meant to help you and your family choose the health care options best suited to your needs. Be sure to study each option carefully. Although the Summary of Benefits and Benefits‐at‐a‐Glance materials provide a summary of coverage available under these options, it does not address important limitations and restrictions that may apply to the health care plans. It is your responsibly to understand how the options work ‐ including the limitations and restrictions – and to make the appropriate health choices. More detailed information on all these plan options can be obtained from the Office of Human Resources. In the event of a discrepancy between the Summary of Benefits and Benefits‐at‐a‐Glance materials and the plan’s membership booklet, certificates and riders, the latter will govern.

Update Address Information The employee is responsible for notifying the Office of Human Resources immediately if their address changes.

Monitor Your Benefits Deductions

Employee should verify benefits deductions on their pay stub to be sure they match the coverage requested. Employees can review their pay stub online by logging onto BannerWeb at www.ltu.edu/bannerweb.

If You Find an Error in Your Deductions

Contact the Office of Human Resources immediately if any data entry errors are found. The University is not responsible for any excess contributions made because the employee failed to provide proper notification of ineligibility of a dependent. This notification must be submitted in writing to the Office of Human Resources. You are urged to keep copies of all forms turned in as well as official University notices.

If You Provide False Information

Employees who submit false information intended to provide health coverage for alleged dependents not eligible for such coverage may be subject to discipline up to and including discharge. Such employee will also be held financially responsible for all claims filed, and will be required to reimburse the University for any payments made on behalf of or for the benefit of an ineligible person claimed as a dependent.

Make Dependent Coverage Changes Promptly

Employees are responsible for notifying the Office of Human Resources if they experience a qualified “status change” within 30 days of the event if the change have affected or will affect their coverage. See Special Enrollment Period for more information.

Federal Laws Refer to Federal Laws that affect your benefits and privacy listed in this booklet.


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SPECIAL ENROLLMENT PERIODSPECIAL ENROLLMENT PERIOD

Elections made to medical, dental, vision, life insurance and flexible spending accounts are binding selections for the entire benefit plan year January 1st through December 31st. Therefore, benefit elections will remain in effect throughout the plan year and cannot be changed until benefits open enrollment. However, special enrollment is allowed if employees experience a “status change.” Status changes include the following:

• Change in marital status

• Birth or adoption of a child

• Death of a spouse or dependent

• Commencement or termination of your spouse’s employment (for termination if a period of unemployment for more than 30 days)

• Switch from full‐time to part‐time employment and vice versa by employee or employee’s spouse

• You or your spouse begin or return from an unpaid leave of absence

• Change in dependent eligibility

• Your spouse has a significant change in health coverage directly attributable to your spouse’s employment

• You are placed on an unpaid Family and Medical Leave, Worker’s Compensation or Leave of Absence

• You elected to participate in the University Medical Opt‐out Program and you lose your other medical coverage

A status change must be reported to the Office of Human Resources within 30 days of occurrence in order to allow selection of different benefit options. Based on your elections, you authorize the appropriate payroll adjustment accordingly.

Employee’s Dependent Eligibility Upon enrollment in benefits, eligible full‐time employees become Subscribers. The Subscriber can enroll their eligible dependents in the medical, dental, vision and dependent life insurance. Coverage eligibility applies to dependents that are:

• Not covered by the University as an employee

• Not covered by the University as a dependent on another University’s employee’s coverage

The Subscriber’s dependents may be enrolled in benefits provided they meet the requirements as follows: Legal spouse, registered same‐sex domestic partner, dependent child under age 27, sponsored dependent, permanently and totally disabled children, and dependent grandchildren.

Note: For same‐sex domestic partner eligibility, employees must complete the Affidavit of Domestic Partnership Form #3032. For additional information regarding this benefit, contact the Office of Human Resources at 248.204.2150 or via email at [email protected].


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PAYING FOR BENEFITSPAYING FOR BENEFITS

The University makes a sizable investment in your benefits by paying a significant portion of the cost. You pay any balance through automatic deductions from your pay. You are responsible for making sure that your pay covers the cost of the benefits you choose.

Cost of your benefit plans Each benefit plan has its own rate structure. The cost of each benefit is published annually in the Benefits Guide booklet. This booklet includes rate information that will help you determine the amount of your specific deductions.

Frequency of deductions Full‐time employees are paid on a semi‐monthly basis – the 15th and last day of the month. Your benefit payroll deductions will be taken in 24 equal installments from the first and second paychecks each month. The monthly cost of benefits as indicated in the Benefits Guide will be divided by two and deducted from your pay on a semi‐monthly basis. Faculty employees who elect 18 pay installments do not have benefit deductions processed during the summer months (June, July and August). Therefore, any benefit deductions to cover the summer months will be processed with the May 31 payroll cycle. Starting with the September 15 payroll cycle, benefit deductions will be reinstated to the regular semi‐monthly amount(s).

Pre‐tax/after‐tax options for paying your share of benefits cost

The Premium Only program complies with Section 125 of the Internal Revenue Service that allows you to pay certain insurance premiums with pre‑tax dollars or after‐tax dollars. With pre‐tax deduction, the premium is subtracted from your pay before federal, state, and FICA taxes are calculated. That reduces your taxable income and saves you money in taxes every payday. Note that when you reduce your FICA taxes, you will also be reducing your Social Security contribution which may affect your future Social Security benefits. Deductions for applicable medical insurance premiums and flexible spending accounts are automatically deducted on a pre‐tax basis. Deductions for optional additional life, dependent life and legal plans premium are automatically deducted after‐tax.

Same‐sex domestic partner tax information

The employee may be responsible for tax liability on the premium costs to cover the same‐sex domestic partner and their dependent(s). The monthly premiums for employees covering a same‐sex domestic partner and the partner’s children are identical to the premium for employees covering a spouse and children. However, the employer cost of providing benefits for same‐sex domestic partners and their children is considered ordinary income or “imputed income” and is, therefore, subject to taxes, including FICA, FICA Medicare, federal, state and city taxes, where applicable. As a result, the cost to the employee of obtaining benefits for a same‐sex domestic partner and dependents are actually more than just the cost of the employee’s required monthly premium.


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MONTHLY HEALTH INSURANCE RATESMONTHLY HEALTH INSURANCE RATES


The following chart summarizes the monthly contribution for the various plans based on the coverage level. The employee monthly contribution amounts shown below are divided by two and subtracted from pay in 24 equal installments before federal, state, and FICA taxes are calculated. Note: Faculty employees who elect 18 pay installments do not have benefits deductions processed during summer months (i.e., June, July and August). Therefore, any benefit deductions to cover the summer months will be processed in a lump sum with the May 31st payroll cycle.

Medical Plan Monthly Premium LTU Contribution Employee Contribution

BCN—Healthy Blue Living HMO1

Single $492.05 $376.41 $115.64

2 Person $1,131.72 $865.76 $265.96

Family $1,279.33 $978.69 $300.64

Sponsored Dependent $591.00 $0.00 $591.00

Blue Cross Blue Shield of MI Simply Blue PPO

Single $541.16 $273.04 $268.12

2 Person $1,298.77 $606.79 $691.98

Family $1,623.47 $749.73 $873.74

Sponsored Dependent $834.89 $0.00 $834.89

Dental

Single $33.45 $16.73 $16.72

Family $92.28 $46.14 $46.14

Vision

Single $5.48 $2.74 $2.74

Couple $10.32 $5.16 $5.16

Family $15.11 $7.57 $7.54

1 BCN HBL HMO members have access to two benefits levels: enhanced and standard. Enhanced benefits have lower deductible and lower copayments, so members save money when using health plan services. To receive enhanced benefits, employees and their covered spouse must choose to meet the requirements. If you and/or spouse choose not to meet the requirements, you will still have health care coverage, but you will receive the standard benefit level, with higher out‐of‐pocket costs. Your Employee Monthly Contribution amount above will not change for the plan year. Learn more about the BCN HBL HMO plan requirements at http://www.mibcn.com/member/healthyBlueLiving/index.shtml.

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The BCN Healthy Blue Living HMO Plan is a Health Maintenance Organization Plan (HMO). This plan is only available to Michigan residents. Under this plan, you must select a participating Primary Care Physician (PCP) through whom all your care will be directed. You are required to obtain a referral from your Primary Care Physician in the event that you need to see a specialist. Females using this plan may select a PCP as well as an OB/GYN and are not required to obtain referrals for routine OB/GYN services. Regular services are allowed twice per year. If you seek services from a physician or hospital outside of the network, no benefits will be payable (unless specified as an emergency). To find a Blue Care Network provider or to change your PCP, log on to www.mibcn.com. See the Healthy Blue Living guide located at http://www.mibcn.com/member/healthyBlueLiving/index.shtml for additional details about the program and the member requirements.

The BCBS PPO Plan is provided through a Preferred Provider Organization (PPO), where a network of pre‐selected hospitals and doctors is available for your use. This is a national plan and is available to all U.S. residents. If you use the network, you will receive the highest level of benefits offered by the plan. While the network is available, you are not required to use it. You always have the complete freedom to select any provider whenever you need care. However, the out‐of‐network benefits are lower and your out‐of‐pocket costs are higher. To find a BCBS PPO provider online, visit www.bcbsm.com. If you use a non‐participating provider, you may also be billed the difference between the approved amount and the provider’s charge.

MEDICAL INSURANCE OPTIONSMEDICAL INSURANCE OPTIONS

Lawrence Tech offers two medical insurance options for each employee and his/her spouse or same‐sex domestic partner and his/her eligible dependents. Depending on the plan elected by the employee, the cost of the monthly premium may be shared by Lawrence Tech and the employee. The employee’s cost depends on the number of people covered and the plan that is chosen. Additional cost to the employee may also include co–payments, deductible and co‐insurance. The basic medical insurance plans coverage includes preventive care, hospitalization, emergency services, urgent care, mental health and chemical dependency treatment, outpatient services, and prescription drug coverage. Additional details regarding the plans are available in the Office of Human Resources.


Medical BenefitsMedical BenefitsMedical Benefits‐‐‐atatat‐‐‐aaa‐‐‐GlanceGlanceGlance

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HEALTHY BLUE LIVINGHEALTHY BLUE LIVING BLUE CARE NETWORK (BCN)BLUE CARE NETWORK (BCN)


New hires Those new hires effective during the first 3 quarters of the employer’s plan year are subject to the same time frames as all employees. Those hired in the last quarter of the year will be placed in the Enhanced plan and will begin the 90 day certification process at renewal.

Healthy Blue Living Overview

Blue Care Network’s Healthy Blue Living HMO plan rewards members with lower out‐of‐pocket costs for living healthy lifestyles and making healthy choices. When enrolled in Healthy Blue Living, you have access to two benefit levels, enhanced and standard. Enhanced benefits have lower deductible and lower copayments, so you save money when you use health plan services. The requirements to qualify for enhanced benefits are listed below.

When your plan year starts, you’ll find that there are several requirements to qualify for enhanced benefits. The health plan concentrates on six high‐impact health measures that effect illness and fitness. Managing them will reduce your chances of developing one or more chronic or disabling diseases.

Healthy Blue Living focuses on wellness and prevention. The plan gives individuals the knowledge, skills and support to achieve their health goals.

Remember, if you or your covered spouse do not meet all the requirements, everyone on your contract will be moved to the standard level.

Test for nicotine: Cotinine testing, which confirms the presence of nicotine in the body, will be required for all new and renewing members. Your doctor can do a blood or urine test during your office visit. To confirm that you no longer smoke, testing will be conducted annually after the first year for members who tested positive for nicotine, indicate they have recently stopped smoking or have completed the Quit the Nic program.

Depression: Depression is the number one cause of disability worldwide. People with depression are more likely to develop cardiovascular disease and diabetes. Depression is more than just feeling sad sometimes; it’s a complex and challenging medical condition.

Weight management programs help you succeed: If your body mass index is 30 or greater, BCN will cover the cost of one of the following weight‐loss programs: Weight Watchers® or the web‐based WalkingSpree’s Pocket PedometerTM program with online reporting. Weight Watchers participation requires you to attend 11 out of 13 weekly meetings per session, while the WalkingSpree program requires you to walk a daily average of 5,000 steps per three month period. After you sign up, you’ll need to actively participate in one of those programs until your BMI falls below 30. If you don’t participate in the Weight Watchers or pedometer program, you will move to the standard benefit level.

For more information, refer to the HBL Member Guide or visit MiBCN.com/hbl.

Health Measure

Wellness target

If a member does not meet the wellness target, how can he or she work to qualify for enhanced benefits?

Tobacco use Nonsmoker • Enroll in Quit the Nic • Actively participate until you complete the program and stop using tobacco.

Weight Body mass index below 30

If your BMI is 30 or above you must enroll in Weight Watchers® or WalkingSpree Pocket PedometerTM program.

Blood pressure Below 140/90 Commit to and follow doctor’s treatment plan.

Cholesterol LDL‐C below target (based on risk factors)

Commit to and follow doctor’s treatment plan.

Depression Depression is in full remission.


Blood sugar At or below target


Note: Members are no longer required to complete any of the online weight management health programs. They are available to you as resources at www.MiBCN.com.

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HEALTHY BLUE LIVINGHEALTHY BLUE LIVING BLUE CARE NETWORK (BCN)BLUE CARE NETWORK (BCN)


Requirements for enhanced benefits:

Follow‐up requirements After the first doctor visit, you (and your covered spouse) may have additional requirements such as actively participate in Quit the Nic until you complete the program and stop using tobacco or enroll in a BCN‐sponsored weight management program (Weight Watchers or WalkingSpree’s Pocket Pedometer program) until your BMI falls below 30. Note: We’ve eliminated the BCN six‐month checkup with your doctor for tobacco use and weight. Qualification Form shows how you measure up Blue Care Network tracks the status of each health measure on the Qualification Form using A, B or C. The health measure points have been eliminated. You must score As and Bs to receive enhanced benefits. Status: A. You are meeting the wellness target.

B. Your health condition may not be controlled but you are actively participating in treatment to improve the condition.

C. You are not meeting the wellness target and you have not committed to treatment or are not following it.

Initial requirements Each plan year, you (and your covered spouse) must meet initial requirements within the first 90 days of enrollment to receive enhanced benefits:

• Qualification Form: Visit your Blue Care Network primary care physician to complete a Qualification Form. The Qualification Form point values are going away. They’re replaced with an easy‐to‐understand alphabetic (A, B, and C) grading system. Deadline: 90 days from the start of the plan year.

• Take a cotinine test to confirm that you do not smoke.

Your doctor will conduct a blood or urine test. Deadline: 90 days from the start of the plan year.

• BCN health assessment: Complete an online health

assessment at MiBCN.com each plan year. Members cannot have this measurement waived. Deadline: 90 days from the start of the plan year.

Quit the Nic: If you smoke, enroll in our Quit the Nic smoking cessation program (1‐800‐811‐1764).

Weight management: If your BMI is 30 or above, you must enroll in Weight Watchers or WalkingSpree’s Pocket Pedometer program. BCN will pay for the program you choose.

You may also have these requirements within 120 days from the start of the plan year:

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HEALTHY BLUE LIVINGHEALTHY BLUE LIVING FREQUENTLY ASKED QUESTIONSFREQUENTLY ASKED QUESTIONS


How do I complete the Health Risk Assessment (HRA)? You and your spouse (if covered) must complete the online Health Risk Assessment and return the signed BCN Healthy Living Qualification Form within 90 days to stay in the Enhanced plan. If you or our spouse smoke, you must also join the Quit the Nic program within 120 days. Those with a BMI over 30 must join a weight management program.

• The HRA can be found on the BCN website: www.mibcn.com − Log into “Member Secured Services”. You will

need to register if you have not already done so. Your current identification card has all the information you will need to do this.

− Click on the “BlueHealthConnection” link − From the “I Want” drop‐down menu, select “Take a

Health Risk Assessment”. − Complete the information requested (about 50

questions) and submit it. − After clicking “Submit”, your certificate of

completion will appear. You will see an overall wellness score and a report on what you're doing well and what you can do better.

− Print the report for your records − This takes about 10 minutes to complete

• You can take the Health Risk Assessment once every six months.

• If you don’t have internet access you can request a paper version by calling 1‐800‐662‐6667.

Where do I get the Qualification Form?

The Qualification Form will be sent to you by BCN after the enrollment process is completed.

What if I don’t complete my Qualification Form? Employees who don’t send in the signed form within 90 days and/or don’t commit to actively work toward their health goals will qualify for the Standard Plan and will pay more when they need medical care.

What if my spouse does not want to work toward health goals? Both adults on a contract have to qualify for the Enhanced Plan. Once they qualify, everyone on the contract, including dependent children, receive the Enhanced Plan.

What happens if my spouse or I do not fill out the Health Risk Assessment or have our doctor complete the Qualification Form? If you both do not complete the Health Risk Assessment and/or visit your PCP and complete the qualification form you and your family will be moved down to the Standard Plan 90 days after the beginning of the Plan Year.

What happens if I get married and enroll my spouse after enrollment? Your spouse will adopt the same level of coverage as you until the following renewal period. At renewal time you and your enrolled spouse need to complete the steps again to qualify for the Enhanced Plan.

What happens when my coverage is renewed next year? This year and at future renewals, you and your spouse will remain in your existing plan for 90 days (Enhanced or Standard). You will both need to complete the Health Risk Assessment, Qualification Form through your PCP and actively maintain a healthy lifestyle to maintain or increase your benefit coverage to the Enhanced Plan after the first 90 days of the Plan Year.

13

MEDICAL PLAN COMPARISONSMEDICAL PLAN COMPARISONS


Your Medical Options:Your Medical Options:Your Medical Options:

• Blue Care Network—Healthy Blue Living HMO

• Blue Cross Blue Shield of MI—Simply Blue PPO

BCN Healthy Blue Living HMO BCBSM Simply Blue PPO

Enhanced Standard In‐Network Out‐of‐Network

CALENDAR YEAR DEDUCTIBLE

Single $500 $2,000 $500 $1,000

Family $1,000 $4,000 $1,000 $2,000

Coinsurance 80% 70% 80% 60%

CALENDAR YEAR COINSURANCE MAXIMUM (Does not include copays)

Single $1,500 $1,500 $2,500 $5,000

Family $3,000 $3,000 $5,000 $10,000

Lifetime Maximum Benefit None None None None

PHYSICIAN OFFICE SERVICES

Office Visit (Illness/ Injury Related) $20 copay $20 copay $20 copay 60% after deductible

Specialist/Referral Office Visit $20 copay after

deductible $20 copay after deductible

$20 copay 60% after deductible

PREVENTIVE SERVICES

Adult Periodic Wellness Exams 100% 100% 100% Not covered

Well‐Baby and Child Care 100% 100% 100% Not covered

ER Copay (waived if admitted) $75 copay after

deductible $100 copay after

deductible $150 copay $150 copay

Ambulance Services Copay 80% after deductible 70% after deductible 80% after deductible 80% after deductible

Urgent Care Visits $35 copay $50 copay $20 copay 60% after deductible

HOSPITAL CARE

Inpatient Hospital Services 80% after deductible 70% after deductible 80% after deductible 60% after deductible

Outpatient Surgery 80% after deductible 70% after deductible 80% after deductible 60% after deductible

PHARMACY Generic Copay Preferred Brand Copay Non‐Preferred Brand Copay

Mail Order

$10 $40 $40

2x copay for 90 day supply

$15 $50 $50


$20 $60

50% ($80 ‐ $100)


$20 $60

50% ($80 ‐ $100) Plus an additional 25% of BCBSM approved amount

for the drug

Not covered

EMERGENCY MEDICAL SERVICES

14

VISION INSURANCEVISION INSURANCE—— EYEMED VISION CAREEYEMED VISION CARE


LTU offers vision care coverage through EyeMed Vision Care. The premium cost for this benefit is shared by the University and employee and covers the employee and their eligible dependents. You are responsible for applicable copayments. EyeMed Vision Care offers a network of over 35,000 optical providers including optical retailers LensCrafters®, Target Optical® and most Sears Optical® and Pearle Vision® locations who have agreed to provide their services at reduced fees. This means lower out‐of‐pocket costs for you. You do not have to use a network provider, however you pay less out‐of‐pocket costs if you use a network provider. The process for members to access their EyeMed vision care benefit is simple. You can access providers by calling the toll‐free locator service, visiting the web site, or referring to the provider listings that are part of the member brochure/ID Cards you will receive. Every 12 months, the new vision plan covers the following benefits less the exam and material copays:

Other Benefits Secondary Discount EyeMed Vision Care offers members discounts on purchases through their secondary purchase plan. These discounts are available on services and products that are purchased after the covered benefits have been used. This plan provides reduced fees for exams, frames, lenses, contact lenses, and accessories, saving members money on these additional purchases. Laser Vision Correction Benefits Members utilizing their EyeMed Vision Care benefit receive a 15% discount off the retail price or 5% off the promotion price for LASIK (Laser In‐Situ Keratomileusis) and PRK (Photorefractive Keratectomy) treatments through the U.S. Laser Network, which is administered by LCA‐Vision. This includes all pre‐ and post‐operative care at no additional charge if the treatment is performed at a Lasik Plus Center, which is part of the U.S. Laser Network.

Eye Exam Contact Exam Option ‐ Standard ‐ Premium

Frames Lenses Contacts ‐ Conventional

‐ Disposables

Covered ‐ $10 copay Covered up to $55 10% off retail price $0 copay, $100 allowance for a frame plus 20% off balance over $100 Covered $25 copay, up to allowable amount (one copay/lenses and frames) Covered $115 allowance toward materials, 15% discount off balance over $115 Covered $115 allowance, plus balance

Reimbursement up to $35 N/A N/A Reimbursement up to $45 Reimbursement to predetermined amount after copay Reimbursement to $92 Reimbursement to $92 over $115

Procedure In‐Network Out‐of‐Network

15

DENTAL INSURANCEDENTAL INSURANCE——ADN DENTALADN DENTAL


Who is ADN Dental?Who is ADN Dental?Who is ADN Dental?

Formed in 1993, ADN is the largest independent dental PPO in Michigan, offering more than 3,100 dentists in Michigan and many more in other states. Though the ADN network, its affiliation with Michigan Dental Plans (MDP) and Dentemax, you have access to a broad range of dentists. Dentemax adds over 600 providers to the network. Your dental card will reflect the new Dentemax logo. How does this benefit me? When you seek dental services with a participating ADN Dental Network, MDP or Dentemax dentist, you receive no billing except for deductibles and copays. This means you will not be responsible for a dentist exceeding the "reasonable and customary" charges; by contract, network providers agree that this won't happen. We encourage you to contact ADN if your provider does not currently participate with ADN or Dentemax. Seeking care from a participating dentist results in a greater benefit and less out‐of‐pocket costs for you. Do I have to use a participating ADN Network Dentist? No. You are not required to use an ADN, MDP or Dentemax dentist. However, if you do not use an ADN Network Dentist, your out‐of‐pocket costs are greater. Will I have to submit any claim forms? No. Your dentist should mail all claims directly to ADN. When you pay your copay depends on your dentist. Some dentists may ask for your copay at the time service is rendered. Other dentists may bill first, then send you a bill for your copay amount.

LTU Dental Benefits at a Glance

In‐Network Out‐Network

Annual Deductible:

Applies to Type 2 and Type 3 Benefits Only

$50 per individual $150 per family

$50 per individual $150 per family

Annual Benefit Maximum: $1,000 $1,000

Type 1 ‐ Preventive Services: 100% 100%

Exams, X‐Rays, Cleaning, Fluoride for Children (to age 14)

Type 2 ‐ Basic Services: 100% 85%

Fillings, Extractions, Root Canals, Treatment of Gum Disease, Repairs to Dentures and Bridges

Type 3 ‐ Major Services: 60% 50%

Crowns (caps) fixed, Bridges, Removable Partial or Complete Dentures

Type 4 ‐ Orthodontia (to age 18):

50% 50%

Lifetime Maximum $1,500 $1,500

LTU offers dental coverage through ADN Dental. The premium cost for this benefit is shared by the University and employee and covers the employee and their eligible dependents. You are responsible for applicable copayments and deductibles.

16

WAIVER OF INSURANCE COVERAGEWAIVER OF INSURANCE COVERAGE—— MEDICAL, VISION AND DENTALMEDICAL, VISION AND DENTAL

If you have medical, vision and dental insurance elsewhere, you may elect to waive Lawrence Tech's coverage. In lieu of benefits, you will be paid opt‐out cash per pay period. Lawrence Tech offers two plan options to opt out of coverage as follows:

Plan Options Plan 1 Plan 2

Program Medical opt out Medical, dental and vision opt out

Opt‐Out Cash $25.00 per pay period $30.00 per pay period

If you choose Plan 1, you opt out of Lawrence Tech’s medical coverage only, however you may enroll in the dental or vision plans. If you choose Plan 2, you opt out of Lawrence Tech’s medical, dental and vision coverage. Both plan options are taxable benefits and subject to FICA, Federal, state and city taxes. The amount deducted for taxes depends on individual circumstances. Calculations will not be provided prior to actual payment. Employees who terminate employment during the plan year will forfeit any remaining waiver fee. If you experience a loss of your other medical insurance coverage, you must re‐establish medical coverage and provide your new medical insurance information to the Office of Human Resources. You may establish medical coverage with the University. You will be required to provide proof of loss of coverage and notify the Office of Human in writing within deadline specified below:

• If you are declining enrollment for yourself, or your dependents (spouse/children) because of coverage under another plan, you may be able to enroll yourself or your dependents in the University plan in the future, provided you request enrollment within thirty (30) days after your other coverage ends.

• If you are declining enrollment for yourself, or your dependents (spouse/children) because of coverage under Medicare or Medicaid, you may be able to enroll yourself or your dependents in the University plan in the future, provided you request enrollment within sixty (60) days after your other coverage ends.

In order to qualify for this special enrollment period, you must certify other coverage was the reason for declining/waiving enrollment in coverage provided through Lawrence Technological University.

To enroll in either plan: 1. Complete the Waiver of

Coverage form.

2. Show proof of other insurance by providing a copy of an insurance I.D. card. Note, Canadian citizens covered by OHIP are also required to show proof of insurance.

3. Submit both documents to the Office of Human Resources.


17

LIFE/AD&D INSURANCELIFE/AD&D INSURANCE‐‐THE HARTFORD THE HARTFORD PERSONAL & DEPENDENT COVERAGEPERSONAL & DEPENDENT COVERAGE

Basic Coverage Because your income is so important to those who depend on you, the University provides group term life and accidental death and dismemberment (AD&D) insurance coverage equal to your annual wage up to $150,000. This amount is rounded up to the nearest $1,000. The first $50,000 of coverage can be paid with pre‐tax dollars. The Internal Revenue Service requires taxation on a portion of your premium for amounts in excess of $50,000. Any applicable taxation will be applied semi‐monthly.

Optional Coverage If you wish, you may purchase Additional Life/AD&D insurance, on a payroll deduction basis, up to four times your annual wage, up to $750,000 overall. The monthly cost of this Life/AD&D insurance is based on your age (see chart). You may elect to add or drop Additional Life/AD&D insurance. If you add or increase your Additional Life/AD&D insurance, you are required to complete an Evidence of Insurability form. If you don't choose the extra Life/AD&D insurance option, you will maintain your current level of coverage. At age 70, the base and supplemental coverage reduces by 50% up to $50,000.

Employee’s Age

Cost of Coverage Month per $1,000

0‐29 $.08

30‐39 $.15

40‐49 $.22

50‐59 $.53

60+ $1.01

Calculate your Monthly Additional Life/AD&D Insurance Costs: Select amount of coverage to multiply by annual wage, round amount up to next $1,000. Omit 000, then multiply by rate to get monthly cost. Select Amount of Coverage _________ x $ = $ Round amount x = $ (1‐4 times annual wage) Additional Annual Base Amount of up to nearest $1,000, Rate Your Monthly Life/AD&D Wage Coverage then omit 000) Cost Example: Additional Life/AD&D Selection = 2 Annual Base Earnings = $31,342 Age 31 years old Select Amount of Coverage 2 x $31,342 = $62,684 Round amount $63 x $0.15 = $9.45 (1‐4 times annual wage) Additional Annual Base Amount of up to nearest $1,000, Rate Your Monthly Life/AD&D Wage Coverage then omit 000 Cost

Dependent Life Coverage Two options are offered for Dependent Life Insurance. Both plans cover the employee's spouse and dependent children. If you choose to cover your spouse, you must provide satisfactory proof of insurability for that individual before this coverage becomes effective. You do not need to provide proof of insurability for children. Your monthly cost for additional life insurance is deducted from your paycheck on an after‐tax basis. Note: If you elect to change your life insurance coverage, your beneficiary on file will be considered your beneficiary for the new level of coverage. If you wish to change your beneficiary designation, please contact the Human Resources Department to request a Beneficiary Change Form. If you don't designate a beneficiary or don't have one on file, benefits will be paid to your estate or as required by law.

The two plans are: Plan 1 Plan 2

Coverage for spouse $10,000 $20,000

Coverage for child $5,000 $10,000

Monthly Cost $5.13 $10.26


18

EMPLOYEE ASSISTANCE PROGRAM EMPLOYEE ASSISTANCE PROGRAM AND TRAVEL ASSISTANCE PROGRAMAND TRAVEL ASSISTANCE PROGRAM


Ability Assist– Employee Assistance Program (EAP) The Hartford’s Ability Assist program, offered by Compsych, helps you and your family cope with life, from the everyday to the unexpected. Whether managing everyday issues such as job pressures, relationships, retirement planning , finding child care, grief, loss, or the impact of a disability, Ability Assist is your resource for professional support.

Ability Assist helps you cope with life by providing the following services:

• Easy confidential access to professionals– toll‐free, 24 hours a day, 7 days a week, 365 days a year

• Up to five face‐to‐face sessions per year

• Financial and legal consultation

• Trusted on line resources and tools Help is only a phone call away. We encourage you to take advantage of the resources available through The Hartford’s Ability Assist program.

1‐800‐96‐HELPS (1‐800‐964‐3577)

www.guidanceresources.com

Getting support to help you manage life is simple. Please contact Human Resources for information on this program.

Employee Travel Assistance Program We are pleased to offer a free Travel Assistance Program through The Hartford. This program provides toll‐free emergency assistance to you, your spouse and your dependents 24 a day, seven days a week when traveling 100 miles or more from your primary home (national or international travel) for 90 days or less. The Hartford's Travel Assistance program provides three kinds of services for your business or vacation travels– Pre‐trip Information, Emergency Medical Assistance and Emergency Personal services.

• Pre‐Trip Information:

− Visa, Passport, Inoculation and Immunization Requirements

− International “Hot Spots” − Travel Advisories − Foreign Exchange Rates − Embassy and Consular Referrals

• Emergency Medical Assistance:

− Medical Referral, Monitoring and Evacuation − Repatriation − Traveling Companion Assistance − Emergency Medical Payments − Medication and Eyeglass Assistance

• Emergency Personal Services:

− Sending and Receiving Emergency Messages − Emergency Travel Arrangements − Emergency Cash − Legal Assistance

Services available for business and personal travel. For inquires within the U.S. call toll free: 1‐800‐243‐6108

19

FLEXIBLE SPENDING ACCOUNTFLEXIBLE SPENDING ACCOUNT—— HEALTH CARE AND DEPENDENT CAREHEALTH CARE AND DEPENDENT CARE


Reimbursement Accounts ‐ Tax Savers

Lawrence Tech offers a Health Care and Dependent Care Flexible Spending Account (FSA) program. The FSA plans are funded by a salary reduction program and administered through WageWorks. The Health Care Reimbursement Account provides a tax‐free method of paying for many health care expenses not covered by your medical, dental and vision plans. The Dependent Care Reimbursement Account provides tax‐free payment for expenses such as day care for a child or other qualified dependent(s). When you make contributions to these accounts, you shelter the amount you contribute from taxes. The money is then available for paying your health care and/or dependent care expenses. The benefit period for Reimbursement Accounts is January 1 ‐ December 31, in which your annual contribution will be reduced from your pay. Please note that you have a grace period of an additional 2 1/2 months (January 1, 2013 ‐ March 15, 2014) after the plan year to incur health care and/or dependent care expenses. Although the accounts offer you the opportunity to pay expenses tax free, IRS rules require that any amount not used for covered expenses under your Health Care and/or Dependent Care Reimbursement Account cannot be returned to you. This is known as the "use‐it‐or‐lose‐it" rule. Careful planning will help you avoid this situation.

How the Reimbursement Accounts Work You make new Reimbursement Account choices each year. During the annual enrollment period, you decide how much money per pay period should go into one or both of the accounts to pay for the next year’s expenses (January 1 ‐ March 15, 2014). You deposit your own before‐tax contributions into the account(s). The Reimbursement Account(s) are designed to reimburse you ‐ not to pay expenses directly. Here are highlights of how the process works: 1. Money is deposited into the account(s) with before‐tax dollars from your pay. 2. When you have an eligible expense during the year, you pay it. 3. After paying the expense, you submit a claim form and documentation (for example, a

receipt from your day care provider or an Explanation of Benefits, or EOB) to receive reimbursement. (For health care claims, always submit claims to the plan under which you're covered before submitting for reimbursement. Submit claims only for unreimbursed health care expenses to the Health Care Reimbursement Account).

4. Then, you're reimbursed from your account: a. Health Care Reimbursement Account ‐ you can be reimbursed for the full annual

amount you elected to contribute (your weekly amount times 52 weeks). b. Dependent Care Reimbursement Account ‐ you can be reimbursed up to the

amount you currently have in your account. Grace period gives you more time to use your plan The account(s) reimburses you for services, products, or treatment incurred within the benefit period. You have from January 1, 2013 through March 15, 2014 to incur dependent care or health care expenses. You have until May 31, 2014 to submit your claim for the expenses which have accumulated from January 1, 2013 through March 15, 2014. This means you can continue to spend your current 2013 account funds for 2 1/2 months after the end of the plan year. A run‐out period will follow the new grace period, giving you time to file claims for those expenses incurred during the previous plan year and/or during the new grace period. The IRS provides two examples to illustrate how the grace period would work for a calendar year plan. In the first example, an individual has $200 remaining in his or her health FSA at the end of 2012 and elects $1,500 for 2013. If the individual incurs $300 in medical expenses during the grace period (January 1 ‐ March 15, 2014), he or she may be reimbursed $200 from the 2013 year‐end balance and $100 from the 2014 plan‐year benefit. In the second example, if the same individual incurs only $150 in medical expenses during the grace period, he or she may be reimbursed $150 from the $200 account balance from 2013, but the remaining $50 is forfeited. The 2013 FSA benefit election would remain untouched.

20



The Health Care Reimbursement Account

Effective January 1, 2013, you may deposit up to $2,500 per year in the Health Care Reimbursement Account. You can use this account to pay for any health care expenses allowed by the IRS and not covered by your health care plans. However, health care insurance premiums or premiums for any other types of coverage are not reimbursable. Here are examples of eligible health care expenses: Healthcare FSA accounts will no longer reimburse for over‐the‐counter medicine (except insulin) unless it is prescribed by a physician. Regular prescribed medications can still be run through your FSA, as well as all other previously eligible medical expenses. A complete list of FSA health care eligible expenses are available at www.WageWorks.com.

• Deductibles and copays

• Routine physical exams

• Mental health/substance abuse services

• Vision care/glasses & contacts

• Dental expenses

• Doctor's office, clinic visits

• Prescription drugs

• Doctor’s prescribed over‐the‐counter drugs

• Hearing care/aids

• Nursing home expenses

FSA Eligible Medical Items That do NOT Require a Doctor’s Prescription

FSA Eligible Medical Items That Require a Doctor’s Prescription

Bandages and related items (over‐the‐counter) Birth control (over‐the‐counter) Blood pressure monitors Cholesterol test kits and supplies Condoms Contact lenses, cleaning solutions, etc. Crutches, canes, walkers or like equipment (purchase or rental) Dentures, bridges, etc. Diabetic monitors, test kits, strips and supplies Eye related equipment/materials Eyeglasses (over‐the‐counter) Fertility monitors (over‐the‐counter) First aid kits (over‐the‐counter) Hearing aids and batteries Incontinence supplies Insulin, testing materials and supplies Magnetic therapy (over‐the‐counter) Medical equipment (for treatment of medical condition) & repairs Medical monitoring and testing devices Medical supplies (for treatment of a medical condition) Monitors & test kits (over‐the‐counter) Occlusal guards to prevent teeth grinding Orthotics Orthopedic and surgical supports Over‐the‐counter bandages and related items Ovulation monitor (over‐the‐counter) Pregnancy tests (over‐the‐counter) Reading glasses (over the counter) Teeth grinding prevention devices Urological products Walking aids (canes, walkers, crutches and related supplies) Wheelchair and repairs Wound care (over‐the‐counter)

Acne treatments Allergy .& sinus medicine and products Antacids Antibiotic ointment Aspirin or other pain relievers Asthma medicines or treatments Canker & cold sore treatments Chest rubs Cold &flu medicines Corn and callus removers Cough drops & sore throat lozenges Cough syrup Diaper rash ointments and creams Ear drops & wax removal Gastrointestinal medications Herbal or homeopathic medicines Laxatives Lice treatments Motion & nausea medicines Over‐the‐counter products for dental, oral and teething pain Pain relievers Propecia (for treatment of a medical condition) Retin‐A (for iron .cosmetic purposes) Sleep aids Toothache and teething pain relievers Wart removal treatments

21



The Dependent Care Reimbursement Account

The Dependent Care Reimbursement Account works in much the same way as the Health Care Reimbursement Account. However, it is a completely separate account with its own rules and procedures. The maximum amount you can put into your Dependent Care Reimbursement Account depends on your Federal income tax filing status. You can put up to $5,000 each year in the account or $2,500 per year if you are married and file a separate income tax return. The maximum limit is a legal limit that applies to all plans to which you may contribute. So, if you participate in a plan through your spouse's employer, it is your responsibility to coordinate your contributions to be sure you stay within the limit. Also, as with the Health Care Reimbursement Account, only expenses accumulated from January 1 through the following December 31 are eligible for reimbursement (although you have until May 31 of the following year to file a claim). You may use your Dependent Care Reimbursement Account to pay for expenses that are directly related to the care of dependent children or adults if the care enables you to work. If you're married, your spouse must be employed outside the home, disabled, or a full‐time student. In addition, for dependent care expenses to be eligible, the following conditions apply:

• Your dependent must be:

− Under age 13 and claimed by you as a dependent on your Federal income tax return; or

− Any age if physically or mentally incapable of self‐support and claimed as a dependent on your Federal income tax return. (So, elder care may be reimbursable).

• The services can be provided almost anywhere ‐ including your home.

• You cannot claim your care provider as a dependent for tax purposes. (Your provider can, however, be a family member, as long as you don't claim that family member as a dependent.)

• The amount to be reimbursed must not be greater than your annual income

or your spouse's, whichever is lower. (If your spouse is a full‐time student or is mentally or physically incapacitated and does not have regular income, IRS rules base your spouse's financial status on an assumed monthly income of $200).

A complete list of FSA dependent care eligible expenses are available at www.WageWorks.com.

Some examples of eligible dependent care expenses are:

• Infant/toddler

• Preschool

• Before/after school care

• School half days

• In‐service days (no school)

• School holidays/vacations

22



Choosing the Best Tax Advantage for Dependent Day Care

If you are a working parent, compare the tax advantage of the Dependent Care Reimbursement Account and the Federal child care tax credit. If you choose to use the Dependent Care Reimbursement Account, the amount you can deduct under the Federal tax credit will be reduced by the amount you contribute to the Dependent Care Reimbursement Account. This is an important decision, because it affects both your enrollment decision and your Federal income tax return. You may want to check with a tax advisor to find out what's best for you.

Things to Think About

When making your Reimbursement Account choices, here are some things to keep in mind:

• What expenses did you have this year? What kinds of expenses do you expect next year? You can enroll in either or both accounts.

• You can contribute to the Health Care Reimbursement Account even if you elect no health care coverage.

• Your spouse's unreimbursed health care expenses are eligible for reimbursement through the Health Care Reimbursement Account even if he or she is insured through another employer.

Use the worksheet below to help you determine how much you may want to contribute.

Health Care Expenses Deductibles and copays Doctor’s office, clinic visits Routine physical exams Prescription drugs Mental health/substance abuse services Dental expenses Vision care/glasses & contacts Hearing care/aids Nursing Home expenses TOTAL

Estimated 2013 Expenses You Will Pay ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________

Dependent Care Expenses Infant/toddler Preschool Before/after school care School half days In‐service days (no school) School holidays/vacations Summer day camp* Elder care TOTAL *Expenses for overnight camps are not reimbursable

Estimated 2013 Expenses You Will Pay ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________

23

THE LEGALSHIELD PLAN/IDENTITY THEFT THE LEGALSHIELD PLAN/IDENTITY THEFT SHIELDSHIELD


All full‐time Lawrence Tech faculty, staff and administrative employees are eligible to enroll in this program at the special group rates listed below:

BENEFIT OPTIONS MONTHLY FEE

• Standard LegalShield Plan (only) $15.95 • Identity Theft Shield (only) $12.95 • Combined Standard LegalShield and Identity Theft Shield $25.90

Fees are processed through payroll deduction.

LegalShield Benefit Includes: • 24/7 emergency assistance for covered legal emergencies

• Preventive Legal Services − Telephone consultations for personal or business questions − Letters/phone calls (plus 2 business letters or calls per year) − Legal document review (up to 10 pages) plus 1 business document per year − Will preparation and updates − Trust preparation available at a 25% discount

• Motor Vehicle Legal Services

− Assistance with moving traffic violations − Assistance with certain motor vehicle related criminal charges − Up to 2.5 hours for help with driver’s license issues and personal injury legal assistance

• IRS Audit Legal Services

− Schedule benefits up to 50 hours of professional services

• Preferred Member Discount − Any other legal services not otherwise covered by the membership are available at a

25% discount

• Trial Defense Services − Assistance with the defense of civil suits and job‐related criminal charges. Up to 60

hours of assistance the 1st membership year, which includes 57.5 hours of trial time and 2.5 hours of pretrial time. Schedule of benefits increase to a maximum of:

2nd year ‐ 120 total hours 3rd year ‐ 180 total hours

• Additional features − Access to full service law firm − All members of the firm are members of the Michigan Bar Association − Fees for covered services provided by Plan Attorney are fully covered − No claim forms are needed − Covers you, your spouse / domestic partner, dependent children / step children in

all 50 states Note: Plan excludes employment‐related matters.

4th year ‐ 240 total hours 5th year ‐ 300 total hours

Identity Theft Shield Benefit Includes:

• Credit report for you and your spouse / domestic partner

• 24/7 credit monitoring

with immediate notification via e‐mail if there is any activity with the credit repository, as well as a monthly activity statement

• Restoration of your

identity by a licensed investigator if you find you have become a victim of identity theft

• Covers you and your

spouse / domestic partner

24

OTHER VOLUNTARY BENEFITSOTHER VOLUNTARY BENEFITS


Automobile/Home Insurance Discount ProgramAutomobile/Home Insurance Discount ProgramAutomobile/Home Insurance Discount Program

Lawrence Tech offers a voluntary personal automobile and homeowners insurance discount program. The program is at the employee’s expense with payment options; however, this program is not administered through payroll deduction. How to Enroll

Refer to the Liberty Mutual Insurance Group contact person under Insurance Provider listing.

Recreational ActivitiesRecreational ActivitiesRecreational Activities

The University’s recreational facility known as the Don Ridler Field House is available for use by employees and students. There is an annual membership fee (applies from July 1 – June 30 of the school year) to join the Ridler Field House. The facility includes:

• Treadmills and elliptical trainers • Four racquetball/wallyball courts • Three volleyball courts • Two full‐court basketball

areas • Cardio‐room with bikes and

rowing machines • Stairmasters and cross‐

trainers • Ping‐pong tables • Billiards room • Free‐weight room • Multipurpose weight room • Fitness track • Locker rooms and saunas • Additional information (i.e.,

hours of operation, fees, etc.) is available on the website at http://www.ltu.edu/athletics/ridler_facilities.asp

How to Join the Ridler Field House Employees can join the facility by completing and returning the Ridler Field House Authorization for Payroll Deduction form. The form is available upon request from the Payroll Office, [email protected].

Retirement PlanRetirement PlanRetirement Plan

The University offers the Lawrence Technological University Defined Contribution Retirement Plan to eligible employees. There are two parts of the Plan: Retirement part and TDA part. Each part has separate eligibility requirements that must be met before participating in the Plan. The contributions you defer into the Plan generally will be contributed on a pre‐tax basis. Deferrals (and related earnings) are always fully vested and cannot be forfeited. The Plan is subject to the discretion of the University to modify, add or eliminate at any time. The Summary Plan Description (SPD) document summarizes the important features of the Plan, including the eligibility requirements, benefits and obligations under the Plan. Download a copy of the SPD document at https://www.ltu.edu/human_resources/retirement.asp or request a paper copy free of charge by emailing [email protected]. How to Enroll Contact the Office of Human Resources for additional information.

University BookstoreUniversity BookstoreUniversity Bookstore

The University bookstore is located in the Wayne H. Buell Management Building. The bookstore sells a wide variety of items including books, instruments, supplies, clothing, greeting cards, etc. Employees of the University receive a 10% discount at the bookstore on all items except: computer software, electronics, food, magazines, rings and textbooks. How to Receive University Bookstore Discounts

Employees may receive discounts on some bookstore purchases when they show their Lawrence Tech picture identification card. Identification cards are issued at the One Stop Center.

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HEALTH CARE TERMSHEALTH CARE TERMS

Annual Copay Maximum: The maximum amount you will pay out of your own pocket for covered medical expenses during the year. Once your payments total the out‐of‐pocket maximum, the plan pays 100% of covered expenses for the rest of the plan year. Beneficiary: A person who is eligible to receive benefits under a health benefits plan. Sometimes “beneficiary” is used for eligible dependents enrolled under a benefits plan; “beneficiary” can also be used to mean any person eligible for benefits, including both employees and eligible dependents. Benefit Year: The coverage period, usually 12 months long, which is used for administration of a health benefits plan. Brand‐Name Drug: A drug manufactured by a pharmaceutical company which has chosen to patent the drug’s formula and register its brand name. Carrier: A term historically used for licensed insurance companies, although now sometimes used to include both licensed insurers and HMOs. Case Management: Coordination of services to help meet a patient’s health care needs, usually when the patient has a condition that requires multiple services from multiple providers. This term is also used to refer to coordination of care during and after a hospital stay. Coinsurance: The percentage of the cost you pay after the deductible has been met. Coordination of Benefits: A provision in a contract that applies when a person is covered under more than one group health benefits program. It requires that payment of benefits be coordinated by all programs to eliminate over‐ insurance or duplication of benefits. Copayment (copay): What the participant pays at the time of service. Copayments are predetermined fees for physician office visits, prescriptions or hospital services. Usually, the plan pays 100% of eligible expenses after you pay the copay. Deductible: The money an individual or family must pay from their own funds toward covered medical expenses, usually based on a calendar year. For example, if a plan has a $100 deductible, the deductible is met once the first $100 of the covered medical expenses for that year have been paid. After that, the plan begins to pay toward the cost of covered health care services. Dependent: A person eligible for coverage under an employee benefits plan because of that person’s relationship to an employee. Spouses, children and adopted children are often eligible for dependent coverage.

Explanation of Benefits (EOB): A statement provided by the health benefits administrator that explains the benefits provided, the allowable reimbursement amounts, any deductibles, coinsurance or other adjustments taken and the net amount paid. A participant typically receives an explanation of benefits with a claim reimbursement check or as confirmation that a claim has been paid directly to the provider. Extension of Benefits: When a person’s coverage is extended under certain conditions, such as disability, after their group health coverage would otherwise have ended. Formulary: A list of preferred drugs. Medications on this formulary list have been shown to be safe, effective and affordable. Formulary includes brand‐name and generic drugs that have been approved by the Food and Drug Administration. Generic Drug: A prescription drug that has the same active‐ingredient formula as a brand‐name drug. A generic drug is known only by its formula name and its formula is available to any pharmaceutical company. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and as effective as brand‐name drugs and are typically less costly. Health Maintenance Organization (HMO): An HMO requires a Primary Care Physician must be selected and members must work with the PCP for specialty care referrals. HMOs are prepaid capitated health care plans structured to emphasize care and cost containment. HMO is the most restrictive plan in health care, giving the greatest level of benefit. Maintenance Medication: Medication that is prescribed for long‐term treatment of chronic conditions, such as diabetes, high blood pressure or asthma. Maintenance medications are often available through the carrier’s mail order service for up to a 90‐day supply and at participating network retail pharmacies for up to a 30‐day supply. Non‐formulary (Non‐preferred): A drug which is not on an approved list for use and/or coverage by the plan. Network: A group of providers (doctors, hospitals and others) who have contracted with a plan to provide health care services. Under some options, receiving care from out‐of‐network providers can severely limit, or eliminate, plan benefits. Preferred Provider Organization (PPO): The PPO offers coverage in or out of network, without a referral. No PCP is required. In‐network coverage is at a higher level than out‐of‐network. Reasonable and Customary Charges: The commonly charged or prevailing fees for health services within a geographic area. A fee is considered reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community.


FEDERAL LAWSFEDERAL LAWS

Your Continuation Coverage Rights Under COBRAYour Continuation Coverage Rights Under COBRAYour Continuation Coverage Rights Under COBRA As a participant in the Lawrence Tech Medical, Dental, Vision, and FSA (referred to here as "the plan(s)"), you are receiving this notice that describes your right to COBRA continuation coverage. COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985, is a federal law affecting most employers who offer group health benefits to their employees. Under this law, you and other members of your family may have the right to temporarily continue your group health benefits when you would ordinarily lose coverage. This document describes your right to this COBRA continuation coverage, when it may become available to you and your family and what you must do to protect your right to receive it. What is COBRA continuation coverage? COBRA continuation coverage extends your health plan coverage when it would otherwise end because of a life change (known here as a qualifying event). After a qualifying event, COBRA continuation coverage must be offered to each person who is a qualified beneficiary. You, your spouse and your dependent children could become qualified beneficiaries if coverage under the plan is lost because of the qualifying event. Qualified beneficiaries who elect COBRA continuation coverage may be required to pay up to 102% of the full cost of the benefit. As an employee covered by the plan, you will become a qualified beneficiary if you lose your plan coverage because:

• Your hours of employment are reduced, or • Your employment ends for any reason except for gross

misconduct on your part. As the spouse of a covered employee, you will become a qualified beneficiary if you lose your plan coverage for any of the following reasons:

• Your spouse dies. • Your spouse's hours of employment are reduced. • Your spouse's employment ends for any reason other than

gross misconduct. • Your spouse becomes entitled to Medicare benefits. • You become divorced or legally separated from your spouse.

As a dependent child of a covered employee, you will become a qualified beneficiary if you lose your plan coverage for any of the following reasons:

• Your employee‐parent dies. • Your employee‐parent's hours of employment are reduced. • Your employee‐parent's employment ends for any reason other

than gross misconduct. • Your employee‐parent becomes entitled to Medicare benefits. • You cease to be a "dependent child" under the terms of the

plan. When is COBRA coverage available?

You are eligible for COBRA continuation coverage only after the plan administrator has been notified that a qualifying event has occurred. Who is responsible for notifying the plan administrator of a qualifying event? Your employer is responsible for notifying the plan administrator if the qualifying event is one of these:

• Your termination or a reduction in your hours of employment. • Your death. • Your becoming entitled to Medicare.

You are responsible for notifying the plan administrator that a qualifying event has occurred when the event is one of these:

• You become divorced or legally separated from your spouse. • Your dependent child ceases to be eligible under the plan.

You must notify the plan administrator within 60 days after the qualifying event has occurred. Provide this notice in writing to:

Lawrence Technological University Office of Human Resources, Business Services Building 21000 West Ten Mile Road Southfield, MI 48075

What happens next? Once the plan administrator has received notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each person will have an independent right to elect or decline the coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouse, and parents may elect the coverage on behalf of their children. How long does COBRA continuation coverage last? COBRA continuation coverage is temporary coverage. Generally, it lasts only up to 18 months, when the qualifying event is a reduction in your hours of employment or your employment ends. COBRA continuation coverage can last up to 36 months when the qualifying event is one of the following:

• You die. • You become entitled to Medicare benefits. • You and your spouse become divorced or legally separated. • Your dependent child ceases to be eligible under the plan.

An 18‐month coverage period can be extended in two ways: through (i) disability or (ii) a second qualifying event. Disability extension If the Social Security Administration determines you or another covered individual in your family to be disabled and you notify the plan administrator in a timely manner (within 60 days of the Social Security determination), you and your family may be entitled to receive up to an


FEDERAL LAWSFEDERAL LAWS

additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started sometime before the 61st day of COBRA continuation coverage and must last at least until the end of the 18‐month period of continuation coverage. If you qualify for the disability extension, you may be required to pay up to 150% of the full cost of the benefit for the additional 11 months of COBRA continuation coverage. A second qualifying event If your family experiences a second qualifying event during its 18‐month period of COBRA continuation coverage, other qualified beneficiaries in your family can obtain an additional 18 months of coverage, for a maximum of 36 months, if the plan administrator is notified in a timely manner of one of these second events:

• You die. • You become entitled to Medicare benefits. • You become divorced or legally separated from your spouse. • Your dependent child ceases to be an eligible dependent under

the plan. A "second qualifying event" extension may be available to your spouse and dependent children only if the event would have caused them to lose coverage under the plan had the first qualifying event not occurred. Protect your rights

• Always keep the plan administrator informed of any address change for any family member.

• Whenever you correspond with the plan administrator, keep a copy for your records.

• Keep in mind that this notice is only a summary of the most important provisions of COBRA. If you have questions or need additional information about COBRA continuation coverage or your group health plan, review your Summary Plan Description or contact the plan administrator:

Lawrence Technological University Office of Human Resources, Business Services Building 21000 West Ten Mile Rd. Southfield, MI 48075 Phone: 248.204.2150 or 248.204.2151

For answers to your questions concerning your rights under COBRA, ERISA, HIPAA and other laws affecting group health plans, contact the nearest regional or district office of the U.S. Department of Labor's Employee Benefits Security Administration or visit the EBSA web site at www.dol.gov/ebsa. Women's Health and Cancer Rights Act of 1998 ‐ Annual Notice Federal law requires a group health plan to provide coverage for the following services to an individual receiving plan benefits in connection with a mastectomy:

♦ Reconstruction of the breast on which the mastectomy has been performed;

♦ Surgery and reconstruction of the other breast to produce a symmetrical appearance, and

♦ Prostheses and physical complications for all stages of a mastectomy, including lymph edemas (swelling associated with the removal of the lymph nodes).

The group health plan must determine the coverage in consultation with the attending physician and patient. Coverage for breast reconstruction and related services will be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan. Newborn and Mother's Health Protection Act ‐ Annual Notice This 1998 Federal law states: "Group plans and health insurers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth.” The law provides that neither you nor your newborn baby may be sent home less than 48 hours following a natural childbirth. If you have a Caesarean section, you may remain at the hospital for 96 hours. A longer stay is based on medical necessity, which is determined by your physician. However, the law does not prohibit either of you from going home in less than 48 hours, or 96 hours following a Caesarean section, provided that you and your physician agrees that is safe to do so. Medicaid /CHIP Special Enrollment Period If you are or a dependent is covered under a Medicaid or a State child health medical plan (CHIP) plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must request enrollment within 60 days after the date eligibility is lost. Finally, if you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must request enrollment within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states. GINA The Genetic Information Nondiscrimination Act of 2008 (P.L 110‐233, 122 Sta. 881), also referred to as GINA, is a new Federal law that prohibits discrimination in the health coverage and employment based on genetic information. The President signed the act into law on May 21, 2008.


HIPAA NOTICE OF PRIVACY PRACTICESHIPAA NOTICE OF PRIVACY PRACTICES

We understand that medical information about you and your health is personal. We are committed to protecting your medical information. For plan administration purposes, the health plan creates a record of reimbursed health care claims. Because we create this record we are required to follow federal health information privacy laws. This notice is to remind you that as a participant in the Lawrence Technological University Benefit Plan you are protected by these laws and you have a right to a copy of our plan’s Privacy Notice upon request. In addition, you will automatically be provided an updated notice if the current privacy policy is changed. This updated notice will be made available within 60 days of the date a material change is made to the privacy policy. As required by HIPAA, the Plan will: make sure that medical information which identifies you is kept private; give you notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms of the policy and notice that is currently in effect. The program benefits that are subject to the privacy laws include: dental and/or health care reimburesement accounts. While we treat all information confidentially, other benefit programs are not subject to the same requirments and there is no specific privacy notice for those plans. If you have questions, please call 248‐204‐2151. To request a copy of the privacy notice please forward a written request for a copy of the Plan’s privacy notice to (please allow two weeks for the delivery of the notice):

Lawrence Technological University c/o Office of Human Resources Business Services Building 21000 West Ten Mile Road Southfield, MI 48075‐1058 (248) 204‐2150 or 2151

Or you may download a copy of the privacy notice at www.ltu.edu/human_resources/privacy.asp.


MEDICARE PART DMEDICARE PART D——NOTICE OF NOTICE OF CREDITABLE COVERAGECREDITABLE COVERAGE

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Lawrence Technological University and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1 Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you

join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2 Lawrence Technological University has determined that the prescription drug coverage offered by the Lawrence Technological University Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

Important Notice from Lawrence Technological University (LTU) About Your Prescription Drug Coverage and Medicare

When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th through December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Lawrence Technological University coverage will not be affected. Summary of Options for Medicare Eligible Employees (and/or Dependents):

Continue medical and prescription drug coverage and do not elect Medicare D coverage. Impact – your claims continue to be paid by the Lawrence Technological University health plan. Continue medical and prescription drug coverage and elect Medicare D coverage. Impact ‐ As an active employee (or dependent of an active employee) the Lawrence Technological University health plan continues to pay primary on your claims (pays before Medicare D). Drop the coverage and elect Medicare Part D coverage. Impact – Medicare is your primary coverage. You will not be able to rejoin the Lawrence Technological University health plan unless you experience a family circumstance change or until the next open enrollment period. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents will not be able to get this coverage back unless you experience a family status change or until the next open enrollment period.


MEDICARE PART DMEDICARE PART D——NOTICE OF NOTICE OF CREDITABLE COVERAGECREDITABLE COVERAGE

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Lawrence Technological University and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the Office of Human Resources at (248) 204‐2150 or 2151 for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Lawrence Technological University changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage:

• Visit www.medicare.gov

• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help

• Call 1‐800‐MEDICARE (1‐800‐633‐4227). TTY users should call 1‐877‐486‐2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1‐800‐772‐1213 (TTY 1‐800‐325‐0778). Updated October 15, 2012 Lawrence Technological University Office of Human Resources Business Services Building 21000 West Ten Mile Road Southfield, MI 48075 (248) 204‐2150 or 2151

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage

and, therefore, whether or not you are required to pay a higher premium (a penalty).

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BCNBCN——Healthy Blue LivingHealthy Blue Living



BCNBCN——Healthy Blue Living (Cont’d)Healthy Blue Living (Cont’d)

This is intended as an easy to read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations and exclusions may apply to covered services. For a complete description of benefits, please see the applicable Blue Care Network certificates and riders. Payment amounts are based on the Blue Care Network approved amount, less any applicable deductible and/or copay amounts required by the plan. This coverage is provided pursuant to a contract entered into in the State of Michigan and shall be construed under the jurisdiction and according to the laws of the State of Michigan. Services must be provided or arranged by member’s primary care physician or health plan. Healthy Blue Living members (subscribers and covered spouse) must complete program requirements within the first 90 days of enrollment or re-enrollment. To qualify for or maintain enhanced benefits, members need to complete a health assessment and qualification form during the first 90 days and follow their primary care physician’s recommendations for a healthy lifestyle. Members who use tobacco must enroll in BCN’s smoking cessation program within 120 days of enrollment or re-enrollment. Members with a BMI of 30 or above must choose one of two BCN-sponsored weight management programs (Weight Watchers or Walkingspree pedometer plan) within 120 days of enrollment or re-enrollment.

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Simply BlueSimply BlueSM SM PPOPPO——Plan 500Plan 500


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Simply BlueSimply BlueSM SM PPOPPO——Plan 500 (Cont’d)Plan 500 (Cont’d)


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Simply BlueSimply BlueSM SM PPOPPO——Plan 500Plan 500 Medical Coverage (Cont’d)Medical Coverage (Cont’d)



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Simply BlueSimply BlueSM SM PPOPPO——Plan 500Plan 500 Medical Coverage (Cont’d)Medical Coverage (Cont’d)



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Blue PreferredBlue Preferred®® Rx Rx Prescription Drug Coverage Prescription Drug Coverage


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Blue PreferredBlue Preferred®® Rx Rx Prescription Drug Coverage (Cont’d) Prescription Drug Coverage (Cont’d)


This guide summarizes certain features of the company’s benefits plans. Full details of the plans can be found in the official plan documents, the official plan documents will govern. The company reserves the right to amend or terminate these benefits at any time. The information in this guide does not constitute a contract of employment. If you have any questions about the benefit plans described in this guide, please contact your Human Resources Representative.

Documents

2013 BENEFIT GUIDE