a guide to your 2016 benefits - texas christian...

Collegiate Association REsource of the Southwest

To view your coverage or to participate in the annual Open Enrollment, log on to

my.tcu.edu/EmployeeCenter

A Guide to Your 2016 Benefits

SERVICE WHO TO CALL PLAN INFORMATION

NUMBER TO CALL WEBSITE

Medical• Benefits and

Eligibility

BlueCross BlueShield of Texas

Network: Blue Choice

PPO Group ID: 066446

HDHP Group ID: 070775

CDHP Group ID: 153484

1.888.762.2190 www.bcbstx.com (non-registered visitors)

Medical• Provider Finder Blue Card Access

1.800.810.2583, (select option 2 and option 1)

ID on card starts with “CAP”

www.bcbstx.com/member(registered member)

Medical• Health Care

Account (HCA) – CDHP only

BlueCross BlueShield of Texas

1.888.762.2190www.bcbstx.com

(registered members or non-registered visitors)

Prescriptions Express Scripts Group ID: JPXA 1.866.776.0056 www.express-scripts.com

Telephonic Medical Consultation

Teladoc 1.800.835.2362 www.teladoc.com

Second Opinion Health Care Service

Best Doctors 1.866.904.0910 www.bestdoctors.com

Health Care Advocate Patient Care 1.866.253.2273 www.patientcare4u.com

Health Savings Account (HSA) – HDHP only

HSA Bank 1.800.357.6246 www.hsabank.com

Employee Assistance Program (EAP)

Magellan Health Services

1.800.327.1393 www.magellanassist.com

Flexible Spending Accounts (FSA)

Discovery Benefits

Group ID: 24658901.866.451.3399 www.discoverybenefits.com

Dental Cigna

Group ID: 3215812

DHMO Network: Dental Care

(a six-digit ID number for a dentist is required when electing coverage)

DPPO Network: Advantage

1.800.244.6224

www.cigna.com (non-registered visitors)

www.mycigna.com (registered members)

Vision UnitedHealthcare Group ID: 7540941.877.426.9300 or

1.800.638.3120www.myuhcvision.com

TCU Human Resources

817.257.7790 www.hr.tcu.edu

Contact Information

Use the following toll-free numbers and websites to get answers to questions you have about your TCU benefits. Be sure

to have your Plan ID Card, Member ID number, or your Social Security Number available when you call or log on.

TCU recognizes that a quality, comprehensive

benefits program is a great way to show you just how

valuable you are to the University. We understand

that no two employees are alike, which is why we

offer multiple benefit choices. This resource guide

is designed to help you evaluate your unique needs

and select the benefits program that fits your lifestyle

best. The right program of benefits can help you

get healthy and stay healthy. When you couple

preventive care, quality healthcare when you are sick

or hurt, and a healthy lifestyle, you are really

making Healthy Choices!

Welcome to your 2016 Benefits

Resource Guide.

TCU Benefits Handbook 2016

Benefit Terms Quick Reference: Health Care Account (HCA) • Health Savings Account (HSA) • Flexible Spending Account (FSA)

4

Healthy ChoicesWelcome to Healthy Choices — your 2016 benefits program overview brought to you by TCU in partnership with the Collegiate Association REsource of the Southwest, Inc. (CARES).

Each of the programs highlighted in this guide are designed to help you make healthy choices for yourself and your family. Whether it’s choosing to schedule an annual physical or to call the Employee Assistance Program (EAP) when you need some guidance, each of these choices is a step towards a more healthy you. So read on! Healthy Choices are just around the corner.

EligibilityYou are eligible for coverage under the CARES Health Plan, CIGNA Dental Plan, and/or UnitedHealthcare Vision Plan if you are working at least 75% of full time (or at least 30 hours a week) in a regular position. You and/or your dependents are automatically enrolled in the Prescription Drug Program through Express Scripts with the election of a medical plan. Please see page 8 for more information.

Your dependents are also eligible for TCU benefits, including:

• Medical • Dental • Vision• Employee Assistance Program

Which Dependents Are Eligible?Eligible dependents include:

• Your legal spouse• Dependent children younger than age 26 • Unmarried, dependent children of any age who become

mentally or physically disabled• Domestic partners

How to EnrollCurrent employees can choose their benefits each year during the Open Enrollment period through my.tcu.edu. For the 2016 plan year, you must enroll to:

• re-elect your current benefit elections for coverage• make a change to your current benefit elections • participate in a Flexible Spending Account (Dependent

Care and/or Health Savings)• enroll in a new benefit.

Note: If you do not re-enroll, you will not have coverage during the 2016 plan year.

Open EnrollmentCurrent employees must choose or waive benefits each year. To elect benefits for the 2016 plan year, current eligible employees must participate in TCU’s annual Open Enrollment. Open Enrollment for benefits in 2016 will be held October 26 - November 6, 2015.

Employees will elect their benefits online through the Open Enrollment process at my.tcu.edu/EmployeeCenter.

Adding DependentsPrior to electing benefits, employees should verify that Human Resources has proof of dependent status for any dependents who are being added. This is not required if your dependents have previously been covered through a TCU insurance health plan. The following documents can be used as proof:

• marriage license for spouse• birth certificates, adoption, or placement papers for

children• signed domestic partner affidavit (available from

Human Resources).

New Hire or Change in Employment StatusIf you are new to the TCU family or have recently become eligible for benefits, plan participation typically begins on the first of the month following your date of hire or change of status.

Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) • Consumer Driven Health Plan (CDHP) • Preferred Provider Organization (PPO)

2016 TCU Benefits Handbook 5

You have 31 days from your initial employment date (or when your employment status changes to 75% of full time in a regular position) to enroll in benefits. Otherwise, you must wait for the next annual Open Enrollment. In that case, your benefits will take effect the following January 1, unless you experience a qualifying event as described below.

Making ChangesYou can only make changes between Open Enrollment periods if you have a qualifying “change in status.”

Changes in status or qualifying events include:• your marriage, divorce or legal separation • birth, adoption or change in legal custody of an eligible

child • death of your spouse or covered child • change in your or your spouse’s work status that affects

benefits eligibility• change in residence or work site that affects your

eligibility for coverage • child’s loss of dependent status, e.g. due to attaining age

26 (loss is effective on the last day of their birth month)• change in your child’s eligibility for benefits provided

through a governmental or educational institution.

If you experience a qualifying change in status, contact Human Resources immediately for assistance with changing your benefit elections. Changes must be submitted within 31 days of the date you experience a qualifying event. The election change must be consistent with the change in status. For example, enrolling in dental insurance would not be consistent with having a baby. You would only be able to add your baby to your existing elections.

Failure to notify Human Resources of your dependent’s change in status could result in termination of benefits.



6

Your Medical ChoicesHaving medical insurance is a healthy choice for multiple reasons:

• coverage for doctor visits, hospital care, and prescription drugs can help you get healthy when you are sick or hurt• preventive care benefits can help you stay healthy.

As a TCU employee, you can choose from four CARES Medical Plan options. All plan options utilize the BlueCross BlueShield of Texas “Blue Choice PPO” network. All plans provide preventive care at no cost to the covered participant.

On the next page is a chart that compares each option’s in-network benefits only. Each plan also offers coverage if you choose to use doctors and other providers that are outside the Plan’s network. If you would like to see the out-of-network benefits for a particular option, please visit the TCU Human Resources website where you can view the summary of benefits for each plan.

What is a self-insured plan?

Self-insured means that TCU pays your actual claims. Every time you go to the doctor or fill a prescription, your benefits are actually paid by CARES and TCU — not an insurance company. TCU pays a fee that covers the cost of the plan’s administration. Actual claims are paid by your premiums and TCU’s contributions. Every dollar you save by making wise healthcare choices is a dollar saved by both you and TCU.

Information about out-of-network benefits.

Each of our plans have an identical network of preferred doctors and other providers. These providers agree to discount fees and file claims for you in exchange for being part of the preferred network. Staying in network saves you money as the insured and also helps to control plan costs, which is important in our self-insured plan. If you choose to see an out-of-network provider:• your deductible will be higher• the percent of the cost that the Plan

pays after the deductible is met is lower (so your cost is higher)

• you may be “balance billed” for charges that are above the Plan’s allowable charge

• you may have to pay the bill in full and then file a claim for reimbursement.



All benefits shown below reflect in-network only coverage. For more information on out-of-network benefits, please visit www.hr.tcu.edu.

HDHP with HSA You Pay

CDHP with HCA You Pay

PPO 90%You Pay

PPO 80%You Pay

Annual Deductible• Individual• Plus children• Plus spouse or family

$2,600$5,200***$5,200***

$1,350$2,550$2,700

$ 550$ 950$1,100

$ 950$1,350$1,500

Out-of-Pocket Maximum • Individual• Plus children• Plus spouse or family

$ 6,450$12,900***$12,900***

$ 6,350$12,700$12,700

$3,050$5,950$6,100

$ 5,950$11,350$11,500

TCU’s Contribution• Individual• If you cover your children,

spouse, or family

To HSA:$ 500$1,000

To HCA: $ 500$1,000

N/A N/A

Preventive Care (adults and children)

No charge No charge No charge No charge

Office Visits• Primary Care• Specialist

20%*20%*

30%*30%*

$20$40

$25$50

Teladoc (see p. 10) 20%* 30%* $10 $10

Urgent Care Facility 20%* 30%* $75+10%(no deductible)

$75+20%(no deductible)

Laboratory and Radiology 20%* 30%* 10%* 20%*

Hospital Admission 20%* 30%* $200+10%* $200+20%*

Outpatient Facility 20%* 30%* $100+10%* $100+20%*

Emergency Room 20%* 30%* $150**+10%(no deductible)

$150**+20%(no deductible)

Prescription Drug Base PlanRetail (30-day supply)• Generic• Formulary• Non-Formulary

Mail Order (90-day supply)• Generic• Formulary• Non-Formulary

20%*20%*20%*

20%*20%*20%*

20% with no deductible (minimum and maximum limits to charges apply) Minimum Maximum $ 0 $15 $20 $45 $50 $75

$ 0 $ 30 $ 40 $ 90 $100 $150

Lifetime Maximum Benefit Unlimited

* After the appropriate deductible is met. ** Waived if admitted.*** If you cover any dependents, the “Individual” deductible will apply as an embedded deductible. That means, for example, if one family

member reaches $2,600 as a participant on the HDHP, the co-insurance portion for services will be 20% until the maximum out-of-pocket is reached. Further, your family’s expenses will be combined together to determine if the total $5,200 “Family” deductible has been met.

Medical Plan Comparison (In-Network)



8

The CDHP and the Health Care AccountThe CDHP offers a unique benefit: TCU will contribute funds that you can use to pay for your medical expenses. The CDHP includes a “Health Care Account” or “HCA” which acts basically like a bank account. TCU deposits funds into your HCA, and when you have a medical expense — such as a visit to the doctor — you can use the money in your HCA to pay the bill.

• If you have Individual coverage, TCU will contribute $500 into your HCA for 2016.

• If you cover any dependents, TCU will contribute $1,000 into your HCA for 2016.

Prescription Drug Buy-Up PlanThe Prescription Drug Base Plan (as described in the chart on page 7) is included in the premium you pay for PPO and CDHP medical coverage. The High Deductible Plan (HDHP) treats prescription drugs as any other medical expense, subject to the Plan deductible and coinsurance. You can choose to keep the included Base Plan coverage or receive the benefits of the Prescription Drug Buy-Up Plan instead. You will pay an additional premium for this enhanced benefit. If you choose the Buy-Up Plan, you pay a set copayment for all prescription drugs. There is no deductible, no coinsurance, and no minimum payment.

Prescription Drug Buy-Up Benefits

Network Retail Pharmacy

(up to 30-day supply)

Express Scripts Mail Order

(up to 90-day supply)

Generic $10 $20

Formulary $20 $40

Non-Formulary $35 $70

The CDHP and HDHP Plans The Consumer Driven Health Plan (CDHP) works in a way that is similar to the High Deductible Health Plan (HDHP). Following is an overview of the two plans.

STAGE 1: Pay the deductible.

A deductible is the amount of money that you pay in one year before the Plan starts paying benefits.

Note: The Plan pays 100% of the cost of your preventive visits — including annual check-ups, mammograms, baseline cancer screenings, OB/GYN exams, well-child visits, immunizations, and some preventive care medications.

STAGE 2: Split the cost with the Plan.

After you have paid the deductible, you start splitting the bill with the Plan. The Plan will pay a portion of your medical bills and you pay a portion.

STAGE 3: The Plan pays 100% of your expenses.

The Plan limits how much money you will have to pay for covered medical expenses in one year. The amount of the limit depends on whether you cover only yourself or if you also cover family members.

If you have very high medical bills — enough so that your portion of the cost reaches that limit — the Plan pays 100% of your bills for the rest of the year, as long as you use providers, e.g. doctors and hospitals, that are in the network.



What You Can Pay for Using Your...

Health Care Account (HCA)

Health Care Flexible Spending Account (FSA)

Medical expenses not paid by Plan:

• deductibles • coinsurance • amounts charged by

non-network providers that are over coverage limits

Medical expenses not paid by Plan:

• deductibles • coinsurance • amounts charged by

non-network providers that are over coverage limits

Note: You cannot use HCA dollars to pay for prescription drugs.

Expenses paid by FSA:• dental• vision• prescription drugs

Managing your accountsYou may be wondering what happens to money left in your accounts at the end of the year or if you leave TCU.

At the end of the year If you leave TCU

HCA Unused money rolls over to next year and there is no limit on the account balance.

You give up any unused money in your HCA. You cannot cash out the account or take the money with you. These funds are also forfeited if you elect another medical plan.

HSA Unused money rolls over to next year. There is no limit on how much money you can accrue in your HSA. However, there are federal limits to how much you can contribute annually. The 2016 annual limits for HSA contributions – yours and TCU’s combined contributions – are:

• $3,350 if you cover only yourself • $6,750 if you cover any family members.

Your HSA is yours to keep — both your contributions and TCU’s.

Health Care FSA

You forfeit any money that is left over after you have filed all eligible calendar year reimbursement claims. However, if you have money left in your account on December 31, you may use that money to pay for medical expenses you have from January 1 – March 15 of the following year..

You surrender any unused money in your Health Care FSA.

The HDHP and the Health Savings AccountWhen you choose to enroll in the HDHP, you are automatically enrolled in a Health Savings Account (HSA), through BlueCross BlueShield of Texas’ HSA vendor partner, HSA Bank. HSAs are an effective and flexible way to save money tax-free for medical expenses because:

• they have higher contribution limits than a Health Care FSA

• unused money can stay in the account year after year• your balance can grow without limits• you can contribute your own funds in your HSA • you own the account and can take it with you if you

leave TCU• you can even use the account balance to make COBRA

payments or pay for expenses after retirement.

NEW! TCU is making your HSA even better by: • increasing contributing funds to your account:

- $500 per year if you have individual coverage - $1,000 per year if you cover any family members

(pro-rated on a quarterly basis for new employees and those with changes due to qualifying life events, other than during Open Enrollment)

• allowing you to choose during Open Enrollment to contribute via payroll deduction through a one-time annual election

Notes:1. If you would like to participate via payroll deduction and receive the

contribution from TCU, you are automatically enrolled in a new HSA through HSA Bank. If you have a previously-established HSA from a previous employer, you can still use the existing balance to pay for medical expenses, but no new contributions will be permitted.

2. Medicare-covered and Tri-care covered employees cannot contribute to an HSA.

In conjunction with the HCA, you can also elect a Health Care Flexible Spending Account (FSA), which can be used to pay for additional out-of-pocket health care expenses. You fund this FSA account yourself on a pre-tax basis through payroll deduction for eligible health care expenses incurred during the calendar year. For more information on the Health Care FSA, see page 17.



10

Things to Consider – Which Plan is Best for Me?Will we go to the doctor a few times ... or many?What if someone ends up in the ER?What if we plan on having a baby?

These are just a few of the questions that may go through your head when trying to choose a Medical Plan. It’s hard to estimate year-to-year just what your actual expenses will be.

Actual out-of-pocket expenses will depend on how you and your family utilize the benefits. You can use the information below to help determine your out-of-pocket costs from each of our four Medical options.

Please use this chart to help you estimate your potential medical expenses for you and your family to help pick the best plan for you.

Do you anticipate any of the following for 2016... Yes NoEstimated 2016 Cost

Change in marital status

Birth or adoption of a child

Dependent becomes ineligible for coverage (over age 26)

Changes in your medical situation – such as a recent diagnosis of chronic condition

Changes in your prescription drugs – such as a change to a brand-name maintenance medication

An increase in the cost of a dependent’s medical or prescription drug needs – such as adding a spouse with a chronic condition or a recent diagnosis that required on-going treatment

Determining the right plan for you depends on many factors including your individual situation, how you prefer to pay for services and how much you will pay in premiums for the year.

Notes:



Individual Coverage Example

Individual’s Expenses HDHP with HSA CDHP with HCA PPO 90% PPO 80%

Annual checkup $0 $0 $0 $0

Sick visit ($80) $80* $80* $20 $25

Trip to Urgent Care center for food poisoning ($150)

$150* $150* $82.50 $90

Generic cholesterol medication*** (4 90-day refills at $115 each using mail-order)

$460* $92 (20% of $115 = $23 per Rx)

$92 (20% of $115 = $23 per Rx)

$92 (20% of $115 = $23 per Rx)

Individual’s Responsibility $690 $322 $194.50 $207

Covered by TCU HSA/HCA Contribution

-$500 -$322 -$0 -$0

Paid by the individual$190**

$0($178 left in HCA)

$194.50** $207**

Annual Plan Premium $917.64 $1,548.12 $2,811.12 $2,062.92

Individual’s Total Cost $1,107.64 $1,548.12 $3,005.62 $2,269.92

* Applies to deductible** This could be reimbursed with tax-free money if individual contributed their own money to their HSA or Heath Care FSA.*** Base Rx Plan

Medical Terms to Know

Deductible: the fixed amount of money a covered member must pay out of pocket before the insurance company pays the claims. If a member’s deductible is $500, then the insurance plan will not start paying for claims until the member has met the out-of-pocket $500 deductible.

Co-insurance: the amount a member is responsible for paying for their health care coverage after meeting the deductible. This can be seen as “sharing the cost” with one’s insurance company. Co-insurance is calculated based on a percent system. If a member has a $100 bill for a medical visit and their portion is calculated at 20%, then, assuming their deductible has already been met, the member will pay $20 of the bill and the insurer will pay the remaining $80 of the bill.

Co-payment (co-pay): the fixed amount of money a patient pays for a covered health care service at the time of service. This is in addition to what the insurance company pays.

Lifetime Maximum Benefit: the maximum amount an insurance company will pay during a covered member’s entire lifetime for their health needs. Under the Affordable Care Act, there are no restrictions on benefits placed on most health plans or insurance policies, including TCU’s plan.

Out-of-Pocket Maximum (or Limit): the highest amount a covered member will pay in their policy period (typically in 12-months), before their medical insurance starts paying 100% of the covered medical expenses in their plan. The member’s deductible and coinsurance are counted toward achieving their maximum.

Note:The above chart is for illustrative purposes only. This illustration is only meant to show a scenario and is in no way a guarantee of payment. Your individual costs will vary based on your unique circumstances. Please contact BCBSTX for exact pricing.



12

Additional Medical ResourcesMedical insurance is important and TCU through CARES is providing several programs that work together with our Medical Plan to help you get the most from your benefits programs. All TCU employees who participate in a TCU Medical Plan are automatically eligible to use these additional resources.

Best Doctors: When you want a second opinion Best Doctors provides a unique combination of information and access to the best medical care for members faced with a serious illness or injury. This benefit is free and confidential for you and your family members who are covered by the TCU Medical Plan. Through Best Doctors, you can receive a second opinion from some of the most qualified specialists and facilities worldwide to ensure that your diagnosis and treatment plans are on target.

How to Use Best Doctors• Call 1.866.904.0910 between 7:00 a.m.-8:00 p.m.

Central Time. You will be connected to a member advocate who will take your medical history and make sure your questions about the service are answered.

• Best Doctors compiles all of your medical information and selects a doctor from their database of more than 40,000 world-renowned doctors, based on your individual situation. The doctor delivers their findings and recommendations back to your Best Doctors member advocate.

• Best Doctors will deliver an easy-to-understand, confidential report to you and, if you choose, your treating physician. Your report will summarize the expert’s findings, confirming if they agree with your diagnosis and treatment plan. Your member advocate will review all of the information with you and answer your questions. Best Doctors is also available for follow-up questions.

You can receive more information on this service at www.bestdoctors.com.

When Teladoc is appropriate

When Teladoc is not appropriate

Teladoc is good for routine issues such as:• Cold and flu symptoms• Bronchitis• Allergies• Poison ivy• Pink eye• Urinary tract infections• Respiratory infection• Sinus problems• Ear infections

Teladoc is not good for diagnoses that require lab tests, such as strep throat, or for injuries such as sprains and broken bones.

Teladoc cannot write prescriptions for:• drugs that are controlled

by the DEA (like some pain medications and most ADHD medications)

• many drugs that have the potential for abuse or addiction

• drugs that do not treat a specific illness

How to Use Teladoc• Before your first call, you need to go online to open

an account and set up your Electronic Health Record (EHR).

• Your EHR will contain information that you would normally provide on a patient medical history form when you have a doctor’s office visit. Having a current EHR ensures that Teladoc has a good idea of your medical history before your visit.

• You can also choose to store credit card information to be used when you call Teladoc.

Teladoc: When you just can’t get to the doctorTeladoc is a service that employs United States board-certified doctors who specialize in internal medicine, pediatrics, family medicine, and emergency medicine. When you schedule a consultation, Teladoc will contact a doctor licensed in your home state to call you back. On average, you will receive a return call in less than 25 minutes.



When you elect to use Teladoc:• Log onto your account at www.teladoc.com or call

1.800.Teladoc (1.800.835.2362) to request a phone or online video consultation with a Teladoc doctor. You will also give them your credit card or FSA debit card information if you do not have a credit card on file.

• A U.S. board-certified doctor or pediatrician licensed in your state reviews your EHR, then contacts you. Your doctor will listen to your concerns and ask you questions, similar to an in-person doctor’s appointment.

• Your Teladoc doctor will recommend treatment for your issue. If a prescription is necessary, it is sent to the pharmacy you choose.

• Teladoc will charge you for your visit. If you participate in the HDHP or the CDHP, you are responsible for the full cost of the visit if you have not met your deductible. If you participate in any PPO, you pay a $10 copay for using Teladoc. You can request a detailed receipt that you can use for reimbursement through a flexible spending account or health savings account, if applicable. Your EHR will be automatically updated by your Teladoc doctor with the information from your consultation. Teladoc can even send a record of your consultation to your primary physician at your discretion.

Patient Care: When you need expert assistanceWe’ve all been perplexed by medical issues, claims, or bills. Wouldn’t it be nice to have an expert by your side to explain the intricacies of healthcare to ensure that you receive the care you need and that your claims are processed properly?

You can. TCU offers you the assistance of Patient Care, a health advocacy service, whenever you need it. From understanding your Explanation of Benefits to researching larger concerns or questions about your personal medical care, your Personal Health Advocate will provide the confidential, value-added expertise to help you navigate complex health care issues.

Use Patient Care to:• Resolve claims• Correct billing errors• Schedule appointments• Find the right doctor, hospital, or testing facility

(especially if you are traveling)• Assist with the transfer of medical records• Navigate your insurance plan• Explain conditions and treatments• Locate eldercare services• Resolve Medicare questions

If you have a healthcare or insurance-related issue, call Patient Care:

1.866.253.2273Monday-Friday, 7:00 a.m. – 8:00 p.m.

Central TimeSaturday, 8:00 a.m. – 1:00 p.m. Central Time

You’ll be assigned a Personal Health Advocate, who works with you one-on-one to find solutions to otherwise time-consuming issues.



14

When to Use the EAPCounseling is available through the EAP for personal issues such as:

• Family and marital conflicts• Parenting concerns• Emotional difficulties• Health coaching and support• Drug and alcohol dependency• Stress management• Grief over death of loved one or other losses• Eating disorders• Questions about legal or financial concerns• Questions about child or elder care

Employee Assistance Program: When You Need an Extra HandFamily and work activities are stressful at times. Counseling and referrals are available through the Employee Assistance Program (EAP), provided by Magellan Healthcare, at no cost to you. All benefits-eligible employees and their dependents may utilize the program regardless of participation in TCU’s medical insurance plan.

How to Use the EAPIf you need assistance, you can call and speak to an EAP counselor. Counselors are available 24 hours a day, including holidays. The toll-free phone number to call is:

Magellan Health Services 1.800.327.1393

Sometimes a telephone call is all it takes. But if you want or need additional counseling, you can schedule an appointment with an EAP counselor for face-to-face assessment. TCU will pay for up to three sessions per person, per issue each year. The EAP can also provide referrals to other providers or community resources if you need additional assistance.

The EAP OnlineYou can also access the EAP services online, including reference materials and more, at www.magellanassist.com. You can contact an EAP specialist via the Magellan Health Service’s website, as well as review a complete collection of articles, resources, and interactive tools to assist you with situations affecting your work and life. To register:

• Click on the Register or Enter as a Guest button• Enter the CARES Member phone number:

800-327-1393• Enter the name of the organization: TCU• Complete the registration process

EAP: Confidentiality is Key

Any assistance you receive from the EAP is completely confidential. Your name, records, and other confidential information are not shared with TCU.



DentalRoutine dental visits help you maintain your existing teeth, as well as prevent or address potential dental disease that, if left untreated, could cause serious health problems due to infection. The TCU benefits program includes two Dental options to consider.

About Your Dental InsuranceThe Cigna Dental HMO has a restricted network of dentists from which you can choose. When you use a network dentist, you pay only a set fee for covered services.

The Cigna Dental PPO also has a network of dentists, but you may choose to use dentists outside the network as well. When you use dentists in the network, your out-of-pocket cost is typically less because they agree to limit their charges to the Plan’s negotiated rates.

Cigna DHMO Cigna Dental PPO ChoiceWhen you see a network dentist, you pay… When you see the dentist, you pay…

Annual Deductible • Individual• Family

NoneNone

$50$150

Preventive & Diagnostic Care No charge No charge

Basic Restorative See schedule of benefits for fees. 20% after deductible

Major Restorative See schedule of benefits for fees. 50% after deductible

Orthodontia• Lifetime maximum, per person

See schedule of benefits for fees. Note: some orthodontia treatment can be paid

on a monthly basis.(available for children and adults)

50% after $50 deductible$1,000 maximum benefit

(available for children up to age 19)

Annual Maximum Benefit One Person Can Receive in addition to orthodontia benefits

No limit $1,500Maximum can increase in future

years if you receive preventive care.

If your dentist is not in the network, they may charge more than these limits. In that case, you would also be responsible for paying any additional charges.

Both Dental Plan options cover the four main types of routine dental expenses:

• Preventive and diagnostic care (routine exams and cleanings, fluoride treatments, sealants, and bitewing x-rays) (2 per year)

• Basic treatment (full-mouth x-rays, pulling teeth, fillings, root canals, and oral surgery)

• Major treatment (dentures, bridges, and crowns)• Orthodontia (braces and other appliances, including

installation, removal, and follow-up care)o PPO (children up to age 19 are covered)o Dental HMO (children and adults are covered)

PPO Maximum Benefit (per member)

Dependent’s Maximum Benefit

2016 $1,500 $1,500

2017 $1,500 $1,650

2018 $1,500 $1,800

2019 $1,500 $1,950 (the max amount that you can have)

We all know that getting dental checkups is important. But now they can save you money! If you receive preventive care in 2016 – cleanings, exams, and/or x-rays – the Plan will pay up to another $150 towards your dental care the next year. This applies to each family member – for example, if your dependent gets their teeth cleaned in 2016 but you don’t, then the next year, your dependent’s annual maximum benefit will be $1,650 – but yours will still be at $1,500. Let’s see how this would work year-to-year if you never get a checkup but your dependent does.

NEW! PPO Plan OnlyGet Your Checkup and Earn More Coverage!

Even if your dependent stops getting check-ups, their maximum benefit will never go down. It will stay at $1,950 per year as long as they participate in the plan.



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Vision CareUnitedHealthcare’s Vision Care Plan gives you two different ways to receive benefits:• use the network and pay a set copayment for most expenses• go to a doctor outside the network and receive a reimbursement for part of the cost of your exams, glasses, and/or contacts.

NEW! Frames & Diabetic Treatment• increase to frames allowance (from $130 to $150 retail)• patients managing diabetes can have up to two exams annually covered at the copay amount

UnitedHealthcare Vision

When you use the network, you pay…When you do not use the network the

plan will reimburse you…

Exams (once every 12 months)

$10 Up to $40

Glasses(frames every 24 months; lenses every 12 months)

• lenses o singleo lined bifocalo lined trifocalo lenticular

• frames

$25

Included

Included up to $50 wholesale (private practice provider) or $150 retail (chain provider)

Up to $40Up to $60Up to $80Up to $80Up to $45

Contacts (every 12 months, instead of eyeglasses)

$25Including fitting/evaluation, contacts, and two follow-up visits. For those who choose

disposable lenses, up to 4 boxes are included.

Medically necessary: Up to $210Not medically necessary: Up to $125

Note: Exams are covered twice each 12 months for diabetics. In addition, Retinal Screening Photography at a network provider is covered at no charge for diabetics patients.



Through the TCU Flexible Spending Accounts (FSA) program, you can use tax-free dollars to pay for:

• most medical, dental, and vision care out-of-pocket expenses like copayments, deductibles, and prescription drugs

• dependent care expenses like day care, babysitters, after-school programs, or elder care programs.

Note: Dependent care spending is limited to the amount contributed from each paycheck.

Each pay period, you make a contribution to your Health Care and/or Dependent Care FSA similar to using a savings account. Then, like a savings account, when you need money, you take it out. There are two ways to use the money in your FSA:

Use Your FSA Debit Card from Discovery Benefits You will receive a debit card that you can use to access your Health and Dependent Care FSA without incurring out-of-pocket expenses on most services. The total amount of your annual contribution is available immediately. After you’ve received service from a provider, e.g. physician’s office or day care provider, you can use your debit card, and you’ll actually pay the expense with money from your FSA. Please note you may be required to provide proof of an expense.

File a Paper Reimbursement Form or Submit OnlineYou may also pay for services and products out-of-pocket and submit a reimbursement form with proof of purchase that reflects dates and type of service through Discovery Benefits.

For more information on eligible expenses and how to file a claim, please visit Discovery Benefits’ website: www.discoverybenefits.com or call 1.866.451.3399.

Make the Most of your FSAsEffectively calculating your annual contribution amount is key to managing your FSA.

• By contributing to an FSA account, you can reduce your overall tax liability by using pre-tax dollars to pay for medical expenses and dependent care.

• IRS rules state that, unlike a savings account, if you do not use all of the funds in your flexible spending account(s) each year, you forfeit the remaining amount (see page 9 for more information.) So, it’s best to be conservative in your estimates when deciding how much to contribute.

How Much You Can Contribute

There are IRS limits on the amount you can contribute to your FSAs.

Health Care FSA Limits• A maximum of $2,550 per year

Dependent Care FSA Limits• A maximum of $2,500 if you and your

spouse file separate tax returns• A maximum of $5,000 if you are

single or if you and your spouse file a joint return

Flexible Spending Accounts



18

Income Protection Benefits

Basic Life InsuranceTCU provides Basic Employee Life at no cost to you.

NEW for 2016 - Basic AD&D InsuranceTCU now provides basic Accidental Death & Dismemberment (AD&D) insurance at no cost to you. AD&D insurance pays a benefit to your beneficiary if you die in an accident. However, it also pays benefits if you have certain disabling injuries.

Basic Life Insurance Basic AD&D Insurance

1x your annual base pay(Minimum coverage of $25,000)

1x your annual base pay(Minimum coverage of $25,000)

Voluntary Term Life InsuranceIn addition to Basic Life Insurance, you may choose to buy Voluntary Term Life Insurance for yourself and your dependents. Employees electing any Voluntary Life Insurance, other than during their new hire period, will be required to complete the Evidence of Insurability (EOI)*, regardless of the amount.

Voluntary Life Insurance for yourself • Maximum coverage of 4x your annual base salary up to $800,000, including basic life

• In increments of $10,000

Voluntary Life Insurance for spouse • No more than 50% of your Voluntary Life Insurance, up to $100,000

• In increments of $10,000

Voluntary Life Insurance for each child Age 2 weeks – 25 years:• $1,000 - $10,000• In increments of $1,000

* Please note: Evidence of Insurability (EOI) is required to enroll in Voluntary Life Insurance, other than during your new hire period. EOI is the documentation of the good health when enrolling or increasing your amount of Voluntary Life Insurance.



Long-Term Disability CoverageLTD Insurance is designed to continue a portion of your salary as long as you are disabled. You can choose from two different levels of coverage.

Plan 1 Plan 2

Benefit you will receive 60% of salary 70% of salary

Maximum benefit that you can receive $10,000 /month $10,000 /month

When benefits start 26-week elimination period 26-week elimination period

How long you may receive benefits while still disabled

Until age 65 or your Social Security Normal Retirement Age, whichever

comes first. If your disability starts after you turn 62, benefits may be payable

past this limit.

Until age 65 or your Social Security Normal Retirement Age, whichever

comes first. If your disability starts after you turn 62, benefits may be payable

past this limit.

This guide summarizes the benefit plans and policies available to you as an eligible employee of Texas Christian University. The details of these plans and

policies are contained in the official plan and policy documents, including some insurance contracts. This guide is meant only to cover the major points of each

plan or policy and it does not contain all of the details that are included in your summary plan description.

While every effort has been made to ensure the accuracy of information in this guide, if there is ever a question about one of these plans and policies, or if there is a conflict between the information in this guide and the formal language of the plan or policy documents, the formal wording in the plan or policy documents will govern.

Please note that the benefits described in this guide may be changed at any time, do not alter the employment-at-will relationship, and do not represent a contractual

obligation on the part of Texas Christian University.

For more information:www.hr.tcu.edu

http://www.caresbenefits.org/tcu.php

Collegiate Association REsource of the Southwest

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