Â鶹´«Ã½Ó¦ÓÃ

Employee Handbook Section 12

Insurance enrollment and payroll deduction

Western Â鶹´«Ã½Ó¦Óà University offers employees many types of insurance. All of these plans will be described to you via Benefits Enrollment, where you will receive enrollment and informational materials.

Enrollment in health insurance, life insurance and long-term disability insurance must be completed by the eligible employee within the first 31 days of employment. Eligible employees who wish to enroll in health insurance after their first 31 days of employment will be able to do so during the next open enrollment period. Under certain circumstances, eligible employees may be able to enroll in health insurance at other times under provisions of the Health Insurance Portability and Accountability Act.

Eligible employees who wish to enroll in optional life insurance and/or in long-term disability insurance after their first 31 days of employment will need to apply for such coverage. Approval for enrollment will be subject to medical underwriting and the eligibility requirements of the applicable insurance carrier. In this case, coverage is not guaranteed, and the carrier retains the right to approve or decline the application.

Payroll deduction is used for most employee contributions for insurance. Insurance deductions are taken every pay period in defined amounts and are not prorated. Typically, health insurance rates increase from year to year. Other insurance rates may also increase.

Health insurance

Regular employees may enroll in the University's health insurance program, which includes a Preferred Provider Organization health plan and prescription drug, dental and vision plans. Employees are given details of the coverage via Benefits Enrollment.

• Cost. Health insurance is offered on a cost-sharing basis between WMU and the employee. This is the case for the employee’s own coverage as well as for coverage of enrolled dependents.
• Dependents. In general, your current spouse, your children, your stepchildren and your foster children are eligible dependents. Children are eligible for coverage to age 26. Please refer to plan provisions for more detail.
• Adding dependents. You can add your eligible dependents to your coverage when you enroll. After initial enrollment, you can add newly eligible dependents within 31 days of a qualifying event, such as your marriage or the birth or adoption of a child. Eligible dependents not added to your coverage within 31 days of a qualifying event can be added to your coverage during the next open enrollment period. Please contact Human Resources for details and forms. Additional information about adding eligible dependents to your coverage is available at Insurance Plans: Health Insurance, Policies and Procedures Manual Section 14.
• Open enrollment. An open enrollment period is held annually, usually in the fall. During open enrollment, employees may add to their health insurance eligible dependents for whom they have previously declined enrollment.
• HIPAA. The Health Insurance Portability and Accountability Act provides for health insurance enrollment by employees who declined enrollment for themselves and/or for eligible dependents previously because of enrollment in coverage elsewhere. If the other coverage is terminated under certain conditions, the employee may enroll in WMU health insurance within 31 days of the event. In addition, employees who separate employment from WMU are able to obtain a certificate proving they had health insurance coverage through the University. Future employers may need this certificate to administer the employee's new coverage. HIPAA also establishes certain privacy rights regarding employees' personal health information. See Health Insurance Portability and Accountability Act.
  
• Medical reimbursement flexible spending account. This optional plan allows you to shelter pre-tax dollars for reimbursement of qualified medical expenses that you pay for out of pocket. See Flexible Spending Plans, Employee Handbook Section 13.

Health insurance continuation under the Consolidated Omnibus Budget Reconciliation Act

Under provisions of the federal Consolidated Omnibus Budget Reconciliation Act, employees, retirees and their dependents may apply to continue enrollment in University group health insurance if they lose eligibility for coverage. Following are such COBRA-qualifying events:

• Employee termination.
• Reduction in work hours.
• Divorce or legal separation from the insured employee or retiree.
• Cessation of eligibility as a dependent child.

The maximum period of continuation depends upon the qualifying event. During the extension period, the insured is required to pay the full cost of the insurance plus an administration fee. Questions about COBRA should be directed to Human Resources.

Life insurance

The University provides employees a certain amount of group term life insurance for non-bargaining employees, for which the University pays the entire cost. Additional optional life insurance is also available, as detailed in the coverage sections below.

• Cost. Your share of premiums is indicated in the coverage sections below. The University will continue making its share of premium payments for the selected coverage as long as you are in active pay status or approved paid leave status. If you are on an unpaid leave of absence, please contact Human Resources for information.
• Taxes. Group life insurance valued at $50,000 or more may create a tax liability. Contact Human Resources for more information.
• Beneficiaries. You designate the beneficiary for each policy, and may change your beneficiary at any time through Self Service.
• Retirement. If you retire from the University, a reduced amount of life insurance may be provided to you at no cost, according to the retirement provisions in effect at the time of your retirement.
• Converting group life insurance to an individual policy. Upon separation from the University, you have the option of retaining your life insurance policies by converting them to individual policies and paying the premiums yourself. If you do not convert the insurance to an individual policy, coverage will cease. The University will not continue to provide life insurance coverage for employees not on the active payroll. Additional information is available at Insurance Plans: Life Insurance, Policies and Procedures Manual Section 14.

Life insurance coverage:

• Basic life
  • Provided at no cost to employee.
  • Coverage amount: $100,000.
• Additional 1 life (optional)
  • Employee pays 50 percent of premium.
  • Coverage amount: $50,000 to $5,000, depending upon age.
  • Death benefit decreases as age increases.
• Spouse life (optional)
  • Only available if employee enrolled in Additional 1 Life.
  • Employee pays 100 percent of premium.
  • Choice of $10,000 increments up to $250,000.
  • Coverage may require evidence of insurability.
  • Coverage may not exceed employee's combined life insurance amount.
  • Premium depends on amount of coverage and spouse's age.
• Child life (optional)
  • Only available if employee enrolled in Additional 1 Life.
  • Employee pays 100 percent of premium.
  • Choice of $2,000 increments up to $10,000.
  • Premium is 16 cents per month per $2,000 of coverage.
• Additional 2 life (optional)
  • Only available if employee enrolled in Additional 1 Life.
  • Employee pays 100 percent of premium.
  • Employee may select coverage amount, at either one or two times the employee's annual base salary.
  • Premium depends on amount of coverage and employee's age.

Long-term disability insurance (optional)

The University offers you the opportunity to enroll in a long-term disability insurance plan. This plan pays qualified disabled employees 66 2/3 percent of their base salary in the event they become disabled while coverage is in effect. Benefits are payable on the later of (a) the 31st day of disability or (b) the first day after exhaustion of all accrued sick leave. The premium for coverage is determined by a multiple of annual pay, and the University contributes a portion of the premium on employees' behalf. Enrolled employees pay the remaining portion of the premium through payroll deduction.

Travel accident insurance

Any time employees travel on University-authorized business, they are automatically covered with accidental death and dismemberment insurance. This insurance provides coverage for loss of life or limbs, but does not cover property damage. There is no charge to employees for this coverage, and employees do not have to enroll to have this coverage.

<back next>