East Stroudsburg University of Pennsylvania

 This brochure highlights the Pennsylvania State System of Higher Education Health Program, Management Benefits Program, Annuitant Health Care Program, and leave entitlements for System coaches.  The benefits described are available to most employees; however, certain eligibility requirements must be met.

 Information is provided for general purposes only.  Legal Plan Documents will govern any discrepancies that may arise.  For additional information concerning these benefits, contact your human resource office.  Benefits, benefit levels, and eligibility rules are subject to change.

If residing in a Point of Service (POS) or Health Maintenance Organization (HMO) service area, may choose between Basic, POS, or HMO Plan coverage; entitled to Management Benefits coverage regardless of selection of basic health care plan.

Pennsylvania Blue Shield facility and provider charges are paid at 100% of the usual, customary and reasonable charges.  Participating providers must accept payment as payment in full.  Non-participating providers may balance bill.

ClassicBlue Inpatient Facility Services
· 365 days
· Semi-private room
· 60 days/12-month period for mental and nervous disorders
· Substance abuse rehabilitation (30 days/year)

ClassicBlue Outpatient Facility Services
· Emergency accident and medical
· Surgery
· Diagnostic studies
· Home care (60 visits/90 day period)
· Mental illness
· Substance abuse rehabilitation (30 visits/year)

ClassicBlue Medical/Surgical Services
· Surgery
· Diagnostic testing
· Treatment of mental illness (up to $25/visit)
· Preventive services and immunizations

ClassicBlueMajor Medical
· $250 deductible/person/year
· 80% employer coinsurance on first $2,000, 100% thereafter up to $1,075,000 lifetime maximum for general medical and mental expenses
· $50 outpatient mental visit allowance payable at 50% ($25)

Most covered services paid in full if care coordinated by primary care physician; care not coordinated by primary care physician is paid at 80% after a $100 deductible.

Inpatient Facility Services
· Unlimited days (including mental and nervous disorders)
· Substance abuse rehabilitation

Outpatient Facility Services
· Emergency accident and medical ($35 copayment unless admitted; certain restrictions apply if out of area)
· Home health care (60 visits/year)
· Mental health or substance abuse rehabilitation ($20 copayment)

Medical/Surgical Services
· Diagnostic studies
· Surgery
· Treatment of mental illness ($20 copayment)
· Office visits ($5 copayment)

Preventive Services and Immunizations
· Well-baby Care

Most covered services paid in full if care is coordinated by primary care physician; care not coordinated by primary care physician is not covered.

· Inpatient facility services
· Outpatient facility services
· Medical/surgical services
· Preventive services and immunizations
· Office visits
· Copayments for certain services may vary
· Benefits may vary by HMO

· $100 individual/$300 family deductible annually
· Retail dispensing up to a 30-day supply
· $5 for generic drugs
· $10 for brand name formulary
· $20 for brand name non-formulary
· Mail service pharmacy dispensing up to a 90-day supply at twice the retail copayment ($10, $20, or $40)
· If brand drug that has a generic equivalent is dispensed, employee responsible for brand drug copayment plus difference in cost between generic and brand drug unless physician requests brand drug be dispensed (“No Substitution”)

· For annuitants under age 65, ClassicBlue/Major Medical coverage same as active employees or HMO coverage same as active employees with prescription drug rider
· For annuitants age 65 and over, Signature-65 coverage to supplement Medicare or Medicare HMO coverage

· State System pays 100% for permanent full-time employees and dependents
· State System pays 50% for permanent part-time employees and dependents, if employee works at least 50% time

· State System contributes the same amount for permanent full-time employees and dependents as it pays for Basic Plan coverage by contract size and geographic location
· Difference paid bi-weekly by employee

· State System pays 100% for full-time employees and dependents and for permanent part-time employees and dependents, if the employee works at least 50% time

· For employees hired prior to July 1, 1997, State System pays 100% for annuitants and dependents when covered employees retire
· at age 60 with at least 10 years of credited service
· at any age with at least 25 years of credited service
· on approved disability with at least 5 years of credited service
· For employees hired July 1, 1997, and after, State System pays 100% for annuitants and dependents when covered employees retire
· at age 60 with at least 15 years of Commonwealth/State System service
· at any age with at least 25 years of Commonwealth/State System service
· on approved disability with at least 5 years of Commonwealth/State System service
· State System pays $5 toward cost of coverage for annuitants not qualifying for fully-paid coverage

Reduces the amount of taxes paid by designating a portion of salary to an account for eventual reimbursement of certain medical and dependent care expenses.  Account balances not used by year’s end are forfeited.

· Maximum annual contribution is $3,000
· Eligible expenses for reimbursement include Major Medical deductibles and amounts in excess of plan allowances or maximums, prescription drug co-payments, POS, and HMO doctor office visit charges, lasik eye surgery, chiropractic services, etc.

· Maximum annual contribution is $5,000 ($2,500 if you are married and filing a separate income tax return)
· Dependent care must be necessary so that you, and if you are married, your spouse can work or look for work
· Eligible expenses for reimbursement include child care centers that care for six or more children and that meet the IRS definition of a qualified day care center, caregivers for a disabled spouse or dependent who lives with you, babysitters, nursery schools, household expenses provided that a portion of these expenses are incurred to ensure a dependent’s well-being and protection

· Permanent full-time employees
· Permanent part-time employees working at least 50% time
· 100% employee-paid

Allows employees who are contributing to the cost of health care (i.e., part-time employees or those enrolled in HMOs and paying an employee share) to pay those contributions on pre-tax basis, resulting in higher take-home pay

· All employees enrolled in a health care plan and contributing toward the cost of that plan

· Term life insurance equal to nearest $1,000 of annual salary
· Minimum coverage $2,500; maximum coverage $50,000
· $20,000 additional work-related accidental death
· Three-month waiting period
· Right to convert upon termination/retirement

· State System pays 100% for permanent employees
· Dependents ineligible

· Employee term life and personal accident insurance in increments of $10,000; maximum coverage $500,000
· Spouse term life and personal accident insurance in increments of $10,000; maximum coverage $100,000
· Children term life and personal accident insurance in amounts of $5,000 or $10,000

· Permanent full-time employees and dependents
· Permanent part-time employees and dependents, if employee works at least 50% time
· 100% employee-paid

· Income protection equal up to 60% of gross annual base salary
· Amount offset by retirement benefits, workers’ compensation, social security, and paid leave with a guarantee of 10% of long-term disability benefit amount or $100/month, whichever is greater
· 180-day elimination period
· Cost of living adjustments

· Permanent full-time employees
· Permanent part-time employees working at least 50% time
· 100% employee-paid

· 15 days for each 47-week service period for full-time coaches
· Entitlement for part time coaches on a pro-rata basis
· Credited at beginning of service period
· Each full day absence charged at 7.5 hrs. and for no more than 5 days per week
· Unused leave may be carried from one year to the next
· Maximum accumulation 300 days
· 3-5 days of leave may be used for death of relative, depending on relationship
· 5 days of leave may be used for sickness in immediate family
· Payment in accordance with the following schedule for accumulated leave at retirement or death while in active service if certain eligibility is met

Days Accumulated  Days Paid
10 - 74                          10
75 - 149                        20
150 - 224                      30
225 - 300                      40

· 50 days of unused leave paid to survivor for work-related death

· 2 days per service period for full-time coaches
· No carry-over from previous year
· Payment for unused accrued leave at termination/retirement

· 10 paid holidays per year
· Observation of holidays may vary by university

· Choice of:
· State Employees’ Retirement System (SERS)
· 6.25% employee contribution to SERS
· Public School Employees’ Retirement System (PSERS)
· 7.5% employee contribution to PSERS
· Alternative Retirement Plan (ARP)
· 5.0% employee contribution to ARP
· Participating ARP companies
· ING – effective 7/1/03
· Met-Life – effective 7/1/03
· TIAA-CREF
· AIG VALIC – effective 7/1/03
· Employee may participate in one or more of the ARP companies at one time
· Employer contribution and benefits vary by plan (see Retirement Comparison Chart)
· Selection of retirement plan must be made within 30 days of date of hire; if no choice is made, employee will automatically default to SERS

· Civil Leave With Pay
· Educational Leave With or Without Pay
· Family Care Leave Without Pay
· Military Leave With or Without Pay
· Parental Leave Without Pay
· Work-Related Disability Leave
· Deferred Compensation/Tax Deferral of Leave Payouts
· Direct Deposit of Pay
· PA State Employees Credit Union (1-800-435-6500)
· Savings Bonds Through Payroll Deduction
· State Employee Assistance Program (1-800-692-7459)
· Social Security
· Tax-Sheltered Annuities
· Tuition Waiver-Full-time only
· Unemployment Compensation
· Workers’ Compensation