Health & Wellness
Benefits Frequently Asked Questions
Benefits Frequently Asked Questions
1) When is the benefit year?
2) What are the rules for covering my children?
3) How are dependents added or dropped from my health and dental programs?
4) I’m not sure which of my dependents I want to enroll. If I change my mind later, can I add or drop dependents from my health plan?
5) I missed this year’s Open Enrollment periods. How can I change my health/dental carriers?
Health Care/ Dental Care Questions:
1) How are medical emergencies covered?
2) I’m going to try a different plan this year. If I don’t like it after a few months, can I change to a different plan?
3) If my doctor leaves the plan I am in, can I switch to another plan?
4) How do the in network and out of network deductibles and out of pocket maximums work together if I sometimes go to network doctors and sometimes to out of network doctors?
5) How does the (insert plan here) plan work if I live in a network area and some of my dependents live in a non-network area?
6) My doctor is in a physician association. When I need to see a specialist, she would only refer me to one of her associates and not to the specialist I wanted to see. Shouldn’t I have been able to see any specialist in my health plan?
7) What are the types of available health plans?
8) Who do I call if I have a question about a claim (or bill)?
9) When should I contact the provider and when should I contact the Benefits Office with concerns?
10) I am moving out of the area. Can I change medical plans?
11) What is COBRA and how do I receive info on it?
12) Can you change plans under COBRA?
13) I enrolled for health and dental benefits last month. When will I receive my ID cards?
14) How do I locate PPOM facilities/providers?
15) If I choose one plan/option and I have a major change in my life, can I change plans?
16) What constitutes a major change?
17) If I waive my coverage because I’m under my spouse’s plan, and he loses coverage, can we both come into GVSU’s plans?
18) I waived coverage. When and how will my cash payments be processed?
19) What happens if I need coverage away from home?
20) What benefits are available if I’m traveling outside the state?
21) What are pre-existing condition requirements? What is HIPAA?
22) What if I don’t have my card?
23) What if I need an Rx filled and don’t have my card?
24) Explain how Rx mail works generic mandatory?
25) What of drugs are restricted excluded?
1) If I sign up for Dependent Life, are all of my eligible dependents automatically covered?
2) How do I change my beneficiaries?
3) May I have different beneficiaries for different life plans?
4) When does life insurance coverage end?
5) Are there restrictions on the level of coverage I may carry?
6) Is there an age limitation to coverage?
7) When does AD&D apply?
8) What if my salary changes during the year?
9) Is there a conversation privilege in the event that I terminate from the university?
1) If I become disabled, will my LTD benefit be taxed?
2) Are there pre-existing condition clauses?
3) How long is the waiting period?
1) Am I better off using the child care tax credit on my income tax or the FSA?
2) When can I enroll for FSA?
3) What is the plan year?
4) How much may I contribute to FSA?
5) How do I submit claims?
6) When are the requests for reimbursement due?
7) May I send claims in all at once, or do I have to submit them individually?
8) Why wasn’t the reimbursement in my paycheck?
9) How long do reimbursements generally take?
10) What is automatic reimbursement and how does it work?
11) Can I use an FSA to pay premiums and co-pays?
12) What happens to the money if I terminate my employment?
13) How can I obtain an account balance?
14) What if I don’t spend it all?
15) Can I change/stop deductions?
1) Do we have vision care coverage?
2) How do I enroll in the vision benefit program?
3) Can my dependents take advantage of vision discounts?
4) What type of identification do I need?
5) Where do I get a list of network doctors for the annual eye exam that is now covered?
6) What if there aren’t any in my area?
Retirement Investment Questions
1) How much money can I defer to save for retirement?
2) What is an MEA?
3) What Retirement vendors are approved by GVSU for supplemental retirement savings?
4) How do I change retirement vendors for future contributions?
5) How can I transfer money from one retirement vendor to another?
6) May I roll over my existing plan from a previous employer into the base retirement plan?
7) How can I change the allocation of funds for my contributions (within one retirement vendor)?
8) What are my payout options?
9) Is it possible to take out a loan on my retirement contributions?
10) I’m moving and want to change my address. How do I do this?
11) How do I go about changing the beneficiaries on my retirement accounts?
1) How does it work? (Salary Continuation)
2) How does it work?
Enrollment Questions:
January 1 – December 31
As long as they are considered legal dependents by the IRS (under 19 or full-time student, single up to the age of 27 in the Base and Enhanced plans, 25 in GVHP and Priority Health) they are covered. See eligibility section of the Base or Enhanced medical plan documents for lengthier definition.
You need to advise us within 30 days of a birth, change in student status, wedding, etc so that dependents can be added or dropped. If we’re not notified within 30 days, you must wait until the next open enrollment period to make changes. After 30 days, dropped dependents are no longer eligible for COBRA (continuation of benefits).
- I’m not sure which of my dependents I want to enroll. If I change my mind later, can I add or drop dependents from my health plan?
Only if there is a major change in family status (birth, death, marriage, change in student status, divorce, etc). Otherwise, you must wait until open enrollment.
You must wait until the next Open Enrollment.
Health Care/Dental Care Questions:
Depends on the plan and where the patient goes for treatment. See your medical comparison chart, or call the health carrier.
- I’m going to try a different plan this year. If I don’t like it after a few months, can I change to a different plan?
No. You must wait until Open Enrollment.
Sure, at OE time. In the event of a major change in family status, you can change your level of coverage (single to family, etc) but not your medical plan.
- How do the in network and out of network deductibles and out of pocket maximums work together if I sometimes go to network doctors and sometimes to out of network doctors?
Deductibles do not apply if you go to doctors in your network. If you choose to go to doctors outside the network, you are responsible for a certain percentage of the expense after your deductible is met for the calendar year. (See medical comparison chart.)
- How does the (insert plan here) plan work if I live in a network area and some of my dependents live in a non-network area?
Covered as out of network, unless there is a participating provider in your dependent’s area.
- My doctor is in a physician association. When I need to see a specialist, she would only refer me to one of her associates and not to the specialist I wanted to see. Shouldn’t I have been able to see any specialist in my health plan?
If you are in a plan in which you need referrals (GVHP or Priority Health) you may ask to be referred to a specific doctor or specialist. (GVHP is not likely to refer out of network) In the GVSU Base and Enhanced Medical Plans, referrals are not required. If the specialist you wish to see is accepting new patients, it is your decision to make.
1 preferred provider network with 2 different plans, and 2 HMO’s (GVHP and Priority Health).
Meritain Health (PPOM/Base or Enhanced plans) – 1-800-748-0003
Priority Health - 1-800-446-5674
Grand Valley Health Plan – 616-949-2410
The only time you would need to contact the Benefits Office with concerns would be if the care provider is unable to verify your coverage. Concerns about why a claim was paid in a certain manner, not paid at all or how it would be paid should be addressed to the provider. When in doubt, contact the provider.
Yes. You must notify the benefits office within 30 days to make this change.
When your employment with GVSU is terminated or dependents become ineligible, you are legally entitled to a continuation of benefits for a certain period of time. The Benefits Office can give info on COBRA and its costs.
Yes, there is an annual open enrollment period for COBRA participants at which time you are able to change your plan.
With the exception of cards for GVSU Base and Enhanced Medical Plans, cards often come within two weeks. We check the information on them and mail them to you ASAP. If you have not received them within the first month, please call the Benefits Office to check.
(Medical) For the most updated list, please go to www.ppom.com. You may also call PPOM at 1-800-878-7766 to see whether the provider of your choice participates. (Dental) This list can be obtained at www.subscribertoolkit.com/Index.jsp. This list is also maintained on our homepage.
You may change the level of coverage (single, dual or family), but not your choice in plans. You must wait until open enrollment.
- Changes in legal marital status, including marriage, death of spouse, divorce, legal separation, or annulment
- Change in number of dependents, including birth, adoption, placement for adoption, or death of dependent
- Termination or commencement of employment by employee, spouse or dependent.
- A reduction or increase in hours of employment by the employee, spouse, or dependent, including a switch between part-time and full-time, a strike or lockout, or commencement or return from an unpaid leave of absence.
- An event that causes an employee’s dependent to satisfy or no longer satisfy the requirements for coverage, examples include attainment of the required age in which a dependent is no longer eligible, or no longer having the status of a student; or
- A change in the place of residence or work of the employee, spouse or dependent.
- If I waive my coverage because I’m under my spouse’s plan, and he loses coverage, can we both come into GVSU’s plans?
Yes. That constitutes a major change.
It will be broken down into per-pay-period amounts and credited to your paycheck as taxable income.
Your claims may be covered as out of the network (refer to Medical Comparison chart for how that would break down) and in some cases may have to pay out of pocket and get reimbursed. Contact your provider for more specific information.
Call your provider to get the number to call in case emergency treatment is needed.
There are no pre-existing condition restrictions for any GVSU plans.
Your physician can call the Benefits Office to verify eligibility.
The pharmacist can call the B.O. or Advance PCS to verify eligibility. You can also pay for the Rx out of pocket and get reimbursed by the provider if need be. Contact the B.O. if you need reimbursement forms.
Have your physician write a prescription for up to a one-year supply of your medication, fill out the form enclosed in the information brochure for your prescription plan and mail. You will receive up to a 90-day supply of your medication with refill request forms if applicable.
Refer to SPD.
Life Insurance Questions:
Yes.
Fill out a change of beneficiary form at the B.O. or to have one mailed to you.
Yes.
Termination of employment or retirement.
For term life insurance, your coverage is equal to your salary up to a $125,000 max. For supplemental, you may carry up to $500,000 or up to 5 times your base salary (whichever is less) in increments of $10,000, subject to the approval of the life insurance carrier.
Yes, refer to Life SPD. Reductions in benefit occur at age 70.
AD&D provides twice the benefit for accidental death and indemnity for loss of limb or eyesight.
Your term life insurance is automatically changed to reflect your new salary.
Yes. Call the B.O. for current rates.
LTD Questions:
Yes, just like regular income.
Yes.
First of the month following date of hire.
FSA Questions:
That varies from individual to individual. Consult a tax advisor for the best answer.
Unless you have a major change or qualifying event, only during OE.
Jan. 1 - Dec. 31, although you have until March 30 of the following year to turn in receipts for expenses incurred on or before 12/31 the previous year.
$10,000 to Health Care; $5,000 to a dependent care account.
Submit the appropriate claim form to Meritain Health Co. Forms are available via:
- the Benefits Office suite
- request via Group Wise e-mail or phone
- our home page www.gvsu.edu/hro
The end of March (90 days form the beginning of the calendar year in the year following the current plan year).
Whichever is most convenient for you.
Reimbursements get mailed to your home address, not credited to your paycheck.
1 - 2 weeks.
If you have gone to a PPOM - participating doctor and are assessed a co-pay, WeyCo will automatically be notified that you have paid it and will process a reimbursement check from your flex medical account without you having to submit the paper work.
Co-pays yes, premiums no. Premiums are taken out pre-tax, just like FSA, making the premiums an ineligible expense.
You may submit claims for services rendered up to the day of your termination, but not after.
Call the FSA contact at Weyco. (Donna Lambert @ x1184)
According to IRS guidelines, the money cannot be returned to you.
Only if a "major change" occurs in your life.
Vision Benefit Questions:
Yes.
When you fill out your OE paperwork, indicate that you would like Vision Insurance.
(With insurance) if you have indicated that they should be covered.
(With other discounts) Yes.
You will receive a card directly from EyeMed, but when making an appointment, it is your responsibility to make sure that your doctor participates with EyeMed and knows that you are a EyeMed member.
This list is available in the B.O. or on our homepage as a link to EyeMed.
You may need to look at another section of the list.
Retirement Investment Questions:
For regular FAC and AP, the university automatically contributes 12% of your base salary, and you may opt to save up and additional $13,000 (2004) if you are under age 50 or $16,000 (2004) if you are over age 50 without having a maximum exclusion allowance (MEA) done (to ensure compliance with IRS regulations).
A Maximum Exclusion Allowance (MEA) is a way of determining how much money you may shelter from tax in a retirement account each year. The retirement vendor (Investment Company) of your Supplemental Retirement Account (SRA) should be contacted to perform an MEA if you wish to invest more than $13,000 if you are under age 50 or $16,000 over age 50. To stay above that amount and to insure IRS compliance, a new MEA must be done each tax year to continue the deduction.
TIAA/CREF, Fidelity, The New England Funds and Merrill Lynch.
Contact the BO for the appropriate forms.
You need to contact the retirement vendor holding the monies to be sure you may do this and to determine the necessary steps.
Contact the retirement vendor to determine eligibility.
Contact the retirement vendor directly. The benefits office does NOT need to be informed of these changes.
Contact the retirement vendor to find out under what circumstances you will be eligible to receive payouts and what your options are at that time.
Some of the requirement vendors allow loans from supplemental retirement accounts. Contact the retirement vendor to inquire. Loans are not allowed from accounts containing contributions from the university.
Contact your retirement vendor for a change of address forms to complete and return to the retirement vendor, or fill out a form from the vendor, available directly from them or our website.
(Investment accounts) contact either the B.O or your retirement vendor for the appropriate paperwork to complete and return to the retirement vendor. (Pension Plans for COT/MGS) Contact the B.O. to obtain the necessary paperwork to complete.
STD Questions:
FAC/EAP are eligible for 100% salary continuation for up to 6 months in the event of a medical or personal situation that prevents them from working, subject to approval by their appointing officer. COT/DPS/ are eligible for 1 day/month if they have been employed for less then 6 months, 10 days if they have been employed longer than 6 months, and 20 days if they have been employed for at least 1 year. This is reset after a person has returned to work for 5 full, consecutive days, subject to approval.
MGS are eligible for .05 hours/1 hour worked not to exceed 160 accrual. They may not use this time until they have been employed at least 6 months, subject to approval.
FAC/EAP see salary continuation. For periods longer than 6 months, see LTD.
COT/DPS/MGS must be under the care of a physician and unable to perform all the duties of their job. Disability starts on the date of the first doctor's exam (Dr. may not be a relative) and provide 75% of basic compensation for up to 22 weeks (after a 20 working day waiting period) Staff members must be employed for at least 6 months to be eligible for this benefit. All the time off is subject to the appointing officer's approval.
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