This publication contains important information about your employee benefit program.Please read thoroughly.

2020BENEFITSENROLLMENT

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TABLE OF CONTENTSYour 2020 Benefits Guide . . . . . . . . . . . . . . . . . . . . . . . 2

Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

2020 Medical Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Prescription Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Health Savings Account (HSA) . . . . . . . . . . . . . . . . . . . . 7

Flexible Spending Account (FSA) . . . . . . . . . . . . . . . . . . 8

LiveHealth Online . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Group Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Additional Life Insurance . . . . . . . . . . . . . . . . . . . . . . . 13

Disability Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Voluntary Hospital Indemnity Coverage . . . . . . . . . . . . 15

Voluntary Accident Coverage . . . . . . . . . . . . . . . . . . . . 16

Voluntary Critical Illness Coverage . . . . . . . . . . . . . . . . 17

Retirement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Tuition Fee Waiver . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Employee Assistance Programs (EAP) . . . . . . . . . . . . . . 22

Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . 23

YOUR 2020 BENEFITS GUIDEAt the University of Southern Indiana, we value our faculty, support staff, and administrators, and recognize them as our greatest asset. USI provides a competitive benefits package for eligible employees, including medical, dental, vision, and life and disability insurance. This benefits guide summarizes our program to help you understand your benefits.

New Hire EnrollmentWelcome to our team! As a new employee, you may be eligible for coverage. You must enroll in benefits within 30 days of your date of hire.

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Benefits Eligibility

Eligible EmployeesYou may enroll in the benefits program if you are a regular employee working at least a 75 percent academic or fiscal year schedule.

Eligible DependentsEligible dependents include your legal spouse and your children up to age 26 for medical, dental, vision, and life plans (natural, stepchildren, foster children, adopted children, or any child for which you have legal custody). Children may be covered on the medical, dental, vision and life plans until the end of the month in which they turn age 26. For life insurance, children must be unmarried.

Social Security Number RequiredYou must provide a valid Social Security Number for yourself and each enrolled dependent. Employers are required to provide names and Social Security Numbers to the federal government for each individual enrolled for medical coverage.

Qualifying Life EventOnce you make your elections, you will not be able to make changes until the next annual enrollment period unless you experience a qualifying life event. A qualifying life event is a change in your personal life that may impact your eligibility or dependent’s eligibility for benefits. Examples of some qualifying events include the following:

� Marriage, death of a spouse, divorce, legal separation, or annulment

� Birth, placement for adoption, adoption of a child, or a court issued guardianship

� Qualified Medical Child Support order (QMCSO) requiring the plan to provide medical coverage for your dependent child

� Change in your spouse’s or dependent’s employment status including termination, change from full-time to part-time (or vice versa), or unpaid leave of absence

� Your dependent loses coverage under any group health plan

� Significant change in the cost of your current coverage or the options being offered

� Death of a covered dependent

� Your spouse’s employer’s medical plan, in which you are currently enrolled, ceases its contributions to the plan’s cost or has a benefits enrollment (does not apply to FSA)

� A dependent becomes eligible or ineligible for coverage, which could put you in a different coverage category

If you experience a qualified family status change, you must notify the benefits team within 31 days of the change. Depending on the type of change, you may need to provide proof of the change. To change your benefit elections, login to myUSI and click on the Benefitfocus icon. This will take you to the benefit administration portal. It is your responsibility to notify the benefits team when a dependent is no longer eligible for coverage.

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Plan HighlightsYou have the option of choosing one of two medical plans. The plans are administered by Anthem BlueCross of Indiana with a Preferred Provider Organization (PPO) network of doctors and medical facilities. The wide range of in-network providers offers you access to quality care with the least amount of out-of-pocket expenses to you when you receive services from in-network providers.

Anthem’s Member SiteThe Anthem BlueCross BlueShield member site, anthem.com offers many valuable services including the following:

� In-network providers searches

� Access to temporary ID cards and means to order another ID card

� Information regarding paid and pending claims

Employee ContributionsBi-Weekly Monthly

Salary below $41,000 Core PlanEmployee Only $57.98 $115.96 Employee and Spouse $127.71 $255.42 Employee and Child(ren) $96.20 $192.40 Employee and Family $159.07 $318.14

HSA PlanEmployee Only $27.89 $55.78 Employee and Spouse $61.45 $122.90 Employee and Child(ren) $46.29 $92.58 Employee and Family $76.54 $153.08 Salary $41,000 and Above Core PlanEmployee Only $68.21 $136.42 Employee and Spouse $150.25 $300.50 Employee and Child(ren) $113.17 $226.34 Employee and Family $187.15 $374.30

HSA PlanEmployee Only $37.10 $74.20 Employee and Spouse $81.75 $163.50 Employee and Child(ren) $61.57 $123.14 Employee and Family $101.81 $203.62

MEDICALThe University of Southern Indiana offers a robust medical insurance program to our employees. We partner with Anthem BlueCross BlueShield to offer this coverage.

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2020 MEDICAL BENEFITSThis plan summary is intended to be a brief outline of your in-network coverage. The entire provisions and out-of-network benefits are contained in the group contract. Coinsurance percent reflects the employee share.

Core Plan HSA PlanAnnual Deductible Embedded EmbeddedSingle $750 $2,800Family $1,500 $5,600Out-of-Pocket Limit (Includes Deductible)Single $4,500 $5,000Family $9,000 $10,000Lifetime Maximum UnlimitedHospitalInpatient 20% after deductible 20% after deductibleOutpatient 20% after deductible 20% after deductibleEmergency Room $250 copay 20% after deductiblePhysician Visits and Ancillary ServicesPreventive Care 0% 0%Live Health Online $15 copay 20% after deductiblePrimary Care (family or general practitioner, internal medicine, pediatrician, OB/GYN)

$30 copay 20% after deductible

Specialist Visits $30 copay 20% after deductibleChiropractic Care $30 copay 20% after deductibleUrgent Care $75 copay 20% after deductibleLab Services 20% after deductible 20% after deductibleX-Ray/Radiology 20% after deductible 20% after deductible

Anthem Provider SearchTo get the highest level of coverage from your plan, use in-network participating health care providers. Receiving services from a participating in-network provider reduces your out-of-pocket health care costs. To confirm if your provider is participating or to search for providers, just follow these simple steps:

1 . Go to anthem.com and click individual and family and then select Find A Doctor

2 . Enter your username/password or continue as a guest

3 . If you continue as a guest, enter in the required fields and continue

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PRESCRIPTION BENEFITS At Caremark.com you will find a variety of tools which can help you learn more about your medicines.

� Be sure any retail pharmacy you use is in your network—Network pharmacies are included in your prescription drug plan to help keep costs low. Find a network pharmacy before you fill at Caremark.com.

� Know which medications are covered—Your plan’s list of covered medications can help you and your doctor find the most cost-effective drug option.

� Use the Check Drug Cost tool—You’ll be able to do a side-by-side comparison of your medications to see where you could be saving.

� Have 90-day supplies delivered by mail—Save on medications you take regularly when you fill in 90-day supplies through our mail service pharmacy.

Prescription Drugs Core Plan HSA PlanRetail (30-day supply)Tier 1 $10 20% after deductibleTier 2 $40 20% after deductibleTier 3 $60 20% after deductibleTier 4—Specialty* $150 20% after deductible

Mail Order (90-day supply)Tier 1 $20 20% after deductibleTier 2 $80 20% after deductibleTier 3 $120 20% after deductible

When you fill your prescriptions at an out-of-network pharmacy, you are responsible for payment of the entire amount charged. You will pay 50% coinsurance if you file a claim.

90-Day Supplies at CVS Retail PharmaciesSave money on maintenance medications (such as high blood pressure or diabetes medicine) when you fill them in 90-day quantities. You can eliminate the need for monthly trips to the pharmacy and pick it up in person just once every three months. Simply pick them up at any CVS pharmacy (including those in Target stores). To get started, visit Caremark.com/90day or call the number on your member ID card.

Mail Order DeliveryYou could save money by ordering up to a 90-day supply of medication. Make fewer trips to the pharmacy and avoid waiting in line. Your medication is shipped directly to your home.

Ask Your Doctor About Generic Drugs Generic drugs offer the same safety and strength as their brand-name counterparts at a lower cost. Check with your doctor to see if a generic alternative is right for you.

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HEALTH SAVINGS ACCOUNT (HSA)What is a Health Savings Account?An HSA is a tax-favored account you can use to pay for eligible current and future health care expenses with tax-free dollars. You must enroll in the HSA plan to be eligible to open a health savings bank account. There is no use it or lose it rule. Any unused money will remain in your HSA for future use.

USI does not own the account. You own the account. If you leave, you keep the funds. You may choose to make contributions to your HSA on a pre-tax basis.

Funds may be withdrawn at any time to pay for qualified medical expenses tax-free for most medical, dental, and vision care. For a complete list of eligible expenses, please refer to IRS Publication 502 at irs.gov.

HSA expenses can be incurred by you, your spouse, and dependents claimed on your personal tax return even if the dependents are not enrolled in the HSA plan.

Funding Your AccountYou may contribute up to the annual IRS limits. It’s important to account for the contributions from USI to ensure, between your contributions and the University’s contributions, you do not go over the IRS limit.

Coverage TierContribution

IRS Annual Limit USI* Your Maximum**

Employee $3,550 $750 $2,800Employee + Dependent $7,100 $1,500 $5,600

USI contributions will be made only to your Health Savings Account through The HSA Authority. If you leave the University, you may not receive all employer contributions for the year.

* USI will contribute seed money at the beginning of each year of $282 for employee-only coverage or $525 for employee + dependent coverage. The remaining contributions (Single $39 per month and Family $81.25 per month) from USI are deposited to your account per pay period.

** Individuals age 55 and older or individuals who reach age 55 by December 31, 2020 can make a catch-up contribution of up to $1,000.

You are Eligible to Open a Health Savings Account if

� You are enrolled in an HSA plan (qualified high deductible health plan)

� You are not covered by your spouse’s health plan, any other health plan, or flexible spending account

� You are not eligible to be claimed as a dependent on someone else’s tax return

� You are not enrolled in Medicare, TRICARE, or TRICARE for Life

� You have not received veterans administration benefits in the past three months

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FLEXIBLE SPENDING ACCOUNT (FSA)What is a Flexible Spending Account?This voluntary benefit is available to regular (non-temporary) full-time employees. The University offers a flexible spending account (FSA) through Nyhart which allows you to set aside pre-tax dollars from your paycheck to pay for qualified medical or dependent care expenses you would normally pay for out of your pocket with after-tax dollars.

Health Care FSAThe health care FSA helps you pay for certain IRS-eligible expenses with pre-tax dollars. The 2020 maximum contribution is $2,700.

Funds you elect to contribute to the health care FSA are available in full on the first day of the plan year. For example, if you elect to contribute $1,000, the full election is available to you on day one. You’ll continue to pay for the election pre-tax from your paycheck throughout the plan year.

Dependent Care FSAThe dependent care FSA lets you set aside pre-tax dollars to use toward qualified dependent care. The maximum amount you may contribute to the dependent care FSA is $5,000 (or $2,500 if married and filing separately) per calendar year. Funds you contribute to the dependent care FSA are available as you accrue them during the plan year.

Use It or Lose ItCarefully consider your FSA contribution amounts for 2020. At the end of the year or grace period, you lose any money left over in your FSA. There is a 2 ½ month grace period at the end of each year.

Please note you cannot contribute to a health care FSA if you are contributing to an HSA.

Eligible Expenses Health Care FSA

� Doctor’s visit copays

� Prescription drug copays

� Medical and dental deductibles

� Over-the-counter medications (with a written prescription)

� Hearing aids

� Eyeglasses/contacts

Dependent Care FSA � Cost of child or adult day care*

� Nursery school

� Preschool (excluding kindergarten)

* Eligible dependent: tax dependent child under age 13; tax dependent spouse, parent, or child unable to care for themselves

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LIVEHEALTH ONLINEUniversity of Southern Indiana is partnering with LiveHealth Online, Anthem’s virtual visit partner to give you access to a doctor online for non-emergency care at any time. LiveHealth Online is a new convenient way for you to get a doctor’s care through a private video visit using your smartphone, tablet, or computer. You can be at home, traveling for work, or even on vacation—all you have to do is register by going to livehealthonline.com or using the free iOS or Android app.

Doctors can assess your condition and send prescriptions to your pharmacy if needed.* Doctors can diagnose and treat a wide range of medical conditions via a virtual visit, including the following:

� Bladder infection/urinary tract infection

� Cold/flu

� Bronchitis

� Fever

� Diarrhea

� Pink eye

� Rash

� Sore throat

� Sinus problems and more

What Does it Cost? � Core plan members—$15 copay

� HSA plan members—average cost of visit is $49 (member responsibility is 20 percent after deductible is met)

* Prescription availability is defined by physician judgment and state regulations. Some state limitations may apply.

You have fast, easy access to a doctor 24 hours a day, 365 days a year the next time you need it. Register at livehealthonline.com or use the free mobile app.

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DENTALWe partner with Health Resources, Inc. to offer you and your family members dental insurance. Visit insuringsmiles.com to find in-network providers and access a variety of online tools and programs.

Dental BenefitsAnnual Maximum $1,350Preventive Care Covered at 100% Basic Care 50% Major Care 50% Orthodontia (adults and children)Coinsurance 50%Lifetime Maximum $1,200

Employee ContributionsBi-Weekly Monthly

Employee Only $2.61 $5.22Employee and Spouse $5.50 $11.00Employee and Child(ren) $6.50 $13.00Employee and Family $9.46 $18.92

If you receive dental care outside of Health Resources in-network dentists, you will likely pay a greater amount for dental care and the provider may balance bill you.

Health Resources Provider Search

� insuringsmiles.com

� Click Find a Dentist on the home page

� Search by ZIP Code or specialty

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VISIONYou can elect vision insurance with Vision Service Plan (VSP) for you and your family members. Visit vsp.com to find in-network providers and access to a variety of online tools and programs. VSP has one of the largest networks of independent providers and includes major retailers such as Heartland Vision, Rx Optical, SVS Vision, CostCo Optical, Tavel, and Visionworks.

In-Network Out-of-NetworkVision Exam $10 copay Up to $45Lenses and FramesSingle-Vision $10 copay Up to $30Bifocal $10 copay Up to $50Trifocal $10 copay Up to $65Lenticular $10 copay Up to $100Frames $10 copay, $130

allowance; 20% off balance over allowance

Up to $70

Contact Lenses (in lieu of glasses)Elective $150 allowance Up to $105Elective Contact Lens Fitting and Evaluation

Covered in full, after a maximum $60 copay

The elective contact lens allowance applies to both

the fitting, evaluation, and the materials

Medically Necessary $0 copay, covered in full Up to $210Benefit Frequency Exam 12 monthsLenses 12 monthsFrames 24 monthsContacts 12 months

Employee ContributionsBi–Weekly Monthly

Employee Only $4.04 $8.08Employee and Spouse $7.07 $14.14Employee and Child(ren) $7.68 $15.36Employee and Family $11.74 $23.48

VSP Provider Search � Visit vsp.com

� Click on Find a Doctor

� Search by ZIP Code or address

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GROUP LIFE INSURANCELife insurance is provided through The Standard Insurance Company.

Basic Group Life Insurance The University of Southern Indiana provides you a life insurance benefit which is 1 ½ times your salary up to $100,000, at no cost to you. If you were hired before February 1, 1988, you are provided life insurance of 2 times your salary up to $100,000.

Example

For an employee hired after February 1, 1988 with an annual salary of $50,000, the life benefit will be $75,000.

Basic Accidental Death and Dismemberment (AD&D) InsuranceIf your death is the result of an accident, your beneficiary will receive the basic life benefit plus the basic AD&D benefit which is equal to that of the basic life. The plan will also pay a benefit amount if an accident leaves you with certain debilitating injuries.

Example � An employee hired after February 1, 1988 with an annual salary

of $50,000

� Basic Life Benefit $75,000

� Basic AD&D Benefit $75,000

� Total paid in the event of death caused by an accident = $150,000

Designating Your BeneficiaryIf you die while covered by this plan, the benefit is paid to the beneficiary you designate on the most recent form completed. Please make sure your beneficiary information is accurate. You can change your beneficiary information outside of enrollment at any time.

Travel Assistance ProgramWhether for business or pleasure, you, your spouse, and your children (to age 25) are covered when traveling internationally or more than 100 miles from home. This coverage through The Standard lasts for up to 180 days and can help with passport replacement, emergency evacuation, currency exchange, and more.

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ADDITIONAL LIFE INSURANCEThe University offers an additional life insurance with competitive group rates so you can purchase additional financial protection you need for you and your family. This voluntary benefit is available to regular (non-temporary) full-time employees.

For YourselfBenefit Amount $10,000 increments Benefit Up to $500,000Guarantee Issue Amount* Up to $200,000For Your SpouseBenefit Amount $5,000 incrementsBenefit Up to $200,000 not to exceed 50% of employee’s elected

amountGuarantee Issue Amount* Up to $50,000For Your Child(ren)Benefit Amount $10,000 not to exceed 50% of employee’s

elected amount

How Much Your Additional Life Coverage Will Cost Per Month

Age Employee and Spouse Rate Per $1,000 of Coverage <25 $0.045

25–29 $0.04630–34 $0.04735–39 $0.05440–44 $0.08145–49 $0.11650–54 $0.19755–59 $0.32360–64 $0.43965–69 $0.78270+ $1.707

Child Monthly Cost Per $1,000 of Coverage$10,000 $0.05

Cost Calculation ExampleRate Per $1,000 Benefit Amount Estimated

Monthly CostEmployee Age 33 $0.047 × $100,000 ÷ 1,000 = $4.70

Coverage will not take effect until approved by the carrier. Age reductions will apply to benefit amounts and guarantee issue amounts.* The guarantee issue amount is available for new hires only. If you do not elect this coverage

within the first 31 days of becoming first eligible, you will be required to submit evidence of insurability (EOI) or proof of good health to enroll at a later date.

Evidence of Insurability (EOI) or proof of good health is required under the following circumstances.

� Late entrant: you have previously waived the opportunity to elect this coverage and are now electing coverage for the first time

� Current participant: you currently have this coverage and are requesting an increase to your current coverage amount

� New hires: you are electing this coverage within the first 30 days of employment and you are requesting coverage over the guarantee issue amount

Visit usi.edu/hr/benefits/ life-disability to complete EOI.

Select Medical History Submission on the right side of page.

Cost of CoverageYour premium rate will depend on your age. Spouse rates will be based on the spouse’s age.

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Short Term Disability (STD)

DISABILITY INSURANCEHave you considered what would happen if you couldn’t go to work as a result of a disabling illness or accident? Disability insurance goes to work when you can’t. Coverage is offered through The Standard. This voluntary benefit is available to regular (non-temporary) full-time employees.

The University offers Short Term Disability insurance to help provide financial security until you get back on your feet and return to work. You can elect coverage for 60 percent of your pre-disability weekly earnings up to $1,500 per week for up to 180 days or until you are no longer disabled. There is a 14-day waiting period for illness and sickness.

Age Rate Per $10 of Benefit Age Rate Per $10 of BenefitUnder 30 $0.661 45–49 $0.293

30–34 $0.693 50–54 $0.32535–39 $0.412 55–59 $0.43340–44 $0.271 60+ $0.553

Short Term Disability Cost Calculation Example—Premium Per Month

Example Rate Per $10 of Covered Weekly Benefit

Weekly Benefit (Annual Earnings/52 x 0.60)

Estimated Cost

Example Age 42 Annual Salary $50,000 $0.271 × $577 ÷ 10 = $15.64

Long Term Disability (LTD)Long term disability protects your family by providing you with a percentage of your income while you are disabled for a longer period than short term disability would otherwise cover. Eligible employees receive a benefit equal to 60 percent of monthly pre-disability earnings up to a maximum of $6,000 per month. LTD benefits are payable until you are no longer disabled or reach Social Security Normal Retirement Age. Benefits begin after 180 days.

The University provides group long term disability insurance coverage for eligible faculty, administrative, and support staff upon completion of three years of continuous service. There is no cost to the employee and USI pays the total premium.

The three-year waiting period may be waived if the employee meets the following:

� Employee was covered by his or her former employer under a similar group program through an insurance company where benefits were payable for a minimum of five years and which was in effect within 100 days prior to his or her employment at the University

� Employee provides documentation of such coverage to the Human Resources Department within 60 calendar days of the first day of employment

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VOLUNTARY HOSPITAL INDEMNITY COVERAGE Why Hospital Indemnity Coverage? Hospital Indemnity coverage, available through Aflac, pays a benefit when you or your covered dependents are admitted to the hospital for a covered stay. This coverage can complement your health insurance to help you pay for the costs associated with a hospital stay. It can also provide funds which can be used to help pay the out-of-pocket expenses your medical plan may not cover, such as coinsurance, copays, and deductibles.

Plan Features � Delivers a tax-free lump sum benefit

� No pre-existing condition exclusion

� Coverage is portable; if you leave University of Southern Indiana, you can take this with you

Summary of BenefitsBenefit Type Benefit Amount

Hospital Admission (Payable once per year)

$1,000

Hospital Confinement $200 per day, up to 31 daysICU Confinement $400 per day, up to 10 days

Employee ContributionsBi-weekly Monthly

Employee Only $10.46 $20.92Employee + Spouse $20.20 $40.40Employee + Child(ren) $16.36 $32.72Family $26.10 $52.20

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VOLUNTARY ACCIDENT COVERAGE Why Accident Coverage? Accident coverage applies to non-work related accidents only. If you elect to purchase accident coverage, this plan pays a tax-free benefit directly to you to help offset unexpected expenses associated with an accident (off the job only) for yourself or a covered family member.

How Does It Work? 1. Get the treatment you need2. File a claim with Aflac3. You’ll receive a benefit for each covered treatment received

Here is a summary of the covered medical services. A full list of covered services will be provided in your certificate.

Plan Pays YouEmergency Room $200Hospital confinement $1,000 + $200 per day (up to 365 days) Intensive care confinement $400 per day (up to 30 days) FracturesSkull (depressed) $3,000Hip or thigh $4,000Vertebrae $3,600Hand, wrist, forearm, foot, ankle, or kneecap

$2,000

Coccyx, rib, finger or toe $320DislocationsHip $3,000Knee $1,950Shoulder $1,500Ankle or foot bones $1,200Finger or toe $240

Employee ContributionsBi-Weekly Monthly

Employee Only $5.35 $10.70Employee + Spouse $9.47 $18.94Employee + Child(ren) $13.28 $26.56Family $17.40 $34.80

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Why Critical Illness Coverage? A critical illness can be a major detriment to your income, health insurance expenses, and daily living. Aflac’s critical illness plan pays a lump sum directly to you for any of the conditions shown in the chart. You also may cover your spouse and dependent children. If you elect coverage for yourself, your child also will receive coverage equal to 50 percent of that amount.

Added Security � Delivers a tax-free lump sum benefit upon diagnosis.

� No pre-existing condition exclusion; benefits are paid based on date of diagnosis.

� Coverage is portable; if you leave the University of Southern Indiana, you can take this with you.

� Rates are based on your age, election tier, and the coverage amount you elect. Please refer to the tables on the next page for more detailed rate information.

Covered Conditions and BenefitsYou may elect to purchase critical illness coverage up to the limits shown in the chart.

Employee Coverage $10,000 increments up to $30,000Spouse Coverage $5,000 increments up to 50% of employee’s coverage

amount or $15,000Child(ren) Coverage 50% of employee’s coverage amount (included)

Some of the covered conditions include:

Critical Illness Percent of Benefit PaidHeart attack 100% Stroke 100%Coronary artery bypass surgery 25%Invasive cancer 100%Non-invasive cancer 25%Benign brain tumor 100%End stage renal (kidney) failure 100%Major organ transplant 100%Coma 100%Blindness 100%Additional covered conditions for dependent children: cerebral palsy, cystic fibrosis, and Down syndrome

50%

Health Screening BenefitThis benefit pays $50 per calendar year per insured individual if a covered health screening test is performed. A full list of covered tests will be provided in your certificate.

VOLUNTARY CRITICAL ILLNESS COVERAGE

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Employee ContributionsEmployee Coverage

Employee Age$10,000 $20,000 $30,000

Bi-Weekly Monthly Bi-Weekly Monthly Bi-Weekly Monthly18-25 $2.64 $5.27 $4.51 $9.02 $6.39 $12.77 26-30 $3.29 $6.57 $5.81 $11.62 $8.34 $16.67 31-35 $3.77 $7.53 $6.77 $13.54 $9.78 $19.56 36-40 $4.74 $9.48 $8.73 $17.45 $12.71 $25.41 41-45 $5.58 $11.15 $10.40 $20.79 $15.21 $30.42 46-50 $6.53 $13.06 $12.30 $24.60 $18.07 $36.14 51-55 $9.83 $19.65 $18.89 $37.77 $27.95 $55.90 56-60 $9.69 $19.38 $18.62 $37.24 $27.55 $55.10 61-65 $19.16 $38.32 $37.56 $75.12 $55.96 $111.92 66+ $33.17 $66.34 $65.59 $131.17 $98.00 $195.99

Spouse Coverage

Spouse Age$5,000 $10,000 $15,000

Bi-Weekly Monthly Bi-Weekly Monthly Bi-Weekly Monthly18-25 $1.55 $3.10 $2.35 $4.69 $3.14 $6.27 26-30 $1.88 $3.75 $2.99 $5.98 $4.11 $8.22 31-35 $2.12 $4.23 $3.48 $6.95 $4.83 $9.66 36-40 $2.61 $5.21 $4.45 $8.90 $6.30 $12.59 41-45 $3.02 $6.04 $5.29 $10.57 $7.55 $15.09 46-50 $3.50 $7.00 $6.24 $12.47 $8.98 $17.95 51-55 $5.15 $10.29 $9.53 $19.06 $13.92 $27.83 56-60 $5.08 $10.16 $9.40 $18.79 $13.72 $27.43 61-65 $9.82 $19.63 $18.87 $37.73 $27.92 $55.84 66+ $16.82 $33.64 $32.88 $65.76 $48.94 $97.88

If you elect coverage for yourself, coverage for your child or children is automatically included in your monthly premium.

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RETIREMENTSupport Staff EmployeesDefined Contribution Plan (TIAA)Eligible support staff members hired on July 1, 2014 and after may participate after one year of employment. If you have been a member of a university-sponsored retirement plan or TIAA for at least one year, the waiting period may be waived, if sufficient documentation is submitted within 60 calendar days of the first day of employment. The University contributes 7 percent of annual salary to this plan.

To enroll go to TIAA.org/usi and select University of Southern Indiana Defined Contribution Retirement Plan for Support Staff, the access code for this plan is 406555.

Public Employees Retirement Fund (PERF)Support staff members in eligible positions hired on or before June 30, 2014 participate in the Indiana Public Employee’s Retirement Fund. Certain rehires may be defaulted in to this plan. The University contributes 11.2 percent of the employee’s gross earnings towards a pension and 3 percent towards an annuity savings account, for a total contribution of 14.2 percent into the Indiana Public Employee’s retirement Fund.

Faculty and Administrative EmployeesDefined Contribution Plan (TIAA) Eligible faculty and administrators may participate after one year of employment. If you have been a member of a university-sponsored retirement plan or TIAA for at least one year, the waiting period may be waive, if sufficient documentation is submitted within 60 calendar days of the first day of employment. The University contributes 11 percent of annual appointment salary to this plan.

To enroll go to TIAA.org/usi and select University of Southern Indiana Defined Contribution Retirement Plan for Faculty and Administrators the access code for this plan is 150771.

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All Employees Supplemental Retirement Plan All full-time and part-time employees are eligible to enroll in this plan except for student workers and non-resident aliens. This plan is used to defer your income on a pre-tax or post-tax basis for retirement savings purposes. To enroll, complete the Voluntary Salary Deferral Form and submit it to Human Resources. You will then need to set up an account online with TIAA. There is no waiting period.

To enroll go to TIAA.org/usi and select the plan of your choosing. For all employees the access code is 150772 or University of Southern Indiana Deferred Compensation 457(b) Plan for all employees the access code for this plan is 150774.

To Schedule a Meeting with a TIAA Representative Call 800-732-8353 or go to tiaa.org/schedulenow and sign up to meet with our TIAA representative on campus. Meetings are in the Wright Administration Building, FA 170.

2020University of Southern Indiana Benefits Enrollment

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TUITION FEE WAIVEREligible employees and official USI retirees receive a full waiver of fees for undergraduate and graduate courses, some restrictions apply per Fee Waiver Policy. Spouses and dependents of employees receive a waiver of 75 percent of student fees for undergraduate and graduate courses, some restrictions apply per Fee Waiver Policy.

� Undergraduate and graduate level tuition fee waivers will be automatically applied, per the fee waiver policy, for eligible employees and dependents listed with HR. Employees will not need to submit an enrollment form each term enrolled.

� You will need to ensure your dependent is listed in the BANNER system. If your dependent is on one of your insurance plans, they will automatically be in the system. If you are unsure, please reach out to a Human Resources representative at feewaivers@usi.edu.

� Eligible employees and official USI retirees also may receive a waiver of fees for noncredit courses held on campus through Outreach and Engagement.

� Apply online for fee waivers for non-credit courses at www.usi.edu/hr/benefits/tuition.

What if the Fee Waivers Do Not Process Correctly?There are many factors that cause fee waivers to be denied, be sure to check these common issues:

� For employees, ensure that no more than 15 credit hours per academic year have been attempted

� For employees, ensure that no more than six credit hour per semester (Fall and Spring); and/or no more than four credit hours per summer term or a maximum of 12 summer credit hours have been attempted

� For dependents, ensure no more than 124 credit hours have been attempted

� For dependents, ensure that your dependents are listed with Human Resources

� For children, ensure they are under 24 years of age and are an eligible dependent

� CAP classes count toward the fee waiver limit, unless you opt out of fee waivers for those classes

For more details of rules that apply, the guidelines for fee waivers are outlined in the University Handbook, Section C.11. For questions regarding fee waiver policy, please reach out to a Human Resources representative at feewaivers@usi.edu.

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EMPLOYEE ASSISTANCE PROGRAMS (EAP)Deaconess CONCERNThe University provides a confidential employee assistance program through Deaconess CONCERN which provides assessment, short-term counseling, referral and follow-up services for eligible employees and members of their household. Family, marital, financial, or work-related problems are dealt with in a completely confidential manner by one of the EAP counselors. Employees and members of their household are eligible for up to eight free visits; additional visits are covered by most health plans. The cost of the EAP is paid by the University.

Work-Life Resources � Dependent Care Resource and

Referral Service

f Childcare

f Eldercare

� Free 30-minute in person appointment with a local attorney

f Family Law

f Estate Planning

f Real Estate

f Criminal Matters

� Financial Services

f Debt Management

f Budgeting

f Credit Report Issues

f Financial Services

� Daily Living Convenience Resource Services

f Pet Services

f Personal Services and Household Services

f Education

f Dining and Nightlife

The Standard If you have Long Term Disability coverage through The Standard, you and your family can contact their employee assistance program at any time for guidance. Their services can help with:

� Depression, grief, and loss

� Family, marital, and relationship issues

� Addictions and substance abuse

� Stress or anxiety

� Financial or legal concerns

Clinicians are available 24/7 by phone, live chat, email, and text and your program includes up to three face-to-face counseling sessions per year.

Contacting DeaconessConcernToll-free 800-874-7104 Local: 812-471-4611

Work-LifeToll-free 866-545-6316

Onlinedeaconess.com/concern User ID: USI Password: employee

2020University of Southern Indiana Benefits Enrollment

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CONTACT INFORMATION

MedicalAnthem BlueCross BlueShield 833-639-1637 anthem.com

Prescription Drug CVS/Caremark 844-259-1254 caremark.com

Vision VSP 800-877-7195 vsp.com

DentalHealth Resources, Inc 800-727-1444 insuringsmiles.com

Basic/Additional Life The Standard 800-628-8600 standard.com

Short Term Disability The Standard 800-368-2859 standard.com

Long Term Disability The Standard 800-368-1135 standard.com

Accident, Critical Illness, and Hospital Indemnity Aflac 800-992-3522 aflac.com

FSANyhart 800-284-8412 nyhart.com

HSAThe HSA Authority 888-472-8697 theHSAauthority.com

Employee Assistance Program Deaconess Concern 800-874-7104 deaconess.com/concern

Retirement TIAA 800-842-2252 tiaa.org

INPRS 844-464-6777 in.gov/inprs/

USI Human Resources 812-464-1815 usi.edu/hr

As an Equal Opportunity/Affirmative Action Employer, the University of Southern Indiana considers all qualified applicants for employment without regard to race, color, religion, sex, pregnancy or marital status, national origin, age, disability, genetic information, sexual orientation, gender identity, veteran status, or any other category protected by law or identified by the University as a protected class.

This Benefit Enrollment Guide is only intended to highlight some of the major benefit provisions of the Company plan and should not be relied upon as a complete detailed representation of the plan. Please refer to the plan’s Summary Plan Descriptions for further detail. Should this guide differ from the Summary Plan Descriptions, the Summary Plan Descriptions prevail.

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