SAINT MARY’S COLLEGE | P.M.B. 4227 • Moraga • CA 94575

2017

| Human Resources (925) 631-4212

EMPLOYEE BENEFIT HANDBOOK

2017 Employee Benefit Handbook

Table of Contents

Getting Started ...........................................................................................................................................................1

Enrollment and Benefit Eligibility ...............................................................................................................................2

Health Care Plans .......................................................................................................................................................4

Medical Cost Summary ...............................................................................................................................................5

Medical HMO Plans ....................................................................................................................................................6

Medical HSA Plan ........................................................................................................................................................7

Dental Benefits ...........................................................................................................................................................8

Vision Benefits ............................................................................................................................................................9

Life and AD&D Benefits ........................................................................................................................................... 10

Long-Term Disability Benefits .................................................................................................................................. 11

Employee Assistance Program ................................................................................................................................ 12

Flexible Spending Accounts ..................................................................................................................................... 13

Retirement Benefit .................................................................................................................................................. 14

Emeriti Retirement Health Solutions....................................................................................................................... 15

Tuition Allowance and Tuition Exchange Program .................................................................................................. 16

Paid Time-Off Benefits ............................................................................................................................................. 17

Other Benefit Information ....................................................................................................................................... 18

MEDICARE PART D NOTICE ...................................................................................................................................... 19

WOMEN’S HEALTH & CANCER RIGHTS ACT ............................................................................................................ 21

DESIGNATION OF PRIMARY CARE PROVIDER .......................................................................................................... 21

HIPAA NOTICE OF SPECIAL ENROLLMENT ............................................................................................................... 22

THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) ........................................................................................ 23

Carrier Contact Information & Resources ............................................................................................................... 26

1

Getting Started

On behalf of the staff of Human Resources, welcome to Saint Mary's College of California. We hope that your association with the College proves to be productive and satisfying. Coverage is automatic only for benefits required by law such as social security, worker’s compensation, state unemployment and state disability insurance. Enrollment forms MUST be completed and returned to the Human Resource Office within the first 30 days of employment even if employee is opting out of coverage. Before you begin your employment with Saint Mary’s, you should have received tax forms and an employment eligibility verification form (I-9). These should be completed and returned, in person, within three (3) days of your employment start date. Please note an SMC email account and computer access will not be granted until I-9 is completed.

W-4 Federal Tax Employee’s Withholding Allowance Certificate – Complete and return the bottom portion to Human Resources.

DE-4 State Tax Employee’s Withholding Allowance Certificate –

Complete and return the top portion if you are claiming different allowances than on the Federal forms.

I-9 Employment Eligibility Verification – Complete the top portion

of the form and bring, in person, to Human Resources one of the acceptable documents listed on the back from column “A”, or one acceptable document from each column marked “B” and “C”.

Direct Deposit Form Complete and return the form with your checking/savings account

and bank routing number. You do not need to provide a voided

check.

Personnel Data Form Provides demographic, emergency and other information for the

College’s database.

ABOUT YOUR BENEFITS

Saint Mary’s College

views benefits as an

integral part of the

overall compensation

program. The College

strives to offer

comprehensive as well

as competitive

programs in order to

attract and retain

competent employees.

The goal of this guide is

to walk you through

your benefit and help

you understand the

options available to

you.

2

Enrollment and Benefit Eligibility

Who is Eligible?

New employees are eligible for benefits on the first day of the month following 30 days

of continuous employment.

• Full Benefit Eligibility [ Medical, Dental, Vision, Life/AD&D, LTD & EAP ]o Staff who work a minimum of 1,560 hours per yearo Ranked Faculty teaching 6-7 courses per academic year

• Partial Benefit Eligibility [ Medical, Dental, Vision ]o Faculty teaching 5 courses receive health, dental and vision coverageo ACA / Look-back

http://www.stmarys-ca.edu/sites/default/files/attachments/files/SMC_ACA_POLICY2-16-15.pdf

Your Eligible Dependents

You may choose to enroll your eligible dependents in the medical, dental, vision, and

dependent life insurance plans. Eligible dependents include:

Your spouse or qualified domestic partner

Your eligible dependent children up to age 26, regardless of full time student or

marital status

Domestic Partner Eligibility Criteria

If you are enrolling a domestic partner, you will be asked to attest to your domestic partner relationship and that you have met all eligibility requirements listed below for the previous twelve months.

You maintain the same principal place of residence and intend to do so in the

future

You agree to be responsible for each other’s basic living expenses in the event

that either of you is unable to provide such expenses for himself or herself

You are both 18 or older

Neither of you is married

You are not related by blood to such a degree that you would be prevented from

marrying in the state in which you reside

Neither of you has maintained coverage for another Domestic Partner under any

health plan within the last six (6) months. (This excludes any domestic partner

that has died within the last six months.)

You agree to notify Saint Mary’s College immediately upon your inability to satisfy

any of the criteria of Domestic Partnership

REGISTERED DOMESTIC

PARTNERS

California Law mandates that health plans provide coverage for the registered domestic partner of an employee, subject to the same terms and conditions as coverage is provided to an employee’s spouse.

Registered domestic partners are those individuals who have filed domestic partner papers with the California Secretary of State and received a Domestic Partnership Certificate.

The registry is only available to same-sex couples or opposite sex couples where one or both partners are over the age of 62.

3

Enrollment and Benefit Eligibility (continued)

If You Waive Coverage

If you choose to waive medical, dental, vision, and/or voluntary life coverage, you

may be subject to benefit waiting periods or evidence of insurability should you

become eligible to enroll in the future. Please refer to each carrier’s detailed

evidence of coverage booklet for additional information.

Note that enrollment forms still need to be completed. There is no “credit” from the

College to the employee for opting out.

If You Leave Your Job

Your employer sponsored benefits will end on the last day of the month for medical,

dental and vision, and on the last day of employment for life and disability insurance

plans. You and your dependents who are covered under our medical, dental, vision

and (in certain situations) the health care spending account FSA plan, have the right

to continue participation in the group health coverage, referred to as “HICUP” (health

insurance continuation plan) at Saint Mary’s College. You have sixty days from your

notification date or coverage end date to enroll in HICUP. If you enroll in HICUP, you

will pay monthly payments for the full premium plus a two percent administration fee.

HICUP coverage is generally available for up to 18 months, with additional extensions

available under certain circumstances. For more information, contact Arrow Benefits

Group, the HICUP administrator, at 707-992-3771 and ask to speak to a health

insurance continuation representative.

You may convert basic life and voluntary life insurance coverage to an individual

policy within 31 days of your termination date by contacting UNUM Member Support

at 800-635-5597.

4

Health Care Plans

For benefit eligible employees, the premium contributions vary depending on plan

choices and whether coverage is for the employee only, or employee plus family.

Employees can select different levels for different types of coverage, e.g. if a

spouse has his/her own medical plan the employee may elect employee only

coverage for medical and employee plus spouse for dental and vision.

MEDICAL PLAN COVERAGE

The College allows you to select from three (3) different medical programs:

Kaiser Permanente HMO*

Health Net HMO*

Health Net PPO/HSA**

Members of the Kaiser HMO program may select a “Primary Care Physician” (PCP)

or one will be assigned if one is not elected. Your PCP will coordinate all your

medical needs, referring you to a specialist when necessary. Office visits have a

$20 copayment.

Members of the Health Net HMO program select a “Primary Care Physician” (PCP)

and medical group from the list of providers. These private practicing physicians will

coordinate all your medical needs, referring you to a specialist when necessary.

Office visits have a $20 copayment.

Health Net also has an PPO/HSA plan which has a lower monthly premium but

requires paying full charges for most services until the annual deductible is met.

*HMO – Health Maintenance Organization **HSA – Health Savings Account

GROUP POLICY

NUMBERS

Kaiser HMO Group# 192-0004 Health Net HMO Group# 70122A Health Net PPO/HSA Group# N7074A (For

Employee Only Coverage)

Group# N7070A (For

Employee + Deps Coverage)

Descriptions of these plans do not include the important legal definitions and limitations which are in plan documents governing your benefits. Therefore, this booklet does not replace the legal documents and, in case of conflict, the legal documents will determine your benefits. Saint Mary’s College of California retains the right to change or terminate these plans at any time with or without prior notice.

5

Medical Cost Summary

Total Monthly Premium and Contribution Comparison

Kaiser HMO

Monthly Premium

College Contribution

Employee Contribution

EE Share Per Pay Period

Employee Only $652.51 $587.26 $65.25 $32.63

Employee + Spouse $1,371.28 $959.90 $411.38 $205.69

Employee + Child(ren) $1,239.77 $867.84 $371.93 $185.97

Employee + Family $2,022.79 $1,415.95 $606.84 $303.42

Health Net HMO

Monthly Premium

College Contribution

Employee Contribution

EE Share Per Pay Period

Employee Only $1,011.29 $924.19 $87.10 $43.55

Employee + Spouse $2,123.70 $1,624.80 $498.90 $249.45

Employee + Child(ren) $1,921.45 $1,470.07 $451.38 $225.69

Employee + Family $3,125.00 $2,388.52 $736.48 $368.24

Health Net HSA – The College will also make a $300 contribution upon enrollment to the

employee’s HSA account.

Monthly Premium

College Contribution

Employee Contribution

EE Share Per Pay Period

Employee Only $994.35 $929.25 $65.10 $32.55

Employee + Spouse $2,088.14 $1,643.82 $444.32 $222.16

Employee + Child(ren) $1,889.27 $1,487.27 $402.00 $201.00

Employee + Family $3,082.61 $2,426.71 $655.90 $327.95

6

Medical HMO Plans

Medical Plans

Plan Type HMO HMO

Calendar Year Deductible None None

Annual Out-of-Pocket Maximum $1,500 / Member $3,000 / Family

$1,500 / Member $4,500 / Family

Lifetime Maximum Benefit Unlimited Unlimited

Coinsurance Covered at 100% Covered at 100%

Hospital Services

Inpatient Hospitalization $250 per admission $250 per admission Outpatient Surgery $20 per procedure / surgery $250 per surgery Emergency Room (Copay waived if admitted)

$50 copay $100 copay

Physician Services

Office Visits – PCP $20 copay $20 copay Office Visits – Specialist $20 copay $20 copay Preventive Care Covered at 100% Covered at 100%

Maternity (Pre-/Post-Natal Care) Covered at 100% Covered at 100%

Outpatient Services

Diagnostic X-Ray & Lab $10 copay Covered 100% MRI, CT Scan and PET $50 copay $100 copay

Prescription Drugs RX Separate $2,000 out-of-pocket annual max

Retail Pharmacy Generic / Tier 1 $10 $10 Brand Formulary / Tier 2 $25 * $30 Brand Non-Formulary / Tier 3 N/A * $50 Number of Day Supply 30-day supply 30-day supply

Mail-Order Pharmacy Program Generic $20 $20 Brand Formulary $50 $75 Brand Non-Formulary N/A $125 Number of Day Supply 100-day supply 90-day supply

Mental or Nervous Disorders & Substance Abuse Pre-authorization Required Inpatient $250 per admission $250 per admission Outpatient $20 copay $20 copay

Employee Share Per Pay Period

Employee Only $32.63 $43.55

Employee + Spouse $205.69 $249.45

Employee + Child(ren) $185.97 $225.69

Employee + Family $303.42 $368.24

* If you have an existing condition that requires a specific prescription and are considering the Kaiser plan, please review their covered prescription list here to confirm it is a covered drug.

Support for Health Net HMO members, contact Member Services: Visit www.healthnet.com Group Policy# 70122A Call (800) 522-0088

Support for Kaiser HMO members, contact Member Services: Visit www.kp.org Group Policy# 192-0004 Call (800) 464-4000

7

Medical HSA Plan

Medical Plans

Plan Type High Deductible PPO HSA

Coverage Network In-Network Out-of-Network

Calendar Year Deductible $2,000 / Employee Only $2,600 Ind / $3,900 Family

$2,000 / Employee Only $2,600 Ind / $3,900 Family

Employer Annual HSA Funding $300 at start of calendar year or upon enrollment

Annual Out-of-Pocket Maximum $2,000 / Employee Only $2,600 Ind / $3,900 Family

$4,000 / Employee Only $3,900 Ind / $7,800 Family

Lifetime Maximum Benefit Unlimited

Coinsurance Covered at 100% after ded Covered at 50% after ded

Hospital Services

Inpatient Hospitalization 100% after deductible 50% after deductible Emergency Room (Copay waived if admitted)

100% after deductible 50% after deductible

Physician Services

Office Visits 100% after deductible 50% after deductible Preventive Care Covered at 100%

(Deductible Waived) Not covered

Maternity (Pre-/Post-Natal Care) 100% after deductible 50% after deductible

Outpatient Services

Diagnostic X-Ray & Lab 100% after deductible 50% after deductible MRI, CT Scan and PET 100% after deductible 50% after deductible

Prescription Drugs RX Subject to annual deductible

Retail Pharmacy Generic / Tier 1 100% after deductible 50% AWP retail Brand Formulary / Tier 2 100% after deductible Brand Non-Formulary / Tier 3 100% after deductible Number of Day Supply 30-day supply

Mail-Order Pharmacy Program Generic 100% after deductible Not covered Brand Formulary 100% after deductible Brand Non-Formulary 100% after deductible Number of Day Supply 90-day supply

Mental or Nervous Disorders & Substance Abuse

Inpatient 100% after deductible 50% after deductible Outpatient 100% after deductible 50% after deductible Employee Share Per Pay Period Employee Only $32.55 Employee + Spouse $222.16 Employee + Child(ren) $201.00 Employee + Family $327.95

Support for Healt Net PPO/HSA members, contact Health Net Member Services: Visit www.healthnet.com Group Policy# N7074A (EE Only Coverage) | N7070A (EE+Deps Coverage) Call (800) 522-0088

8

Dental Benefits

Dental Plans

You have the option to choose dental HMO or PPO dental care coverage through Delta Dental, regardless of which medical

plan you choose. With the PPO plan you can see any dentist you wish for eligible dental care services. You are not required

to choose a Delta Dental network dentist, but when you do, you will have lower out-of-pocket costs. Benefit payments to non-

dentists are based on a fee allowance as defined by Delta Dental. Please consult the chart below for a summary of the Delta

Dental plan benefits. With the DHMO plan, you MUST see dentists who are in the DeltaCare HMO network. To find a

participating dentist near you, simply visit www.deltadentalins.com and search under “Find A Dentist” located on the far right

side of the web page.

PPO Plan

Network PPO Network Non-Contracted/Out-of-Network

Maximum Contract Allowance (Reimbursement Basis)

PPO Contracted Fee* Fee Allowance **

*PPO dentists agree to accept PPO Contracted Fees as payment in full. **Fee allowance is the amount determined by Delta Dental for such services.

PPO Network Premier Network

Non-PPO Network

Delta Care HMO

Annual Maximum Benefits $2,000 per person per calendar year No maximum

Lifetime Orthodontia Maximum $1,500 per person per lifetime No maximum

Annual Deductible (waived for preventive) $ 50 Individual $150 Family

$100 Individual $300 Family

$100 Individual $300 Family

None – Copay applies depend on services

Preventive Services (cleanings, exams, x-rays) 100% 100% 100% of UCR No copay

Basic Services (extractions, fillings, periodontics) 80% 80% 80% of UCR $0-$280 copay

Major Services 50% 50% 50% of UCR $50 - $325 copay

Orthodontia (children to age 26) 50% 50% 50% of UCR Adult - $1,900 copay Child - $1,700 copay

Employee Benefit Contribution Per Pay Period

Per Pay Period Rate Dental PPO Dental HMO

Employee Only $0.00 $0.00

Employee + Spouse $16.22 $8.60

Employee + Child(ren) $18.02 $7.37

Employee + Family $27.76 $12.29

Member Services for Delta Dental PPO: Visit www.deltadentalca.org Group Policy# 18620 Call (800) 765-6003

Member Services for DeltaCare HMO: Visit www.deltadentalins.com Group Policy# 78818 Call (800) 422-4234

9

Vision Benefits

Vision Plan

Saint Mary’s College provides you with vision care coverage through the Vision Service Plan (VSP) Choice Plan. With this

plan, you can see any vision provider you wish for vision care, and may purchase your glasses at any location. When you

obtain services from providers who participate in VSP network, your coverage is greater. When you obtain services from

providers who do not participate in the network, your out-of-pocket expenses will be higher. To look for an in-network provider,

visit www.vsp.com.

Using VSP is easy! With open access to see any eyecare provider, you can see the one who’s right for you.

Benefits Frequency of Covered Services

Exam Every 12 months Lenses Every 12 months Frames Every 12 months Copay $20 exam & $20 materials copay

VSP Network Out-of-Network

Exams: Covered 100% $45 allowance

Lenses: Single Covered 100% $30 allowance Bifocal Covered 100% $50 allowance Trifocal Covered 100% $65 allowance

Contacts (in lieu of glasses) Medically Necessary Covered 100% $210 allowance Elective $130 allowance $105 allowance

Frames $130 allowance $70 allowance

Additional Coverage Diabetic Eyecare Plus Program

Did you know you can save taxes on your out-of-pocket vision care expenses? See Flexible Spending Accounts for more

information.

Employee Benefit Contribution Per Pay Period

Per Pay Period Rate VSP Vision

Employee Only $0.00

Employee + Spouse $2.25

Employee + Child(ren) $1.83

Employee + Family $3.10

For member support, please contact VSP Member Services: Visit www.vsp.com Group# 30071092 Or call 800-877-7195

10

Life and AD&D Benefits

Basic Life and AD&D Insurance

Saint Mary’s College provides Basic Life and Accidental Death & Dismemberment (AD&D) insurance through UNUM as follows:

Eligible Employee Group(s) Benefit Amount

All Regular full-time employees 1x annual salary to a maximum of $150,000

Your beneficiary will receive the benefit amount in the event of your death. If your death is the result of an accident, your beneficiary will receive an additional amount equal to your Basic Life benefit amount. It is important to note that the Federal government requires the cost for employer-paid life insurance over $50,000 to be taxed as imputed income and reported on your W-2. Benefits reduce starting at age 65. Please refer to the UNUM summary for more details. Saint Mary’s College pays the full premium cost of this benefit.

Voluntary Life and AD&D Insurance

Saint Mary’s College offers employees the opportunity to purchase additional term life insurance. The amount of coverage you select will be in addition to the employer paid Life/AD&D benefit. Premiums are paid through convenient payroll deductions.

Benefit Amount Guarantee Issue Amount*

Employee Increments of $10,000 up to 5x salary or $300,000 maximum

$120,000

Spouse/Partner 100% of employee coverage in increments of $5,000 to $300,000 maximum

$25,000

Child(ren) Increments of $2,000 up to $10,000 maximum Child benefits @ age 14 days to 26 years (26 if full-time student)

$10,000

In order to purchase coverage for your spouse and/or child, you must purchase coverage for yourself. If you apply and enroll for this benefit within 31 days of your employment date, you can be guaranteed up to the Guarantee Issue Amount of coverage as listed above. If you enroll during Open Enrollment, Guarantee Issue Amount will not apply and you must show Evidence of Good Health for all amounts. If you are over age 65, please read the Certificate of Coverage for additional benefit limitations.

Life Rate Per $10,000

Age Range Employee Spouse

0-24 $0.50 $0.25

25-29 $0.60 $0.30

30-34 $0.80 $0.40

35-39 $0.90 $0.45

40-44 $1,20 $0.60

45-49 $1.80 $0.90

50-54 $3.00 $1.50

55-59 $5.50 $2.75

60-64 $6.60 $3.30

65-69 $11.30 $5.65

70-74 $20.10 $10.05

75+ $20.10 $30.05

Child Rate $0.248 per $2,000

Example Premium Calculation: A 35 year-old employee with a 42 year-old spouse and a child selects the following coverages:

Employee $100,000

Spouse $ 50,000

Child $ 10,000

Based on the example above and the rates on the left side of this form, the employee’s monthly cost would be:

Coverage Benefit Rate/$10,000 Premium

Employee $100,000 $0.90 $ 9.00

Spouse $ 50,000 $0.60 $ 3.00

Child $ 10,000 $0.248 $ 1.24

Total Monthly Premium

$13.24

11

Long-Term Disability Benefits

Long-Term Disability Coverage

Long-Term Disability (LTD) coverage provides you and your family important financial security. For all eligible employees,

Saint Mary’s College provides an employer-paid LTD benefit. This policy is underwritten by the UNUM Life Insurance

Company.

Long-Term Disability All Employees

Benefit 60% of monthly earnings

Benefit Maximum $10,000 per month

Elimination Period 90 days

Benefit Duration The duration of your benefit payments is based on your age when your disability occurs. Your LTD benefit is payable for the period during which you continue to meet the definition of disability. If you become disabled before age 62, benefits may continue until the Social Security Normal Retirement Age. If disabled at age 62 or older, the benefit duration is determined by the age when disability begins.

Definition of Disability For the elimination period and the first 24 months for which LTD benefits are paid, the employee must be unable to perform their own occupation or the employee is unable to earn 80% or more of their indexed pre-disability earnings while working in their own occupation. After that, the employee must be unable to engage with reasonable continuity in that occupation or any occupation which an employee could reasonably be expected perform satisfactorily in light of their age, education, training, experience, station in life and physical and mental capacity.

LTD benefits are reduced by other group, State, or Federal benefits

Travel Assistance

Wherever you go, this service gives your covered employees, their families and travel companions access to: qualified medical resources,

prescription replacement, legal and interpreter referrals, transportation assistance and more.

If you need travel assistance, contact Assist America immediately:

Within the US: 1-800-872-1414

Outside the US: +(US access code) 609-986-1234

Via email: medservices@assistamerica.com

Reference number: 01-AA-UNM-7216

All services must be provided through Assist America Inc. No claims for reimbursement accepted. These services are not valid after policy

termination. Learn more at www.UNUM.com/travelassistance or download the mobile app

12

Employee Assistance Program

If you and your family members need assistance with balancing life’s demands, or require help with personal or financial

management, you will benefit from the Saint Mary’s College Employee Assistance Program (EAP).

The EAP offers confidential telephone counseling sessions through Managed Health Network (MHN) and allows each

family member unlimited free telephone consultation with an EAP counselor available 24/7. Referrals to local counselors with up to 8 face-to-face visits per incident per calendar year.

It’s All About Balance Living a productive and fulfilling life requires a healthy mind and a healthy body. Unfortunately, managing the daily stresses of work, home and family can have a negative effect on our overall health and well-being. For many of us, life is quite simply “out of balance,” leaving us feeling overwhelmed and stressed-out. The EAP program can help.

A Wealth of Practical, Solution-Focused Resources including Clinical Counseling.

The EAP has the resources and the tools to help you bring things back into balance. From online resources to confidential

telephonic consultations to referrals and licensed behavioral health professional to help you make changes to reduce stress,

strengthen relationships, increase productivity and improve the overall quality of your life. Here are just a few of the

challenges where the EAP can help:

Education Dependent Care & Care Giving Legal Counseling o Admissions testing & procedures o Adoption Assistance o Family Law o Adult re-entry programs o Before/after school programs o Wills and contract o College planning o Day care o Personal Injury o Financial aid resources o Elder care o Home buying o Finding a pre-school o In-home services o Immigration

Lifestyle & Fitness Management Working Smarter Financial Consultations o Anxiety & depression o Career development o Develop a personal & family budget o Divorce & separation o Effective managing o Bankruptcy issues o Drugs & alcohol Rehabiliation o Credit rights and options

… Support is a phone call or click away

Unlimited free telephone consultation with an EAP counselor available 24/7 at 800-977-7585

Referrals to local counselors with up to 8 face-to-face visits per incident per calendar year

State of the art website featuring thousands helpful articles and topics like wellness, training courses, and a legal and

financial center

Visit www.members.mhn.com

For Access Code, type in smceap

Or call 800-977-7585

13

Flexible Spending Accounts

How Flexible Spending Accounts Work

Before enrolling, you decide how much you want to contribute annually to your account(s). The annual maximum amount

allowed for Health Care accounts is $2,550 and $5,000 for Dependent Care accounts. Your salary contributions are made in

equal installments each pay period. The portion of your contribution that comes from your salary will be taken before federal,

state, social security, Medicare and state disability are withheld, saving you money.

The College offers three (3) different flexible spending accounts administered by Navia Benefit Solutions:

1. Health Care Spending Account (HCSA)

The Health Care Spending Account allows you to set aside pre-tax dollars to pay for qualifying out-of-pocket

expenses including deductibles, coinsurance payments and copays for medical, dental, vision and prescription drug

expenses. The maximum amount you can set aside is $2,600 per calendar year. Expenses for dependents who are

not covered through the Saint Mary’s College health plan may also qualify for reimbursement. Per IRS Up to $500

unspent funds can be rolled over to the following plan year.

2. Dependent Care Spending Account (DCSA)

The Dependent Care Spending Account allows you to set aside pre-tax dollars to pay for eligible dependent care

expenses to a maximum of $5,000 per year (if you are married and filing separate returns, there is a $2,500 per

person maximum). This includes child care, elder care, or other eligible dependent care who meet IRS guidelines.

Both you and your spouse (if married) must actually be at work to participate.

Spending Account Rules

1. You must designate how much money you wish to contribute annually to each account by December 31st for the

next plan year. Money set aside for the one account cannot be moved to another account.

2. You may change your annual contributions only if you experience a qualifying change in family status, such as

marriage, divorce, additional or loss of a dependent, or a change in your own or your spouse’s employment.

3. It is important to carefully review your estimated expenses since any unspent funds remaining in each account at

the end of the plan year must be forfeited. Participants have 120 days following the end of the plan year to file

for claims incurred during the plan year.

How an FSA Can Help You Save Money With FSA Without FSA

Sample monthly gross earnings $3,000 $3,000

Monthly pre-tax contribution $200 $0

Monthly taxable earnings $2,800 $3,000

Monthly taxes* $1,138 $1,220

Monthly earnings after taxes $1,662 $1,780

Monthly after-tax expenses $0 $200

Monthly spendable earnings $1,662 $1,580

Increase in monthly spendable earnings $82 None *Assumes 40.65% tax bracket (28% federal, 7.65% FICA and 5% state tax)

3. Commuter Benefits Account

You can use pre-tax deductions to pay for your eligible commuting expenses. Monthly contribution limits are based

on current IRS guidelines. Please contact Saint Mary’s Human Resources for more information.

14

Retirement Benefit

Saint Mary's College regards retirement planning as an integral part of your work experience and places great importance on you and your family's quality of life both during your work years and after.

TIAA

Teachers Insurance Annuity Association is the recognized expert in retirement planning with over 75 years of experience serving the educational community. Their counselors are experienced retirement planning specialists, not commissioned sales people. TIAA manages over $100 billion in assets and TIAA has received the highest possible ratings from all three of the industry’s leading independent rating agencies. All staff working at least 20 hours per week, 12 months per year and faculty with the rank of Assistant Professor, Associate Professor or Professor are eligible to participate in the Teachers Insurance Annuity Association (TIAA) program after one year of service and age 21. Participation is immediate if an employee has completed one year of direct service with an eligible employer (institution of higher education). Eligible employees will be required to complete an online enrollment. Once eligibility requirements have been met, the College will begin a contribution equal to 8.25% based on the employee’s semi-monthly earnings. You are not required to contribute but may do so on a tax-deferred basis, with as little as $25 per pay period to a maximum of as defined by the IRS annually. TIAA offers several options for investing your retirement dollars. You may choose to allocate your retirement earnings into one or all of these accounts and can change the options at any time. One-on-one meetings with a TIAA councilor are available through the year to introduce TIAA to eligible employees as well as to provide on-going information regarding the program and your personal retirement strategy. You will be contacted at the appropriate time and asked to complete the application to begin the College’s contribution to your retirement savings plan. Saint Mary’s College works with, and encourages your participation with other insurance companies, to provide a payroll reduction for tax sheltered annuities but does not sponsor or contribute to any program other than TIAA.

TIAA offers several

options for investing

your retirement dollars.

Some options include:

a traditional annuity

stock account

money market

bond account

growth funds

inflation linked bond

account

lifecycle funds

mutual funds

15

Emeriti Retirement Health Solutions

Saint Mary’s College offers you the Emeriti Plan, comprehensive retirement health care

benefits for you and your dependents. Emeriti provides access to and assets for healthcare

security in retirement:

Emeriti Health Account – Save during your working years for healthcare expenses in

retirement

Reimbursement Benefits – Use the tax-advantaged reimbursement benefit for qualified

medical expenses after separation of service

Health Insurance – Choose from a menu of health plans to fit your individual need and a

budget when you retire

Ongoing Education – Life-stage communications throughout your lifetime in the program

Dependent eligibility for Emeriti Plan Benefits

Under Saint Mary’s Plan, domestic partner, dependent children, and dependent relatives – as

defined by IRS guidelines – may also be eligible to receive benefits while you are receiving

benefits and may continue to do so after you die.

Using your Emeriti Retiree Health Insurance

You will also be eligible for the Emeriti Health Insurance Plan Options if you satisfy the criteria

for Retirement Eligibility under the Plan:

Attained age 55 while employed by SMC with at least 5 years of continuous service

Became permanently disabled during active service and received a disability

determination letter from Social Security

Having met criteria for Retirement Eligibility, you will be able to enroll in the Emeriti Health

Insurance after terminating service with the Institution, attaining age 65, and enrolling in

Medicare Parts A and B.

Your Employer’s Contributions

Saint Mary’s College will begin making

contributions for you upon commencement

of employment and attaining age 40. The

amount of contribution will be determined

by the Institution. The Institution will cease

making its contributions on the earliest of

the following:

After 25 years of contribution

The date you cease employment

The date of death during employment

Your Own Contributions

You can begin to make contributions to your Emeriti Health Account at any time. Voluntary contributions may be made by payroll deduction during active service or by ACH transfer from your bank account even after you terminate or retire. Your voluntary contributions will be made on an after-tax basis, but employer contributions and all earnings will accumulate and be paid out tax-free for your retiree health insurance and other qualified medical expenses.

Visit EmeritiHealth.org

for more information

To check your account,

visit tiaa-cref.org or call

the Emeriti Service Center

at 866-363-7484 and

select option #3

16

Tuition Allowance and Tuition Exchange Program

TUITION ALLOWANCE

Tuition allowance provisions apply to all full-time faculty and staff who have completed one year of service. This benefit only applies to courses taken at Saint Mary's College excluding courses offered in inter-institutional, extension, and cooperative or contract programs. All applicants for tuition allowance must meet the normal admissions requirement for the College and of the academic program for which application is being made. Spouses and employees are entitled to receive 100% tuition remission of one course per semester, quarter, or term. Depending on the tax codes, Graduate course tuition that has been waived may be considered taxable. The children of currently employed faculty and staff members are entitled to a 100% remission of tuition after only one year of full-time service. To be considered eligible for a tuition allowance, a son or daughter of an employee MUST be a dependent for income tax purposes AND MUST have enrolled before reaching his/her 25th birthday.

TUITION EXCHANGE PROGRAM

The Tuition Exchange Program provides a national scholarship exchange program for dependents of eligible employees with 600 participating institutions throughout the United States and the United Kingdom. Nationally, approximately 3,000 students receive scholarship annually. Colleges and Universities participating in this program have agreed to waive tuition for eligible dependents from other member institutions. The primary obligation of a member institution is to maintain a balance between “exports” and “imports.” ELIGIBLE EMPLOYEES: All full-time faculty, currently teaching six (6) or more courses per academic year and staff, working 30 or more hours per week, 12 months per year, who have completed seven (7) years of employment. ELIGIBLE DEPENDENTS: Sons and daughters of eligible employees who are considered by the Internal Revenue Service to be legal dependents, and who have enrolled prior to attaining age 25. Verification of dependent status is required. Participation in this program is in lieu of eligibility for enrollment at Saint Mary’s College. SCHOLARSHIP: Two (2) exports are allowed per academic year. A tuition waiver for up to four (4) years of full-time undergraduate degree study, provided the student maintains continuing eligibility. Room, board, and fees are normally NOT included in the scholarships offered by the host institution. Those institutions with very high tuition rates are allowed to award less than full tuition. Most institutions will reduce their scholarship by the amount of other grants available to the student. Exclusion from scholarship are part-time study, graduate study, study in a non-degree program and study for a second undergraduate degree.

ADMISSION

REQUIREMENTS

All prospective students

must seek admission and

meet ALL applicable

admission requirements.

Tuition waiver forms are

available online and for

pick up at the Human

Resources Office.

Application period takes

place annually in October.

17

Paid Time-Off Benefits The College strives to offer a flexible and generous vacation and leave policy. The employees at Saint Mary’s are an important resource of the College and in recognizing this significance, the programs listed below are directly related to the well-being of each and every employee.

Holidays Non-academic employees receive fifteen paid holidays per fiscal year (July through June) in accordance with the local custom

and the liturgical calendar. The following are normal holidays with some variation announced annually:

New Year’s Day

Martin Luther King, Jr.

Good Friday

Easter Monday

Memorial Day

Part-time staff receive pro-rated holidays based on their percentage of full-time.

Sick Leave Sick leave is not paid in lieu of taking the time off.

Full-time faculty receive one (1) month of sick leave for each year worked up to a maximum of three (3) months.

Per course adjunct professors receive 24 hours upon hire and annually to a max of 24 hours.

Staff and administrators earn one (1) day of sick leave for each month worked up to a maximum of 60 working days.

Variable hour employees (Temps, On-Call, Summer Camp), Student and Federal Work Study employees will receive one (1) hour of paid sick leave for every 30 hours worked to a maximum of 48 hours.

Sick leave is to be used for a legitimate illness of the employee or a member of the employee’s immediate family, or in the event of a doctor/dentist appointment or pregnancy. Documentation of illness may or may not be required. Please check with your supervisor for department policies and the Staff Handbook for additional rules and procedures.

Vacation

Faculty have no specified vacation benefits. All other regular administrative staff employees accrue vacation from their hire date according to the following schedule:

Length of Service Accrual Rate in Weeks per Year Accrual Rate in Days per Year

(1) Secretarial, Clerical, Maintenance and Service Staff (Non-Exempt)

0 – 3 years 2 weeks 15.0 days

4 - 7 years 3 weeks 22.5 days

8 - 15 years 4 weeks 30.0 days

Over 15 years 5 weeks 37.5 days

(2) Managerial, Administrative and Professional Staff (Exempt)

0 – 3 years 3 weeks 22.5 days

4 - 7 years 4 weeks 30.0 days

Over 7 years 5 weeks 37.5 days

No one may accumulate more vacation than what is earned in an 18-month period. For example: You have worked for the College for a year and not taken any vacation. Your accumulation will stop once you have accrued 15 days for group (1) or 22.5 days for group (2). You will not lose the accrual that has been earned, however the accrual will cease until some vacation has been taken. Once you have completed your third (3rd) year of service, your maximum accumulation will advance to the next tier as scheduled in the table above. All time-off should be requested and approved in advance by your supervisor.

Independence Day – July 4th

Labor Day

Thanksgiving Day

Day after Thanksgiving Day

Christmas Week

18

Other Benefit Information

State Disability Insurance (SDI): This benefit is paid wholly by the employee and is payable when work cannot be performed due to a non-work related illness or injury. The State of California annually determines the tax contribution rate and its limit. Payments are made to disabled employees based on highest earnings in a particular quarter and are paid to the employee on a weekly basis up to 52 weeks.

Workers’ Compensation: This coverage is effective on your first day of employment at no cost to you. Benefits received

include payment of all medical expenses related to a work-related accident or illness and weekly benefits to cover any lost

wages. There are specific rules for reporting a work-related injury or illness which are covered in more detail in the staff

handbook and available in human resources.

Federal Income Contribution Act: This is a tax shared by the employee and the college which is otherwise known as social

security. Social security taxes are used to pay for benefits at retirement. You pay the taxes into the system during your work

years, then you and members of your family receive monthly benefits when you retire or become disabled. As you work and

pay taxes, you earn social security “credits” and most people need 40 credits to qualify for benefits. There are several

booklets explaining this program available outside human resources.

Unemployment Insurance: California unemployment insurance is not based on need and is not considered welfare. Saint

Mary’s pays the entire cost of the insurance to provide you with a weekly income when you are out of work through no fault of

your own. Your claim has a benefit year, the 52-week period beginning the day your claim is effective. In this year, weekly

benefits may be paid for 26 weeks or until have you have received half of your base period wages, whichever is less. You

may file a claim for unemployment insurance if you were laid-off, relocated, or had a compelling reason to resign.

Campus Meals and Discounts in Bookstore: “Flex dollars” can be used on campus at Oliver Hall, faculty/staff dining hall,

and Café Louis. Employee receive a 10% discount on items purchased in the campus bookstore.

Library and Art Museum Privileges: Employees have full access to Saint Mary’s library and research staff. Library is

stocked with current books and movies, as well as access to library resources throughout California. The Hearst Art Museum

is located on campus and hosts interesting exhibits each year.

Cultural and Athletic Events: The campus hosts exciting and thought-provoking events to which employees can attend

plays, speakers, readings and forums. There are also special in-service days on the college’s Catholic, Lasallian, liberal arts

traditions, staff development events, special masses and even a staff appreciation day. Employees can also receive

discounted tickets to games and athletic events.

Athletic Summer Camps: A $25 discount is offered to children of employees who wish to participate in any of the sport

camps operated by the college during the summer months.

Cellular Discount: Employees are eligible for a discount on monthly cell phone fees with Sprint, AT&T, Verizon, and T-

Mobile.

Joseph Alioto Rec. Center: For $20 a month, you can receive access to the Rec. Center and all its amenities.

Free or Discounted Membership: Employees can join Travis Credit Union, or a fitness club with discounted membership

fees through their health insurance. Yoga and Pilates classes are held on campus weekly. Liberty Mutual also offers

discounts on home and auto insurance.

19

MEDICARE PART D NOTICE

Important Notice from Saint Mary’s College About Your Prescription Drug Coverage and Medicare

Please read this notice carefully and keep it where you can find it. This notice has information about your current

prescription drug coverage with Saint Mary’s College and about your options under Medicare’s prescription drug

coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are

considering joining, you should compare your current coverage, including which drugs are covered at what cost, with

the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about

where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug

coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this

coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that

offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by

Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Saint Mary’s College has determined that the prescription drug coverage offered by Health Net and Kaiser

Permanente is, on average for all plan participants, expected to pay out as much as standard Medicare prescription

drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable

Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare

drug plan.

__________________________________________________________________________

When Can You Join A Medicare Drug Plan?

You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th -

December 7th.

However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also

be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?

If you decide to join a Medicare drug plan, your current coverage may be affected.

If you do decide to join a Medicare drug plan and drop your current Saint Mary’s College coverage, be aware that you

and your dependents will not be able to get this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your current coverage with Saint Mary’s College and don’t join a

Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a

penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription

drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per

month for every month that you did not have that coverage. For example, if you go nineteen months without

creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary

premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug

coverage. In addition, you may have to wait until the following October to join.

20

MEDICARE PART D NOTICE - Continued

For More Information About This Notice Or Your Current Prescription Drug Coverage…

Contact your Human Resource Department for further information. NOTE: You’ll get this notice each year. You will

also get it before the next period you can join a Medicare drug plan, and if this coverage through Saint Mary’s College

changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You”

handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted

directly by Medicare drug plans.

For more information about Medicare prescription drug coverage:

Visit www.medicare.gov

Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For

information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-

772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be

required to provide a copy of this notice when you join to show whether or not you have maintained creditable

coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).

21

WOMEN’S HEALTH & CANCER RIGHTS ACT

Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides

benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve

symmetry between the breasts, prostheses and complications resulting from a mastectomy, including

lymphedemas?

The Women’s Health and Cancer Rights Act of 1998 requires group health plans to make certain benefits

available to participants who have undergone a mastectomy. In particular, a plan must offer mastectomy

patients for:

All stages of reconstruction of the breast on which the mastectomy was performed

Surgery and reconstruction of the other breast to produce a symmetrical appearance

Prostheses

Treatment of physical complications of the mastectomy, including lymphedema

Contact Anthem Blue Cross or Kaiser Permanente for more information.

DESIGNATION OF PRIMARY CARE PROVIDER

Health Net and Kaiser Permanente generally requires the designation of a primary care provider. You have the

right to designate any primary care provider who participates in the Health Net or Kaiser network and who is

available to accept you or your family members. For information on how to select a primary care provider, and

for a list of the participating primary care providers, contact the Health Net or Kaiser Member Services for

assistance.

For children, you may designate a pediatrician as the primary care provider.

You do not need prior authorization from Kaiser Permanente in order to obtain access to obstetrical or

gynecological care from a health care professional in the Kaiser network who specializes in obstetrics or

gynecology. The health care professional, however, may be required to comply with certain procedures,

including obtaining prior authorization for certain services, following a pre-approved treatment plan, or

procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics

or gynecology, contact Health Net or Kaiser Member Services for assistance.

22

HIPAA NOTICE OF SPECIAL ENROLLMENT

If you are declining enrollment for yourself or your dependents (including your spouse or domestic partner)

because of other health insurance or group health plan coverage, you may be able to enroll yourself and your

dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer

stops contributing toward your or your dependents’ other coverage). However, you must request enrollment

within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing

toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption,

you may be able to enroll yourself and your dependents. However, you must request enrollment within 30

days after the marriage, birth, adoption, or placement for adoption.

Also, you may be entitled to special enrollment rights pursuant to the Children’s Health Insurance Program

Reauthorization Act of 2009 (the Act) if you or your dependents:

1. Lose coverage under a Medicaid or State Plan (such as California’s Medi-Cal); or

2. Become eligible for group health premium assistance under a Medicaid plan or State Plan.

If a special enrollment right is provided pursuant to the Act, you may change your election consistent with

such special enrollment right within 60 days as long as the election is made consistent with the special

enrollment.

Waiver of Coverage

If you elect to waive coverage for yourself or your dependents (including your spouse), you acknowledge that

you and your spouse and/or dependent child(ren) can only enroll later during an annual open enrollment

period. An exception to this is if you and your spouse and/or dependent child(ren) are entitled to enroll in

accordance with the “Special Enrollment Rights” described above.

To request special enrollment or obtain more information, contact your Human Resources Department.

23

PREMIUM ASSISTANCE UNDER MEDICAID and

THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States

use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or http://www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan.

Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or

CHIP, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at http://www.askebsa.dol.gov or by calling toll-free 1-866-444-EBSA (3272).

If you live in one of the following States, you may be eligible for assistance paying your employer

health plan premiums. The following list of States is current as of July 31, 2013. You should

contact your State for further information on eligibility –

ALABAMA – Medicaid COLORADO – Medicaid

Website: http://www.medicaid.alabama.gov

Phone: 1-855-692-5447

Medicaid Website: http://www.colorado.gov/

Medicaid Phone (In state): 1-800-866-3513

Medicaid Phone (Out of state): 1-800-221-3943 ALASKA – Medicaid

Website:

http://health.hss.state.ak.us/dpa/programs/medicai

d/

Phone (Outside of Anchorage): 1-888-318-8890

Phone (Anchorage): 907-269-6529

ARIZONA – CHIP FLORIDA – Medicaid

Website: http://www.azahcccs.gov/applicants

Phone (Outside of Maricopa County): 1-877-764-

5437

Phone (Maricopa County): 602-417-5437

Website: https://www.flmedicaidtplrecovery.com/

Phone: 1-877-357-3268

GEORGIA – Medicaid

Website: http://dch.georgia.gov/

Click on Programs, then Medicaid, then Health

Insurance Premium Payment (HIPP)

Phone: 1-800-869-1150

24

IDAHO – Medicaid and CHIP MONTANA – Medicaid

Medicaid Website:

www.accesstohealthinsurance.idaho.gov

Medicaid Phone: 1-800-926-2588

CHIP Website: www.medicaid.idaho.gov

CHIP Phone: 1-800-926-2588

Website:

http://medicaidprovider.hhs.mt.gov/clientpages/

clientindex.shtml

Phone: 1-800-694-3084

INDIANA – Medicaid NEBRASKA – Medicaid

Website: http://www.in.gov/fssa

Phone: 1-800-889-9949

Website: www.ACCESSNebraska.ne.gov

Phone: 1-800-383-4278

IOWA – Medicaid NEVADA – Medicaid

Website: www.dhs.state.ia.us/hipp/

Phone: 1-888-346-9562

Medicaid Website: http://dwss.nv.gov/

Medicaid Phone: 1-800-992-0900

KANSAS – Medicaid

Website: http://www.kdheks.gov/hcf/

Phone: 1-800-792-4884

KENTUCKY – Medicaid NEW HAMPSHIRE – Medicaid

Website: http://chfs.ky.gov/dms/default.htm

Phone: 1-800-635-2570

Website:

http://www.dhhs.nh.gov/oii/documents/hippapp.pdf

Phone: 603-271-5218

LOUISIANA – Medicaid NEW JERSEY – Medicaid and CHIP

Website: http://www.lahipp.dhh.louisiana.gov

Phone: 1-888-695-2447

Medicaid Website:

http://www.state.nj.us/humanservices/

dmahs/clients/medicaid/

Medicaid Phone: 609-631-2392

CHIP Website:

http://www.njfamilycare.org/index.html

CHIP Phone: 1-800-701-0710

MAINE – Medicaid

Website: http://www.maine.gov/dhhs/ofi/public-

assistance/index.html

Phone: 1-800-977-6740

TTY 1-800-977-6741

MASSACHUSETTS – Medicaid and CHIP NEW YORK – Medicaid

Website: http://www.mass.gov/MassHealth

Phone: 1-800-462-1120

Website:

http://www.nyhealth.gov/health_care/medicaid/

Phone: 1-800-541-2831

MINNESOTA – Medicaid NORTH CAROLINA – Medicaid

Website: http://www.dhs.state.mn.us/

Click on Health Care, then Medical Assistance

Phone: 1-800-657-3629

Website: http://www.ncdhhs.gov/dma

Phone: 919-855-4100

MISSOURI – Medicaid NORTH DAKOTA – Medicaid

Website:

http://www.dss.mo.gov/mhd/participants/pages/hipp.

htm

Phone: 573-751-2005

Website:

http://www.nd.gov/dhs/services/medicalserv/medicai

d/

Phone: 1-800-755-2604

25

OKLAHOMA – Medicaid and CHIP UTAH – Medicaid and CHIP

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

Website: http://health.utah.gov/upp

Phone: 1-866-435-7414

OREGON – Medicaid and CHIP VERMONT– Medicaid

Website: http://www.oregonhealthykids.gov

http://www.hijossaludablesoregon.gov

Phone: 1-800-699-9075

Website: http://www.greenmountaincare.org/

Phone: 1-800-250-8427

PENNSYLVANIA – Medicaid VIRGINIA – Medicaid and CHIP

Website: http://www.dpw.state.pa.us/hipp

Phone: 1-800-692-7462

Medicaid Website:

http://www.dmas.virginia.gov/rcp-HIPP.htm

Medicaid Phone: 1-800-432-5924

CHIP Website: http://www.famis.org/

CHIP Phone: 1-866-873-2647

RHODE ISLAND – Medicaid WASHINGTON – Medicaid

Website: www.ohhs.ri.gov

Phone: 401-462-5300

Website:

http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm

Phone: 1-800-562-3022 ext. 15473

SOUTH CAROLINA – Medicaid WEST VIRGINIA – Medicaid

Website: http://www.scdhhs.gov

Phone: 1-888-549-0820

Website: www.dhhr.wv.gov/bms/

Phone: 1-877-598-5820, HMS Third Party Liability

SOUTH DAKOTA - Medicaid WISCONSIN – Medicaid

Website: http://dss.sd.gov

Phone: 1-888-828-0059

Website: http://www.badgercareplus.org/pubs/p-

10095.htm

Phone: 1-800-362-3002

TEXAS – Medicaid WYOMING – Medicaid

Website: https://www.gethipptexas.com/

Phone: 1-800-440-0493

Website:

http://health.wyo.gov/healthcarefin/equalitycare

Phone: 307-777-7531

To see if any more States have added a premium assistance program since July 31, 2013, or for more information on special enrollment rights, you can contact either:

U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa http://www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137

26

Carrier Contact Information & Resources

Benefit Plans Phone Policy Numbers Email/Website

Delta Dental PPO (800) 765-6003 18620 www.deltadentalca.org

DeltaCare HMO (800) 422-4234 78818 www.deltadentalins.com

Employee Assistance Program (800) 977-7585 code: smceap members.mhn.com

Health Net HMO (800) 522-0088 70122A www.healthnet.com

Health Net PPO/HSA (800) 676-6976 N7074A (EE coverage) N7070A (EE+Deps coverage)

www.healthnet.com

Kaiser HMO (800) 464-4000 192-0004 www.kp.org

Liberty Mutual Auto Insurance (800) 438-6388 106339 www.LibertyMutual.com

Retirement – TIAA (800) 842-2007 624 www.tiaa-cref.com

Travel Assistance (800) 872-1414 01-AA-UNM-7216 www.assistamerica.com

Unemployment (800) 480-3287 www.edd.ca.gov

UNUM Life and Disability (800) 445-0402 143461 www.unum.com

Vision Service Plan (800) 877-7195 30071092 www.vsp.com

Human Resources Benefit Specialist

Jean Ann Balassi (925) 631-4055 Benefits@stmarys-ca.edu

Director, Benefits and Compensation

Ann Kelly (925) 631-4055 Benefits@stmarys-ca.edu

r e s o u r c e s