YourBenefits2021 it's all about - Northwestern University
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What’s Inside The Basics.................................................................. 1 Eligibility............................................................. 1 Faculty and Staff.............................................. 1 Dependents...................................................... 1 Medical, Dental, and Vision Coverage Tiers.......... 1 Effective Date of Coverage.................................. 2 Premium Costs.................................................... 2 For Your Health.......................................................... 3 Medical............................................................... 3 Health Savings Account.................................... 6 Prescription Drug Benefits................................ 9 Dental............................................................... 10 Vision................................................................ 11 Health Care Flexible Spending Account............. 13 For Your Protection................................................... 15 Extended Sick Time........................................... 15 Long-Term Disability.......................................... 15 Life Insurance................................................... 17 For Your Well-being.................................................. 19 Dependent Care Flexible Spending Account...... 19 Commuter Benefit............................................. 20 Tuition Benefits................................................. 21 YourLife Wellness Benefits................................ 22 Work/Life & Family Resources........................... 23 For Your Future......................................................... 24 Retirement Benefits.......................................... 24 Retiree Benefits & Privileges............................. 25 Glossary................................................................... 26 Directory.................................................................. 28 2 | Benefits Guide 2018 | Northwestern University
The Basics Eligibility In general, you are eligible to participate in the Voluntary Savings Plan if you are an FACULTY AND STAFF actively-employed faculty or staff member For Your Health/For Your Protection/ paid by Northwestern. However, if you are a For Your Wellbeing contractor, leased employee, or nonresident alien of the U.S. you may not be eligible to You are eligible to participate in most of the participate. To qualify for Northwestern University benefit plans in these benefits coverage, three categories if you are a: DEPENDENTS your Northwestern § Faculty member appointed to work You may include your benefits-eligible Depen- University salary full-time or part-time (half-time or more) must be sufficient to dents under your medical, dental, and vision for the entire academic year or on a cover any premium coverage, as well as under spouse and depen- full-time basis for half the academic year. costs that may be dent life insurance. Your benefits-eligible deducted from your pay § Regular staff member scheduled to work Dependents can also take advantage of based on the choices at least 18.75 hours per week (half-time certain Tuition Benefits. In addition, family you make during or more) for at least 12 months or 37.5 members may access programs and services benefits enrollment. hours per week (full-time) for at least six offered through the YourLife Wellness Program months. and Work/Life & Family Resources. For more information, see Dependent Medical You are eligible to participate in University- Coverage: Proof of Eligibility Required on page 2. For details regarding sponsored Tuition Benefits if you are a full-time faculty or staff member; a service- eligibility guidelines based eligibility guideline also applies to these Medical, Dental, and Vision for the benefit plans benefits. These benefits are not available to Coverage Tiers described in this part-time faculty and staff. If you choose to participate in a medical, guide, visit http:// dental and/or vision plan, you also must www.northwestern. For Your Future choose a Coverage Tier: edu/hr/benefits/. You are eligible to participate in the § You Only – coverage for you only Northwestern University Retirement Plan if § You + Spouse – coverage for you and you are a faculty or staff member (as defined your legal spouse/civil union partner by the plan) and: Throughout this § You + Child(ren) – coverage for you booklet, key terms § You are at least age 21 and one or more child(ren) appear in initial caps; § You are scheduled to work at least 18.75 definitions of these § You + Spouse + Child(ren) – coverage hours per week, and terms can be found in for you, your legal spouse, and one or the Glossary on pages § You have completed two years of continu- more child(ren) 26 and 27. ous service (24-consecutive months of service with the University) as of the first Remember: You can include adult child(ren) anniversary of your employment date or under your medical, dental, and vision any subsequent anniversary of that date. coverage to age 26 – regardless of their Note: Under certain circumstances, prior educational, marital, tax, or work status. service with a tax-exempt educational or research organization or a state educa- tional organization immediately prior to your Northwestern employment date may be used to satisfy this service requirement. Northwestern University | Benefits Guide 2021 | 1
The Basics Effective Date of Coverage Within the If you are a: Northwestern University benefits § Current employee and you enroll for coverage during annual Open Enrollment – any program, some new coverage options you choose will take effect on the following January 1. benefits provide § New hire and you enroll for coverage within 31 days of start date – any coverage options you automatic cov- choose will begin on the first day of the month after your hire date (or on your date of hire if erage for which your hire date is the first of the month), unless otherwise noted in this booklet. Northwestern pays the full cost, while Premium Costs others provide Your cost for any coverage options you elect will be deducted from your pay using Pre-Tax coverage options Contributions or After-Tax Contributions, depending on the coverage for which the premium is for which you and being deducted. 2021 premium costs are included in this booklet; see the appropriate section Northwestern for each benefit. share the cost (or for which you pay the full cost). Your costs will Dependent Medical Coverage: Proof of Eligibility Required be based on the coverage options If you include dependents under your University-sponsored medical coverage, you must you choose. submit proof of eligibility for each dependent and Social Security number (for those who have one). Coverage for a dependent will not begin until the insurance company accepts such proof. Benefits-Eligible Dependent Acceptable Documentation Spouse – the person to whom you are legally married under the • Government-issued marriage certificate or laws of your state of residence • J-2 or H-4 visa (foreign nationals only) Partner – the person to whom you are legally joined in a civil • Government-issued civil union certificate or union; any reference in this guide to a “spouse” also refers to a • J-2 or H-4 visa (foreign nationals only) civil union partner Child(ren) – to age 26, regardless of their educational, marital, tax, or work status. • Biological child(ren) • Child(ren)’s government-issued birth certificate • Other qualified child(ren), including foster children, stepchil- • See requirements listed at https://www.northwestern.edu/ dren, legally adopted children or grandchildren, and any child hr/benefits/eligibility-changes/verify-dependents.html for whom you are the legal guardian, as defined by a court order 2 | Benefits Guide 2021 | Northwestern University
For Your Health Medical You can choose a medical plan based on While enrolling in a medical plan, you should the protection you and your family need. assess your needs and those of your family. All four Northwest- You can use the health cost estimator, located ern-sponsored Northwestern offers four medical plans: in the online enrollment site, to estimate the medical plans pay § Premier PPO, Select PPO, and Value PPO benefits you may receive and what you may 100% of the cost – three preferred provider options (PPOs) pay in out-of-pocket costs (premiums and of Preventive Care that offer the flexibility to go to any Deductible, Coinsurance, and/or Copays and will help you provider you choose (though you will combined) under different scenarios. and your family receive greater benefits and pay lower with the costs of Whichever plan you choose, you can enroll in out-of-pocket costs when you see a maintaining good coverage just for yourself, or you may include provider who is a member of the North- health and treating one or more eligible family members under western Medicine or BlueCross disease and injury. your coverage (see Medical, Dental, and Vision BlueShield PPO Network). Coverage Tiers on page 1). § HMO Illinois – a health maintenance organization (HMO) coverage option that You and Northwestern share the cost of the gives you access to the HMO Illinois medical coverage you choose. You pay your provider Network, but pays no benefits share through Pre-Tax Contributions, which when you see a provider who is not a will be automatically deducted from your member of the Network (except in an paycheck. emergency). BlueCross BlueShield of Illinois administers all four medical plans. The four medical plans differ in: § How you and each plan share the cost of covered health care services – potential out-of-pocket expenses (the amounts you may pay in Deductible, Coinsurance and/or Copays) vary by plan and, if you choose a PPO coverage option, whether you receive services from a Northwestern Medicine provider, in-Network, or out-of- Network (see Medical Plans At-a-Glance on page 4). § How much you pay in monthly premiums – premiums vary by plan based on Coverage Tier and salary tier (see Monthly Premium Costs: Medical on page 5) Northwestern University | Benefits Guide 2021 | 3
For Your Health Medical Plans At-a-Glance Plan Feature Premier PPO1 Select PPO1 Value PPO2,3 HMO Illinois1 Northwestern Medicine Tier 1 Providers $250 individual/ $500 individual/ $1,500 individual/ Deductible $750 family $1,500 family $3,000 family Coinsurance 5% 10% 10% Out-of-Pocket $1,200 individual/ $1,800 individual/ $2,400 individual/ Not applicable Maximum $3,200 family $4,800 family $6,400 family 10% after Office Visit Copay $10 Primary Care Physician/$20 specialist Deductible $150 (waived if admitted) + Coinsurance 20% after ER Copay 10% Coinsurance 20% Coinsurance Deductible In-Network Providers $400 individual/ $750 individual/ $2,000 individual/ Deductible $1,200 family $2,250 family $4,000 family Not applicable Coinsurance 10% 20% Out-of-Pocket $2,400 individual/ $3,000 individual/ $3,000 individual/ $1,500 individual/ Maximum $6,600 family $8,000 family $8,000 family $3,000 family $25 PCP/ Office Visit Copay $25 Primary Care Physician/$35 specialist 20% after $35 specialist $150 (waived if admitted) + Coinsurance Deductible $150 ER Copay 10% Coinsurance 20% Coinsurance (waived if admitted) Out-of-Network Providers $800 individual/ $1,500 individual/ $3,000 individual/ Deductible $2,400 family $4,500 family $6,000 family Coinsurance 30% 40% after Deductible Not applicable Out-of-Pocket $4,800 individual/ $6,000 individual/ $7,500 individual/ Maximum $12,800 family $16,000 family $20,000 family 30% after Office Visit Copay 40% after Deductible Deductible $150 (waived if admitted) + Coinsurance 20% after $150 ER Copay 10% Coinsurance 20% Coinsurance Deductible (waived if admitted) 1 Copays apply toward the out-of-pocket maximums. 2 The in- and out-of-Network Deductibles are tracked separately; a separate out-of-pocket maximum applies. 3 For Value PPO participants who choose You + Spouse, You + Child(ren), or You + Spouse + Child(ren) coverage, the family Deductible and out-of-pocket rates apply. 4 | Benefits Guide 2021 | Northwestern University
For Your Health Monthly Premium Costs: Medical Premier PPO Select PPO Value PPO HMO Illinols Coverage/Salary Tier Full-Time Part-Time Full-Time Part-Time Full-Time Part-Time Full-Time Part-Time You Only Under $42,000 $234 $426 $47 $227 $17 $184 $106 $274 $42,001 - $75,000 $277 $453 $86 $253 $37 $196 $139 $296 $75,001 - $128,000 $334 $493 $139 $289 $84 $229 $181 $324 $128,001 - $182,000 $405 $540 $201 $331 $131 $259 $230 $357 $182,001 and above $511 $611 $293 $391 $199 $305 $307 $409 You + Spouse Under $42,000 $512 $932 $105 $497 $39 $403 $233 $600 $42,001 - $75,000 $606 $993 $188 $552 $80 $429 $304 $648 $75,001 - $128,000 $731 $1,078 $304 $631 $182 $497 $395 $709 $128,001 - $182,000 $887 $1,182 $443 $722 $285 $568 $503 $781 $182,001 and above $1,119 $1,338 $640 $855 $432 $666 $673 $895 You + Child(ren) Under $42,000 $435 $794 $88 $422 $34 $341 $201 $518 $42,001 - $75,000 $516 $848 $159 $468 $68 $365 $262 $559 $75,001 - $128,000 $622 $918 $260 $535 $153 $422 $341 $611 $128,001 - $182,000 $757 $1,009 $376 $614 $242 $481 $433 $673 $182,001 and above $953 $1,140 $543 $726 $368 $565 $580 $772 You + Spouse + Child(ren) Under $42,000 $771 $1,400 $156 $745 $57 $602 $350 $903 $42,001 - $75,000 $910 $1,493 $282 $830 $120 $644 $457 $975 $75,001 - $128,000 $1,098 $1,619 $456 $946 $273 $746 $595 $1,067 $128,001 - $182,000 $1,332 $1,777 $664 $1,086 $427 $849 $757 $1,176 $182,001 and above $1,681 $2,010 $962 $1,285 $648 $997 $1,013 $1,347 The salary tier for current employees is assigned salary tier, unless you transition from determined by your salary on September 1st full-time to part-time or part-time to full-time. of the year preceding the plan year (e.g., premiums starting January 1, 2021 are based If you are covered by a collective bargaining on your September 1, 2020 salary). Mid-year agreement, consult your contract for changes to salary will not change your additional employee contribution information. Northwestern University | Benefits Guide 2021 | 5
For Your Health HEALTH SAVINGS ACCOUNT – When You Enroll in a Health Savings FOR VALUE PPO PARTICIPANTS ONLY Account for the First Time: You must renew If you choose coverage under the Value PPO You must activate your HSA upon notification your election to medical plan: from PayFlex. Simply go to www.payflex.com, § You can open a Health Savings Account click on “Create Your Profile” and follow the make Pre-Tax (HSA) and make Pre-Tax Contributions to prompts. Contributions to this account. During the initial set-up of an HSA, the bank a Health Savings § You can use the Pre-Tax Contributions in must fulfill certain obligations to establish Account each your HSA to pay for qualified health care and maintain a Customer Identification year during Open expenses for yourself, your spouse, or Program (CIP) for each HSA participant, based Enrollment. If you your dependent(s), including Deduct- on federal laws, including the USA Patriot Act, don’t, your HSA ibles, Copays, Coinsurance, and eligible the Bank Secrecy Act, the Money Laundering services that are not covered by your Control Act and other anti-money laundering Pre-Tax Contribu- plan. laws, as they may apply. tion amount for § The amount contributed to your HSA is As part of this process, you may receive a the next year will subject to an annual maximum – $2,600 request from the partner bank to submit default to $0. if you elect You Only coverage and additional information, which may include a Northwestern will match $1,000; $5,200 copy of your driver’s license or passport, or a if you elect You + Spouse, You + recent utility bill. You must provide the re- Child(ren) or You + Spouse + Child(ren) quested information; if you don’t, the bank will coverage and Northwestern will match not be able to set up your account (and you $2,000 – and will be equally split will not be able to receive any contribution between your own contributions and from Northwestern). matching contributions Northwestern will make on your behalf (see Contributing to an HSA on page 7). § Any unused balance in your HSA at year-end will rollover to the next year. § If you retire or leave Northwestern you can take your HSA with you. Important! Under IRS rules, if you open an HSA, you cannot participate in a traditional Health Care Flexible Spending Account (FSA); however, you can participate in a limited-use Health Care FSA (see page 13 for details). 6 | Benefits Guide 2021 | Northwestern University
For Your Health Contributing to an HSA Enrolled in Medicare? 1 Your own contribution – You can make your If you will be turning age 65 in 2022 (and will own Pre-Tax Contribution of up to $2,600 if enroll in Medicare), you can choose coverage you elect You Only coverage or $5,200 if you under the Value PPO medical plan, but you will elect You + Spouse, You + Child(ren) or You + not be eligible to make Pre-Tax Contributions Spouse + Child(ren) coverage. to an HSA – or to receive Northwestern matching contributions to an HSA after 2 Northwestern’s matching contribution December 31, 2021. However, you may – Northwestern will match your Pre-Tax continue to use any balance you have in an Contribution to your HSA up to: HSA to pay qualified health care expenses in § $1,000 – if you elect You Only coverage, or 2022 and beyond (and this money will remain tax-free). § $2,000 – if you elect You + Spouse, You + Child(ren) or You + Spouse + Family coverage. If you and Northwestern contribute the Any money added to your HSA – including maximum allowed, the total contributions Northwestern matching contributions – is to your HSA for the year will equal the your money to keep. annual maximum contribution allowed under federal regulations. 3 “Catch-up” contribution – If you are age 55 or older, you can make an annual “catch-up” contribution4 (using Pre-Tax Contributions) to your HSA each year. This contribution – over and above the maximum annual contribution – can help you accumulate more in your HSA sooner. Northwestern does not match any “catch-up” contributions. Northwestern Annual Annual Your Own Matching Maximum “Catch-Up” Value PPO Medical Plan Coverage: Contribution Contribution Contribution Contribution4 You Only Up to $2,600 + Up to $1,000 = $3,600 + Up to $1,000 You + Spouse, You + Child(ren), or Up to $5,200 + Up to $2,000 = $7,200 + Up to $1,000 You + Spouse + Child(ren) 4 You can make “catch-up” contributions only if you are age 55 or older – or will reach age 55 – in 2021. Once eligible, you may continue to make catch-up contributions until the year in which you reach age 65 or become eligible for Medicare. Northwestern University | Benefits Guide 2021 | 7
For Your Health Qualified Health Care Expenses Using Your Health Savings Account You can use pre-tax dollars from your HSA to If you participate in an HSA, you’ll receive a pay qualified health care expenses only. PayFlex debit card. It’s all you’ll need whenever Qualified health care expenses – as defined by you want to use pre-tax dollars from your HSA the Internal Revenue Service (IRS) – include: to pay qualified health care expenses. If you § Deductible, Coinsurance, and Copay already have an unexpired PayFlex debit card amounts you pay under your medical from prior years, you will not receive a new one. coverage § Prescription drugs – including over-the- counter drugs for which you have a prescription § Acupuncture and chiropractic services § Dental care – including orthodontia (after meeting your medical deductible) § Vision care – including contact lenses, prescription sunglasses and LASIK surgery (after meeting your medical deductible) Using the PayFlex website – www.payflex.com. § Hearing aids – including batteries – you can: § Premiums for medical coverage while § Access your account information, view receiving federal or state unemployment transactions, and check the status of benefits claims § COBRA continuation coverage after § See a complete listing of qualified health leaving your Northwestern employment care expenses, and § Premiums for eligible long-term care, and § Obtain account-related forms. § Medicare premiums and out-of-pocket expenses – including Deductibles, Important! Be sure to save itemized receipts Copays, and Coinsurance. of all your HSA transactions in case you need To learn more to provide documentation supporting your about available You can use your HSA to pay qualified health use of the account for qualified health care HSA investment care expenses incurred on or after the date expenses. options, visit the you open your account, and you can use it to PayFlex website – pay qualified health care expenses incurred by Over time, the balance in your HSA can grow www.payflex.com. your spouse and children even if they are not through the contributions that you and enrolled as dependents under your Value PPO Northwestern make to your account, rollovers medical plan coverage. of your unused account balance from year-to- year, as well as investment earnings. For more information about qualified health care expenses, visit the IRS Web site at Investing Your HSA for Growth www.irs.gov. Once the balance in your HSA exceeds $1,000 you can start investing the excess in one or more mutual funds managed by Bank of New York Mellon. You will be able to manage your investments and track your account growth online. 8 | Benefits Guide 2021 | Northwestern University
For Your Health PRESCRIPTION DRUG BENEFITS All four Northwestern-sponsored medical plans provide benefits toward the cost of prescription drugs. Express Scripts – www.express-scripts.com – is the Pharmacy Benefit Manager for all four plans. Is a Generic Premier PPO, Select PPO, and HMO Illinois Value PPO Alternative You pay a copay of: Available? § You pay the full cost of § $10 for each Generic Drug prescription all prescription If a Generic Drug is § $30 for each Preferred Brand Name Drug Retail – medications until you available but you prescription 1 month supply5 meet the plan’s choose to fill a § $60 for each Non-Preferred Brand Name Drug annual Deductible prescription with a prescription Preferred Brand Name § After that, you pay § $90 for each Specialty Drug prescription 20% of your prescrip- or Non-Preferred Brand You pay a copay of: tion drug costs Name Drug, an ancil- (Coinsurance) until lary charge will be § $20 for each Generic Drug prescription your total out-of- added to your cost for Home Delivery – § $60 for each Preferred Brand Name Drug pocket expenses the medication – even 3-month supply5 prescription reach the plan’s if your doctor checked § $120 for each Non-Preferred Brand Name Drug annual Out-of-Pocket the “dispense as prescription Maximum written” box on the § $180 for each Specialty Drug prescription prescription form. The ancillary charge 5 If a prescribed medication requires prior authorization, your physician must be consulted before it can be will be 50% of the cost dispensed. Physicians should call Express Scripts at 800-417-1764 to provide authorization. difference between the If you elect coverage under the Premier PPO, If You Are Prescribed a Specialty Drug: brand-name version of Select PPO, or HMO Illinois medical plans, the the drug and the amount you pay in out-of-pocket costs for Prescriptions for all Specialty Drugs must generic version. This be filled through Accredo mail order; these ancillary charge will prescription drugs each year is subject to an prescriptions cannot be filled at a retail not apply toward the annual $1,500 “stop loss.” This annual stop- pharmacy. maximum cost per loss feature applies separately to you and to prescription or the each covered family member. If the amount annual Out-of-Pocket Accredo – a wholly owned subsidiary of you pay in Copays reaches $1,500 for you or a Maximum. Express Scripts – is a mail-order pharmacy covered family member in a calendar year, the whose sole purpose is specialty medication prescription drug Copays noted above will no management. Accredo fills prescriptions for longer apply to prescriptions filled for you or Specialty Drugs for oral, injectable, and that family member for the balance of the year. infused medications and provides on-call Prescription drug costs that exceed the nurse and pharmacist support for patients on approved dispensing limit in any given month these complex, expensive drugs. – or that are for medications not covered by Because many Specialty Drugs require refrig- your plan – will not count toward your annual eration, Accredo takes precautions to ensure out-of-pocket expenses. product preservation, including using temper- ature-controlled packaging and working with patients to arrange for safe and secure package delivery. For example, if you are unable to receive your medications at home, you may request delivery to your workplace, your doctor’s office, or a family member’s home. Northwestern University | Benefits Guide 2021 | 9
For Your Health Dental Free checkups help maintain good oral health. coverage must choose a dentist who is a Both plans pay member of the Guardian Dental HMO 100% of the cost of You can choose coverage under one of two provider Network as your primary dental preventive dental dental plans: care provider. The plan pays the full cost health care and § BlueCross BlueShield of Illinois Dental of preventive services. For all other will help you and PPO – You and your covered family covered services, the plan pays 100% of your family with members can go to any dentist, but you the cost after you pay a specified Copay. the costs of main- will generally receive higher benefits (and taining good dental Whichever plan you choose, you can choose pay less out-of-pocket) for services you health and treating coverage just for yourself, or you may include receive from a dentist who is a member dental disease one or more eligible family members under of the BlueCross BlueShield of Illinois and injury. your coverage (see Medical, Dental, and Vision Dental PPO provider Network. The plan Coverage Tiers on page 1). pays the full cost of preventive services when using an in-Network dental You and Northwestern share the cost of the provider. dental coverage you choose. You pay your share § Guardian Dental HMO – You and each through Pre-Tax Contributions, which will be family member you include under your automatically deducted from your paycheck. Dental Plans At-a-Glance BlueCross BlueShield of Illinois Plan Features Dental PPO Guardian Dental HMO Diagnostic and Preventive Services – oral exams, Plan pays 100% – with no Deductible Plan pays 100% x-rays, cleanings, fluoride treatments Annual Deductible $50 individual/$150 family – Miscellaneous Services – sealants, space main- Plan pays 80% of the cost after Plan pays 100% of the cost after tainers, pulp vitality tests, palliative treatment to annual Deductible specified Copay relieve dental pain Restorative Services, Endodontic Services, Plan pays 80% of the cost after Plan pays 100% of the cost after Periodontal Services, Oral Surgery annual Deductible specified Copay Plan pays 50% of the cost after Plan pays 100% of the cost after Crowns/Inlays/Onlays annual Deductible specified Copay Plan pays 50% of the cost after Implants – annual Deductible For dependent children under age 26 For children and adults – plan pays Orthodontic Services – plan pays 50%, up to $3,000 lifetime 100% of cost after specified Copay maximum Annual Benefit Maximums $3,000 per person – Monthly Premium Costs: Dental BlueCross BlueShield of Illinois Dental PPO Guardian Dental HMO Coverage Tier Full-Time Part-Time Full-Time Part-Time You Only $21 $30 $7 $10 You + Spouse $45 $64 $13 $18 You + Child(ren) $51 $72 $14 $20 You + Spouse + Child(ren) $72 $102 $20 $28 10 | Benefits Guide 2021 | Northwestern University
For Your Health Vision Don’t underestimate the value of regular You can choose EyeMed Vision Care Plan eye exams. coverage just for yourself, or you may include one or more eligible family members under Northwestern’s vision plan through EyeMed your coverage (see Medical, Dental, and Vision offers comprehensive coverage, including eye Coverage Tiers on page 1). exams and allowances for eyewear. With open access to see any eye care provider, you can If you choose coverage under the EyeMed see the one who is right for you. Eye exams are Vision Care Plan, you pay the full cost of this an important part of overall health care for you coverage through Pre-Tax Contributions, and your entire family which will be automatically deducted from your paycheck. If you choose coverage under the EyeMed Vision Care Plan, you and your covered family While Northwestern-sponsored medical After you pay a members can go to any optometrist, but you plans have built-in vision discounts, provided $10 Copay, the will generally receive higher benefits (and pay through the Blue365 Discount Program (see EyeMed Vision less out-of-pocket) for services you receive Blue365 Discount Program: Overview); you can Care Plan will pay from a vision care provider who is a member of choose to enroll in the EyeMed Vision Care 100% of the cost the EyeMed provider Network. Plan, which will provide coverage for vision of an annual eye care services. Important! You cannot use exam performed EyeMed uses a national Network of more than both the Blue365 Discount Program and the by an EyeMed 35,000 retail chains and private practice EyeMed Vision Care Plan simultaneously to Network provider. providers. To locate an EyeMed Network cover the same vision services. provider near you, go to www.eyemedvision- Family members care.com (choose “Members” and under Find you include a Provider select the “Insight” Network). under your Eye- Med coverage can each receive an BLUE365 DISCOUNT PROGRAM: OVERVIEW annual eye exam for just $10, as Blue365 is a vision services discount § HMO participants – may be applied to well. program sponsored by BlueCross BlueShield remaining balances for covered vision for participants enrolled in the Premier PPO, care services (including frames, Select PPO, Value PPO, and HMO Illinois contact lenses, and various lens medical plans; it is not a vision insurance options) after the vision coverage plan. provided through their HMO Illinois coverage has been applied or Blue365 discounts for: exhausted. § PPO participants – may be applied to covered vision care services (including The Blue365 Discount Program is provided exams, frames, lenses, contact lenses, at no additional cost. and various lens options). These For details about how the Blue365 Discount discounts are provided through two Program works and how it can save you vision care providers: EyeMed and money, call BCBS at 800-327-8497 or visit Davis Vision. Participants who are also www.blue365deals.com. enrolled in the EyeMed Vision Care Plan may take advantage of these discounts only after they exhaust their EyeMed Vision Care Plan benefits. Northwestern University | Benefits Guide 2021 | 11
For Your Health Vision Plan At-a-Glance EyeMed Vision Plan Plan Features In-Network Out-of-Network Annual Eye Exam – once every 12 After $10 Copay, plan pays 100% Plan pays up to $40 months Exam Options: Contact Lenses • Standard Fit and 2 Follow-up Visits After $10 Copay, plan pays 100% Plan pays up to $40 • Premium Fit and Follow-up After $10 Copay, plan offers 10% discount on Plan pays up to $40 retail prices, then applies $55 allowance Frames – once every 12 months Plan pays 80% of balance over $130 Plan pays up to $65 Standard Plastic Lenses – once every 12 months • Single Vision After $10 Copay, plan pays 100% Plan pays up to $40 • Bifocal After $10 Copay, plan pays 100% Plan pays up to $60 • Trifocal/Lenticular After $10 Copay, plan pays 100% Plan pays up to $80 • Standard Progressive After $75 Copay, plan pays 100% Plan pays up to $60 • Premium Progressive – scheduled After $101-$113 copay, plan pays 100% Plan pays up to $60 • Premium Progressive – other After $75 Copay, plan pays 20% less $120 – allowance Standard Lens Options • UV Coating/Tint (solid and gradient) $15 – • Standard Scratch Resistance/ No Copay; plan pays 100% Plan pays up to $5 Standard Polycarbonate • Standard Anti-Reflective Coating $45 – • Polarized 20% discount off retail price – • Photochromic/Transitions Plastic $75 – • Premium Anti-Reflective Coating $57-$68 – – scheduled • Other Add-Ons and Services 80% discount off retail price – Contact Lenses – once every 12 months • Conventional No Copay; you pay 85% of balance over $200 Plan pays up to $160 • Disposable No Copay; you pay 100% of balance over $200 Plan pays up to $160 • Medically Necessary Plan pays 100% Plan pays up to $210 Lasik or PRK – from US Laser You pay 85% of retail price (95% of – Network promotional price) Monthly Premium Costs: Vision Coverage Tier EyeMed Vision Care Plan You Only $12 You + Spouse $24 You + Child(ren) $28 You + Spouse + Child(ren) $33 12 | Benefits Guide 2021 | Northwestern University
For Your Health Health Care Flexible Spending Account Save money on eligible health care expenses. § You can be reimbursed for eligible health care expenses up to the full You can save money when you use tax-free value of the Pre-Tax Contributions dollars from a Health Care Flexible Spending you’ve agreed to make for the year from Account (Health Care FSA) to pay eligible the first day of the benefit year – even health care expenses incurred by you, your before all scheduled contributions for spouse or your dependent child(ren). Note: You the year have been made. do not need to be enrolled in a Northwestern- sponsored medical plan to participate in a § You can use the money you contribute Health Care FSA. to a Health Care FSA each year to pay eligible expenses incurred in the If you choose medical coverage under the: calendar year (January 1-December 31) in which they are made, as well as § Premier PPO, Select PPO, or HMO Illinois You must renew medical plan – You can open (and contrib- eligible expenses incurred January your election to 1-March 15 of the following calendar ute to) a traditional Health Care FSA. make Pre-Tax year (the grace period). § Value PPO medical plan – You can open Contributions to (and contribute to) a limited-use Health § The deadline for submitting claims is a Health Care FSA Care FSA. March 31 of the year following the each year during calendar year in which the contribu- Open Enrollment. Whether you participate in a traditional or tions are made. If you don’t, your limited-use Health Care FSA, you can contrib- § You will forfeit any unused contribu- Health Care FSA ute up to $2,700 a year to your account. The tions in a Health Care FSA as of the Pre-Tax Contribu- minimum annual contribution is $240. claim filing deadline. tion amount for the next year will If you choose to contribute to a Health Care FSA: § Funds in your Health Care FSA are default to $0. not “portable” if you retire or leave § Once your enrollment takes effect, you Northwestern. will not be able to change your Pre-Tax Contributions to the account until the next Open Enrollment unless you experi- ence a qualifying life event. Traditional vs. Limited-Use Health Care FSA: What’s the Difference? According to IRS rules, if you open a Health Savings Account – which you can do only if you choose coverage under the Value PPO medical plan – you cannot contribute to a traditional Health Care FSA. However, you can contribute to a limited-use Health Care FSA. Here’s how a traditional Health Care FSA and a limited-use Health Care FSA differ: Traditional Health Care FSA Limited-Use Health Care FSA For Premier PPO, Select PPO, and HMO Illinois participants For Value PPO participants with an HSA • Use Pre-Tax Contributions to pay eligible health care • Use Pre-Tax Contributions to pay eligible DENTAL and expenses at ANY time within the plan year or grace period VISION expenses at ANY time • Use Pre-Tax Contributions to pay ALL eligible health care expenses incurred AFTER Value PPO annual Deductible has been met Northwestern University | Benefits Guide 2021 | 13
For Your Health Eligible Health Care Expenses Using Your Health Care FSA Eligible health care expenses you can reim- If you participate in a traditional or limited-use burse using tax-free dollars from a Health Health Care FSA, you’ll receive a PayFlex debit Care FSA include out-of-pocket expenses – card. It’s all you’ll need whenever you want to Deductibles, Coinsurance, and Copays under use pre-tax dollars from your Health Care FSA For a complete your medical coverage – as well as services to pay eligible health care expenses. However, list of health care that may not be covered by your medical, you can pay eligible health care expenses out services for which dental, and vision plans, including: of your own pocket and file a claim using the you may claim Express Claims feature on the PayFlex website eligible expenses, § Acupuncture – www.payflex.com. Once your claim is see IRS Publication § Chiropractic care processed, you will be reimbursed from your 502, available at § Dental and orthodontia Health Care FSA, up to the amount you have www.irs.gov. elected to contribute to a Health Care FSA for § Flu shots the year. § Laser eye surgery § Prescription drugs § Over-the-counter medications and items for which your doctor provides a prescription6 § Vision exams, eyeglasses and contact lenses, and § Weight loss programs. 6 Costs for over-the-counter medications and items purchased without a prescription are not eligible expenses and may not be reimbursed through a Health Care FSA. You may use your contributions to a Health You can also use the PayFlex website to: Care FSA for eligible expenses incurred during § Access your account information, view the calendar year in which the contributions transactions, and check the status of were made, as well as those incurred January claims 1 through March 15 of the following year. The § Set up direct deposit deadline for submitting claims for these eligible expenses is March 31 of that § See a complete listing of eligible health following year. care expenses, and § Obtain account-related forms, including claim forms, direct deposit forms, letters of medical necessity, enrollment forms, and other IRS publications. Important! Be sure to keep itemized receipts of all your Health Care FSA transactions in case you need to provide documentation supporting your use of the account for eligible health care expenses. 14 | Benefits Guide 2021 | Northwestern University
For Your Protection Extended Sick Time Long-Term Disability Continuing income if you’re unable to work Continuing income if you’re unable to work due to illness or injury for up to six months. due to illness or injury for more than six months. Extended Sick Time (EST) will provide continuing income in the event you are unable Long-Term Disability provides a monthly To learn more to work due to an illness or injury unrelated benefit if – due to illness or injury – you are about EST and how to work. unable to perform: it works – and for a § Your regular job – during the first two copy of frequently If you experience an extended illness or injury asked questions years of your disability, or and you are approved for EST benefits, you will about the program receive 100% of your hourly rate or monthly § Any reasonable job – after two years of – visit http://www. salary for up to 25 weeks following completion disability. northwestern. of an elimination period in which you are edu/hr/benefits/ To receive LTD benefits, you must be absent absent from work for seven consecutive disability-plans/ from work for six months of continuous calendar days or five consecutive business Extended-Sick- disability, then file an LTD claim. days. Time.html. There are two parts to the LTD plan: You do not need to enroll to be eligible to receive EST benefits. Your coverage under this § Core Plan – This plan provides a monthly program will begin automatically once you LTD benefit equal to 50% of your last complete six months of continuous benefits- working University salary, up to a maxi- eligible service with Northwestern. mum benefit of $11,500 per month. You are automatically enrolled in Core LTD The EST program is managed by The Hartford coverage. Insurance Company. To receive EST benefits, § Buy-Up Plan – This plan provides a you must be absent from work for five monthly LTD benefit equal to 60% of your consecutive business days, then file an EST last working University salary, up to a claim with The Hartford and be approved. maximum benefit of $13,800 per month. Northwestern pays the full cost of your It also allows for a benefit up to 70% from coverage under this program; there is no cost all sources, including Social Security to you. Disability Income (SSDI). You can enroll in Buy-Up LTD coverage during any benefits enrollment but you will be required to submit a Personal Health Application if you choose to enroll in any enrollment period other than your first enrollment opportunity as a new hire. If you are diagnosed or receive care for a condition within 26 weeks prior to your effective date of LTD coverage, you will not be covered by the LTD plan until you have been covered under the plan for at least 12 months. Northwestern University | Benefits Guide 2021 | 15
For Your Protection The maximum benefit period for which LTD The LTD program is managed by The Hartford benefits will be paid depends on your age at Insurance Company. Northwestern the time you become disabled and your Social requires faculty Security Normal Retirement Age. Northwestern pays the full cost of your and staff who Core LTD coverage. If you elect Buy-Up LTD apply for LTD Benefits typically cease at your Social Security coverage, you will pay the cost of that benefits to also Normal Retirement Age, but may continue additional 10%. The amount you pay will be apply for Social based on your age at disability according to based on your age. Security Disability the following table. Income (SSDI). The Hartford will Age at Disability Maximum LTD Benefit Period offset any LTD 62 or younger To Normal Retirement Age or 42 months, if greater benefit payments 63 To Normal Retirement Age or 36 months, if greater you receive with 64 30 months any SSDI benefits 65 24 months for which you are approved. 66 21 months 67 18 months 68 15 months 69 or older 12 months Annual Premium Costs: LTD Buy-Up Plan Your Age Rate Under 30 $0.082 30-34 $0.109 35-39 $0.123 40-44 $0.145 45-49 $0.187 50-54 $0.243 55-59 $0.284 60-64 $0.307 65 older $0.287 Note: To calculate your annual premium under the Buy-Up Plan, divide your annual salary by 100, then multiply by the rate for your age bracket. 16 | Benefits Guide 2021 | Northwestern University
For Your Protection Life Insurance Financial protection for you and your SUPPLEMENTAL, SPOUSE, AND Do you know family. DEPENDENT CHILD TERM LIFE INSURANCE who your beneficiaries Northwestern provides a combination of Basic You can increase your life insurance protection are? Term Life Insurance for you and the opportu- by electing the following types of optional nity to purchase additional Supplemental, coverage: Your Beneficiary Spouse, and Dependent Child Term Life is the person (or § Supplemental Term Life Insurance persons) who will Insurance. – Additional life insurance coverage for receive your Basic This coverage is provided through Dearborn yourself in increments of your Annual and Supplemental National. Northwestern Salary, up to a maximum of Term Life Insur- 5x your pay or $2,000,000, whichever is ance benefits if Northwestern pays the cost of your Basic Term less. Evidence of Insurability is not you die. Life Insurance. You pay the cost of any Supple- required for Supplemental Term Life mental, Spouse, and Dependent Child Term Insurance coverage of up to 3x your You can name Life Insurance you elect based on group Annual Northwestern Salary (or anyone you insurance rates. $1,000,000, whichever is less) at time want as your of hire; for Supplemental Term Life Beneficiary(ies) – BASIC TERM LIFE INSURANCE Insurance in excess of this amount (or if and designate as adding coverage during Open Enrollment) many people as As a benefits-eligible Northwestern faculty or Evidence of Insurability is required and Beneficiary(ies) as staff member, you receive Basic Term Life coverage will be subject to approval by you wish – for your Insurance automatically and at no cost to you. Dearborn National. Basic and Supple- You have the choice between Basic Term Life mental Term Life Insurance coverage equal to: § Spouse Term Life Insurance – Life Insurance. (Note: insurance for your spouse in increments You may not name § $50,000, or of $10,000, up to a maximum equal to Northwestern § 2.5 x your annual salary up to a the value of your total Basic Term Life University as a maximum of $250,000. Insurance plus Supplemental Term Life Beneficiary.) You Insurance election or $500,000, which- must specify the If you do not make a selection, you will default ever is less. Evidence of Insurability is not to the $50,000 coverage amount. percentage of the required for Spouse Term Life Insurance benefit to be paid coverage of up to $30,000 at time of hire; to each Beneficiary Note: Under IRS regulations, the value of for Spouse Term Life Insurance in excess (up to a maximum employer-based basic term life insurance in of this amount (or if adding coverage of 100% for all excess of $50,000 is considered “imputed” (or during Open Enrollment), Evidence of allocations). taxable) income. If you don’t want to incur this Insurability is required and coverage will imputed income, you may elect the $50,000 You are automati- be subject to approval by Dearborn Basic Term Life Insurance option. cally the Benefi- National. ciary for payment § Dependent Child Term Life Insurance of any Spouse Term – Life insurance for your unmarried Life Insurance child(ren) who are under age 26 and and/or Child Term financially dependent on you in incre- Life Insurance ments of $5,000, up to a maximum of coverage you $25,000 for each child. Evidence of elect. Insurability is not required. Northwestern University | Benefits Guide 2021 | 17
For Your Protection Monthly Premium Costs: Supplemental, Spouse, and Dependent Child Term Life Insurance Supplemental Term Life Insurance/ Supplemental Term Life Insurance/ Spouse Term Life Insurance Spouse Term Life Insurance Per person per $1,000: You Spouse Per person per $1,000: You Spouse Under age 25 $0.021 $0.021 Age 55-59 $0.211 $0.217 Age 25-29 $0.021 $0.021 Age 60-64 $0.280 $0.288 Age 30-34 $0.026 $0.026 Age 65-69 $0.432 $0.445 Age 35-39 $0.039 $0.040 Age 70 and older $0.691 $0.712 Age 40-44 $0.048 $0.049 Age 45-49 $0.075 $0.077 Dependent Child Term Life Insurance Age 50-54 $0.114 $0.117 Per child per $1,000 $0.128 Does This Coverage Provide Benefits in the Event of Accidental Injury or Death? All four types of term life insurance – Basic, For details regarding circumstances under Supplemental, Spouse and Child – include which AD&D benefits will be paid – as well as accidental death and dismemberment (AD&D) additional details about AD&D coverage – visit Insurance. This AD&D coverage will provide a http://www.northwestern.edu/hr/benefits/ benefit in an amount up to the applicable life resources/hw_spd.pdf. insurance if – as the result of an accident – you or your covered spouse, partner, or child: § Loses your sight, hearing, or a limb § Becomes paralyzed § Dies, or § Suffers certain other losses. AD&D coverage will pay a benefit equal to all or a specified percentage of the corresponding life insurance coverage amount, based on the nature of the loss. 18 | Benefits Guide 2021 | Northwestern University
For Your Well-being Dependent Care Flexible Spending Account Save money on eligible dependent § Funds in your Dependent Care FSA care expenses. are not “portable” if you retire or leave You must renew Northwestern. your election to You can save money when you use tax-free dollars from a Dependent Care Flexible Northwestern Reimbursement make Pre-Tax Spending Account (Dependent Care FSA) to Contributions to a If you open and contribute to a Dependent Dependent Care FSA pay eligible dependent care expenses. Your Care FSA, Northwestern will reimburse each year during qualified dependents may include your to your paycheck an amount equal to a Open Enrollment. children through age 12, or spouse, parents, percentage of your contribution if: If you don’t, your in-laws, siblings, or child(ren) over the age of 13 incapable of self-care. Those covered must § You have full-time status – 100% Dependent Care FSA be declared as a dependent on your tax return. full-time appointment or scheduled to Pre-Tax Contribu- work at least 37.5 hours per week tion amount for If you are single or married filing taxes jointly, the next year will § Your spouse is working or studying default to $0. If you you may contribute up to $5,000 per house- full-time, and are eligible to re- hold a year to a Dependent Care FSA. The minimum annual contribution is $240. § Your combined adjusted gross household ceive a reimburse- income is $130,000 or less. ment contribution If you choose to contribute to a Dependent from Northwestern, Care FSA: Combined Reimbursement Adjusted Gross Percentage/ you must re-submit § Once your enrollment takes effect, you Household Income Maximum7 your application for will not be able to change your contribu- this contribution Up to $60,000 80% – up to $4,000 tion to that account until the next Open each year, as well. $60,001 to $75,000 60% – up to $3,000 Enrollment unless you experience a qualifying life event. $75,001 to $100,000 40% – up to $2,000 $100,001 to $130,000 20% – up to $1,000 § You can be reimbursed for eligible dependent care expenses up to your 7 The maximum reimbursement amount is based on current account balance ONLY. Any a Dependent Care FSA annual contribution of expenses in excess of your current $5,000. The reimbursement amount is considered taxable income. account balance will be reimbursed as additional contributions are added to If you are eligible for – and wish to receive – your account throughout the year. a reimbursement, you must : § You can use the money you contribute to § Complete the online Dependent Care a Dependent Care FSA each year to pay Employer Match Application available eligible expenses incurred in the calendar on myHR (for instructions, see the User year (January 1-December 31) in which Guide), and they are made. § Provide Benefits a copy of the page from § The deadline for submitting claims is your most recent U.S. income tax Form March 31 of the year following the 1040 showing your tax-filing status and calendar year in which the contributions adjusted gross income (line 37). are made. To submit a request for reim- bursement, you must complete a PayFlex If your application is received after the start of claim form and submit it to PayFlex. the calendar year (January 1), Northwestern’s reimbursement for the year will be pro-rated. § You will forfeit any unused contributions Important! The enrollment form must be in a Dependent Care FSA at year end. completed each year if you wish to receive these funds. Northwestern University | Benefits Guide 2021 | 19
For Your Well-being Eligible Dependent Care Expenses Commuter Benefit Eligible dependent care expenses you can For your convenience, the University has reimburse using pre-tax dollars from a partnered with PayFlex to administer our Dependent Care FSA include: Commuter Transit and Parking program. § Day camp and camp activities (The campus parking programs administered by the Evanston Parking Office and by § Day care for your child(ren) For a complete list Transportation & Parking for the Chicago of child and dependent § Day care for an elderly or disabled Campus are not included.) care services for dependent which you may claim The program allows you to have the cost of § Nanny salary and taxes, and eligible expenses, your commuting expenses taken from your see IRS Publication § Summer sports day camp (overnight check on a pre-tax basis. 503, available at camp is NOT an eligible expense). www.irs.gov. See the HR Benefits website for more When filing a claim for reimbursement with information. PayFlex, you will be required to provide a tax ID number for the individual or facility providing eligible dependent care services. Using your Dependent Care FSA If you participate in a Dependent Care FSA, Important! Be sure you will pay eligible dependent care expenses to save itemized out of your own pocket and file a claim using receipts of all your the Express Claims feature on the PayFlex Dependent Care website – www.payflex.com. Once your claim FSA transactions is processed, you will be reimbursed for your in case you need claim from the available funds in your to provide Dependent Care FSA. documentation supporting your use You can also use the PayFlex website to: of the account for § Access your account information, view eligible dependent transactions, and check the status of care expenses. claims § Set up direct deposit § See a complete listing of eligible dependent care expenses, and § Obtain account-related forms, including claim forms, direct deposit forms, letters of medical necessity, enrollment forms, IRS Form 2441, and other IRS publica- tions. 20 | Benefits Guide 2021 | Northwestern University
For Your Well-being Tuition Benefits Offering financial assistance for you, your For classes taken outside of Northwestern: spouse, and your dependent child(ren) § Employee Portable Tuition8 – Reim- under age 26 bursement of tuition for undergraduate Tuition benefits at Northwestern are designed or graduate university degrees pursued In addition, to support the ongoing efforts of full-time, at schools other than Northwestern; Northwestern benefits-eligible faculty and staff – and their 2021 calendar year reimbursement is offers a 25% eligible family members – to pursue higher 100%; maximum annual benefit is discount per education. You can apply for these benefits $12,000 through 2020 ($5,250 for classes class on tuition online through the myHR Self-Service portal. that start on or after January 1, 2021). for non-degree § Dependent Portable Tuition – Tuition lessons taken For classes taken at Northwestern: assistance for undergraduate university at the Music § Employee Reduced Tuition – Reduced degrees pursued by employees’ depen- Academy by tuition for undergraduate or graduate dent children at U.S. accredited schools faculty, staff and university courses taken at Northwestern: other than Northwestern after a five-year retirees, their 2021 calendar year discount is 90%; service period; 2021 rate is 50% of tuition spouses and maximum annual discount is $12,000. and eligible fees for up to 8 semesters/12 dependent § Enhanced Employee Reduced Tuition – quarters lifetime maximum. children. Reduced tuition for undergraduate or Using the Online Application9 graduate university courses taken at Northwestern after a three-year service 1. Use a Firefox browser. period and while earning less than 2. Log into myHR Self-Service at https:// $100,000 a year; 2021 calendar year myHR.northwestern.edu with your NetID, discount is 90%; there is no limit on the Password, and Multifactor Authentication. annual discount. 3. Select “Benefits” and choose “My Tuition § Employee Northwestern Certificate Benefit Application.” Tuition – Reimbursement of tuition for 4. Select “Submit New Application.” non-credit, short duration certificate 5. Select the “Tuition Benefit Year.” programs taken at Northwestern; 2021 6. Use the magnifying glass icon to select calendar year reimbursement is 100%; the “Plan ID” (your eligible tuition benefit maximum annual benefit is $12,000. options will appear). § Dependent Reduced Tuition – Reduced 7. Follow instructions to complete application tuition for undergraduate university and upload required documentation. degrees pursued by employees’ spouses and dependent children at Northwestern For more information, visit http://www. – 85% for undergraduate courses in the northwestern.edu/hr/benefits/tuition. For School of Professional Studies (SPS) information on additional professional devel- after a six-month service period; 50% for opment opportunities, visit http://www. all other undergraduate level courses northwestern.edu/hr/learning/development/ after a five-year service period; 90% if index.html. hired full-time before January 1, 2000 – for up to 12 quarters lifetime maximum. 8 This plan is not available to employees hired on or after January 1, 2020. 9 If you do not have access to myHR Self Service, please email tuition-benefits@northwestern.edu. Northwestern University | Benefits Guide 2021 | 21
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