Human Resources - Lehigh University - Benefits Administration

Step one is electing the coverage on your flexible benefits enrollment. However, step two makes the coverage accessible to you. Step two is completing a Medical Enrollment/Change Application form and forwarding the form to Human Resources. If the medical plan you select requires that you choose a primary care physician, your application must include that information or it will not be complete. Your enrollment (and provider choice, if required) is then communicated to the plan by Human Resources.

It is your responsibility to complete both steps of the enrollment process. Your failure to do so does not constitute a Qualifying Life Event and will not permit you to dis-enroll from a plan you have initially selected before the next open enrollment period (the following November).

I am considering using the mail order drug program for my routine, maintenance medication. What is the cost?

The cost of a three-month supply of prescription drugs through Walgreen’s Health Initiatives (WHI) is 10 percent of the average wholesale price (AWP) for generic drugs up to a maximum cost of $75 and 20 percent of the (AWP) for brand names up to a maximum cost of $150. Remember that your percentage cost share may be lower than at your local pharmacy because the mail program buys drugs in larger quantities. You share in the savings larger quantity purchases may produce. You can check prescription prices with WHI using the telephone number on your ID card.

How are diabetic supplies covered by University-sponsored medical plans?

The WHI drug card program covers insulin, diabetic tablets, syringes, and diabetic supplies. All University medical plans provide coverage for diabetic supplies (glucose monitors, lancets, test strips, insulin pumps, infusion pumps, injection aids), orthotics, and self-management education programs.

The CMM Plan fee-for-service plan covers these latter supplies without referral under the standard deductible/copayment benefit.
PPO 80 subjects Durable Medical Equipment (DME) supplies to deductible and copayment as well.
PPO 100 covers 100 percent of the cost of the latter supplies only with a prescription and only at a DME provider.
Keystone Health Plan Central (KHP) offers two different levels of coverage — 100 percent at a DME provider (with a referral and prescription) or 50 percent at a pharmacy (with a prescription and KHP ID card). Insulin is covered only at 50 percent, regardless of purchase location. Remember that you can purchase insulin with only a 20 percent copayment using your WHI drug benefit.

If I select the HMO, can I change my primary care physician?

You can change your Keystone HMO primary care physician by calling Keystone Member Services at 1-800-669-7061. The change is normally effective the first of the month following the request.

How often can I change from one health insurance coverage plan to another?

You can always change to another plan during the Open Enrollment period, typically held from mid-November to December. That is the only time of year you can change to another carrier. If you are dissatisfied with your current coverage, please contact Human Resources. It is important to tell us about any problems you encounter.

I am getting married soon. Can I add my new spouse and/or stepchild(ren) to my coverage or do I have to wait until there is an open enrollment period?

You have 30 days from the date of marriage to add your spouse and/or stepchild(ren) to your health and/or dental coverage. After 30 days, you must wait for the next open enrollment period. Keep the spousal surcharge in mind when adding your spouse to your medical plan. You must contact Human Resources, provide a copy of your marriage documentation, and complete the appropriate documents.

How do I enroll my domestic partner and his/her dependent children in the plan?

The process for adding a domestic partner and his/her dependent children to your benefits program is similar to the process of adding any new dependent(s). Your first step is to complete a Personal Information Change Form, which can be found on the HR Website or by calling HR at 610-758-3900. On this form you’ll provide the names, dates of birth, and Social Security numbers of your dependents.

Next, you and your partner will complete affidavits to document and provide evidence that you are involved in a committed relationship. The affidavits are available on the HR Website or by calling HR at 610-758-3900. These completed affidavits are filed and retained in Human Resources.

To include these dependents in the Open Enrollment process on the Web for Employees, all you need to do is indicate your coverage choices on the available screens. For example, if you want life insurance for your partner, you’ll need to elect Dependent Life Insurance and identify the level of insurance you want to purchase. For medical plans, you’ll select your plan choice and then indicate the level of family coverage you need. You’ll also have to complete a medical coverage enrollment form for the carrier you select — including primary care physicians if you elect Keystone Health Plan coverage.

At any other time during the benefit plan year, you will have 30 days from the beginning of the partnership to add your partner and his or her dependent child(ren) to your health and/or dental coverage. After 30 days, you must wait for the next open enrollment period.

Keep the spousal/partner surcharge in mind when adding your spouse/partner to your medical plan. You must contact Human Resources and complete the appropriate affidavits.

If you elect medical coverage for a same-sex domestic partner and/or the child(ren) of that partner, you will incur a tax liability equal to the value of the benefits provided unless your partner and his/her child(ren) are tax qualified dependents pursuant to section 152 of the Internal Revenue Code. Please see “Tax Information On Health Benefits for Domestic Partners” on the HR Website. You are also urged to consult with your personal tax advisor or attorney.

I am expecting a baby soon. Can I add the baby to my coverage?

You have 30 days from the date of birth or adoption placement to add a child (under age 19) to your medical and/or dental coverage. You must contact Human Resources, provide proof of birth or adoption placement, and complete the appropriate documents.

My dependent child just turned age 19. Is he or she still covered on my medical plan?

Dependent children may be covered up to age 23 as long as they are unmarried, have never been married, are full-time students, and are financially dependent upon the employee. If disabled, special rules apply. Please contact Human Resources for information.

Can my grandchild or niece/nephew be covered under my health plan?

If the child is under age 19, unmarried, living in a parent-child relationship, and economically dependent upon the employee and the employee has legal guardianship of or has formally adopted the child, he or she may be covered under the employee’s health plan. The natural parent cannot be living in the same household as the child. If disabled, special rules apply. The dependent must be enrolled within 30 days from the date of legal custody. You must contact Human Resources, provide proof of custody, and complete the required documents.

Can my dependent parents be covered by my medical plan?

No. Even if totally dependent on the employee, parents are not eligible for coverage.

Can I submit claims to my Health Care Spending Account for my dependent parents?

Yes, you can submit claims for any person who is financially dependent on you and that you claim as a dependent on your income tax return.

Can I continue my health benefits if I resign?

Yes. COBRA continuation coverage provides you the option of continuing your medical and/or dental plan for up to 18 months. You would be responsible for paying the entire premium amount to Ceridian (Lehigh’s COBRA administrator) plus a two percent administrative fee. The provisions of COBRA also apply to dependents that lose coverage. Contact Human Resources for further information.

If I am disabled on a long-term basis, will I continue to receive income?

If you are continuously disabled for a period exceeding six months, you may receive 66-2/3 percent of your pre-disability LTD Base Salary. This benefit is offset by any Worker’s Compensation or Social Security disability benefits, and is provided under a Group Long-Term Disability policy with The Hartford Insurance Company.

What is the difference between pre-tax and post-tax long-term disability (LTD) plans?

If you purchase LTD coverage on a pre-tax basis, this means you pay federal income tax on the benefit if you become disabled but you pay no federal income tax on the premium. If you choose the post-tax option, you pay federal income tax on the premium but no federal income tax on the benefit (or income) if you become disabled. It is necessary to pay for the benefit on a “post-tax” basis for a period of 36 months to make the benefit 100 percent free of federal taxation.