IMPORTANT FORMS

Health Care Enrollment and Change Form **All full-time faculty and staff MUST submit this form to continue coverage for 2010**
Primary Coverage Spouse Form
Flexible Spending/Reimbursement Account Form
Life Insurance/Long-Term Disability Form
Voluntary Vision Plan Enrollment Form

OPEN ENROLLMENT INFORMATION  **Any and all forms that apply to you are due by 5:00 pm on Friday, November 20, 2009**

• BGSU's open enrollment for Plan Year 2010 begins on Monday, October 26 and continues until 5:00 pm on Friday, November 20, 2009.
• Any changes will become effective January 1, 2010
• NEW MEDICAL PLAN OPTION (B) - Refer to 2010 Open Enrollment Brochure for details
• NEW VOLUNTARY VISION PLAN - Refer to 2010 Open Enrollment Brochure for details
• We will accept the original form, faxed copy, or a scanned copy via e-mail. Please do not e-mail, fax, or scan and then follow up with the original.  Only send in one format.
• An e-mail confirmation that the Office of Human Resources has received your form(s) will be sent within three business days of receipt of the form. Please do not call OHR to validate if we have received your form(s). If five business days have passed since OHR should have received your form(s), then please contact our office.

2010 Open Enrollment Brochure

This explains any changes that have been made to your benefit package, which includes medical, prescription, and dental coverage. Information can also be found about the Working Spouse Rule, Dependent children eligibility, vendors web sites and phone numbers, etc.

Health Care Enrollment and Change Form

This form needs to be completed and returned by November 20, 2009 in order to continue coverage for 2010. 

• If you cover yourself only, complete the "Basic Information" until it reads to drop to "Signature" section and complete.
• If you cover a spouse, you will need to also complete the section under "Basic Information," "Questions," and "Other Insurance Information" if applicable. Then drop to "Signature" section and complete.
• If you cover dependent children, you will need to complete the "Basic Information," "Dependent Information," and also "Other Insurance Information" if they have other coverage. This includes if they are covered by Medicare or Medicaid. Then drop to "Signature" section and complete.
• If you are waiving coverage, complete the "Basic Information," then drop to "Waiver" section and complete.

Primary Coverage Spouse Form

If your spouse is working full-time and his/her employer offers health care coverage to their employees and pays 70% or more of the cost, your spouse must take at least a single-coverage plan through his/her employer. You are permitted to cover your spouse under BGSU as a secondary coverage, if you choose.

In order for the rule to apply, all three conditions must be met:

1) The spouse works full time
2) The spouse's employer offers health care coverage
3) The spouse's employer covers at least 70% or more of the cost toward the health care coverage

This form must be completed during every open enrollment only if you cover your spouse as primary under the BGSU Health Care Plan. If the spouse of a BGSU employee begins to work full-time anytime during the Plan Year, or has a job change, the BGSU employee is required to notify the Office of Human Resources of the spouse's change in employment and complete a new Primary Coverage Spouse Form.

Health Care and/or Dependent Care Reimbursement Account Form

Reimbursement Accounts, sometimes referred to as Section 125 Plans or Flexible Spending Accounts, allow reimbursement of certain expenses with tax-free dollars. BGSU offers two Reimbursement Accounts through the FlexSave Program administered by Medical Mutual Services:

1) A Health Care Account for medical, dental, prescription (and some over-the-counter drugs) and vision expenses not covered by a benefit plan
    
    Health Care Account Worksheet

2) A Dependent Care Account for work-related child care or elder care expenses.

Life Insurance/Long-Term Disability Insurance Form (Full-time Faculty and Administrative Staff Only)

Administrative and Faculty Staff have two options to choose from for benefits that include basic life insurance and Long-Term Disability (LTD) coverage. They are:

Choice A:  Life insurance benefit is 2.5 times annual salary, up to a maximum of $150,000. The LTD benefit (eligible after one year of full-time employment) is 60% of your monthly salary not to exceed $5,000/month. This is jointly paid by you and BGSU.
Choice B: Life insurance benefit is $50,000. The LTD benefit (eligible after one year of full-time employment) is 60% of your monthly salary not to exceed $2,000/month. This is paid by BGSU.

During open enrollment, you may wish to elect the one that you are not currently in.  If you are in Choice B and wish to elect Choice A, you will be required to submit evidence of insurability (EOI). This can be completed on-line through Sun Life's web site.  You will also need to complete and return the Life Insurance/Long Term Disability Form to the Office of Human Resources.  If you are in Choice A and would like to change your coverage to Choice B, you will need to complete and return the Life Insurance/Long Term Disability Form to the Office of Human Resources.

Optional Life Insurance

Full-Time Administrative, Classified, and Faculty Staff have the opportunity to purchase optional life insurance under a group plan vs. an individual plan. You will receive a personalized packet of information from Sun Life Financial sent to you by campus mail with your pertinent information and a price sheet of costs to purchase the optional life insurance. If you do not currently have any optional life insurance and wish to enroll, you will be required to provide "Evidence of Insurability (EOI)." This must be completed by the deadline of open enrollment. 

If you are currently enrolled in optional life insurance, you will able to increase it by one level without providing EOI as long as the level is not in excess of the guaranteed issue amount based on your age or salary. On your personalized form, any amounts above the guaranteed issue amount will be asterisked so you will know if they entail submitting EOI.

Classified staff may purchase optional long-term disability coverage. If you are not currently enrolled, you will need to complete the EOB by the deadline of open enrollment.

You may complete the EOI by going to Sun Life's web site. Click here.

**NEW OPTION**  Voluntary Vision Plan

Voluntary Vision Plan Enrollment Form

Information regarding Voluntary Vision Plan

Summary of Signature Plan

Dependent Child Eligibility

Effective January 1, 2009, unmarried children are covered through the end of the year they obtain age 19 or through the end of the year they obtain 24 as long as they are full-time students.  You must show proof of full-time student status to continue coverage for your unmarried children beyond the end of the year they obtain age 19.  "Full-time student means a person who is enrolled and attending full time in a recognized course of study or training at one of the following educational institutions:

1) an accredited high school or vocational school; or
2) an accredited college or university; or
3) a licensed technical school, beautician school, automotive school, or similar training school."

For those dependents after the end of the year they obtain 19, to continue coverage, validation of full-time student status will be conducted twice a year, in the spring and again in the fall. You, as the employee, will receive a targeted e-mail regarding detailed information, deadlines, etc.

If you would like to assist your dependent child researching the cost of purchasing an individual policy through Medical Mutual, please visit their web site link  to build a quote.  

          Super Med One

• If your dependent child will be a part-time student at BGSU, please click on the link below regarding information on BGSU's student health insurance. If you have any questions regarding BGSU's student health insurance, please contact Student Health Services at 419-372-7496.
  
  BGSU's student health insurance information
  
• If your dependent will be a part-time student at another institution, please click on the link below to find out more information regarding student health insurance offered through a specific institution.  Please not that not all institutions utilize Aetna as their student health insurance carrier.
  
  Aetna student health insurance information
  
• The Ohio Department of Insurance also has a listing of insurers offering individual coverage. Click here for more information.
  

These various options noted above are being provided to assist you and your dependent child in finding a health care plan that meets his/her need.  This information is not intended to endorse one vendor/policy over another.

Faculty and Staff Communications from OHR regarding Open Enrollment