Benefit Highlights & Enrollment Form
Medical Insurance
Dental Insurance
Vision Insurance
Retirement Savings Plan
Flexible Spending Account Program
Life & Accident Insurance
Long Term Care Insurance
Short Term Disability
Long Term Disability
Family & Medical Leave (FMLA)
Time Off Programs
Tuition Remission/Exchange
Employee Assistance Program
ProCare Network
Central Indiana Commuter Services (CICS)
Miscellaneous Benefits
Full-time Staff Benefit Highlight Sheet (WORD document)
2009 Benefit Election Form (WORD document)
2010 Open Enrollment
Online Enrollment Instructions - Instructions for enrolling online for you 2010 benefit elections.
2010 Benefit Election Form - Complete this form if you prefer to enroll on paper for your 2010 benefits.
Mid-year Changes - IRS regulations require that benefit elections remain in place for the entire year unless you experience an IRS-defined change in status. A change in status, such as marriage, divorce, or the birth of a child, allows you to make a change to your elections as long as it is within 30 days of the event. Please notify HR if you qualify to make a mid-year change.
Duty to notify of ineligibility - the employee is responsible for notifying HR within 30 days of any change that affects a dependent's eligibility. For example, you must notify HR if your dependent gets married, obtains health insurance through employment, or is no longer a tax dependent.
- For life insurance, dental and vision you must provide notification when your dependent reaches the age limit.
- Dependents will automatically be terminated in Anthem's system when a dependent reaches the age limit for medical. You must still notify HR in order to change your benefit deductions.
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2009 Anthem Medical Summary (WORD document) - this summary compares the 3 medical plans, giving you the deductibles, co-pays, and co-insurances for each plan.
For more detailed information about our medical plans:
PPO Core – Summary Plan Description (PDF)
PPO Buy Up – Summary Plan Description (PDF)
PPO Plus – Summary Plan Description (PDF)
Anthem Blue Cross and Blue Shield Claims Department
P.O. Box 37690
Louisville, KY 40233-7690
1-800-345-2460
www.anthem.com
To find in-network providers: Go to Anthem's website at www.anthem.com and click on "Find a Doctor." You'll be asked for our Plan, which is Blue Access (PPO).
Anthem Precertification
1-877-814-4803
Blue Card Customer Service
(to locate a provider while traveling)
1-800-810-2583
Anthem Formulary
T o hear recent changes to the prescription drug formulary, call 1-877-468-5279
View the online formulary
Anthem Rx Direct (mail-service pharmacy)
1-800-962-8192
Dependent Eligibilty - Dependent age for medical insurance is the end of the calendar year in which your dependent turns 24 if a tax dependent. Dependents no longer have to be full-time students if over the age of 19.
In-Network and Out-of-Network Providers
It is important to always make sure your provider is in the Blue Access (PPO) network because you will receive a higher level of benefit . Providers in our network have agreed to charge a reduced, negotiated fee for their services. Our coverage is national and you can find an in-network provider even while traveling.
Out-of-Network: Our plans have benefits at a reduced level when you receive care from out-of-network providers. Please keep in mind that you have to meet your out-of-network deductible before the plan will pay. Even if you've met your deductible with an in-network provider, you have to meet it again with an out-of-network provider. You will also be billed for charges in excess of the Usual & Reasonable reimbursement paid by the plan. Prior-authorization is required for all out-of-network services.
Emergency Visits: Our plan will pay in-network benefits when you need care for an emergency. However, even in an emegency, out-of-network providers may bill you for their charges in excess of the Usual & Reasonable reimbursement paid by the plan. You will be responsible for the excess charges.
Referrals: With our PPO plans, you don't need a referral to see a specialist. However, you want to make sure the specialist is in the network. There are times when an in-network provider will refer you to a specialist. A referral from your doctor does not mean that the provider is in-network. It is always the patient’s responsibility to verify the network status of a referred physician or facility.
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Delta Dental Plan of Indiana
P.O. Box 9085
Farmington Hills, MI 48333-9085
1-800-292-0626
www.deltadentalin.com
GROUP NUMBER: 7070-0001
In-network dentists: You have access to dentists in the Delta PPO and Delta Premier network. To find in-network dentists, go to Delta's website or view the Delta PPO Directory and Delta Premier Directory .
Summary of Dental Plan Benefits (WORD document) - this summary shows the covered services and the percentages paid by Delta.
Out-of-Network: You may receive dental care from any licensed dentist. However, you will receive a higher level of benefits when covered services are obtained from a Delta Dental PPO or Premier Network dentist. In-netowrk dentists have agreed to charge a reduced, negotiated fee for their services. If you go to an Out-of-Network dentist, you may be billed for charges in excess of the Usual & Reasonable reimbursement paid by the plan.
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National Vision Administrators (NVA)
P.O. Box 2187
Clifton, NJ 07015
1-800-672-7723-Customer Service
www.e-nva.com
GROUP NUMBER: 8232000001
In-netowrk vision providers: Go to www.e-nva.com and type in our Group Number: 8232000001.
Click here to review the Summary of Vision Plan Benefits (PDF)
For details about the plan: NVA Certificate
NVA Claim form - for out-of-network expenses
NVA Privacy Statement
Contact Fill Brochure -a mail order discount contact lens service.
Lasik Eye Surgery Discount- read this brochure to learn more about lasik discounts.
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TIAA-CREF
730 Third Avenue
New York, NY 10017-3206
1-800-842-2776
www.tiaa-cref.org
TIAA-CREF Retirement Plan – Summary Plan Description (WORD document)
Salary Reduction Agreement Form (WORD document) - use this form to make make changes to the amount that is being contributed to your retirement account with TIAA-CREF.
Signing up for the first time? You must enroll online with TIAA-CREF. Follow the steps in the How to Enroll Online document.
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UMR (Formerly Fiserv Health)
P. O. Box 2708
Dayton, OH 45401-2708
1-877-310-3539
UMR Website
To access your personal information, such as claims and balances, access the UMR Website and follow these instructions:
• For initial “Login”, you will need to enter your Username, which is your Social Security Number with the dashes and 00 added at the end. For example 123-45-678900
• For your Password, use your Social Security Number only with the dashes, 123-45-6789. You can change these anytime you wish by accessing your personal data field.
Summary Plan Description (PDF document)
Medical & Dependent Care Expenses Reimbursement Form (WORD document)
Additional Debit Card Request for Spouse Form (EXCEL document)
New UMR website access instructions
Tax-Savings: Our flexible spending plan is designed to save tax dollars when you pay for certain IRS-eligible expenses. When you elect to contribute to flexible spending, the contributions are not subject to federal, state, local, or FICA taxes. This can mean substantial savings to you.
Debit Card: The annual amount you choose to contribute is loaded onto a convenient debit card that has the MasterCard logo. You can use it to pay for office visit co-pays, prescription co-pays, vision expenses, deductibles and other IRS-eligible expenses. The debit card eliminates paying out-of-pocket expenses as the funds are deducted directly from your FSA account. It also significantly reduces manual paper claim submission and eliminates waiting for reimbursement checks.
Other Points to Remember
- In order to be reimbursed from your account, the expenses you claim must be eligible under IRS regulations - you are responsible for keeping receipts in case you are audited.
- Butler does not have a grace period - All expenses must be incurred between January 1 and December 31, 2009. Claims can be submitted up until March 31, 2010, but the expense must be incurred in the plan year.
- Unused 2009 flexible spending contributions are forfeited per IRS regulations. They cannot be “rolled over” into the next plan year.
- You do not have to be enrolled in a medical, dental or vision plan to participate.
- Contributions are elected on an annual calendar year basis. Annual elections cannot be changed during the year unless you experience an IRS-defined change of status.
- We have two flexible spending accounts, Medical and Dependent Care. You may elect to participate in either or both of them.
- The minimum amount you can flex per year is $120. The maximum amount is $5,000.
View the FSA Frequently Asked Questions to find out more details about Flexible Spending. For example, find out what are eligible and ineligible expenses, how to submit claims, and much more.
FSA Brochure - this brochure gives an example of how much you can save by signing up for flexible spending. It also gives information about using the convenient debit card to pay for your expenses.
Wondering how much to flex? Use the FSA Worksheet to determine the amount you should contribute to flexible spending.
Did you know that some of your Over-the-Counter medications are eligible for flexible spending dollars? View the OTC Flyer to learn more.
You can also learn more about Flexible Spending by going to the FSA website .
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Life Insurance Company of North America
1601 Chestnut Street
Philadelphia, PA 19192-2235
Life & Accident Insurance Rate Sheet (WORD document) – premium rates for Supplemental Life Insurance and ADD
View the Personal Accident Insurance flyer to learn more about AD&D.
View the Supplemental Life Insurance flyer to learn more Life Insurance.
For more detailed information about our plans:
Summary Plan Description for Life Insurance (PDF)
Summary Plan Description for Personal Accident Insurance (PDF)
Secure Travel (PDF)
Identity Theft Protection (PDF) - available to anyone that purchases Personal Accident Insurance
Change of Beneficiary Form (WORD document) – change your beneficiary on this form and return to Human Resources
Dependent Eligibility - Dependent age is up to age 19 or up to age 24 if a full-time student. The employee is responsible for notifying HR when their dependent is no l
longer eligible.
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Long Term Care Insurance Presentation - Click on this link to view a webinar on Long Term Care Insurance. This presentation will answer many of your questions about Long Term Care Insurance, including how to enroll and the plan options available.
To enroll or to get an online quote, visit Genworth's website:
www.genworth.com/groupltc
Group Name: butleru
Access Code: groupltc
You can also call Genworth at 1-800-416-3624.
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Life Insurance Company of North America
1601 Chestnut Street
Philadelphia, PA 19192-2235
1-800-732-1603
STD Summary Plan Description (PDF)
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Life Insurance Company of North America
1601 Chestnut Street
Philadelphia, PA 19192-2235
1-800-732-1603
LTD Summary Plan Description (PDF)
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Family and Medical Leave must be approved by Human Resources. Please contact HR at x9355 for more information.
FMLA Policy & Procedures (WORD document)
Request for FMLA form (WORD document)
Medical Certification form (PDF)
Employee Fitness for Duty form (WORD document)
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Holidays (WORD document)
Personal Time Off (PTO) (WORD document)
Sick Time (WORD document)
Vacation (WORD document)
Absence and Overtime Report Form (WORD document)
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Tuition Remission Policy (WORD document)
Tuition Remission Form (WORD document)
Tuition Exchange Policy * (WORD document)
Tuition Exchange Form (PDF)
Tuition Exchange Universities/Colleges –
www.tuitionexchange.org * While Butler University participates in the tuition exchange program, The Tuition Exchange website is managed by the Tuition Exchange organization. Butler University has no involvement or control over the colleges and accuracy of data listed on the website. Be sure to confirm all information with the institution of interest. Schools must remain on the list of participating members because they still have students on their program – schools cannot withdraw completely until all scholarships have been completed, all bills have been paid and they are in balance with the number of imports and exports. Many schools, not just withdrawing schools, decide from year to year not to accept imports or not to send out exports - schools are not required to send out or bring in students under our program.
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Methodist Assistance Program
Methodist Hospital of Indiana
I-65 at 21st Street
P.O. Box 1367
Indianapolis, IN 46206-1367
Helpline (317) 962-2622
Non-local (800) 745-4838
EAP Summary (WORD document)
Frequently Asked Questions (WORD document)
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ProCare Network
www.procarenetwork.com/go
317-974-2039
ProCare Network is a FREE program for Butler employees and their families that offers access to a wide range of personalized services and discounted pricing from over forty professional and service firms. For example, you can get discounts on dry cleaning, travel, tax preparation, auto maintenance and much more.
To access services within the network, pick up a membership ID card in Human Resources (Jordan Hall 144) or call ProCare’s Call Center at 317-974-2039 for assistance. Once you obtain a member ID, you can get specific information and access discounts by visiting www.procarenetwork.com/go .
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Central Indiana Commuter Services (CICS) www.327ride.net
317-327-RIDE (7433)
Save money and reduce stress by riding the bus, carpooling or vanpooling to work. Central Indiana Commuter Services ( CICS ) is a federally funded program whose mission is to help reduce congestion and reduce air pollution. CICS will help you find alternatives to driving alone to work for free ! CICS will even help you find someone to carpool with! Visit www.327ride.net and click “Sign Up Now” to find out who you can carpool or vanpool with to work. And if you want to find out how much your commute is really costing you, try the “Commute Cost Calculator”.
If you are currently carpooling, walking, biking or riding the bus to work, register with Central Indiana Commuter Services ( CICS ) at www.327ride.net or call 317-327-RIDE (7433) and get free Emergency Ride Home ( ERH ) service. ERH is a free taxicab service that will take you home from work in the event of an emergency.
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- Discounted or Free Tickets to Selected Clowes Hall and Athletic Events
- Bookstore Discount
- Selected Services at Health and Counseling Center
- Library Privileges at Irwin Library or the Science Library at Gallahue Hall
- No-Cost Membership Available to Indiana Member's Credit Union
- Wellness Stipend for HRC Membership and participation with Healthy Horizons – Wellness Stipend Application
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