2020
EMPLOYEE
BENEFITS
OVERVIEW
B
THE CATHOLIC UNIVERSITY OF AMERICA
REMINDERS AND UPDATES FOR 2020
• As a reminder, this is a passive enrollment. This means
you will be auto-enrolled with your current benefits with
the exception of the employee FSA contributions if you
do not make any changes during Open Enrollment.
• The Catholic University of America’s Benefits
Enrollment Site can be accessed by going to
www.mycuabenefits.com. The site is open from
October 21 through November 8 for open enrollment
for plans eective January 1, 2020. Please feel free to
access the site throughout the year to obtain benefit
documents and to review your plans.
• All new participants in the H.S.A. medical plan will be
eligible to participate in the H.S.A. Savings Account. The
benefit enrollment system will prompt you for permission
to allow The Catholic University of America to open an
H.S.A. Optum bank account on your behalf, so that you
will be able to contribute pre-tax dollars and receive
The Catholic University of America’s monthly contribution.
If you waive or decline this option, you will lose the
opportunity to receive The Catholic University of
America’s contribution.
Unum Supplemental Life Insurance
• The Catholic University of America is oering an
enhanced supplemental life insurance benefit! During
open enrollment subject to evidence of insurability, or as
a new hire, you can now receive up to 5x your salary or
$500,000 guaranteed issue, in
increments of $10,000.
• Your supplemental life insurance premium will
be based on your attained age as of 1/1/2020. Your
spouse’s supplemental life insurance premium will be
based on their age as of 1/1/2020.
• Employees currently enrolled in UNUM Supplemental
coverage will not be required to re-enroll unless it is a
new election or change in coverage amount.
FSA Plans
• If you are enrolled in the Flexible Saving Accounts
(Medical/Dependent), please remember that your
elections for your contributions into your FSA will be for
the period from 1/1/2020 – 12/31/2020. Maximum Limit
for Medical FSA contributions for 2020 is $2,700.
Wellness
• If you are enrolled in a UHC health plan, you can
participate in Rally at no additional cost. Rally can help
you make simple changes to your daily routine, set
smart goals, and track your progress. After completing
a quick and fun survey, you’ll get personalized
recommendations to get you moving more, eating
better, and feeling happier. You also receive free gift
cards for completing program activities. Visit myuhc.com
to take advantage of the rewards.
EAP
• Don’t forget, The Catholic University of America oers
a comprehensive EAP program with 5 face-to-face
counseling visits and additional telephonic support!
CareBridge EAP can help with relationships, grief
counseling, legal concerns, financial pressures, work
stress, child care arrangements, and more.
1
TABLE OF CONTENTS
The Catholic University of America Reminders & Updates 2020 ......Inside Cover
Table of Contents ............................................................................................................................1
Who To Call ........................................................................................................................................ 2
Eligibility And How To Enroll ...............................................................................................3
Medical Plans ................................................................................................................................ 4-6
Locate Free Standing Facility .................................................................................................. 7
Prescription Drug Coverage ................................................................................................... 8
Additional Programs .................................................................................................................... 9
EAP Benefits ..........................................................................................................................................9
Dental Benefits .............................................................................................................................. 10
Vision Benefits ................................................................................................................................ 11
Employee Premium Contributions ....................................................................................... 12
Flexible Spending Accounts And Smart Benefits ................................................13-14
Life and Accidental Death & Dismemberment (AD&D)
and Long-Term Disability Insurance .........................................................................
15-16
Voluntary Benefits ...................................................................................................................... 17
Retirement Plans ........................................................................................................................... 18
Other Benefits .........................................................................................................................19-20
Required Notices ...................................................................................................................21-22
Terms ...................................................................................................................................................... 23
Please Note: Required Federal Notices and SBCs are available on www.mycuabenefits.com.You may also
request free paper copies of any of the notices, by contacting The Catholic University of America Human
Resources department.
2
WHO TO CALL
Benefit Plan Provider Name Telephone
Number
Website
ARAG Legal ARAG 800-247-4184
www.ARAGLegalCenter.com
Access Code: 17022cua
COBRA/Retiree Questions Businesssolver 877-547-6257 www.mycuabenefits.com
Credit Union EP Federal Credit Union 202-526-4528 www.epfcu.org
Dental MetLife 800-942-0854
www.metlife.com/mybenefits
Group: 150525-1-G
Employee Assistance Plan Carebridge 800-437-0911
www.myliferesource.com
Access code: HSBH4
Flexible Spending
Accounts
United Healthcare 866-755-2648
www.myuhc.com
Group: 710972
Health Advocate Health Advocate 866-695-8622
www.healthadvocate.com
Group: CUA
Human Resources
The Catholic University of
America
202-319-5050 http://humanresources.cua.edu
Life and AD&D Insurance
(Basic and Voluntary)
Unum 1-800-421-0344
www.unum.com
Group: 912219
Long-Term Disability Unum 1-800-421-0344
www.unum.com
Group: 912219
Medical United Healthcare 866-633-2446
www.myuhc.com
Group: 710902
Pet Insurance Nationwide 877-738-7874 www.petinsurance.com/affiliates/cua_npr
Retirement Plan TIAA 800-842-2776 www.tiaa.org/catholic
Travel Assist – Inside U.S. Unum 1-800-872-1414
[email protected]
Access code: 01-AA-UN-762490
Travel Assist – Outside U.S. Unum 1-609-986-1234
[email protected]
Access code: 01-AA-UN-762490
Tuition Assistance
The Catholic University of
America
202-319-5050 http://policies.cua.edu/employment/tuition-full.cfm
Tuition Exchange
The Catholic University of
America
202-319-5050 http://humanresources.cua.edu/benefits/exchange.cfm
Vision United Healthcare Vision 800-638-3120
www.myuhcvision.com
Group: 710902
Insurer and Service Provider Information
3
ELIGIBILITY & HOW TO ENROLL
Before You Enroll
Before you log onto the online benefit enrollment
system, there are some things about your benefits you
need to know.
Who Is Eligible?
You are eligible for The Catholic University of America
Benefits if you are in a benefit eligible position as a sta
or faculty member working at least 20 hours per week.
Your eligible dependents can be enrolled in certain The
Catholic University of America benefits.
When Am I Eligible?
If you are eligible for coverage, you must enroll within
30 days of your date of hire or when you become benefit
eligible. Your medical, dental, vision, flexible spending,
long-term disability, and ARAG legal plan voluntary
benefits are eective on the first of the month after
your date of hire. Life insurance is eective the first of
the month following 90 days of employment.
How Do I Enroll?
Before enrolling, you need to create an account on our
benefits website. If you used the system previously,
you do NOT need to complete the registration process
again. Simply use your log in information and password.
1. Go to www.mycuabenefits.com
2. Company key: CUA (all caps)
3. Create a password.
When you want to enroll:
1. Log into your account on www.mycuabenefits.com
2. Use ID: CUA + Your employee ID number (for
example: CUA123456)
3. Password: Use the password you created at
registration, if you forgot your password, choose
Forgot Password.
3. Make your benefit choices
4. Confirm your choices
If you need assistance with enrolling, please call
(202) 319-5050.
Can I Make Changes to My Benefits?
Usually you can make changes to your benefits during
the Open Enrollment period, typically held each fall.
Changes made during Open Enrollment are eective
January first of the next calendar year. However, if
you have a qualifying event that requires you to make
changes to your benefit elections, you can do so as
long as you notify the Human Resources Department
within 30 days of the event and provide supporting
documentation of the event and a status event form.
These qualified events include:
• Adding dependents through marriage, birth,
adoption or legal guardianship
• Removing coverage for dependents due to divorce,
legal separation, death or if the dependent loses
eligibility status (is eligible to enroll in another
medical plan)
• Enrolling or removing coverage due to a significant
change in your (or your spouse’s) health coverage
that occurs due to your spouse’s employment
What If I Don’t Elect Any
Benefits?
Some benefits are available to you at no cost
as a benefit eligible employee of The Catholic
University of America. You do
not need to sign up for these benefits. These
core benefits include:
• Employee Assistance Program (Begins on
your date of hire)
• Basic Life & AD&D Insurance (Begins the
first of the month following 90 days of
employment )
• Long-Term Disability (Begins the first of the
month after your date of hire)
4
MEDICAL PLANS
How the Medical Plans Work
The following is a Q&A that will explain how the three Medical Plans are dierent — and the same. The chart on
Page 7 shows how your cost would vary based on the option you choose.
Health Savings
Account (HSA)
Plan
Silver Plan Basic Plan
Can I go to any doctor I want?
Can I see doctors in and
outside the United Healthcare
network?
Yes. However, you will pay less and receive a higher level of benefits if you choose an
in-network doctor. The Emergency Room benefits are the same whether your hospital
is in-network or not.
Do I need a referral to see a
specialist?
No. Under all three plans, you can go directly to a specialist without a referral.
When does the deductible
apply?
The deductible does not apply
to in- network preventive care.
However, it does apply to all
other expenses, including
prescription drugs.
The deductible does not
apply to in-network preventive
care, doctor’s oce visits,
urgent care, emergency room
visits, and prescription drugs.
You pay a copay for these
expenses. The deductible
applies to ambulance, services,
hospital care, outpatient
surgery, lab and x-rays, and
hospital stays.
The deductible does not
apply to in-network preventive
care or to prescription drugs.
However, it does apply to all
other expenses.
What expenses count toward
my annual out-of-pocket
maximum?
Deductibles, copays and
coinsurance amounts,
including those for
prescription drugs, all count
toward your annual out-of
pocket maximum. Once you
meet your annual out-of-
pocket maximum, all of your
covered expenses will be paid
at 100% for the remainder of
the plan year.
Deductibles, copays and
coinsurance amounts,
including those for
prescription drugs, all count
toward your annual out-of
pocket maximum. Once you
meet your annual out-of-
pocket maximum, all of your
covered expenses, including
copays, will be paid at 100%
for the remainder of the plan
year.
Deductibles, copays and
coinsurance amounts,
including those for
prescription drugs, all count
toward your annual out-of
pocket maximum. Once you
meet your annual out-of-
pocket maximum, all of your
covered expenses will be paid
at 100% for the remainder of
the plan year.
Is preventive care (well-child
care, checkups, etc.) covered?
Yes. Preventive care is covered at 100% when you use an in-network provider. Copays and
deductibles do not apply.
Are prescription drugs
covered?
Yes. After the deductible,
you pay a set copay for
prescription drugs when you
use an in-network pharmacy.
Yes. You pay a set copay for prescription drugs when you use
an in-network pharmacy.
Can I use mail order for
medication I use regularly?
Yes. If you take a maintenance medication, you may save money on your prescriptions by using
the mail order service. Please see the prescription drug section for important information on the
mail order prescription program.
5
MEDICAL PLANS
Thinking About the Definity
Health Savings Account Plan?
HSA Plans are quickly growing in popularity. And there
are lots of good reasons why:
• More choice of providers — The Definity HSA Plan
provides benefits when you use out-of-network
providers. Treatment from an out-of-network
provider may result in additional charges over
and above the Reasonable & Customary (R&C)
charges, which you will be responsible to pay in
addition to your deductible and coinsurance.
• The Catholic University of America contributes
to your Health Savings Account (HSA) — If you
sign up for the HSA Plan, The Catholic University
of America contributes to your Health Savings
Account (HSA). This contribution can help cover part
of the cost of your annual deductible. In 2020, The
Catholic University of America will contribute to your
HSA account:
– $25 per month if you have employee only
coverage
– $50 per month if you have employee + 1 or
family coverage
• No use it or lose it rule — Unlike a Flexible
Spending Account (FSA), money in your HSA can
stay in your account and grow if you don’t use it.
So there is no risk to contributing to the account —
unlike FSA contributions, which you lose if you don’t
use by March 15th of the next year. In fact, even if
you later choose not to participate in the HSA Plan,
you can still keep your HSA open.
• Change your HSA contribution amount quarterly
— Let’s say it’s October and you have had next
to no out-of-pocket expenses. You’d really like to
discontinue your monthly contributions. You can!
Or, you may find that you have a large, unexpected
medical bill and want to contribute more to your
account. You can! Either one works with an HSA.
(Just make sure you don’t contribute more than
the current IRS limit when you start making extra
contributions!) To change contributions, contact HR.
• Save extra for the future — HSA money doesn’t
have to be used now. It doesn’t even have to be
used while you work for The Catholic University of
America. Your account is yours to keep — including
any unused contribution from The Catholic University
of America — and is totally portable. You can use
it for future medical expenses, and it can even be
used for medical expenses after retirement including
COBRA.
Medical Benefit Exclusions
No payment will be made under The Catholic University
of America’s medical plan for expenses incurred for:
• Oral contraceptives and devices
• Oral and injectable fertility drugs administered
in conjunction with artificial insemination in-
vitro fertilization (IVF), GIFT, ZIFT, tubal ligation,
vasectomy or any other treatment designed to
replace normal reproductive processes to achieve
pregnancy
• Infertility services and infertility drugs, reversal of
voluntary sterilization procedures or abortion
How much can you
contribute to an HSA?
There are federal limits to the amount you can
contribute annually to your HSA and vary based
on your coverage. Contribute up to:
• $3,550 if you have individual coverage
• $7,100 if you have employee + 1 or family
coverage
• If you are 55 years old or older, you may
contribute an additional $1,000 annually to
the limits listed above
• The above limits include your employer
contribution
6
MEDICAL PLANS
United Healthcare
Definity HSA Plan
United
Healthcare Silver
PPO Plan
United
Healthcare Basic
PPO Plan
In-network
you pay…
Out-of-network
you pay…
In-network
you pay…
Out-of-network
you pay…
In-network
you pay…
Out-of-network
you pay…
Annual Deductible
• Individual
• Family
$1,500*
$3,000*
$3,500*
$7,000*
$500*
$1,000*
$1,000*
$2,000*
$500*
$1,000*
$1,000*
$2,000*
Annual Out-of-Pocket
Maximum (including
deductible and copays)
• Individual
• Family
$3,500
$6,850
$4,500
$9,000
$3,500
$7,000
$7,000
$14,000
$3,500
$7,000
$7,000
$14,000
Preventive Care
(adults and children, oce
visits, routine testing, and
immunizations)
No charge
You pay 100% until
deductible is met.
After you meet
the deductible,
you pay 20% of
eligible expenses
until the annual
out-of-pocket
maximum has
been met.
No Charge
After meeting
the deductible:
30%
No Charge
After meeting
the deductible:
30%
Doctor’s Oce Visit
• Primary Care
• Specialists
You pay
100% until
deductible
is met. After
you meet the
deductible,
you pay
nothing.
Complex
Imaging and
Outpatient
Surgical
Services
performed
in a Hospital
Based
facility will
be subject to
an additional
$250 copay.
$30
$40
After meeting the
deductible:
30%
After
meeting the
deductible:
25%
25%
After meeting
the deductible:
30%
30%
Emergency Care
• Urgent Care
• Hospital ER
$45
$150
After meeting
the deductible:
30%
After
meeting the
deductible:
25%
25%
After meeting
the deductible:
30%
30%
Hospital Care
• Inpatient
• Outpatient**
After meeting
the deductible:
$0
$0
After meeting
the deductible:
30%
After meeting
the deductible:
25%
0% facility,
25% physician/
surgeon
After meeting
the deductible:
30%
Lab & X-ray**
Overall
deductible
does not apply;
individual service
deductible may
apply
After meeting
the deductible:
30%
After
meeting the
deductible:
25%
After meeting
the deductible:
30%
Prescription Drugs Prescription drugs are covered under all three options. Please see Page 8 for detailed information.
Lifetime Maximum
Benefit
Unlimited Unlimited Unlimited
The table above is not a complete summary of the plan. In case of any conflict or question, the ocial plan documents or applicable policies, as
amended from time to time, will govern.
* If you have Employee +1 or Family coverage, you must satisfy the entire family deductible before any benefits are paid. Deductibles do not cross
accumulate between in and out-of-network services.
Plan Comparison
**Outpatient Surgery, Outpatient Complex Imaging, and Scopic Procedures are subject to the
deductible. There are no additional copays at a Freestanding Facility. An additional $250 copay will be
charged at a Hospital Based Facility.
7
LOCATE FREE STANDING FACILITY
How do I locate a Freestanding Facility for
outpatient complex imaging services and outpa-
tient surgical services?
To find a Free Standing Facility at United Health Care,
go to www.myuhc.com. You may be required to log in
or register.
Select the tab at the top of the page “Find Care and
Cost.
Once you select Find Care and Cost, In the search bar,
type in “Free Standing Facilities.”
On the left side of the page, select clinics and facilities.
A list of clinics will appear.
All of the clinics listed will be considered Freestanding
Facilities. Please keep in mind that UHC web page is
updated weekly, so it is imperative that you verify this
information with the facility before you schedule an
appointment.
Please keep in mind that you are able to use a Hospital
based Facility for outpatient surgery, but you will also
be subject to an additional copay.
Health Advocate cost is included in all medical contributions
UHC Definity HSA UHC Choice Silver UHC Choice Basic
Employee
Employee +1
Family
$174.05
$374.70
$534.93
Employee
Employee +1
Family
$208.11
$446.51
$637.26
Employee
Employee +1
Family
$138.38
$299.68
$427.51
Medical & Prescription Drug Plan Monthly Contributions 2020
8
PRESCRIPTION DRUG COVERAGE
Your three-tier prescription benefit gives you choice
over which medications you use while also balancing
costs. To do this, the benefit breaks most prescription
medications into three categories, or tiers:
• Tier 1: Generic
• Tier 2: Formulary brand-name
• Tier 3: Non-formulary
You have coverage for all three categories. Your copay
depends on which medication (or tier) you and your
doctor choose. Generics cost the least, and non-
formulary medications cost the most with a three-tier
prescription benefit design.
When you enroll in The Catholic University of America
Medical Plan, you are automatically enrolled in the
Mail Service Member Select Program. This program
gives you the ability to use mail order for maintenance
medications which may be more convenient, and may
save you money. You may choose to opt out of the Mail
Service program at any time by contacting Optum.
This program is only for maintenance medications.
Generally, maintenance medications are medications
you take for at least three months such as:
• Blood pressure medications
• Cholesterol medications
• ADHD medications
• Other medications that treat chronic conditions
If you choose to remain in this program, when you
receive a prescription for a maintenance medication:
• You may fill the prescription at a retail pharmacy up
to two times.
• After each refill, you will receive a reminder to
switch your prescription to the Mail Service Program.
• After two refills, you must make a decision to switch
to the Mail Service Program or to continue filling at a
retail pharmacy.
• If you do not make a decision to switch to the Mail
Service program or to continue filling at a retail
pharmacy, future refills at a retail pharmacy will
not be covered by the Medical Plan.
If you opt out of the program:
• You can continue to have your prescriptions filled at
a retail pharmacy.
• You will not have the convenience of having your
prescriptions automatically mailed to you.
• You will not have the money-saving benefits of the
Mail Service program.
This chart shows your cost when you use a retail
pharmacy vs. when you use the Mail Service.
Note: Mail Service program is for a larger quantity.
Silver
and
Basic
Plan
Network
Retail
Pharmacy
Mail Service
Member
Select
Program
Does Plan
deductible
apply?
Silver Plan: No
Basic Plan: No
Amount
dispensed at
one time
Up to 31 day
supply
Up to 90 day supply
Tier 1 (includes
most generics)
$10 $25
Tier 2
$40 $100
Tier 3
$60 $150
HSA Plan Network
Retail
Pharmacy
Mail Service
Member
Select
Program
Does Plan
deductible
apply?
HSA Plan: Yes
Amount
dispensed at
one time
Up to 31 day
supply
Up to 90 day supply
Tier 1 (includes
most generics)
$10 $25
Tier 2
$30 $75
Tier 3
$50 $125
8
9
ADDITIONAL PROGRAMS
Simply Engaged
Would you like to take a more active role in improving
your health? Would you like to earn rewards at the
same time? Simply Engaged allows you and your
enrolled spouse to earn gift cards to hundreds of
national retailers by completing certain wellness
activities. For more information call 1-877-818-5826 or
logon to myuhc.com, click on the Health & Wellness tab,
and complete one of the activities.
Health Advocate
If you have questions about your benefits or if you
have a clinical or administrative issue that needs
expert attention, Health Advocate is available for all
employees that are enrolled in any of The Catholic
University of America’s medical plans as well as your
spouse, children, parents and parents-in-law.
Health Advocate’s services are available whenever you
need them. Call Health Advocate at 866-695-8622 or
log on to www.healthadvocate.com/members (member
log in is The Catholic University of America) to:
• Assist with claims and correct billing errors
• Find the right doctor, hospital or testing facility
(especially if you are traveling)
• Assist with the transfer of medical records
• Navigate your insurance plan
• Explain conditions and treatments
• Locate eldercare services
• Resolve Medicare questions
Carebridge Employee Assistance
Program (EAP)
The Catholic University of America has contracted for
the professional services of Carebridge Corporation
to provide you with support in personal and family
problems common in contemporary life. Coverage
includes you, your spouse and dependents cost free.
When to Use the EAP
Counseling is available through the EAP for personal
issues such as:
• Eldercare consultation and referrals
• Depression and anxiety
• Drug and alcohol dependency
• Stress management
• Grief over death of loved one or other losses
• Child care resources and referrals
• Family/parenting relationships
• Personal financial management
• Time management & life balance
How to Use the EAP
If you need assistance, you can call and speak to a
Master’s-level EAP counselor. Counselors are available
24 hours a day, including holidays. The toll-free phone
number to call is: 800-437-0911.
Sometimes a telephone call is all it takes. But if you
want or need additional counseling, Carebridge will
provide up to five face-to-face sessions per person,
per issue, per year. The EAP can also provide referrals
to other providers or community resources if you need
additional assistance. If you or a dependent requires
longer-term counseling, the EAP can refer you to a
participating provider in The Catholic University of
America Medical Plan, if you are enrolled in the Plan.
EAP: Confidentiality is Key
Carebridge administers the EAP. Any help you
receive from the EAP is completely confidential.
Your name, records, and other confidential
information are not shared with The Catholic
University of America.
10
DENTAL BENEFITS
The Catholic University of America oers a choice of dental coverage through MetLife. Both Dental Plan options
operate like a Preferred Provider Organization (PPO). This means that if you see an in-network dentist, you will only
be responsible for your deductible and coinsurance. An in-network dentist will not send you any additional bills. To
find a network dentist in your area, visit www.metlife.com/mybenefits or call MetLife Member Services at 800-942-0854.
Treatment from an out-of-network dentist may result in additional charges over and above Reasonable & Customary
(R&C) charges, which you would be responsible to pay in addition to your deductible and coinsurance.
MetLife Silver Dental Plan MetLife Gold DentalPlan
When you use network
providers, you pay…
When you do not use
network providers,
you pay…
When you use network
providers, you pay…
When you do
not use network
providers, you pay…
Deductible
• Individual
• Family
$75
$225
$75
$225
$50
$150
$50
$150
Preventive Services
• 2 exams per year
• 4 cleanings per year
No charge, no
deductible
40%
No charge, no
deductible
No charge, no
deductible
Basic Services
Fillings, Extractions, Root canals
50% 60% 20% 20%
Major Services
Crowns, Bridges, Dentures
60% 70% 50% 50%
Maximum benefit you can
receive in one year
(not including orthodontia)
$1,000 $1,500 $1,500
Orthodontia for children
• Maximum lifetime benefit, per
child up to age 19.
60%
$1,000
70%
$1,000
50%
$1,500
50%
$1,500
The table above is not a complete summary of the plan. In case of any conflict or question, the ocial plan documents or
applicable policies, as amended from time to time, will govern.
Dental Plan Monthly Contributions 2020
MetLife Silver MetLife Gold
Employee
Employee +1
Family
$12.67
$24.40
$40.26
Employee
Employee +1
Family
$38.24
$66.74
$101.44
Dental ID Card
MetLife does not distribute Dental ID cards for MetLife members. All you need to do is notify your dentist’s oce
that MetLife is your dental provider when scheduling your appointment. If you prefer to print an ID card, please go to
www.metlife.com/mybenefits or download the free MetLife app from your app store to have a copy of your member
information on your smart phone at all times.
$1,000 $500
11
VISION BENEFITS
United Healthcare Vision
Service When you use an in-network
provider, you pay…
When you use an out-of-
network provider, the plan will
reimburse you up to…
How often can you receive
benefits?
Eye Exam
$10 $40 Once every 12 months
Glasses
• Frames
• Lenses
$20 material charges +
charges over $150
$20 (if purchased alone)
$0 (if purchased with frames)
$45
Single: $40
Lined Bifocal: $60
Lined Trifocal: $80
Lenticular: $80
Once every 12 months
(instead of contacts)
Contact Lenses
• Medically necessary
• Not medically necessary
$20 from covered collection
$20+ charges over $125
for purchases outside the
covered collection
$210
$125
Once every 12 months
(instead of glasses)
For the most up-to-date listing of in-network providers in your area and to print your vision ID card, visit the United
Healthcare website (www.myuhc.com) or call 800-839-3242. Or contact your current eye care professional and ask if
he or she accepts United Healthcare PPO Vision.
The table above is not a complete summary of the plan. In case of any conflict or question, the ocial plan
documents or applicable policies, as amended from time to time, will govern.
Vision ID Card
Thanks to United Healthcare’s paperless benefits and claims process, you do not need a member ID card to use your
vision benefits. If you would like to print a personalized Vision ID Card, you can do so by logging on to
www.myuhcvision.com and then select print ID card.
Our vision care plan helps pay for routine vision services and supplies through United Healthcare’s PPO Vision Plan.
UHC’s network consists of private practicing optometrists, ophthalmologists, opticians, and optical retailers.
The plan gives you two dierent ways to receive benefits:
• Use the network of providers and aliates and receive discounts and significant plan benefits for services
• Go to a doctor outside the network and receive a reimbursement for part of the cost of your exams, glasses and/
or contacts.
Vision Plan Monthly
Contributions 2020
UHC Vision
Employee
Employee +1
Family
$6.36
$9.29
$15.22
12
EMPLOYEE PREMIUM CONTRIBUTIONS
Medical & Prescription Drug Plan Monthly Contributions 2020
Health Advocate cost is included in all medical contributions
UHC Definity HSA UHC Choice Silver UHC Choice Basic
Employee
Employee +1
Family
$174.05
$374.70
$534.93
Employee
Employee +1
Family
$208.11
$446.51
$637.26
Employee
Employee +1
Family
$138.38
$299.68
$427.51
Dental Plan Monthly Contributions
2020
MetLife Silver MetLife Gold
Employee
Employee +1
Family
$12.67
$24.40
$40.26
Employee
Employee +1
Family
$38.24
$66.74
$101.44
Vision Plan Monthly Contributions
2020
UHC Vision
Employee
Employee +1
Family
$6.36
$9.29
$15.22
Voluntary Term Life Insurance Monthly Contributions 2020
Age Your Monthly Cost Per $1,000 of Coverage Spouse Monthly Cost Per $1,000 of Coverage
Less than 30 $0.044 $0.044
30-34 $0.056 $0.056
35-39 $0.070 $0.070
40-44 $0.094 $0.094
45-49 $0.144 $0.144
50-54 $0.238 $0.238
55-59 $0.399 $0.399
60-64 $0.583 $0.583
65-69 $0.992 $0.992
70+ $1.874 $1.874
Cost for Your Child(ren)
Covers all eligible children
$0.103
Legal Plan Monthly
Contribution 2020
ARAG Voluntary Legal Plan
Employee $22.00
12
13
EMPLOYEE PREMIUM CONTRIBUTIONS
FLEXIBLE SPENDING ACCOUNTS
Through the Flexible Spending Account (FSA) program,
you can use tax-free dollars to pay for:
• Most medical, dental and vision care expenses
such as copayments, deductibles, and prescription
drugs — even many over-the-counter medications
as long as you have a written prescription for these
medications
• Dependent care expenses such as day care,
babysitters, after-school programs, or elder care
programs so that you and your spouse can work or
go to school.
Using tax-free dollars means that you spend less for
these expenses. NOTE: If you participate in the medical
HSA Plan, you cannot contribute to a Health Care FSA.
Instead, you can make tax-free contributions to your
HSA.
Keep in mind that you can only use:
• Health Care FSA money for health care expenses
• Dependent Care FSA money for dependent care
expenses
They are not interchangeable!
Please plan carefully when electing your coverage
amounts as these funds are use or lose.
How Much You Can
Contribute
There are limits on the amount you can contribute
to your FSA Accounts. NOTE: If you participate in
the HSA Plan, you cannot contribute to a Health
Care FSA. Instead, you can make tax-free
contributions to your HSA.
Health Care FSA Limits
• A minimum of $100 per year
• A maximum of $2,700 per year
Dependent Care FSA Limits
• A minimum of $100 per year
• A maximum of $2,500 if you and your spouse
file separate tax returns
• A maximum of $5,000 if you are single or if
you and your spouse file a joint return
Using Your Health Care FSA
When you enroll in the Health Care FSA, you will
automatically receive an FSA debit card. When you go
to the doctor’s oce or pharmacy to fill a prescription,
simply swipe your debit card to pay. The money will
come out of your Health Care FSA, not your checking or
savings account. Best of all: you do not have to file for
reimbursement! But you should always save your bills
or receipts in the event that you are audited.
14
FLEXIBLE SPENDING ACCOUNTS
Please note that you can use your FSA debit card for
your dependent’s eligible expenses, even if they are
not enrolled in any of the medical plans oered by
The Catholic University of America. You can use your
FSA debit card for all sorts of unreimbursed expenses
including:
• Prescriptions
• Charges at your doctor’s oce or other medical
facility
• Charges at your dentist or eye doctor
• Charges at your lens lab when you buy contacts or
glasses
• Co-pays, deductibles, co-insurance and those
charges that are over R&C charges
The full amount of your FSA is available to you on the
first day of your coverage even though it has not been
deducted from your pay.
There are a lot of options of how to use your FSA
account. However, you are only able to use your FSA
debit card for purchases that the IRS considers an
eligible expense.
Using Your Dependent Care FSA
You may either use the debit card mailed to your
address on file or the FSA reimbursement form located
on the www.myuhc.com website, when you have
reimbursable expenses. If there is not enough money
in your account at that time to fully reimburse you, you
will receive the amount currently available in your
account. The rest will be paid automatically when your
next deposit is made into your account.
SMART BENEFITS Commuter
Benefits
You can pay for your SmarTrip card with pre-tax dollars.
via payroll deductions — and lower your payroll taxes at
the same time!
• A maximum Parking benefit of $265.00 per month
• A maximum Transit benefit of $265.00 per month
• SmarTrip transit cards can be used around
Washington, Baltimore, and the surrounding area.
• Please remember that you must register your
SmarTrip card prior to submitting your form to HR.
To register, go to www.wmata.com.
Amounts are subject to change.
For MARC or VRE, please contact Commuter Direct at
www.commuterdirect.com.
Zimride
Want to ride-share instead of using public
transportation? Introducing a partnership that
oers a fun, money-saving way to commute to
campus – Zimride by Enterprise. Zimride is an
online ride-matching network that connects
faculty and sta with the same destination,and
helps save time and money on their commute.
For more information see www.zimride.com/CUA.
15
Basic Life Insurance
The Catholic University of America provides Basic Employee Life Insurance to eligible employees the first of the
following month after the employees have completed their initial 90 days. The cost of this benefit is paid by The
Catholic University of America and there is no cost to the employee. The Life and AD&D insurance amount reduces
at age 70 by 35% and at age 75, it reduces by 50%.
Basic Life Insurance Basic AD&D Insurance
1 x your annual salary 1 x your annual salary
Voluntary Term Life Insurance
In addition to Basic Life Insurance, you may choose to buy Voluntary Term Life Insurance for yourself and your
dependents. The Supplemental Life and AD&D insurance amount reduces at age 70 by 35% and at age 75, it
reduces by 50%.
Voluntary Life Insurance for
yourself
$10,000 - $500,000
• Maximum Coverage of 5x your annual salary
• In increments of $10,000
• New Hires can choose coverage up to the maximum of $500,000 without
being subject to evidence of insurability (you will need to provide evidence
of insurability if you enroll after you are first eligible or want to increase
your election later)
Voluntary Life Insurance
for your Spouse-only available if
the employee elects supplemental life
insurance.
$5,000 - $250,000
• In increments of $5,000
• No more than 50% of your Employee Voluntary Life Insurance amount.
• Spouses of New Hires can choose coverage of up to $50,000 without
answering medical questions
Voluntary Life Insurance
for Each Child-only available if
the employee elects supplemental life
insurance.
Age 0 – 13 days: No coverage
Age 14 days – 6 months: $500
Age 6 months – 26 years:
• $2,500 - $10,000
• In increments of $2,500
LIFE AND ACCIDENTAL DEATH &
DISMEMBERMENT AD&D AND
LONGTERM DISABILITY INSURANCE
16
LIFE AND ACCIDENTAL DEATH &
DISMEMBERMENT AD&D AND
LONGTERM DISABILITY INSURANCE
Voluntary Term Life Insurance Monthly Contributions 2020
Age Your Monthly Cost Per $1,000 of Coverage Spouse Monthly Cost Per $1,000 of Coverage
Less than 30 $0.044 $0.044
30-34 $0.056 $0.056
35-39 $0.070 $0.070
40-44 $0.094 $0.094
45-49 $0.144 $0.144
50-54 $0.238 $0.238
55-59 $0.399 $0.399
60-64 $0.583 $0.583
65-69 $0.992 $0.992
70+ $1.874 $1.874
Cost for Your Child(ren)
Covers all eligible children
$0.103
Long-Term Disability Coverage
The Catholic University of America provides Long-
Term Disability (LTD) insurance at no cost to you. LTD
Insurance continues a portion of your salary as long as
you are considered disabled and eligible for long-term
disability benefits.
Long-Term Disability
(Paid for by The Catholic University of America)
Benefit you will receive 60% of salary
Maximum benefit that you can
receive
$10,000/month
When benefits start After 90 days of disability
Age on Date of Your
Disability
Benefit Period
Less than 60 To age 65
60 60 months
61 48 months
62 42 months
63 36 months
64 30 months
65 24 months
66 21 months
67 18 months
68 15 months
69 or over 12 months
Maximum Long-Term Disability
Benefit Period
The Maximum Benefit Period is the later of your Social
Security Normal Retirement Age or the period shown in
the chart below:
Voluntary Term Life Insurance
17
ARAG Legal Plan
Through the ARAG Legal Plan, you can have legal
services available to you and your family when you
need them. Whether you are buying or selling a home,
need assistance with a case of identity theft, have an
immigration issue, or have family legal matters, your
ARAG coverage can help.
The services available to you as a member include:
• Legal representation from a network attorney
• Telephone legal advice and consultation
• Online legal tools and resources
• Financial education and counseling services
• Identity theft services
• Immigration assistance
When you enroll, your premiums are paid through
payroll deduction on an after-tax basis. To learn
more about ARAG before you join, log onto
www.ARAGLegalCenter.com and use access code:
17022cua. To reach ARAG by phone, call 800-247-4184
between 8 a.m. and 8 p.m. Eastern.
Legal Plan Monthly
Contribution 2020
ARAG Voluntary Legal Plan
Employee $22.00
Auto & Home Insurance
You may be able to save up to 10% on auto and home
insurance with Liberty Mutual.
• Rates are guaranteed for 12 months
• The Catholic University of America does not directly
administer this plan. All transactions take place
directly between you and Liberty Mutual
Contact Gloria Harrison at 301-666-3160 or email
[email protected] for a free coverage
evaluation and rate quote.
Nationwide Pet Insurance
You can purchase health insurance for your dog, cat,
bird or exotic animals through the Nationwide Pet
Insurance program. Like a regular health insurance
plan, coverage is available for both wellness and
illnesses and injuries. Below is an overview of how the
Plan works:
• There is a $250 annual deductible.
• After meeting the deductible, the Plan reimburses
you for a portion of your cost for covered oce
visits and services.
• You receive a premium discount because you are
purchasing coverage through a group.
• Your coverage is portable, and your coverage will
continue if you leave The Catholic University of
America.
• Your premium is based on your pet’s species, age,
benefits coverage selected, and where you live and
whether you choose “My Pet Protection” or “My Pet
Protection with Wellness” coverage.
You will be billed directly by Nationwide. Payroll
deduction is not available.
VOLUNTARY BENEFITS
Expanded ID Theft Protection, which includes the
following:
• Credit Monitoring
• Child Monitoring
• Internet Surveillance
• Lost Wallet Services
• Full-Service Identity Restoration
State Tax Audit
Credit Records Correction
Tax Services
18
RETIREMENT PLANS
The Catholic University of America Retirement Plan
The Catholic University of America has a Defined Contribution Savings Plan (403(b)), which enables you to save for
retirement on a pre-tax basis.
The University strongly encourages employees to set financial goals and plan for retirement. The retirement plan is
administered by TIAA, the largest private pension plan in the United States. TIAA provides retirement plans at more than
15,000 colleges, universities and non-profit organizations.
You are eligible to participate in the pre-tax deferral voluntary portion of the plan the first of the following month after
your date of hire. This portion of the plan is the Group Supplemental Retirement Annuity Plan (GSRA). There is no age
requirement or years of service requirement for deferring your compensation as pre-tax into the GSRA plan. There is no
employer contribution to this GSRA plan. However, actual commencement of deferral is contingent upon the receipt and
approval by the Oce of Human Resources of all the necessary administrative forms.
Once you have met the age and service requirements listed below, you will be enrolled in Option 1(see below) of the
University Contribution Matching Plan the first day of the following month and become eligible to receive Employer
Contributions or Matching Contributions from the University. If you participated in the GSRA plan, please contact Human
Resources to change your contributions to the Matching Plan.
University Contribution Matching Plan Eligibility Requirements:
• You must be at least age 26 and have 1 year of eligible service with the University before you will be eligible to
receive matching contributions from the University. A year of eligible service is only granted if you complete at least
1,000 hours of service during that period.
• A year of eligible service means a 12 consecutive month period.
• New employees who worked for a prior employer with a qualified 401(a), 403(b) or 457(b) plan immediately
preceding 90 days of employment at the University may apply for a waiver of the one year of service requirement.
Please contact the Human Resources for more information on this provision.
Once the requirements have been met for the Matching Plan, the university contributions will be allocated to your 403(b)
The Catholic University of America’s account equal to 5% of your compensation as defined by the plan without making any
election or any contribution. You will be automatically enrolled in Option 1. If you contribute more, through Options 2 or 3,
the university contribution increases.
The amount of your salary reduction will produce a total university contribution that does not exceed the employee’s
statutory exclusion allowance under IRC Section 403(b), the limitations of IRC Section 415, or the limitations of IRC Section
402(g), whichever is least.
If you wish to enroll or make changes to your retirement savings elections, you should forward a completed Authorization for
Salary Reduction form (form is available at humanresources.cua.edu) to the Oce of Human Resources. Your new retirement
election(s) will only be eective in your first paycheck following the next month after this form is signed and accepted by the
Oce of Human Resources.
Retiree Eligibility:
To be eligible for retirement benefits, an employee must be at least age 60 and his/her age plus at least 10 years continuous
service in a regular benefits eligible position must equal at least 75.
Please see the Announcements page at http://humanresources.cua.edu for a schedule of TIAA
Information Sessions. For additional information, please contact Human Resources at 202-319-5050.
The Catholic University of America Retirement Plan
The Catholic University of America has a Defined Contribution Saving Plan (403(b)), which enables you
to save for retirement on a pre-tax basis.
The University strongly encourages employees to set financial goals and plan for retirement. The
retirement is administered by TIAA/CREF, the largest private pension plan in the United States.
TIAA/CREF provides retirement plans at more than 15,000 colleges, universities and non-profit
organizations.
You are eligible to participate in the pre-tax deferral voluntary portion of the plan the first of the month
after your date of hire. This portion of the plan is the Group Supplemental Retirement Annuity Plan
(GSRA). There is no age requirement or years of service requirement for deferring your compensation as
pre-tax into the GSRA plan. There is no employer contribution to this GSRA plan. However, actual
commencement of deferral is contingent upon the receipt and approval by the Office of Human
Resources of all the necessary administrative forms.
Once you have met the age and service requirements listed below, you will be enrolled in Option 1(see
below) of the University Contribution Matching Plan the first day of the next month and become eligible
to receive Employer Contributions or Matching Contributions from the University. If you participated in the
GSRA plan, please contact Human Resources to change your contributions to the Matching Plan.
University Contribution Matching Plan Eligibility Requirements:
You must be at least age 26 and have 1 year of eligible service with the University before you will
be eligible to receive matching contributions from the University. A year of eligible service is only
granted if you complete at least 1000 hours of service during that period.
A year of eligible service means a 12 consecutive month period.
New employees who worked for a prior employer with a qualified 401(a), 403(b) or 457(b) plan
immediately preceding 90 days of employment at the University may apply for a waiver of the one
year of service requirement. Please contact the Human Resources for more information on this
provision.
Once the requirements have been met for the Matching Plan, the university contributions will be allocated
to your 403(b) CUA’s account equal to 5% of your compensation as defined by the plan without making
any election or any contribution. You will be automatically enrolled in Option 1. If you contribute more,
through Options 2 or 3, the university contribution increases.
Option 1 No Employee contribution 5 % University contributions
Option 2 2.5 % Employee contribution 7.5 % University contribution
Option 3 5 % Employee contribution 10% University contribution
The amount of your salary reduction will produce a total university contribution that does not exceed the
employee’s statutory exclusion allowance under IRC Section 403(b), the limitations of IRC Section 415, or
the limitations of IRC Section 402(g), whichever is least.
If you wish to enroll or make changes to your retirement savings elections, you should forward a
completed Authorization for Salary Reduction form (form is available at humanresources.cua.edu) to
the Office of Human Resources. Your new retirement election(s) will only be effective in your first
paycheck following the next month after this form is signed and accepted by the Office of Human
Resources.
Please see the Announcements page at humanresources.cua.edu for a schedule of TIAA-CREF
Information Sessions. For additional information, please contact Human Resources at 202-319-5050.
Sta employees become eligible to receive tuition
assistance for dependent children and spouses the first
semester following their date of hire
19
OTHER BENEFITS
Credit Union
The Catholic University of America employees are
eligible to join the EP Federal Credit Union which has
three full-service locations in the Washington DC area
– including one on The Catholic University of America
campus. For more information, see www.epfcu.org or
visit the on-campus location at 150 Leahy Hall.
The Catholic University of
America Tuition Assistance
Through the Tuition Assistance program, The Catholic
University of America employees can take up to two
courses per semester, up to four courses per academic
year. Employees must be admitted through the regular
admission process. Employees taking graduate courses
are required to pay taxes for any tuition costs over
$5,250 each year.
Upon meeting the eligibility requirements, employees
are able to receive tuition assistance, as specified
below, for courses taken at The Catholic University of
America. If employment with The Catholic University
of America terminates prior to the completion of the
semester for which an employee is receiving tuition
assistance, the employee forgoes the benefit for that
semester. Fees and other expenses are not covered
by the tuition assistance benefit, and tuition assitance
benefits may not be combined with University
scholarships or funds.
Tuition Assistance for Dependents
Your spouse or dependent children may also attend
The Catholic University of America if admitted through
the regular admission process as a degree-seeking
candidate pursuing their initial undergraduate degree.
• Employees become eligible to receive tuition
assistance for dependent children up to age 23 and
spouses the first semester following their date of hire
• Tuition only is waived, including overseas programs
• Room, board, books, and other fees are not covered
by this program
Tuition Exchange
Your dependent child may be eligible to attend a school
that participates in the National Tuition Exchange
scholarship program. In order to participate, you must
have completed at least two years of service at The
Catholic University of America. Your child:
• Should apply to the program and the school(s) that
participate in the program one year before the year
in which they plan to enroll
• Must be accepted by the participating school(s) and
acceptance is not guaranteed
• Must re-apply each year as scholarships are
awarded one year at a time
Each school has dierent criteria for acceptance into
the program, and makes decisions based on their
criteria and ability to accept additional students into
their Tuition Exchange scholarship program.
For more information and a list of participating schools, see
http://humanresources.cua.edu/benefits/exchange.cfm.
Special Enrollment Period
For Medicare
After your Initial Enrollment Period is over, you may
have a chance to sign up for Medicare during a Special
Enrollment Period. If you didn’t sign up for Part B (or
Part A if you have to buy it) when you were first eligible
because you’re covered under a group health plan
(with 20 or more employees) based on current
employment (your own, a spouse’s , or a family
member’s (if you have a disability)), you can sign
up for Part A and/or Part B:
• Anytime you’re still covered by the group health plan
• During the 8-month period that begins the month
after the employment ends or the coverage ends,
whichever happens first
• Must re-apply each year as scholarships are
awarded one year at a time
If you have additional questions, please contact
www.medicare.gov (website) or 1-800-MEDICARE
20
OTHER BENEFITS
Family Medical Leave
The Federal Family & Medical Leave Act of 1993 and the
District of Columbia Family & Medical Leave Act of 1990
allows for all eligible employees to take job-protected,
unpaid leave, after a 12-month waiting period, for:
• the birth or adoption of a child or placement of a child
for foster care
• the care of a family member with a serious health
condition
• when the employee has a serious health condition
Federal law allows up to 12 work weeks in any 12-month
period. District of Columbia law allows an additional 4
weeks in any 24-month period for one’s own serious
health condition and a separate 16-week period allowed
for the birth, adoption, placement of a child for foster
care or the care of a family member with a serious health
condition. The Federal and District of Columbia laws run
concurrently.
Workers Compensation
If you are injured on the job, the D.C. Workers’
Compensation Act of 1979 entitles you to full medical
care for your work related injury or illness and provides
reimbursement for lost wages. If you are injured on
the job, report it to your supervisor immediately. You or
your supervisor must complete a First Report of Injury
or Occupational Illness form and return it to Human
Resources within 3 days of the incident.
Inclement Weather Policy
Due to inclement weather, The Catholic University of
America may have delayed openings and/or emergency
closings. Ocial delayed openings and emergency
closings are paid leave for non-essential sta. Call
(202)-319-5000 to inquire if the University will be closed.
Please note:
• Extra pay is not provided to those who work
during inclement weather. Essential employees, as
determined by your supervisor, are expected to work.
• Employees on vacation or sick leave may not claim
leave for inclement weather
• The Catholic University of America does not
necessarily close if local government oces are
closed
• Announcements of closings are usually made by
6:30 a.m.
Campus Smoke-Free Policy
The Catholic University of America does not allow
smoking in any building or The Catholic University
of America owned vehicle. You may smoke outside
buildings, but please be considerate of others and do
not block the doorways.
21
REQUIRED NOTICES
Women’s Health Act
The Women’s Health and Cancer Rights Act of 1998 requires
that all health insurance plans that cover mastectomy also
cover the following medical care:
• Reconstruction of the breast on which the mastectomy
was performed
• Surgery and reconstruction of the other breast to produce
a symmetrical appearance
• Prostheses and treatment of physical complications at all
stages of the mastectomy, including lymphedemus, and
mastectomy bras and external prostheses limited to the
lowest cost alternative available the meets the patient’s
physical needs
Newborns’ and Mothers’ Health
Protection Act
Federal law (Newborns’ and Mothers’ Health Protection Act of
1996) prohibits the plan from limiting a mother’s or newborns’
length of hospital stay to less than 48 hours for a normal
delivery or 96 hours for a Cesarean delivery or from requiring
the provider to obtain preauthorization for a stay of 48 or 96
hours, as appropriate. However, federal law generally does
not prohibit the attending provider, after consultation with the
mother, from discharging the mother of her newborn earlier
than 48 hours for normal delivery or 96 hours for Cesarean
delivery.
Mental Health Parity Act
According to the Mental Health Parity Act of 1996, the lifetime
maximum and annual maximum dollar limits for mental health
benefits under the The Catholic University of America medical
plan are equal to the lifetime maximum and annual maximum
dollar limits for medical and surgical benefits under this plan.
Health Insurance Portability
and Accountability Act (HIPAA)
The Catholic University of America, In accordance with HIPAA,
protects your Protected Health Information (PHI). The Catholic
University of America will only discuss your PHI with medical
providers and third party administrators when necessary to
administer the plan that provides you your medical, dental,
and vision benefits or as mandated by law. A copy of The
Catholic University of America’s Notice of Privacy Practices is
available upon request in the Human Resources department.
Michelle’s Law
This law amends the Employee Retirement Income Security
Act of 1974 (ERISA), the Public Health Service Act, and the
Internal Revenue Code to prohibit a group health plan from
terminating coverage of a dependent child due to a medically
necessary leave of absence from, or any other change in
enrollment at, a postsecondary education institution that
commences while such child is suering from a serious illness
or injury and that causes such child to lose student status for
purposes of coverage under the plan, before the earlier of: (1)
one year after the first day of the medically necessary leave
of absence; or (2) the date on which such coverage would
otherwise terminate under the terms of the plan. Michelle’s
Law requires written certification by the child’s treating
physician and directs group health plans to include notice of
the terms of this Act with any notice regarding a requirement
for certification of student status for coverage under the plan.
Michelle’s Law also provides that coverage under this Act
continues in the manner in which the participant or beneficiary
is covered under the plan changes so long as the change
of coverage continues to provide coverage of beneficiaries
as dependent children. It also applies such requirement to
coverage oered in the individual market.
Summary of Material
Modifications
This enrollment guide constitutes a Summary of Material
Modifications (SMM) to the The Catholic University of
America 2015 summary plan description (SPD). It is meant to
supplement and/or replace certain information in the SPD,
so retain it for future reference along with your SPD. Please
share these materials with your covered family members.
22
Summary of Benefits and
Coverage (SBC)
Health insurance issuers and group health plans are required
to provide you with an easy-to-understand summary about
a health plan’s benefit coverage. The new regulation is
designed to help you better understand and evaluate your
health insurance choices. These documents are available at
www.mycuabenefits.com and at www.myuhc.com.
REQUIRED NOTICES
Medicaid and the Children’s Health Insurance Program (CHIP)
Oers Free Or Low-Cost Health Coverage To Children And Families
If you are eligible for health coverage from your employer, but are unable to aord the premiums, some States
have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid
or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance
in paying their health premiums. More information about the Medicaid and the CHIP notice is available at
www.mycuabenefits.com.
Medicare Part D
The Medicare Modernization Act (MMA) requires employers (whose policies include prescription drug coverage) to
notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means
that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage.
Each year UHC performs an actuarial evaluation to determine whether our prescription drug plan is creditable or
non-creditable. UHC has completed an updated actuarial evaluation and our plan was determined to meet the
creditability criteria, which means that our plan is expected to pay on average as much as the standard Medicare
prescription drug plan. 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. To obtain a copy of the annual
notice of creditable coverage, go to www.mycuabenefits.com. If you have purchased a Medicare (D) drug plan you
may want to contact Medicare for additional information (1-800-Medicare). The entire document is available at
www.mycuabenefits.com .
Individual Marketplace Notice
The Catholic University of America is distributing the
Marketplace Notice as required by federal law to all eligible
employees. The notice explains your health coverage under
our plans in 2019 and the new Health Insurance Marketplace
(know as the “Exchange”). This document is also available at
www.mycuabenefits.com.
23
TERMS
Coinsurance: The percentage of covered expenses that
you or the plan pays. Only the Basic Plan has coinsurance.
Copay: A set amount that you pay for medical care or
prescription drugs.
Deductible: The amount you pay towards medical or
dental expenses each year before the plan starts paying
benefits.
Emergency: An emergency is a sickness or injury severe
enough that failure to receive immediate medical care
could put the patient’s health in serious jeopardy.
Flexible Spending Account (FSA): If eligible, you can
contribute tax-free money to their Health Care, Dependent
Care, and/or Commuter FSA via convenient payroll
deductions. When you incur an eligible expense, you can
file a claim for reimbursement from your FSA. FSA money
does not roll over from year to year.
Generic Drugs: Generic drugs have the same
active ingredients and the same dosage levels and
administrative method as name brand drugs. Generic
drugs typically cost less than a name brand drug.
Network Provider: A health care provider that has
contracted to furnish services or supplies for a negotiated
charge and is included in the plan’s provider network. Also
called an “in-network provider.”
Non-Network Provider: A health care provider that is
not included in the plan’s provider network. Also called an
“out-of-network provider.”
Out-of-Pocket Maximum: The Medical Plan limits how
much you pay towards your medical care in a year. When
your deductible, copay, and coinsurance payments reach
the out-of-pocket maximum for a calendar year, the plan
begins paying 100% of your covered expenses for the rest
of the year.
Premium: The amount that you and The Catholic
University of America pay for providing medical insurance.
Preventive Care: This care does not treat a particular
condition, but is meant to help the patient get and stay
healthy. Preventive care includes well-child check-
ups, immunizations, annual exams, and many cancer
screenings, such as mammograms.
Primary Care Physician (PCP): A family or general
practitioner, internist or pediatrician who provides a broad
range of routine medical services and refers patients to
specialists, hospitals and other providers as necessary. An
OB/GYN is considered a PCP when providing routine care.
Reasonable and Customary Charges: If you use
out-of-network providers, benefits may be based on
reasonable and customary charges. These are the fees
determined from claims data to be the usual charge by
most providers in your geographic area for a particular
service or supply.
Specialist: A provider whose practice is limited to
treating a specific disease, specific parts of the body
or specific procedures. Examples of specialists include
dermatologists, cardiologists, oncologists, and surgeons.
NOTES
About This Guide
This guide describes the benefit plans and policies available to you as an employee of The Catholic University of America. The
details of these plans and policies are contained in the ocial plan and policy documents, including some insurance contracts.
This guide is meant only to cover the major points of each plan or policy. It does not contain all of the details that are included in
your summary plan description (as described by ERISA).
If there is ever a question about one of these plans and policies, or if there is a conflict between the information in this guide and
the formal language of the plan or policy documents, the formal wording in the plan or policy documents will govern.
Please note that the benefits described in this guide may be changed at any time and do not represent a contractual obligation on
the part of The Catholic University of America. Summary Plan Descriptions for all plans can be found at www.mycuabenefits.com.
EMPLOYEE PREMIUM CONTRIBUTIONS
Medical & Prescription Drug Plan Monthly Contributions 2020
Health Advocate cost is included in all medical contributions
UHC Definity HSA UHC Choice Silver UHC Choice Basic
Employee
Employee +1
Family
$174.05
$374.70
$534.93
Employee
Employee +1
Family
$208.11
$446.51
$637.26
Employee
Employee +1
Family
$138.38
$299.68
$427.51
Dental Plan Monthly Contributions
2020
MetLife Silver MetLife Gold
Employee
Employee +1
Family
$12.67
$24.40
$40.26
Employee
Employee +1
Family
$38.24
$66.74
$101.44
Vision Plan Monthly Contributions
2020
UHC Vision
Employee
Employee +1
Family
$6.36
$9.29
$15.22
Voluntary Term Life Insurance Monthly Contributions 2020
Age Your Monthly Cost Per $1,000 of Coverage Spouse Monthly Cost Per $1,000 of Coverage
Less than 30 $0.044 $0.044
30-34 $0.056 $0.056
35-39 $0.070 $0.070
40-44 $0.094 $0.094
45-49 $0.144 $0.144
50-54 $0.238 $0.238
55-59 $0.399 $0.399
60-64 $0.583 $0.583
65-69 $0.992 $0.992
70+ $1.874 $1.874
Cost for Your Child(ren)
Covers all eligible children
$0.103
Legal Plan Monthly
Contribution 2020
ARAG Voluntary Legal Plan
Employee $22.00