2012 Benefit Enrollment Guide - Education Management Corporation

Educated Choices 

2012 Benefit Enrollment Guide 

Make educated choices for your health, 

wealth and wellness.


for your health, wealth and wellness 

In This Guide: 

Educated Choices… ..............................................1 

Get Ready to Enroll........................................................1 

Your 2012 Choices........................................................2 

Benefit Costs.............................................................3 

Waiving Coverage.........................................................3 

Eligibility.................................................................4 

Enrollment...............................................................6 

When Participation Ends................................................... 7 

Your Health… ....................................................8 

Medical..................................................................8 

Prescription Drugs.........................................................13 

Dental...................................................................15 

Vision................................................................... 18 

Your Wealth… ................................................... 20 

Life Insurance.............................................................21 

Disability Insurance........................................................25 

Flexible Spending Accounts (FSA)............................................27 

The Retirement Plan – 401(k)............................................... 29 

Commuter Program.......................................................30 

More Benefits............................................................ 30 

Your Wellness… ..................................................31 

Employee Assistance Program (EAP)..........................................31 

Wellness Programs from ActiveHealth........................................32 

Wellness Incentive Program – Healthy Rewards Pricing..........................33 

Important Notices for Participants...............................34 

Patient Protection and Affordable Care Act....................................34 

Notice of Privacy Practices for Protected Health Information......................34 

Notice of Women’s Health and Cancer Rights Act of 1998...................... 36 

Important Notice of Credible Coverage and Information 

About Your Prescription Drug Coverage and Medicare..........................36 

Medicaid and the Children’s Health Insurance Program (CHIP) Notice............. 37 

Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC).


Your Educated Choices program offers you health, wealth and wellness benefits in one total package. 

You receive: 

• Engaging health benefits that help you control costs 

• Financial benefits that offer peace of mind 

• Wellness programs to help you focus on what’s truly important — living life to the fullest 

Many of the Educated Choices products, programs and services work together, giving you and your family well-rounded 

protection for your mind, body and wallet. 

Here are just a few ways your health, wealth and wellness benefits can work together: 

• Take advantage of wellness programs and preventive care coverage to help you realize your best health potential. 

• Have a nurse case manager, who knows both your health and prescription drug plans, help you manage your chronic condition(s). 

• Enroll in a flexible spending account (FSA) to save on taxes, then use that money to cover eligible out-of-pocket medical costs. 

• Participate in the wellness program to earn an incentive that reduces your health plan premium. 

Get Ready to Enroll 

1. 

Understand how your benefits work. Understanding your 

options is key to selecting benefits that best fit your needs, 

so please take time to review this guide. You can also find 

helpful information and educational tools on the HR One 

Connect Employee Resource website (http://ess.edmc.edu). 

2. 

Compare your benefit options using the Health Plan 

Educator tool. This fun and interactive tool can be found on 

Employee Resource. After answering a few questions about 

yourself, your guide “David” will explain the plans and assist 

you in choosing the medical plan which best meets your needs. 

3. 

Consider ways to lower your out-of-pocket costs. 

• Flexible Spending Accounts (FSA). FSAs are a great way to 

put aside money — free of federal and most state and local 

taxes — to pay for expenses that may not be covered by your 

plans (see page 27 for more details). 

• The EDMC Wellness Program. You can qualify for reduced 

medical plan premiums when you participate in programs and 

take actions that promote a healthy lifestyle. More information 

about the program is available on page 32. 

4. 

Look at other benefits that can give you and your family 

added protection. EDMC provides basic life and accidental 

death and dismemberment insurance as well as short-term 

disability coverage. To give you and your family added 

protection, you may be able to buy additional life insurance 

for yourself and your dependents and long-term disability 

coverage. See pages 21 through 26 for more information. 

5. 

Enroll Online. Visit Employee Resource (http://ess.edmc.edu) 

to make your educated benefit choices. 

Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC). 

1

Your 2012 Choices 

To help you get started reviewing your benefit choices, here are all your options at a glance. You can find detailed information 

about each option in the applicable sections of this guide or online on Employee Resource. 

Benefit Programs Options Who’s Eligible Who Pays the Cost Deductions 

Medical and 650 Deductible Plan 

Prescription Drug 450 Deductible Plan 

250 Deductible Plan 

Dental 

Basic Plan 

Premium Plan 

Full Time Grandfathered You and You Pay EDMC Before After 

Part Time* EDMC the Full Pays the Taxes Taxes 

Share in Cost at Full Cost 

the Cost Discounted 

Group Rates 

X X X X 

X X X X 

Vision Premium Plan X X X X 

Basic Life/AD&D 2 times annual salary 

(maximum of $500,000)** 

for full-time employees 

$25,000 for part-time* 

employees 

X X X N/A 

Additional 1-3 times annual salary 

Life/AD&D (maximum of $500,000)** X X X 

Dependent 

Spouse Life 

Dependent 

Child Life 

$10,000 - $100,000 of 

coverage, in increments of 

$10,000 

$500 from age 14 days 

to 6 months 

$5,000 from 6 months 

to age 26 

Short-Term Coverage equal to 100% 

Disability (STD) of your annual base salary 

Long-Term 

Disability (LTD) 

Coverage available for: 

50% of annual salary 

66 2 ⁄3% of annual salary 

Flexible Spending Health Care 

Accounts (FSAs) Dependent Care 

Employee 

Assistance 

Program 

Available to employees 

and their household 

members 

Retirement Plan 401(k) Plan 

The Company matches 

your contributions at 100% 

up to 6% of annual salary 

on a per pay basis 

Commuter 

Program 

Allows pretax payroll 

deductions to pay your 

commuter expenses 

X X X 

X X X 

X X N/A 

X X X 

X X X X 

X X X N/A 

X X X X 

X X X X 

* Part-time employees with hire dates prior to December 1, 2011 will retain benefits eligibility in a grandfathered status through December 31, 2013. 

Part-time employees hired on or after December 1, 2011 are eligible for the Employee Assistance Program and the 401(k) Plan only. 

** Rounded to the next highest thousand. 

2 Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC).

Benefit Costs 

If you choose to enroll in benefits, you and EDMC share in 

some of the costs (see previous page). Your actual premium 

rates can be found on Employee Resource. 

Making your premium payments 

You pay your premiums through convenient payroll deductions, 

beginning with the first pay date after benefits begin. 

For example, if your benefits begin January 1, your 

first premium will be deducted from the first pay 

in January. 

Waiving Coverage 

Full-time employees who choose to waive 

participation in the medical plan will receive a 

waive credit as additional, taxable income in each 

paycheck. In order to be eligible to receive the 

waive credit, you must make an election to waive 

participation during enrollment. Part-time* 

employees are not eligible for the waive credit. 

* Part-time employees with hire dates prior to 

December 1, 2011 will retain benefits eligibility in a 

grandfathered status through December 31, 2013. 

Part-time employees hired on or after December 1, 2011 

are eligible for the employee assistance program and 

the 401(k) plan only. 


3

Eligibility 

Understanding who qualifies for benefits is an important part 

of ensuring your coverage and that of your family. 

New full-time employees are eligible to participate in most 

benefits on the first day of the month following or coinciding 

with 30 calendar days of employment. For example, if your 

date of hire is June 12, your benefits would start on August 1. 

Employees who transfer from a non-full-time position to a 

full-time position may participate on the first day of the month 

after the date of transfer. For example, if you transfer to a 

full-time position June 15, your benefits become effective 

on July 1. If you transfer to a full-time position on the first 

of the month, your benefits become effective the first of the 

following month. For example, if you transfer to a full-time 

position June 1, your benefits become effective on July 1. 

Who can enroll? 

• You. 

• Your legal spouse. 

• Your domestic partner (see next page). 

• Your or your domestic partner’s child(ren) under 

age 26. Dependents remain eligible to age 26 

as long as they are not eligible for another 

employer-sponsored health plan. 

• Your or your domestic partner’s unmarried, 

dependent child(ren) ages 26 and above, 

if disabled upon attainment of age 26. 


About domestic partner coverage 

You can enroll your same-sex or opposite-sex domestic partner for medical, dental and vision coverage. To qualify, domestic 

partners must be a “spousal equivalent,” meaning among other things, that you are in a long-term committed relationship and 

share a primary residence and financial responsibility. A notarized Domestic Partner Affidavit form is required if you are enrolling 

a same-sex or opposite-sex domestic partner. 

You can find the Domestic Partner Affidavit form on Employee Resource. 

Note: Under current regulations, domestic partners can only be enrolled if the employee is a new hire or is enrolling the domestic 

partner during the annual Open Enrollment period. Domestic partners are not permitted to enroll outside of these two time frames 

and are not eligible for qualifying life event changes. 

If you elect domestic partner coverage, the cost for your partner’s benefit coverage will be deducted from your pay on an after-tax 

basis, and you will be required to pay tax on the fair market value of a portion of the premium. This is called “imputed income.” 

Have more than one plan? 

When both you and your spouse have a health plan that covers 

the same dependents, we must coordinate benefits with that 

other health plan. You cannot file a claim for the same coverage 

under both plans. Follow these guidelines: 

• You: As an employee and subscriber of the plan, EDMC’s plan 

is your primary carrier. Submit claims to our plan first. You may 

then submit any unpaid expenses to your spouse’s plan. That 

plan may or may not pay an additional amount. 

• Your spouse: Your spouse should file claims under his/her 

employer’s plan first. If the amount payable under our plan 

is greater than what your spouse’s plan paid, you can then file 

a claim for that difference under the EDMC plan. 

• Your child(ren): If your child(ren) is/are covered under 

both plans, payment of benefits depends on whether 

your birthday or your spouse’s birthday occurs first in 

the calendar year. For example, if your birthday is 

before your spouse’s, submit your child(ren)’s bills 

to our plan first, then to your spouse’s plan. 

• Same employer? If you and your spouse or domestic 

partner are both employed by EDMC, you may only 

cover dependents under one plan. 


5

Enrollment 

When to enroll 

New full-time employees: You have until your 30th calendar 

day of employment to complete the enrollment process. If you 

do not meet this 30-day deadline, you must wait until the next 

annual Open Enrollment period. You will, however, be enrolled 

in automatic benefits, including basic life/accidental death 

and dismemberment, the employee assistance program (EAP) 

and short-term disability. 

Current employees: Open Enrollment is typically held in the 

fall of each year for benefits effective January 1. If you do not 

complete the enrollment process, you will automatically be 

enrolled in the same plan(s) that you had the previous year, with 

the exception of any flexible spending accounts (FSA). You must 

complete the enrollment process each year to enroll in an FSA. 

Verifying coverage: Verify that your expected premiums 

are deducted from your first pay to be sure your elections took 

effect. You have seven calendar days after the first impacted 

pay date to notify us of any errors to your benefit elections. 

If there are any errors, call HR One Connect at 1-888-471-3362 

(1-888-HR1-EDMC) right away so we can make necessary 

corrections. Your next opportunity to correct any errors will 

be during the following annual Open Enrollment period. 

How to enroll 

Visit Employee Resource to access benefits information. 

1. 

2. 

3. 

4. 

5. 

Be sure to update dependent and beneficiary information 

before making benefit elections. 

Click through the enrollment screens to make elections 

or changes. 

Click “Finalize Your Elections” to submit your elections. 

Print a copy of your confirmation statement for 

your records. 

Qualifying life events 

Each year — during Open Enrollment — you have an 

opportunity to select your benefits for the upcoming year. 

Since your personal situation may change, this ensures that 

you can always choose the right benefit coverage each year. 

The choices you make will be effective from January 1 through 

December 31. IRS regulations require that you cannot change 

benefit options during the year unless you have a qualifying life 

event. To make benefit changes due to a qualifying life event, 

complete a Benefit Election Form (available on Employee 

Resource) and provide written verification of the qualified 

life event. Submit all required paperwork to HR One Connect 

within 30 calendar days of the event. If you miss the 30-day 

window, you must wait until the next Open Enrollment period 

to make the change. Changes to your benefit elections will be 

effective on the first of the month following or coinciding with 

the date of the event. 

Qualifying life events include: 

• The birth, adoption or placement for adoption of an eligible 

dependent child 

• The death of an eligible dependent or spouse 

• Your marriage, divorce, annulment or legal separation 

(if recognized by state law) 

• A change in your or your eligible dependent’s 

employment status 

• A dependent becomes eligible or ceases to be eligible 

under the plan, including attainment of age 26 

• A change in the place where you, your spouse or eligible 

dependent(s) reside (if it affects your eligibility) 

Requested changes must be consistent with the qualifying 

life event. For example, the birth of a child allows you to 

add coverage for your new dependent, 

but does not allow you to add 

vision coverage for yourself. 

Documents you may need to complete 

your enrollment 

Download these forms from Employee Resource: 

• Domestic Partner Affidavit form 

• Evidence of Insurability (EOI) form 


When Participation Ends 

For medical, dental, vision and employee assistance program: 

Participation will end on the last day of the month in which 

the earliest of the events shown below occurs. 

For other programs, including: 

• short-term disability 

• long-term disability 

• basic and additional life/accidental death and dismemberment 

• dependent spouse and dependent child life 

• flexible spending accounts 

Participation will end immediately on the date in which the 

earliest of the events shown below occurs. 

Eligible Employee: 

• Your employment terminates 

• You cease to be eligible to participate in the plan 

• EDMC discontinues the plan for any reason 

Eligible Dependent / Domestic Partner: 

• The eligible employee’s participation ends 

• The eligible dependent or domestic partner ceases to 

be an eligible dependent or domestic partner 

• EDMC discontinues the plan for any reason 

Continue your benefits if you lose coverage 

You and your eligible dependents can continue your medical, 

dental, vision, employee assistance program and health care 

flexible spending account, for a specified period of time, if you 

become ineligible for benefits through EDMC by experiencing 

a qualifying event. This continued coverage is afforded to you 

under the Consolidated Omnibus Budget Reconciliation Act — 

better known as COBRA. 

With COBRA, you (or your dependent) must pay the 

premium — on an after-tax basis and without employer 

contribution — directly to the COBRA administrator. 

You have 60 days to sign up for COBRA. This 60-day window 

begins when your coverage ends or when you receive a notice 

from us saying that you are eligible for COBRA (whichever 

occurs last). 

Here are a few examples that would qualify you or your 

dependents for COBRA: 

• Your employment status changes to one that is not eligible 

for that benefit 

• You end your employment with EDMC 

• Your dependent turns age 26 and loses eligibility 

• Your spouse loses eligibility due to divorce 

You’ll receive instructions on how to enroll in COBRA benefits 

with your eligibility notice. 

See the Signature Benefits Plan Summary Plan Description 

(available on Employee Resource) for more details. 

Getting married? Having a baby? 

Sending children off to college? 

Check out the My Life section of Employee Resource to 

discover important information to help you make critical 

decisions regarding new or upcoming changes in your life. 


7

Your Health 

All full-time and part-time* employees can enroll in benefits for your health — that includes medical, 

prescription drug, dental and vision. Prescription drug coverage is included when you enroll in any of the 

Aetna medical plan options. You’ll find premium information for each of the health plans on Employee 

Resource. These premiums are all conveniently deducted from your paycheck before taxes are calculated. 

Brought To You By: 

1-866-738-6737 

www.aetna.com 

Medical 

The medical plans are administered by Aetna. The plans are 

PPO plans by design, offering coverage both in and out of 

network. However, they are known as Aetna Choice ® POS II 

on the Aetna website. Note this whenever you need to identify 

the plan by name, for example when searching for a doctor in 

Aetna’s DocFind ® directory. 

Aetna plans come with valuable tools, wellness programs 

and other extras — at no additional cost to you and your family. 

Aetna is a world-class leader in integrating wellness with their 

medical plans. They focus on giving you the tools you need to 

make smart health care decisions along with the help you need 

to reach your best health. You can read more about those 

extras in this section and in the Wellness section of this guide 

on page 31. 

You have four medical plan options to choose from: 

Option 1…. 650 Deductible Plan 



Option 4…. Waive Coverage 

Health advice available when you need it 

If you’ve ever wondered about a health concern in the middle of 

the night, you will appreciate the fact that the toll-free Informed 

Health ® Line is available 24 hours a day, seven days a week. 

Call 1-866-738-6737 and request to be connected to an 

Informed Health Line registered nurse. While the nurses aren’t 

authorized to diagnose illnesses or prescribe drugs, they can: 

• Answer health-related questions 

• Tell you about simple steps you can take to address a health 

problem until you can get to a doctor 

• Help you understand health issues and treatment choices 

• Give you some good questions to ask your doctor 

• Provide information about the latest research on certain 

treatments and procedures, and explain their risks 

and benefits 

The nurses can help you make sense out of your choices and 

help you communicate better with your doctor. They’ll give you 

the facts you need to make decisions you can feel good about. 

Full-time employees who choose to waive participation in the 

medical plan will receive a waive credit as additional, taxable 

income in each paycheck. In order to be eligible to receive 

the waive credit, you must make an election to waive 

participation during enrollment. 

The following is a quick view of differences between options. A more detailed view is shown in the Medical Summary of Benefits on 

page 10. 

Medical Plan Options Deductible Copay** Coinsurance*** 

In Network Out of Network PCP Specialist The Plan Pays 

In Network Out of Network 

650 Deductible Plan $650 $1,300 $20 $35 80% 60% 

450 Deductible Plan $450 $900 $20 $35 90% 70% 

250 Deductible Plan $250 $500 $20 $35 100% 80% 

* Part-time employees with hire dates prior to December 1, 2011 will retain benefits eligibility in a grandfathered status through December 31, 2013. 

Part-time employees hired on or after December 1, 2011 are eligible for the employee assistance program and the 401(k) plan only. 

** Deductible does not apply. 

*** After deductible, until out-of-pocket maximum is reached. 


How the plans work 

You have the freedom to receive care from any licensed provider 

and the opportunity to save when you use doctors within the 

network. That’s because benefits are paid at a higher level 

when you use in-network providers, which means you pay less 

out of pocket for care. 

Each year you will be responsible for paying a deductible, 

after which the plan starts to pay benefits. Once you’ve 

met the deductible, you pay a percentage of your covered 

expense (coinsurance). The chart on the next page shows your 

deductible and what you pay for covered services. There are 

no primary care provider (PCP) requirements and no referrals 

needed to see specialists. 

Save with “in-network” doctors 

When you choose a doctor who participates in the Aetna 

network, you generally pay a lower deductible and coinsurance. 

That’s because Aetna network doctors and other health care 

providers have contracted with the plan to charge reduced rates 

for their services. That means, not only do you pay a lower share 

of the cost, your percent share (coinsurance) is starting from a 

lower amount — so you save twice. 

Also, doctors who do not participate in the Aetna network may 

bill you for the difference between what Aetna allows and their 

actual charge. That’s another good reason to stay in the 

network. Want more? Aetna network doctors will even file 

claims for you, so there’s no paperwork involved. 

Want to use a doctor or hospital outside 

Aetna’s network? 

No problem. Aetna will still cover eligible expenses, just at 

a lower benefit level — you can get your medical care from 

any licensed doctor or health care provider. 

See if your doctor is in the network 

The DocFind directory is available at www.aetna.com/docfind. 

Follow the prompts to search for a specific doctor’s name, or to 

see a list of in-network doctors available in your zip code and 

surrounding area. Be sure to choose “Aetna Choice ® POS II 

(Open Access)” under the Plan field. 

After you enroll, your search can get even easier when you 

enter DocFind through Aetna Navigator ® , your secure 

member website. That’s because the system prefills your 

specific information, like your zip code and plan name. 

Be confident with high-performance specialists 

If you need to see a specialist, you can enjoy the confidence 

of knowing that your doctor has passed Aetna’s tough 

standards for quality and efficiency. The Aexcel ® network 

includes select doctors in the 12 most commonly needed 

specialty areas: cardiology, cardiothoracic surgery, 

gastroenterology, general surgery, neurology, neurosurgery, 

obstetrics and gynecology, orthopedics, otolaryngology/ENT, 

plastic surgery, urology and vascular surgery. 

It’s easy to find Aexcel specialists — just look for the stars. 

When searching the DocFind directory, you’ll see a blue 

star ★ next to the Aexcel specialist’s name. 

Preventive care covered at 100% after the 

applicable copay 

To keep our employees healthy, routine in-network preventive 

care services are covered at 100% after the applicable copay — 

regardless of which medical plan option you choose. This allows 

you to get your necessary health screenings for just your normal 

copay amount. You do not have to meet your deductible or pay 

additional coinsurance to get this coverage. Be sure your doctor 

codes the visit as a preventive care exam in order for Aetna to 

be able to correctly process the claim and cover it at 100%. 

Emergency and out-of-area care 

You are covered anywhere in the country for routine and 

emergency care. That includes vacations, business travel, 

and even covered students who are away at college. You pay 

the same amount as you would if you were at home. There is a 

$75 copay for emergency room visits. This is waived if you are 

admitted to the hospital. For routine care, your out-of-pocket 

costs will be lower when you visit an in-network doctor. 


9

Medical Benefits Summary 

Benefit 

Benefit Period 

Individual Deductible 

Family Deductible 

650 Deductible 450 Deductible 250 Deductible 

In Network Out of Network In Network Out of Network In Network Out of Network 

Calendar Year Calendar Year Calendar Year 

$650 

$1,300 $450 $900 $250 $500 

$1,300 $2,600 $900 $1,800 $500 $1,000 

Payment Level/ 

Coinsurance 

80% after 

deductible until 

out-of-pocket 

maximum is met, 

then 100% 

60% after 


out-of-pocket 


then 100% 

90% after 


out-of-pocket 


then 100% 

70% after 


out-of-pocket 


then 100% 

100% after 

deductible 

80% after 


out-of-pocket 


then 100% 

Out-of-Pocket 

Maximums 

$2,000 Individual 

$4,000 Family 


$10,000 Family 


$2,000 Family 


$5,000 Family 

Not Applicable 


$5,000 Family 

Lifetime Maximum 

Unlimited 

Unlimited 

Unlimited Unlimited Unlimited Unlimited 

Physician Office Visits 

Specialist Office Visits 

100% after 

$20 copayment* 

100% after 


60% after 

deductible 

60% after 

deductible 

100% after 


100% after 


70% after 

deductible 

70% after 

deductible 

100% after 


100% after 


80% after 

deductible 

80% after 

deductible 

Preventive Care — Adult 

Routine Physical Exams 

Routine Gynecological 

Exams, Including a 

Pap Test 

100% after 


100% after 


Not Covered 

100% after 

Not Covered 

100% after 

Not Covered 



60%* 

100% after 


100% after 

70%* 


80%* 

Mammograms 

100%* 60%* 100%* 70%* 100%* 

80%* 

Preventive Care — Pediatric 

Routine Physical Exams 

100% after 


Not Covered 

100% after 


Not Covered 

100% after 


Not Covered 

Pediatric Immunizations 

100%* 60%* 100%* 70%* 100%* 

80%* 

Medical and Hospital Expenses 

Emergency Room 

Services 

Ambulance 

Inpatient 

Outpatient 

Maternity 

Infertility Counseling, 

Testing and Treatment 

Assisted Fertilization 

Procedures 

100% after $75 copayment* 

(waived if admitted) 





80% after In-Network deductible 90% after In-Network deductible 100% after In-Network deductible 

80% after 

deductible 

80% after 

deductible 

80% after 

deductible 

80% after 

deductible 

60% after 

deductible 

60% after 

deductible 

60% after 

deductible 

60% after 

deductible 

90% after 

deductible 

90% after 

deductible 

90% after 

deductible 

90% after 

deductible 

70% after 

deductible 

70% after 

deductible 

70% after 

deductible 

70% after 

deductible 

100% after 

deductible 

100% after 

deductible 

100% after 

deductible 

100% after 

deductible 

Not Covered Not Covered Not Covered 

80% after 

deductible 

80% after 

deductible 

80% after 

deductible 

80% after 

deductible 

Medical/Surgical Expenses 

(except office visits) 

80% after 

deductible 

60% after 

deductible 

90% after 

deductible 

70% after 

deductible 

100% after 

deductible 

80% after 

deductible 

Spinal 

Manipulations 

100% after 


60% after 

deductible 

100% after 


70% after 

deductible 

100% after 


80% after 

deductible 

Combined limit: 25 visits/benefit period Combined limit: 25 visits/benefit period Combined limit: 25 visits/benefit period 


Medical Benefits Summary 


Diagnostic Services 

(Lab, X-ray and 

other tests) 

Physical Therapy 

Speech Therapy 

Occupational Therapy 

Durable Medical 

Equipment, Orthotics 

and Prosthetics 

Skilled Nursing 

Facility Care 

Home Health Care 

Private Duty Nursing 

(excludes inpatient) 

Hospice 

650 Deductible 450 Deductible 250 Deductible 

In Network Out of Network In Network Out of Network In Network Out of Network 

80% after 

deductible 

100% after 


60% after 

deductible 

60% after 

deductible 

90% after 

deductible 

100% after 


70% after 

deductible 

70% after 

deductible 

100% after 

deductible 

100% after 


100% after 

deductible 

80% after 

deductible 

80% after 

deductible 

Combined limit: 50 visits/benefit period Combined limit: 50 visits/benefit period Combined limit: 50 visits/benefit period 

80% after 

deductible 

80% after 

deductible 

Limit: 100 days/benefit period Limit: 100 days/benefit period Limit: 100 days/benefit period 

80% after 

deductible 

90% after 

deductible 

80% after 

deductible 

Limit: 100 visits/benefit period Limit: 100 visits/benefit period Limit: 100 visits/benefit period 

80% after 

deductible 

Limit: 200 visits/benefit period Limit: 200 visits/benefit period Limit: 200 visits/benefit period 

80% after 

deductible 

60% after 

deductible 

60% after 

deductible 

60% after 

deductible 

60% after 

deductible 

60% after 

deductible 

90% after 

deductible 

90% after 

deductible 

90% after 

deductible 

90% after 

deductible 

70% after 

deductible 

70% after 

deductible 

70% after 

deductible 

70% after 

deductible 

70% after 

deductible 

100% after 

deductible 

100% after 

deductible 

100% after 

deductible 

100% after 

deductible 

80% after 

deductible 

80% after 

deductible 

80% after 

deductible 

80% after 

deductible 

Mental Health 

Inpatient & Outpatient 

Hospital 

Office Visits 

80% after 

deductible 

100% after 


60% after 

deductible 

60% after 

deductible 

90% after 

deductible 

100% after 


70% after 

deductible 

70% after 

deductible 

100% after 

deductible 

100% after 


80% after 

deductible 

80% after 

deductible 

Substance Abuse 

Inpatient Detoxification 

and Rehabilitation 

80% after 

deductible 

60% after 

deductible 

90% after 

deductible 

70% after 

deductible 

100% after 

deductible 

80% after 

deductible 

Outpatient Hospital 

80% after 

deductible 

60% after 

deductible 

90% after 

deductible 

70% after 

deductible 

100% after 

deductible 

80% after 

deductible 

Office Visits 

100% after 


60% after 

deductible 

100% after 


70% after 

deductible 

100% after 


80% after 

deductible 

* Deductible does not apply 

This is not intended as a contract of benefits. It is designed purely as a 

reference of the many benefits available under your program. For more 

detailed information, visit Employee Resource. 


11

Tools and programs to help you be 

an active participant in your health 

When you enroll in an Aetna medical plan, you automatically 

get tools and programs to keep you engaged in both your 

health benefits and your health care. And all this is at no 

additional cost. 

Your secure online member website 

Every Aetna member can register for their personalized 

Aetna Navigator website. It has everything you need to 

manage your benefits: 

• See who’s covered under the plan 

• Download a claim form and track claims 

• Print a temporary ID card 

• Link to credible health information 

• Contact Member Services and much more 

A condensed version of Aetna Navigator is available from 

your smart phone or Blackberry ® . You can check medical plan 

coverage details while standing in the doctor’s office. Or, find 

an ear, nose and throat doctor for your child — and make an 

appointment — during your bus or train ride home. Get access 

to a prescription drug cost estimator — even driving directions 

to your doctor. Now you can take your medical plan information 

with you. 

Save with healthy discounts 

Aetna members have access to a network of vendors who offer 

great discounts on health-related products and services like gym 

memberships, weight-loss products, hearing aids, vitamins, 

massage therapy and so much more. 

Join a wellness program 

When you enroll in any of the medical plans, you automatically 

are eligible to participate in the following wellness programs: 

• Online health resources 

• Personal health record (PHR) 

• Healthy lifestyle coaches 

• Chronic condition nurse case managers 

• Maternity program 

Turn to page 31 to learn more about wellness programs. 

Lower your premium 

When you join any of the medical plans, you can take 

healthy actions toward lowering your premium. Participate in 

the wellness program and qualify for Healthy Rewards Pricing 

described on page 33. It’s a great way to save money while 

you strive for your best health. 

Get a preview now of what you’ll be able to do on 

your secure member website. 

Visit www.aetna.com and click on Aetna Navigator “Member 

Log In” to find the “Take a Tour” link. 



Prescription Drugs 

When you enroll in a medical plan, you automatically receive prescription drug benefits, which are easy 

to use. If you choose to waive medical coverage, you also waive prescription drug coverage. 

The prescription drug benefit, administered by Aetna, works the same way regardless of which medical 

plan you choose. You must buy the medications from a pharmacy in the Aetna network or use the 

mail-order service available. To find a list of participating pharmacies near you, go to www.aetna.com/docfind. 

Choose “Pharmacy” under the provider category and follow the prompts. 

1-866-738-6737 

www.aetna.com 

Here’s how much you will pay for covered prescription medications: 

Generic drugs 

Generic drugs are approved by the FDA and are just as effective 

as their brand-name counterparts, but they cost much less. 

You can save even more by getting medications you take 

every day through the convenient mail-order service. You pay: 

Retail: 

Mail order: 

30-day supply = $10 90-day supply = $20 

Note: Approved smoking cessation prescriptions are covered at 

the generic copayment amount. 

Brand-name formulary drugs 

A formulary is a list of medications that Aetna prefers to cover, 

generally because they cost less than other equally effective 

brand-name drugs. You can find a copy of the Aetna Preferred 

Drug List (formulary) at www.aetna.com/formulary (when 

prompted, select the “Three-tier Open Formulary”). You pay: 

Retail: 

Mail order: 

30-day supply = 30% coinsurance 90-day supply = 30% coinsurance 

($20 minimum / $100 maximum) ($40 minimum / $200 maximum) 

Brand-name nonformulary drugs 

These are brand-name medications that are not on the Aetna 

Preferred Drug List (formulary). They generally cost more than 

drugs on the formulary. You can talk with your doctor to see if it 

is safe to switch to a medication that will cost you less. You pay: 

Retail: 

Mail order: 

30-day supply = 30% coinsurance 90-day supply = 30% coinsurance 

($35 minimum / $100 maximum) ($70 minimum / $200 maximum) 

Over-the-counter Claritin ® or Prilosec 

If needed, ask your doctor for a prescription for Claritin or 

Prilosec, specifying “OTC” on the prescription. Give the 

prescription to the pharmacist to fill and you will be charged 

the applicable copay amount. If you pick up the product from 

the shelf and take it to the cashier, you will be charged the 

store’s retail price. You pay: 

Retail: 30-day supply = $5 Mail order: not available 

90-day supply = $10 

A quick note about prescribed generic medications 

You are responsible for the payment differential when a generic 

drug is authorized by your physician and you elect to purchase a 

brand-name drug. Your payment is the price difference between 

the brand-name drug, and the generic drug, in addition to the 

brand-name drug copayment or coinsurance amounts which 

may apply. 


13

Try these mail-order options for savings, 

convenience and service 

Aetna Rx Home Delivery ® mail-order service 

If you use medication on an ongoing basis (such as those used 

to treat high blood pressure and high cholesterol), you can order 

up to a 90-day supply and have it delivered right to your home 

with the mail-order service. It can save you money, too. 

There’s more to it than that. Registered pharmacists check 

your order for accuracy. If you have questions or an emergency, 

they’re just a phone call away, day or night. 

Here’s how it works: 

1. Ask your doctor for two initial prescriptions: one for a 

30-day supply that you can fill right away at a retail 

pharmacy and the other for a 90-day supply that you 

can mail to Aetna Rx Home Delivery. 

2. 

3. 

Complete an order form. Once an enrolled member, it’s 

available by logging in to your secure member website at 

www.aetna.com and selecting “Access your pharmacy 

benefits.” Mail the form back with your prescription and 

payment. Or, have your doctor fax your prescription and 

completed order form. 

To reorder, you have three options: by phone, mail or online. 

Instructions are included with each order. 

Aetna Specialty CareRx SM Program 

For specialty medications, like those that need special 

handling or refrigeration, you must order through Aetna 

Specialty Pharmacy. You may, however, get your initial 30-day 

supply at a retail pharmacy. 

Delivery is free and doctors and nurses are on hand to answer 

your questions — 24 hours a day, 7 days a week. 

Aetna Specialty Pharmacy typically limits your supply to 30 days. 

This lets them check on you more often. It prevents waste 

and saves you money if your medication or dose changes 

between refills. 

As an enrolled member, you can choose one of these three 

ways to get started: 

• Fill out a Patient Profile form. Then send it in along with your 

prescription. Visit www.AetnaSpecialtyRx.com and click 

“Enroll” to access this form and directions to submit it. 

• Ask your doctor to fax your prescription to 1-866-FAX-ASRX 

(1-866-329-2779). 

• To transfer a prescription to Aetna Specialty Pharmacy, 

call toll free at 1-866-353-1892. 



Dental 

A healthy mouth and healthy body go hand in hand. Cavity protection isn’t the only reason 

to take care of your teeth: a wide range of medical problems, including diabetes, heart disease, 

and premature babies have been linked to poor oral health and gum disease. EDMC offers dental 

plan options to help you and your family pay for quality dental care. 

United Concordia is EDMC’s dental plan provider. United Concordia serves more than 8 million members with 40 years of 

experience in group dental insurance.* 

You have two plan choices that are very similar. The primary difference is your annual benefit maximum and orthodontia coverage. 

Dental Plan Options 

You have three options to consider for dental insurance: 

1-866-851-7568 

www.ucci.com 

Option 1…. Basic Plan 

Option 2…. Premium Plan 


The following is a quick view of differences. A more detailed view is shown in the Dental Benefits Summary on page 17. 

Dental Plan Deductible Preventive Care Orthodontia Annual Benefit 

Maximum 

Individual Family (The plan pays) (Per person) 

Basic $25 $75 100% Not Covered $750 

Premium $25 $75 100% Covered $1,500 

** Based on United Concordia internal research and reports, 10/11 


15

Choose where you receive care 

Both the Basic Plan and the Premium Plan allow you to go 

to any licensed dentist — in or out of the Concordia Advantage 

Plus dental network. But, there is a big advantage to using 

network dentists. 

Visit an in-network dentist 

You can search for a Concordia Advantage Plus dentist by 

visiting www.ucci.com and clicking on “Find a Dentist.” 

• Network dentists charge reduced rates for services. 

• You pay your deductible and coinsurance based on the 

reduced rate. 

• Network dentists will file claims for you. 

• Network dentists undergo rigorous review and routine 

verification of their credentials. 

Also, most of the Concordia Advantage Plus dentists offer 

discounts for all services — covered or not*. That means 

you can: 

• Get non-covered services at a discount — just look for 

the dentists with a black box next to their name in 

“Find a Dentist.”** 

• Save on services above your annual maximum. 

* Discount arrangements are available where allowed by law. 

** Non-covered services are services in which no benefit payments, including 

alternate benefit payments, are made by United Concordia. Discount levels 

may vary by procedure and geographic area. 

Visit any licensed dentist out of network 

• You pay your deductible and coinsurance. 

• You may also have to pay the difference between 

United Concordia’s allowed amount and the actual charge. 

• You may have to file claim forms. 

Find it online 

As an enrolled member, visit www.ucci.com, enter the 

“Members” section and select “My Dental Benefits” to set 

up your personal account. After you log in, you can: 

• Search the network for dentists 

• Download a claim form 

• Print a temporary ID card 

• Monitor your annual benefit usage and more 

For more information about your dental benefits plan, visit 

www.ucci.com or call Customer Service at 1-866-851-7568. 

Are you expecting? Special care is available for 

expectant mothers. 

United Concordia’s Smile for Health program provides 

additional cleanings and other protective services during 

pregnancy. This can help prevent periodontal disease, which 

has been linked to premature and low-birth-weight babies. 

Visit www.ucci.com for more information. 


Dental Benefits Summary 


Individual Deductible 

Family Deductible 

In Network 

$25 

$75 

Basic Plan* 

Premium Plan* 

Out of Network 

In Network 


$25 $25 $25 

$75 $75 $75 

Annual Benefit Maximum 

Per Person 

Lifetime Orthodontia 

Maximum Per Person 

Prophylaxis (cleanings) 

Cleanings During 

Pregnancy** 

Oral Examinations 

Non-surgical Periodontics 

Topical Fluoride 

Treatments 

X-rays 

Space Maintainers 

Sealants 

Basic Restorative Services 

Fillings 

(including posterior resin) 

Simple Extractions 

Complex Oral Surgery 

(impacted teeth) 

Crown, Denture and 

Bridge Repair/ 

Re-cementing 

Endodontics 

General Anesthesia 

Periodontics (surgical) 

$750 $750 $1,500 $1,500 

Not Covered Not Covered $1,500 $1,500 

100% 

100% 

80% after deductible 80% after deductible 


80% after deductible 80% after deductible 80% after deductible 80% after deductible 





80% after deductible 

100% 100% 100% 

Two per calendar year 


One additional cleaning** 

100% 100% 100% 



100% 100% 100% 100% 

100% 100% 100% 100% 

One treatment per calendar year for 

dependent children up to age 19 

100% 100% 100% 100% 

Full Mouth X-rays: One every 3 years 

Bitewing X-rays: One set per calendar year for adults 

Two sets per calendar year for children 

One additional cleaning** 

One treatment per calendar year for 

dependent children up to age 19 

Full Mouth X-rays: One every 3 years 

Bitewing X-rays: One set per calendar year for adults 

Two sets per calendar year for children 

100% 100% 100% 100% 

Dependent children up to age 19 Dependent children up to age 19 

100% 100% 100% 100% 

One application every 3 years for each molar 

for dependent children up to age 14 

One application every 3 years for each molar 

for dependent children up to age 14 

In connection with oral surgery, extractions or other covered dental services 

80% after deductible 80% after deductible 80% after deductible 

Major Restorative Services 

Bridges and Dentures 

Not Covered 

Not Covered 


Initial placement to replace one or more natural teeth 

lost while covered by the Plan. Dentures/bridgework 

replaced once every 5 years. 

Crowns/Inlays/Onlays 

Oral Surgery 

Orthodontia 



Not Covered 

Not Covered 

50% 50% 

Employees, dependent spouses and dependent children 

* The listed network percentages represent the portion of United Concordia’s maximum allowable charges (MAC) for which the plan will be responsible. Network 

providers agree to accept United Concordia’s MAC for covered services as payment in full and also agree to file claims for you. If you or your covered dependents 

receive services from an out-of-network provider, United Concordia will apply the percentages shown to United Concordia’s MAC for covered services and you 

will be responsible for the difference, up to the provider’s charge. United Concordia’s standard exclusions and limitations apply. 

**Part of the Smile for Health Benefit. 


17


Vision 

Your eyes work hard for you every day. Whether you are staring at a computer screen, reading a book 

or driving home from work, it’s important to have excellent vision. Not only can a regular eye exam 

uncover vision problems, but vision checkups can offer clues to other underlying health conditions, as well. 

1-800-638-3120 

www.myuhcvision.com 

UnitedHealthcare Vision is EDMC’s vision plan provider. 

With a state-of-the-art optical lab, diversified network, 

electronic claims system and superior customer care, it’s clear 

to see the emphasis UnitedHealthcare places on the quality 

of the materials and services they provide. 

During enrollment, you have two options to consider: 

Option 1.… Premium Plan 

Option 2.… Waive Coverage 

To help make your decision, determine your usual annual 

expenses for vision care and compare that against your annual 

pretax contributions and any coinsurance you might pay 

throughout the year. 

Remember that you can also use a health care flexible spending 

account (FSA) to pay for vision care expenses. Consider this as 

an alternative if you are not sure whether you want to elect 

vision benefits or not. See page 27 for more about the 

tax-advantaged flexible spending accounts (FSAs). 

Higher level of coverage, better service — when 

you stay in the network 

While you are covered at any licensed vision care provider, 

your coverage is greater if you visit a network provider. See the 

vision benefits summary on the next page for details. 

Network providers will also file claims for you. Just show your 

UnitedHealthcare vision member ID card at the time of your 

visit and they’ll take it from there. 

As an enrolled member, if you visit a provider who is not in the 

network, go to www.myuhcvision.com for instructions on 

how to file an out-of-network claim. 

Finding a network provider near you is a quick 

click or call away 

Log in to www.myuhcvision.com and select the provider 

locator option to look up participating vision care providers in 

your area. No Internet access? Call 1-800-839-3242 — any 

time, 24/7 — and follow the voice response prompts to find 

a vision provider near you. 


Vision Benefits Summary 


Benefit Period 

In Network 

Premium Plan 

12 month period from last date of service 


Vision Exams 

(one every 12 months) 

100% 

Up to $60 

Lenses* 

(once every 12 months) 

Single Vision 

100% $40 allowance 

Bifocal 


Trifocal 


Lenticular 

100% 

$80 allowance 

Polycarbonate 

100% 

Not Covered 

Scratch-Resistant Coating 

100% 

Not Covered 

Frames 


$130 $50 

Contact Lenses 


Elective-covered in full** 

100% 

$150 

Elective-specialty*** 

$150 $150 

Medically Necessary**** 

100% 

$250 

Laser Vision Correction 

Access to discounted laser vision correction procedures from numerous provider locations throughout the U.S. To find 

a participating laser vision correction surgeon in your area, visit www.myuhcvision.com or call 1-877-28-SIGHT. 

****One pair of standard single vision, lined bifocal, lined trifocal or standard lenticular lenses is covered in full. Options, such as progressive lenses, tints, 

UV, and anti-reflective coating may be available at a discount. 

****The fitting/evaluation fees, contacts (including disposables) and up to two follow-up visits are covered in full (after the applicable co-pay) for many of the 

most popular brands on the market. If covered disposable contact lenses are chosen, up to 6 boxes (depending on your prescription) are included when 

obtained from a network provider. UnitedHealthcare Vision’s covered-in-full contact lenses may vary by provider. 

****Toric, gas permeable, and bifocal contacts are examples of contacts that are outside of the “covered-in-full” category. 

****Necessary contact lenses are determined at the provider’s discretion for one or more of the following conditions: Following post-cataract surgery without 

intraocular lens implant, to correct extreme vision problems that cannot be corrected with spectacle lenses and with certain conditions of anisometropia 

or keratoconus. If your provider considers your contacts necessary, ask your provider to contact UnitedHealthcare Vision concerning the reimbursement 

that UnitedHealthcare Vision will make before you purchase such contacts. 

The chart shown above represents an overview of the covered services and plan limitations within each of the vision plan categories. The above overview is not a 

complete description. The UnitedHealthcare Vision contract and benefit booklet for the plan will govern if any discrepancies exist between this overview and the 

contract and/or actual benefit booklet. 


19

Your Wealth 

We offer a “wealth” of financially based benefits for full-time 

employees and even a few options for part-time* employees. 

These benefits offer you security for the future — some 

unexpected events, like accidents and illnesses — and expected 

events like your retirement. 

Protect your loved ones and yourself with: 

• Life insurance (basic and additional) 

• Spousal and dependent life insurance 

• Short- and long-term disability 

• Flexible spending accounts (FSAs) 

• The retirement plan – 401(k) 

• Tax-advantaged commuter benefits, tuition 

assistance and much more 

*Grandfathered part-time employees are eligible for basic life 

insurance, flexible spending accounts (FSAs), commuter benefits, 

and the 401(k) plan. Part-time employees with hire dates prior to 

December 1, 2011 will retain benefits eligibility in a grandfathered 

status through December 31, 2013. Part-time employees hired on 

or after December 1, 2011 are eligible for the employee assistance 

program and the 401(k) plan only. 



Life Insurance 

Life and accident insurance provide important financial protection in the event you die or 

become dismembered while an employee of EDMC. When considering life insurance, 

it’s important to give some serious thought to what expenses and income needs your 

family would have if something happened to you. 

1-866-502-8883 

www.mylibertyconnection.com 

Claimant services ID: EDMCDIS 

PIN: Your Social Security number 

To make sure you have the protection you need, EDMC offers: 

• Basic life insurance for full-time and part-time* employees 

at no cost 

• Accidental death and dismemberment (AD&D) insurance 

to full-time and part-time* employees at no cost 

• Additional life insurance for full-time employees needing 

supplemental coverage 

• Spouse and child life insurance options for full-time employees 

Basic Life and AD&D 

EDMC automatically provides basic life and accidental death 

and dismemberment (AD&D) insurance through Liberty Mutual ® 

to all full-time and part-time* employees. These benefits 

are company paid. That means you don’t have to make 

contributions to receive them. 

Full-time employees 

• Basic life = 2X annual salary** 

(rounded to the next highest thousand, up to $500,000) 

• Basic AD&D = 2X annual salary** 

(rounded to the next highest thousand, up to $500,000) 

Part-time* employees 

• Basic life = $25,000 

• Basic AD&D = $25,000 

A note about imputed income 

The total value of your basic life insurance that exceeds $50,000 

is considered imputed income and is taxable to you. The income 

is imputed on the cost of the life insurance, not the coverage 

amount. You pay taxes on imputed income just as though it 

were part of your regular paycheck. Imputed income is added to 

your total annual compensation reported to the IRS and appears 

on your W-2 statement. 

*Part-time employees with hire dates prior to December 1, 2011 will retain 

benefits eligibility in a grandfathered status through December 31, 2013. 

Part-time employees hired on or after December 1, 2011 are eligible for the 

employee assistance program and the 401(k) plan only. 

**Annual salary is defined as current base salary plus any bonus paid the 

previous calendar year. 


21

Additional Life and AD&D 

Everyone has different needs when it comes to life insurance. 

The Educated Choices program allows you to tailor your life 

insurance protection to your specific needs. The coverage you 

purchase will be in addition to any company-provided coverage. 

This is voluntary and for full-time employees only. You will pay 

the entire premium amount as shown in your enrollment 

materials. Payments will be deducted from your paycheck on 

an after-tax basis. 

You have four options: 

Option 1 .… 1X Annual Salary* 



Option 4 .… Waive Coverage 

The combined maximum coverage allowed for basic life and 

additional life is $1,000,000. 

Don’t forget to update your beneficiary information 

Your beneficiary is the person(s) who will receive your life 

insurance benefit in the event of your death. You are 

encouraged to designate a beneficiary when you first elect 

life insurance, but it is a good idea to update that information 

from time to time. You can review and make changes on 

Employee Resource. 

*Annual salary is defined as current base salary plus any bonus paid the 

previous calendar year. 

Evidence of Insurability: What you need to know 

• New full-time employees are guaranteed coverage up to 

1X annual salary, up to $500,000. If you elect 2X or 3X salary, 

you must submit an Evidence of Insurability form. Any amount 

over 1X salary will be subject to carrier approval. However, you 

will be enrolled for 1X salary while your request for additional 

coverage is processed. 

• Employees who move from a non-full-time status to a 

full-time status will be treated as new employees and will 

be granted the 1X salary guarantee if you choose to enroll. 

• Existing employees may request to add or increase coverage 

during Open Enrollment or for a limited time after a qualifying 

life event (if the request is consistent with the event), such 

as the birth of a child. You must complete an Evidence 

of Insurability form, subject to the carrier’s approval. 

Your current level of coverage will continue while your 

request for increased coverage is processed. 

Evidence of Insurability: How does it work? 

• Download, print and complete the Evidence of Insurability 

form from Employee Resource. In order for Liberty Mutual to 

determine eligibility, the form includes questions about your 

health (or your spouse’s health for dependent spouse life). 

Instructions for submitting the form to Liberty Mutual are 

printed on the form. 

• Liberty Mutual will process the form. If necessary, they may 

ask you for more information or ask you to get a physical 

examination or lab work through your doctor. You are 

responsible for any expenses associated with the exam. 

It is your responsibility to follow up with Liberty Mutual in 

a timely manner. 

• Liberty Mutual will advise you if your request is approved or 

denied, or if the request is incomplete. If approved, the 

amount will be effective the first day of the month 

following approval. 


Life Insurance: Take it with you if you leave the company 

Your basic and/or additional life insurance coverage ends when 

your employment ends. However, you will be eligible for a 

portability option to continue your coverage and pay your 

premiums directly to Liberty Mutual. 

To qualify for the portability option, you must: 

• Be under age 75 

• Be a citizen or resident of the United States or Canada 

• Not be a full-time member of the armed forces of any country 

• Elect the portable life insurance option and not the conversion 

option (converting to a personal policy as opposed to the 

same group policy) 

Guidelines for the portability option: 

• Waiver of premium does not apply. 

• Accelerated death benefit does not apply. 

• AD&D coverage is not portable. 

• You must elect the portability option within 31 days of the 

date your participation in the plan ends. Contact HR One 

Connect for the appropriate paperwork at 1-888-471-3362 

(1-888-HR1-EDMC). 

• Ported coverage begins after the paperwork is completed 

and received by Liberty Mutual. 

• Ported coverage ends at age 75. 

• You pay the premiums directly to Liberty Mutual. 

• Portability life insurance coverage will remain in effect as long 

as EDMC’s policy for life insurance coverage continues with 

Liberty Mutual. 

• When ported coverage terminates, you have the right to 

convert coverage to a personal policy. 

• In addition to the portability option, terminated employees 

also have the option to convert life insurance to a personal 

policy. Contact HR One Connect for the appropriate 

paperwork at 1-888-471-3362 (1-888-HR1-EDMC). 

Dependent Spouse Life Insurance 

Full-time employees may purchase dependent spouse life 

insurance for their eligible spouses. Domestic partners are 

not eligible for this benefit. 

Choose from: 

Option 1.… Coverage in $10,000 Increments 

to a Maximum of $100,000 


Spousal coverage is limited to 50% of the employee’s 

total life insurance coverage, which includes both basic and 

additional life. For example, if the employee has a total coverage 

amount of $160,000, the spouse’s coverage cannot be more 

than $80,000. 

If you and your spouse are both employed by EDMC, 

neither of you are eligible for dependent spouse life insurance 

coverage. That’s because you both qualify for the employee 

life insurance coverage. 

You, the employee, are automatically listed as the beneficiary of 

dependent spouse life insurance. You are responsible for the full 

payment of the premium. Your premium will be deducted from 

your paycheck on an after-tax basis. 


23

Evidence of Insurability: What you need to know 

• New full-time employees are guaranteed coverage up to 

$50,000 in dependent spouse life insurance coverage (not to 

exceed 50% of the employee’s total life insurance coverage). 

If you request more than that, your spouse must submit an 

Evidence of Insurability form. Any amount over $50,000 will 

be subject to carrier approval. However, your spouse will 

be enrolled for $50,000 while your request for additional 

coverage is processed. 


full-time status will be treated as new employees and will 

be granted the $50,000 guarantee if you choose to enroll. 

• Existing employees may request to add or increase dependent 

spouse life insurance coverage during Open Enrollment or 

for a limited time after a qualifying life event (if the request 

is consistent with the event), such as the birth of a child. 

You must complete an Evidence of Insurability form, subject 

to the carrier’s approval. Your current level of coverage 

will continue while your request for increased coverage 

is processed. 

See “Evidence of Insurability: How does it work?” on page 22 for 

information about completing the Evidence of Insurability form. 

Dependent Child Life Insurance 

Full-time employees may elect dependent child life insurance 

coverage for their eligible child(ren). Dependent children of 

domestic partners are not eligible for this benefit. 

Choose from: 

Option 1…. $5,000 Coverage 


You, the employee, are automatically listed as the beneficiary 

of dependent child life insurance. Your election covers all of your 

eligible children. The cost of coverage is a flat amount regardless 

of the number of children you insure. 

Covered dependent children from age 14 days to 6 months 

will receive $500 in life insurance coverage. The coverage 

automatically increases to $5,000 at age 6 months to age 26. 

No Evidence of Insurability is required. 

You are responsible for the full payment of the premium. 

Your premium will be deducted from your paycheck on an 

after-tax basis. 



Disability Insurance 

Accidents happen. Illness strikes. And that can mean weeks, even years, of not being able 

to earn a living. But, you can protect yourself with disability insurance which replaces a 

portion of your income while you are unable to work. 

1-866-502-8883 

www.mylibertyconnection.com 

Claimant services ID: EDMCDIS 

PIN: Your Social Security number 

Short-Term Disability 

No one wants to be ill or injured, especially if it means missing 

work. That’s why EDMC provides short-term disability (STD) 

coverage at no cost to eligible full-time employees. Employees 

must satisfy an eligibility waiting period before the plan benefits 

take effect. 

The benefits payable under the STD plan are equal to 100% of 

your base salary that is in effect on the first day of your disability. 

Base salary does not include overtime pay, bonuses or other 

forms of special compensation. 

Payment of STD will only be made for the period of time that 

the disability has been certified by Liberty Mutual. You are 

eligible for payment of STD benefits as of the first day of 

absence that: 

• Extends more than five consecutive workdays, and 

• Is due to pregnancy or non-work-related illness, accident 

or injury.* 

The chart below shows the number of workdays for which 

you may be eligible to receive STD benefits based on your 

length of service. 

Filing a disability claim 

To file a short-term disability claim, follow these simple steps: 

1. Notify your supervisor by completing a Request for Leave 

form (found on Employee Resource). 

2. 

Report the nature of your disability and the length of 

time you will be unable to work to Liberty Mutual 

by phone at 1-866-502-8883, or online at 

www.mylibertyconnection.com. You will need your 

claimant services ID (EDMCDIS) and your personal identification 

number (PIN), which is your Social Security number. 

Liberty Mutual will review your application and authorize 

payments as applicable. If you have LTD coverage, you do not 

have to file a claim. Liberty Mutual will automatically transfer 

your STD claim to LTD for review. 

Years of Service 

Workdays at Full Pay 

Date of eligibility to completion Up to 10 days 

of 6 months 

Beginning of 7 months 

Up to 30 days 

to completion of 2 years 

Beginning of 3 years 

Up to 50 days 



Up to 70 days 



Up to 90 days 



Up to 110 days 


Beginning of 16 years and over Up to 130 days 

Available days are calculated on a rolling 12-month “look-back” 

basis and your eligible service with EDMC or any predecessor 

company. If you pass a service milestone while receiving STD 

benefits, the additional number of workdays will be added, 

provided you remain disabled. 

*See the STD Booklet found on Employee Resource for a full listing of 

plan exclusions. 


25

Long-Term Disability 

Long-term disability (LTD) coverage can be an important 

benefit for you to choose. Many people think that Social 

Security benefits will cover their needs if they become disabled. 

The reality is that Social Security pays only a portion of your 

income, and the rules for qualifying are strict. Consider what 

would happen financially if you became disabled and could no 

longer work due to a non-occupational injury or illness. It’s likely 

that it would be a financial challenge to replace enough income 

to meet your monthly expenses. 

Only full-time employees may elect long-term disability insurance. 

You must be absent from work for 60 calendar days before 

you are eligible to receive benefits under the LTD plan. This is 

called an “elimination period.” You may elect one of the 

following options: 

Option 1…. 50% of Annual Salary 

Option 2…. 66 2 ⁄3% of Annual Salary 


LTD: What you need to know 

• The maximum monthly benefit is $10,000. For purposes of 

calculating your LTD benefit amount, annual salary is defined 

as current base salary plus any bonus paid the previous 

calendar year. 

• You pay the entire premium for LTD coverage. Your premiums 

will be deducted from your paycheck on an after-tax basis. 

• New employees who elect LTD insurance are guaranteed 

coverage at either the 50% or 66 2 ⁄3% level. 


full-time status will be treated as a new employee for 

guaranteed coverage. 

• Existing full-time employees may request to enroll in or 

increase their existing level of coverage during Open 

Enrollment or as the result of a qualifying change of status 

event (if the request is consistent with the event). However, 

in either case, an Evidence of Insurability form must be 

completed and your request will be subject to the carrier’s 

approval. Your current level of coverage will be maintained 

while your request is processed. 

See “Evidence of Insurability: How does it work?” on 

page 22 for information about completing the Evidence 

of Insurability form. 

• Benefits decrease if your income from other sources 

increases — LTD benefit payments will be decreased by the 

amount of income you receive from other sources, such as 

Social Security and Workers’ Compensation. The LTD benefit 

payments you receive will not be considered taxable income 

since you pay the entire premium with after-tax dollars. 

• Pre-existing condition exclusion — If you have received 

medical treatment (including consulting with a doctor, taking 

medicine or having diagnostic work done) at any time during 

the three months before the date you become covered under 

this plan, you have a pre-existing condition as defined under 

the terms of the LTD policy. If you suffer a disability in the 

first 12 months of coverage and the disability is caused 

by a pre-existing condition, no benefits will be payable for 

that disability. 

• When coverage ends — If you terminate employment or 

cease to be a full-time employee, you will no longer be 

eligible to participate in the LTD plan. Your coverage will 

end as of the date you are no longer eligible to participate. 

Portability options are not available under the LTD plan. 



Flexible Spending Accounts 

Flexible spending accounts (FSA) help you save on taxes because you put money aside 

from your paycheck — before taxes — to pay for certain types of health care and 

dependent care expenses. 

Tel: 1-877-WageWorks 

1-877-924-3967 

Fax: 1-877-353-9236 (claims) 

www.wageworks.com 

Full-time and part-time* employees may choose from 

two flexible spending accounts (FSA): 

• Health Care 

• Dependent Care 

Enrolling in an FSA 

You must enroll each year if you want to participate in a flexible 

spending account (FSA). You cannot automatically re-enroll 

in an FSA from year to year by doing nothing. New hires must 

enroll no later than their benefits’ effective date. 

To enroll in one or both FSAs, call 1-877-WageWorks 

(1-877-924-3967) or log in to the WageWorks website at 

www.wageworks.com. If it’s the first time you’re visiting 

the site, you’ll need to register by creating a user name 

and password. 





How flexible spending accounts (FSAs) work 

It’s easy to use these accounts: 

• You contribute to the account(s) with pretax dollars deducted 

from your paycheck. When you enroll, you specify how much 

you wish to contribute each year. 

• You pay for certain eligible expenses out of your pocket 

as usual. 

• Then, you submit a claim along with the appropriate 

documentation to be reimbursed for those expenses from 

the dollars in your account. 

• Or, use your WageWorks Card to pay for eligible health care 

expenses. (Be sure to save your receipts for future verification.) 

Health Care FSA 

You may contribute up to $3,000 to your health care FSA for 

2012. These pretax dollars may be used for eligible expenses, 

such as: 

• Medical and dental plan deductibles and copayments 

• Prescription medications 

• Over-the-Counter (OTC) drugs. You must get a prescription 

from your doctor to be reimbursed from the FSA for overthe-counter 

drugs. Just send the prescription in with your 

claim form. 

• Hearing aids 

• Glasses and contacts 

• Any other health care expense that is an eligible tax deduction 

(except insurance premiums, nonprescription drugs and 

cosmetic surgery). 

Check out IRS Publication #502, available at www.irs.gov, 

for a complete list of qualified health care expenses. 

The total amount that you elect to contribute to a health care 

FSA will be made available to you as of the first day of the plan 

year. This means, if you file a claim that exceeds the amount in 

your health care account, you can still be reimbursed up to the 

annual amount you’ve elected. 


27

Dependent Care FSA 

This account reimburses you for qualified day care expenses 

that are necessary so that you, or you and your spouse, can 

work. If you are single or if you are married and filing a joint 

tax return, you can contribute up to $5,000 annually into 

your dependent care FSA ($2,500 if married and filing 

separate federal income tax returns). 

The expenses covered on the days you are working include 

charges for: 

• Licensed nursery schools 

• Daycare centers 

• Babysitting 

• Disabled dependent day care (in or out of your home) 

If the care is in your home, the provider cannot be one of your 

dependents. On the claim form, you must provide the name, 

address and taxpayer identification number of the person 

performing dependent care services. 

You cannot receive advance reimbursements from a dependent 

care FSA. You can only be reimbursed up to the balance in 

your account. 

Use it or lose it 

When deciding how much to contribute to your health care or 

dependent care FSA for the year, be sure to estimate carefully. 

Consider predictable expenses based on past experience and 

upcoming events or changes. It’s important to do the math 

accurately, because if you don’t use up your FSA dollars by the 

end of the year, you will lose them. 

Note: Eligible health care expenses can be incurred through 

March 15, 2013 for reimbursement from your 2012 health 

care FSA. 

Filing a claim for reimbursement from your FSA 

To submit a claim for your eligible dependent care and/or 

health care FSA, complete a claim form, available on 

Employee Resource. Attach the dated receipts along with 

any other required documentation and fax or mail the form 

to WageWorks. 

WageWorks Card = instant reimbursement 

When you elect to contribute to a health care FSA, you will 

receive a WageWorks Card for on-the-spot access to your 

pretax dollars. Your WageWorks Card is similar to a VISA ® debit 

card. Use it to pay for eligible expenses directly at the point of 

service when you incur an expense at a designated health 

care merchant (doctor’s office, hospital, health care clinic, 

pharmacy, etc). However, you must keep receipts, as you may 

be required to send your receipts to WageWorks for review. 

When coverage ends 

You will not be eligible to receive reimbursement for expenses 

incurred after your participation end date. Your participation in 

the health care FSA or dependent care FSA will end: 

• On the date you terminate employment or cease to be a 

full-time or part-time* employee 

• When you elect to stop participating — if permissible — 

due to a qualifying change of status event 

Health care FSA participants whose participation has ended 

due to a COBRA qualifying event will be extended the 

opportunity to continue their participation in the health care 

FSA under COBRA. 







The Retirement Plan— 401(k) 

Many financial planners believe that participating in a 401(k) savings plan is the best way to 

save for your future. That’s because the 401(k) plan gives you the tools you need to assist you 

in building a solid financial future and retirement. 

1-800-835-5092 

www.401k.com 

All full-time, part-time, and adjunct employees are eligible to participate in the EDMC Retirement Plan. What makes this an 

even more attractive investment vehicle is that EDMC will match your contributions — dollar for dollar — up to 6% of your 

annual salary on a per pay basis. 

To enroll in the EDMC Retirement Plan, log in to Fidelity NetBenefits ® at www.401k.com or call the Fidelity Retirement Benefits 

Line at 1-800-835-5092. 

Tax-deferred savings 

Your contributions are deducted from your paycheck — on 

a tax-deferred basis. This means that the deduction from your 

paycheck is made before taxes are taken out. Instead of 

paying taxes for this money now — or for EDMC’s matching 

contributions and the investment earnings as you build 

your retirement fund — you will pay taxes as you receive 

distributions later. This is even more helpful if you expect to 

be in a lower tax bracket in your retirement years. 

Contribution limits 

If you are under age 50, the IRS contribution limit for 2011 

is $16,500. If you will be at least age 50 during the year, the 

plan may allow you to defer an additional $5,500 as catch-up 

contributions. 

Transfers and rollovers 

You can roll over eligible savings from a previous employer’s 

plan into this plan. You can also take your plan vested account 

balance with you if you leave the company. 

Investment options 

You have the flexibility to select from investment options that 

range from more conservative to more aggressive, making it 

easy for you to develop a well-diversified investment portfolio. 

To learn more about the investment options available to you, 

visit www.401k.com. 


29

Commuter Program 

The commuter program is another easy and convenient way to 

save on taxes while paying for predictable expenses. Full-time 

and part-time* employees — who pay to get to work — can 

sign up for the commuter program. You can sign up at any time 

of the year. There’s no specified enrollment period, but elections 

must be made by the 10th of the month for participation in the 

following month. And it’s so easy to use. 

Step 1: Enroll. Log in to www.wageworks.com. 

Click “Sign Me Up!” if you’re new to WageWorks. Sign up by 

choosing your provider and payment type. 

Or, enroll by phone. Call 1-877-WageWorks (1-877-924-3967) 

Monday through Friday, from 8 a.m. to 8 p.m. Eastern Time. 

Step 2: That’s it. Just set it. And forget it. See how easy it is? 

Your pretax payroll deductions will be used to pay your 

commuter expenses that you defined when you enrolled. 

* Part-time employees with hire dates prior to December 1, 2011 will retain 




You have four options for qualified 

transportation 

Buy My Pass. This option is for public transportation 

commuters — bus, light rail, regional rail, streetcar, trolley, 

subway or ferry. When you sign up for the program, you 

can choose your transit provider and pass type. The rest is 

automatic. You’ll receive your transit pass or tickets in the mail 

every month, in time for the month they’re valid. If you 

have a SmartCard or other electronic pass, it will be 

reloaded automatically. 

Pay My Parking. Select your parking provider and monthly 

amount when you sign up, and the program pays your expenses 

automatically every month. You do nothing. 

Pay Me Back. If your expenses vary from month to month, 

or your provider only accepts cash, you can also send in a Pay 

Me Back form for reimbursement. Just print the form from the 

WageWorks website and mail or fax it with your receipts. 

Commuter Card. You can elect the Commuter Card if your 

parking provider accepts credit or debit cards. The Commuter 

Card is a MasterCard ® stored value card, which works just like 

a credit card at your parking facility. 

Not all commuter fees qualify. Exclusions include transportation 

costs that are not related to work, expenses for other family 

members, tolls, mileage, and taxis and limousines. For more 

information, please visit www.wageworks.com. 

Cancel the program at any time 

You can cancel your participation in the commuter program 

at any time. Your cancellation will become effective on the same 

schedule as signing up – cancellations must be made by the 

10th of the month for cancellation the following month. 

More Benefits 

Visit Employee Resource to learn more about these 

other valuable benefits that are available to you as an 

EDMC employee. 

• Tuition Assistance 

• Adoption Assistance 

• Paid Time Off (PTO) 

• Employee Discount Programs 


Your Wellness 

EDMC’s benefit programs focus on helping you reach your best state of health and wellness. 

Wellness means something different for each of us. Whether you’re already in peak condition 

or if you have a chronic disease, there’s something for everyone. 


1-800-828-6025 

www.wellnessworklife.com 

Employee Assistance Program (EAP) 

Job satisfaction and productivity are best achieved when you 

strike a balance between personal and professional demands. 

Achieving this balance can sometimes be challenging; that’s 

why EDMC provides you and your household members with a 

free and confidential* employee assistance program (EAP), 

managed by The Wellness Corporation. 

All full-time, part-time, and adjunct employees and family 

members living in their household can call the EAP at any time. 

You don’t have to enroll to use EAP services. This is a free 

company-paid benefit with no enrollment necessary. 

Someone to talk to 

Call an EAP counselor for confidential discussions about alcohol 

and drug abuse, and mental health and other emotional issues. 

Each eligible employee and the adults or children living in their 

household are eligible for five counseling sessions per issue/per 

calendar year at no charge. The EAP is staffed by licensed 

counselors who will respond quickly to your request for help 

in a caring, respectful manner. 

Advice from an expert 

The EAP program provides support, information and resources 

to employees for a broad range of concerns, such as: 

• Health problems 

• Family, marital and relationship issues 

• Dealing with stress 

• Help with children 

• Debt counseling 

• Work or performance problems 

• And more 

Learn more or contact the program 

Visit Employee Resource or call The Wellness Corporation at 

1-800-828-6025. You may also visit www.wellnessworklife.com. 

EAP assistance is available 24 hours a day, including weekends 

and holidays, for emergencies. 

* Information you discuss with an EAP counselor remains private unless you 

sign a release of information, permitting the EAP to contact a specific person. 

Only in rare instances does the law require a licensed counselor to notify an 

outside party. These situations occur when there is a serious threat to yourself 

or others, or the abuse/neglect of a child, elder or disabled person. 


31


Wellness Programs from ActiveHealth 

We’re making it easier than ever to improve your health with new health management programs 

through ActiveHealth Management ® . Employees who enroll in an Aetna medical plan are eligible for 

all of the ActiveHealth wellness programs. There’s no additional cost to participate. 

1-866-738-6737 

www.aetna.com 

These programs can help you improve the quality of care you receive and help you manage chronic health conditions for 

yourself and your family. 

Your Privacy is Guaranteed 

All of the ActiveHealth programs are confidential, and all 

health information is kept private and only shared between 

ActiveHealth and your health plan administrator, Aetna. 

Your personal and identifiable health information is not shared 

with EDMC. 

Find health information online 

As an enrolled member, you can become totally engaged in 

your health through your personalized and secure member 

website at www.aetna.com. After you register, you can access 

all your wellness programs and health information by clicking on 

“Go to MyActiveHealth.” Here, you can also track your wellness 

progress, send yourself appointment reminders, organize 

meaningful information and so much more. 

Here are just some of the features you’ll find: 

• Health Assessment and Personal Health Record 

• Drug Information 

• Healthy Recipes 

• Customizable Conditions Center 

• Resource Center 

• Health Tools and Trackers 

In fact, it’s the place to get started with all of the ActiveHealth 

wellness programs described here. 

Create your Personal Health Record 

Ever have to try to remember what year you had a surgery or 

when your child received a vaccination? Now it’s easy with 

your secure, online Personal Health Record (PHR). 

The PHR gives you one place to store all of your health information. 

You can update it at any time. In fact, it interacts with claims from 

your medical plan that is administered by Aetna — just to make 

it easy. When the plan receives a claim for — say — a preventive 

care checkup or a new prescription drug, it records it in your PHR. 

As an enrolled member, you can access your PHR by logging 

in to www.aetna.com and clicking “Go to MyActiveHealth.” 

www.aetna.com > Go to MyActiveHealth > Health Record 

Engage a lifestyle coach 

Looking for a better way to stick with a diet or exercise 

regimen? Need to learn how to better manage your stress 

levels? Want to quit smoking? Enrolled medical plan members 

can take advantage, free of charge, of an Active Lifestyle Coach. 

Active Lifestyle Coaching is a telephone support program with 

nurses, dieticians and other trained professionals who can help 

you maintain a healthy lifestyle. Help is just a phone call away 

at 1-866-738-6737. 

Give your baby a healthy start in life 

With the ActiveHealth maternity program, you can speak 

live with a nurse coach who can help you understand what 

to expect at each stage of pregnancy. Your nurse can explain 

prenatal tests and what the results mean, help you lower your 

risk and recognize the signs of early labor, and follow a diet 

that’s healthy for you and your baby. After your baby is born, 

your nurse coach can follow up to see how you’re both doing. 

There’s no cost to join. As an enrolled member, just call 

1-866-738-6737 to sign up for the ActiveHealth maternity 

program. Enroll early for a better chance at a healthy pregnancy. 


Manage your chronic condition 

Asthma. Diabetes. High blood pressure. Migraines. If you’re 

living with a chronic condition, you know how much it can 

impact your life. With a little help, you can get on the right track 

to managing your condition without letting it manage you. 

ActiveHealth offers two ways to get the help you need: 

• Online coaching – You choose what you want to work on, 

like eating foods that are best for your condition, building 

an exercise plan, or maybe just learning more about your 

condition. Whatever your goal, online tools walk you 

step-by-step through the process of creating a plan for better 

health — privately, at your own pace. Once you are enrolled, 

you can learn more about online coaching by logging in to 

www.aetna.com and clicking “Go to MyActiveHealth.” 

• Nurse coach – If you’re at high risk for a chronic health 

condition, or if you’ve already been diagnosed, you can work 

one-on-one with a registered nurse who can help you take 

control of your health and avoid future complications. Your 

nurse coach can help you better understand your condition, 

recognize warning signs and symptoms, help you stick to your 

doctor’s treatment plan and maybe just feel better every day. 

In most cases, if your claims show you have a chronic 

condition, a nurse coach will call you. Or, as an enrolled 

member, you can call 1-866-738-6737 to connect with a 

disease management nurse directly. 

www.aetna.com > Go to MyActiveHealth > OnlineCoaching 

Wellness Incentive Program – 

Healthy Rewards Pricing 

Following a healthy lifestyle makes sense not only because 

you’ll feel better, but because you could spend less on 

your health care. That means more money in your pocket 

for other things. 

EDMC rewards healthy living and positive choices for better 

health with financial incentives through our wellness incentive 

program. Employees who enroll in an Aetna medical plan are 

eligible. There’s no additional cost to participate. In fact, 

participation pays you. 

Healthy Rewards Pricing is the incentive — incentive for you 

to reach for your best health. And the reward? By performing 

healthy actions, you can lower the premium you pay for the 

health plan you choose. 

Beginning on January 1: 

Take Healthy Actions to Earn Healthy Rewards 

You must complete a total of five healthy actions to receive 

the healthy rewards. 

1. 

Engage 

The first three actions will get you started. You must complete 

these actions before moving on to others. 

• Complete the Health Assessment 

• Participate in the Health Screenings 

• Live a Tobacco-Free Lifestyle (validated through Health 

Screening) 

2. 

Participate 

After your health assessment is complete, you will receive 

a report of your current health condition and health risks. 

You’ll also get an action plan with suggestions on how you 

can improve your health. These can translate into actions that 

you can choose from to complete your five healthy actions. 

Choose at least two of the following: 

• Complete three healthy actions as suggested on your health 

assessment report 

• Achieve your health screening goals 

• Participate in an online coaching program 

• Enroll and engage in telephonic lifestyle coaching 

• Engage with a disease management registered nurse if you’re 

at high risk for a chronic condition 

3. 

Track your progress 

Log in to www.aetna.com to track your progress. The easyto-read 

Activity Table will tell you how close you are to achieving 

your incentive reward. You’ll also find details and tips for 

reaching your goal. Engage in the program early in the year 

for the best chance at lowering your premiums. 

www.aetna.com > Go to MyActiveHealth > Rewards Center 

As an enrolled Aetna plan member, you can complete the 

healthy actions and track your progress by logging in to 

www.aetna.com and clicking on “Go to MyActiveHealth.” 


33

Important Notices for Participants 

Patient Protection and Affordable Care Act 

Notice Regarding Grandfathered Health Plan Status 

Under the Patient Protection and Affordable Care Act (referred to as the 

“Health Care Reform Act”), certain health plans (called grandfathered plans) 

in existence on March 23, 2010 had to be changed to reflect only some, 

and not all, of the new health plan rules. Education Management LLC 

(“Education Management”) believes that the Medical Feature of the Education 

Management LLC Signature Benefits Plan (the “Signature Benefits Plan”) 

is a grandfathered plan. That means that the Medical Feature has been 

changed only in limited ways, such as eliminating lifetime limits on benefits. 

If you have any questions about which new health plan rules apply to 

grandfathered plans and which ones do not apply to grandfathered plans, 

you may contact the plan administrator at the address or phone number 

listed below. You may also contact the Employee Benefits Security 

Administration (“EBSA”), U.S. Department of Labor at 1-866-444-3272 

or www.dol.gov/ebsa/healthreform. The EBSA’s website has a table 

summarizing which health plan rules do and do not apply to grandfathered 

health plans. 

Notice of Opportunity to Enroll in Connection with Extension 

of Dependent Coverage to Age 26 

Starting on January 1, 2011, the age limit for children to be eligible dependents 

under the Signature Benefits Plan was changed to age 26 (i.e., until 26th 

birthday). Dependent children whose coverage ended, or who were denied 

coverage (or were not eligible for coverage), because the availability of 

dependent coverage of children ended before attainment of age 26 are 

eligible to enroll in the Signature Benefits Plan so long as the child does 

not have coverage available through another employer-sponsored health plan. 

Enrollment may be requested for such children during the annual Open 

Enrollment period. Enrollment will be effective January 1. For more information, 

contact the plan administrator at the address or phone number listed below. 

Notice that Lifetime Limit No Longer Applies and Enrollment Opportunity 

Starting on January 1, 2011, the lifetime limit on the dollar value of benefits 

under the Medical Feature of the Signature Benefits Plan do not apply. 

Individuals whose coverage ended by reason of reaching a lifetime limit 

under the Medical Feature of the Signature Benefits Plan may again be eligible 

to enroll. Individuals may request enrollment during the annual Open Enrollment 

period. Enrollment will be effective January 1. For more information, contact the 

plan administrator at the address or phone number listed below. 

Reservation of Rights 

It is important to explain that Education Management has always reserved, 

and continues to reserve, the right to amend, modify or terminate the 

Signature Benefits Plan (and any Feature) at any time and for any reason. 

That means, for example, that the changes described in this Notice could be 

changed further, that any other provision may be changed, and that the 

Signature Benefits Plan could be discontinued in its entirety for any reason. 

Plan Administrator 

Health and Welfare Plan Committee 

Education Management LLC 

c/o HR One Connect 

210 Sixth Avenue, 21st Floor 

Pittsburgh, PA 15222 

Phone Number: 1-888-HR1-EDMC 

Notice of Privacy Practices for Protected Health Information 

This notice describes how health information about you may be used and 

disclosed and how you can get access to this information. Please review 

this notice carefully. 

Introduction 

Education Management LLC (“EDMC”) sponsors and administers a group 

health, dental and vision plan, which also includes a health care flexible 

spending account and employee assistance program. This Notice applies to all 

of these benefits. This Notice refers to these benefits collectively as the “Plan.” 

The Plan’s Duties 

1. Safeguard The Privacy Of Your Protected Health Information (“PHI”). Federal 

law requires that the Plan safeguard the privacy of your “protected health 

information” or “PHI.” PHI includes individually identifiable information 

created or received by, or on behalf of, the Plan relating to your past, present 

or future physical or mental health condition, treatment for that condition, 

or payment for that treatment. Information that is de-identified is not PHI 

and is not subject to this Notice. 

2. Notify You Of The Plan’s Privacy Policies. Federal law requires that the Plan 

notify you of their legal duties and privacy policies and procedures with 

respect to your PHI. This Notice is intended to satisfy that requirement. 

3. Use And Disclose Your PHI Only As Described In This Notice. The Plan will 

abide by the terms of this Notice as long as it remains in effect. The Plan will 

use and disclose your PHI without first obtaining your written authorization 

only as described in this Notice. If the Plan obtains your written authorization 

for a use or disclosure not described in this Notice, you may revoke or modify 

that authorization at any time by submitting the appropriate form to the 

Privacy Official designated in this Notice. The Privacy Official will provide you 

with a copy of the form upon request. 

How The Plan Will Use And Disclose Your PHI Without Your Authorization 

1. Uses And Disclosures For Treatment. The Plan may use and disclose your 

PHI for “treatment.” “Treatment” includes the provision, coordination or 

management of health care and related services by one or more health care 

providers. For example, the Plan may assist in coordinating health care and 

related benefits. 

2. Uses And Disclosures For Payment. The Plan will use and disclose your PHI for 

“payment.” “Payment” includes, but is not limited to, claims processing, 

claims payment, payroll deductions, eligibility determinations, and claims 

disputes. For example, the Plan will use your PHI to determine whether you 

are entitled to benefits and, if you are, to determine your benefits. 

3. Uses And Disclosures For Health Care Operations. The Plan will use and 

disclose your PHI for “health care operations.” “Health care operations” 

include, but are not limited to, securing or placing a contract for reinsurance 

of risk relating to claims for health care; arranging for medical review, legal 

services, and auditing functions; fraud and abuse detection programs; 

business planning and development; investigating and resolving complaints 

of privacy violations; and business management and general administrative 

activities. For example, the Plan may disclose PHI as part of an investigation 

into a fraudulent claim. 

4. Disclosures To The Plan’s Sponsor. The sponsor of the Plan is EDMC. The Plan 

will disclose your PHI to EDMC employees responsible for “plan administration 

functions.” “Plan administration functions” include, but are not limited to, 

claims processing, eligibility determinations, and appeals from denials of 

coverage. EDMC employees are prohibited from using or disclosing your 

PHI for employment-related decisions. 

5. Disclosures To Business Associates. The Plan has contracted with one or 

more third parties (referred to as a business associate) to use and disclose 

your PHI to perform services for the Plan. The Plan will obtain each business 

associate’s written agreement to safeguard your PHI. 

6. Information-Sharing Among EDMC’s Health Plan. EDMC’s health plans 

will share PHI with each other, and with business associates, as permitted 

by state and federal law, to carry out treatment, payment or health care 

operations. 


How The Plan Might Use Or Disclose Your PHI Without Your Authorization 

Federal law generally permits the Plan to make certain uses or disclosures of PHI 

without your permission. Federal law also requires the Plan to list in the Notice 

each of these categories of disclosures. The listing is below. 

1. Uses Or Disclosures Required By Law. The Plan may use or disclose your 

PHI as required by any statute, regulation, court order or other mandate 

enforceable in a court of law. 

2. Disclosures For Workers’ Compensation Purposes. The Plan may disclose 

your PHI as required or permitted by state or federal workers’ compensation 

laws. 

3. Disclosures To Family Members Or Close Friends. The Plan may disclose 

your PHI to a family member or close friend who is involved in your care or 

payment for your care if (a) you are present and agree to the disclosure, 

or (b) you are not present or you are not capable of agreeing, and EDMC 

determines that it is in your best interest to disclose the information. 

4. Disclosures For Judicial And Administrative Proceedings. The Plan may 

disclose your PHI in an administrative or judicial proceeding in response to a 

subpoena or a request to produce documents. The Plan will disclose your 

PHI in these circumstances only if the requesting party first provides written 

documentation that the privacy of your PHI will be protected. 

5. Disclosures For Law Enforcement Purposes. The Plan may disclose your PHI 

for law enforcement purposes to a law enforcement official, such as in 

response to a grand jury subpoena. 

6. Incidental Uses And Disclosures. The Plan may use or disclose your PHI in a 

manner which is incidental to the uses and disclosures described in this Notice. 

7. Uses And Disclosures For Public Health Activities. The Plan may disclose 

your PHI to a government agency responsible for preventing or controlling 

disease, injury, disability, or child abuse or neglect. The Plan may disclose 

your PHI to a person or entity regulated by the Food and Drug 

Administration (“FDA”) if the disclosure relates to the quality or safety 

of an FDA-regulated product, such as a medical device. 

8. Uses And Disclosures For Health Oversight Activities. The Plan may disclose 

your PHI to a government agency responsible for overseeing the health care 

system or health-related government benefit programs. 

9. Disclosures About Victims Of Abuse, Neglect, Or Domestic Violence. 

The Plan may disclose your PHI to the responsible government agency if 

(a) the Privacy Official reasonably believes that you are a victim of abuse, 

neglect, or domestic violence, and (b) the Plan is required or permitted by 

law to make the disclosure. The Plan will promptly inform you that such a 

disclosure has been made unless the Plan’s Privacy Official determines that 

informing you would not be in your best interests. 

10. Uses And Disclosures To Avert A Serious Threat To Health Or Safety. The 

Plan may use or disclose your PHI to reduce a risk of serious and imminent 

harm to another person or to the public. 

11. Disclosures To HHS. The Plan may disclose your PHI to the United States 

Department of Health and Human Services (“HHS”), the government 

agency responsible for overseeing the Plan’s compliance with federal 

privacy law and regulations regulating the privacy of PHI. 

12. Uses And Disclosures For Research. The Plan may use or disclose your 

PHI for research, subject to conditions. “Research” means systemic 

investigation designed to contribute to generalized knowledge. 

13. Uses And Disclosures In Connection With Your Death Or Organ Donation. 

The Plan may disclose your PHI to a coroner for identification purposes, 

to a funeral director for funeral purposes, or to an organ procurement 

organization to facilitate transplantation of one of your organs. 

14. Uses And Disclosures For Specialized Government Functions. The Plan may 

disclose your PHI to the appropriate federal officials for intelligence and 

national security activities authorized by law or to protect the President or 

other national or foreign leaders. If you are a member of the U.S. Armed 

Forces or of a foreign armed forces, the Plan may use or disclose your PHI 

for activities deemed necessary by the appropriate military commander. 

If you were to become an inmate in a correctional facility, the Plan may 

disclose your PHI to the correctional facility in certain circumstances. 

If applicable State law does not permit the disclosure described above, the 

Plan will comply with the stricter State law. 

The Plan’s Disclosures With Your Prior Authorization 

The Plan will obtain your written authorization, if and to the extent required 

by state or federal law, before disclosing any of the following categories of 

information: 

1. Psychotherapy Notes. Psychotherapy notes are separately filed notes about 

your conversations with your mental health professional during a counseling 

session. Psychotherapy notes do not include summary information about 

your mental health treatment. The Plan may use and disclose such notes, 

without your authorization, when needed by the Plan to defend against 

litigation filed by you. 

2. HIV/AIDS Status, Infection Or Test Results. “HIV” means human 

immunodeficiency virus. “HIV infection” means infection with HIV or any 

other related virus identified as a probable causative agent of AIDS. “AIDS” 

means acquired immunodeficiency syndrome. 

3. Results Of Genetic Testing. “Genetic testing” means any laboratory test 

of human DNA-RNA or chromosomes that is used to identify the presence 

or absence of alterations in genetic material which are associated with a 

predisposition for a clinically recognized disease, disorder, or syndrome. 

“Genetic testing” includes only those tests which are direct measures of such 

alterations. “Genetic testing” does not include chemical, blood or urine 

analyses that are widely accepted and used in clinical practice and are not 

used to determine genetic traits. 

4. Substance Abuse Records. Substance abuse records contain information 

created by a drug or alcohol abuse program about the patient’s diagnosis, 

prognosis or treatment. 

Your Privacy Rights As A Participant In The Plan 

You may exercise the rights described below for each Plan in which you 

participate. The forms referenced below can be obtained from EDMC’s 

Privacy Official (the “Privacy Official”). 

1. Right To Access Your PHI. You may request a review or photocopies of your 

PHI on file with the Plan by submitting the appropriate form to the Privacy 

Official. The Plan will provide access, or will mail the photocopies to you, 

within 30 days of your request unless the PHI is not available on-site, in 

which case the Plan will provide access or mail the photocopies within 60 

days of your request. The Plan may extend the deadline for access or mailing 

by up to 30 days. The Plan will provide you with a written explanation of any 

denial of your request for access or photocopies. The Plan may charge you a 

reasonable, cost-based fee for photocopies or for mailing. If there will be a 

charge, the Privacy Official will first contact you to determine whether you 

wish to modify or withdraw your request. 

2. Right To Amend Your PHI. You may amend your PHI on file with the Plan 

by submitting the appropriate request form to the Privacy Official. The Plan 

will respond to your request within 60 days. The Plan may extend the 

deadline by up to an additional 30 days. If the Plan denies your request 

to amend, the Plan will provide a written explanation of the denial. 

You would then have 30 days to submit a written statement explaining 

your disagreement with the denial. Your statement of disagreement 

would be included with any future disclosure of the disputed PHI. 

3. Right To An Accounting Of Disclosures Of Your PHI. You may request 

an accounting of the Plan’s disclosures of your PHI by submitting the 

appropriate form to the Privacy Official. The Plan will provide the accounting 

within 60 days of your request. The Plan may extend the deadline by up to 

an additional 30 days. The accounting will exclude the following disclosures: 

(a) disclosures for “treatment,” “payment,” or “health care operations,” (b) 

disclosures to you or pursuant to your authorization, (c) disclosures to family 

members or close friends involved in your care or in payment for your care, 

(d) disclosures as part of a data use agreement, and (e) incidental disclosures. 

The Plan will provide the first accounting during any 12-month period 

without charge. The Plan may charge a reasonable, cost-based fee for each 

additional accounting during the same 12-month period. If there will be a 

charge, the Privacy Official will first contact you to determine whether you 

wish to modify or withdraw your request. 

4. Right To Request Additional Restrictions On The Use Or Disclosure Of Your 

PHI. You may request that the Plan place restrictions on the use or disclosure 

of your PHI for “treatment,” “payment,” or for “health care operations” 

in addition to the restrictions required by federal law by submitting the 

appropriate request form to the Privacy Official. The Plan will notify you in 

writing within 30 days of your request whether or not it will agree to the 

requested restriction. The Plan is not required to agree to your request. 


35

5. Right To Request Communications By Alternative Means Or To An 

Alternative Location. The Plan will honor your reasonable request to receive 

PHI by alternative means, or at an alternative location, if you submit the 

appropriate request form to the Privacy Official. 

6. Right To A Paper Copy Of This Notice. You may request at any time that the 

Privacy Official provide you with a paper copy of this Notice. 

A Note About Personal Representatives 

All of the rights described previously may be exercised by your personal 

representative after the personal representative has provided proof of his or her 

authority to act on your behalf. Proof of authority may be established by (a) a 

power of attorney for health care purposes, or a general power of attorney, 

notarized by a notary public, (b) a court order appointing the person to act as 

your conservator or guardian, or (c) any other document which the Privacy 

Official, in his or her sole and absolute discretion, deems appropriate. 

Your Right To File A Complaint 

If you believe that your privacy rights have been violated because the Plan has 

used or disclosed your PHI in a manner inconsistent with this Notice, because 

the Plan has not honored your rights as described in this Notice, or for any 

other reason, you may file a complaint in one, or both, of the following ways: 

1. Internal Complaint: Within 180 days of the date you learned of the conduct, 

you can submit a complaint using the appropriate complaint form to the 

Complaint Official, c/o Education Management LLC, 210 Sixth Avenue, 21st 

Floor, Pittsburgh, PA 15222-2603 or call 1-888-HR1-EDMC and ask for the 

HIPAA Privacy Official. You can obtain a complaint form from the Privacy Official. 

2. Complaint To HHS: Within 180 days of the date you learned of the 

conduct, you may submit a complaint by mail to the Secretary of the 

U.S. Department of Health and Human Services, Hubert H. Humphrey 

Building, 200 Independence Ave., S.W., Washington, D.C. 20201. 

The Plan’s Anti-Retaliation Policy 

The Plan will not retaliate against you for submitting an internal complaint, a 

complaint to HHS, or for exercising your other rights as described in this Notice 

or under applicable law. 

Whom To Contact For More Information About The Plan’s Privacy 

Policies And Procedures 

If you have any questions about this Notice, or about how to exercise any 

of the rights described in this Notice, you should contact the Benefits 

Manager by mail c/o Education Management LLC, 210 Sixth Avenue, 21st 

Floor, Pittsburgh, PA 15222-2603 or call 1-888-HR1-EDMC and ask for the 

HIPAA Privacy Official. 

Revisions To The Privacy Policy And To The Notice 

The Plan has the right to change this Notice or the Plan’s privacy policies and 

procedures at any time. If the change to the Plan’s privacy policies and 

procedures would have a material impact on your rights, the Plan will notify 

you of the change by promptly mailing (either electronically or by U.S. Postal 

Service) a revised Notice to you which reflects the change. Any change to the 

Plan’s privacy policies and procedures, or to the Notice, will apply to your PHI 

created or received before the revision. 

Effective Date Of This Notice: 7/1/2011 

Notice of Women’s Health and Cancer Rights Act of 1998 

If you have had or are going to have a mastectomy, you may be entitled to 

certain benefits under the Women’s Health and Cancer Rights Act of 1998 

(WHCRA). 

Under the Education Management LLC medical plans, for mastectomy-related 

benefits, coverage will be provided in a manner determined in consultation 

with the attending physician and the patient, for: 

• All stages of 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 of the mastectomy, including 

lymphedema. 

These benefits will be provided subject to the same deductibles and coinsurance 

applicable to other medical and surgical benefits provided under the plan. 

Therefore, the deductibles and coinsurance associated with these benefits will 

apply (see your Benefit Plan Description for more details). 

More information about WHCRA can be requested by calling HR One Connect 

at 1-888-471-3362 (1-888-HR1-EDMC). 

Important Notice of Creditable Coverage and Information About 

Your Prescription Drug Coverage and Medicare 

Please read this notice carefully and keep it where you can find it. This notice 

has information about your current prescription drug coverage with Education 

Management LLC and about your options under Medicare’s prescription drug 

coverage. This information can help you decide whether or not you want to join 

a Medicare drug plan. If you are considering joining, you should compare your 

current coverage, including which drugs are covered at what cost, with the 

coverage and costs of the plans offering Medicare prescription drug coverage in 

your area. Information about where you can get help to make decisions about 

your prescription drug coverage is at the end of this notice. 

There are two important things you need to know about your current coverage 

and Medicare’s prescription drug coverage: 

1. Medicare prescription drug coverage became available in 2006 to everyone 

with Medicare. You can get this coverage if you join a Medicare Prescription 

Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that 

offers prescription drug coverage. All Medicare drug plans provide at least a 

standard level of coverage set by Medicare. Some plans may also offer more 

coverage for a higher monthly premium. 

2. Education Management LLC has determined that the prescription drug 

coverage offered as part of the Signature Benefits Plan is, on average 

for all plan participants, expected to pay out as much as standard 

Medicare prescription drug coverage pays and is therefore considered 

Creditable Coverage. 

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. 

You can join a Medicare drug plan when you first become eligible for 

Medicare and each year from October 15th through December 7th. 

However, if you lose creditable prescription drug coverage, through no fault 

of your own, you will also be eligible for a two (2) month Special Enrollment 

Period (SEP) to join a Medicare drug plan. 

If you decide to join a Medicare drug plan, your current Education Management 

LLC coverage will not be affected. Education Management LLC will continue 

to pay primary or secondary as it had before you enrolled in a Medicare 

prescription drug plan. You may also drop the Education Management LLC 

coverage, in which case Medicare will be your only payer. You can re-enroll in 

the Education Management LLC plan during the annual open enrollment 

period or if you have a special enrollment event. 

You should also know that if you drop or lose your coverage with Education 

Management LLC and don’t join a Medicare drug plan within 63 continuous 

days after your current coverage ends, you may pay a higher premium 

(a penalty) to join a Medicare drug plan later. 

If you go 63 continuous days or longer without creditable prescription drug 

coverage, your monthly premium may go up by at least 1% of the Medicare 

base beneficiary premium per month for every month that you did not have 

that coverage. 

For example, if you go nineteen months without creditable coverage, your 

premium may consistently be at least 19% higher than the Medicare base 

beneficiary premium. You may have to pay this higher premium (a penalty) as 

long as you have Medicare prescription drug coverage. In addition, you may 

have to wait until the following October to join. 

For more information about your options under Medicare 

prescription drug coverage 

More detailed information about Medicare plans that offer prescription 

drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the 

handbook in the mail every year from Medicare. You may also be contacted 

directly by Medicare drug plans. 

For more information about Medicare prescription drug coverage: 

• Visit: www.medicare.gov 

• Call your State Health Insurance Assistance Program (see the inside back cover 

of your copy of the “Medicare & You” handbook for their telephone number) 

for personalized help 

• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 

1-877-486-2048 


If you have limited income and resources, extra help paying for Medicare 

prescription drug coverage is available. For information about this extra help, 

visit Social Security on the web at www.socialsecurity.gov, or call them at 

1-800-772-1213 (TTY 1-800-325-0778). 

Remember: Keep this Creditable Coverage notice. If you decide to join 

one of the Medicare drug plans, you may be required to provide a 

copy of this notice when you join to show whether or not you have 

maintained creditable coverage and whether or not you are required 

to pay a higher premium (a penalty). 

Education Management LLC will provide this notice each year before the next 

Medicare drug plan enrollment period and/or if prescription drug coverage 

through Education Management LLC changes. You also may request a copy. 

For more information about this notice or your current prescription drug 

coverage available to you under the Education Management LLC group 

insurance program, contact: 

Date: October 15, 2011 

Name of Entity/Sender: Education Management LLC 

Contact – Position/Office: HR One Connect 

Address: 210 Sixth Avenue, 21st Floor 

Pittsburgh, PA 15222 

Phone Number: 1-888-471-3362 (1-888-HR1-EDMC) 

Medicaid and the Children’s Health Insurance Program 

(CHIP) Notice 

If you are eligible for health coverage from your employer, but are unable to 

afford 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. 

If you or your dependents are already enrolled in Medicaid or CHIP and you live 

in a State listed below or on the following page, you can contact your State 

Medicaid or CHIP office to find out if premium assistance is available. 

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, 

and you think you or any of your dependents might be eligible for either of 

these programs, you can contact your State Medicaid or CHIP office or dial 

1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. 

If you qualify, you can ask the State if it has a program that might help you pay 

the premiums for an employer-sponsored plan. 

Once it is determined that you or your dependents are eligible for premium 

assistance under Medicaid or CHIP, your employer’s health plan is required to 

permit you and your dependents to enroll in the plan – as long as you and your 

dependents are eligible, but not already enrolled in the employer’s plan. This is 

called a “special enrollment” opportunity, and you must request coverage 

within 60 days of being determined eligible for premium assistance. 

If you live in one of the following States, you may be eligible for 

assistance paying your employer health plan premiums. The following 

list of States is current as of July 31, 2011. You should contact your 

State for further information on eligibility — 

ALABAMA – Medicaid 

Website: http://www.medicaid.alabama.gov 

Phone: 1-800-362-1504 

ALASKA – Medicaid 

Website: http://health.hss.state.ak.us/dpa/programs/medicaid/ 

Phone (Outside of Anchorage): 1-888-318-8890 

Phone (Anchorage): 907-269-6529 

ARIZONA – CHIP 

Website: http://www.azahcccs.gov/applicants/default.aspx 

Phone (Outside of Maricopa County): 1-877-764-5437 

Phone (Maricopa County): 602-417-5437 

CALIFORNIA – Medicaid 

Website: http://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx 

Phone: 1-866-298-8443 

COLORADO – Medicaid and CHIP 

Medicaid Website: http://www.colorado.gov/ 

Medicaid Phone (In state): 1-800-866-3513 

Medicaid Phone (Out of state): 1-800-221-3943 

CHIP Website: http:// www.CHPplus.org 

CHIP Phone: 303-866-3243 

FLORIDA – Medicaid 

Website: https://www.flmedicaidtplrecovery.com/ 

Phone: 1-877-357-3268 

GEORGIA – Medicaid 

Website: http://dch.georgia.gov/ 

Click on Programs, then Medicaid 

Phone: 1-800-869-1150 

IDAHO – Medicaid and CHIP 

Medicaid Website: www.accesstohealthinsurance.idaho.gov 

Medicaid Phone: 1-800-926-2588 

CHIP Website: www.medicaid.idaho.gov 

CHIP Phone: 1-800-926-2588 

INDIANA – Medicaid 

Website: http://www.in.gov/fssa 

Phone: 1-800-889-9948 

IOWA – Medicaid 

Website: www.dhs.state.ia.us/hipp/ 

Phone: 1-888-346-9562 

KANSAS – Medicaid 

Website: http://www.kdheks.gov/hcf/ 

Phone: 1-800-792-4884 

KENTUCKY – Medicaid 

Website: http://chfs.ky.gov/dms/default.htm 

Phone: 1-800-635-2570 

LOUISIANA – Medicaid 

Website: http://www.lahipp.dhh.louisiana.gov 

Phone: 1-888-695-2447 

MAINE – Medicaid 

Website: http://www.maine.gov/dhhs/OIAS/public-assistance/index.html 

Phone: 1-800-572-3839 

MASSACHUSETTS – Medicaid and CHIP 

Website: http://www.mass.gov/MassHealth 

Phone: 1-800-462-1120 

MINNESOTA – Medicaid 

Website: http://www.dhs.state.mn.us/ 

Click on Health Care, then Medical Assistance 

Phone (Outside of Twin City area): 800-657-3739 

Phone (Twin City area): 651-431-2670 

MISSOURI – Medicaid 

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm 

Phone: 573-751-2005 

NEBRASKA – Medicaid 

Website: http://www.dhhs.ne.gov/med/medindex.htm 

Phone: 1-877-255-3092 

NEVADA – Medicaid 

Medicaid Website: http://dwss.nv.gov/ 


NEW HAMPSHIRE – Medicaid 

Website: www.dhhs.nh.gov/ombp/index.htm 

Phone: 603-271-8183 

NEW JERSEY – Medicaid and CHIP 

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/ 


CHIP Website: http://www.njfamilycare.org/index.html 

CHIP Phone: 1-800-701-0710 

NEW YORK – Medicaid 

Website: http://www.nyhealth.gov/health_care/medicaid/ 

Phone: 1-800-541-2831 

NORTH CAROLINA – Medicaid 

Website: http://www.nc.gov 

Phone: 919-855-4100 

NORTH DAKOTA – Medicaid 

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ 

Phone: 1-800-755-2604 

OKLAHOMA – Medicaid and CHIP 

Website: http://www.insureoklahoma.org 

Phone: 1-888-365-3742 


37

OREGON – Medicaid and CHIP 

Website: http://www.oregon.gov/OHA/OPHP/FHIAP/index.shtml 

Phone: 1-888-564-9669 

PENNSYLVANIA – Medicaid 

Website: http://www.dpw.state.pa.us/hipp 

Phone: 1-800-692-7462 

RHODE ISLAND – Medicaid 

Website: www.dhs.ri.gov 

Phone: 401-462-5300 

SOUTH CAROLINA – Medicaid 

Website: http://www.scdhhs.gov 

Phone: 1-888-549-0820 

TEXAS – Medicaid 

Website: https://www.gethipptexas.com/ 

Phone: 1-800-440-0493 

UTAH – Medicaid and CHIP 

Website: http://health.utah.gov/upp 

Phone: 1-866-435-7414 

VERMONT– Medicaid 

Website: http://www.greenmountaincare.org/ 

Phone: 1-800-250-8427 

VIRGINIA – Medicaid and CHIP 

Medicaid Website: http://www.dmas.virginia.gov/rcp-HIPP.htm 


CHIP Website: http://www.famis.org/ 

CHIP Phone: 1-866-873-2647 

WASHINGTON – Medicaid 

Website: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm 

Phone: 1-800-562-3022, ext. 15473 

WEST VIRGINIA – Medicaid 

Website: www.dhhr.wv.gov/bms/ 

Phone: 304-558-1700 

WISCONSIN – Medicaid 

Website: http://www.badgercareplus.org/pubs/p-10095.htm 

Phone: 1-800-362-3002 

WYOMING – Medicaid 

Website: http://www.health.wyo.gov/healthcarefin/index.html 

Phone: 307-777-7531 

To see if any more States have added a premium assistance program 

since July 31, 2011, or for more information on special enrollment 

rights, you can contact either: 

U.S. Department of Labor 

Employee Benefits Security Administration 

www.dol.gov/ebsa 

1-866-444-EBSA (1-866-444-3272) 

OMB Control Number 1210-0137 (expires 09/30/2013) 

U.S. Department of Health and Human Services 

Centers for Medicare & Medicaid Services 

www.cms.hhs.gov 

1-877-267-2323, Ext. 61565 

Enroll through the HR One Connect 

Employee Resource website. 

You’ll find everything you need to help you decide, such as: 

• Enrollment options 

• Rates 

• Plan comparison tools 

• Communication materials 

1-888-471-3362 (1-888-HR1-EDMC) / http://ess.edmc.edu 

Although it is the company’s intention to continue the benefits and the individual options contained in this brochure, the Company reserves the right to 

unilaterally change, modify or discontinue any benefit or individual option (in total or in part) without notice. If a plan is changed or terminated, you will be 

notified. The benefit information in this brochure is not meant to be a complete representation of all the terms and conditions of the individual benefit plans, 

nor is this information intended to serve as the summary plan description. All benefit coverage, terms and conditions are subject to the provisions detailed in the 

respective plan documents, insurance contracts and summary plan descriptions. To the extent any difference exists between the information in this booklet and 

the contracts, the differences will be resolved by the Signature Benefits Plan Document. Receipt of this brochure does not create an employment contract between 

the Company and its employees. Further information can be obtained by contacting HR One Connect at 1-888-471-3362 (1-888-HR1-EDMC). 

CCG EDMC-0002 (10/2011)

2012 Benefit Enrollment Guide - Education Management Corporation

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