Benefit Plan Overview Full Time Administrative & Support Staff

Delaware County Community College
Benefit Plan Overview
WELCOME
D
elaware County Community College
takes pride in offering a comprehensive
and competitive benefits package
to its employees. Through all of its
benefit partners, offers you a program that is
designed to best meet the needs of you and
your family.
It is important that you take the time to review
all of the plan options and the associated cost
carefully, and choose the benefits package that
will best meet your and your family’s needs
throughout the year.
There are three medical plans available
through Independence Blue Cross/
Keystone Health Plan East to you and
your family for access to quality, affordable
healthcare. The Plans are the
Keystone HMO and the Personal
Choice PPO.
Full Time Administrative & Support Staff
Medical & Rx Benefits
The medical plans cover a broad range of
healthcare services and supplies, including
office visits, laboratory services and hospitalization.
The Internal Revenue
Service (IRS) states
that eligible employees
may only make
elections to the plan
once a year at open
enrollment. Medical,
Prescription Drug,
Dental and Vision
benefit choices are
binding through September 30th
of each year.
The following circumstances are the
ONLY reasons you may change your
benefits during the year: Marriage,
Divorce, Birth, Adoption, Death of
Spouse or Dependent, Loss of Dependent
Status, or Loss of Spouse’s
job where coverage is maintained
through a spouse’s plan.
These special circumstances, often
referred to as life event changes,
will allow you to make plan changes
at any time during the year in which
they occur. For any allowable
changes, you must complete the
appropriate documentation and
send it to Human Resources within
30 days of the event to avoid a
lapse in coverage. All other changes
are deferred to open enrollment.
The plans differ when it comes to how
they share costs with you. Please refer to
the summary on the next page for details
on the medical and prescription drug
benefits for both available plans.
Employees share in the cost of the medical
plan on a pre-tax basis. Actual employee
cost depends on plan and enrollment
tier chosen.
Eligibility: Benefits are effective the 1st of
the month after 30 calendar days of employment.
2010
OBJECTIVE:
To provide Delaware
County Community
College employees and
their spouses with
information about the
resources available to
them through Delaware
County Community
College Program.
INSIDE THIS ISSUE:
Medical & Rx Benefits 1-2
Dental Benefits 2
Vision Benefits 3
Basic Life and
AD&D Insurance
Long-Term Disability 3
Voluntary STD and
Cancer Plan
Voluntary Accident
Insurance
Supplemental Term
Life
Employee Assistance
Plan
Flex Spending
Accounts
3
3
4
4
4
4
This benefits summary describes the highlights of our benefits in non-technical language. Your specific rights to benefits under the plan are governed solely, and in every
respect, by the official documents and not the information in this summary. If there is any discrepancy between the descriptions of the programs as contained in these materials
and the official plan documents, the language of the official plan document shall prevail as accurate. Please refer to the plan-specific documents for detailed plan information.

Page 2
Medical Benefits Description
DELAWARE COUNTY COMMUNITY COLLEGE
Medical & Rx
Benefits Description
Primary Care Physician Requirement
Deductible
Employee
Family
Out-of-Pocket Maximum
Employee
Family
Personal Choice PPO 10/20/70
Personal Choice PPO C2-F3
F3-01
Keystone
HMO C1-F1
In-Network Out-of-Network In-Network Out-of-Network Referred
No N/A No N/A Yes
N/A
N/A
N/A
N/A
$300
$600
$2,000
$4,000
N/A
N/A
N/A
N/A
$500
$1,500
$3,000
$9,000
N/A
N/A
$1,000
$2,000
Inpatient Hospitalization
$75/day; 5 day max
per admission
70% after Deductible
$150/day; 5 day max
per admission
70% after Deductible Covered 100%
Office Visits
Primary Care Physicians
Specialist
$10 Copayment
$20 Copayment
70% after Deductible
70% after Deductible
$15 Copayment
$30 Copayment
70% after Deductible
70% after Deductible
$10 Copayment
$20 Copayment
Emergency Room
$40 Copayment $40 Copayment
$100 Copayment (not
waived if admitted)
$100 Copayment (not
waived if admitted)
$100 Copayment
(not waived if
admitted)
Outpatient Surgery $75 Copayment 70% after Deductible $75 Copayment 70% after Deductible Covered 100%
Lifetime Max Unlimited $1,000,000 Unlimited $1,000,000 Unlimited
Prescription Drug (retail 30 day supply) **
Generic
Preferred Brand
Non-Preferred Brand
Mandatory Mail Order
$10 Copayment
$20 Copayment
$35 Copayment
Yes
Reimbursement will be at
the 30% of the drugs
retail cost
N/A
$10 Copayment
$20 Copayment
$35 Copayment
Yes
Reimbursement will be at
the 30% of the drugs retail
cost
N/A
$10 Copayment
$20 Copayment
$35 Copayment
Yes
Mandatory Mail Order (retail 30 day
supply)
Generic
Preferred Brand
Non-Preferred Brand
$20 Copayment
$40 Copayment
$70 Copayment
Not covered
$20 Copayment
$40 Copayment
$70 Copayment
Not covered
$20 Copayment
$40 Copayment
$70 Copayment
** Should there be any discrepancies between the above summary and the actual plan contract(s), the Plan contract(s) supersedes this summary.
*Under both the Personal Choice 10/20/70 and Personal Choice C2-F3-01 plans, The College will self-insure and reimburse employees for the $75 co-payment for outpatient
surgery for the calendar year 2010. Under these same two Personal Choice plans, the College will self-insure and reimburse employees for the $75 co-payment for
inpatient hospital services (maximum of $375 per admission) for the calendar year 2010.
**IBC Prescription Drug Program ($10/$20/$35 Rx) includes a mandatory mail order program for maintenance drugs and/or drugs for chronic conditions for up to a 90-day
supply. An employee will have an annual out-of-pocket maximum for the $15 difference between the $20 copay for the brand formulary drugs and the $35 copay for nonformulary
brand drugs of 2% of their annual gross compensation. The College will pay an employee who must pay more than the out of pocket maximum the amount over
their maximum. The out of pocket maximum does not apply to non-participating pharmacy charges.
Dental Benefits
Good dental health is important to your overall well-being.
MetLife's dental plan provides affordable coverage based on
the type of services obtained– Preventive, Basic or Major -
whether or not you obtain services from a In-network of
Out-of-network provider.
Dental Benefits Description
For more information visit:
www.metlife.com/mybenefits
Or call MetLife at 1-800-942-0854.
Delaware County Community College pays 100% of the
Dental Premium
In-Network
MetLife
Out-of-Network
Deductible: Individual/Family (applies to Basic &
Major Services Only) Ortho Deductible: $50/lifetime $25/$75 $25/$75
Diagnostic & Preventive Services 100% 100%
Basic Services: Fillings, Oral Surgery, Simple Tooth
Extractions,
80% 80%
Major Services: Crowns, Inlays, Onlays and Periodontontics
80% 80%
Orthodontics Benefits (adult & children) 50% 50%
Annual Maximum $1,000 $1,000
Lifetime Orthodontia Maximum Plan Payment $1,000 $1,000

Page 3
Vision Benefits
DELAWARE COUNTY COMMUNITY COLLEGE
The College pays 100% for all regular full time
employees. Eligible participants can get eye
examination, lenses and contact lenses once a
year. Participants have the options of receiving
care from a network or out-of-network provider,
however, if you use a non–network provider
you will incur higher out-of-pocket expenses.
www.eyemedvisioncare.com
Vision
Benefits Description
In-Network
Out-of-Network
Examinations (once every 12
months)
$0 Copay Up to $70
Lenses (once every 12 months)
Single Vision
Bifocal
Trifocal
$0 copay
$0 copay
$0 copay
Up to $70
Up to $120
Up to $150
Frames (once every 12
months)
$130 Allowance; 80% of
balance over $130
Up to $130
Contact Lenses
Conventional
Medical Necessary
$0 copay; $210 allowance
$0 copay; $210 allowance
Up to $210
Up to $210
Basic Life and Accidental Death
& Dismemberment Insurance
The College provides to eligible employees a Basic Life and Accidental death insurance equal
to 2 times the employees basic annual earnings to a maximum benefit of $400,000. These
benefits are paid by Lincoln Financial Group insurance company.
Long Term Disability
The College provides to eligible employees a Long-Term Disability plan in the event that you become
totally disabled, disability payments equal 60% of your base annual salary will be paid after
the ninetieth (90) consecutive days of disability. The monthly disability benefit, with a maximum
payment of $7,000 per month, shall be reduced by primary Social Security benefits, benefits payable
under Worker’s Compensation or any disability or retirement benefits actually received under
an employer’s pension plan.
Voluntary Short Term Disability and Personal
Cancer Plan
Employees are eligible to purchase voluntary short term disability and personal cancer plan
from Allstate Insurance. On the short term disability policy you may select the monthly benefit
amount, elimination period and benefit period. Benefits pay employees regardless of any
other insurance. It is guaranteed renewable up to age 65.
The Cancer and Specific Diseases includes wellness Benefits, initial diagnosis benefit, Chemotherapy,
Experimental Treatment, Mammography Benefit, other lump sum benefits.

Page 4
DELAWARE VALLEY COMMUNITY COLLEGE
Voluntary Accident Insurance
Employees have the option to purchase accident
insurance for themselves and dependents.
Accident insurance can help you pay expenses
if you or your spouse are seriously injured or
killed in a covered accident.
Pays lump sum benefits amount when an accident
occurs on or off the job.
Supplemental Term Life Insurance
Employees have the option to purchase additional
supplemental term life insurance on themselves as
well as for eligible dependents. Employee must
elect Voluntary coverage for themselves for their
dependents to be eligible.
You will be required to complete an Evidence of
Insurability (EOI) form if you have coverage
amounts from current levels or purchasing an
amount greater than $100,000 for yourself,
$25,000 for spouse and $10,000 for child(ren).
Supplemental Term Life (Optional Life)
• 1,2,3 or 4 times your annual earnings rounded
to the next higher $1,000.
• $500,000 Maximum benefit
Employee Assistance Program
Summary of the benefits include
$1,000/Intitial Hospitalization Confinement,
$200/Day for each hospitalized up to max 90
Days, Medical Expense up to $500, pays lump
sums for dislocation or fracture, accidental life
insurance, ambulance reimbursement, ICU
benefit, wellness benefit for physician’s visits—2
visits Individual and 4 visits for Family.
The College has contracted for the professional services of Carebridge Corporation to provide you
with support in personal and family problems common in contemporary life. Coverage includes
you , your dependents, spouse or domestic partner. These services are made available to you
cost-free. Call: 1-800-437-0911 or www.myliferesource.com. Online access code: CR9MY
Flexible Spending Accounts (FSA)
Spouse Only
• Option 1 - $10,000
• Option 2 - $25,000
• Option 3 - $50,000
Children Only
• Option 1 - $ 5,000
• Option 2 - $ 7,500
• Option 3 - $ 10,000
Spouse/Dependent Children
• Option 1 - Spouse $10,000 /Child $5,000
• Option 2 - Spouse $25,000 /Child $7,500
• Option 3 - Spouse $50,000 /Child $10,000
The College allows you to defer a portion of your pay
through payroll deduction into Flexible Spending Accounts.
The money that goes into an FSA is deducted on
a pre-tax basis, which means it is taken from your pay
before Federal and Social Security taxes are calculated.
Because you do not pay taxes on the money that goes
into your FSA, you decrease your taxable income.
Team Member account reports are available online @
www.ezflexplan.com/CBIZPA or (866) 511-2249.
It is important that you estimate carefully. If you do
not use all of the money in your accounts by the end
of the plan year, Federal law requires you to forfeit
any unused balances. You have up to 3 1/2 months
after the plan year ends to submit qualified expenses for
reimbursement incurred during the prior year. Additionally,
you have 2 1/2 months grace period after the
plan year ends to continue to incur claims for expenses.
Medical FSA:
You may deposit up to $3,000 per plan year into
your Medical FSA to cover you & your dependents
during the plan year. Eligible expenses
include, but are not limited to, deductibles, copayments
and coinsurance payments, over-thecounter
drug costs, routine physicals, uninsured
dental expenses, vision care expenses and hearing
expenses.
Dependent Care FSA:
You may deposit up to $5,000 per plan year into
your Dependent Care FSA during the plan
year. Eligible expenses include payments to
day care centers, preschool costs, before and
after school care and elder care.
Delaware County Community College is an equal employment and educational opportunity institution conforming to all applicable legislation that prohibits discrimination. The College
does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other characteristic protected by state or federal
laws in its educational programs, activities, admission or employment policies, as required by Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act of
1973 and other applicable statutes. Inquiries concerning Title IX and/or 504 compliance should be referred to: Betty Brown, associate dean for student success, room 2195, 610-359-
5320; and/or Connie McCalla, vice president of human resources, room 3572, 610-359-5094. TTY for the hearing impaired: 610-359-5020.
Delaware County Community College is accredited by the Middle States Association of Colleges and Schools, Commission on Higher Education, 3624 Market St., Philadelphia, PA
19104.
Copyright 2010 CBIZ, Inc. NYSE Listed: CBZ. All rights reserved.