2013 Benefit Enrollment Guide - Education Management Corporation

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2013 Benefit Enrollment Guide - Education Management Corporation

Educated Choices

2013 Benefit Enrollment Guide

Make educated choices for your health,

wealth and wellness.


Educated Choices

for your health, wealth and wellness

In This Guide:

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

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

Your 2013 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 (FSAs)............................................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 Creditable 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).


Educated Choices

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 (https://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 (FSAs). 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 (https://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 2013 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

Short-Term

Disability (STD)

Long-Term

Disability (LTD)

$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

Coverage ranging from

50% - 80% of your base salary

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 pre-tax 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 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.

*** To be added during 2013.

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 date

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.

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

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.

* Please note: You can enroll your domestic partner’s child(ren) only

if you are enrolling your domestic partner.

Dependent eligibility verification

Enrolled dependents are subject to verification. You will

be asked to provide documentation to substantiate

that your dependent(s) meet the eligibility requirements

described above. If sufficient verification is not provided in

a timely manner, your dependent(s) will not be covered.

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


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. As part of the dependent eligibility verification process, you will be required to

provide documentation, such as a Domestic Partner Affidavit form, to validate that your domestic partner is qualified.

You can find a Domestic Partner Affidavit form on Employee Resource. If you do not already have a notarized affidavit, you should

complete one at this time to submit when verification is requested.

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

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

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.

Evidence of Insurability (EOI)

During enrollment, you may need to complete and

submit an EOI form. This form can be downloaded

from Employee Resource (see page 22).

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.

Please note: Your newly enrolled dependent(s) are subject

to verification. You will be asked to provide documentation

to substantiate that your dependent(s) meet the

eligibility requirements described on page 4.

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


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.

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

7


Your Health

All full-time and part-time* employees can enroll in benefits for their health care needs — 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 2…. 450 Deductible Plan

Option 3…. 250 Deductible Plan

Option 4…. Waive 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.

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 below 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.

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

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


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.

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 you now have two

convenient 24/7/365 resources available to you.

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.

Telemedicine services are also available wherever and whenever

you and your family need them. You have phone and online

access to a national network of board-certified physicians who

can diagnose, treat, and write prescriptions, when necessary,

for routine medical conditions or issues such as:

• Allergies

• Upper respiratory infection

• Bronchitis

• Sinus infection

• Ear infection

• Urinary tract infection

• Pink eye

• Vaginal yeast infection

• Flu

Telemedicine services are a convenient, cost-effective alternative

to hospital emergency rooms and urgent care clinics and you

can access this quality care from home, the office, or even while

traveling. Visit Employee Resource for more detailed information

about these services.

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

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

deductible until

out-of-pocket

maximum is met,

then 100%

90% after

deductible until

out-of-pocket

maximum is met,

then 100%

70% after

deductible until

out-of-pocket

maximum is met,

then 100%

100% after

deductible

80% after

deductible until

out-of-pocket

maximum is met,

then 100%

Out-of-Pocket

Maximums

$2,000 Individual

$4,000 Family

$5,000 Individual

$10,000 Family

$1,000 Individual

$2,000 Family

$2,500 Individual

$5,000 Family

Not Applicable

$2,500 Individual

$5,000 Family

Lifetime Maximum

Unlimited

Unlimited

Unlimited Unlimited Unlimited Unlimited

Physician Office Visits

Specialist Office Visits

100% after

$20 copayment*

100% after

$35 copayment*

60% after

deductible

60% after

deductible

100% after

$20 copayment*

100% after

$35 copayment*

70% after

deductible

70% after

deductible

100% after

$20 copayment*

100% after

$35 copayment*

80% after

deductible

80% after

deductible

Preventive Care — Adult

Routine Physical Exams

Routine Gynecological

Exams, Including a

Pap Test

100% after

$20 copayment*

100% after

$20 copayment*

Not Covered

100% after

Not Covered

100% after

Not Covered

$20 copayment*

$20 copayment*

60%*

100% after

$20 copayment*

100% after

70%*

$20 copayment*

80%*

Mammograms

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

80%*

Preventive Care — Pediatric

Routine Physical Exams

100% after

$20 copayment*

Not Covered

100% after

$20 copayment*

Not Covered

100% after

$20 copayment*

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)

100% after $75 copayment*

(waived if admitted)

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

$20 copayment*

60% after

deductible

100% after

$20 copayment*

70% after

deductible

100% after

$20 copayment*

80% after

deductible

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

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


Medical Benefits Summary

Benefit

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

$20 copayment*

60% after

deductible

60% after

deductible

90% after

deductible

100% after

$20 copayment*

70% after

deductible

70% after

deductible

100% after

deductible

100% after

$20 copayment*

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 and Outpatient

Hospital

Office Visits

80% after

deductible

100% after

$20 copayment*

60% after

deductible

60% after

deductible

90% after

deductible

100% after

$20 copayment*

70% after

deductible

70% after

deductible

100% after

deductible

100% after

$20 copayment*

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

$20 copayment*

60% after

deductible

100% after

$20 copayment*

70% after

deductible

100% after

$20 copayment*

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.

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

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 smartphone 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.

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


Brought To You By:

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 Non-Sedating Antihistamines

or Proton Pump Inhibitors (PPIs)

If needed, ask your doctor for a prescription for drugs such

as 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.

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

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.

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


Brought To You By:

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 6 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

Option 3…. Waive Coverage

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, 9/12.

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

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 United Concordia

Alliance network. But, there is a big advantage to using

network dentists.

Visit an in-network dentist

You can search for a United Concordia Alliance 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 United Concordia Alliance 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.

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


Dental Benefits Summary

Benefit

Individual Deductible

Family Deductible

In Network

$25

$75

Basic Plan*

Premium Plan*

Out of Network

In Network

Out of 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 80% after deductible

50% after deductible 50% after deductible 80% after deductible 80% after deductible

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

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

50% after deductible 50% after deductible 80% after deductible 80% after deductible

80% after deductible

100% 100% 100%

Two per calendar year

Two per calendar year

One additional cleaning**

100% 100% 100%

Two per calendar year

Two per calendar year

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

50% after deductible 50% after deductible

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

50% after deductible 50% after deductible 50% after deductible 50% after deductible

50% after deductible 50% after deductible 50% after deductible 50% after deductible

Not Covered

Not Covered

50% 50%

Employees, dependent spouses/ domestic partners

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. Plan exclusions and limitations apply.

**Part of the Smile for Health Benefit.

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

17


Brought To You By:

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

pre-tax 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.

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


Vision Benefits Summary

Benefit

Benefit Period

In Network

Premium Plan

12 month period from last date of service

Out of Network

Vision Exams

(one every 12 months)

100%

Up to $60

Lenses*

(once every 12 months)

Single Vision

100% $40 allowance

Bifocal

100% $60 allowance

Trifocal

100% $80 allowance

Lenticular

100%

$80 allowance

Polycarbonate

100%

Not Covered

Scratch-Resistant Coating

100%

Not Covered

Frames

(once every 12 months)

$130 $50

Contact Lenses

(once every 12 months)

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.

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

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.

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


Brought To You By:

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 was

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.

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

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 2 .… 2X Annual Salary*

Option 3 .… 3X 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 they 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.

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


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

Option 2…. Waive Coverage

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.

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

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.

• 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 $50,000 guarantee if they 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

Option 2…. Waive 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.

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


Brought To You By:

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 range from

50% – 80% of your base salary for up to 90 calendar days.

Days paid during the 90-day period will only be for regularly

scheduled workdays and company holidays for which you are

absent and receive certification from Liberty Mutual. Base salary

is considered your salary in effect on the first day of your

disability and does not include overtime pay, bonuses or other

forms of special compensation.

Payment of STD benefits 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.*

If Liberty Mutual certifies your disability, you will receive a

percentage of base salary for workdays up to a 90 calendar day

period. The chart below shows the percentage of base salary

you may be eligible for 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.

Service with EDMC

Percentage of base

salary for up to

90 calendar days

Less than 1 year

50% of base salary

1 year to 5 years 66 2 ⁄3% of base salary

More than 5 years

80% of base salary

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

plan exclusions.

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

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 90 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

Option 3…. Waive Coverage

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.

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

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.

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


Brought To You By:

Flexible Spending Accounts (FSAs)

Flexible spending accounts (FSAs) 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 (FSAs):

• 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 website, you’ll need to register by creating a user name

and password.

*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.

How flexible spending accounts (FSAs) work

It’s easy to use these accounts:

• You contribute to the account(s) with pre-tax 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 $2,500 to your health care FSA for

2013. These pre-tax 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.

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

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, 2014, for reimbursement from your 2013 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

pre-tax 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.

*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.

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


Brought To You By:

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 can be 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.

Roth 401(k) option (to be added during 2013)

Unlike the tax-deferred 401(k), the Roth 401(k) allows you

to contribute after-tax dollars to the plan, but then withdraw

tax-free dollars from your account when you retire. The same

IRS limits that apply to tax-deferred contributions to the plan

also apply to the Roth contributions. This means that each

dollar of a Roth contribution reduces the amount that can

be contributed on a tax-deferred basis, and vice versa.

Transfers and rollovers

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

plan into this plan. You can also take your plan’s 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.

Contribution limits

The IRS determines and publishes contribution limits on an

annual basis. If you will be at least age 50 anytime during

the year, this plan will allow an additional catch-up contribution

that year.

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

29


Brought To You By:

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 pre-tax 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

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.

Tel: 1-877-WageWorks

1-877-924-3967

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

www.wageworks.com

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

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


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.

Brought To You By:

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

• Personal legal consultation

• Financial assistance services

• 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.

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

31


Brought To You By:

Wellness Programs from ActiveHealth

1-866-738-6737

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

www.aetna.com

ActiveHealth Management ® . Employees and their spouses/domestic partners who enroll in an Aetna

medical plan are eligible for all of the ActiveHealth wellness programs. There’s no additional cost to participate.

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.

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


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 the required wellness program activities

to receive the healthy rewards. Your spouse/domestic partner,

if also enrolled in the plan, is invited to participate in the

program as well. Their participation, however, is not required

for you to qualify for Healthy Rewards Pricing.

1.

Engage

These first actions will get you started. You must complete

these actions to qualify for the incentive.

• Complete the Health Assessment

• Participate in a Biometric Screening

• Live a Tobacco-Free Lifestyle (validated through Biometric

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 required wellness

program activities. Choose from the following:

• Attain Biometric Screening targets

• Participate in online coaching

• Engage in telephonic lifestyle coaching

• Engage in telephonic coaching with a disease management

registered nurse if you’re at high risk for a chronic condition,

or a maternity management nurse if you’re expecting

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 goals. 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

wellness program activities and track your progress by logging

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

Your spouse/domestic partner, if also enrolled in the plan, is

invited to participate in the program as well. Their participation,

however, is not required for you to qualify for Healthy

Rewards Pricing.

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

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.

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


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.

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

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

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


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, 2012

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)

Premium Assistance Under Medicaid and the Children’s Health

Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you are eligible for

health coverage from your employer, your State may have a premium assistance

program that can help pay for coverage. These States use funds from their

Medicaid or CHIP programs to help people who are eligible for these programs,

but also have access to health insurance through their employer. If you or your

children are not eligible for Medicaid or CHIP, you will not be eligible for these

premium assistance programs.

If you or your dependents are already enrolled in Medicaid or CHIP and you live

in a State listed below, 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, as well as eligible under your employer plan,

your employer must permit you to enroll in your employer plan if you are not

already enrolled. This is called a “special enrollment” opportunity, and you

must request coverage within 60 days of being determined eligible

for premium assistance. If you have questions about enrolling in your

employer plan, you can contact the Department of Labor electronically at

www.askebsa.dol.gov or by calling toll-free 1-866-444-EBSA (3272).

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, 2012. You should contact your

State for further information on eligibility.

ALABAMA – Medicaid

Website: http://www.medicaid.alabama.gov

Phone: 1-855-692-5447

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

Phone (Outside of Maricopa County): 1-877-764-5437

Phone (Maricopa County): 602-417-5437

COLORADO – Medicaid

Medicaid Website: http://www.colorado.gov/

Medicaid Phone (In state): 1-800-866-3513

Medicaid Phone (Out of state): 1-800-221-3943

FLORIDA – Medicaid

Website: https://www.flmedicaidtplrecovery.com/

Phone: 1-877-357-3268

GEORGIA – Medicaid

Website: http://dch.georgia.gov/

Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP)

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: 1-800-889-9949

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/ofi/public-assistance/index.html

Phone: 1-800-977-6740

TTY: 1-800-977-6741

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: 1-800-657-3629

MISSOURI – Medicaid

Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 573-751-2005

MONTANA – Medicaid

Website: http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml

Phone: 1-800-694-3084

NEBRASKA – Medicaid

Website: www.ACCESSNebraska.ne.gov

Phone: 1-800-383-4278

NEVADA – Medicaid

Medicaid Website: http://dwss.nv.gov/

Medicaid Phone: 1-800-992-0900

NEW HAMPSHIRE – Medicaid

Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf

Phone: 603-271-5218

NEW JERSEY – Medicaid and CHIP

Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid

Medicaid Phone: 1-800-356-1561

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.ncdhhs.gov/dma

Phone: 919-855-4100

NORTH DAKOTA – Medicaid

Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/

Phone: 1-800-755-2604

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

37


OKLAHOMA – Medicaid and CHIP

Website: http://www.insureoklahoma.org

Phone: 1-888-365-3742

OREGON – Medicaid and CHIP

Website: http://www.oregonhealthykids.gov

http://www.hijossaludablesoregon.gov

Phone: 1-877-314-5678

PENNSYLVANIA – Medicaid

Website: http://www.dpw.state.pa.us/hipp

Phone: 1-800-692-7462

RHODE ISLAND – Medicaid

Website: www.ohhs.ri.gov

Phone: 401-462-5300

SOUTH CAROLINA – Medicaid

Website: http://www.scdhhs.gov

Phone: 1-888-549-0820

SOUTH DAKOTA – Medicaid

Website: http://dss.sd.gov

Phone: 1-888-828-0059

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

Medicaid Phone: 1-800-432-5924

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: 1-877-598-5820, HMS Third Party Liability

WISCONSIN – Medicaid

Website: http://www.badgercareplus.org/pubs/p-10095.htm

Phone: 1-800-362-3002

WYOMING – Medicaid

Website: http://health.wyo.gov/healthcarefin/equalitycare

Phone: 307-777-7531

To see if any more States have added a premium assistance program

since July 31, 2012, 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)

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) / https://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-0015 (10/2012)

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