UPHS_Enrollment_Flipbook_Print_Version

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Eligible Dependent Care ExpensesYou can use your Dependent Care FSA to be reimbursed for child or elder care expenses whichenable you to work. This includes costs you incur for child care for dependent children under age13 and/or an adult living with you whom you claim as a tax dependent and who is physically ormentally incapable of self-care (e.g., disabled spouse, elderly parent).You can only be reimbursed for up to the amount that has been deposited into your FSA at thetime you request reimbursement.Vision ExpensesVision care services not covered by your vision plan, such as an extra eye exam, contact lensesand glasses, and other services, such as laser vision correction (LASIK) or even contact lenssolution, are eligible for reimbursement.Life, Disability and EAPAs a UPHS employee, a range of benefits are available that safeguard you and your family in theevent of an illness, injury or death. Some of these you are enrolled in automatically and are fullypaid for by the Company, and some you must decide if you want to enroll in and are paid for byyou.Employee and Dependent Life InsuranceUPHS offers you the options of Core and Supplemental Life Insurance for yourself and DependentLife Insurance for your spouse and children. If you leave UPHS, you may convert your coverage toan individual policy within 30 days of your termination date.Core Coverage• All benefit-eligible employees may elect UPHS-provided Core Coverage of 1x your base pay atno cost to you.• You can elect to opt out of Core Coverage.Imputed IncomeUnder IRS rules, you must pay taxes on the premium value of UPHS-paid Core Coverage over$50,000. This is called imputed income and will be shown on your pay stub. The IRS determinesthe amount of this tax.Supplemental Coverage• You can also choose employee-paid Supplemental Coverage of 1x, 2x, or 3x your base pay.• You must elect Core Coverage to elect Supplemental Coverage.• The cost of Supplemental Coverage is based on your coverage option, base pay and your age.• Premiums will be deducted from your paycheck on an after-tax basis.The combined maximum employee life insurance coverage amount (UPHS-provided CoreCoverage plus Supplemental Coverage) is $1,000,000.19
Naming a BeneficiaryBe sure to name a beneficiary when you first become insured. You may name anyone as yourbeneficiary; however, minors will not be entitled to benefits until they reach legal adult age. Youmay change your beneficiary at any time.Dependent Life InsuranceDependent life insurance provides benefits to you, as the beneficiary, in the event of the death ofyour spouse/partner and/or child(ren). If you choose any of the dependent life insurance options,deductions for the coverage are made with after-tax dollars. If your spouse works for UPHS, onlyone of you can elect dependent life insurance.Coverage options available:Spouse/PartnerChild(ren)$2,000 for your spouse/partner $1,000 for your child(ren)$5,000 for your spouse/partner $2,000 for your child(ren)$10,000 for your spouse/partner $5,000 for your child(ren)Accidental Death & Dismemberment InsuranceAD&D coverage pays benefits — in addition to any life insurance benefits you receive — if you dieor are dismembered as the result of an accident. You may also elect family coverage for yourspouse/partner and any eligible dependent children. If you choose any of the family coverageoptions, deductions for the coverage are made with after-tax dollars.Employee-Paid AD&D Coverage• Your choices for employee-paid AD&D coverage are 1x, 2x, 3x, 4x base pay, or no coverage.• The maximum available AD&D coverage amount is $500,000.• Required premiums for coverage will be deducted pre-tax from your paycheck.Family AD&D Coverage• Coverage for your spouse will equal 50% of the amount you choose for yourself.• Coverage for each dependent child will equal 15% of the amount you choose, to a maximum of$25,000.• If you elect family AD&D coverage, you are automatically the beneficiary for any benefits thatmay be payable.Naming a BeneficiaryBe sure to name a beneficiary when you first become insured. You may name anyone as yourbeneficiary; however, minors will not be entitled to benefits until they reach legal adult age. Youmay change your beneficiary at any time.20
Page 2 and 3: Table of ContentsEnrolling for Bene
Page 4 and 5: Quick Checklist for Enrolling Go th
Page 6 and 7: • Outpatient surgery: $100 copay
Page 8 and 9: UPHS realizes that certain life eve
Page 10 and 11: Emergency Room$25 (waived ifadmitte
Page 12 and 13: Carewise Health ProgramsCarewise He
Page 14 and 15: Dental BenefitsYou can choose from
Page 16 and 17: IBC Davis Vision Premium PlanHow to
Page 18 and 19: Keep in mind that elections do not
Page 22 and 23: Short-Term DisabilityShort-Term Dis
Page 24 and 25: Adoption ReimbursementThe financial
Page 26 and 27: Prescription Drugs• The U.S. Food
Page 28 and 29: Enrolling OnlineHere are the steps
Page 30 and 31: Coverage forPreventive ServicesAs a
Page 32 and 33: Additional covered preventiveservic
Page 34 and 35: Uses and Disclosures for Health Car
Page 36 and 37: Restrictions on Use and Disclosure
Page 38 and 39: Important Notice from the Universit
Page 40 and 41: Medicaid and the Children’s Healt
Page 42: NORTH DAKOTA - MedicaidWebsite:http

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