UNCLASSIFIED Fringe Benefit Orientation UW-L Human Resources

Tax-Sheltered Annuity Program (TSA) Wisconsin Deferred Compensation Employee Reimbursement Account (ERA) Edvest College Tuition Program UW-L Human Resources

Supplemental retirement account. ◦ Voluntary employee contributions ◦ No employer matching 6 TSA Companies to choose from: ◦ Dreyfus ◦ Fidelity ◦ T. Rowe Price ◦ TIAA-CREF ◦ Ameriprise/RiverSource Life Insurance ◦ Lincoln National Life Insurance 2014 Contribution amounts ◦ Maximum: $17,500 per year ◦ Minimum: $20 per month ◦ Age 50 and older: $23,000 Enroll by completing vendor application and salary reduction agreement form $12.00 annual administrative fee to participate. Waived for Contact Cedric Steine at for additional information UW-L Human Resources

To enroll or for additional information, please contact: ◦ Telephone Number: (877) ◦ Website: Funds are chosen and monitored by the State Deferred Compensation Board Contribution amounts ◦ Maximum: $17,500 per year ◦ Minimum: None ◦ Age 50 and older: $23,000 Annual fees based on total account balance and will be between $0 and $66 per year UW-L Human Resources

Annual Open Enrollment ◦ Application due within 30 days of employment. Dependent Care ◦ $5,000 maximum  Single, Head of Household and Married, Filing Jointly ◦ $2,500 maximum  Married, Filing Separately Medical Expenses  $100 minimum  $2,500 maximum UW-L Human Resources

Administered by the Office of the State Treasury with TIAA-CREF providing records management for all accounts Call toll free: (888) for an information and enrollment kit. Enrollment Web site: or call toll free at UW-L Human Resources

Health Insurance Life Insurances ◦ State Group Life ◦ Individual & Family Life Ins. ◦ UW Employees Inc. Accidental Death & Dismemberment (AD & D) EPIC Benefits Plus Dental Wisconsin VSP Vision Insurance Long-term Care Insurance UW-L Human Resources *Premiums are paid by payroll deduction

An application must be submitted indicating whether you elect or decline the insurance within 30 days of employment. Applications received on the first of the month will be effective on that day. Applications received after the first become effective the next month. See “It’s Your Choice” booklet for additional information. All health insurance information, can be found in the It’s Your Choice: Decision Guide and the It’s Your Choice: Reference Book at: To find out which health plans have providers in your area, refer to the Choose Your Health Plan section beginning on page 20 of the Decision Guide. UW-L Human Resources

HMO Plans (La Crosse area) ◦ Health Tradition ◦ Gundersen PPO (Preferred Provider Plan) ◦ Select Plan (WPS) UW-L Human Resources

HMO medical care must be received in selected Medical Center except for emergency care or when referred. ◦ Health Tradition  Provider: Mayo Health System – Franciscan Health Care  ◦ Gundersen  Provider: Gundersen Medical Center  Pre-tax deduction: ◦ Single:$44.00 ◦ Family:$ All HMO plans are required to provide same level of benefits (Uniform Benefits) UW-L Human Resources

10% Coinsurance up to out-of-pocket maximum ◦ Preventative care covered at 100% ◦ Out-of-pocket max is $500/person, $1,000/family HMO plans have limited uniform dental coverage ◦ Preventive & Diagnostic  No deductible  100% coverage ◦ Primary (basic) Service  No deductible  80% coverage ◦ Maximum Dental Benefit: up to $1,000 per person per year UW-L Human Resources

WPS is administrator of Standard Plan No dental coverage available. Freedom to choose physician and location of service. ◦ In-network provider  Plan pays 90% for benefits. 10% co-insurance.  Deductible $400 per person per calendar year or $800 per family per calendar year. ◦ Out-of-network provider  Plan pays only 70% for most benefits. 30% co-insurance until maximum deductible amount is met.  Deductible $500 per person per calendar year or $1,000 per family per calendar year.  Maximum deductible of $2,000 per person or $4,000 per family per calendar year. ◦ Maximum deductible of $200 per person or $1,000 per family per calendar year. Advantage Program requires prior notice of non-emergency admissions, or within 48 hours after an emergency admission. Pre-tax deduction is: ◦ Single:$ ◦ Family:$ UW-L Human Resources

Administered by Navitus Health Solutions. You will receive an ID card from Navitus that you will need to present when you pick up a prescription. 3 Tiers for Co-Payments ◦ Tier 1: $5.00 ◦ Tier 2: $15.00 ◦ Tier 3: $35.00 ▪ Tier 3 prescription drugs do not count toward the annual out-of-pocket maximum. Annual prescription drug out-of pocket maximums: ◦ Individual: $410 ◦ Family: $820 Standard Plan: ◦ Individual: $1,000 ◦ Family: $2,000 Mail Order is available through WellDyneRx. Up to a 90-day supply of Tier 1 and Tier 2 drugs may be purchased for two copayments. For additional information, please contact (866) or visit the website: UW-L Human Resources

University Insurance Association Life Insurance University of Wisconsin Employees, Inc. Life Individual & Family Group Life UW-L Human Resources

Coverage is MANDATORY, by action of the Board of Regents, for all unclassified employees with base salary of at least $2, per month Coverage begins October 1 following employment start date Decreasing term life insurance Benefit level begins at $101,000 for individuals 28 years of age and younger Benefit level decreases to $3,400 at age 70 and above $24.00 annual premium: ◦ Deduction taken on November 1st check No application is necessary Beneficiary designation:

Must apply within 30 days of employment and be eligible to participate in the State Group Health Insurance Program. Coverage begins on the first of the month after Human Resources receives application. Late enrollment requires medical evidence of insurability. Benefits include: ◦ Decreasing term insurance. ◦ Coverage amount based on age. ◦ Ranges from $30,000 to $4,000 at age 65 and over. Beneficiary Designation: UW-L Human Resources

Must apply within 30 days of employment. Coverage begins the first of the month after Human Resources receives application. You may elect initial coverage at the following amounts: ◦ Employee: $5,000 / $10,000 / $15,000 / $20,000 ◦ Spouse/Domestic Partner: $5,000 / $10,000 ◦ Children: $2,500 / $5,000 Can increase coverage level on an annual basis during Annual Increase Option Period every October. Maximum coverage amount: ◦ Employee: $300,000 ◦ Spouse/domestic partner: $150,000 ◦ Children: $25,000 Late enrollment requires medical evidence of insurability. Beneficiary Designation: UW-L Human Resources

Open enrollment anytime Insurance is effective on the first of the month following receipt of the application Benefit payable for accidental death or dismemberment only Includes an education and training benefit for any covered surviving dependents Coverage options range from $25,000 to $500,000 for single and family coverage Premiums are based upon plan and coverage option selected Coverage also includes Zurich Travel Assist package Application/Beneficiary Designation: ◦ UW-L Human Resources

Must apply within 30 days of employment Supplemental Dental Coverage: ◦ Crowns, implants, bridges, and other major services are covered at 50% with an annual benefit maximum of $1,500/person after a $75 deductible Orthodontia Coverage: ◦ Pays 50% up to $1,200 orthodontia lifetime maximum for dependent children under age 19, after a 12-month waiting period Vision Benefit: ◦ Davis Vision Discount Program is optional for an added premium Hospital/Surgery Benefit: ◦ Pays $100 for each outpatient surgery (at approved facility) or $100/day of hospital confinement beginning with third day Accidental death & dismemberment coverage This does not replace Health Insurance Coverage Options Without Vision With Vision Employee$19.77$24.02 Employee and Child$39.54$47.04 Employee & Spouse/ Domestic Partner $39.54$47.04 Family$59.31$70.34 UW-L Human Resources 2014 Monthly Premiums

Must apply within 30 days of employment. A dental provider must be selected from those associated with the plan A plan orthodontist must be used Two plans to choose from:  Preferred Provider Plan (PPO)  Select Plan UW-L Human Resources

If your medical plan does not include dental benefits OR you want flexibility to use any dentist of your choice Obtain a greater benefit for services by using in-network provider Annual deductible: ◦ $25 in-network dentist ◦ $50 out-of-network dentist Waiting period: ◦ Diagnostic and Preventative services ◦ Basic and Major Services: 3 months for new enrollees only ◦ Orthodontia: 12 months PPO Provider Directory: ov.pdf ov.pdf 2014 Monthly Premiums PPO Plan Employee$28.32 Employee & Spouse/ Domestic Partner $59.96 Employee & Child(ren) $67.04 Family$ UW-L Human Resources

If your health plan has a dental benefit AND you want additional comprehensive benefits This plan supplements dental benefits provided by health plan Freedom to choose any dentist No coverage for preventive or diagnostic services. Many restorative services are partially covered after a $50 deductible. Waiting Period: ◦ Basic and Major Services: 3 months for new enrollees only ◦ Orthodontia: 12 months 2014 Monthly Premiums Select Plan Employee$20.52 Employee & Spouse/Domesti c Partner $42.19 Employee & Child(ren) $48.68 Family$71.59 UW-L Human Resources

Must enroll within 30 days of employment begin date ◦ No subscriber card: Use Person ID# Covers: ◦ One eye exam per year with a $10 co-pay ◦ One pair of lenses/contacts per year after co-pay ◦ Frames covered once every 24 months after $25 co-pay Must enroll for entire year for eligibility Premiums are paid pre-tax Plan Information: vision.htm vision.htm 2014 Monthly Premiums Coverage Options Employee Only$6.35 Employee & Spouse/Domesti c Partner $12.70 Employee & Child(ren) $14.30 Employee & Family $22.85 UW-L Human Resources

All employees, spouses and parents of both may apply at any time, subject to medical underwriting. Visit the ETF website for additional information: UW-L Human Resources