Insurance Coverage
Group Health Insurance - EBMC
Kenyon College is interested in the health and well-being of both you and your family. Accordingly, a comprehensive health insurance program is available for benefit eligible employees, their spouses and/or same or opposite sex domestic partners and their children. Participation in the College's health insurance program is optional and becomes effective on the first day of eligible employment.
Premiums are based on salary levels. Please contact the Office of Human Resources for current premiums and rates of participation.
- Schedule of Benefits - General Plan Information
- Health Care Coverage
- Enrollment Information for Domestic Partners
- Definition of a Domestic Partner
- Eligibility Requirements for Your Domestic Partner's Children
- Change in family status
- Health Insurance for Eligible Dependents After the Death of an Active Employee
- Health Insurance/Medicare - Active Employees
- Long-Term Disability Insurance
- The Standard Life Insurance
- The Standard Life and Accidental Death and Dismemberment Insurance
- Termination of Insurance/COBRA
Schedule of Benefits - General Plan Information
The following benefits are provided, as further defined and limited in the literature provided by Kenyon College and EBMC:
Benefit Period 7/1 through 6/30
Dependent Age Limit end of year of 23rd birthday
Pre-Existing Condition Waiting Period 90 Days
Copayment As set forth in the Schedule of benefits provided at enrollment
| Deductible per benefit period | |
| High Plan: | |
| Individual | $250 |
| Family | $500 |
| Low Plan: | |
| Individual | $500 |
| Family | $1,000 |
| Coinsurance | |
| High Plan: | |
| Preferred Provider | 20% |
| Non-Preferred Provider | 40% |
| Low Plan: | |
| Preferred Provider | 30% |
| Non-Preferred Provider | 50% |
| Coinsurance Limits | |
| High Plan: | |
| Preferred Provider | |
| A. Individual | $1,000 |
| B. Family | $2,000 |
| Non-Preferred Provider | |
| A. Individual | $2,000 |
| B. Family | $4,000 |
| Low Plan: | |
| Preferred Provider | |
| A. Individual | $ 3,000 |
| B. Family | $6,000 |
| Non-Preferred Provider | |
| A. Individual | $5,000 |
| B. Family | $10,000 |
Amounts incurred toward the Preferred Provider Coinsurance Limit will be applied to the Non-Preferred Provider Coinsurance Limit. In addition, amounts incurred toward the Non-Preferred Provider Coinsurance Limit will be applied to the Preferred Provider Coinsurance Limit.
Lifetime Maximum Benefit $2,000,000
Health Care Coverage
| High Plan: | ||
| Preferred Provider | Non-Preferred Provider | |
| Inpatient Hospital Services | 20% After Deductible | 40% After Deductible |
| Inpatient Medical Services | 20% After Deductible | 40% After Deductible |
| Surgical Services | 20% After Deductible | 40% After Deductible |
| Outpatient Services | ||
| Physician Office Visits | $15 Copayment, No Deductible and No Coinsurance* | 40% After Deductible |
| *Except as may be specified for specific Outpatient services, tests, screenings as noted in this Schedule of Benefits, Physician Office Visits rendered by a Preferred Provider will be subject to this Copayment. | ||
| Diagnostic Services | 20% After Deductible | 40% After Deductible |
| Physical Therapy | 20% After Deductible | 40% After Deductible |
| Chiropractic Care | 20% After Deductible | 40% After Deductible |
| Child Preventative Care Services* | $15 Copayment, No Deductible and No Coinsurance | 40% After Deductible |
| * Benefits for these services are limited to age 9. | ||
| Routine Mammography Screenings** | 20% After Deductible | 40% After Deductible |
| ** Benefits for these services are limited to $85 per screening. In addition, routine mammography screenings will be covered on an outpatient basis subject to the following schedule:
| ||
| Routine Prostate Cancer Screenings *** | 20% After Deductible 40% | After Deductible |
| *** Benefits for these services are limited to one per benefit period and $65 per screening. In addition, routine prostatic screenings will be covered on an outpatient basis subject to the following schedule:
| ||
| All Other Services Listed in Outpatient Services Section | 20% After Deductible | 40% After Deductible |
| Psychiatric and Substance- Abuse Services | ||
| Inpatient Services | 20% After Deductible | 40% After Deductible |
| Outpatient Services | 50% up to $550, then 20% After Deductible | 50% up to $550, then 40% After Deductible |
| Home Health Care Services | 20% After Deductible | 40% After Deductible |
| Skilled Nursing Facility Services | 20% After Deductible | 40% After Deductible |
| Ambulance Services | 20% After Deductible | 40% After Deductible |
| Private Duty Nursing Services | 20% After Deductible | 40% After Deductible |
| Prescription Drugs | Not covered under your Medical Coverage. Refer to your Prescription Drug Coverage at the end of your Schedule of Benefits. | |
| Medical Supplies, Equipment & Appliances | 20% After Deductible | 40% After Deductible |
| Human Organ Transplant Services | ||
| Transplant Surgery | 20% After Deductible up to a $250,000 lifetime maximum | 40% After Deductible up to a $250,000 lifetime maximum |
| Acquisition | 20% After Deductible up to a $10,000 maximum per transplant | 40% After Deductible up to a $10,000 maximum per transplant |
| Dental Services for an Accidental Injury | 20% After Deductible | 40% After Deductible |
PRESCRIPTION DRUG COVERAGE
Benefit Period: 7/1 through 6/30
Dependent Age Limit: End of year of 23rd birthday
Retail Coverage
A. Deductible: $50 single/$150 family
B. Coinsurance: 20% (if you use a non-member pharmacy, the payment will be 75% of the Pharmacy's billed charges, after the Deductible and Coinsurance are applied)
Prescription Drugs are available as covered drugs when obtained from a Pharmacy. Under this portion of your Prescription Drug Coverage, covered drugs are drugs which require a prescription under federal law, are approved for general use by the Food and Drug Administration and are dispensed for your outpatient use by a licensed Pharmacy on or after your effective date. When obtaining Prescription Drugs from a Pharmacy, you should present your Prescription Drug Card.
Mail Service Coverage (30 to 90 day supply)
| Copayment: | |||
| A. Generic | $15.00 per prescription | ||
| B. Brand Formulary | $30.00 per prescription | C. Non-Preferred/Other Brand | $45.00 per prescription |
Maintenance Drugs prescribed in quantities of 30 to 90-day supplies are covered when dispensed for your Outpatient use by the Mail Service Drug Company on or after your effective date. Each prescription or refill is limited to a 90-day supply. Insulin syringes and needles are covered only when prescribed and dispensed at the same time as insulin. The Plan will pay for all charges except the Copayment amount.
| Low Plan: | ||
| Preferred Provider | Non-Preferred Provider | |
| Inpatient Hospital Services | 30% After Deductible | 50% After Deductible |
| Inpatient Medical Services | 30% After Deductible | 50% After Deductible |
| Surgical Services | 30% After Deductible | 50% After Deductible |
| Outpatient Services | ||
| Physician Office Visits | $20 Copayment, No Deductible and No Coinsurance* | 50% After Deductible |
| *Except as may be specified for specific Outpatient services, tests, screenings as noted in this Schedule of Benefits, Physician Office Visits rendered by a Preferred Provider will be subject to this Copayment. | ||
| Diagnostic Services | 30% After Deductible | 50% After Deductible |
| Physical Therapy | 30% After Deductible | 50% After Deductible |
| Chiropractic Care | 30% After Deductible | 50% After Deductible |
| Child Preventative Care Services* | $20 Copayment, No Deductible and No Coinsurance | 50% After Deductible |
| * Benefits for these services are limited to age 9. | ||
| Routine Mammography Screenings** | 30% After Deductible | 50% After Deductible |
| ** Benefits for these services are limited to $85 per screening. In addition, routine mammography screenings will be covered on an outpatient basis subject to the following schedule:
| ||
| Routine Prostate Cancer Screenings *** | 20% After Deductible | 40% After Deductible |
| *** Benefits for these services are limited to one per benefit period and $65 per screening. In addition, routine prostatic screenings will be covered on an outpatient basis subject to the following schedule:
| ||
| All Other Services Listed in Outpatient Services Section | 30% After Deductible | 50% After Deductible |
| Psychiatric and Substance- Abuse Services | ||
| Inpatient Services | 30% After Deductible | 50% After Deductible |
| Outpatient Services | 50% up to $550, then 20% After Deductible | 50% up to $550, then 20% After Deductible |
| Limited to 40 visits per year. | ||
| Home Health Care Services | 30% After Deductible | 50% After Deductible |
| Limited to one visit per day. | ||
| Skilled Nursing Facility Services | 30% After Deductible | 50% After Deductible |
| Ambulance Services | 30% After Deductible | 50% After Deductible |
| Private Duty Nursing Services | 30% After Deductible | 50% After Deductible |
| Prescription Drugs | Not covered under your Medical Coverage. Refer to your Prescription Drug Coverage at the end of your Schedule of Benefits. | |
| Medical Supplies, Equipment & Appliances | 30% After Deductible | 50% After Deductible |
| Human Organ Transplant Services | ||
| Transplant Surgery | 30% After Deductible up to a $250,000 lifetime maximum | 50% After Deductible up to a $250,000 lifetime maximum |
| Acquisition | 30% After Deductible up to a $10,000 maximum per transplant | 50% After Deductible up to a $10,000 maximum per transplant |
| Dental Services for an Accidental Injury | 30% After Deductible | 50% After Deductible |
PRESCRIPTION DRUG COVERAGE
Benefit Period: 7/1 through 6/30
Dependent Age Limit: End of year of 23rd birthday
Retail Coverage
A. Deductible: $75 single/$225 family
B. Coinsurance: 20% ($10 minimum)
Prescription Drugs are available as covered drugs when obtained from a Pharmacy. Under this portion of your Prescription Drug Coverage, covered drugs are drugs which require a prescription under federal law, are approved for general use by the Food and Drug Administration and are dispensed for your outpatient use by a licensed Pharmacy on or after your effective date. When obtaining Prescription Drugs from a Pharmacy, you should present your Prescription Drug Card.
Mail Service Coverage
No Coverage
Enrollment Information for Domestic Partners
As a Kenyon College benefits eligible employee, you may enroll an unmarried same or opposite sex Domestic Partner and/or your Domestic Partner's child(ren) in the Kenyon College health insurance plan.
To enroll yourself and your Domestic Partner and/or your Domestic Partner's child(ren), you must:
1. Complete the regular Medical Plan enrollment form.
2. Complete, sign and have your Partner sign the Certification of Domestic Partnership form.
Definition of a Domestic Partner
Kenyon College defines Domestic Partner as the partner of an eligible employee who is of the same or opposite sex, sharing a long-term committed relationship of indefinite duration with the following characteristics:
- Living together for at least six months.
- Having an exclusive mutual commitment similar to that of marriage.
- Financially responsible for each other's well-being and debts to third parties. This means that you have entered into a contractual commitment for that financial responsibility or have joint ownership of significant assets (such as home, car bank accounts) and joint liability for debts (such as mortgages or credit cards.
- Neither partner is married to anyone else nor has another domestic partner.
- Partners are not related by blood closer than would bar marriage in the state of their residence.
Eligibility Requirements for Your Domestic Partner's Children
In order for your Partner's child to be claimed as a dependent under Kenyon College's plan, the child must meet all of the following requirements:
A. The child(ren) of the employee's Domestic Partner must be the legal tax dependents of the employee under IRS Sec. 152. Legal tax dependent is defined as follows:
(1) is a citizen of the United States, Mexico, Canada, the Canal Zone or the Republic of Panama,
(2) is a member of your household for the year, had his or her principal place of abode in your home for the year,
(3) by engaging in the relationship, does not violate local law,
(4) receives over half of his or her support for the year from you. Support includes food, shelter, clothing, medical and dental care, and education, and,
(5) the dependent's gross income must be less than the Federal personal exemption amount unless the dependent is under age 19 OR a full-time student (enrolled as a full-time student for at least five months during the year), under age 24.
Change in family status
If an employee needs to change his or her coverage due to a change in his or her family status (i.e., marriage or the birth or adoption of a child, addition of a domestic partner, etc.) the employee should contact the Office of Human Resources within thirty-one days of the event.
Health Insurance for Eligible Dependents After the Death of an Active Employee
In the event of the death of an active employee who was enrolled on Kenyon's health insurance plan, the spouse and eligible dependents may continue to be enrolled for a period of one year at the same contribution levels as active employees. After the one year, the surviving spouse may continue the coverage by paying the full cost of the applicable premium. If the surviving spouse remarries or if dependents should lose their dependent status (as defined in the health insurance certificates), they will be eligible for continued coverage under COBRA.
Health Insurance/Medicare - Active Employees
When active employees become eligible for Medicare, they will be contacted by the Office of Human Resources, who will advise them of their right to designate the College's health plan as the primary carrier (i.e., the plan that pays on all covered medical expenses before any other plans pay). They will also be advised that they have the right to waive enrollment in Part B of Medicare until retirement. These rights will also be applicable to spouses of active employees who are eligible for Medicare. Employees should notify the Office of Human Resources when their spouses become eligible for Medicare. Please refer to the health insurance "Summary Plan Description" for more information.
Long-Term Disability Insurance
If you are a benefits eligible employee of Kenyon College, you will be enrolled on our long-term total disability policy. This total disability insurance becomes effective the first day of the month after one year of eligible employment with Kenyon. This one-year waiting period is waived if the employee was enrolled in a prior employer's total disability plan within three months of joining Kenyon and the plan with the previous employer provided income benefits for five or more years of total disability. The total cost of the premium is paid by the college.
Should an employee become disabled and apply for the total disability benefit, there is a six month elimination period before benefits begin. Kenyon will normally continue the employee's salary during the elimination period provided the employee is certified as disabled. For more details regarding the benefits this policy provides, please refer to your certificates. Disability insurance cannot be continued at retirement.
The Standard Life Insurance
If you are a benefits eligible employee of Kenyon College, you are covered by our Group Life Insurance. This insurance is payable in the event of your death and includes an Accidental Death and Dismemberment provision. The benefit is equal to the employee's annual earnings (excluding overtime); at age 65 the amount is decreased by 35%. You may change your beneficiary whenever you wish by submitting the appropriate documents to the Office of Human Resources. The College pays the entire cost of the premium. Should an employee become totally disabled before his or her 60th birthday, and continue to be disabled until death, the life insurance coverage will continue, provided required proof of disability and its continuance is submitted each year to The Standard Insurance Company. At retirement or termination of employment, this policy may be converted to a personal policy at the employee's expense. Refer to the literature provided by our insurance company for more details on this life insurance coverage.
The Standard Life and Accidental Death and Dismemberment Insurance
If you are a benefits eligible employee of Kenyon College, you are eligible to enroll in the elective plan provided by Standard. This insurance has an optional Accidental Death and Dismemberment provision. The rates and coverage amount varies according to age of the employee. The College funds a portion of the monthly cost of this elective benefit. Refer to the literature provided by our insurance company for more details on this life insurance coverage.
Termination of Insurance/COBRA
Consolidated Omnibus Budget Reconciliation Act (COBRA).
This federal regulation states that if employees lose health insurance coverage due to a reduction in hours or termination of employment (for reasons other than gross misconduct), they and their eligible dependents can continue that coverage for up to eighteen months from the date of loss of coverage. (In certain situations, such as the covered persons total disability during the first 60 days of the COBRA period, the continuation of coverage would extend up to 29 months.)
Your insurance will terminate when the insurance policy terminates, when you fail to make an agreed contribution to premium when due, when you cease to be eligible for coverage under the terms of our group insurance program, when you cease to be eligible for benefits with Kenyon, or when you are no longer employed by Kenyon. Kenyon College may, by continuing to pay the premium, keep your insurance in effect for a brief period if you cease to be an eligible employee for any reason other than resignation, dismissal, or failure to meet the terms of eligibility of our group insurance program.