Benefit FAQ's

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You are eligible for the full benefit package if you are a staff member who works at least 30 hours per week or a faculty member with at least a .75 full-time equivalent (FTE). The full benefit package includes medical, vision, dental, life, AD&D, disability, flexible spending, and the retirement supplemental and annuity plans.

You are eligible for the partial benefit package if you are a staff member who works at least 20 hours per week or a faculty member with at least .50 FTE. The partial benefit package includes medical, vision, dental, flexible spending, and the retirement supplemental and annuity plans.

If you are a adjunct faculty member with at least .50 FTE, you are eligible for the partial benefits package with the exception of the retirement annuity plan. Benefits are not extended to temporary employees.

Yes, you can enroll your spouse/domestic partner and your dependent children up to age 23 for medical and dental coverage. A signed affidavit is *required* to enroll spouse or domestic partner; please read this MEMO for more information.

As a new hire your effective date of benefit coverage is the first day of the month following your date of hire. For example, if your hire date is on September 8th, your benefits would begin on October 1st. In order for your benefits to become effective, you must complete and submit all of the required enrollment forms to the Human Resource Office with 31 days of your date of hire. Sadly, if your forms are not returned within your initial 31 days of employment, you will need to wait for the annual Open Enrollment period or a qualifying event to enroll in your benefits.

The Open Enrollment period has closed for the 2008-2009 plan year (April 1st- March 31st).

The next Open Enrollment opportunity will begin in mid-February 2009. Open Enrollment allows you to enroll in any plan that you are not currently enrolled in, cancel coverage for any plan you are enrolled in, change your plans, add or delete your dependents from your coverage, or change the amounts that you are contributing to your flexible spending accounts.

Any changes made during Open Enrollment will be for the upcoming plan year that begins April 1st.

A qualifying event is a change in your or your dependent’s personal lives which may allow you to add, change or terminate some of your benefit elections. If you have experienced a qualifying event, you must notify us within thirty-one (31) days of the qualifying event date in order to make a change to your benefits. If the thirty-one (31) days have passed, you must wait until the next open enrollment period to make the change.

Examples of qualifying events:

1. Change in your marital or domestic partner status, including marriage or meeting the six (6) month requirement for domestic partnership, death of spouse/domestic partner, divorce or dissolution of partnership, legal separation, or annulment.
2. Change in the number of your dependents, including a change due to birth, adoption, or loss of dependent status (e.g., a child reaches the age limit under the plan, 23 yrs, or is no longer eligible as a dependent).
3. Change in your employment status, including a beginning or termination of employment, beginning or returning from an unpaid leave of absence, sabbatical, and a change to/from part-time employment.
4. Change in your spouse/domestic partner or dependent’s employment status, causing a gain or loss of health coverage for you or your dependent. Some examples are beginning or ending employment, increasing or decreasing hours, strike or lockout.
5. Changes associated with your spouse/domestic partner's open enrollment period, including changes in the type and cost of their coverage like a gain or loss of eligibility for you, your spouse/domestic partner, or your dependents.

You will need to provide the required documentation for your qualifying event in order for the change to be effective. Please contact us for more information about qualifying events, as this list is not inclusive of all qualified change in status events.

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Plan Years:

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For the purposes of changes, including administrators, plan design and rates, the PEHT plan operates on the April 1st-March 31st plan year. However, for the purposes of deductibles and annual out of pocket maximums, the PEHT plan operates on a calendar year. That means that every January you must meet your deductible again.

The Personal Choice Flexible Spending accounts run on an April 1st-March 31st plan year. The absolute drop dead date to submit for eligible expenses, occurred through the previous plan year, is June 30th, otherwise the money is forfeited.

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Prescriptions:

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For the Trust, prescription claims accounted for 20% of the total claims costs. Ongoing research, development and marketing of new drugs drive up costs. Prescription costs have doubled since 1997 and are still on the rise.

Yes. Of the medications prescribed to Lewis & Clark College participants, over 50% had generic equivalents available. Participants chose generic drugs 90% of the time, thus helping to contain premium increases.

Comparatively, the average cost of a generic drug is $32; "preferred" brand names are $56; and $100 for a "non-preferred" brand-name drugs.

You can use pre-tax money for your co-pays on medical, dental, vision care and prescription costs through the HealthCare Spending Account. This includes deductibles and costs for alternative health care. Click HERE for more information on the Health Care Spending Account.

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Costs:

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In addition to a large percentage of medical and dental premium costs, the College also pays the full premiums for the group Life and AD&D, Long-term Disability, Employee Assistance Plan (EASE), and 10% towards each eligible employee's retirement plan (TIAA-CREF).

The College budgets approximately 30% of the total salary pool for employee benefits. For example, for every $1,000 salary earned, the College contributes approximately $300 towards benefits.

The Fringe Benefits Committee evaluates the existing employee benefit programs and makes recommendations for the improvement, addition, or deletion of programs. They follow the general financial policies established by the Board of Trustees, and the guidelines provided by the Executive Council and the Council of Deans. As a regular part of its work, the committee reviews the cost, utilization, and efficacy of the health programs specifically, and other employee welfare programs generally.

The committee represents different areas and constituencies on campus and makes recommendations to the Executive Council.

The following individuals are on the Fringe Benefits Committee:

Barbara Roberts - LCCSSA
Bernie Vail - Law School Faculty
Brian White - CAS Staff
Carol Doyle - Grad School Faculty
Cliff Wright - Teamsters
David Ellis - Exempt Staff
David Kelley - Law School Staff
Greg Walters - Human Resources
Katie Lahey - Human Resources
Kris Codron - Chair
Sharon Bosserman-Benson - Common Services
Sharon Chinn - Grad School Staff
Yung-Pin Chen - CAS Faculty

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Change to Regence BlueCross BlueShield:

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Unfortunately, we are no longer able to view our claims online with CoreSource because they are no longer our "active" third party claims administrator as of April 1, 2008, and they do not allow online access to "inactive" groups.

However, CoreSource will still be paying claims for 2007 as long as it is within the timely filing rule. To check on your claim you will need to call the customer service office at 866-280-4120.

What is it?

Requesting dual insurance information is a standard practice for all insurance companies. An example of dual coverage would be if an employee and their spouse/domestic partner both had medical coverage through each of their employers and both were listed as dependents on each others plans. The Coordination of Benefits (COB) rule will allow the employee and the spouse/domestic partner to use both of their medical plans to pay for the balance of the cost of covered services, up to the total allowable amount determined by both of the carriers.

If Regence does not have enough information to work with your other group insurance company, they will need to hold your claims until the data is clarified. The previous administrators CoreSource and Covenant had the exact same process. The coordination of benefits (COB) information will be requested annually.

What should I do?

You MUST respond to this notice, even if you do not have any other group insurance. You can either call Regence customer service at 1-866-219-7222 or you may complete the coordination of benefits form and mail it in. If you decide to call, state that you are on the Pioneer Educators Health Trust (PEHT) and give them your group #842995010.

I do have other group insurance

If you currently have another group insurance or have had another group insurance policy within the last 12 months, you will need to be able to provide them with the details. Please have your other group insurance card handy when calling or completing the form.

I don't have other group insurance or I am not sure

If the only medical coverage for you and your family during the last 12 months has been through the PEHT College plan, you may check NO on the form, sign the last page and mail it back. This is because CoreSource is considered your previous third-party claims administrator, not your other group insurance.

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In 2003, Lewis & Clark College joined six other Oregon colleges and universities to form a self-insured benefits consortium. The Trust is essentially the "insurance company" for the PPO medical plan and the Fee-for-Service dental plan.

Regence BlueCross BlueShield is the third-party claims administrator for the Trust plans. They process payment of the claims submitted by providers.

Because we are committed to containing costs, the Trust compared our current administrator, CoreSource, to several other companies early in the summer of 2007. As a result of this analysis, effective April 1, 2008, PEHT has contracted with Regence BlueCross/BlueShield of Oregon to provide administration -- claims management and payment within its networks of physicians and medical facilities. The plan design has not changed, and PEHT will continue to be a multiple employer welfare arrangement (MEWA); Regence is simply our third party administrator (TPA) instead of CoreSource.

Some outstanding features that helped us make the decision to switch to Regence include:

Over the past 3 years, Regence has significantly enhanced their claims administration program. The Trust actually considered them 5 years ago, but at that time, their program was not robust enough to meet our needs.

Regence, through the BlueCross and BlueShield Association, offers a national preferred provider (PPO) network of physicians with which they have negotiated deep discounts that has resulted in lower out-of-pocket costs for our members.

All facets of your medical coverage, including the provider network of doctors and medical facilities, prescription and mail order management, and claims processing/payment, is coordinated under Regence's one umbrella This eliminated the need to use separate vendors for prescription and mail order administration -- which were, RxAmerica and Escalante. We have seen that this simplification has provided greater accountability and better customer service.

Regence provides innovative resources to empower you to take charge of your health and/or health conditions and to improve your overall well-being.

I thought the Pioneer Educator Health Trust (PEHT) plan was a point of service (POS), now it's being called a preferred provider organization (PPO). What is the difference?

A point of service (POS) plan offers a choice of networks to choose from, whereas a preferred provider organization (PPO) is a single network of providers. Previously, under our old administrator CoreSource, the Trust plan offered a choice between the MHN and Providence networks. With the change to Regence as our third-party provider on April 1, 2008 there is only one network of providers to choose from, the BlueChoice network.

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