Some Medical and Dental Coverage Highlights

Family Members/Domestic Partners

The following family members of eligible faculty and staff members are eligible for medical and dental plan coverage:

·         A spouse.

·         Dependent children under age 19 or under age 25 if a full-time student.

·         An unmarried same or opposite-sex, long term qualified domestic partner and the partner’s dependent child(ren), if they satisfy eligibility requirements. For eligibility information and an Affidavit of Domestic Partnership please see http://www.wesleyan.edu/hr/forms

Coverage for Survivors

Widows, widowers, domestic partners and surviving dependent children of participating faculty, staff, or early retirees may continue medical and dental insurance for up to one year after the participant dies; and following the expiration of this one year period, may continue such coverage for the applicable COBRA period by paying the full premium as described below.

Continuing Coverage When Eligibility Is Lost: COBRA

If a faculty or staff member, or a covered spouse or dependent, becomes ineligible for Wesleyan medical and dental insurance as a result of termination of the faculty or staff member’s Wesleyan employment or a reduction in the number of hours worked, the faculty or staff member, or covered spouse or dependent, may continue coverage by paying the full premium for up to 18 months.

If coverage is lost because of the faculty or staff member’s death, divorce, legal separation, Medicare entitlement, or loss of a covered dependent’s dependency status (e.g., a dependent child reaches the maximum permitted age), the spouse or dependent may continue coverage for a maximum of 36 months by paying the full premium.

Examples:

·         A dependent child reaches the maximum permitted age but the faculty or staff member continues to work full-time.  The dependent child may elect to continue coverage for up to 36 months.

·         The faculty or staff member’s employment terminates and his or her covered child is 10 years old.  Both the faculty or staff member and the child may elect to continue coverage for up to 18 months.

·         A covered child is 24 years old and a student when the faculty or staff member’s employment terminates but becomes 25 six months later.  The child may elect to continue coverage for up to 36 months from when the faculty or staff member’s employment terminated.

Retiree Medicare Supplement

Wesleyan pays the full cost of a plan that supplements Medicare and Medigap insurance for eligible retirees and their spouses or qualified domestic partners. Subject to some required participant co-payments that are subject to change, the plan provides payment for prescription drugs and certain other services, including nursing services, blood transfusions and hospital costs during confinements of 91 days or more, up to a lifetime maximum of $25,000 for each covered person.

The plan does not cover any physician or surgeon services or any expenses for mental, emotional, or functional nervous disorders. For more information please see http://www.wesleyan.edu/hr/

Coverage for Family Planning Services and Adoptions

Coverage for birth control prescriptions, legal abortions, tubal ligations, and vasectomies are provided by all five medical plan options with the same deductibles and copayments applicable to other physician, hospital, clinic, or pharmaceutical services. Attempts to reverse tubal ligations and vasectomies are not covered.

Wesleyan pays up to $4,000 toward expenses incurred when adopting a child. Wesleyan will also pay $4,000 toward the treatment of infertility.  Benefits for adoption and fertility treatment are subject to the following limitations:

• Infertility – Procedures that are covered are in-vitro fertilization, gamate intra-fallopian transfer (GIFT), or zygote intra-fallopian transfer (ZIFT) procedures.  More routine testing and treatment is usually covered by the medical plans.
• Maximum payments for adoption and infertility treatment are $4,000 in any single 12 month period and $8,000 total.

Smoking Cessation Programs

IRS regulations permit expenses incurred for smoking cessation programs and related prescription drugs to be reimbursed from a Medical Expenses Reimbursement account.