Lake Superior State University
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Section: Employee/Labor Relations Section Number: 4.3.11
Subject: Fringe Benefits: Vision Care Insurance Date of Present Issue: 11/07/00
  Date of Previous Issues:
09/89, 09/91

POLICY:
  1. Eligibility for Group Coverage

    All faculty bargaining unit members, and full-time administrative/professional employees and ESP bargaining unit members are eligible to enroll in the group vision care plan. Eligible employees (and/or their spouses) reaching age 65, who elect to remain in the group insurance plan, will have vision insurance continued under the same conditions as other employees during the term of their employment.

  2. Enrollment

    New employees may enroll before the 26th of the month in which hired or rehired for coverage effective on the first day of the following month. New employees hired or rehired between the 26th and the last day of the month may enroll at time of hire, but coverage will become effective one month later. EXAMPLE: an employee hired between January 26 and February 25 will be covered March 1. An employee hired on February 26 will be covered on April 1. Employees who fail to apply for group coverage at the time of hire may sign up only during the yearly re-opening period in November with coverage effective on December 1.

    Newly hired, full-time faculty who have signed a letter of appointment may complete enrollment procedures in the month prior to being initially placed on payroll so that coverage will be effective on the first day of the month in which they are to be placed on payroll. Usually this will be September 1.

  3. Benefits

    The group vision care plan provides for vision testing examinations and glaucoma testing (with a $5 co-payment); lenses for correcting vision (co-pay of $7.50 for lenses and dispensing fee); contact lenses when medically necessary; if selected optionally, a flat fee of $35 will be paid; and eyeglass frames every twelve months, at "reasonable and customary" rates for qualified participating providers.

  4. Contributions

    The University pays the basic rate of the one-person, two-person, or family premium for vision care insurance, for eligible full-time employees (employed over 26 hours per week).

    The Faculty Association and Educational Support Personnel Agreements outline contribution requirements for these two employee groups.

    Children reaching age 19 may continue on the family coverage through December 31 of the year in which they become 19. Rider coverage may be provided for a child past age 19, possibly at the employee's expense, by completing a Family Continuation rider application form and a payroll deduction form for payment of premiums, if the child is:

    1. between 19 and 25

    2. unmarried

    3. a member of the subscriber's household

    4. subscriber provides more than half of the dependent's support

    5. related to the subscriber by blood, marriage or legal adoption

    6. a full-time student for at least five months of the year or received gross income of less than four times the current personal exemption identified by the IRS.

    If required, the cost of the Family Continuation Riders is paid by the employee and is deducted each month from the first paycheck of the month for coverage for the current month.

  5. Changes in Coverage

    Any changes in coverage: birth, death, marriage, or divorce, must be reported immediately on a Change of Record form, available in the Human Resources Office within 30 days of occurrence. Failure of the enrollee to report these changes places liability for loss of coverage, or additional costs on the individual.

  6. Termination of University-Paid Coverage

    University-paid coverage terminates on the last day of the same month if employment terminates on or before the 15th of any month. University-paid coverage will be continued to the last day of the following month if employment terminates on or after the 16th of any month.

    University-paid coverage for faculty members on academic year appointments terminating at the end of the academic year (May) will be extended through August 31 of their year of termination.

  7. Cash Payments and Election of Continuation of Coverage

    1. Payments may be accepted for employees on unpaid medical leave, or on unpaid leave of absence of up to one year, if payment is made prior to the 20th of the preceding month for each month of coverage.

    2. The option to continue coverage in the group is available, with identical coverage, without proof of insurability, under the same conditions as other group members, by paying the group premium rate, plus 2%, for the following: (COBRA Law).

      18 months for employees and qualified beneficiaries who:

      1. Lose coverage due to termination of employment (other than gross misconduct), reduction in work hours or layoff.

      29 months for employees and qualified beneficiaries who:

      1. were disabled before they stopped working and then applied for disability at the time of work termination.
      2. Become disabled at anytime during the first 60 days of COBRA coverage.

      36 months for spouses or dependents who lose coverage for any of the following reasons:

      1. Death of the subscriber.
      2. Employee becomes entitled to Medicare.
      3. There is a divorce or legal separation.
      4. Dependent becomes ineligible.

      Election to remain in the group plan must be made within 60 days of notification of the right to elect this option. Premiums must be paid by the 20th of the prior month, for continuous coverage, and retroactive payments made within 45 days of election of continuous coverage.

    3. Persons desiring to make payments should contact the Human Resources Office for assistance.

  8. Termination of Subscriber-Paid Coverage

    The University will terminate Continuation Coverage prior to expiration of the 36- or 18-month optional period if:

    1. the vision plan provided to any employee is eliminated

    2. the beneficiary fails to pay the premium

    3. the beneficiary becomes eligible for another vision plan upon re-employment, remarriage, or attainment of Medicare eligibility.

    Forms are available in the Human Resources Office.

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