benefits.TI.com  
TI HR Connect: 888-660-1411


 

Frequently Asked Questions

 
Table of Contents

GENERAL
Enrollment
Find a Doctor
ID Card
PPO vs. HMO
Provider vs. Carrier

HEALTH (WELLNESS) ASSESSMENT

HEALTH SAVINGS ACCOUNT (HSA)

HIGH-DEDUCTIBLE HEALTH PLAN (HDHP)

INDIVIDUAL HEALTH MANAGEMENT (IHM) PROGRAM

LIFE EVENTS
Reporting a Life Event

HEALTH CARE COST
Unpaid Leave of Absence (LOA) Health   Benefits Billing
Plan Prices

LIFE INSURANCE
Evidence of Insurability (EOI)

ABSENCE & DISABILITY MANAGEMENT
Disability Pay Continuance (DPC)
Family and Medical Leave Act (FMLA)
Long-Term Disability (LTD)
Workers' Compensation
Supervisor Information

PRESCRIPTION DRUGS
Generic Drugs


Deductibles

Question

Answer

In the Blue Cross Blue Shield HDHP or PPO, what happens if I get sick while traveling? Am I covered?

Your benefits travel with you. For an emergency illness or injury requiring immediate care, you should be treated at the nearest hospital or doctor’s office, regardless of whether that provider is in-network. In the case of services rendered as a result of an accident or medical emergency, benefits will be reimbursed at the in-network benefit level. If hospitalization is required, once you are stable, it might be necessary for you to transfer to a network hospital (if available) to receive the highest level of benefits coverage.

Inside the United States: If you need another doctor, you can find an in-network doctor by using any of the following options by:

  • Go to the Fidelity NetBenefits website. Under the Health & Insurance tab, click "Details" for your medical coverage, then “Find a Provider” in the right column.
  • Contacting Blue Cross Blue Shield directly by calling the TI Benefits Center through TI HR Connect at 888-660-1411, option 1.

Outside the United States: If you are on personal or business travel, your Blue Cross Blue Shield coverage will still be in effect. When TIers need services outside of the United States, it is recommended that you use the BlueCard Worldwide (BCWW) network, but this is not mandatory. There will be no reduction in benefits if you use a non-network facility or provider. To locate a provider in the BCWW network, call 800-810-2583 or call collect at 804-673-1177, available 24/7.

If you enrolled in accidental death and dismemberment (AD&D) coverage and have an emergency situation outside of the United States, you should first contact International SOS (ISOS) at the TI-dedicated number, 215-244-1149 (available 24/7). ISOS will arrange emergency transportation to the most appropriate health care facility, arrange for your admission, provide medical monitoring during the hospitalization and, if needed, provide medical evacuation to another location.

What can I do if the Blue Cross Blue Shield HDHP or PPO doesn't pay a claim that I believe they should be paying?

There is a formal appeal process in place should Blue Cross Blue Shield (BCBS) deny payment on a claim. You must submit a written appeal to Blue Cross Blue Shield. See the Health and Insurance Benefits Guide for additional information, including time requirements. The guide is available on this Web page from the left column, under Benefits Guides.

What is coinsurance?

Coinsurance is the percentage that you pay for your eligible medical expenses after you meet your medical deductible. For example, if the coinsurance amount is 80/20, that means that TI, through the Blue Cross Blue Shield HDHP or PPO, pays 80 percent and you pay 20 percent of the allowable amount for the eligible medical charges.

What is a copay/copayment? A copayment is a flat dollar amount you pay, in addition to any applicable deductible, directly to the doctor or hospital when you receive certain covered services.

What is a deductible?

A deductible is the amount you must pay for eligible medical expenses each year before most benefits begin. In the Blue Cross Blue Shield (BCBS) PPO, if you have covered dependents, all charges applied toward each individual's deductible will be applied toward the family deductible amount. When the family deductible amount is reached, no further individual deductibles will have to be satisfied for that calendar year. No individual will contribute more than the individual deductible amount toward the family deductible amount.

Be aware that, in the BCBS High-Deductible Health Plan, the deductible functions differently. The deductible for family coverage applies to all covered family members -- there is no individual deductible. The entire deductible must be fulfilled before coinsurance begins, except for qualified preventive procedures.

 

What is a lifetime maximum?

A lifetime maximum is the maximum amount the plan will pay for covered medical expenses for each covered participant during that participant's lifetime. Effective Jan. 1, 2011, medical benefits offered to TI employees will not be subject to a lifetime maximum. This is one of the features of health care reform legislation passed in 2010.

What is reasonable and customary?

Some plan options set reasonable and customary (R&C) limits on fees that non-network providers charge. They are based on what providers typically charge for that procedure in your geographical area. This might be referred to on your explanation of benefits (EOB) as the "allowable amount". Effective Jan. 1, 2011, the BCBS PPO and HDHP set out-of-network reimbursements maximums at a percentage of the Medicare rate in a geographic area. For example, this means that if the Medicare rate for a particular procedure in an area is equal to or less than $900, then $1,800 (200% of $900) would be the most that would be reimbursed for that procedure, or the allowable charge. You would be responsible for charges over $1,800, in addition to your deductible and coinsurance.

What is Blue Access?

This is the Blue Cross Blue Shield member access website containing information such as your membership and claims details. Go to bcbstx.com/member/.

How do the deductible amounts work for family coverage under both the PPO and the HDHP?

Under the HDHP, deductibles and out-of-pocket maximums are set as either Employee or Family:

  • Employee -- If the TIer has employee-only coverage, the deductible is $1,500 and the total out-of-pocket maximum on allowed expenses, including the deductible, is $3,000.
  • Family -- If the TIer has employee+spouse, employee+children or employee+family coverage, the deductible is $3,000 and the out-of-pocket maximum on allowed expenses, including the deductible, is $6,000. Expenses incurred by the TIer and all covered dependents apply to the $3,000 deductible and coinsurance does not kick in for any family member until the $3,000 deductible has been met.

Under the PPO, if a TIer covers dependents, the most the entire family must meet in deductibles is $600, and the maximum out-of-pocket is $5,000 for medical and $8,000 for prescription drugs. This family maximum combines the amounts paid by all family members, but the most any one member of the family has to meet is a $300 deductible and medical out-of-pocket of $2,500, which includes the deductible, plus the pharmacy/prescription drug out-of-pocket maximum of $4,000.

I have an unmarried, dependent child who is a full-time student and will be turning 19 next year. Can he/she continue to be covered under my medical coverage?

As of Jan. 1, 2011, you can cover your dependents under age 26 as part of your TI medical insurance, regardless of their student or marital status. This is one of the features of health care reform legislation passed in 2010.

As of Jan. 1, 2012, eligibility for coverage under the dental, vision and child life insurance programs was extended to age 26, regardless of student or marital status. Previously, only medical coverage was extended to age 26.

Behavioral Health Care
Employee Assistance Program (EAP)

Do I need to call the Employee Assistance Program (EAP) prior to receiving behavioral Health care?

No. However, in order to receive appropriate referral and treatment, TIers covered under the Blue Cross Blue Shield HDHP and PPO are advised to call the Employee Assistance Program (EAP) at 800-888-CARE (2273) before receiving behavioral health care. Failure to use a behavioral health care network provider will result in expenses being reimbursed as out-of-network benefits.

Will enrollment be entirely online this year?

No. Annual enrollment changes can be made online through the Fidelity NetBenefits website or by calling the TI Benefits Center through TI HR Connect at 888 660-1411, option 1.

If I do not make any changes for annual enrollment, what will happen to my coverage?

Unless you take action during annual enrollment to choose another type of coverage for the coming year, you will be defaulted into the same coverage you have in the current year. All elections (other than elections for flexible spending accounts) will automatically continue, if you do not make new elections.

Once annual enrollment is over, you will not be able to change your coverage until the next annual enrollment period, unless you have an appropriate qualified status change. Changes in coverage must be consistent with the change in status. You must make changes within 30 days of a qualifying event. (Beginning Jan. 1, 2016, you'll have 60 days for a birth or adoption.)

If both spouses work for TI, can one carry PPO employee-only coverage and the other have HMO family coverage and cover the PPO spouse under both (to receive double coverage)? No. A TIer cannot have dual enrollment under TI’s plan, meaning you cannot be covered as both an employee and as a dependent.

If the Blue Cross Blue Shield explanation of benefits (EOB) is online, are TIers also sent a paper copy?

Yes. TIers may, however, elect to suppress obtaining hard copies of EOBs through the mail. This is done via the Blue Cross Blue Shield Blue Access website. You can register to use the Blue Access website by going to bcbstx.com – click "Log in" and under New User  click "Register Now."

Where can I obtain forms to file my claims?

You can access claim forms from the left navigation column of this Web page. You can also access claim forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance plan on the home page.

Is there a deadline to file Blue Cross Blue Shield medical claims? Yes. All medical expenses claims must be sent to Blue Cross Blue Shield and postmarked no later than June 30 following the end of the calendar year in which the expenses were incurred; otherwise, they will be denied as untimely. It is your responsibility to ensure that your claims are filed before the June 30 deadline.

Will we get new medical ID cards from Blue Cross Blue Shield for 2016?

Generally, you will receive new ID cards if you change insurance options or if you are enrolling for the first time. If needed, BCBS will mail you a new ID card in late December.

If you have questions about your ID cards, please contact BCBS directly at 866-866-2300. The TI group number is 080946 if you are in the PPO and 089524 if you are in the HDHP. You can also register on bcbstx.com and print out a temporary card, or request additional ID cards.

For ID cards from other insurance carriers, check with the specific carrier, which you can contact through TI HR Connect, 888-660-1411, option 1.

Will my Social Security number be on my ID card?

No. Due to legislation in some states prohibiting the use of Social Security numbers on ID cards and explanations of benefits (EOBs), Blue Cross Blue Shield changed member subscriber numbers (Social Security numbers) to unique identification numbers.

What's the difference between in-network and non-network?

Blue Cross Blue Shield has a network of doctors and hospitals with which it has negotiated rates. You are free to choose any doctor or hospital. However, when using network providers for your medical care, you will receive the network (highest) level of benefits and you will not have to file your own claims - the network provider will file the claims for you.

If you use an out-of-network doctor, does only the 50% covered cost apply to your yearly deductible? The allowed amount is applied to the deductible. For example, if your out-of-network doctor charges $500 for his services, and BCBS allows $400 for those services (the regional reimbursement limit for that procedure), $400 will be applied to the deductible. If you had already met your deductible, your coinsurance would be 50% for out-of-network services, so you would pay $200 and the TI plan would pay $200.

Do TIers have online access to their Blue Cross Blue Shield accounts?

Yes. Once enrolled in the Blue Cross Blue Shield HDHP or PPO, TIers may access claims and membership information via Blue Access, available at bcbstx.com. Click "Log in" and under New User click "Register Now" to sign up for Blue Access.

In addition, members may obtain duplicate copies of their explanations of benefits (EOBs), as well as temporary health ID cards.

How do I get to Blue Access?

If you are currently enrolled in the Blue Cross Blue Shield HDHP or PPO, go to bcbstx.com. Click "Log in" and under New User click "Register Now" to sign up for Blue Access.

How does an annual out-of-pocket maximum work?

The out-of-pocket maximum is the annual limit you would pay for most eligible expenses in a calendar year, and includes deductible and coinsurance. After the out-of-pocket maximum is reached, the Blue Cross Blue Shield HDHP and PPO pay 100 percent of most covered charges for the rest of the plan year.

Under the PPO, the out-of-pocket maximum for medical/behavioral health care expenses does not include your hospital copays, charges not covered by the plan or exceeding the Allowable Amount or other plan limits, or any pharmacy costs. There is a separate out-of-pocket maximum for prescription drug expenses. The out-of-pocket maximum for prescription drug expenses does not include the cost difference you pay if a brand-name drug is received when a generic is available.

In the HDHP, the out-of-pocket maximum for medical/behavioral health care expenses does not include charges not covered by the plan or exceeding the Allowable Amount or other plan limits. The coinsurance you pay for pharmacy expenses is applied to the out-of-pocket maximum, but the cost difference you pay if a brand-name drug is received when a generic is available is not applied to the out-of-pocket maximum.

Does the Blue Cross Blue Shield HDHP or PPO have a pre-existing clause?

The plan does not impose any limitations on pre-existing conditions.

Where can I find details about what preventive benefits are covered under the Blue Cross Blue Shield?

Information about preventive benefits can be accessed via benefits.ti.com. Select the Wellness tab, then in the left navigation column select Preventive Screenings. Or just click here.

This information can also be viewed in the Health and Insurance Benefits Guide under Adult Preventive Health Care. The guide is available on this Web page from the left navigation column, under Benefits Guides.

How can I determine if my doctor is in the Blue Cross Blue Shield network?

Visit the Provider Directory on the Fidelity NetBenefits or use the Provider Finder tool on the Blue Cross Blue Shield of Texas website at bcbstx.com. (Select the BlueChoice PPO network.) You can also call Blue Cross Blue Shield through TI HR Connect at 888 660-1411, option 1.

Can I nominate a doctor for the Blue Cross Blue Shield network? How?

Yes. You can fill out a provider nomination form and mail it to Blue Cross Blue Shield. You can access this form via the Forms tab in the left navigation column of this Web page. You can also access forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance program on the home page.

Nominating a provider does not guarantee that he or she will join the network.

How often are the lists of Blue Cross Blue Shield providers updated?

 

The Blue Cross Blue Shield provider listing is generally updated monthly. We recommend that you also confirm a provider's status with Blue Cross Blue Shield customer service or contact the provider directly.

 

Are doctor referrals required in the Blue Cross Blue Shield HDHP or PPO?

No. You do not need a referral to see a specialist. You can visit any doctor or hospital, but you will receive the highest level of benefits coverage when using in-network providers.

Is my domestic partner eligible for benefits? Yes. Active TI employees can enroll their eligible same-gender and opposite-gender domestic partners in medical, dental, vision, accidental death and dismemberment (AD&D) and life insurance benefits. However, the employee must be enrolled in the same medical, dental, vision, AD&D and/or life insurance plan for the domestic partner coverage to be effective. Certain criteria must be met; see the Health and Insurance Benefits Guide for details. The guide is available on this Web page from the left navigation column, under Benefits Guides.
What is the definition of a domestic partner?

To be eligible for domestic partner benefits, all of the following criteria must be met:

  • At least 18 years or older
  • Unmarried
  • Not related by blood
  • Financially interdependent or your domestic partner is primarily dependent on you for care and financial support
  • Share a common residence for at least one year and intend to do so indefinitely
  • Affirm you are in a committed relationship and intend to remain so
  • Not in a relationship to solely attain benefits.

Are my domestic partner’s benefits subject to imputed income?

Yes.  If you choose to cover a domestic partner, under any benefits, who is not your dependent for tax purposes and/or their dependents, the value of the company’s cost in providing such coverage will be imputed to you as income and shown on your paycheck in the Taxable Benefits section. Taxes related to such imputed income will be deducted from your paycheck on an after-tax basis.

 

I want to keep my doctor and he is not participating in my available HMO option. How do I get transition of care information for when I change my medical option?

If any of the following conditions apply to you, you might be eligible to remain with your current doctor for a transition period of up to three months:

  • Pregnancy, with expected delivery in the first quarter of the coming year
  • Extensive therapy such as chemotherapy
  • A terminal illness
  • Waiting for a transplant
  • Behavioral health issues (beyond EAP)
  • Surgery scheduled for the first quarter of the coming year

If you have other ongoing medical conditions and your current doctor is not in the new network, you may be eligible for other assistance. Your new medical benefit carrier will be able to help you find an appropriate doctor in the network so that your health care can be continued without disruption. You can find Transition of Care forms under Forms in the left navigation column of this web page. You can also access forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance program on the home page.

If you are hospitalized at the end of the year and your hospital stay continues into the next year, you should contact your current medical benefit carrier and your new one to understand what procedures need to be followed.

CIGNA COPAY PLAN
How do I know if my doctor is in the Cigna Copay Plan? Visit the Provider Directory on the Fidelity NetBenefits or go to cigna.com and enter your doctor’s information in the Find A Doctor section. You can also call Cigna through TI HR Connect at 888 660-1411, option 1.
In the Cigna Copay Plan, what happens if I get sick while traveling? Am I covered? If you are enrolled in the Cigna Copay Plan and travel to another city or state, you may be able to access treatment for non-emergency services if the Open Access Plus Network has contracted with providers in that area.

If you are traveling in a foreign country or there are no Open Access Plus Network providers in the area where you are traveling, the only services covered would be for qualified emergency treatment.
What can I do if the Cigna Copay Plan doesn't pay a claim that I believe they should be paying? There is a formal appeal process in place should Cigna deny payment on a claim. You must first submit a written appeal to Cigna. If Cigna initially upholds the denial of your claim, you may then submit a written appeal to Cigna for a second-level appeal. See the Health and Insurance Benefits Guide for additional information, including time requirements. The guide is available on this Web page from the left column, under Benefits Guides.
Will we get new Cigna medical ID cards each year? Cigna will be issuing ID cards to all new enrollees or dependents in late December. If you have questions about your ID cards, please contact Cigna directly at 800-244-6224. You can also register on mycigna.com.
CASTLIGHT HEALTH
What is Castlight?

If you are in the High-Deductible Health Plan (HDHP), Castlight is a way to compare costs and quality of your health care providers. Castlight tools on the web or through a smart phone app can help you:

  • Get cost information on doctors, clinics, hospitals and prescription drugs.
  • Save money on routine medical care. Castlight says costs for an X-ray can vary from $20 to $288, without a difference in quality.
  • Track your annual deductible, as well as link to your health savings account balance.
  • Better understand your claims history. If you were previously enrolled in a Blue Cross Blue Shield plan, your claims history has been loaded into your Castlight account.

You can activate your personal account by going to mycastlight.com/ti. Your covered spouse and dependents over 18 can also activate their own accounts.

If you have any problems with your Castlight account, a Castlight Guide is ready to assist you at 855-569-1901. You can also send questions to myHealth@list.ti.com.

Where can I find more details about Castlight? Go to myCastlight.com/ti for in-depth information plus frequently asked questions. (Look under “Need Help?”)
Is this new service completely free to employees? Yes, if you are enrolled in the High-Deductible Health Plan (HDHP).
Can spouses/dependents use Castlight? How do they sign up?

Yes. Any person age 18 and over who is covered under the High-Deductible Health Plan has an account at Castlight ready for activation. To do so, they go to mycastlight.com/ti, click “Activate Castlight now,” and then click the link “Family members start here.”

Can I see the accounts of my spouse and dependents?

From the FAQs on the Castlight website:

Castlight conforms to all federal and state health care laws and statutes including HIPAA. By default you will see past medical care records for yourself and your minor children. You will see only limited billing information (as required by law) for your spouse/domestic partner and adult dependents. However, your spouse/domestic partner and adult dependents can choose to change their profile settings to display full past medical care records.

Your spouse/domestic partner will see only their information and the information of minor children. You can choose to grant your spouse/domestic partner access to your past medical care records by changing your profile settings. Adult dependents can only see their own past medical care records.

To read additional FAQs, on mycastlight.com/ti, click “Need Help?” in the upper right corner.
Why is TI providing this type of service? This program is part of TI's ongoing efforts to help TIers manage their health and health care costs. Castlight will help TIers enrolled in the Blue Cross Blue Shield HDHP be smart shoppers for health care, by giving them an easy way to compare costs for various providers and procedures.
Is there a similar service available for TIers in other medical plans besides the HDHP? Some of the insurance carriers, such as Blue Cross Blue Shield and Cigna, offer cost information on health care providers and prescription drugs. However, that information is not as extensive as what is provided through Castlight. If you have questions, call the customer service number provided on the back of your medical insurance ID card.
How much of my past claims information will be visible through Castlight? If you have been in a Blue Cross Blue Shield plan, you’ll see information as far back as mid-year 2012.
Why does my 2012 past care seem incomplete in Castlight? As much information as possible was loaded from 2012 records at Blue Cross Blue Shield, but for the most part only the second half of 2012 could be captured.
Why are the hours of operation for my pharmacy not listed correctly in Castlight? That information is provided by a third party, based on the most recent information received from individual pharmacies. It is best to confirm the hours with the pharmacy before you visit.
Why is there a difference between my past care claim details and what’s shown on my Castlight home page? Your Castlight home page summary information is updated as claims are received. The more detailed claims information on your past care page is loaded monthly.
Will Castlight show the accurate cost for my prescriptions? Castlight estimates are based on claim averages, so in most cases estimates should be very close to actual cost. Be aware, however, that if you select a brand-name drug when a generic is available, you must pay the difference, and the Castlight system is unable to factor that into the estimates.
I tried to log in to Castlight and it wouldn’t let me, then I received an email inviting me to try again. Why is this? If you’re not enrolled in the High-Deductible Health Plan, you won’t be able to set up an account with Castlight. The email is an automated message to ensure those who are eligible get the assistance they need to log in successfully.
   
Who qualifies as a dependent under MetLife dental plan coverage?

As of Jan. 1, 2012, eligibility for coverage under the dental, vision and child life insurance programs was extended to age 26, regardless of student or marital status. Previously, only medical coverage was extended to age 26.

Can orthodontic treatment be paid from the HSA account?

Yes.

Claim Appeal Process

What can I do if MetLife doesn't pay a claim that I believe they should be paying?

There is a formal appeal process in place should MetLife deny payment on a claim. You must first submit a written appeal to MetLife. If MetLife upholds the denial of your claim, you may then submit a written appeal to the plan administrator. See the Health and Insurance Benefits Guide for additional information, including time requirements. The guide is available on this web page from the left navigation column, under Benefits Guides.

I was told that if I'm on MetLife Dental Plus and then sign up for MetLife Dental Basic, I can't sign back up for Dental Plus again. Is that true?

This is not true. MetLife Dental Basic and MetLife Dental Plus should both be displayed as available options during annual enrollment, which will allow you to change your dental coverage between the available choices.

Please be aware that switching from MetLife Dental Basic to MetLife Dental Plus does not allow increased orthodontia benefits. In addition, please note there are cost differences between the two plan options.
ID Cards

Will I receive a MetLife Dental ID card?

No. A MetLife ID card is not necessary to receive dental coverage through MetLife. However, if you feel a card is needed, a printable generic copy of the card is available under the Forms tab in the left navigation column of this web page. You can also access forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance program on the home page.
Definitions
What is the annual maximum for MetLife Dental?

The annual maximum for Dental Basic is $1,000 and the annual maximum for Dental Plus is $2,000.

Orthodontia services are covered at 50 percent up to the lifetime maximum of $1,000 for Dental Basic and 50 percent up to the lifetime maximum of $1,500 for Dental Plus.

What is "reasonable and customary"? "Reasonable and customary" charges are the usual costs for comparable treatment in a geographic area.
Filing Claims
Where can I obtain forms to file my claims? You can find claim forms under the Forms tab in the left navigation column of this web page. You can also access forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance program on the home page.
Is there a deadline to file MetLife dental claims? Yes. All dental expense claims must be sent to MetLife and postmarked no later than June 30 following the end of the calendar year in which the expenses were incurred; otherwise, they will be denied as untimely. It is your responsibility to ensure that your claims are filed before the June 30 deadline.
Network vs. Non-Network
What is the advantage of using a network provider in the MetLife dental plan options?

Dentists in the MetLife network must negotiate their rates, resulting in lower fees for you and TI. Reasonable and customary limits do not apply if you use network providers.

There is not a penalty or coinsurance difference if you do not use a MetLife dentist, but reasonable and customary limits do apply.

Online Account Access

Do TIers have online access to their MetLife accounts?

Yes. Once enrolled in a MetLife dental option, TIers may access claims and membership information via MetLife's My Benefits website. In addition, members may obtain duplicate copies of their explanations of benefits (EOBs) or print a generic ID card.

How do I get to MetLife's My Benefits Web site?

If you are currently enrolled in a MetLife plan option, click here: My Benefits website.

You can also access the MetLife My Benefits website from Fidelity NetBenefits by clicking MetLife on the Health & Insurance page.
Provider

How do I find out whether my dentist is in one of the other dental plan offerings?

Visit the NetBenefits website and select the "Find a Provider/Doctor" option. You can also call MetLife or Aetna Dental HMO (DMO) by contacting the TI Benefits Center through TI HR Connect at 888 660-1411, option 1.

If I do not make a dental election during annual enrollment, what type of coverage will I have?

If you do not make an election for dental benefits by the enrollment deadline, you will be automatically enrolled in the coverage you had this year. If you had no coverage this year, you will be assigned no coverage in the coming year.

How can I nominate a dentist in the Aetna DMO?

If you would like to nominate dental providers for the Aetna DMO, click here to go to the Aetna website. This page is also available through aetna.com . Select "Doctors and Hospitals," then "Provider Application Request," then "Dental.”

Common Questions
If I have a health savings account (HSA), can I use it for dental and vision expenses? Or do I have to enroll in the Dental/Vision FSA (HSA-Compatible)? Yes, you can use your HSA account for qualified dental and vision expenses. However, setting up a Dental/Vision FSA (HSA-Compatible) allows you to set aside more of your pay in both the FSA and HSA before taxes and reimburse yourself for qualified expenses out of the appropriate account. Remember that the Dental/Vision FSA (HSA-Compatible) has the “use it or lose it” rule, whereas the HSA funds are yours and cannot be taken away.
If my spouse has individual medical coverage and an FSA at his company, can I enroll in the HDHP-HSA plan and use both the FSA and HSA for family medical expenses? No. If either of you is enrolled in a regular flexible spending account, you can't contribute to a health savings account. However, you can contribute to a health savings account while enrolled in the Dental/Vision FSA offered by TI.
How does the Dental/Vision FSA (HSA-Compatible) work? The Dental/Vision FSA (HSA-Compatible) is available to anyone enrolled in the high-deductible health plan (HDHP) with a health savings account (HSA). This is the only health flexible spending account option available to you if you participate in the HDHP-HSA option.

The Dental/Vision FSA (HSA-Compatible) works just like the other spending accounts. You set aside money from your paycheck before taxes, and then use that money to reimburse yourself for qualified dental and vision expenses. This preserves your HSA funds for other purposes, including simply saving those funds for the future.
After the first of the year, can I change the amount of money I'm having deducted from my paycheck for the Dental/Vision FSA (HSA-Compatible)? No. After annual enrollment, you can only change your Dental/Vision FSA (HSA-Compatible) election if you incur a qualified family status change, such as a marriage, divorce or birth/adoption. Changes in coverage must be consistent with the change in your status. You must make changes within 30 days of a qualifying event. (Beginning Jan. 1, 2016, you'll have 60 days for a birth or adoption.)
Can I pay for the balance of my children's orthodontic treatment from the Dental/Vision FSA (HSA-Compatible) if the treatment began in the previous calendar year? Due to the extended nature of the treatment and the manner in which fees are paid, reimbursement of orthodontia expenses can be complicated. The services are often paid over an extended time with an initial down-payment and monthly payments over the life of the contract.

Usually, the initial down payment would be reimbursed from an FSA in the year when paid, and then monthly payments reimbursed in the year when paid.

It is even more difficult if the amount is paid in full when treatment begins. You may want to consult with a tax advisor in this case.
Why can't I use dollars from the HSA to cover my dental and vision expenses, in addition to my FSA money? You can use the HSA to pay for dental and vision expenses. TI is offering the Dental/Vision FSA (HSA-Compatible) to allow people who want to save their HSA contributions to be able to do so, while still being able to pay for dental and vision expenses with before-tax dollars.
For the Dental/Vision FSA (HSA-Compatible), who qualifies as a dependent?

For the most complete answer, you should refer to IRS Publication 969 or consult with your tax advisor.

Are procedures such as Lasik and surgery for cataracts eligible for reimbursement from a Dental/Vision FSA (HSA-Compatible)?

Yes.
I just submitted a claim. How do I know when WageWorks has received it and when my claim will be paid?

Claims received will be processed within 10 business days after the date of receipt of the claim.

Once your claim has been processed you'll receive notification from WageWorks regarding the status of your claim. If your claim is approved for reimbursement, you will either receive a check or an electronic funds transfer to your designated bank account. If you have already established direct deposit of your payroll check through TI, your spending account reimbursement will be deposited automatically to the same bank account that you have established for your net pay for TI payroll. If you would like to make direct deposit changes, you should contact “HR and Payroll” through TI HR Connect at 888-660-1411, option 3.
I have elected the automatic claims submission option available for BCBS PPO, Caremark, and MetLife Dental. When will I receive payment for an automatic claim? If you have chosen the automatic claims submission option, your Health Care FSA is open to accept any and all claims that are remitted to WageWorks through carrier files. WageWorks receives electronic claims at approximately the same time you receive the explanation of benefits (EOB) in the mail from your insurance carrier, indicating your service provider and insurance carrier have completed their portion of the submission process.

Please understand that auto-claim submissions are only received by WageWorks after the claim has been submitted by your provider and processed by any of the automatic submission-eligible benefit carriers. As you may be aware, some providers may delay submitting claims for thirty days or more.

If you don't want to have these claims automatically sent to WageWorks, you can change the election: log on to your WageWorks account and select ‘No’ for auto claims submission..
What expenses are eligible against the Health Care FSA?

Services are generally eligible if used to treat a medical condition performed by a medical professional within your active plan period for you, your spouse or your legal dependents. Also eligible are any prescriptions prescribed by a medical professional to directly alleviate or mitigate a medical condition. You may also file claims for reimbursement of over-the-counter items with a doctor's prescription.

Additional information is available on this website. In the left navigation column, select the Health Plans tab, then Flexible Spending Accounts.

What documentation needs to accompany the claim form?

An easy acronym for remembering what to include with the claim form documentation is DAPT: Date (of Service), Amount, Provider, Type of Service.

Also, please remember to date and sign all claim forms.

Please include itemized receipts or other supporting documentation (for example, explanation of benefits (EOBs) for the Health Care FSA) with your claim. If you have lost your receipt, contact the provider to request a copy, or call your benefit carrier or visit your benefit carrier's website, for an explanation of benefits (EOB). When submitting your claim, please send legible COPIES of your receipts. Do not send original receipts; keep all original receipts for your records.

How do I submit my expenses for reimbursement?

Claims can be submitted for reimbursement online, by fax or by mail. NOTE: All claims must be submitted no later than three months after the end of the plan year (March 31) in which you incurred the expenses.

If you submit a claim online you will need to use the following steps:

  • Complete and submit the claim form on the WageWorks website
  • Print your personalized claim form
  • Fax the claim form and your receipts to the number provided below

Website: www.WageWorks.com.
Click on the “Submit Receipt or Claims” link. There is also an option to upload your receipt once you have submitted your claim online.

If you’re a first-time user, enter your name, date of birth (month/day), ZIP code, and the last four digits of your Social Security number.

Fax: 877-353-9236
Please do not fax a cover sheet when submitting claims by fax, as this may cause delays.

Mail:
WageWorks Claims Administrator
P.O. Box 14053
Lexington, KY 40512

WageWorks Support Center: 855-774-7441

Is there a deadline to file flexible spending account (FSA) claims? All FSA claims must be mailed and postmarked or faxed to WageWorks no later than three months after the end of the plan year (March 31) in which the expenses were incurred; otherwise, they will be denied as untimely.
Can I change my flexible spending account goal amount after enrollment?

You may only change your elections only if you have an appropriate qualified status change and you notify the Plan Administrator within the 30 or 60 day limit applicable to your qualified status change.

Note: If you choose to increase your election, due to IRS regulations, the amount will be effective as of the date of the qualified status change. Expenses incurred prior to the date of the qualified status change may not be paid from contributions made to your account as a result of the qualified status change. Expenses incurred on or after the date of the qualified status change may be paid from your newly elected amount or from the amount contributed before you increased your contributions.

What qualifies as a status change?

Qualified status changes include changes such as the birth or adoption of a child, marriage or divorce. You must make changes within 30 days of a qualifying event. (Beginning Jan. 1, 2016, you'll have 60 days for a birth or adoption.) If you do not make changes during this period, you will not be able to make these changes until the next annual enrollment period.

Changes in coverage must be consistent with the change in status event. You can make qualified status changes through the Life Events page on Fidelity NetBenefits or by calling the TI Benefits Center through TI HR Connect at 888 660-1411, option 1.

Note: If you choose to increase your election, the increased amount will be effective as of the date of the qualified status change. Expenses incurred prior to the date of the qualified status change may not be paid from contributions made to your account as a result of the qualified status change. Expenses incurred on or after the date of the qualified status change may be paid from your newly elected amount or from the amount contributed before you increased your contributions.

Where does the balance of an FSA go if at the end of the year I haven't used the elected dollar amount?

As required by the IRS, TI retains the account balances.

Which benefit carriers offer automatic claims submission?

Currently, automatic claims submission is available for the Blue Cross Blue Shield PPO (for both medical and Caremark prescription drug expenses) and MetLife Dental.

Will other carriers such as Cigna implement automatic claims submission?

At this time carriers other than those listed above are not able to offer auto claims submission. However, TI will continue to examine the possibility of adding this feature at other carriers in future plan years.

Will I get reimbursement by check to my home, or will it be deposited into my bank account?

If you have your paycheck direct deposited, your reimbursements for the health care and dependent daycare spending accounts will automatically be deposited directly to the same account that you have established for your net pay for TI payroll. Otherwise, a check will be mailed to your home address on file.

Claim Appeal Process
What can I do if WageWorks denies a claim for reimbursement that I believe they should be paying? There is a formal appeal process should WageWorks deny a claim. You must submit a written appeal to WageWorks. See the Health and Insurance Benefits Guide for additional information, including time requirements. The guide is available on this Web page from the left navigation column, under Benefits Guides.
What is an EOB and why do I need to send it in for my Health Care FSA?

Benefit carriers other than HMOs (e.g., PPOs) provide participants with documents called explanations of benefits, or EOBs. If you have medical insurance through a PPO or other benefit carrier, proof of any amount paid by other coverage, such as an EOB, is necessary to prove that the reimbursement for the Health Care FSA is substantiated. The EOB is the most detailed information regarding the actual cost to the employee after the health plan has made payments.

Many insurance carriers offer online copies of participants’ EOBs. Read more here.

Why do I need to provide detailed itemized receipts or explanations of benefits (EOBs) for my Health Care FSA claims?

The Internal Revenue Service (IRS) requires that an EOB or detailed itemized receipt be provided to prove that expenses are eligible under the Health Care Spending Account.

For claims reimbursement or validation of claims, submit EOBs or detailed receipts along with the appropriate flexible spending account (FSA) claim form. If you elected automatic claims submission for your Health Care Spending Account and you are covered under the Blue Cross Blue Shield PPO or MetLife Dental, additional EOBs or receipts are not required. If you did not elect automatic claims submission, eligible claims should be submitted manually (online, by fax or by mail) through WageWorks.

What happens if I lost my receipt?

If you've lost your receipt, contact your provider to request a copy, or call your benefit carrier for an explanation of benefits (EOB). You can also visit your benefit carrier's website for a copy of an EOB. For help doing this, read this page .

What does the receipt need to include?

In order to validate the expense, your receipt will need to include the date of service, the name of the provider, supplier or pharmacy (doctor, pharmacist, hospital, etc.), the name of the person who received the service or prescription, the name of the drug or product and/or a description of the service, and the amount paid. In many instances, the amount you pay (for example, at the doctor's office) is not what you would be required to pay after your insurance has paid negotiated rates. In these instances, your receipt or EOB needs to reflect what your cost is after the insurance pays.

How do I find an FSA claim form?

Claim forms are available from this Web page under the Forms tab in the left navigation column. You can also access forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance program on the home page. You may also obtain a claim form by calling the WageWorks Support Center at 855-774-7441.

How do I submit an FSA claim?

Complete a claim reimbursement form and submit it (online, by fax or by mail) to WageWorks with the required documentation (date of service, amount of service, provider name, type of service or drug name) for processing.

NOTE: All claims must be submitted no later than three months after the end of the plan year (March 31) in which you incurred the expenses.

Website: www.WageWorks.com.
Click on the “Submit Receipt or Claims” link. There is also an option to upload your receipt once you have submitted your claim online.

If you’re a first-time user, enter your name, date of birth (month/day), ZIP code, and the last four digits of your Social Security number.

Fax: 877-353-9236
Please do not fax a cover sheet when submitting claims by fax, as this may cause delays.

Mail:
WageWorks Claims Administrator
P.O. Box 14053
Lexington, KY 40512

WageWorks Support Center: 855-774-7441

 

If I don't use all the money in my FSA why can't I roll my money over to the next year?

According to IRS regulations, the money in your FSA is forfeited and is no longer eligible to be used for claims that occurred after the end of the plan year.

For the Health Care and Dental/Vision FSAs, only the expenses you incurred while working as a TIer are eligible for reimbursement, unless COBRA is elected following termination. For the Dependent Daycare FSA, only the expenses you incurred while working as a TIer are eligible for reimbursement.

All claims must be submitted no later than three months after the end of the plan year (March 31) in which you incurred the expenses; otherwise, they will be denied as untimely.

Are there limits to what I can elect to contribute to a flexible spending account?

 

Yes. The minimum amount you can elect in your Health Care FSA, Dental/Vision FSA or Dependent Daycare FSA is $100. The maximum for 2017 is $2,550 for health care and dental/vision, and $5,000 for dependent daycare.

 

Why are some over-the-counter (OTC) medicines and items covered and others not?

Beginning in 2004, the IRS allowed over-the-counter (OTC) medicines and items to be covered, but only for specific medical conditions (instead of for general health). Medicines and items used to treat specific conditions were covered, but general purpose vitamins were not.

As of 2010, a purchase of OTC drugs requires a physician’s prescription to be reimbursable from your Health Care FSA. However, insulin remains eligible without a prescription, as well as OTC supplies and equipment, including first-aid kits, hearing aid supplies, foot therapy supplies and diabetic management supplies.

For your convenience, WageWorks provides a list of eligible expenses. Click here.

How long does it take to process an FSA claim?

Most claims are processed within 10 business days. If you are signed up for direct deposit, your reimbursement will be deposited in your account in two to three business days from the date of the reimbursement. If not, a check will be mailed within two business days (allow one to three days for postal delivery).

How do I track my FSA claims?

You can use WageWorks's secure website for review of your claims paid throughout the plan year: WageWorks.com. If you’re a first-time user, enter your name, date of birth (month/day), ZIP code, and the last four digits of your Social Security number.

To track pending claims, contact the WageWorks Support Center at 855-774-7441.

What is the impact of the extended dependent coverage mandated as part of health care reform?

As of Jan. 1, 2012, eligibility for coverage under the dental, vision and child life insurance programs was extended to age 26, regardless of student or marital status. Previously, only medical coverage was extended to age 26.

When can I change my benefit elections? You can do it during each year's annual enrollment period. (Go to the Fidelity NetBenefits website.) Once annual enrollment is over, you will not be able to change your coverage until the next annual enrollment period, unless you have an appropriate qualified status change, such as a marriage, divorce or birth/adoption. Changes in coverage must be consistent with the change in your status. You must make changes within 30 days of a qualifying event. (Beginning Jan. 1, 2016, you'll have 60 days for a birth or adoption.)
What if my spouse has an HDHP (or HSA, FSA or HRA)? You can participate in the Blue Cross Blue Shield High-Deductible Health Plan and Fidelity Health Savings Account if your spouse is covered under another high-deductible health plan. Your spouse also can have his or her own health savings account but it is your responsibility to make sure your combined contributions (employee and employer contributions for both you and your spouse) do not exceed the federal limit.

You can also participate in the HDHP-HSA if your spouse is covered under traditional employer medical coverage (such as a PPO or HMO), as long as you are not covered, but neither of you can use a health care flexible spending account due to the tax-advantaged status. You can, however, use the Dental/Vision FSA offered by TI.

Who do I call for an issue with my enrollment for benefits?

Call the TI Benefits Center at Fidelity through TI HR Connect, 888-660-1411, option 1.

If I opt out of benefit coverage, can I ever get back in and sign up again?

If you are an active employee and you previously opted out of coverage, you can enroll during annual enrollment. If you have an eligible qualified status change such as a marriage, divorce or birth/adoption. Changes in coverage must be consistent with the change in your status. You must make changes within 30 days of a qualifying event.  (Beginning Jan. 1, 2016, you'll have 60 days for a birth or adoption.)

How can I find a doctor in my network near my home?

There are several ways to find a network doctor, or any other type of health care provider, in a TI health plan.

Through Castlight: If you're in the High-Deductible Health Plan (HDHP), log into mycastlight.com/ti. In the search box, enter the type of doctor you're looking for. You can also download the mobile app and search anytime, anywhere.

Through NetBenefits: Log into netbenefits.com/ti. From the Menu icon at the top left, click Health & Insurance, then Medical, then "Find a Network Provider" (on the right side of the page). NOTE: With this tool you can also find dentists and other health care providers for all your enrolled benefits.

Through your health plan: On the back of your insurance ID card, call the listed phone number or visit the website.

NOTE: If you contact Blue Cross Blue Shield, be sure to specify the BlueChoice PPO network. This applies to both the High-Deductible Health Plan as well as the PPO plan.

What do I do if I have to go to the doctor and I have not received my medical ID cards?

The insurance carriers will be mailing new ID cards, if required, in late December. If you have questions about your ID cards, please contact the insurance carrier. You can contact BCBS directly at 866-866-2300. You can also register on bcbstx.com and print out a temporary card, or request additional ID cards. 

Cigna participants can contact Cigna at 800-244-6224 or register online at mycigna.com

For other insurance carriers, check with the specific carrier, which you can contact through TI HR Connect, 888-660-1411, option 1.

If you don't receive your card by mid-January, verify your address information is recorded correctly on on myInfolink.ti.com. Under Career & Benefits, go to My Information, then Personal Information.

If your address information is correct, contact your benefit carrier through TI HR Connect at 888-660-1411, option 1, to request that replacement cards be mailed to you.

What is the difference between a PPO and an HMO?

Under a PPO (preferred provider organization), you have the freedom to choose any provider when you need care as long as you are willing to pay more for a non-network provider. There is also no need for physician referrals under a PPO. You can make an appointment directly with a specialist. TI's two PPOs are the Blue Cross Blue Shield HDHP and the Blue Cross Blue Shield PPO.

Under an HMO (health maintenance organization), you must use HMO network providers to receive benefits, and your medical care must typically be provided by a primary care physician (PCP) who will arrange for referrals to specialists and coordinate any hospital services. TI offers one regional HMO, the Kaiser HMO for northern California.

The Cigna Copay Plan is not an HMO but functions like one in that you must use a network provider to receive benefits.

What is the difference between a provider and a carrier/supplier?

In general a provider is considered to be your doctor, hospital or pharmacist (a person or place that treats your illness), while a carrier/supplier is your health insurance carrier, such as Blue Cross Blue Shield, Cigna, MetLife or Aetna (a group that administers or pays the claims based on the design of the plan).

HEALTH SAVINGS ACCOUNT (HSA)
What is a health savings account (HSA)? A health savings account is a savings account used in conjunction with a high-deductible health plan. It offers a different way for consumers to pay for health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. You own and you control the money in your HSA. Decisions on how to spend the money are made by you without relying on a third party or a health insurer.
How do I use my HSA to pay for medical expenses? Fidelity offers an HSA debit card, online bill pay or checkbook (additional fees may apply) to pay your health care provider directly from your HSA. You'll use this to pay the required amount at the medical services provider or pharmacy.
Who can use funds from my HSA? HSA funds can be used to cover eligible medical expenses for:
  • The account holder
  • The account holder's tax dependents (spouse, children, etc.)
You do not need to be covered by an HDHP nor do you have to be covered by the HSA account holder's plan in order to use HSA funds.
What expenses can be reimbursed "tax-free" from my HSA account? Refer to IRS Publication 502 for a list of qualified and non-qualified expenses. In general, you can use your HSA to pay tax-free for all out-of-pocket medical, dental, orthodontia (including braces for your tax dependent children) and vision expenses, as well as other expenses which are not reimbursed by insurance or any other source. This includes in-network and out-of-network expenses. You may also use HSA funds for long-term care services and certain insurance premiums (refer to IRS Publication 969).

Is my HSA treated the same for federal and state income tax purposes?

Not all of the states with income taxes have adopted the federal HSA rules as part of their income tax laws. Talk with your tax advisor for more information on the state tax implications of HSAs.

How can I confirm, for both the HSA and the dental/ vision FSA, if specific expenses are qualified, such as orthodontia, fillings, eye exams, etc.?

You can confirm this information with WageWorks (TI’s FSA administrator) and Fidelity (the HSA provider). You can reach both providers through TI HR Connect at 1-888-660-1411, option 1.

Check this page for more FSA resources available from WageWorks. For the HSA, refer to the IRS publications referenced in the previous answer.

Do I need to provide receipts to show proof of an eligible medical expense in order to distribute funds from my HSA account? No. However, you should keep those receipts for your records to show that the distribution was for eligible medical expenses in the event you are audited by the IRS.
What happens if I don't spend all of the money in my HSA by the end of the year? If you do not spend all of the money in your HSA, the remaining balance rolls over to the next plan year. Unlike a flexible spending account, you do not lose your HSA money if you do not spend it by the end of the year.
If I choose the HSA and later decide to switch to another medical option, or if I leave TI, can I still use the money that is already in the HSA for medical expenses tax-free? Once funds are deposited into the HSA, the account can be used to pay for qualified medical expenses tax-free, even if you no longer have HDHP coverage. The funds in your account roll over automatically each year and remain indefinitely until used. There is no time limit on using the funds.
What would happen to the HSA when I retire? Because you own the account and any account funds, you are not taxed on withdrawals as long as you use the monies for eligible out-of-pocket medical expenses while an employee, retiree or if you decide to leave and work elsewhere. You may use the funds for qualified medical expenses (see IRS Publication 502 and IRS Publication 969) or continue to carry forward the balance to use in the future.
What happens to the money in an HSA after you turn age 65? You can continue to use your account tax-free for out-of-pocket health expenses. If used for other expenses, the amount withdrawn will be taxable as income but will not be subject to any other penalties. Individuals under age 65 who use their accounts for non-medical expenses must pay income tax and a 20 percent penalty on the amount withdrawn.
What happens to my HSA if I leave TI before retirement? You own the account and any funds contributed to it. The HSA is portable and you take it with you, even if you leave employment. If you want to move your account from one financial institution to another institution, you can receive a distribution from the HSA and then roll the funds into another eligible account. This type of transaction is limited to once a year (except for direct trustee-to-trustee transfers) and must be completed between the institutions within 60 days to avoid paying taxes on the savings. Please note that the institution is not required to accept the rollover, so please verify the process with your institution before beginning a rollover.
Can I use the HSA monies to pay for non-qualified or non-health-related expenses? Yes. You may withdraw money from your HSA for items other than qualified health expenses, but it will be subject to income tax and, if you are under 65 years old and not disabled, an additional 20 percent tax penalty on the amount withdrawn.
Who is responsible for determining whether an HSA distribution has been used for qualified medical expenses? The IRS places the responsibility on the owner of the HSA to make sure that a distribution is for a qualified medical expense. The owner must maintain records of all medical expenses. The IRS may require you to show that the distributions have been made exclusively for qualified medical expenses and are therefore excludable from gross income and not subject to penalties. You may withdraw funds at any time. In the event of an audit, it is your responsibility to substantiate that the withdrawal is for a qualified medical expense. Qualified medical expenses are defined in section 213(d) of the Internal Revenue Code (see IRS Publication 502 and IRS Publication 969). Any qualified disbursements from the HSA account will remain tax-free. Please note that there are tax penalties for account disbursements that do not qualify under the regulations.
Are insurance premiums a qualified medical expense?

Since you already have the option to pay for your health care premiums pre-tax, premiums are not a qualified expense. The following other premiums are qualified expenses:

  • Qualified long-term care insurance (subject to annual dollar limits based on age - see IRS Publication 502 and IRS Publication 969)
  • COBRA health care continuation coverage
  • In addition, if you are over age 65 you may reimburse yourself from your HSA funds for the Medicare premiums automatically deducted from your Social Security benefit payment.
When will TI's contribution to my HSA be deposited?

For those who have enrolled in the HDHP and established their HSA during annual enrollment, the TI contribution will be processed in January.

For new hires, TI's contribution will be processed with your first regular paycheck after the date you established your health savings account. The deposit into your Fidelity HSA will be made by the Friday of that pay week.

Who is eligible to receive a contribution from TI? Active-status employees and all employees on any type of leave of absence are eligible for a TI contribution. COBRA and retiree participants are not eligible for the TI contribution; these individuals are eligible to enroll in the qualified HDHP and can set up an individual HSA - they just won't be eligible for the employer contribution.
Do you anticipate TI offering a $1,250 family contribution in future years, or will this contribution be a one-time event?

The TI contribution ($750 for employee-only coverage; $1,250 for other types of coverage) is an important part of the design of the HDHP-HSA offering and reflects TI’s commitment to help TIers prepare for long-term financial needs.

As with any other benefit, TI may adjust the program design in the future based on usage experience and overall effectiveness.

How soon will I have access to the funds in my HSA? As soon as TI's contribution is deposited in January, you can use funds in your account to pay for eligible expenses. You can access amounts up to your account balance, so if you elect to contribute through payroll deduction or by sending a contribution directly to Fidelity, additional funds are available as soon as the deposit is posted.
If I am single and have received the $750 at the beginning of the year and then I get married in June, will I receive additional money from TI? Yes, if you cover your spouse with TI insurance. The HSA contribution is prorated based on the number of months during the year a person is covered by an HSA-eligible plan as of the first day of the month.
What happens if I need to fill a prescription on Jan. 2 and TI's contribution has not yet been deposited? You'll need to pay the pharmacy and reimburse yourself out of your HSA.
What happens if I have a large claim (over $1,000) in January? You can use your HSA checkbook, online bill pay or debit card to pay the provider up to the amount you have on deposit. If you elect to contribute to the HSA, you can reimburse yourself each pay period, but you'll want to be careful you don't over-reimburse yourself. Due to the tax implications, you must have receipts to back up all distributions from the HSA.
How do I add money to my HSA account? When should I expect my contributions to be deposited? First you set up your HSA by following instructions at netbenefits.com/ti. At that time, or later if you choose, you designate how much money you want to contribute out of each paycheck, if any. Payroll contributions will generally be deposited in your HSA account on Friday in the week in which your payday falls.

You can also add money through other methods besides your paycheck. Keep in mind other methods may have tax implications. Contact Fidelity Investments for details.
Are my contributions pre-tax? Yes. In fact, your contributions are tax-free, meaning payroll deductions are made before-tax, investment earnings are not taxable, and you will not be taxed on distributions used to pay for qualified medical expenses.
How often can I change my contribution?

As often as you like. Just keep in mind the cut off dates for each payroll period.

To make a change, call the TI Benefits Center through TI HR Connect at 888-660-1411. Select option 1.

Keep in mind that it is your responsibility to ensure that your payroll deductions and direct contributions, combined with TI’s contributions, do not exceed the IRS limits. For details, refer to IRS Publication 969 or consult with your tax advisor.


How do I change my HSA payroll contribution?

To change your payroll deduction for your personal HSA contribution, call the TI Benefits Center and speak with a representative. Call TI HR Connect at 888-660-1411, option 1, to reach the benefits center. Representatives are available weekdays, 8:30 a.m. to 8:30 p.m. Eastern Time, except for most New York Stock Exchange holidays.

Keep in mind that it is your responsibility to ensure that your payroll deductions and direct contributions, combined with TI’s contributions, do not exceed the IRS limits. For details, refer to IRS Publication 969 or consult with your tax advisor.

How can I make sure I contribute the maximum per paycheck?

You can contact Fidelity to change your HSA contribution (see instructions in previous FAQ). Your maximum HSA deduction per paycheck is limited to the amount you elect to contribute on an annual basis prorated on a per-pay period basis.  

Example: You have family coverage and are under age 55, so your maximum annual HSA contribution in 2017 is $5,500 ($6,750 minus the $1,250 TI contribution). You call Fidelity and ask for the maximum contribution to be deducted from your paycheck, which would be $229 for an entire year ($5,500 divided by 24 pay periods). For less than a year, you would divide the maximum contribution by the remaining number of pay periods.

Keep in mind that it is your responsibility to ensure that your payroll deductions and direct contributions, combined with TI’s contributions, do not exceed the IRS limits. For details, refer to IRS Publication 969 or consult with your tax advisor.

How do I make a direct contribution, for example, if I want to load my HSA amount early in the year?

You can make a direct contribution with after-tax funds and still receive the tax advantages of your HSA. Information is available at netbenefits.com/ti.

Example: Instead of funding your HSA through payroll deduction, you decide to use part of your profit sharing to fund the account. After receiving your payout, you transfer money from your personal checking account to your Fidelity HSA account. This is after-tax money, so you will receive IRS Form 5498-SA from Fidelity to claim a deduction for eligible after-tax contributions with your income tax return.  

Keep in mind that it is your responsibility to ensure that your payroll deductions and direct contributions, combined with TI’s contributions, do not exceed the IRS limits. For details, refer to IRS Publication 969 or consult with your tax advisor.
Can I change my contribution online through NetBenefits? No, you may call Fidelity at any time to make a change in your HSA contribution amount. See contact information in the answer above.
How much money can I contribute to my HSA each year? In 2017, your HSA contributions, combined with TI's contributions, cannot exceed the 2017 IRS limit of $3,400 for individual coverage or $6,750 for family coverage (including the TI contribution). Exceeding this amount will result in tax implications at the end of the year.

If you are covered by a qualified HDHP on Dec. 1, you are allowed the full annual contribution (plus catch-up contribution, if 55 or older by year-end), regardless of the number of months eligible in the year. For individuals who are no longer eligible individuals on Dec. 1, both the HSA contribution and catch-up contribution apply pro-rata based on the number of months of the year a taxpayer is an eligible individual.
What about additional contributions, such as catch-up contributions? The IRS allows employees who are 55 and older to make additional "catch up" contributions. For 2017, if you are eligible, you can contribute up to an additional $1,000 into your HSA.

A spouse who is 55 or older can also contribute up to $1,000 beyond the normal limits, but it must be into a separate HSA, due to IRS requirements. If a spouse doesn't have his or her own HSA through their employer, they could call Fidelity and open a separate HSA for the spouse. This second account could not receive TI payroll deductions, of course, so it would have to be a "direct" contribution.
I turned 55 this year. Can I make the full "catch up" contribution? If you had HDHP coverage for the full year, you can make the full catch-up contribution regardless of when your 55th birthday falls during the year. If you did not have HDHP coverage for the full year, you must pro-rate your "catch-up" contribution for the number of full months you were "eligible," i.e., had HDHP coverage. However, if you are covered on Dec. 1 of your first year of HSA eligibility, you are treated as an eligible individual for the entire year and get the full contribution.
My husband participates in an HDHP with an HSA at his work. Does this affect how much I can contribute? Yes, together you can only contribute to the annual IRS maximum limit.

Also, see the answer above to the question, "What about additional contributions ... ."
How will I know if I exceed the HSA limit for the year? Participants will be responsible for ensuring that they do not exceed the HSA limits each year.
How can I invest my HSA funds? With HSA funds of at least $500, you may elect to invest through Fidelity Investments in a broad range of options, including a full range of Fidelity mutual funds, non-Fidelity funds, individual stocks and bonds or the self-directed brokerage account. Any earnings on your Fidelity HSA investments are automatically reinvested and grow tax free. You'll want to talk to a Fidelity representative to learn all the details.
Will there be fees? Yes, there are fees associated with a health savings account, but TI will pay the monthly service charges for your HSA while you are a TI employee or are on paid leave, military leave, FMLA leave or medical leave. You, however, are responsible for any other charges incurred (e.g., trading fees with regard to your self directed brokerage account or fees associated with a bounced check).

Once you cease employment at TI or retire, you will be billed an HSA administrative fee. (Banking fees are subject to change. Contact Fidelity for fee information.)
Will I get a statement? Yes. Online account statements will be available at Fidelity.com. Participants may opt to receive a paper statement if they prefer by contacting Fidelity. After the end of the year, Fidelity will send an investment report, (1099SA and 5498SA) to all HSA participants.
Will I have online access to my HSA account? Yes. Fidelity will provide you details as to how to view your account online.
Can I pick my own HSA administrator/trustee? Yes. But TI will only make company contributions and employee deductions deposits to your Fidelity HSA.
My husband is enrolled in a Health Care Flexible Spending Account with his employer. Can I still enroll in the HSA if I ensure that I don't run any of my husband's expenses through my HSA? No. You are not eligible to enroll in an HSA if you or your spouse is enrolled in a Health Care FSA.
How does the HSA compare to a Health Care FSA?

Question

HSA

FSA

Do the funds belong to the employee?

Yes

Yes

Can employees use the funds for things other than medical expenses?

Yes

No

Can employees take the money with them if they switch employers?

Yes

No

Do the funds roll over year to year?

Yes

No

Who can contribute to the account?

Employers and employees

Employee

Is there a “use it or lose it” clause if not used by the end of the year?

No

Yes

When are expenses reimbursed?

Up to amount on deposit

Up to annual goal amount

Is the combined HSA for two employees still limited to $6750 total for both? Yes, The combined contribution maximum is a total of $6750 for family coverage, even if the couple has two separate HSA accounts.

What happens if I exceed the annual contribution limit?

Contributions made to your HSA that exceed the IRS annual contribution limits are not tax-free. You can contact Fidelity Investments for information on how to adjust your contributions and remove excess contributions. In addition, an excise tax for each taxable year is imposed on excess contributions.

See your tax advisor for details.

How many debit cards can I request for my family? You can request up to five debit cards.

Are medical expenses you incurred prior to enrolling in the plan considered HSA-eligible expenses?

No.
Can orthodontic treatment be paid from the HSA account? Yes.
Can the HSA be used for nursing home expenses? Please refer to IRS Publication 502 and IRS Publication 969 for a list of qualified medical expenses.
Can the HSA be used for assisted living expenses? Please refer to IRS Publication 502 and IRS Publication 969 for a list of qualified medical expenses.
What happens to my HSA when I die? If your spouse is the named beneficiary of your account, the HSA becomes the HSA of your surviving spouse. If the HSA passes to a person other than your spouse, your beneficiary is required to include in gross income the fair market value of the HSA assets as of the date of your death. This includible amount is reduced by any payments from the HSA made for your qualified medical expenses, if paid one yer after your death.

During the online application process for your HSA, you will be asked to designate a beneficiary. You can also designate a beneficiary or make changes online at any time on the Fidelity NetBenefits website.
If both my wife and I passed away with a balance in the HSA, can my adult children inherit the account? Yes. The HSA is your personal account. When you enroll, you will have the opportunity to name beneficiaries.
Is there any limit for carry over money in the health savings account? There is no limit on how much you can carry over from year to year. The only limit is on how much you can contribute each year.
If a TIer's spouse also works for TI, can one elect the HDHP employee-only level to receive the $750 contribution, and the other elect the HDHP employee+children level to get the $1250 contribution? Yes.
If I choose HDHP next year, and then change to the BCBS PPO the year after, can I still contribute to the HSA? No, you can't contribute to the HSA if you're not enrolled in the high-deductible health plan. You can use the funds that you've saved, but you can't contribute additional funds.
Is the TI contribution dependent on the amount in my HSA account? No. TI will make the annual contribution based on what level of coverage you select -- $750 for employee-only coverage and $1,250 for the other levels of coverage.
Can I use my HSA for an overseas (out side of USA) medical expense? Yes, if it is a qualified medical expense. Please refer to IRS Publication 502 and IRS Publication 969 for a list of qualified medical expenses.
Can the HSA be used the same for dental expenses as it is for medical expenses? Yes, any qualified medical expense can be reimbursed from the HSA - this includes dental and vision expenses. Please refer to IRS Publication 502 and IRS Publication 969 for a list of qualified medical expenses.
Are there any differences on how the funds are distributed to pay for dental versus medical? No, you will either be able to use your HSA debit card at the point of service or reimburse yourself later from the account.
Under the HSA, who qualifies as a dependent?

For the most complete answer, you should refer to IRS Publication 969 or consult with your tax advisor.

Can my HSA savings be used for health care insurance premiums in early retirement?

This depends on the type of retiree health premiums and your age. TI can’t make a determination on this, so it would be best for you to consult a tax advisor, or at least review the actual IRS guidelines in these documents:

IRS Publication 502

IRS Publication 969

www.treas.gov/offices/public-affairs/hsa/faq_using.shtml#hsa8

How much do you pay in brokerage fees and/or commissions if you buy or sell investments in your HSA account?

You can find the brokerage fee schedule here - http://personal.fidelity.com/accounts/pdf/FBS-BKCOMMSCHED-0105.pdf. This document is made available during the account opening process.

My spouse elected a regular health care flexible spending account (FSA) during his/her non-calendar year plan coverage (such as July-June). How does that affect my eligibility to elect HDHP coverage or open and make contributions to my HSA?

You may elect HDHP coverage without regard to your spouse's health FSA participation. But if your spouse participates in a regular health care FSA, and can submit claims for your expenses to the FSA, you may not open and make HSA contributions through TI. If you want to participate in TI's HDHP plan and open an HSA, you have several options:

1. Check with your spouse’s plan to see if it considers a spouse’s differing plan year as a qualified status change -- some plans do and some don’t, and some plans might have different rules for health insurance coverage as opposed to participation in a flexible spending account. If your spouse’s plan does allow a qualified status change due to differing plan years, you can make your own elections during TI’s annual enrollment to participate in the HDHP-HSA. Then you need to make sure that your spouse drops his/her FSA participation effective Dec. 31, since your new coverage will take effect Jan. 1.

2. You can elect TI’s HDHP plan but not open an HSA until after your spouse's FSA coverage ends. (This means after the end of the plan year for your spouse's FSA coverage.) Keep in mind that some plans have an additional 2-1/2 month grace period for FSA claims and your HSA contributions must not overlap the grace period. In this case, you would pay your cost-share in the TI plan out-of-pocket until you can establish your HSA.
         Once you’ve established your HSA, then qualified expenses incurred after the establishment date and after the grace period for your spouse's health FSA are HSA-eligible expenses. For example, if your spouse has a July–June benefit plan year and a health FSA that has a 2-1/2 month grace period (extending to Sept. 15, for example), you should not establish an HSA or incur expenses for submission to the HSA until Sept. 16.

3. You can enroll in a different 2017 plan option and change to HDHP-HSA midyear. You would do this under the qualified status change rules of TI’s plan. Your spouse would drop the other employer's health coverage during his/her annual enrollment, then you could apply to change your coverage under the TI plan, provided you do so within 30 days of the date your spouse's coverage ends. At that point you could elect coverage under the HDHP option for the remainder of 2017, including coverage for your spouse. After enrolling in the HDHP you could open an HSA.

4. You can enroll in a different 2017 plan option and your spouse could drop his/her FSA. Next year, when your spouse completes his/her employer's annual enrollment, your spouse can discontinue participation in the regular health care FSA. Then he/she can enroll in a limited-purpose FSA (such as dental & vision only, if one is available), or you may enroll in the TI Dental/Vision FSA, provided you submit this new coverage election to TI within 30 days of the date your spouse's coverage ends. Then, during TI's next annual enrollment (usually every November), you could elect the HDHP and open an HSA.
My spouse participates in a flexible spending account (FSA) through his/her employer that is a calendar year plan (January -December) but allows claims incurred up to 2-1/2 months after the plan year as eligible expenses. If I can't be covered by an HSA and an FSA at the same time, does this "grace period" apply? Yes. For a calendar year health FSA with a 2-1/2 month grace period extending to March 15, the HSA cannot be established and expenses cannot be incurred for submission to the HSA until March 16.
Can I contribute my profit sharing payout to my Fidelity Health Savings Account (HSA)?

Yes, you can make a direct contribution with after-tax funds and still receive the tax advantages of your HSA. After receiving your payout, you can take money from your personal account and put it in your Fidelity HSA account. You do this by writing a personal check or making a one time transfer on NetBenefits. Further details can be found on NetBenefits.

This is after-tax money, so you will receive IRS Form 5498-SA from Fidelity to claim a deduction for eligible after-tax contributions with your income tax return. Keep in mind that it is your responsibility to ensure that your payroll deductions and direct contributions, combined with TI’s contributions, do not exceed the IRS limits. For details, refer to IRS Publication 969 or consult with your tax advisor.

Why can't I put some of my profit sharing in my HSA by paycheck deduction? You can, by increasing your HSA deduction, but that deduction is limited to the per-paycheck amount that equals your maximum HSA contribution for the year. To contribute more than the maximum amount per paycheck, you can make a direct contribution to your HSA using after-tax dollars, then claim a deduction for your federal taxes (see previous answer). To make a change to the paycheck deduction for your HSA contribution, call the TI Benefits Center through TI HR Connect at 888-660-1411. A TI Benefits Center customer service representative will assist you with making the change. Representatives are available weekdays 8:30 a.m. to 8:30 p.m. Eastern time, except for New York Stock Exchange holidays.
HIGH-DEDUCTIBLE HEALTH PLAN (HDHP)
If I enroll in the HDHP for family coverage, then I need to meet the $1500 deductible before coinsurance applies. Is this correct? No, you'll need to meet the $3,000 deductible which applies to family coverage under the HDHP. Both medical and prescription expenses will apply to your deductible.
How much do I need to pay out-of-pocket before the HDHP insurance starts paying? If you enrolled in employee-only coverage, insurance starts paying after you meet your $1,500 deductible. If you enrolled in You + Spouse, Employee + Child(ren) or You + Family coverage, insurance starts paying once you and your family have met your $3,000 deductible.

Remember that, if you cover more than yourself, the HDHP does not have individual deductible or out-of-pocket limits like in the PPO.
My spouse is on expensive medication that costs over $2,500 per month. In the past I paid 40% until I had paid $5,000 for his medicine. Since I enrolled in the HDHP, it seems like I reached the out-of-pocket maximum sooner. Why?

In the HDHP you pay all of the cost for your prescription medication until your expenses meet the family deductible of $3,000. After that you pay coinsurance based on the type of medication:

  • 20% coinsurance for generic drugs, up to a maximum of $25
  • 30% coinsurance for preferred brand drugs, up to a maximum of $75, plus the brand differential if a generic is available
  • 50% coinsurance for non-preferred brand drugs, up to a maximum of $100, plus the brand differential if a generic is available

Once you have paid another $3,000 in coinsurance, you'll hit the HDHP family out-of-pocket maximum of $6,000 and your medical AND prescription drug expenses will be covered at 100% (unless you elect a brand-name drug when an equivalent generic is available).

The PPO had a $4,000 per individual pharmacy out-of-pocket maximum, in addition to the medical out-of-pocket maximum.

How does the deductible work in the HDHP versus the regular PPO?

Under the HDHP, deductibles and out-of-pocket maximums are set as either Employee or Family:

  • Employee -- If the TIer has employee-only coverage, the deductible is $1,500 and the total out-of-pocket maximum on allowed expenses, including the deductible, is $3,000.
  • Family -- If the TIer has employee+spouse, employee+children or employee+family coverage, the deductible is $3,000 and the out-of-pocket maximum on allowed expenses, including the deductible, is $6,000. Expenses incurred by the TIer and all covered dependents apply to the $3,000 deductible and coinsurance does not kick in for any family member until the $3,000 deductible has been met.

Under the PPO, if a TIer covers dependents, the most the entire family must meet in deductibles is $600, and the maximum out-of-pocket is $5,000 for medical and $8,000 for prescription drugs. This family maximum combines the amounts paid by all family members, but the most any one member of the family has to meet is a $300 deductible and medical out-of-pocket of $2,500, which includes the deductible, plus the pharmacy/prescription drug out-of-pocket maximum of $4,000.

Are expenses in the HDHP based on negotiated rates with Blue Cross Blue Shield and Caremark? Yes. HDHP claims are administered just like PPO claims, and use the BCBS PPO network. Eligible expenses applied to the deductible and out-of-pocket maximums are discounted based on contracted rates Blue Cross Blue Shield and Caremark have negotiated with its network providers and drug manufacturers.
Why is the HDHP the only option being offered to employees hired Jan. 1, 2012, or later? TI believes that the HDHP-HSA option is the most efficient plan we can offer to employees. It helps TIers by giving them control of the dollars they spend on health care, thereby making them wiser health care consumers. The wise decisions TIers make helps TI save on the overall cost of health care. As a result we pass cost savings on in the form of TI contributions and lower premiums.

We believe that more and more employees will consider the new HDHP-HSA option. We see an increasing number of our competitors offering HDHP-HSAs.

As TI has done in the past, when a major change is made to a benefit plan, current benefits remain available to employees who were employed prior to the date of the change and new hires are eligible only for the new benefit structure.
If I retire and then decide to return to work at TI, will the HDHP be my only medical insurance option? Yes. The HDHP is the only option offered to new hires, which includes new employees, co-op conversions, acquisitions, payroll transfers, rehires and returning retirees.
Will the HDHP be an option on TI Extended Health Benefits when I retire? Yes, for pre-Medicare-eligible retirees, the HDHP is currently an option. However, there is not a TI contribution to your HSA.
My hire date was prior to Jan. 1, 2012, and I am enrolled in the HDHP-HSA option for 2012. Can I change my coverage to the PPO or the Cigna Copay Plan or a regional HMO? Yes, you can make a change and elect any eligible plan during annual enrollment.
My husband and I work at TI. If I choose the Cigna Copay Plan (no FSA) and he chooses the HDHP with HSA, can I use his HSA for my eligible medical expenses? Yes.
If I enroll my family in the HDHP and then drop the dependent coverage mid-year due to a qualifying life event, how is the deductible handled?

When you move to employee-only coverage, you will be responsible for a $1,500 deductible.  Any expenses you incurred prior to dropping dependent coverage that were applied to the $3,000 family deductible would be applied to the $1,500 deductible.

However, if you had no expenses and your dependents met the entire $3,000 family deductible and then dropped off the plan, you would still have to meet a $1,500 deductible. 

Is the new HDHP-HSA portable (convertible to a private policy) if I leave TI? No, the HDHP insurance plan is not portable.

However, the HSA (where TI and TIer contributions are deposited) is a personal account and you would carry it with you if you left TI. You can use the funds in the HSA after you leave employment to pay for medical expenses, regardless of the insurance plan you are in.
Are there any restrictions on pre-existing conditions with the new HDHP? No.
Under the high-deductible health plan, are wellness screenings covered the same as under the BCBS PPO? Yes.
INDIVIDUAL HEALTH MANAGEMENT (IHM) PROGRAM
What is the IHM program? The IHM program is offered to eligible employees and their families as a health information service which helps participants better understand and manage their health care. This confidential service is offered to individuals covered under a TI-sponsored medical plan who experience conditions requiring extensive use of medical services. If you are eligible, you will be contacted by Knova Solutions, a third party contracted by TI to provide the IHM program. Knova will contact you first by letter and then by phone.
Who is Knova? Knova Solutions is one of the providers that works with TI's Individual Health Management (IHM) program. If you received a letter from Knova inviting you into the IHM program, you are eligible to use its services. Knova's services are completely paid by TI to help you make appropriate health and medical decisions. It is up to you whether to use the service and it is completely confidential.
LIFE EVENTS
How do I report a life event (for example, birth, adoption, death, marriage, divorce, etc.) and change my benefits elections?

Except as noted in the summary description of a plan or program, you can only make appropriate changes in your coverage, or add or drop dependents, as follows:

  • Within 30 days of your first day as a TI employee
  • Each year during annual enrollment
  • Within 30 days of a qualified status change, which includes:
    • Changes in legal marital status (judgment, decree or order resulting from a divorce, legal separation or annulment)
    • Changes in number of dependents
    • Changes in employment status (yours or spouse’s or domestic partner’s)
    • Changes in dependent eligibility (meets or fails to meet eligibility requirements)
    • Loss of other health plan coverage, including reaching a plan’s lifetime limit on all benefits (yours or spouse’s or domestic partner’s, or dependents)
    • Changes in residence of the employee, spouse or domestic partner, or dependent (move out of an HMO’s coverage area)
    • Changes in legal custody that require health coverage for a child (including a Qualified Medical Child Support Order or a National Medical Support Notice)
    • Death of a spouse or domestic partner/dependent

Beginning Jan. 1, 2016, you'll have 60 days for a birth or adoption.

A full list of qualified status changes can be found in the Health and Insurance Benefits Guide. The guide is available on this Web page from the left navigation column, under Benefits Guides.

Note: Changes in coverage must be consistent with the change in status.

You must make your election changes within 30 days of the qualifying event (or 60 days for a birth or adoption, beginning Jan. 1, 2016) by contacting the TI Benefits Center or registering the change on the Fidelity NetBenefits website. On NetBenefits, go to the Health & Insurance page and click on the "What To Do When" tab. To contact the TI Benefits Center, call 888-660-1411 and select the first option.

If you move, you will need to update your home address with TI. To update your home address, go to myinfolink.ti.com (select Career & Benefits tab, then under My Information, select Personal Information).

If you are covered by an HMO and move out of that HMO's service area, you may enroll in the Blue Cross Blue Shield HDHP, PPO or another HMO, if available in your area. In such cases, you must process your request on NetBenefits or contact the TI Benefits Center within 30 days of your move.

I'm currently on an unpaid leave of absence (LOA). When will I be billed for my health benefits?

Billing notices will be generated on the 10th of the month and mailed on the 15th of the month for plan prices due the first of the month.

For example: January billing notices will be generated on Dec. 10, 2016, and mailed Dec. 15, 2016, for January plan premiums due on Jan. 1, 2017, for participants who are not enrolled in automatic bank withdrawal.

If automatic bank withdrawal has been established, you will no longer receive a paper billing notice. Your monthly bank statement will show all withdrawals from your account (the date and the amount). The amount withdrawn from your account will be the same as your monthly coverage cost unless a coverage change has been made during the month. In this case, the amount withdrawn may be more or less than the previous monthly cost. You will be notified of any amount change at least 10 days before the withdrawal will be made.

Please note: If you make changes after the 10th of the month, you will see an adjustment on a subsequent bill.

Where can I see my health plan premiums?

You can review the general premium table on this website by clicking on the Health Plan Premium tab in the left navigation column. You can get specific premiums for you personally by logging in to the Fidelity NetBenefits website or by calling TI HR Connect at 888-660-1411, option 1, and speaking to a TI Benefits Center representative.

When will my plan prices be deducted from my payroll check and are they all deducted from one paycheck per month?

Deductions for benefits will start with the first paycheck in the year. The annual cost is spread across 24 paychecks for all employees for all your health care benefits. In the months that have three biweekly check dates, only the first two paychecks will have deductions for Health & Welfare (medical, dental, vision, life, AD&D, DPC, LTD and FSAs).

If an employee gets a physical done in September, can they use those results for evidence of insurability when extending their Life Insurance? If evidence of insurability is needed for life insurance, MetLife will set up a request via phone call or letter with the employee. At that time the employee can inform the representative that a physical has been done previously -- as long as it is within six months. MetLife will send a form to the employee who will then take to the physician to complete and return back to MetLife.
When is an evidence of insurability form required for Supplemental Life? For new hires, evidence of insurability (EOI) is not required for coverage up to $300,000.

For current employees, you are not required to complete an EOI form if you are currently enrolled in Supplemental Life insurance coverage and increase such coverage by one-time your annual base salary during annual enrollment, provided total coverage after the increase does not exceed $300,000 .
Can my spouse also increase her life insurance one level up without providing evidence of insurability? No. Only the TIer can increase coverage one multiple without being subject to evidence of insurability (up to $300,000.)

How long do I have to submit my evidence of insurability (EOI) form? Who approves it and when is my coverage updated?

Your evidence of insurability (EOI) form must be submitted to MetLife within 60 days.

Once it has been reviewed, MetLife will determine if the EOI is approved or denied. If your request is approved, MetLife will send the TI Benefits Center notification of the approval. Your coverage will then be updated on the later of the coverage effective date or the date of approval by the carrier. If your request is denied, MetLife will notify you directly.

When increasing your life insurance on Fidelity NetBenefits, you will have the option to complete the EOI online through MetLife.

A MetLife EOI form (labeled Statement of Health) is also available from this web page under the Forms tab in the left navigation column. You can also access forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance program on the home page.

My doctor prescribed a brand-name drug and I can't take the generic drug in its place. Do I still need to pay the higher coinsurance or copay?

Employees/dependents enrolled in the Blue Cross Blue Shield HDHP or PPO will pay the appropriate prescription drug coinsurance as stated below.

HDHP -- After your deductible is met, you pay:

  • 20% coinsurance for generic drugs, up to a maximum of $25
  • 30% coinsurance for preferred brand drugs, up to a maximum of $75, plus the brand differential if a generic is available
  • 50% coinsurance for non-preferred brand drugs, up to a maximum of $100, plus the brand differential if a generic is available

PPO:

In Network
Generic: 25% coinsurance
Brand: 40% coinsurance, plus the brand differential if a generic is available

Out of Network
Generic: 45% coinsurance
Brand: 60% coinsurance, plus the brand differential if a generic is available

Keep in mind that, under both the HDHP and the PPO, when a generic drug is available and you purchase a brand-name drug instead, you'll pay the cost difference between the brand-name and the generic drug PLUS the appropriate coinsurance on the remainder.

Note: An appeal process is available to avoid the brand penalty due to medical necessity. Contact CVS Caremark for details.

If you participate in the Cigna Copay Plan or a regional HMO, please contact your current carrier for details on their process.

How do I see what the pricing will be for my prescription drugs?

For coverage under the Blue Cross Blue Shield HDHP or PPO, check here. Be aware that the CVS Caremark pricing tool will show the drug's pricing accurately but will not necessarily indicate whether it falls into the preferred or non-preferred tier. For a specific list, see the Preferred Drug List on caremark.com.

For coverage under the Cigna Copay Plan or a regional HMO, please contact your current carrier for details on its prescription drug pricing.

How do I view my online claims history for CVS Caremark?

To view your CVS Caremark claims history online, log on to the CVS Caremark Website ( www.caremark.com). Click the member quick link "View Prescription History." Select the participant and date range to view prescriptions. You can choose to view/print a prescription report.

How can I get my Caremark prescriptions through the mail-order program?

To participate in the Caremark mail-order program you must complete the mail service order form. The form is available from this web page under the Forms tab in the left navigation column. You can also access forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance program on the home page.The form can also be accessed on the Caremark website ( www.caremark.com). Click "Online Forms," then "Mail Service Order Form." Or you can contact Caremark directly through TI HR Connect at 888-660-1411, option 1.

Filing Claims
Where can I obtain forms to file my claims?

You can find forms under the Forms tab in the left navigation column of this Web page. You can also access claim forms on the Fidelity NetBenefits website by selecting the appropriate quick link next to your insurance plan on the home page.

Is there a deadline to file pharmacy claims? Yes. All pharmacy expense claims must be sent to CVS Caremark and postmarked no later than 365 days from the date of service; otherwise, they will be denied as untimely. It is your responsibility to ensure that your claims are filed before the deadline.

What is disability pay continuance (DPC)?

Disability Pay Continuance, or DPC, provides eligible TIers with income protection for up to 26 weeks of disability for illnesses/injuries, including the required disability benefits waiting period.

The plan also provides eligible TIers  with income protection for a total of 9 disability weeks for maternity leave, including the required disability benefits waiting period, starting on the date of delivery. If your date of delivery is on a non-scheduled workday, your paid leave of absence will start on the first lost workday following your date of delivery.

DPC benefits are paid after you have been absent from work for a required period (disability benefits waiting period) of 40 consecutive scheduled hours (or three complete consecutive scheduled shifts for those on compressed shift work schedules or the equivalent of a full consecutive work week for those on an alternative work schedule) due to a non-occupational illness or injury or leave of absence for the birth of a child. Partial days missed are not covered by the 40-hour or 3-schedule shift requirement. Partial days may be taken as Time Bank (if available) or as unpaid time.

All DPC payments are contingent upon an examination by a health care provider and medical documentation that a disabling condition exists that prevents you from performing the essential functions of your job or a modified job.

For more information regarding the DPC process, go to the Absence & Disability Management website.

If you have questions about DPC, contact the TI Absence & Disability Management consultant (ADMC) assigned to your business.

How do I request DPC?

Call TI Absence & Disability Management through TI HR Connect at 888-660-1411, option 5.

If you have questions about DPC, contact the the TI Absence & Disability Management consultant (ADMC) who supports your group

You will need to provide current medical information, with the assistance of your physician, for disability certification. The ADMC will determine medical qualification and set approval of the disability period based on the medical information you/your physician provides. You and your supervisor will be notified of approval dates for the disability period. If an extension is needed, you must contact the ADMC assigned to your claim.

Does the DPC benefit cover shift premiums, bonuses or overtime I usually receive?

For hourly TIers, DPC is based on your base rate of pay. Overtime and shift premiums are not included.

For salaried TIers, it is based on your base rate of pay, or if you are on an alternative work schedule, your adjusted base rate of pay.

For sales bonus plan participants, your base rate of pay does not include your sales bonus target amount.

Does Time Bank accrue while I am on an approved medical leave of absence (LOA)?

If you are on a leave of absence (LOA) due to Workers' Compensation, medical, maternity, military, the Family and Medical Leave Act (FMLA)/California Family Rights Act (CFRA), or pursuant to any other applicable law providing for leave, you will continue to earn monthly Time Bank accruals for up to 6 months, at the same rate you had before going on leave.

Can I change my DPC coverage while I am on a disability leave during annual enrollment?

TIers on disability leave during annual enrollment may not increase their coverage for the following year.

What benefits am I eligible for while on an approved medical leave of absence (LOA)?

An approved medical absence is considered continuous employment with respect to eligibility for most of your TI benefits. See the Continuation of Other Benefits section under DPC in the Health and Insurance Benefits Guide. The guide is available on this Web page from the left navigation column, under Benefits Guides.

Will my DPC benefit be reduced if I am receiving other income?

Your benefit will be reduced by any of the following benefits you are eligible to receive:

  • Social Security Disability Income benefits and/or other Social Security benefits
  • Workers' Compensation or other occupational disease benefits
  • Disability pay from other sources
  • Time Bank
  • Other governmental disability income programs
  • Automobile No Fault (if required by law)
  • Third-party liabilities (effective for disabilities occurring on or after Jan. 1, 1994)
  • Mandatory state temporary disability insurance program benefits

What is the Family and Medical Leave Act (FMLA)?

FMLA -- and for California employees, the California Family Rights Act (CFRA) -- provides eligible TIers with up to 12 weeks of unpaid leave during  a 12-month period. The leave must be for a TIer's own serious health condition that makes the TIer unable to perform his or her job, or to care for the TIer’s parent, spouse (or, under the CFRA, registered domestic partner) or child with a serious health condition, or to care for the TIer’s child after birth or placement for adoption or foster care ; or, under FMLA only, for incapacity due to pregnancy, prenatal medical care or child birth; or, under FMLA only, because of certain “qualifying exigencies” arising out of the fact that the TIer’s spouse, son, daughter, or parent is on covered active duty (or has been notified of an impending call or order to covered active duty) in the Armed Forces.

NOTE: For purposes of granting FMLA leaves, TI shall consider “spouse” to be the other person with whom the TIer entered into marriage as defined or recognized under state law for purposes of marriage in the state in which the marriage was entered into or, in the case of marriage entered into outside of any U.S. state, if the marriage is valid in the place where entered into and could have been entered into in at least one U.S. state.

TI shall inform a TIer requesting FMLA/CFRA leave whether the TIer is eligible for the leave requested. If the TIer is eligible, TI shall notify the TIer of any additional information required as well as the TIer’s rights and responsibilities. If the TIer is not eligible, TI shall provide a reason for the ineligibility. TI shall notify TIers if leave will be designated as FMLA/CFRA protected and the amount of leave counted against the TIer’s leave entitlement. If TI determines that a leave is not FMLA/CFRA protected, it shall notify the TIer.

For more information, see the FMLA section in the Health and Insurance Benefits Guide. The guide is available on this Web page from the left navigation column, under Benefits Guides.

If you are a TI employee in California, you may be eligible for paid family leave benefits.

Who is eligible for FMLA leave?

To be eligible for leave under FMLA -- and for California employees, the California Family Rights Act (CFRA) -- TIers must have a minimum of one year of service and have worked 1,250 hours for TI in the past 12 months, and must work at a location where at least 50 employees are employed by TI within 75 miles of the location.

NOTE: For TIers who do not meet the geographical requirement that they work at a location where at least 50 employees are employed within 75 miles, TI will still consider a request for FMLA/CFRA leave and will grant an equivalent leave when possible. However, if TI determines that its business needs would preclude such a leave, the request may be denied within TI’s sole discretion.

TI must approve all FMLA/CFRA leaves. You must consult with the TI Absence & Disability Managerment consultant (ADMC) assigned to your business to determine if an absence qualifies under FMLA/CFRA.

How is my time coded when the FMLA leave is requested for self (leave must be approved by the TI ADMC)?

For FMLA leave for self, you are required to use Time Bank until it is no longer available. You must code your time as "FMLA paid" while Time Bank is available and "FMLA unpaid" after Time Bank is no longer available.

How is time coded when the FMLA leave is requested for a family member (leave must be approved by the TI ADMC)?

For FMLA leave for a family member, you may opt for paid or unpaid FMLA leave. You may code your time as "FMLA paid," if Time Bank is available. You may also opt to code it as "FMLA unpaid."

What happens to my health plan payments while on FMLA leave?

Health plan payments must be kept current while you are on FMLA/CFRA leave. TIers on FMLA/CFRA leave who are eligible to receive DPC payments will have costs deducted from the DPC check. TIers on unpaid FMLA leave will be billed monthly. Payments must be made within 30 days of the due date. If payment is not made on time, group health insurance may be cancelled (TI will provide written notice at least 15 days before the date that health coverage will lapse), or, at TI’s option, TI may pay the TIer’s share of the premiums during FMLA/CFRA leave, and recover these payments upon the TIer’s return to work.

What is long-term disability (LTD)?

If you have elected LTD coverage, LTD benefits are payable after 26 weeks of full, partial or intermittent disbility pay continuance (DPC) benefits. Your LTD benefit will continue to pay a benefit to you as long as you remain disabled or totally and permanently disabled (see the following definition) up to age 65 (and up to age 70 on a graduated basis if the disability began after age 60) or until you recover.

Total Disability
You are considered totally disabled when you are unable to perform the essential functions of your job or any job for which you may qualify and cannot be reasonably accommodated.

Your LTD benefits will continue during the period you remain totally disabled (as defined above). It may be necessary to submit a doctor's certification of your continued total disability on request or your LTD benefits will stop.

Total and Permanent Disability
You may be considered totally and permanently disabled (TPD) with the appropriate medical documentation, Social Security disability income benefits award, and the inability to perform the essential functions or be reasonably accommodated for a job that pays a minimum of 75 percent of your base pay before the disability leave. Once you have been on leave of absence for 48 months, your employment with TI will terminate. The 48 months begins with the commencement of your disability.

How long benefits are payable
You must file for Social Security Disability Insurance (SSDI) benefits within 12 months from the onset of your disability and must be approved by the end of 48 months (four years) from the onset of disability or long-term disability benefit payments will be terminated. At the discretion of the Claims Administrator, TI may continue the LTD benefit at the end of 48 months if a decision is pending at the next step in the SSDI appeal process, with resolution not to exceed six months.

LTD benefits are payable through age 65 (or up to age 70 on a graduated basis if the disability began after age 60) if SSDI benefits have been awarded.

If you have questions about LTD, contact the TI Absence & Disability Managerment consultant (ADMC) assigned to your business.

Is long-term disability (LTD) coverage provided by TI and what does it pay?

LTD coverage is not provided by TI; an employee must elect this coverage when hired or during annual enrollment. Two levels of cverage are available:

LTD Basic covers 50 percent of your basic monthly earnings less other income benefits, such as income from TI or any government program.

LTD Plus covers 66 2/3 percent of your basic monthly earnings less other income benefits, such as income from TI or any government program. The maximum monthly benefit is $25,000.

What are basic monthly earnings?

Hourly: straight-time hourly rate of pay multiplied by 173.3 hours

Salaried: monthly salary

Your basic monthly earnings do not include overtime, shift premiums or any other additional compensation.

For sales bonus plan representatives, your monthly salary does not include your sales bonus target amount.

When does long-term disability (LTD) coverage begin?

You must be actively working on the date your coverage begins. If you are not in active service, your coverage will begin on the date you return to work for one full shift. LTD benefits begin after you have been totally, partially or intermittently disabled for a total of 26 disability weeks.

Can I change my LTD coverage while I am on a disability leave during annual enrollment?

TIers on disability leave during annual enrollment may not increase their coverage for the following year.

What benefits am I eligible for while on an approved medical leave of leave of absence (LOA)? An approved medical absence is considered continuous employment with respect to eligibility for most of your TI benefits. See the Continuation of Other Benefits section under LTD in the Health and Insurance Benefits Guide. The guide is available on this web page from the left navigation column, under Benefits Guides.
Will my LTD benefit be reduced if I am receiving other income?

Your benefit will be reduced by any of the following benefits you are eligible to receive:

  • Social Security Disability Income benefits and/or other Social Security benefits
  • Workers' Compensation or other occupational disease benefits
  • Disability pay from other sources
  • Time Bank
  • Other governmental disability income programs
  • Automobile No Fault (if required by law)
  • Third-party liabilities (effective for disabilities occurring on or after Jan. 1, 1994)
  • Mandatory state temporary disability insurance program benefits
What is Workers' Compensation?

Key features of Workers' Compensation are:

  • Health care coverage for an illness or injury that is work-related
  • Income protection for time missed from work due to a work-related illness or injury

Who do I call to report an on-the-job injury?

Call your local emergency number to seek immediate medical treatment and notify your supervisor. After seeking medical treatment (or if medical treatment is not needed) call TI HR Connect at 888-660-1411 and choose option 4, "report an on-the-job injury."

Next, contact the TI Absence & Disability Managerment consultant (ADMC) assigned to your business.

If I get injured at work, where do I send the medical bills to be paid?

To verify Workers' Compensation and cover medical bills, please contact the TI Workers' Compensation office (Zurich NA); the adjuster will verify coverage and provide office information. You can reach your adjuster by dialingTI HR Connect toll-free at 888-660-1411 and choosing option 4, "report an on-the-job injury," and then "to get status on an existing claim." Have your claim number available when you call.

If I am terminated, does Zurich still cover medical bills? If your claim is accepted as compensable, you have lifetime coverage for all reasonable and necessary treatment related to your claim.
Am I eligible for disability pay continuance (DPC) or long-term disability (LTD) coverage while receiving lost time wages from Workers' Compensation? Yes, but DPC and LTD benefits will be offset by Workers' Compensation benefits.

How do I code time for employees requesting disability pay continuance (DPC)?

DPC benefits are paid after an employee has been absent from work for a required period (disability benefits waiting period) of 40 consecutive scheduled hours (or three complete consecutive scheduled shifts for those on compressed shift work schedules or the equivalent of a full consecutive work week for those on an alternative work schedule) due to a non-occupational illness or injury or leave of absence for the birth of a child.

TIers approved for DPC benefits will also be certified concurrently for FMLA (and CFRA, if applicable). The required disability benefits waiting period will be coded as FMLA/CFRA leave. The the TI Absence & Disability Management Consultant (ADMC) who supports your group will notify the supervisor of the employee’s FMLA eligibility. Partial days missed are not covered by the 40 hour or 3 schedule shift requirement. Partial days may be taken as Time Bank (if available) or as unpaid time.

After using the required Time Bank, employees must contact TI Absence & Disability Management via the toll-free HR Connect number at 888-660-1411 (option 5) for disability pay approval.

How do I code time for hours not worked for an employee approved for partial or intermittent disability pay continuance (DPC)? Code time as Disability Pay when you are notified that the leave is approved by the TI Absence & Disability Management Consultant (ADMC) who supports your group.

How do I code time for an employee approved for FMLA leave for self (leave must be approved by the TI ADMC)?

For FMLA leave for self, the employee is required to use Time Bank FMLA until it is no longer available. You must code the time as Time Bank FMLA while Time Bank is available and FMLA Unpaid after Time Bank is no longer available. Normal call-in procedures must be followed unless unusual circumstances prevent it.

How do I code time for an employee approved for FMLA leave for a family member (leave must be approved by the TI ADMC)?

For FMLA leave for a family member, employees may opt for paid or unpaid FMLA leave. Per the employee's choice, code the time as Time Bank FMLA, if Time Bank is available. The employee may also opt to code the time as FMLA Unpaid. Normal call-in procedures must be followed unless unusual circumstances prevent it.

Who do I contact if I am unable to enter or correct an employee’s time?

Send Payroll a message at pay6@list.ti.com or call TI HR Connect at 888-660-1411 and select option 3, "HR and payroll."

HEALTH ASSESSMENT
Is it true we're no longer required to complete the TI Health Assessment to get lower premiums?

Yes. TI employees and covered spouses/domestic partners no longer must complete the annual health assessment to avoid a $120/person surcharge on medical insurance premiums. You will automatically receive the lowest premium available for the plan in which you enroll.

For more explanation, read this article from Ben Carter, TI vice president for compensation and benefits.

 

 

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