Medical Benefit Plans

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Plan Administrator. This Welfare Benefit Plan is administered by Rhodes College, 2000 North Parkway, Memphis, TN 38112 whose Internal Revenue Service Employer Identification Number is EIN620476301. The Plan Number is 501. The plan year is July through June. This is a contract administration plan and the third party administrator (TPA) is Pittman & Associates. Information regarding Plan eligibility, enrollment, cost, and the procedure for applying for benefits is contained in this section. The Plan Document which each covered employee receives without cost, includes a description of benefits under the Plan and the conditions under which these benefits are available to covered individuals. For a copy of the Plan Document please contact the Human Resources office.

Employees Eligible for the Plan. All full-time faculty and staff categories A and B and their dependents and qualified domestic partner are eligible to be enrolled in the Medical Benefit Plan. Part-time employees and their dependents hired after July 1, 1989 are not eligible for medical coverage.

Date Eligible for Coverage. Each employee becomes eligible for medical coverage under the Plan the first day of the month following the date of employment with Rhodes.

Pre-existing Condition Clause. There is a 12-month pre-existing condition clause in the Medical Benefit Plan. A pre-existing condition is a condition for which medical advice, diagnosis, care, or treatment was recommended or received within six months of a person’s enrollment date. For these purposes, genetic information is not a condition. Treatment includes receiving services and supplies, consultations, diagnostic tests or prescribed medicines. In order to be taken into account, the medical advice, diagnosis, care, or treatment must have been recommended by, or received from, a physician.

The pre-existing condition does not apply to pregnancy, or to any covered person under age 19. The length of a pre-existing condition’s limitation may be reduced or eliminated if an eligible person has creditable coverage from another health plan.

An eligible person may request a certificate of creditable coverage from his or her prior plan.

If, after creditable coverage has been taken into account, there was still a pre-existing condition limitation imposed on an individual, that individual will be notified by the Third Party Administrator, Pittman & Associates.

Creditable Coverage. As required by the Health Insurance Portability and Accountability Act (HIPAA) certificates of coverage will be provided without charge for covered employees or dependents covered under Rhodes College Medical Benefit Plan.

Date Eligible for Dependent Coverage. A dependent shall become eligible for coverage on either (a) the first day that the employee becomes eligible for coverage and satisfies the definition of eligible dependent coverage or (b) the day a covered employee first acquires an eligible dependent. New dependents must be added to your medical coverage within 30 days of the event (i.e., marriage, birth, etc.). The definition of the dependents eligible for coverage under this Plan appears in the Medical Benefit Plan Document, which each covered employee receives.

Enrolling in the Plan. An employee and his or her dependents may become covered on the date of first eligibility. Enrollment forms, which should be completed promptly, may be obtained from the Human Resources Office. Additional information about enrollment procedures, including special enrollment periods, may also be obtained from the Director of Human Resources.

Plan A — PPO Benefits

  • 100% coverage after $30 office co-payment on physician’s charges if you see a physician participating in the Partner Solutions PPO network.
  • X-ray and lab charges are paid at 80% of PPO rate and the deductible waived for PPO Select providers.
  • $400 calendar year deductible per person (family maximum of 3). All eligible expenses apply toward the deductible except the $30 office co-payment, the 20% coinsurance for in-network X-ray and lab charges and prescription drug co-payments if purchased from a network pharmacy.
  • 80% coverage for eligible expenses after the deductible has been met.
  • 100% coverage on all eligible expenses after $2,000 per covered individual (plus deductible and co-payments) per calendar year has been paid out-of-pocket by the covered person.
  • 12-month pre-existing condition clause for persons age 19 and older.
  • Well baby care and routine exams.
  • Pre-admission certification is required for hospital admissions.

Plan A — Non-PPO Benefits

  • $500 calendar year deductible per person (family maximum of 3). All eligible expenses apply toward the deductible except prescription drug co-payments if purchased from a network pharmacy.
  • 50% coverage on eligible expenses after the deductible has been met.
  • 12-month pre-existing condition clause for persons age 19 and older.
  • Pre-admission certification is required for hospital admissions.

Plan B — PPO Benefits

  • $800 calendar year deductible per person (family maximum of 3). All eligible expenses apply toward the deductible except prescription drug co-payments if purchased from a network pharmacy.
  • 80% coverage on eligible expenses after deductible has been met.
  • 100% coverage on all eligible expenses after $3,500 per covered individual (plus deductible and co-payments) per calendar year has been paid out-of-pocket by the covered person.
  • 12-month pre-existing condition clause for persons age 19 and older.
  • Pre-admission certification is required for hospital admissions.

Plan B — Non-PPO Benefits

  • $1,000 calendar year deductible per person (family maximum of 3). All eligible expenses apply toward the deductible except prescription drug co-payments if purchased from a network pharmacy.
  • 50% coverage on eligible expenses after deductible has been met.
  • 12-month pre-existing condition clause for persons age 19 and older.
  • Pre-admission certification is required for hospital admissions.

Applications, Requests, and Questions Directed to the Plan Administrator. Applications, requests, and questions regarding enrollment, participation, or other administrative matters and service of legal process on issues arising from such questions, should be directed to the Plan Administrator, Director of Human Resources, Rhodes College, 2000 North Parkway, Memphis, TN 38112, 901-843-3750.

The Cost of the Plan. Effective July 1, 1989, employees will be responsible for sharing in the cost of the Medical Benefit Plan through a medical benefit premium payment. At the employee’s option, medical benefit premium payments can be deducted through a flexible benefits program (pre-tax option).

Amendment to the Medical Benefit Plan. Rhodes shall be the Administrator for this Plan, and as such, shall have the authority to control and manage the operation and administration of the Plan. The Administrator has designated in writing the Director of Human Resources to carry out duties under the Plan.

The Board of Trustees reserves the right to modify or discontinue the Plan at any time.

Revised October 3, 2013.
Revised December 3, 2008.
Revised July 1, 2008.
Revised February 13, 2007.
Revised July 30, 2003.
Vice President for Finance and Business Affairs.

Note: The Rhodes College Handbook is not a contract of employment, nor should it be construed to create a contract with the College. Rhodes reserves the right to make future changes to its policies, practices, and fringe benefits. If such changes occur, the College will inform employees of such changes and their effect, if any. If you have questions, please contact The Rhodes Human Resources Department at hr@rhodes.edu.