General Questions
Health Plan
Vision Plan
Dental Plan
Life & Disability Insurance
Spending Accounts
Health Savings Account
Q: What will Cooper do to help me prepare open enrollment?
A: Cooper is committed to providing the tools and information you need to understand the Health & Well-Being program and to participate in open enrollment. An enrollment guide was sent to you recently to outline the price tags and flex allowances, provide you with complete enrollment instructions and highlight any new aspects of the Benefit program. You also received a Personalized Enrollment Worksheet (PEW) listing your benefit options. Additionally, we are again providing a call center where you can obtain answers to your enrollment questions and help to enroll.
Q: Can I speak to a live person when I call the Cooper Spectrum Benefits Call Center?
A: If you need assistance or have enrollment questions, you can contact a Cooper Spectrum representative at the call center during the open enrollment session each fall between 11:00am and 7:00pm. Or you may access the open enrollment website https://hrms.sequent.biz.
Q: What if I don't have Internet access at home?
A: Most local libraries offer free public access to the Internet or you can enroll by calling toll-free 1-888-474-1148.
Q: Is the Mac computer compatible with the Sequent system?
A: No.
Q: What if I change my mind about my enrollment choices?
A: You may change your coverage choices as many times as you wish during the open enrollment period. However, after open enrollment is closed, you cannot change your benefit coverage until next year's open enrollment - (Dental and Vision Plan coverage can only change every two years). You can make changes only if you have a qualified status change. You experience a qualified status change if:
Q. When a married couple are both Cooper employees who should sign up the family for dental and vision coverage? And does the person who opts out get the dental opt out flex allowance?
A. The birthday rule applies to both dental and vision for purchasing coverage for dependent children. The second birthday Cooper spouse should make the decision regarding employee only coverage for themselves depending on how they want to spend their dental and discretionary flex allowance. The Cooper spouse who opts out of dental will receive the $60 flex allowance to spend on other benefits.
Q: What if my spouse also is a Cooper person?
A: To ensure consistency in how our plans are administered, Cooper people who are eligible to participate in the Spectrum Health & Well-Being Program can be covered as both an employee and a dependent. Our goal in establishing the following guidelines is to be as fair as possible. The Cooper person with the birth date earliest in the year will be responsible for covering the entire family for medical coverage. The other Cooper person will have the opportunity to enroll in the remaining plans as they choose. It is also important to note that since a Cooper person can not be both an employee and a dependent, that neither Cooper person can cover their spouse for dependent life. These guidelines ensure that all Cooper people are treated the same and that a family unit does not have to incur additional expenses (i.e. higher deductibles and co-payments) simply because they are married to another eligible Cooper person.
Q. If a spouse/child is insured through another company that does not offer dental, vision, or a prescription card, can we choose coverage for those specific items only?
A. Dental and Vision - Yes. Medical and prescription benefits come tied together. An employee cannot buy prescription coverage only.
Q. How is age used in determining flex allowances?
A. Age will only be used in calculating the flex allowance for life insurance since the cost of purchasing the insurance also increases as you get older. The flex allowance for life insurance will be equal to the cost of purchasing one times (1x) your annual salary.
Q. Will flex allowances be re-calculated each year based on changes to your base pay?
A. Where flex allowances are tied to base pay we will use your base pay in effect on September 1 of each year.
Q: Is there a possibility that Cooper will change my benefits?
A: : As with any employer, Cooper does reserve the right to change its benefit plans at any time. We are continuously looking at our benefits to provide affordable access to Health & Well-Being benefits that meet the needs of you and your family and, at the same time, help strengthen our competitive position in the marketplace.
Q. Is birth control covered?
A. Oral birth control is covered by mail order prescription only. In office administered injections are covered under medical plan provisions. This coverage is for employees and spouses only. Birth control for dependents will need to be certified as medically necessary.
Q. Are diabetic supplies covered?
A. Insulin and needles are covered through the prescription drug plan. Lances and test strips are covered through the medical plan.
Q. Are the 6-month check-ups covered under adult preventive testing?
A. No. The 6-month check-ups are considered "diagnostic" and not considered preventive testing.
Q. Does the medical plan cover dependent pregnancy?
A. No.
Q. Do we have to show proof of college enrollment again even if we already did last year?
A. Yes.
Q. Do health care facilities have a number to call to verify coverage?
A. Yes, the name and phone number for Health Design Plus is on your identification card.
Q. What is the web address for Blue Cross Blue Shield (Anthem)?
A. It is www.anthem.com. To find a provider in the Anthem network, click on Provider, and then click on Find a Doctor
Q. Are my claims sent to Blue Cross Blue Shield (Anthem) for processing?
A. . No. All claims will be forwarded directly to Health Design Plus for repricing and processing payments and Explanation of Benefit forms.
Q. What is the advantage of using an in-network doctor?
A. Providers that are participants in the network have agreed to a fee schedule for covered services. Therefore, there will not be charges that are excluded as above reasonable and customary charges.
Q. My physician is not a member of the PPO in my area, how can he be added?
A. Human Resource Departments have a nomination form available for Cooper people to complete and submit to Health Design Plus to nominate their physician. This form is also available on CooperSpectrum.com under the "Get Doctor In Network" link.
Q. How will Chiropractic Visits be covered?
A. Chiropractic services will be covered to a maximum of $1000 per year. This includes x-rays and manipulations. These services are paid as out-of-area unless the chiropractor is a member of your network. Co-pays do not apply to chiropractic visits, however plan deductibles apply.
Q. Can both Cooper spouses carry insurance on the children?
A. There would be no benefit to doing so.
Q. Is pre-certification required from Health Design Plan before medical surgeries?
A. Yes. There is also a list of other procedures requiring pre-certification in the summary plan description. If you fail to obtain pre-certification, there is a $250 fee.
Q. Is Lasik surgery covered under the medical plan?
A. No.
Q. Can you use your Health Care Spending Account to pay your medical charges that are above Reasonable and Customary?
A. Yes.
Q. Can you give me more information about going to a doctor "in-network" and how charges are paid?
A. An employee's home zip code governs in which network he/she is a member. If the employee goes outside his/her specific network to a doctor, the charges incurred will be adjudicated at the out-of-network level even if the doctor is a member of one of the four other Cooper networks.
Q. Is Medicaid considered "other insurance" for the purpose of an employee opting out of Cooper's medical plan?
A. Medicaid is generally not considered "other insurance" for purposes of opting out of a medical plan. In addition, fulltime employees generally will not have spouses eligible for Medicaid.
Q. If a person travels internationally, how are claims handled for medical expenses incurred in another country?
A. The employee pays the bill at the time he/she receives services, and then submits the bill for direct reimbursement in accordance with appropriate deductibles/co-pays. Deductibles/copays will be in accordance with the coverage level the employee has chosen during enrollment. (Note: This direct reimbursement is required outside the U.S. since foreign health care providers don't have U.S. identification numbers for processing claims. In case of major or extensive emergency services needed outside the country (involving greater expense than a person could be expected to cover), contact Jill Knack in Findlay to make special arrangements.
Q. Can a disabled employee collect both LTDI and Disability retirement benefits?
A. LTDI benefits are coordinated with any payments received for retirement or workers comp.
Q. How many hours does a person have to work to be eligible for health care coverage?
A. A person must be considered a fulltime employee to be eligible for health care coverage.
Q. For reimbursement purposes, what year is an eligible Health Care Spending Account expense reimbursable?
A. The year in which the expense is incurred or through March 15 of the following year. There will be 90 days after March 15 in which you can file the claim for expenses incurred the previous year. Should you terminate your employment and not elect to continue contributing to your Health Care Spending Account through COBRA, you may only submit claims incurred up to your termination date for that year. If you do elect to continue contributions you may continue to submit claims.
Q. Is evidence of insurability required for children with pre-existing conditions?
A. Not for the medical plan.
Q. How does medical deductible work when an employee has a mix of in-network and out-of-network providers?
A. Out of network deductibles will apply when you use out-of net work doctors, but the deductible will also be added together. For example, if you elected the Basic PPO and you had already accumulated $800 worth of deductibles for your family, and then one of your family members went to an out-of-network doctor, there would be additional deductible to be met between $800 and $1600.
Q. Do co-pays under the Consumer Choice option apply to Deductibles and Maximum Out-of-Pocket Limit?
A. Under the Consumer Choice option there are no co-pays, only coinsurance. Coinsurance does apply to the maximum out of pocket limit.
Q. Does the $2 million lifetime limit apply to each individual or the family?
A. Each individual has a $2 million lifetime limit.
Q. When my spouse works full-time for another company that offers medical insurance, what are the rules that apply to my selection of flex plans and the processing of claims?
A. As long as your spouse's company contributes any portion of the cost of the medical coverage, your spouse must choose his/her employer as primary coverage for themselves. You may choose to be covered by either Cooper or your spouse's medical plan for your primary coverage. Please use caution, however, and be absolutely sure your spouse's medical plan will accept you for primary coverage before you choose to "opt out" of Cooper 's medical plan. If you choose to "opt out", Cooper assumes that you have medical coverage elsewhere.
Q. If the doctor prescribes "name brand" drugs, do I have to pay the higher "brand" charge?
A. Yes.
Q. Do 30-day drugs purchased at a retail store apply toward the deductible?
A. They would only under the Consumer Choice option if the drugs were processed through the Plan.
Q. Would drugs that are considered "preventative drugs" still be considered preventative is taken after a related medical event?
A. Yes. Medco does not consider the diagnosis when dispending the drug. They refer to the preventive drug list and the name of the medication.
Q. Do you have to co-pay the brand cost of a prescription if no generic is available, or only if you demand to get the brand name?
A. Even if only a brand name drug is available you will need to pay the percentage applicable to brand name drugs. However, if a generic option is available but you choose a brand, you must pay the generic copay plus the cost difference between the brand and generic drugs. This also applies if a generic is available but your doctor has indicated dispense as written (DAW) on the prescription.
Q. Does a person need proof of insurability to return to a plan, i.e. I went under my spouse's plan previously, but now need to come back to ours.
A. Evidence of insurability is not needed for the medical plan.
Q. What if my spouse loses his/her coverage?
A. If your spouse loses medical coverage because he/she terminated employment (voluntarily or involuntarily), that would be considered a qualifying life event and you would be able to then enroll him/her in Cooper's medical plan with the assistance of your local HR representative.
Q. How does coordination of benefits with the PPO programs work?
A. Coordination of benefits is the same no matter which Health Plan you select. For the coordination of benefits, Cooper will be using a method called "carve out". Using an example: Let's say the charge for a procedure is $100 and the spouse's primary coverage pays $80 of the $100 charge. (For the sake of simplicity, let's ignore deductibles in this example). If under Cooper's plan $80 was the amount that would have been paid, Cooper's health plan will not pay any of the remaining $20 as secondary coverage. If your spouse's plan paid $70, and Cooper's plan would have paid $80, the Cooper's health plan will pay $10 as secondary coverage ($80-$70 = $10.00)
Q. To what age will children be covered under the employee+ dependent plan?
A. Age 19 unless a full-time student. If a full-time student - to age 25.
Q. Are adult physicals, pap smears, and mammograms covered?
A. Yes.
Q. Are there other co-pays besides office visits?
A. Co-pays apply to charges for primary physician office calls, specialists' office call, inpatient hospital stays, emergency room visits and use of urgent care facilities.
Q. Are well baby immunizations covered?
A. Well baby immunizations are covered through age 4.
Q. Is there a discount for non-smokers?
A. Yes there is a Tobacco-Free credit available. Please see your Benefits Enrollment Guide for more information.
Q. What happens when you're traveling & you're away from your normal area? Do you fall under the "out of area" category if there isn't a doctor who participates in the network?
A. If you are traveling and your need was a true emergency, procedures will be reimbursed as if you went to an in-network doctor or hospital. (Assuming you were enrolled in one of the PPO plans.)
Q. Does an office visit cost $25, or $25 plus the applicable co-pay?
A. The $25 is the co-pay for primary care. If you go to an in-network doctor $25 is all you would pay for the charges billed as the office call. For a specialist, the co-pay is $35.
Q. Is there an appeal process for medical claims?
A. Yes. Please refer to the instructions in your summary plan description.
Q. Please describe how the Birthday Rule works. Is there an appeals process for exceptional situations?
A. Primary coverage for natural, dependent children is to be obtained by the spouse with the earliest birthday in the year. Yes, there is an appeals process. Please refer to your summary plan description.
Q. If both spouses work here, can they both carry dependent vision insurance so they can have their eyes checked every year?
A. No. The birthday rule and spousal coverage rule applies to Vision Insurance also.
Q. Does the vision care benefit co-pay apply to exams and materials?
A. A $5 co-pay applies to the exam, a $10 co-pay applies to a covered selection of frames and lenses.
Q. How are disposable contacts paid for?
A. There is a set amount available to pay for contacts in total. From that total, VSP subtracts the cost of evaluation and fitting and then any money left from that goes toward the cost of either regular or disposable contacts.
Q. Is oral surgery covered under dental or medical?
A. Oral surgery, including partial or complete bony impacted wisdom teeth, is covered under the medical plan. Procedures such as x-rays, extractions and root canals are covered under the dental plan only. Routine or soft tissue extractions of wisdom teeth are also covered under dental. For additional information, please refer to page 29 in your Summary Plan Description.
Q. What is considered preventive, basic, and major under dental?
A. Preventive is two routine exams, cleanings and one fluoride treatment per year. Basic is fillings, diagnostic tests, root canals, and stainless steel crowns. Major is dentures, bridgework, all other crowns, and caps. Sealants are not covered.
Q. Is orthodontia included in the yearly per person maximum?
A. No, orthodontia is a separate lifetime maximum (covered up to age 19 only). The maximums by option are as follows:
Option I - $750/ yr for regular dental/Orthodontia Lifetime is $750
Option II - $1500/yr for regular dental/Orthodontia Lifetime is $1500
Q. Is precertification of dental benefits required?
A. No.
Q. Are there in network dentists?
A. Dentists are not part of any of our network plans.
Q. Is there coordination of benefits in the Dental Plan?
A. Yes.
Q. If one Cooper Spouse purchases family dental, does the other Cooper spouse having elected no coverage, get to use the $60 flex allowance to purchase other benefits?
A. Yes.
Q. Does the birthday rule apply for dental insurance?
A. No.
Q. How does the two-year lock work?
When you choose dental coverage for you and you and your specific dependents, your choice is locked for two years. If during open enrollment you add a dependent to your dental plan, that dependent plus you are now locked for the next two years.
Q. Since the dental plan is a 2-year commitment, will the flex allowance and employee cost be frozen for both years?
A. No, the cost could go up or down as well as the flex allowance.
Q. Is there open enrollment without proof of insurability every year?
A. Directly enrolling for the first time in Employee Life/AD&D at 4 x annual base salary or any coverage amount over $750,000 will require Evidence of Insurability (EOI) before your choice can be accepted.
Cooper people already enrolled in Employee Life/AD&D may increase coverage by one level without EOI. This also applies to Employee Life/AD&D increasing from 3x to 4x base salary. EOI is required, however, to move up more than one level for Employee Life/AD&D coverage.
When EOI is required, you'll automatically receive the next lowest coverage level available while your EOI form is being approved. An EOI form will be included with your confirmation statement, and you will need to complete and return it in the envelope provided.
Q. Are there any Evidence of Insurability (EOI) requirements for the Long Term Disability Plan?
A. You may increase your Long Term Disability coverage one level (from 50% of annual base salary to 66 2/3%) without Evidence of Insurability (EOI), but you must have EOI to move from No Coverage to the 66 2/3% coverage level. New hires can enroll into either coverage level without EOI.
If you are enrolling for the first time, a pre-existing condition exclusion applies. This means that benefits will not be paid for any disability caused by a medical condition that existed before your coverage began until you have gone three months without needing treatment for that condition or you have been enrolled for 12 months, whichever occurs first. This same provision applies for increasing coverage from the 50% to the 66 2/3 % level.
When EOI is required, you'll automatically receive the next lowest coverage level available while your EOI form is being approved. An EOI form will be included with your Confirmation Statement, and you will need to complete and return it in the envelope provided.
Q. Is imputed income being calculated for dependent life insurance benefit amounts?
A. No.
Q. Are employees on severance eligible to enroll for LTD benefits?
A. No.
Q. On the Life/AD&D plan, does the amount increase if death happens while on company business?
A. Cooper will provide Business Travel Insurance at no cost. If a Cooper person dies in an accident while on company business, his/her beneficiary will receive two times base salary.
Q. If a medical exam is required for Evidence of Insurability, who will pay for the exam?
A. In the event Minnesota Life (life insurance carrier) needs medical evidence for evidence of insurability, it will be at Minnesota Life's expense.
Q. Can you choose to have $75,000 of spouse coverage under dependent life and $15,000 of child coverage?
A. Yes, as long as the spouse's total does not exceed 50% of what you purchased for yourself.
Q. Can an employee purchase/participate in Long Term Disability Insurance (LTDI) after age 65?
A. No, the program is set up to terminate at that age.
Q: If I participate in a spending account, can I submit a claim for more than the amount I have in my account?
A: For a Health Care Spending Account, yes, as long as it is less than or equal to the total you have chosen to contribute for the that plan year. For a Dependent Care Spending Account, however, you can only be reimbursed up to the amount in your account at that time, according to current IRS regulations.
Q. If my spouse's employer also offers HCSA, can we both contribute $5,000 per year or must it be a total of $5,000?
A. You can both contribute to your company maximum.
Q. How do you get reimbursed from a health care spending account?
A. There are two methods to be reimbursed from your HCSA: paper submission or automatic reimbursement. To submit by paper, you can obtain the appropriate form on the Cooper Spectrum website or from your local HR office, attach your Explanation of Benefits (EOB) or receipt and send it to Health Design Plus. For automatic reimbursement for your doctor's visits, medical procedures or prescription drugs, you can choose automatic reimbursement at the time you enroll in the HCSA. Dental, vision and eligible over-the-counter drugs will still require paper submission for reimbursement.
Q. How do you get reimbursed from the dependent care spending account?
A. Reimbursement forms are available on the Spectrum web site and at your local HR office.
Q. What are the eligible expenses that can be reimbursed by the spending accounts? What is excluded?
A. Eligible expenses are determined by the IRS. IRS information on eligible expenses can be obtained by going to www.irs.gov and then going to Forms and Publications and then Publication 502.
Q. Can the Health Care Spending account be used toward the employee's portion of coverage beyond the company flex allowance? Or is the employee's portion already pre-tax?
A. The employee's cost is already paid for with pre-tax dollars.
Q. What is The Benny Card's web address?
A. The web address is www.mybenny.com.
Q: What is a Health Savings Account?
A: A HSA is a tax-exempt trust or custodial account that you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. A qualified HSA trustee can be a bank, an insurance company, or anyone already approved by the IRS to be a trustee of individual retirement arrangements. AN HSA is "portable" so it stays with you if you change employers or leave the work force.
Q. I participate in a Health Savings Account, can I submit a claim for more than the amount I have in my account?
A. No. You can only use what is the current balance in the account, just like a regular checking or savings account.
Q. What is the website for HSA Bank?
A. It is www.hsabank.com. We are discontinuing our relationship with HSA Bank effective December 31, 2008.
Q. What is the website for Principal Bank?
A. A. It is www.principal.com.
Q. Are there any fees to move funds from regular accounts at HSA Bank to The Principal?
A. No, there are no fees.
Q. Can a Cooper employee open an HSA if his spouse, who has insurance coverage through her employer, does not have access to an HSA?
A. No. An employee may enroll in the Consumer Choice (which is a high deductible health plan - HDHP) and his spouse may enroll in a non-HDHP at her employer. However, the employee cannot cover the spouse on his plan and vice verse and be eligible for the HSA.
Q. What are the eligible expenses that can be reimbursed with the Health Savings Account? What is excluded?
A. Eligible expenses are determined by the IRS. IRS information on eligible expenses can be obtained by going to www.irs.gov and then going to Forms and Publications and then Publication 502.