Employee Benefits Handbook
Table of Contents Page Number
Health Insurance 2
- Open Enrollment 2
- Eligibility and Participation 2
- Domestic Partner Coverage 2
- Enrollment Points to Consider 3
- CIGNA Comprehensive/PPO Plan 7
- CIGNA HealthCare (POS) Plan 7
- Kaiser Permanente 7
- Health Plan Comparison Guide 8
- Frequently Asked Questions 11
Dental Plans 12
- Delta Dental Indemnity/PPO Plan 12
- Schedule of Dental Benefits 13
- Delta Care USA Dental Care Plan 14
- Frequently Asked Questions 14
Enrollment – Points to Consider 10
Life Insurance 14
Accidental Death and Dismemberment Insurance (AD&D) 16
Optional Term Life Insurance 16
Dependent Term Life Insurance 18
Long-Term Disability 18
Flexible Spending Accounts 18
- Health Care Spending Account 20
- Dependent Care Spending Account 21
Group Legal Benefit 22
- Summary of Services 23
- Non-Attorney Costs 26
- Personal Injury 25% Contingent Fee 26
- National Protection Rider 27
- Master Plan Exclusions 27
- Expanded Coverage Rider 27
Vision Plan 28
- Frequently Asked Questions 29
Long Term Care Insurance 31
- Level Premiums 31
- Portability 32
- Additional Base Plan Features 32
- Optional Features 32
- Qualifying for Benefits 32
- Rates 33
- Frequently Asked Questions 35
Accomodations under ADA 41
Workers Compensation 41
Unemployment Insurance 42
Continuation of Health/Dental Benefits 42
- COBRA 42
- Retirement 43
Health Information Privacy Notice 44
Leave Policies 49
- Annual Leave 49
- Sick Leave 49
- Personal Leave 50
- Holiday Leave 50
- Special Leaves with Pay 51
Court Attendance 51
Annual Military Reserve Training 52
Professional Meeting 52
Professional Development Leave 52
Administrative Leave 52
- Leave Without Pay 52
- Family and Medical Leave 53
- Disability Leave 54
Retirement Programs 55
Supplemental Retirement Annuities (SRA’s) 56
Professional Development and Training 57
- External Opportunities 58
- Internal Opportunities 60
Tuition Waiver – Employee Only 62
Tuition Waiver – Dependent/Spouse 62
Frequently Asked Questions 63
MC Wellness Connection 64
Diversity Program 65
Faculty/Staff Assistance Program 66
Payroll Information 67
- Tax Forms 68
- Direct Deposit 68
- Bonds 68
- Credit Union 68
- Time Sheets 68
- Pay Sheets 68
Facilities and Services 68
- Bookstore 68
- Automatic Teller Machines 69
- Library 69
- Paydays 69
- Parking 69
- United Buying Service 69
Office of Human Resources Web Sites 70
Office of Human Resources Directory 72
Employee Benefit Vendor Contact Information 74
Delta Dental Privacy Notice 75
This Employee Benefits Handbook has been created to provide a reference manual of benefits available at Montgomery College (the “College”).
Much of the information contained in this Handbook may be subject to change at the sole discretion of the College and without prior notice, and
may, at any time, be superceded by changes in the Collegewide Policies and Procedures Manual, collective bargaining agreements, Maryland
state law, external legal requirements, or other current, official College documents. Consequently, this Handbook cannot be considered binding.
This Handbook should not be construed as constituting a contract, express or implied, between the College and any person. The College may
issue supplements at its sole discretion.
Readers should use this Handbook solely as a reference document, recognizing that it is not always the most authoritative or complete source of
information. All employees are encouraged to use this Handbook in conjunction with current editions of other important College publications and
documents, particularly the Collegewide Policies and Procedures Manual and any applicable collective bargaining agreement. Although this
publication has been carefully reviewed for accuracy and currency, where there is a conflict between any official College documents and any
summary of such documents, which may appear in this Handbook, the provisions of the official document shall apply.
Attention – Medicare-Eligible Participants:
If you have Medicare or will become eligible for Medicare in the next 12 months, a new federal
law gives you new choices about your prescription drug coverage, starting in 2006. Please refer
to Page 4 of this booklet for a special notice about this new Medicare prescription drug
Full-time and Part-time, Regular and Temporary with Benefits Employees
The Open Enrollment period for calendar year 2008 will be November 2, 2007 through November 30, 2007 for a January 1, 2008 effective date.
Generally, you cannot change your election or vary the benefits you have selected during the entire Plan Year (January 1 through December 31,
2008) outside of Open Enrollment, except in cases of a change in your family status. Please refer to the section entitled “Enrollment - Points to
Consider” on page 3 for the rules relating to these types of changes.
Montgomery College offers a variety of high quality and affordable medical and dental benefit plans. You may elect to enroll in one of the three
medical plans and/or two dental plans described below.
Eligibility and Participation
All full-time and part-time regular and temporary with benefits employees (and their dependents) are eligible to participate in the health benefit
plans described in this booklet. You and the College share in the cost of the plans. Your bi-weekly contribution varies depending upon the plan
you elect. If you are enrolling for the first time or changing your coverage, you will also need to complete the Montgomery College Group
Insurance Enrollment Form.
Newly hired employees are eligible to participate in the benefit plans on the first of the calendar month following employment date, provided the
enrollment forms have been completed and received by Human Resources by the last day of the month in which they were hired. Newly hired
employees must complete, sign and return their Enrollment Forms(s) to the Office of Human Resources within 31 days of employment. Failure to
return the enrollment form within 31 days will preclude participation in this Plan until the next, or any subsequent, open enrollment period.
Copies of birth certificates and marriage certificates are required to add dependents (spouse and children) to group health, dental, and vision
insurance plans. Certificates for dependents must be submitted within three months of your hire date, or insurance coverage for dependents will
be terminated. Once coverage is terminated it cannot be reinstated until the next open enrollment period.
Domestic Partner Coverage
Effective January 1, 2006, the College’s health, dental, and vision insurance contracts were amended to allow same-sex domestic partner
coverage. To establish an eligible same-sex domestic partnership, an employee and the partner must satisfy all of the following requirements:
be the same sex;
share a close personal relationship and be responsible for each other’s welfare;
be at least 18 years old;
have voluntarily consented to the relationship, without fraud or duress;
not be married to, or in a domestic partnership with, any other person;
not be related by blood or affinity in a way that would disqualify them from marriage under State law if the employee and partner
were opposite sexes;
be legally competent to contract; and
share sufficient financial and legal obligations.
Domestic partners are not eligible for this benefit (as they do not qualify as a dependent under the IRS Tax code).
To enroll a same-sex domestic partner, the employee and his or her partner must execute an Affidavit for Same-Sex Domestic Partnership (found
on the Open Enrollment Website) and attach all required evidence and documentation, as well as complete a Group Insurance Enrollment Form
and any other necessary enrollment forms. Documentation of the domestic partner relationship consists of the following:
Evidence that the employee and his/her partner share items described in at least two (2) of the following:
a joint housing lease, mortgage, or deed;
joint ownership of a motor vehicle;
a joint checking or savings account;
designation of the partner as a primary beneficiary of the employee’s life insurance, retirement benefits, or residuary estate under a
designation of the partner as holding durable power of attorney for health care decisions regarding the employee.
The Internal Revenue Service regulations require different tax treatment for group insurance costs associated with domestic partner coverage in
cases where the partner does not quality as a tax dependent under the IRS Code (in determining the tax effect of domestic partner coverage, the
College will assume that neither the domestic partner nor the partner’s eligible dependent qualify as tax dependents, unless provided
documentation to the contrary).
Enrollment - Points to Consider
Newly hired employees who elect coverage are eligible effective the first of the month following the month of employment. Certain changes in
your family status may make you eligible to modify your benefit coverage before the end of the Plan Year. These changes include:
Marriage, legal separation, or divorce
Death of a spouse or child
Birth or adoption of a child
Dependent child reaches plan’s maximum age limit
Dependent child becoming eligible or re-eligible for coverage
Dependent child going to College out of state
Loss of your spouse’s job
Adding or dropping coverage through your spouse’s plan during its open enrollment (i.e., during the thirty (31) day period beginning
with the first day of your spouse’s open enrollment period.
In all cases, you MUST notify the Office of Human Resources of your change of status, AND complete new enrollment forms within thirty-one (31)
days of the event. Failure to notify the Office of Human Resources of a change in your family status may result in a denial of coverage.
Documentation for adding or dropping coverage because of your spouse’s open enrollment or your spouse’s change of employment is required as
well as copies of birth and marriage certificates, if adding dependents to the plans.
Special note when adding a new baby: Even employees who already have family coverage must notify the Office of Human Resources and
complete new forms to add children born or adopted during the Plan Year within thirty-one (31) days of the birth or adoption. Failure to notify the
Office of Human Resources of a newborn or newly adopted child will result in a denial of coverage for that child.
Employees ending their employment with Montgomery College are covered through the last calendar day of the month in which they were actively
Employees on leave of absence without pay are responsible for paying both the employee and employer cost for benefits for the duration of their
leave. If payment is not received prior to the 15 of the month needing coverage, coverage will be canceled promptly. However, employees on
leave of absence under the Family and Medical Leave Act (FMLA) are eligible for an employer contribution to health insurance. Employees going
on leave of absence without pay should contact the Office of Human Resources for further details.
Important Notice from Montgomery College About Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current Montgomery College
prescription drug coverage and the new prescription drug coverage available January 1, 2006 for people with Medicare. It also tells you
where to find more information to help you make decisions about your prescription drug coverage.
Starting on January 1, 2006, new Medicare prescription drug coverage (also known as Medicare Part D) will be available to everyone with Medicare.
Montgomery College has determined that the prescription drug coverage offered by the Montgomery College Plan is, on average for all plan
participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay.
Read this notice carefully - it explains the options you have under Medicare prescription drug coverage, and can help you decide whether or not you
want to enroll.
About Medicare Part D
You may have heard about Medicare's new prescription drug coverage, and wondered how it would affect you. Montgomery College has determined
that your prescription drug coverage under the Montgomery College Plan is, on average for all plan participants, expected to pay out as much as the
standard Medicare prescription drug coverage will pay.
Starting January 1, 2006, prescription drug coverage will be available to everyone with Medicare through optional Medicare prescription drug plans.
All Medicare prescription drug plans will provide at least a standard level of coverage set by Medicare. Some plans might also offer more coverage
for a higher monthly premium.
When You Can Enroll
People with Medicare can enroll in a Medicare prescription drug plan from November 15, 2005 through May 15, 2006. However, because you
have existing prescription drug coverage that, on average, is as good as Medicare coverage, you can choose to join a Medicare prescription drug
plan after May 15, 2006 and not pay a late enrollment penalty. Each year after that, you will have the opportunity to enroll in a Medicare prescription
drug plan between November 15 through December 31 .
If you do decide to enroll in a Medicare prescription drug plan, your prescription drug coverage under the Montgomery College may be affected.
If you drop your coverage with Montgomery College and enroll in a Medicare prescription drug plan, you may not be able to get this coverage back
later. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare
prescription drug coverage in your area.
In addition, your current coverage pays for other health expenses, in addition to prescription drugs, and you will not be eligible to receive all of your
current health and prescription drug benefits if you choose to enroll in a Medicare prescription drug plan.
Late Enrollment Fee
You should also know that if you drop or lose your coverage with Montgomery College and don't enroll in Medicare prescription drug coverage after
your current coverage ends, you may pay more to enroll in Medicare prescription drug coverage later.
If after May 15, 2006, you go 63 days or longer without prescription drug coverage that's at least as good as Medicare's prescription drug
coverage; your monthly premium will go up at least 1% per month for every month after May 15, 2006 that you did not have that coverage. For
example, if you go 19 months without coverage, your premium will always be at least 19% higher than what most other people pay. You'll have to
pay this higher premium as long as you have Medicare coverage. In addition, you may have to wait until next November to enroll.
For More Information
For more information about this notice or your current prescription drug coverage, contact:
Social Security Administration at 1-800-772-1213 or www.socialsecurity.gov;
Medicare at 1-800-MEDICARE (1-800-633-4227) or www.medicare.gov; or
Montgomery College Human Resources at (240) 567-5359 or (240) 567-5365.
You may receive this notice at other times in the future, such as before the next enrollment period for Medicare prescription drug coverage, or if
this coverage changes. You also may request a copy of this notice.
You may be contacted directly by Medicare prescription drug plans. You can also get more information about Medicare prescription drug plans
from these places:
Visit www.medicare.gov for personalized help;
Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number); and
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help
is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov, or
call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this notice. If you enroll in one of the new plans approved by Medicare, which offer prescription drug coverage after
May 15, 2006, you may need to give a copy of this notice when you join to show that you are not required to pay a higher premium
CIGNA PPO Plan - PPO Plan
CIGNA HealthCare POS - Point of Service Plan (POS)
Kaiser - HMO
General descriptions of your medical care options are presented below. You should refer to the Montgomery College Open Enrollment Health
Plan Comparison Guide and plan brochures for more detailed descriptions.
The CIGNA PPO provides traditional insurance coverage under which you are reimbursed for covered expenses on the schedule of benefits as
outlined in the Health Plan comparison guide.
Effective January 1, 2001, a Preferred Provider Organization (PPO) network was incorporated into the CIGNA Comprehensive Plan. This change
provides the opportunity for savings to both the College and employees. A national network of preferred providers (physicians, specialists,
hospitals and other facilities) is available to participants. Participants may elect to utilize one of these providers for medical care or they may
continue to use any provider of choice. If the choice is made to use a preferred provider, the cost of the service is based on a negotiated reduced
rate. The participating provider files the paperwork necessary to process the claim and the provider then bills the participant for the coinsurance
due. Basically, the participant is responsible for paying 20% of the negotiated reduced fee as opposed to 20% of the full fee traditionally charged.
Effective January 1, 2008, Cigna will no longer act as the pharmacy benefit provider. A new vendor, Caremark, will administer the prescription
drug benefit for both pharmacy and mail order, for both the Cigna plans. Participants will receive new i.d. cards to be used when obtaining
CIGNA HealthCare POS
This plan provides employees and their families the flexibility to (a) use the plan as an HMO (in-network) by selecting a Primary Care Physician, in
which case services are covered by payment of specific co-pays and/or deductibles, or (b) select their own physician (out-of-network) in which
case the participant pays a greater share of the total cost. When using the plan like an HMO, participants must abide by specific rules concerning
referrals for specialists. If you have any questions regarding specialty services, please call your Primary Care Physician prior to any appointment
with a specialist. Effective January 1, 2008, Cigna will no longer act as the pharmacy benefit provider. A new vendor, Caremark, will administer
the prescription drug benefit for both pharmacy and mail order, for both the Cigna plans. Participants will receive new i.d. cards to be used when
obtaining prescription drugs.
Kaiser Permanente HMO
This is a traditional group model health plan in a clinic-type setting. Medical centers are located throughout the Washington, D.C. metropolitan
area with primary care physicians, specialists, and vital services all under one roof. Kaiser Permanente is fully accredited by the National
Committee for Quality Assurance (NCQA), the industry watchdog group that measures health plan quality and performance.
Health Plan Comparison Guide
CIGNA CIGNA Kaiser
PPO HealthCare (POS) Permanente
Hospital $250 Copay per admission 100% after 100%
Room & Board 80% R&C $250 copay per
Surgery 80% R&C 100% 100%
Anesthesia 80% R&C 100% 100%
Medical 80% R&C 100% 100%
Services after ded.
Diagnostic 80% R&C 100% 100%
Tests after ded.
Special Duty 80% R&C 100% 100%
Nursing after ded.
Drugs and 80% R&C 100% 100%
Medications after ded.
Mental Health $250 Copay per admission 100% after 100%
80% R &C $250 copay per
up to 30 days per CY admission
up to 30 days per CY
PPO – Additional discounts available through Preferred Provider Organization.
R&C - Reasonable and Customary charges
CY - Calendar Year
ded. – Deductible
NOTE: This guide has been prepared to help you compare the benefits available through the various group health plans offered by the College. IT IS
ONLY A SUMMARY. For specific coverage, limitations, and exclusions, please consult the literature provided by each company or call the appropriate
member services number.
CIGNA CIGNA Kaiser
PPO HealthCare (POS) Permanente
Office 80% R&C $15 copay $10 copay per PCP visit
Visits after ded. per PCP visit $20 copay for specialist
$20 copay for specialist
Routine Adult 80% R&C $15 copay $10 copay
& Pediatric Exams after ded. per visit (PCP) Per PCP visit
Surgery 80% R&C 100% $20 copay
Diagnostic 80% R&C 100% 100%
Tests after ded.
Prescription $150 deductible, then $10/$20/$40 retail copay $10/$20 generic/brand at Kaiser
Drugs $10/$20/$40 retail copay $20/$40/$80 mail order Pharmacy
$20/$40/$80 mail order copay $16/$32 generic/brand at a
copay generic/formulary/brand Participating Pharmacy
generic/formulary/brand name $10/$20 Mail Order
name Drug Utilization Review
Drug Utilization Review Program
Mental Health After ded., 50% $20 copay visits $20 copay/individual visits
Care R&C up to 20 visits 1-5, $30 copay $10 copay/group visits
per CY, limit 1 visit visits 6-30, $50
per week copay thereafter
Deductible $300 per person N/A* N/A
Maximum $2,000 per N/A* N/A
out-of-pocket person per
100% R&C if pre-admission
Limit does not apply to skilled nursing facilities, pre-certification, mental health care, cost containment penalties and prescription drugs.
* The CIGNA Healthplan has an “optout” feature which allows members to use non-participating physicians under an indemnity benefits structure. See brochure for details.
Effective April 1, 2005, double copay penalty applies on 4 fill at retail level on maintenance medications.
This program ensures appropriate drug therapies for members using prescriptions within the following key areas: Nonsteroidal Anti-inflammatory, gastrointestinal, fungal
infection, migraine and sexual dysfunction.
CIGNA CIGNA Kaiser
PPO HealthCare (POS) Permanente
Routine Eye not covered $5 copay (exam), $20-$75 $10/$20 copay (exam),
Exams reimbursement for 25%/15%
glasses or contacts discount for eyeglasses/
(every 12 months) contacts purchased at
Kaiser Optical Shops
Routine Hearing not covered $20 copay $10/$20 copay
Exams per visit
Allergy Testing 80% R&C $20 copay $10/$20 copay
after ded. per visit
Skilled Nursing 80% R&C 100% for 60 days 100% for
Facility after ded. per CY 100 days per CY
for 60 days per CY
Home Health 100% R&C for 100% 100%
Care 60 visits - then
Hospice Care 100% R&C to 100% 100%
Children until age 19 until age 19 until age 25
Covered as or up to age 23 if a full-time or up to age 23 if a full-time If tax dependent
Dependents student student regardless of student status
Emergency 80% R&C $100 copay $50 copay
Room after ded.
PPO – Additional discounts available through Preferred Provider Organization.
R&C - Reasonable and Customary charges
CY - Calendar Year
ded. - Deductible
ASP - Average semi-private
Frequently Asked Questions – Health Insurance (FAQ’s)
When am I allowed to change health carriers?
Employees are allowed to change health carriers once a year at open enrollment.
What if I get married or have a baby?
Changes in dependent coverage must be made within 31 days of the qualifying event (for example, birth or marriage date). Copies of marriage
and birth certificates are required to add dependents.
How do I change my doctor if I’m in an HMO?
All three of our carriers offer the flexibility to change physicians and this can be done by calling the toll free number listed on your identification
What is a PPO?
PPO stands for Preferred Provider Organization. What this means to you is that there is a list of Doctors that have agreed to charge negotiated
rates for office visits and procedures. These rates are lower than if you go to a doctor that does NOT participate in the PPO. If your doctor
participates in the PPO you will not have to file a claim form. Your doctor will file with CIGNA, CIGNA will pay them the negotiated rate, and the
Doctor will bill you for your portion. If your doctor does not participate in the PPO then you may still see them (as before), you will file claim forms,
and not benefit from the negotiated rates.
If I lose my directory of participating physicians where can I get another book?
The Office of Human Resources has these on hand and will be happy to send you an additional one at your request. If you elected to participate
in the CIGNA HealthCare Plan or the Comprehensive/PPO Plan the directories are available on the Internet. The address is:
Which dental plan allows me to choose my own dentist?
The Delta Dental PPO plan allows you to go to the dentist of your choice.
If I signed up for the CIGNA PPO plan, how do I get reimbursed?
If your doctor participates in the PPO portion of the plan, your doctor will bill CIGNA, CIGNA will pay them the negotiated rate and you will be billed
for your portion. If your doctor does not participate in the PPO a claim form must be completed. These claim forms may be downloaded from the
H.R. website, accessible through My MC. The claim form should be completed, signed, and dated, and any receipts should be attached and sent
to the address on the bottom of the second page of the claim form.
What is a generic drug?
A generic drug is a prescription drug that has the same active-ingredient formula as a brand-name drug. A generic drug is known only by its
formula name and its formula is available to any pharmaceutical company. Generic drugs are rated by the Food and Drug Administration (FDA) to
be as safe and as effective as brand-name drugs and are typically less costly.
What is a formulary listing?
It is a list of preferred, commonly prescribed prescription drugs. These drugs are chosen by a team of doctors and pharmacists because of their
clinical superiority, safety, ease of use and cost.
What is a brand or non-formulary drug?
It is a drug manufactured by a pharmaceutical company that has chosen to patent the drug’s formula and register its brand name.
Each eligible employee has the option to enroll in a dental plan. Effective January 1, 2008, the dental plan carrier is changing to Delta Dental.
Delta Dental PPO Plan
The Delta Dental PPO plan provides traditional dental insurance coverage under which you are reimbursed for covered expenses on the schedule
of benefits as outlined in the certificate of coverage (which may be obtained by calling the Office of Human Resources). This dental plan offers the
flexibility to see the dentist of your choice with a deductible and co-insurance varying depending on the services provided. Please note - annual
maximum dollar limits apply to both restorative and orthodontic/periodontic services.
The Delta Dental PPO Plus Premier network combines the Delta Dental PPO and Delta Dental Premier networks. Three out of four dentists
participate in the Dental Premier network. It is recognized as the largest network in the U.S. Participants can use the plan in three ways:
- Use a dentist who participates in the Delta Dental PPO network (biggest savings to patient)
- Use a dentist who participates in the Delta Dental Premier network
- Use a dentist who does not participate with Delta Dental
Schedule of PPO Dental Benefits
How your dental plan works
Class I Plan pays 100% of R & C
Preventative There is no Deductible
Basic Plan Pays 80% R & C
Restorative You or Your
Pays $50 annual
Major Plan Pays 60% R & C
Orthodontia Plan Pays 60% R & C
You or Your
Pays $50 lifetime
Periodontia Plan Pays 60% R & C
Classes I, II, III Combined
Calendar Year Maximum $2,000.00
Classes IV, V Combined
Calendar Year Maximum $1,000.00
Individual Deductible (Classes II, III) $50.00/annual
Individual Deductible (Classes IV, V) $50.00/lifetime
A person must satisfy these deductible amounts before Dental Benefits are payable.
DeltaCare USA Plan
This plan provides dental coverage under an HMO-like structure. This plan provides coverage based on a predetermined fee schedule with many
basic services being covered at NO CHARGE. There are no patient charges for most preventative procedures, no claim forms, no deductibles
and no annual dollar maximums. Complex procedures are available at low, pre-set patient charges. For further information concerning DeltaCare
USA and the fee schedule, please carefully review the brochure, which will be available at the Benefits Fairs or from the Office of Human
Frequently Asked Questions – Dental (FAQ’s)
Which dental plan allows me to choose my own dentist?
The Delta Dental PPO plan allows you to go to the dentist of your choice.
What is the difference between the two dental plans?
The DeltaCare USA plan is a managed dental care program. There is a list of dentists that must be utilized, and there is a set fee schedule for
services. There are no deductibles or claim forms, only copayments (which vary depending on the services provided).
The PPO Dental plan has a $50 deductible and the flexibility to see any dentist, however claim forms must be completed for reimbursement if
using a non-PPO dentist.
The employee’s share of all health and dental insurance premiums will be paid with pre-tax dollars, as allowed by Section 125 of the Internal
Revenue Service (IRS) code. This means that the health and dental insurance premiums deducted from your paycheck each pay period are not
taxed. Therefore, by electing medical and/or dental coverage, you are also selecting pre-tax health premiums. All Section 125 contributions must
be coordinated with any 403(b) and 457(b) contributions you make to any retirement annuity programs.
Montgomery College offers a group life insurance plan through The Standard that provides a death benefit amounting to two times the employee’s
annual salary, rounded up to the next $500, not to exceed $100,000.00. It is important to be aware that any life insurance valued in excess of
$50,000.00 will be included as taxable income. Seventy-five percent of the cost of the plan is paid by the college and twenty-five percent by the
employee. The basic life insurance provides a waiver of premium provision if you are disabled prior to age 60. Life insurance benefits are
described in the Group Life Insurance Certificate maintained by the Office of Human Resources.
The life insurance plans also include, at no additional cost to employees, a Travel Assistance Program and Beneficiary Assist program (grief, legal
and financial counseling). Employees, their spouses, and eligible dependent children are covered.
What is MEDEX Travel Assist?
It’s a comprehensive program of information, referral, assistance, transportation and evacuation services designed to help you respond to medical
care situations and many other emergencies that may arise during travel (100 miles or more from home or in a foreign country). MEDEX Travel
Assist also offers pre-travel assistance, which gives you access to information on things like passport and visa requirements, foreign currency and
worldwide weather. All services are provided by MEDEX Assistance Corporation, one of the most experienced assistance companies in the United
States. To access the Travel Assistance Plan, please call toll-free from the U.S., Canada, Puerto Rico, U.S. Virgin Islands, and Bermuda: 800-
527-0218. In other locations worldwide, please call collect: 410-453-6330. A list of some of the services that are provided is below:
Medical Assistance Services: Emergency Personal Services: Pre-Trip Information
Locating Medical Care Emergency Message Service Visa, Passport, Inoculation and
Case Communications Credit Card/Ticket Replacement Immunization Requirements
Translation/Interpreter Services Emergency Cash Health Hazards Advice
Medical Repatriation (Return Home) Passport/Document Replacement Temperature and Weather
Emergency Evacuation Locating Legal Assistance/Bail Conditions
Return of Dependent Children Prescription Drug Assistance Embassy and Consular Referrals
Visit from Family Member or Friend Missing Baggage Assistance Foreign Exchange Rates
Medical Insurance Assistance Travel Locator Service
Repatriation of Remains
Hotel Convalescence Arrangements
When a life insurance claim is filed, the beneficiary is sent a booklet of information from The Standard regarding the grief, legal, and financial
counseling services available, along with a phone number to contact.
Note: Employees are eligible to purchase additional life insurance. See Optional Group Term Life.
Accidental Death and Dismemberment Insurance (AD&D)
AD&D is provided to all employees who elect the basic life insurance benefit. Employees or beneficiaries will be paid if an employee sustains
body injuries or loss of life as a result of an accident. AD&D benefits are described in the certificate maintained by the Office of Human
Resources. AD&D benefits are not payable if your death or loss is caused directly or indirectly by:
suicide, whether sane or insane,
physical or mental illness
an act of war
while serving in the military for any Country,
injury while taking part in any crime you commit or attempt to commit,
riding or descending in an aircraft as pilot or crew member, or
bacterial infection or poisoning.
Optional Term Life Insurance
Effective January 1, 2003, employees may purchase optional life insurance in the following quantities:
1 x salary (up to $300,000)
2 x salary (up to $300,000)
3 x salary (up to $300,000)
This benefit is available to all support, associate and administrative staff, working at least 20 hours per week in a regular or temporary-with-
benefits position and full-time faculty.
This program was designed to be flexible and affordable, allowing for additional life insurance protection over the college basic coverage. The
premiums, which have been structured on an age-rated basis, will be deducted from your bi-weekly paycheck.
The premium for Optional Life Insurance Coverage is paid entirely by the employee.
Below are the rates, which will be effective for the period January 1, 2008 through December 31, 2011.
Age Cost per pay period per $1,000 of coverage
26 Deductions 20 Deductions
Under 30 0.0222 0.0288
30 - 34 0.0226 0.0294
35 - 39 0.0263 0.0342
40 - 44 0.0383 0.0498
45 - 49 0.0582 0.0756
50 - 54 0.1002 0.1302
55 - 59 0.1717 0.2232
60 - 64 0.2774 0.3606
65 - 69 0.4357 0.5664
70 - 74 0.6734 0.8754
75+ 1.0186 1.3242
To calculate your pay period cost, take either 1, 2, or 3 x your annual salary and round up to the next $500, then multiply that amount by the
appropriate pay period rate and divide by 1,000.
Example: Employee, age 36, earning $35,253 (on a 26 pay period schedule)
($35,500 x .0263)/1,000 = $0.93 per pay period = 1 x salary Benefit
($71,000 x .0263)/1,000 = $1.87 per pay period = 2 x salary Benefit
($106,000 x .0263)/1000 = $2.79 per pay period = 3 x salary Benefit
Coverage is not automatic if this benefit was not elected during the initial offering or at the time of hire. You must complete an evidence of
Dependent Term Life Insurance
Employees have the opportunity to purchase term life insurance on dependents effective January 1, 2003. To be eligible to purchase dependent
life insurance the employee must also be enrolled in Optional Life Insurance (minimum of 1 x salary benefit). The benefits are paid as follows:
$25,000 - Spouse
$ 5,000 - Per Dependent
The cost of the insurance on the spouse is calculated on the age of the employee, times the volume of life benefit ($25,000). The rates for
dependent life insurance are the same as the optional term life insurance rates (please reference the chart above). The child rate is $.0222 (staff),
The premium for Dependent Life Insurance Coverage is paid entirely by the employee.
Example: Employee, age 36 (on a 26 pay period schedule, $35,000 Life Insurance Benefits ($25,000/spouse, $5,000/dependent 1,
$5,000/dependent 2 = $35,000)
($25,000 x .0263)/1,000 = $0.66 per pay period
($10,000 x .0222)/1,000 = $ .22
Total $0.88 per pay period
To be eligible an employee must complete six months of continuous service. The benefit is 60% of your base monthly salary to a maximum of
$5,000/month, payable after 12 months of total, continuous disability, until age 65.
Flexible Spending Accounts
There are two kinds of spending accounts available to Montgomery College employees. One is for health care expenses, and the other is for
dependent care expenses. Both accounts permit you to be reimbursed for certain expenses with money that is tax-free. You may set up either
account, just one, or none. Participation in the Health Care Flexible Spending accounts may only be elected during the Open Enrollment
period. New employees hired must wait until the next Open Enrollment period to enroll in this benefit. New employees may elect to
participate in the Dependent Care Flexible Spending Account at the time of hire. You may participate in a health care reimbursement
account even if you do not elect health, dental or vision care through the College.
Health Care Reimbursement Account Limit - $4,000.00 *NEW HIGHER LIMIT FOR 2008*
Dependent Care Reimbursement Account Limit - $5,000.00 (Married filing joint & single)
- $2,500.00 (Married filing separate)
If you set up an account, pre-tax dollars are deducted from your paycheck in equal installments 26 or 20 times a year depending upon your pay
Please note, that elections to participate in the Health Care and/or Dependent Care Accounts MUST be made on an annual basis. Enrollment is
only available on-line through the Office of Human Resources Open Enrollment web-site. The deadline for enrolling is Friday, November 30,
Important Information for Flexible Spending Accounts
You may only be reimbursed for expenses you incur during the plan year.
These are “use it or lose it” accounts. The money you contribute to your account may only be used for eligible expenses.
If you do not use all the money in an account by the end of the plan year (calendar year), it cannot be returned to you or
carried over to the next year. If you estimate your expenses carefully, you can save money and lose nothing.
You have 90 days after the close of the plan year to submit receipts for reimbursement. At the end of the 90-day period
(March 31) after the plan year, any money that remains in the account will be forfeited.
You cannot modify the amount you decide to contribute to an account until the next open enrollment period, unless you
have a change in family status and submit the proper documentation.
You may not transfer money from one account to the other.
Reimbursement checks will be cut on a weekly basis.
Employees can select to have payments direct deposited into a checking or savings account or if they prefer, a check can
Employees can check claim status at www.myflexonline.com
Claim forms can be faxed directly to BeniSource at the following fax number: 800-584-4185 or mailed to the following address:
310 First Street
Roanoke, VA 24011
Health Care Spending Account
Begin by anticipating the eligible health care expenses you will have during the coming year. You may use your health care account to be
reimbursed for medical and dental expenses that are not fully covered by your medical and dental plans. These include deductibles and
copayments, expenses not reimbursed for orthodontics, vision, hearing and other services, over-the-counter medications, and any other health
care service which would qualify as a medical deduction under IRS rules. Some examples are weight loss or smoking cessation programs
prescribed by your physician, special medical equipment, transportation for special medical services under certain circumstances, etc.
Eligible health care expenses may be for you, your spouse, or your eligible dependents – even though they may not be eligible for coverage, as
long as you claim them as dependents on your federal tax return. However, please keep in mind that medical and dental premiums under the
College benefits program are already excluded from your income and not eligible for reimbursement. Also, premiums paid toward coverage under
your spouse’s employer’s medical and/or dental plan and expenses incurred for cosmetic surgery are not eligible for reimbursement. The
following illustration shows you how a health care reimbursement account actually increases your spendable income (taken from BeniSource brochure).
Without Flexible Spending With Flexible Spending
Gross Monthly Salary $2,500 $2,500
Less pre-tax medical expense $0 $100
Less pre-tax dependent care expense $0 $400
Adjusted taxable salary $2,500 $2,000
Less Federal Taxes $375 $300
Less State Tax $175 $140
Less FICA Tax $191 $153
Less after tax medical expense $100 $0
Less after-tax dependent care expense $400 $0
Monthly Spendable Income $1,259 $1,407
By taking advantage of both Flexible Spending Accounts this employee is able to increase his spendable income by $148 per month for annual tax
savings of $1,776.
A few examples of reimbursable expenses, which are commonly considered, are medical and dental plan deductibles, co-insurance and co-
payments, routine eye exams, glasses, contact lenses and necessary cleaning solutions.
The following is a summary of medical expenses that are eligible for medical care reimbursement accounts. For more information, please refer to
IRS publication 502. You can order a copy of publication 502 by calling 1-800-TAX-FORM (1-800-829-3676).
Medical services fees (from doctors, dentists, surgeons, specialists, and other medical practitioners).
Prescription medicines (those requiring a prescription by a doctor for their use by an individual) and insulin
Over the counter (OTC) medications. (OTC drugs or medicines merely beneficial for general health are not eligible for reimbursement)
Oxygen equipment and oxygen
Hospital services fees (lab work, therapy, nursing services, surgery, etc)
Special items (artificial limbs, false teeth, eyeglasses, contact lenses, hearing aids, crutches, wheelchairs, etc.)
Expenses of an organ donor
Meals and lodging provided by a hospital during medical treatment
Wages for nursing services (see Publication 502)
Social Security tax for worker-provided medical care (see Publication 926)
Psychiatric care at a specially equipped medical center (includes meals and lodging)
Capital expenses for equipment or improvements to your home needed for medical care (see Publication 502)
Special school or home for mentally or physically disabled persons (see Publication 502)
Transportation for needed medical care (see Publication 502)
Treatment at a drug or alcohol center (includes meals and lodging provided by the center)
Legal operation to prevent having children
Cost and care of guide dogs or other animals aiding the blind, deaf, and disabled.
Cost of lead-based paint removal (see Publication 502 Quick Reference of Expenses Eligible for Flexible Spending Accounts:
The following is a summary of medical expenses that are not eligible for medical care reimbursement accounts. For more information, please
refer to IRS publication 502.
Surgery for purely cosmetic reasons.
Expenses for your general health (even if following your doctor’s advice) such as:
Health club dues
Household help (even if recommended by a doctor)
Social activities, such as dancing or swimming lessons
Trip for general health improvement
OTC drugs or medicines merely beneficial for general health are not eligible for reimbursement
Funeral, burial or cremation expense
Illegal operation or treatment
Life insurance or income protection policies, or policies providing payment for loss of life, limb, sight, etc.
Medical insurance included in a care insurance policy
Nursing care for a healthy baby
Toothpaste, toiletries, cosmetics, etc.
Dependent Care Flexible Spending Account
Are you part of a two-income family with dependent children or parents? Are you a single parent? If so, you may want to consider opening a
dependent care spending account. A dependent care account lets you set aside part of your salary to pay for day care while you work. The
amount you set aside is not taxed.
To determine how much to set aside in your account, begin by anticipating the eligible dependent care expenses you will have during the coming
plan year (January 1 - December 31). You can use the dependent care account to pay for child care and adult day care required for you to be
able to work. These expenses include day care centers, preschool tuition, after school care, summer day camp and care provided inside or
outside your home by someone age 19 or older who is not your dependent. A qualified dependent is anyone under age 13 whom you claim on
your federal tax return. Other dependents, such as your parents, your spouse, or an older child, may qualify if they are unable to care for
themselves, require full-time care, and you claim them as dependents on your tax return.
You pay your dependent care provider as usual. Make sure to get a receipt for each payment. You will be required to furnish the name, address,
social security number or the taxpayer identification number of the dependent care provider. Submit your claims to BeniSource. You will receive a
reimbursement check for the eligible claims submitted. You will be reimbursed in full for all eligible expenses, up to the current balance in your
dependent care account.
Group Legal Benefit
In the Spring of 2002 the College began offering a group legal plan. This is an employee pay all benefit. Employees will have the opportunity to
enroll annually at Open Enrollment. Please note that this benefit requires that deductions occur one month prior to effective date so that premium
is paid in advance.
All attorney fees for legal services listed in the “Summary of Services” (which follows below) are either covered in full 100% or discounted 25%
depending on the legal matter.
You choose a law firm from the Legal Resources Network. Their experienced, local attorneys will provide all the services covered by the plan.
You will receive your Subscriber Membership Card with your plan attorney firm’s name and phone number.
The affordable payroll deducted monthly fee includes unlimited use of covered services for all covered family members.
If you leave the College you can keep this benefit for up to two years and pay your employer’s group rate in effect.
The plan provides nationwide coverage with their National Protection Rider.
Examples of Estimated Legal Services Estimated Attorney Fees without Legal Attorney Fees as Legal Resources
Legal Counsel and Advice for all covered benefits $200/Hour $0
Traffic Court Representation $300 - $750 $0
DUI Court Representation (1 Offense) $750 - $1,500 $0
Will Preparation (Includes contingent trust for $300 - $500 $0
minors, living will, medical durable power of
attorney, and advance directives)
Credit/Warranty Disputes $200/Hour $0
Reviewing a financial contract or lease $200/Hour $0
Tenant Disputes with Landlords $200/Hour $0
Uncontested Divorce Representation $500 - $750 $0
Uncontested Domestic Adoption (includes name $500 - $750 $0
Purchasing a primary residence $400 - $600 $0
Selling a primary residence (A minimum $50.00 $200 - $400 $0
administrative charge will apply in all real estate
closings conducted by the Plan Attorney)
Defending a Civil Action in District Court $750 - $1,000 $0
Defending your child in Juvenile Court $500 - $1,000 $0
Last year the plan added an important benefit: Identity Theft Services. Plan members can now call Legal Resources at (800) 728-5768 and speak
to a specialist who will:
1. Help them understand what “identity theft” is and how to avoid it.
2. Walk the plan member through a checklist of activities and provide them with resources to help them minimize and recover from the theft.
3. Review and explain any in-office legal coverages that apply to the situation and refer the plan member to an attorney.
4. Provide the member with a comprehensive check list and brochure on identity theft.
This benefit must be paid in advance to the effective date, therefore, employees that enroll during this open enrollment period will have deductions
that commence the pay period ending November 30, 2007 (the paycheck received on December 7, 2008).
Summary of Services
The duties and responsibilities of the Plan Attorney under this Agreement to the Subscriber and Covered Person (where applicable) shall consist
of the following legal services:
1. General Consultation and Advice: To be provided at the Plan Attorney’s office, or by telephone as deemed appropriate by the Plan
Attorney regarding general legal issues covered under the Summary of Services. For matters listed under the Expanded Coverage Rider,
up to one (1) hour of initial consultation is provided. Any other consultation and advice will be at the discretion of the Plan Attorney.
2. Consumer Relations: Representation of Subscriber in connection with any action which may be brought in the District Court against a
manufacturer, distributor, service agency or retailer for defects in any merchandise, article or service or in a recovery on any warranty or
guarantee whether implied or expressly given in connection with the sale of any merchandise, article or service, where such claim is in
excess of $200. Personal injury claims as a result of such defects are specifically excluded.
3. Credit Protection: Consultation, advice, and preparation of clarification letter(s) relating to billing disputes and collection agency
harassment. District Court representation is provided if applicable. This does not include credit recovery action(s) or extensive credit
negotiations in cases of bankruptcy.
4. Preparation of Will and Related Documents: Preparation, revision and periodic review of Will. This Will is defined as a Will with a
reasonable number of direct bequests of money and/or property, and which:
• in Virginia may also include a simple contingent trust provision for children in the event of the death of both parents.
• in Maryland and the District of Columbia may also include a provision for a transfer under the Uniform Transfer to Minors Act
for the benefit of each child in the event of the death of his/her parents. These services do not include Wills requiring the creation
of other types of trust. This Will may include, at Subscriber’s request, an Advanced Medical Directive Medical Durable Powers of
Attorney and the preparation of “Living Wills”) and Financial Powers of Attorney.
5. Estate Advice: Plan Attorney will also provide advice to Covered Person in connection with problems they may encounter as
beneficiaries, administrators, or executors with respect to any estate, provided that the estate is not of a size to require the filing of a
Federal estate tax return. However, this provision shall not require the Attorney to act as administrator or executor of such estate.
6a. Civil Actions (Plaintiff): Representation as a plaintiff in connection with the filing of a civil action subject to the jurisdiction of the District
Court. Representation shall be limited to action in the District Court. Claim must exceed $200. Collection of judgements covered under the
Expanded Coverage Rider. No representation shall be available under this item for any action that the Plan Attorney deems is either non-
meritorious, calculated to be vexatious only, of a non-material or non-consequential nature or which would be contrary to public policy.
In the event any damages are recovered or some form of monetary benefit received, the first one thousand dollars ($1,000) of any such
recovery shall be free from any fee assessment by the Plan Attorney. The one thousand dollar ($1,000) exclusion does not apply to
Personal Injury Claims (see Personal Injury Box). With respect to any excess, however, a contingency fee may be assessed by prior
written agreement between the Covered Person and the Plan Attorney. If legal fees are awardable by either statute, rule of court, or
contract Plan Attorney shall be entitled to the full amount of such fees.
6b. Civil Actions (Defendant): Representation in connection with any civil action in which the covered person is named as a defendant, at
the District Court only. Claim must exceed $200. This excludes cases where Covered Person is provided legal representation through
insurance or other indemnification arrangements.
7. Domestic Adoptions: (1) Representation of Covered Person as adopting step-parent in an uncontested adoption; (2) representation of
Covered Person as adopting family member with parental consent in uncontested adoptions of family members; and (3) representation of
Covered Person as adopting parent or step-parent in an uncontested adoption previously recommended by a licensed child placement
agency. These services include change of name of adopted child. This does not include Parental Placement or other private adoptions
where the Court functions as agency representative.
8a. Real Estate Transactions (Closings): The Subscriber is entitled to legal assistance and representation in connection with the sale and/or
purchase of the Subscriber’s primary dwelling. If purchasing, this includes representation in relation to the purchase of the primary family
dwelling. Representation will be on either the purchase and closing of the lot, or the closing on a construction loan, or the closing on a
permanent mortgage, but not each individually unless they are combined into a single closing. If selling, this includes contract review and
deed preparation for the Subscriber. The real estate benefit is not transferable to dependents or non-subscribers involved in the
This shall not include representation for refinancing or negotiations for such transfer or financing, or to perform any title search or surveys,
or situations involving special circumstances (such as liens or title issues) as deemed by the Plan Attorney (see Expanded Coverage
Rider). In Real Estate cases where closing services are provided for the Subscriber (by a builder, real estate agent, title company, etc.),
representation will not be provided. However, if circumstances develop in the closing which leave the Subscriber without representation,
the Plan Attorney will provide representation. The Plan Attorney is not responsible for administrative costs associated with the closing. A
minimum $50 administrative fee will be charged to cover non-attorney costs.
8b. Non-Sale Real Estate Transactions (Deeds): Review and preparation of quit claim deeds, and deeds of transfer, provided the legal work
requested is for the Covered Person.
9. Insurance Matters: Representation of Covered Person in connection with any claim against his or her insurer by reason of failure to
provide or pay the benefits as contracted for and general advice as to interpretation of any policy provision. Includes: Accident and Health,
Life Annuity, Fire, Automobile and Homeowners. Litigation limited to District Court. In the event of litigation, the conditions set forth in item
6a. (Plaintiff) shall apply.
10a. Tenant-Landlord Matters: Representation of Covered Person as Tenant in connection with any claims or controversies arising out of a
tenant-landlord relationship with respect to Covered Person’s apartment or dwelling which is the Subscriber’s principle place of residence.
Litigation limited to the District Court only.
10b. Landlord-Tenant Matters: Up to one (1) hour of initial consultation and advice on matters involving Subscriber as Landlord. This will
include preparation of“ five-day late letter ”and advice for filing the motion for judgement. Court representation is not included.
11. Traffic Violations: Representation before the District Court for misdemeanor traffic offenses for Covered Person with a valid driver’s
license not subject to restriction or suspension (See Expanded Coverage Rider). Alcohol related traffic offenses are limited to “first
offense” as defined in State/District where offense occurred.
12. Preparation and Review of Legal Documents: Preparation and review of routine legal documents including but not limited to specific
and general powers of attorney, financial powers of attorney, bills of sale, and affidavits. Elderly parent powers of attorney will be provided
in accordance with Plan Attorney’s professional and ethical requirements in the event of incapacity of the parent where parent is granting
Covered Person power of attorney. Elderly parent powers of attorney do not include estate matters, gifting, disclaimers and 0creation of
trusts and all such documents.
13, Defense of Juveniles: Representation of Subscriber’s minor dependent children in misdemeanor proceedings in the District Court, in
Maryland the Juvenile Court. Felonies and felony related charges excluded. (See Expanded Coverage Rider).
14. Uncontested Divorce: The Subscriber only shall be entitled to representation in connection with any uncontested divorce proceeding or
separation, including the preparation of a separation agreement and the filing of the bill of complaint for divorce, separation or annulment
and other services necessary for termination of the relationship.
Uncontested divorce refers to initiating a no fault divorce which will include a property settlement agreement reconciling all equitable
distribution; property issues; and child custody, support and visitation issues; signed by your spouse. It includes the draft of one proposed
property settlement agreement meant to resolve all issues. It does not include multiple drafts of property settlement agreements with the
exception of correcting (a) clerical errors and (b) minor revisions.
In the event of a contested divorce/separation matter or family law issues which arise subsequent to the divorce/separation,
representation by your Plan Attorney will require a separate fee as stated under the Expanded Coverage Rider.
The preparation of Qualified Domestic Relations Orders, pre-nuptial agreements, or representation in any separate family law matters
involving child custody, visitation, and support; spousal support; or contested adoption, maybe available under the Expanded Coverage
15. Criminal Violations: Representation in misdemeanor matters as defendant through trial in the District Court.
16. Change of Name: Simple uncontested change of name.
17. Local Administrative Proceedings: Consultation, advice and representation if applicable (at the initial hearing) with respect to civil
administrative proceedings by or against any local government commission or local government board such as zoning or property
Covered Person responsible for all non-attorney costs (i.e., filing fees, court costs, mileage, postage, phone calls, etc.).
Personal Injury 25% Contingent Fee
Consultation and review for Covered Person in connection with a personal injury claim as plaintiff. Attorney will evaluate all factors and determine,
at the attorney's discretion, whether or not representation will be provided. If attorney represents covered person and any damages are recovered
or a monetary benefit is received, a contingent fee of twenty-five percent (25%) will be assessed by the Plan Attorney. The one thousand dollar
($1,000) exclusion under Item 6a does not apply. Federal Court, Appellate Court, Supreme Court, Medical Malpractice claims
and products liability claims may require a separate fee arrangement based upon the mutual agreement of the Covered Person and the Plan
Attorney. Covered Person will be responsible for all non-attorney costs.
National Protection Rider
• Receive free initial advice and consultation on legal matters outside your Covered Area.
• Receive either a 25% attorney fee discount, reduced flat fee or reduced hourly rate for most personal legal matters, where attorneys
You must call Legal Resources to be referred to a National Protection Rider representative.
Master Plan Exclusions
No benefits or services of any kind are provided under the Master Plan wherein the following circumstances are present:
A. Controversy or proceeding between Administrator and any party to the Plan.
B. Controversies or matter involving Subscriber, Spouse, or dependents against Participating Sponsor/Employer regarding employment
grievances or disputes. This does not apply to product or service disputes.
C. Controversies or any matter between Subscriber and spouse or dependents, Subscriber only is covered.
D. Any legal matter which might involve or name the Covered Person, but the legal work, advice, or action requested is for the benefit of a
non-covered person. Except in the event of elderly parent powers of attorney as set forth under item 12.
E. Any matter between Subscriber and Plan Attorney.
Expanded Coverage Rider
A twenty-five percent (25%) attorney fee and/or legal assistant/paralegal fee discount on customary and usual fees. Plan Attorney Firm will
evaluate all factors, before representation will be provided where specialized attorney services are available.
(Pre-Existing). The matter requiring legal services originated prior to the effective date of the Subscriber Enrollment Form and involved either
(1) the commencement of any legal action or legal proceeding by or against the Subscriber; or, (2) the prior retention by the Subscriber of the
services of another attorney or mediator; or, (3) the signing of a real estate contract or separation agreement prior to membership.
Any legal matter for spouse or dependent in action against Subscriber listed under Exclusions, item C. This does not apply to any
Probation Violations, Bond Hearings and/or violations of existing court orders, and capias charges (failure to appear).
Any matter not specifically covered under the Summary of Services herein.
Personal and Family Matters
Preparation of Qualified Domestic Relations Orders, contested family law issues, pre-nuptial agreements, Parental Placement Private
Adoptions, guardianships, bankruptcy filing, estate representation, elder law, felonies, expungements, applicable DUI and/or traffic
offenses, collection of judgments, tax law issues, securities law issues, immigration law issues, appellate court proceedings, removal,
appeals, trials de novo, felonies, and federal court proceedings
Real Estate Matters
Civil actions and disputes not tried in District Court. These include matters evolving from a real estate closing such as a dispute with
builder and/or breach of contract. Other matters include real estate issues involving specialized property rights, adjacent property
acquisitions, home equity/improvement matters, refurbishment requirements, refinances, second homes and rental property.
Small Business Matters
Representation for Covered Person for routine business or commercial matters. To qualify, business must not exceed $100,000 gross
revenue per year.
Court and Arbitration Representation
Representation as plaintiff or defendant in arbitrated disputes; federal courts and non-covered state courts.
Additional Administrative Proceedings
Representation for school board disputes, civil administrative proceeding by or against any state or federal government agency, and family
law or other social services disputes, and representation in condo/homeowner associations and other non-government entity disputes.
Legal Matters Outside Covered Area
Legal matters that can be referred to a Plan Attorney in another Covered Area.
Effective January 1, 2003, the College began offering a stand alone Vision Plan (employee pay all benefit). This plan was intended for Cigna PPO
plan participants (no vision coverage), but can also provide supplemental coverage for the other medical plans that currently have vision benefits.
The vendor is Vision Service Plan (VSP).
The VSP WellVision Plans define the industry standard for quality vision care benefits by including:
Thorough eye exams that ensure ongoing eye care wellness.
A wide variety of eyewear coverage options, including eyeglasses and contact lenses.
Controlled pricing on eyewear and lens options through VSP doctors and labs.
Choice of eye care doctors from one of the nation’s largest doctor networks.
VSP offers the most extensive national doctor network of independent, private practitioners. In fact, 90% of Americans are within 10 miles of a
VSP doctor. Annually, VSP retains more than 98% of the doctors in their network, so members develop lasting relationships with the eye care
advisors they trust.
The plan design is 12/12/12. Eye exams are covered every 12 months, frames every 12 months, and lenses every 12 months.
The plan offers a $10 copayment for exams and a $20 copayment for materials (for participating doctors and opticians). If your doctor does not
participate there is still a benefit, however, coverage is not as comprehensive as it is with in-network provider selections. Please also note that
out-of-network claims must be filed online with VSP within 180 days from the date of service.
VSP Frequently Asked Questions (FAQ’s)
How do I obtain a list of VSP doctors?
If you need information about VSP doctor locations, contact Vision Service Plan at (800) VSP-7195 or access VSP’s World Wide Web site at
Can I see one doctor for my exam and have my glasses made by another doctor or optical shop?
Yes. If you see two VSP doctors, be sure to identify yourself as a VSP member when making each appointment. You should also inform the
second VSP doctor that you are seeking materials only in order to avoid any confusion. Also, check with the dispensing doctor’s office to assure
that he or she will fill another doctor’s prescription.
What if I am dissatisfied with a VSP doctor or the materials I receive through a VSP doctor?
If you receive unsatisfactory services or materials, complete an Issue Resolution Form, which can be obtained from your group’s benefits
department, to document your concern in writing, or contact VSP’s Customer Service Department at (800) 877-7195.
VSP’s philosophy is to guarantee complete patient satisfaction with services received from VSP doctors.
If I am eligible for an eye exam and materials, but I choose to only have an exam, can I utilize my materials benefit later in the year?
Yes. However, by receiving your exam and materials at different times in the year, you will split your benefits and may not be eligible at the same
time for both an exam and materials the following service year.
When seeing a VSP doctor, what type of frame selection will be covered in full by VSP?
VSP's frame benefit covers a wide range of frames on the market today. Because buying habits and tastes differ from one region to the next,
frame inventories may vary from office to office. When deciding on a frame, ask your doctor which ones are covered in full.
What are some of the cosmetic options for which I can expect to incur out-of-pocket expenses?
Some examples of cosmetic options are:
Any frame that exceeds your plan allowance.
Are my dependents also responsible for a copayment?
Yes. If your plan includes a copayment, it will apply to you as well as all dependents who are covered under the plan. You are responsible for
paying the appropriate copayment(s) at the time covered services are obtained. The amount of the copayment(s) is determined by your group’s
contract with VSP.
What types of contact lenses may I receive through VSP?
As long as your contact lenses contain a prescription, your allowance remains the same for all types of contacts. If the contacts selected exceed
your maximum allowance, you are responsible for the payment of any remaining balance.
How are disposable contact lenses covered?
Like all other types of contact lenses, VSP covers disposables within your group’s allowance. You can purchase disposable lenses at the time of
Long Term Care Insurance
Long Term Care Insurance provides coverage for custodial care for the following types of service:
Home Health Care
Adult Day Care
You have your choice of Daily Maximums for Home and Community Based Care and Nursing Home Care. Prudential will pay for your covered
expenses up to the applicable Daily Maximum you select.
Nursing Home Care Daily Maximum Home & Community Based Care Daily Maximum Lifetime Maximum*
$100 $50 $182,500.00
$150 $75 $273,750.00
$200 $100 $365,000.00
*All benefits paid will draw down the Lifetime Maximum
Your premiums are based on the coverage options you choose and your age on your coverage effective date. Your premiums will not increase
solely because you get older, nor will they increase if your health status changes or your leave your job. Your premiums can increase only if you
increase your coverage, or if Prudential increases premiums for all plan members of our insured class.
If you decide to leave your job or association, you may keep your coverage and your premium rate will not be affected due to this change. Your
coverage will continue as long as you pay your premiums on time and do not exhaust your Lifetime Maximum.
Additional Base Plan Features:
Benefit Waiting/Elimination Period (90 Days)
Waiver of Premium
Alternate Plan of Care Benefit
Lifestyle Changes Benefit
Bed Reservation Benefit (20 Day)
Respite Care (20 Days/Year – 100 Days Maximum)
Information and Referral Services
You may select other options available through this plan (at additional cost), to further customize your coverage to meet your needs.
Automatic Inflation Option – Helps protect against inflation diminishing the value of your benefits in the future.
Non-Forfeiture Benefit – Shortened Benefit Period Option – Helps you retain a portion of your insurance coverage even if you stop
paying your premiums (after 5 years)
Cash Benefit Option – Allows you to receive benefit cash payments equal to the Home and Community Based Care Daily
Maximum you elect, without having to incur formal expenses.
Qualifying for Benefits
In order to qualify for benefits, you must be confirmed as having a Chronic Illness or Disability. A Chronic Illness or Disability is defined as a:
Loss of ability to perform, without substantial assistance, for at least 90 days, two or more of the following
activities of daily living: bathing, continence, dressing, eating, toileting or transferring, or a severe cognitive
impairment which requires substantial supervision to protect you from threats and safety.
Once you are determined to be eligible for benefits and have satisfied the benefit waiting/elimination period, benefits will be payable according to
the Plan of Care developed for you by the Licensed Health Care Practitioner responsible for your care.
Contact the Benefit Office for an Enrollment Kit or call Prudential at 1-800-732-0416 from 8:00 a.m. to 5:00 p.m. Monday through Friday,
EST. Or you may wish to visit Prudential’s web site at: www.prudential.com/gltc/mca.html. You will need to login using the group name, mc
and the password is mcltc.
Basic Basic Plan Plus Cash Benefit Basic Plan Plus Automatic Basic Plan Plus Auto Inflation & Cash
Plan Option Inflation Benefit
Option Option Option Option Option Option Option Option Option Option Option Option
Age $100 $150 $200 $100 $150 $200 $100 $150 $200 $100 $150 $200
<25 $4.03 $6.05 $8.06 $6.86 $10.29 $13.72 $22.64 $33.96 $45.28 $32.81 $49.22 $65.62
25 4.31 6.47 8.62 7.28 10.92 14.56 23.65 35.48 47.30 34.21 51.32 68.42
26 4.61 6.92 9.22 7.73 11.60 15.46 24.71 37.07 49.42 35.67 53.51 71.34
27 4.93 7.40 9.86 8.21 12.32 16.42 25.82 38.73 51.64 37.19 55.79 74.38
28 5.27 7.91 10.54 8.72 13.08 17.44 26.98 40.47 53.96 38.77 58.16 77.54
29 5.63 8.45 11.26 9.26 13.89 18.52 28.19 42.29 56.38 40.42 60.63 80.84
30 6.01 9.02 12.02 9.83 14.75 19.66 29.45 44.18 58.90 42.14 63.21 84.28
31 6.42 9.63 12.84 10.44 15.66 20.88 30.77 46.16 61.54 43.93 65.90 87.86
32 6.87 10.31 13.74 11.09 16.64 22.18 32.15 48.23 64.30 45.79 68.69 91.58
33 7.34 11.01 14.68 11.79 17.69 23.58 33.59 50.39 67.18 47.73 71.60 95.46
34 7.84 11.76 15.68 12.53 18.80 25.06 35.10 52.65 70.20 49.76 74.64 99.52
35 8.38 12.57 16.76 13.32 19.98 26.64 36.68 55.02 73.36 51.87 77.81 103.74
36 8.95 13.43 17.90 14.15 21.23 28.30 38.32 57.48 76.64 54.07 81.11 108.14
37 9.57 14.36 19.14 15.04 22.56 30.08 40.04 60.06 80.08 56.35 84.53 112.70
38 10.23 15.35 20.46 15.98 23.97 31.96 41.84 62.76 83.68 58.75 88.13 117.50
39 10.93 16.40 21.86 16.98 25.47 33.96 43.72 65.58 87.44 61.24 91.86 122.48
40 11.68 17.52 23.36 18.05 27.08 36.10 45.69 68.54 91.38 63.84 95.76 127.68
41 12.53 18.80 25.06 19.29 28.94 38.58 47.85 71.78 95.70 66.71 100.07 133.42
42 13.46 20.19 26.92 20.62 30.93 41.24 50.12 75.18 100.24 69.72 104.58 139.44
43 14.44 21.66 28.88 22.04 33.06 44.08 52.49 78.74 104.98 72.87 109.31 145.74
44 15.50 23.25 31.00 23.56 35.34 47.12 54.97 82.46 109.94 76.15 114.23 152.30
45 16.64 24.96 33.28 25.17 37.76 50.34 57.57 86.36 115.14 79.58 119.37 159.16
46 17.87 26.81 35.74 26.91 40.37 53.82 60.29 90.44 120.58 83.17 124.76 166.34
47 19.17 28.76 38.34 28.77 43.16 57.54 63.16 94.74 126.32 86.93 130.40 173.86
48 20.58 30.87 41.16 30.74 46.11 61.48 66.14 99.21 132.28 90.84 136.26 181.68
49 22.09 33.14 44.18 32.85 49.28 65.70 69.28 103.92 138.56 94.94 142.41 189.88
50 23.72 35.58 47.44 35.12 52.68 70.24 72.55 108.83 145.10 99.22 148.83 198.44
51 25.73 38.60 51.46 37.85 56.78 75.70 76.58 114.87 153.16 104.38 156.57 208.76
52 27.92 41.88 55.84 40.80 61.20 81.60 80.82 121.23 161.64 109.79 164.69 219.58
53 30.28 45.42 60.56 43.98 65.97 87.96 85.29 127.94 170.58 115.49 173.24 230.98
54 32.86 49.29 65.72 47.40 71.10 94.80 90.02 135.03 180.04 121.49 182.24 242.98
55 35.66 53.49 71.32 51.10 76.65 102.20 95.02 142.53 190.04 127.79 191.69 255.58
56 38.68 58.02 77.36 55.07 82.61 110.14 100.28 150.42 200.56 134.42 201.63 268.84
57 41.96 62.94 83.92 59.36 89.04 118.72 105.84 158.76 211.68 141.40 212.10 282.80
58 45.53 68.30 91.06 63.98 95.97 127.96 111.71 167.57 223.42 148.74 223.11 297.48
59 49.40 74.10 98.80 68.97 103.46 137.94 117.90 176.85 235.80 156.46 234.69 312.92
60 53.59 80.39 107.18 74.34 111.51 148.68 124.43 186.65 248.86 164.58 246.87 329.16
61 58.16 87.24 116.32 79.98 119.97 159.96 131.72 197.58 263.44 173.25 259.88 346.50
62 63.12 94.68 126.24 86.04 129.06 172.08 139.43 209.15 278.86 182.37 273.56 364.74
63 68.50 102.75 137.00 92.57 138.86 185.14 147.58 221.37 295.16 191.98 287.97 383.96
64 74.34 111.51 148.68 99.60 149.40 199.20 156.22 234.33 312.44 202.08 303.12 404.16
65 80.67 121.01 161.34 107.15 160.73 214.30 165.36 248.04 330.72 212.73 319.10 425.46
66 87.55 131.33 175.10 115.29 172.94 230.58 175.04 262.56 350.08 223.93 335.90 447.86
67 95.02 142.53 190.04 124.02 186.03 248.04 185.27 277.91 370.54 235.72 353.58 471.44
68 103.11 154.67 206.22 133.44 200.16 266.88 196.11 294.17 392.22 248.14 372.21 496.28
69 111.91 167.87 223.82 143.57 215.36 287.14 207.59 311.39 415.18 261.21 391.82 522.42
70 121.45 182.18 242.90 154.45 231.68 308.90 219.73 329.60 439.46 274.97 412.46 549.94
71 134.74 202.11 269.48 170.11 255.17 340.22 237.45 356.18 474.90 295.95 443.93 591.90
72 149.48 224.22 298.96 187.36 281.04 374.72 256.60 384.90 513.20 318.54 477.81 637.08
73 165.85 248.78 331.70 206.34 309.51 412.68 277.30 415.95 554.60 342.86 514.29 685.72
74 184.01 276.02 368.02 227.25 340.88 454.50 299.66 449.49 599.32 369.03 553.55 738.06
75 204.14 306.21 408.28 250.29 375.44 500.58 323.83 485.75 647.66 397.20 595.80 794.40
76 226.91 340.37 453.82 276.60 414.90 553.20 352.33 528.50 704.66 430.30 645.45 860.60
77 252.22 378.33 504.44 305.69 458.54 611.38 383.33 575.00 766.66 466.16 699.24 932.32
78 280.36 420.54 560.72 337.84 506.76 675.68 417.07 625.61 834.14 505.00 757.50 1,010.00
79 311.63 467.45 623.26 373.37 560.06 746.74 453.78 680.67 907.56 547.08 820.62 1,094.16
80 346.39 519.59 692.78 412.62 618.93 825.24 493.72 740.58 987.44 592.67 889.01 1,185.34
81 373.31 559.97 746.62 443.57 665.36 887.14 524.42 786.63 1,048.84 627.56 941.34 1,255.12
82 402.31 603.47 804.62 476.84 715.26 953.68 557.04 835.56 1,114.08 664.51 996.77 1,329.02
83 433.57 650.36 867.14 512.59 768.89 1,025.18 591.69 887.54 1,183.38 703.63 1,055.45 1,407.26
84 467.25 700.88 934.50 551.04 826.56 1,102.08 628.48 942.72 1,256.96 745.05 1,117.58 1,490.10
85 503.54 755.31 1,007.08 592.37 888.56 1,184.74 667.57 1,001.36 1,335.14 788.91 1,183.37 1,577.82
To add the Shortened Benefit Period Option to any plan, add 10% to
Frequently Asked Questions - Long Term Care (FAQ’s)
What is long term care?
Long term care refers to a very broad range of medical, personal and social services provided to people who are unable to care for themselves
over a relatively long period of time. While these individuals are usually considered chronically disabled, care is not limited to a nursing home, as
some people believe. It can be at assisted living facilities or at home by caregivers such as home health care workers, nurses or therapists, or in
community-based settings such as adult day care centers. The ultimate purpose of long term care insurance is to help individuals retain their
independence as long as possible, help assure that they may have freedom and choice in where they receive assistance, and help preserve their
assets as much as possible.
Who needs long term care?
Two out of five people will need nursing home care sometime in their lives. Accidents can happen at any age, and serious illnesses can occur
unexpectedly. A serious car accident could render someone in need of long term care. Someone with a broken hip could require rehabilitative
care. A person recovering from a heart attack or stroke could need assistance with daily living activities like bathing and dressing.
Is there a waiting period under the plan?
Yes. There is a one time, cumulative calendar day 90-day waiting period that applies towards all benefits except for Hospice Care, Respite Care,
Lifestyle Changes Benefits, or Information and Referral Services.
Once an insured is assessed to be eligible for benefits under the plan, he/she must satisfy the waiting period, in calendar days, before benefits will
be payable. The waiting period can be satisfied in one occurrence or in multiple occurrences where the waiting period accumulates with each
occurrence until it is satisfied. No out of pocket expenses need to be incurred in order to satisfy the waiting period.
The Looming Crisis: 15 Questions About Long Term Care, American Health Care Association, September, 1998, p.1
What about Medicare and Medicaid? I thought they paid for these types of expenses.
Neither Medicare nor Medicare supplement insurance provides benefits for most long term care expenses. Medicare was never designed to cover
long-term care expenses. For example, Medicare does not pay for care received at home except for very limited situations and only if certain
conditions are met. You have to be hospitalized and then go to a Medicare-approved facility to have any nursing home care covered and even
then, it’s only covered for the first 100 days. And, assisted living facilities and Alzheimer’s care facilities are not covered at all by Medicare.
Does the plan include a premium waiver?
Yes. Premiums will be waived the first of the month following the date eligible benefit expenses are incurred. This feature applies to all benefits
with the exception of Respite Care, Lifestyle Changes Benefit, and Information and Referral Services.
Eligible expenses include charges for services provided by a state licensed or certified facility, as well as services included in the Lifestyle
Changes and Bed Reservation benefits as defined in this coverage. Charges are only considered to be eligible if the waiting period has been
Premiums will be billed for the first of the month following a month in which we do not receive a claim or bill for services.
Does the plan have a cash benefit option?
Our Group Long-Term Care Insurance plan is for a reimbursement model. As such, the policy provides coverage in the form of reimbursement
benefits, according to the option the insured chooses, for covered long term care expenses, subject to the coverage waiting period and Daily,
Annual, and Lifetime Maximums. Once benefit eligibility has been determined, the Prudential Claims Department will reimburse or pay for
services on behalf of the insured.
Long Term Care Insurance is designed to provide coverage for necessary diagnostic, preventive, therapeutic, curing, treating, mitigating,
rehabilitative services, and maintenance or personal care services, provided in a setting other than an acute care unit at a hospital, such as in a
Nursing Home, in the community, or in the home. As such, it will help an insured to pay for covered expenses, but not to pay for more than the
insured actually incurs. This policy will reimburse or pay the actual charges, up to the selected Daily Maximum, for Nursing Home facility care for
as long as the insured is incurring covered expenses.
The Daily Maximum is the maximum amount Prudential will reimburse or pay for each day of Nursing Home services. The insured may choose to
use the selected Daily Maximum on Nursing Home Care, Home Health Care, Adult Day Health Care, or any combination of care, provided he or
she meets the benefit eligibility criteria. Eligible expenses for Home and Community Based Care are paid up to a percentage of the elected Daily
Many people prefer the flexibility of cash benefit payments as opposed to a benefit that reimburses for bills already paid. To facilitate this,
Prudential’s Group Long Term Care Insurance product offers a Cash Benefit Option. Should an insured elect this option, he or she will receive
benefit cash payments equal to the Home and Community Based Care Daily Maximum he or she elects without having to incur formal expenses.
The cash benefits the insured receives can be used at his or her own discretion. Since benefits paid under this optional rider are made without
regard to costs incurred by the insured, part of the benefits could be considered taxable income. A tax advisor should be consulted for more
information concerning any possible tax implications.
Is there an inflation option under the plan?
Prudential’s Group Long Term Care Insurance product allows an insured to keep up with inflation by increasing his or her benefits (Daily Maximum
and Lifetime Maximum), through one of the following options:
1. Periodic Inflation Protection: Included in the plan design, this feature will be offered at least every three years to those participants who
did not elect the Automatic Inflation Option. No medical underwriting will be required unless an insured declines two consecutive inflation
offerings. Coverage amounts would increase by at least 5%, compounded annually. Rates for this additional coverage will be based on
the age of the insured at the time the increase becomes effective. An insured will be offered the increasing coverage even if he or she is
receiving benefits. However, the increased coverage will not take effect until the insured stops receiving benefits.
2. Automatic Inflation Increase: An insured may also elect to increase his or her coverage amount through an automatic, built-in inflation
option. On each policy anniversary date, the Lifetime Maximum will be increased by 5%, compounded annually. Increases will continue
as long as the policy remains in force. The additional premium for this coverage is built into the entry age premium when the policy is
purchased and is intended to remain level throughout the life of the policy.
Does the plan offer have a non-forfeiture feature?
At an additional cost, an insured may elect a Non-Forfeiture Shortened Benefit Period Option to ensure some level of coverage even if he or she
decides to stop paying premiums.
Is the plan portable?
Yes. Prudential’s Long Term Care Insurance product includes a portability provision. Under this provision, coverage is fully portable for all
participants. As long as the insured continues to pay premiums on a timely basis and does not exhaust his or her benefits, coverage may be
maintained regardless of his or her relation to the group contract holder and regardless of the relationship between the group contract holder and
Prudential. Rates do not change as a result of an individual becoming a portable insured
Does the plan provide coverage for informal caregivers, e.g., family members. Please explain how the use of informal caregivers may
At an additional cost, the Cash Benefit Option is offered for those who would like the flexibility of receiving cash benefits for services performed by
non-qualified/informal care providers. Under this option, eligible caregivers include skilled or non-skilled care providers such as family members
Please explain the medical underwriting process used to determine insurability.
Under Prudential's standard medical underwriting requirements, all full-time and part-time employees who are actively-at-work at the time of the
initial enrollment and all full-time and part-time new hires (who enroll within 60 days of being eligible) will be guaranteed issue.
All other applicants (including retirees, spouses, domestic partners, parents, parents-in-law, grandparents, and grandparents-in-law, as well as late
entrants) are required to complete a medical history health statement. Responses will be used by Prudential to determine eligibility for insurance.
Each applicant age 72 and older will receive an in-person interview to determine their functional and cognitive status. Information obtained by the
assessor is reviewed by the Medical Underwriting area responsible for determining the impact of this data on insurability.
Prudential pays the cost of the in-person assessments for those individuals who apply during the open enrollment period.
Upon receipt, an application will be reviewed for completeness. Incomplete applications are returned and the completed applications are entered
into the system and handled based on the underwriting guidelines. Active employees are guaranteed issue. Confirmation letters along with the
Certificates of Insurance and premium billing statements where applicable will be issued to the insureds.
Medically underwritten applications also will be reviewed for completeness. If the application is not rejected for medical reasons, it is forwarded to
the Medical Underwriting division. There the responses are reviewed in accordance with standards developed for underwriting Long Term Care
Insurance. Additional information from the physician is requested when the responses of the applicant warrant it.
What is the average turnaround time for processing an application?
Within two working days of receipt, an enrollment form is scanned for completeness. If incomplete, it is returned to the applicant. Complete
applications are entered into the system and handled based on Prudential’s underwriting guidelines.
If coverage is guaranteed issue for active employees, a confirmation statement is generated when the application is entered into the system. This
confirmation statement, with the Certificate of Insurance and premium billing statement, if required, is mailed to the insured within 5 working days.
If an applicant is subject to medical underwriting, the application is forwarded to the Underwriting Section and underwriting proceeds based on the
underwriting guidelines. Automatic rejections are mailed as soon as the rejection is determined. A maximum turnaround time of 60 days is
anticipated for full underwriting of a Long-Term Care Insurance application. If underwriting is not completed within this time frame, the application
Are there any medical conditions that would result in an automatic rejection for Long Term Care Insurance coverage?
Yes. The medical history section of Prudential's enrollment form lists unacceptable conditions, which will result in an automatic rejection for Long
Term Care Insurance. These conditions include Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex, Amyotrophic Lateral
Sclerosis (ALS or Lou Gehrig’s Disease), Chronic Memory Loss or Senility or Dementia or Organic Brain Syndrome, Metastatic Cancer, more
than one Stroke or Cerebrovascular Accident, Liver Cirrhosis, Multiple Sclerosis, Muscular Dystrophy, and Parkinson's Disease. Automatic
rejection notices will be mailed as soon as the rejections have been determined.
What are the criteria for determining benefit eligibility?
An insured must be assessed and confirmed as having a Chronic Illness or Disability. Prudential will arrange for an Assessor to conduct an
assessment using objective and professionally recognized industry standards to determine whether an insured has a Chronic Illness or Disability.
The assessment may be conducted by telephone or in person depending upon an insured’s particular circumstances.
A Chronic Illness or Disability is one in which there is:
A loss of the ability to perform, without Substantial Assistance, at least two Activities of Daily Living (ADL's) for a period of at least 90 consecutive
days. Activities of Daily Living are: Bathing, Continence, Dressing, Eating, Toileting, and Transferring; or
A similar level of disability as that described above; or
A severe Cognitive Impairment, which requires Substantial Supervision to protect an insured from, threats to his or her health and safety.
The term Substantial Assistance means:
1. The physical assistance of another person without which an insured would not be able to perform an Activity of Daily Living; or
2. The constant presence of another person within arm’s reach which is necessary to prevent, by physical intervention, injury to the insured
while he/she is performing an Activity of Daily Living.
The term Substantial Supervision means:
Continual oversight that may include cueing by verbal prompting, gestures, or other demonstrations by another person, and which is necessary to
protect the insured from threats to his or her health or safety.
Is there an appeal process for underwriting denials?
Yes. If an application has been rejected, a letter will be sent explaining the reason(s) for the rejection. This letter also invites applicants to submit
additional information if they wish to appeal the decision. A written appeal should be submitted to Prudential at the address specified in the
Upon receiving the appeal, the original application will be reviewed by a clinical supervisor who will consider the additional information submitted
and determine whether, according to underwriting criteria, the decision stands. If additional information is required, Prudential will again request
the information and another clinical review will be conducted. The applicant will be notified of the appeal's results.
Will premiums ever increase?
The pricing does not anticipate the need to adjust rates in the future. Should the actual plan experience emerge to be significantly different than
that assumed in our original pricing, a rating adjustment may be appropriate after the initial rate guarantee period.
What is the process for submitting a claim?
An insured or his/her representative can start the process of determining eligibility for benefits by calling Prudential's Long Term Care Customer
Service Center to arrange for an assessment. We encourage insureds to call Prudential before beginning to use Long-Term Care services so that
they know in advance whether insurance coverage will be available. If the bills were incurred prior to notifying Prudential and the insured was
determined to be eligible for benefits as a result of the notification, it is Prudential’s practice to reimburse eligible charges incurred up to seven (7)
days prior to Prudential being notified.
Prudential has contracted with LifePlans, Inc. Family Caring Network (FCN) to provide on-site (i.e., in-home) benefit eligibility assessments
throughout the United States. At the request of and under the direction of Prudential, FCN provides services to all of Prudential insureds. Each
plan of care is provided and developed through the FCN with LifePlans, Inc. FCN’s staff of approximately 3,000 geriatricians are well trained to
perform professional and objective assessments and develop appropriate plans of care.
Prudential will contact the Family Caring Network’s Assessor who will call the insured person (or his/her representative), to arrange for an in-
person interview and to complete the interview. The information gathered in this interview will be reviewed by a Prudential Care Counselor to
determine eligibility for benefits. Eligibility assessments will be paid for by Prudential. Insureds can receive covered services from any state
licensed or certified provider they choose.
Once deemed eligible, the insured is reassessed based on the severity of the condition. All claims are reassessed at least once yearly, as
required by HIPAA.
The average claim processing time from receipt of claim to payment/denial of claim is ten (10) business days. Insureds who are determined to be
eligible for benefits will be sent a supply of claim forms with a written notification that they have been approved. Payment can be made directly to
a Long-Term Care provider or the insured. Upon submission of a claim, it will be audited for completeness, for conformity to the criteria of the
particular group contract (i.e., pre-existing conditions criteria, Coordination of Benefits criteria, and contractual benefits), for conformity to the
qualifications of the provider (i.e., licensed or otherwise qualified to deliver the care provided), and for conformity to the regulations of the state of
Claims are also automatically audited for duplication and overpayment. Long Term Care claims are reviewed by a Claim Consultant who has
responsibility for quality review functions. All claim payments or denials are accompanied by a written Explanation of Benefits, which explains the
payment or denial.
Claims are closed when the person recovers functional or cognitive ability and no longer qualifies for benefits, the maximum benefits have been
paid, or death.
What if my claim is denied? Can I appeal?
A claimant has the right to appeal a decision made about his or her claim. The Explanation of Benefits notice will explain the procedure the
claimant should follow if he or she chooses to appeal a claim decision. The claimant can submit a written appeal within 15 calendar days from the
date he or she received the decision.
Prudential will send the claimant a written acknowledgment of the appeals letter. If additional information is required and the appeal is denied, the
acknowledgment will include a detail explanation of the reason(s) for the denial. If additional information is required, Prudential will explain what
information is needed. Upon receipt and review of the additional information, Prudential will notify the claimant in writing of the result of the review.
If the claimant still disagrees with the appeal decision, he or she can request in writing within 60 days of the decision that the matter be submitted
to the Claim Appeal Committee. This Committee includes, but is not limited to, clinical consultants, legal consultants, and product management
staff. After a thorough review, the Committee will send a written notification of its decision.
What effect could this insurance have on my taxes?
As long as the coverage you are purchasing is federally tax-qualified, (and Prudential’s is), meaning it meets federal requirements and the criteria
set forth in the Health Insurance Portability and Accountability Act which was signed by the President in 1996, your benefits are not subject to
federal income tax. All non-reimbursable (out of pocket) long-term care expenses that exceed 7.5% of adjusted gross income may be tax
deductible, and a portion of policy premiums may be tax deductible based on your age, if you itemize your deductions. Please contact your tax
advisor regarding your personal circumstance.
Accommodations under ADA
Requests for accommodations under the Americans with Disabilities Act (ADA) should be directed to Rowena D’Souza, HR Specialist at 240-567-
On July 1, 2007, Gallagher Bassett, Inc. assumed responsibility for the management of the Montgomery College Workers’ Compensation
Program. They serve as a general contractor and manager of the program with responsibility to provide Total Program Management.
The program is designed to provide close coordination of all the services necessary to assure that Montgomery College employees receive prompt
and necessary medical care.
The following is a brief description of the flow process of workers’ compensation claim:
1. Injured employee or supervisor reports claim to Security.
2. Security provides employee with basic information about the work injury program at Montgomery College.
3. Security informs Human Resources about injury.
4. The workers’ compensation incident is reported to a toll free number.
5. Within 24 hours the claim is electronically sent to The Schaffer Company and HR.
6. Contact is attempted with the treating physician, the employee and the employer in the first 24 hours.
7. Within the first 14 days, the claim is investigated to determine if it is covered under the workers’ compensation laws of the State of Maryland.
8. Schaffer monitors the claim to assure that the claimant is improving as expected. If not, they will direct additional resources to assure that the
employee receives the medical care necessary to return to productive employment
All questions concerning the workers’ compensation program at Montgomery College should be directed to Rowena D’Souza at (301) 279-5370
Unemployment compensation may be available upon termination of employment with the college as determined by the rules and regulations set
forth by the State of Maryland, Office of Unemployment Insurance.
Continuation of Health/Dental Benefits
COBRA - the Consolidated Omnibus Budget Reconciliation Act of 1985
Please note as an employer offering group health plans, the College is required by Public Law 99-272, Title X, to offer employees and their
families the opportunity for a temporary extension of medical and dental coverage in certain instances where coverage under the group plan would
otherwise end. This notice is intended to inform you of your rights and obligations concerning the continuation of your benefits if your coverage
Listed below are events that may cause you, your spouse or children to lose medical and/or dental insurance. Next to each qualifying event is the
length of time for which you are entitled to continue that coverage.
Length of Time Benefits
Employees May be Continued
1. Cessation of Employment 18 months
(except for gross misconduct)
2. Reduction in the hours you work 18 months
1. Death of the employee 36 months
2. Divorce or legal separation 36 months
3. Employee becoming eligible for Medicare 36 months
4. Dependent child reaching maximum age 36 months
You, your spouse and/or dependent child must notify the Office of Human Resources immediately upon divorce or
separation, or when your child reaches the maximum age eligible for participation in the plan under which he/she was
insured. An election package will be sent to your home address as most currently listed on your employment records. Included in this package
will be instructions, premium information and an election form. You will have 60 days from the later of the date of the qualifying event or the date
of the notification to decide if you wish to continue coverage for yourself and/or dependent(s). Whether or not you exercise your option, the
election form must be completed and returned to the Office of Human Resources.
Any person opting for continued medical/dental benefits must assume 102% of the actual premium being charged for the same coverage offered
to active employees. The extra 2% is charged to cover the cost of administering the program.
There will be a 45-day grace period to pay the initial premium after you notify the Office of Human Resources of your decision to continue
coverage. You are responsible for paying any past due premium from the date coverage would have normally ceased.
If the group plan benefits and/or premium change, your benefits and/or premium will change accordingly. You will be notified in advance of any
circumstances affecting your coverage.
You and/or your dependents continued coverage would terminate under the following circumstances:
1. The maximum time period (18 or 36 months) is reached. However, during the last 180 days of continued benefits, a conversion
privilege is available.
2. The premium is not paid according to the terms defined in the election package. There is no reinstatement provision for late
3. The continuing individual(s) become insured for group medical benefits, either as an employee or dependent.
4. The College ceases to provide any medical and/or dental benefits to our active employees.
HIPAA - The Health Insurance Portability and Accountability Act of 1996 made the following important changes in COBRA continuation coverage
rules that took effect on January 1, 1997:
The Health Insurance Portability and Accountability Act of 1998 (HIPAA) limits the circumstances under which coverage may be excluded
for medical conditions present before you enroll. Under the law, preexisting condition exclusions generally may not be imposed for more
than 12 months (18 months for a late enrollee). The 12-month (or 18-month) exclusion period is reduced by your prior health coverage.
You are entitled to a certificate that will show evidence of your prior health coverage. If you buy health insurance other than through an
employer group health plan, a certificate of prior coverage may help you obtain coverage without a preexisting condition exclusion.
You have the right to receive a certificate of prior health coverage since July 1, 1996. You may need to provide other documentation for
earlier periods of health care coverage. To obtain a certificate, please call the Office of Human Resources at extension 75365.
Employees may continue health coverage with the college after retirement. The college defines a retiree as someone who as has commenced
receiving a retirement benefit from the College. The cost of insurance to the retiree varies and is dependent upon the length of service with the
Health Information Privacy Notice
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires health plans to notify plan participants and beneficiaries about its
policies and practices to protect the confidentiality of their health information. This document is intended to satisfy HIPAA's notice requirement
with respect to all health information created, received, or maintained by Montgomery College (the “Plan”), as sponsored by Montgomery College.
The Plan provides coverage for the following types of benefits:
Flexible Spending Accounts
Faculty Staff Assistance Program
The Plan needs to create, receive, and maintain records that contain health information about you to administer the Plan and provide you with
vision insurance and flexible spending accounts. The notice tells you the ways the Plan may use and disclose health information about you,
describes your rights, and the obligations the Plan has regarding the use and disclosure of your health information. However, it does not address
the health information policies or practices of your health care providers.
Montgomery College’s Pledge Regarding Health Information Privacy
to a physical or mental health condition or the payment of your health care expenses. This individually identifiable health information is known as
“protected health information” (PHI). Your PHI will not be used or disclosed without a written authorization from you, except as described in this
notice or as otherwise permitted by federal and state health information privacy laws.
Privacy Obligations Of The Plan
The Plan is required by law to:
Make sure that health information that identifies you is kept private;
Give you this notice of the Plan’s legal duties and privacy practices with respect to health information about you; and
Follow the terms of the notice that is currently in effect.
How the Plan May Use and Disclose Health Information About You
The following are the different ways the Plan may use and disclose your PHI:
For Treatment. The Plan may disclose your PHI to a health care provider who renders treatment on your behalf. For example, if you are
unable to provide your medical history as the result of an accident, the Plan may advise an emergency room physician about the types
of prescription drugs you currently take.
For Payment. The Plan may use and disclose your PHI so claims for health care treatment, services, and supplies you receive from
health care providers may be paid according to the Plan's terms. For example, the Plan may receive and maintain information about
surgery you received to enable the Plan to process a hospital’s claim for reimbursement of surgical expenses incurred on your behalf.
For Health Care Operations. The Plan may use and disclose your PHI to enable it to operate or operate more efficiently or make certain
all of the Plan’s participants receive their health benefits. For example, the Plan may use your PHI for case management or to
perform population-based studies designed to reduce health care costs. In addition, the Plan may use or disclose your PHI to conduct
compliance reviews, audits, actuarial studies, and/or for fraud and abuse detection. The Plan may also combine health information
about many Plan participants and disclose it to the College in summary fashion so it can decide what coverages the Plan should
provide. The Plan may remove information that identifies you from health information disclosed to the College so it may be used
without the College learning who the specific participants are.
To the College. The Plan may disclose your PHI to designated College personnel so they can carry out their Plan-related administrative
functions, including the uses and disclosures described in this notice. Such disclosures will be made only to the College’s Plan
Administrator and/or the members of the College’s Office of Human Resources. These individuals will protect the privacy of your
health information and ensure it is used only as described in this notice or as permitted by law. Unless authorized by you in writing,
your health information:
may not be disclosed by the Plan to any other College employee or department, and
will not be used by the College for any employment-related actions and decisions or in connection with any other employee benefit plan
sponsored by the College.
To a Business Associate. Certain services are provided to the Plan by third party administrators known as "business associates." For
example, the Plan may input information about your health care treatment into an electronic claims processing system maintained by the
Plan's business associate so your claim may be paid. In so doing, the Plan will disclose your PHI to its business associate so it can perform
its claims payment function. However, the Plan will require its business associates, through contract, to appropriately safeguard your health
Treatment Alternatives. The Plan may use and disclose your PHI to tell you about possible treatment options or alternatives that may be of
interest to you.
Health-Related Benefits and Services. The Plan may use and disclose your PHI to tell you about health-related benefits or services that
may be of interest to you.
Individual Involved in Your Care or Payment of Your Care. The Plan may disclose PHI to a close friend or family member involved in or
who helps pay for your health care. The Plan may also advise a family member or close friend about your condition, your location (for
example, that you are in the hospital), or death.
As Required by Law. The Plan will disclose your PHI when required to do so by federal, state, or local law, including those that require the
reporting of certain types of wounds or physical injuries.
Special Use And Disclosure Situations
The Plan may also use or disclose your PHI under the following circumstances:
Lawsuits and Disputes. If you become involved in a lawsuit or other legal action, the Plan may disclose your PHI in response to a
court or administrative order, a subpoena, warrant, discovery request, or other lawful due process.
Law Enforcement. The Plan may release your PHI if asked to do so by a law enforcement official, for example, to identify or locate a
suspect, material witness, or missing person or to report a crime, the crime's location or victims, or the identity, description, or
location of the person who committed the crime.
Workers’ Compensation. The Plan may disclose your PHI to the extent authorized by and to the extent necessary to comply
with workers' compensation laws other similar programs.
Military and Veterans. If you are or become a member of the U.S. armed forces, the Plan may release medical information about
you as deemed necessary by military command authorities.
To Avert Serious Threat to Health or Safety. The Plan may use and disclose your PHI when necessary to prevent a serious threat
to your health and safety, or the health and safety of the public or another person.
Public Health Risks. The Plan may disclose health information about you for public heath activities. These activities include
preventing or controlling disease, injury or disability; reporting births and deaths; reporting child abuse or neglect; or reporting
reactions to medication or problems with medical products or to notify people of recalls of products they have been using.
Health Oversight Activities. The Plan may disclose your PHI to a health oversight agency for audits, investigations, inspections, and
licensure necessary for the government to monitor the health care system and government programs.
Research. Under certain circumstances, the Plan may use and disclose your PHI for medical research purposes.
National Security, Intelligence Activities, and Protective Services. The Plan may release your PHI to authorized federal officials:
(1) for intelligence, counterintelligence, and other national security activities authorized by law and (2) to enable them to provide
protection to the members of the U.S. government or foreign heads of state, or to conduct special investigations.
Organ and Tissue Donation. If you are an organ donor, the Plan may release medical information to organizations that handle
organ procurement or organ, eye, or tissue transplantation or to an organ donation bank to facilitate organ or tissue donation and
Coroners, Medical Examiners, and Funerals Directors. The Plan may release your PHI to a coroner or medical examiner. This
may be necessary, for example, to identify a deceased person or to determine the cause of death. The Plan may also release
your PHI to a funeral director, as necessary, to carry out his/her duty.
Your Rights Regarding Health Information About You
Your rights regarding the health information the Plan maintains about you are as follows:
Right to Inspect and Copy. You have the right to inspect and copy your PHI. This includes information about your plan eligibility, claim and
appeal records, and billing records, but does not include psychotherapy notes. To inspect and copy health information maintained by the
Plan, submit your request in writing to the Plan Administrator. The Plan may charge a fee for the cost of copying and/or mailing your request.
In limited circumstances, the Plan may deny your request to inspect and copy your PHI. Generally, if you are denied access to health
information, you may request a review of the denial.
Right to Amend. If you feel that health information the Plan has about you is incorrect or incomplete, you may ask the Plan to amend it. You
have the right to request an amendment for as long as the information is kept by or for the Plan. To request an amendment, send a detailed
request in writing to the Plan Administrator. You must provide the reason(s) to support your request. The Plan may deny your request if you
ask the Plan to amend health information that was: accurate and complete, not created by the Plan; not part of the health information kept by
or for the Plan; or not information that you would be permitted to inspect and copy.
Right to An Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of disclosures of your
PHI that the Plan has made to others, except for those necessary to carry out health care treatment, payment, or operations; disclosures
made to you; or in certain other situations. To request an accounting of disclosures, submit your request in writing to the Plan Administrator.
Your request must state a time period, which may not be longer than six years prior to the date the accounting was requested.
Right to Request Restrictions. You have the right to request a restriction on the health information the Plan uses or disclosures about you
for treatment, payment, or health care operations. You also have the right to request a limit on the health information the Plan discloses about
you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that the
Plan not use or disclose information about a surgery you had. To request restrictions, make your request in writing to the Plan Administrator.
You must advise us:
1) what information you want to limit;
2) whether you want to limit the Plan’s use, disclosure, or both; and
3) to whom you want the limit(s) to apply.
Note: The Plan is not required to agree to your request.
Right to Request Confidential Communications. You have the right to request that the Plan communicate with you about health matters in
a certain way or at a certain location. For example, you can ask that the Plan send you explanation of benefits (EOB) forms about your benefit
claims to a specified address. To request confidential communications, make your request in writing to the Plan Administrator. The Plan will
make every attempt to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice. You may write to the Plan Administrator to request
a written copy of this notice at any time.
Changes To This Notice
The Plan reserves the right to change this notice at any time and to make the revised or changed notice effective for health information the Plan
already has about you, as well as any information the Plan receives in the future. The Plan will post a copy of the current notice in the College’s
Office of Human Resources at all times.
If you believe your privacy rights under this policy have been violated, you may file a written complaint with the Plan Administrator at the address
listed below. Alternatively, you may complain to the Secretary of the U.S. Department of Health and Human Services, generally, within 180 days
of when the act or omission complained of occurred.
Note: You will not be penalized or retaliated against for filing a complaint.
Other Uses and Disclosures Of Health Information
Other uses and disclosures of health information not covered by this notice or by the laws that apply to the Plan will be made only with your written
authorization. If you authorize the Plan to use or disclose your PHI, you may revoke the authorization, in writing, at any time. If you revoke your
authorization, the Plan will no longer use or disclosure your PHI for the reasons covered by your written authorization; however, the Plan will not
reverse any uses or disclosures already made in reliance on your prior authorization.
If you have any questions about this notice, please contact:
Rowena D’Souza – HIPAA Privacy Official
Human Resources Specialist
900 Hungerford Drive
Rockville, MD 20850
Notice Effective Date: April 14, 2003
(If the terms and conditions of your employment are governed by a collective bargaining agreement (AFSCME or
AAUP) please refer to your specific contract for information in reference to your leave benefits.)
Montgomery College has extensive leave regulations covering every type of situation necessary for an employee to be absent from work. A few
brief statements are listed here describing some of the leave policies. Employees who have a situation that may not be listed should contact their
immediate supervisor or the Office of Human Resources for further information. Requests for leave must be approved by the employee’s
supervisor before the start of the leave.
NOTE: Employees unable to report for a scheduled work period must notify their immediate supervisor as soon as possible. Failure to report for
work as scheduled or to report the reason for absence to the employee’s supervisor will be considered as an unauthorized absence.
All Staff employees and temporary employees who receive benefits earn leave. Employees assigned to work 20 hours per week but less than 40
hours earn leave in the proportion that their workweek is to a 40-hour week. For example, if an employee works a 30-hour week, their leave
should be figured by multiplying 30/40 times the amount of leave earned. Ten-month employees earn leave only during those pay periods when
they are actively on the payroll. During the months when they are inactive, leave cannot be earned nor used. Earned leave may be used by the
week(s), full day, or by the hour/portion of an hour, as necessary.
For purposes of calculation, please note that Staff and Administrators are not paid twice a month, but rather every two weeks, which equals 26 pay
periods per year. Full-time Faculty are paid on an academic year basis and their salary is calculated over 20 pay periods.
Creditable Service – The rate of annual accrual for sick and annual leave is based upon the amount of service time which an employee has
accumulated. This period of time is referred to as "creditable service” and is computed by including all current service time the employee has
working at Montgomery College as well as the following:
Previous full-time service in an established position with the College.
Annual leave is granted to allow vacation time or for taking care of activities that can’t be scheduled on non-working days. It can also be used to
supplement sick leave when necessary. Employees assigned to work a 40-hour week earn annual leave as follows:
Leave Earned Leave Earned
Length of Service Per Pay Period Per Year
Less than 3 years 4.61 hours 15 days per year (120 Hours)
3 years but less than 15 6.15 hours 20 days per year (160 Hours)
15 years or more 8 hours 26 days per year (208 Hours)
Annual leave may not be used during the first 30 days of employment unless pre-arranged as a condition of employment. Annual leave must be
scheduled with your supervisor at a time which will be in the best interest of the College.
Up to one year of accumulation of unused annual leave may be carried forward to the next year. All other unused annual leave will be lost. Upon
termination of employment with Montgomery College, employees are paid in full for all unused annual leave up to a maximum of one year of
accumulation at their current rate of accumulation. Please note that for part-time employees the amount of leave carried forward each year or for
which the employee may be paid upon termination is pro-rated according to the proportion that their workweek is to a 40-hour workweek.
Sick leave is granted for personal illness, injury, and quarantine, as well as for medical, dental, or optical examinations and treatment. The leave
policy permits use of sick leave for illness in the immediate family when the employee’s presence is required. Full time employees earn sick leave
at 3.69 hours per pay period (12 days per year). Sick leave can be used only after it has been earned. Upon recommendation of the employee’s
supervisor, an advancement to an employee of unearned sick leave with pay not to exceed the amount earned during the next succeeding 12
months (96 Hours for full-time employees) may be carried forward from year to year without limit. Upon termination, employees hired prior to
January 1, 1993, and who have 5 years or more consecutive service with Montgomery College are eligible to receive pay for 25% of their unused
sick leave balance up to a maximum of 25% of 180 days. This benefit is not available to employees hired after that date.
Employees who are unable to report to work due to illness or injury, should notify their supervisor as soon as possible, preferably before or during
the working hours of the first day they are absent. Supervisors are to report excessive or questionable use of sick leave in writing to the Office of
Personal leave with pay is granted on a noncumulative basis to a maximum of 24 hours (3 days) per calendar year for full-time employees and on
a prorated basis for part-time employees. It is to be used for personal obligations such as those listed below, or for other important personal
unplanned crises or emergencies involving family members or personal property. Personal leave is advanced at the beginning of the each
calendar year and does not accrue from year to year.
The following are guidelines to assist employees in determining what situations are appropriate for use of personal leave. However, while
personal leave must be requested from and approved by the immediate supervisor, employees are on the honor system and do not need to
provide their supervisors with a reason for requesting the leave.
Personal Leave may be used for purposes such as the following:
Appointment with a lawyer
Court appearance, if not covered under Civil Leave policy
Settlement/purchase, walk-through on a house
School registration or conference for children
Bereavement for other than family members
Personal Leave should not be used for the following:
Voting (the polls are open a sufficient number of hours to allow employees to vote during non-duty hours)
Servicing car if not an emergency
Out-of-town family requests
Family illness (covered under sick leave)
Employees are authorized paid leave on official holidays when such holidays fall on days when the employees are regularly scheduled to work.
Such leave is referred to as “holiday leave”. Official holidays are those days designated each year in the College calendar on which the College is
listed as being closed, including the Saturdays and Sundays. Generally there are 14 paid holidays each year. Some employees may be required
to work on an official holiday if determination is made that certain College services must be maintained. Non-exempt employees who are required
to work on an official holiday are paid (in addition to pay for their regular holiday leave) at one and one-half times their pay for each hour of work
performed on the holiday.
When an official holiday falls on an employee’s regularly scheduled day off, the employee will not be paid for that day. In those situations where a
temporary change in work schedule serves to reduce the individual’s number of paid holidays below the minimum number received by those
employees working a regular work schedule, the person so affected will receive an alternate paid holiday during the same week.
Special Leaves with Pay
Employees may be allowed up to a maximum of five consecutive workdays of special leave with pay upon the death of a member of the
employee’s immediate family. The employee’s supervisor has the authority to approve the extent of the leave to be granted up to the maximum
number of days permitted. Bargaining unit employees should refer to their respective contracts for details.
Employees who are subpoenaed as a court witness or who are called to serve on a jury may be granted court attendance leave for the period
required to be in court plus necessary travel time. Employees must submit the appropriate leave form with a copy of the subpoena or summons to
the Director of Personnel Services. Any pay (less travel or other necessary and uncompensated expenses) received by the employee for such
service is paid to the College unless the employee elects to use annual leave or leave without pay, in which case the employee may retain all pay
received for such court service.
Annual Military Reserve Training
Employees who are members of the National Guard or of the United States Armed Forces Reserves may be granted special leave with pay for
training purposes not to exceed 15 calendar days in any 12-month period when required by federal or state order. In addition, such leave with pay
as required may be granted to an employee when his/her reserve unit is activated by federal or state order in the event of a civil disturbance or
other emergency. Employees must submit the appropriate leave form, with a copy of the military or other governmental orders attached, to the
Director of Personnel Management. Any pay (less travel or other necessary and uncompensated expenses) received by the employee for such
active duty must be paid to the college unless the employee elects to use annual leave or leave without pay, in which case the employee may
retain all pay received for such active duty.
Granted for purposes of attending off-campus professional meetings that are in the best interest of the College and the employee.
Professional Development Leave for Staff
Is available for administrative, associate, and support staff for a period of three months or one semester at full pay. To be eligible to apply and be
considered for this leave an employee must have served continuously at Montgomery College for at least 3 years. The employee must sign a
written agreement to return to work at the College for at least 4 months for each month of leave after the Professional Development leave ends.
Employees in temporary positions with benefits are not eligible for this particular leave.
Sabbatical Leave for Faculty
Sabbatical leave provides full-time faculty the opportunity to take time away from the classroom to engage in various types of professional
development endeavors for a period of one semester at full pay or one full academic year at half-pay. To be eligible for sabbatical, a faculty
member must have14 consecutive semesters of service. The faculty member must sign a written agreement to return to work for the next
succeeding four (4) full academic semesters after completion of the leave period.
Paid administrative leave is granted when the health, safety, or general welfare of an employee is in danger, or when leave is in the best interest
of the College. Leave may be authorized for all employees or for selected offices of personnel of the College. Non-exempt staff employees who
are classified as “essential personnel” and who are required to work during administrative leave are paid (in addition to their regular pay) at one
and one-half times their regular rate of pay for those hours worked.
NOTE: Administrative leave is the leave granted for weather related emergencies. When the decision is made to close the College (not just
cancel classes), staff are not required to report for work.
1. Obtain your information on such closings from radio or TV announcements rather than by calling the campuses. The radio stations the
College notifies for weather closings generally include:
WMAL - 630 AM WGAY - 99.5 FM
WINX - 1600 AM WGMS - 103.5 FM
WFMD - 930 AM (Frederick) DC101 - 101 FM
WFRE - 99.9 FM (Frederick) WASH - 97.1 FM
WTOP - 103.5 FM WHFS - 99.1 FM (Baltimore/Annapolis)
WLTT - 94.7 FM WRC - 980 AM
The Associated Press and United Press International and all local TV stations are also notified. The stations are notified by the
Institutional Advancement Office as early as the information is available.
2. If no radio or TV announcement is made, assume the College is open.
3. When the College is closed or there is a delayed opening, all non-institutional use of facilities will be cancelled during those hours that the
College is closed.
4. Persons considered “essential personnel” are: chief administrative officer, director of college relations, director of facilities, campus
facilities managers, all general maintenance workers and supervisors, building service workers and supervisors, security officers and
supervisors, building equipment mechanics, automotive mechanics and all trades helpers. Other positions may be designated “essential”
by the chief administrative officer.
The following options may be exercised during emergency closing:
1. The College will close at (time). Essential personnel are expected to remain or report to work and will be paid at the overtime rate (fi
eligible) for hours worked when the College is closed. All other employees are granted administrative leave.
2. The College will delay opening until (time), or the College is closed and will reopen at (time). Essential personnel will report to work at the
normal time and will be paid at the overtime rate (if eligible) for hours worked when the College is closed. All nonessential personnel will
be granted administrative leave for the hours that the College is closed and will report to work at the designated time of opening.
3. Employees who choose to take leave due to inclement weather when the College remains officially open must report their absence as
Leave without Pay
Up to 12 months of leave without pay may be granted for reasons such as illness in the family, maternity (beyond the period of disability), military
service, travel, family obligations, professional development, disability, or any other reason which is in the best interests of both the College and
the employee. With the exception of military service, employees who are on leave may continue to participate in the Montgomery College
employee benefit plans by paying 100% of the cost.
Leave without pay for 1 to 5 working days may be granted by the employee’s supervisor. Leave for more than 5 days requires the approval of the
employee’s supervisor and the Chief Human Resources Officer.
Family and Medical Leave
Under the Family and Medical Leave Act of 1993 (FMLA), employees are eligible for up to 12 weeks of unpaid leave if they have worked for the
College for at least 12 months and for at least 1,250 hours over the previous 12-month period. Unpaid leave will be granted for any of the
To care for an employee’s child after birth, or placement for adoption or foster care,
To care for the employee’s spouse, son or daughter, or parent who has a serious health condition, or
For a serious health condition that makes the employee unable to perform his/her job.
The College will require the employee to substitute paid leave for which the employee may be eligible for all or part of the leave to which the
employee is entitled under FMLA.
The College will require medical certification to support a request for leave because of a serious health condition, and may require a second or
third opinion (at College expense) and a fitness for duty to return to work.
For the duration of leave under the FMLA, the College will maintain group insurance coverage under the same conditions as if the employee were
These procedures will be administered in accordance with the provisions of the FMLA.
Employees who work in regular budgeted positions may be eligible for disability leave if they have worked at least 6 months for the College.
(Employees in temporary positions with benefits are not eligible for this particular benefit). Employees who have been disabled because of
sickness or accidental bodily injury may be granted disability leave with pay during the first 12 months of disability. Proof of disability must be
submitted to the Office of Human Resources. After all accumulated sick leave and advanced sick leave has been used, a percentage of the
employee’s salary will be continued according to the following chart:
Workers’ Compensation Disability 100% of pay
Employees with 6 months but less
Than 3 years of service 50% of pay
Employees with 3 years but less
Than 10 years of service 60% of pay
Employees with 10 or more
Years of service 80% of pay
In workers’ compensation cases, the use of sick leave will not be required before Disability Leave is authorized. Salary continued by the College
is reduced by other disability benefits or pay for rehabilitative work.
As an educational institution of the State of Maryland, Montgomery College has access to state-funded retirement programs that are offered to
During your working years, you’re busy with your career, family and social life – but you also need to think about retirement. A comfortable,
secure retirement requires planning.
You select a retirement program when you begin employment and your election takes effect on the first of the month following receipt of your
Full-time, Faculty, Administrators and Professional Staff
These employees are able to choose between the Maryland State Pension System Plan and the Optional Retirement Plan.
Pension System for Employees and Teachers of the State of Maryland
The Maryland State Retirement and Pension System for Teachers is a contributory plan up to the level of the current Social Security wage base.
Employees are required to contribute 4% of their gross annual salary deducted over the academic year. This reduction will not be subject to
federal taxes; however, it is subject to state and FICA taxes. If or when an employee’s gross wages exceed the Social Security wage base
(monitored by the payroll department), the individual would contribute five (5%) to the plan. Contributions earn interest at the rate of five percent
(5%). The State contribution to the MSRPS is determined annually by the State Retirement systems Actuary. There is a five-year minimum
service requirement in order to be vested. This is a defined benefit plan.
Optional Retirement Plan (ORP)
There are two vendors to select from in the Optional Retirement Plan (ORP): Fidelity or TIAA-CREF.
Employees do not have a required contribution. The State of Maryland (or Montgomery College for certain employees) contributes 7.25% of the
employee’s academic year salary to their annuity account. Benefits are vested immediately under the Optional Retirement Plan. This is a defined
Full-time, Support, Paraprofessional and Technical Staff
Support staff employees are automatically enrolled as members of either the Maryland Teacher’s Pension System or the Maryland Employees’
Pension System according to state regulations.
The Employees Pension system requires a 4% contribution over the calendar year. The reduction will not be subject to federal taxes; however,
it is subject to state and FICA taxes. Contributions earn interest at the rate of five percent (5%). There is a five-year minimum service requirement
in order to be vested.
The Teacher’s Pension system requires a 4% contribution over the academic year. The reduction will not be subject to federal taxes, however,
it is subject to state and FICA taxes. Contributions earn interest at the rate of five percent (5%). There is a five-year minimum service requirement
in order to be vested.
Part-time employees are also eligible for retirement benefits on a prorated basis. Faculty and professional staff employees can choose between
MSRPS and one of the Optional Retirement Plans. Support, Paraprofessional, and Technical Staff are automatically enrolled in MSRPS.
Supplemental Retirement Annuities (SRA’s)
In addition to the group insurance and retirement benefits available to you as a Montgomery College employee, you also have the opportunity to
participate in Supplemental Retirement Annuities (SRA) as permitted under Section 403(b) and Section 457(b) of the Internal Revenue Code. You
may reduce your salary in accordance with IRS limits allowed on a pre-tax basis and the College will remit such funds to one of the SRA plans
offered. You may establish a SRA contract with ING, Equitable, TIAA-CREF and/or VALIC. Each plan provides a variety of fixed and variable
accounts in which to invest your funds.
It is never too early to plan for retirement. No one should expect that his or her retirement income can be comprised only from an employer plan
and Social Security - personal savings is absolutely necessary. You are fortunate to have a SRA program available. Generally, an employee can
contribute 100% of his/her salary, up to a maximum of $15,500 per. This limit is effective 1/1/08. If you are over age 50 or turning age 50 in 2008
you can contribute an additional $5,000 per year (for a total of $20,500) per type of annuity. The college is also offering employees an additional
opportunity to save pre-tax dollars for retirement. In addition to the 403(b) products already offered, you have the opportunity to participate in a
457(b) plan. The college is offering a 457(b) plan in addition to the 403(b) plans. 457(b)’s offer employees the capability to save up to an
additional $15,500 or ($20,500 if you are 50 or turning 50 in 2008). The contributions reduce taxable income and earnings grow tax-deferred.
REMEMBER - these contributions are made on a pre-tax basis and the investment returns on these funds accrue tax free. You will pay taxes at
the time the funds are distributed, which will likely occur during your retirement years when you are apt to be in a lower tax bracket.
TIAA-CREF, VALIC, Equitable and ING offer a variety of investment options which may include annuities, mutual funds, and/or money market
funds. These programs offer significant tax savings while planning for retirement and the convenience of making contributions through salary
reduction. The Office of Human Resources has the necessary forms, and plan representatives will be pleased to discuss these programs in detail.
Representatives can be reached at:
ING Retirement Services
Harry Schiavone - 703-449-2917
Telephone Counseling Center - 800-842-2776
The Equitable Financial Companies
Mark S. Purisch - 301-840-1551
Robert G. Keller, Jr., CFP - 800-892-5558 x 88422
Frequently Asked Questions - Supplemental Retirement Annuities (FAQ’s)
When can I make changes in the amount I am having deducted from my pay for my supplemental retirement annuity (SRA)?
Changes can be made twice a year - once January through June and once again July through December.
Is there a dollar limit to how much I can contribute to my SRA?
Yes, the federal law limits this deduction to 100% of your annual salary up to $15,500.00 for calendar year 2008. If you are 50 or older you can
contribute an additional $5,000 for calendar year 2008 (for a total of $20,500)
Am I allowed to have more than one SRA?
Yes, the college has contracts with 4 companies. They are TIAA-CREF, VALIC, Equitable and ING. However, the total deductions cannot exceed
the amount stated earlier (100% of your salary to $15,500 or $20,500 if you are over 50 for calendar year 2008).
Professional Development and Training
Montgomery College’s mission states, in part, that “We encourage continuous learning for our students, our faculty, our staff, and our community.”
To fulfill this commitment, numerous programs and services are offered to faculty and staff. There are two departments at the College whose
primary purpose is to provide training and development to College employees: the Human Resources Center for Professional & Organizational
Development (CPOD) and The Center for Teaching and Learning (CTL). Information regarding CPOD and CTL’s programs and services can be
found at their respective websites:
Center for Professional & Organizational Development: http://www.montgomerycollege.edu/departments/cpod/
Center for Teaching and Learning: http://www.montgomerycollege.edu/departments/ctl/
MONTGOMERY COLLEGE PROFESSIONAL DEVELOPMENT OPPORTUNITIES
Internal Programs & Opportunities
Title Description Eligibility Contact
Academic Leadership Program A year-long program designed to support and continue Faculty Chairs, Program HR - CPOD
dialogue on learning and training effectiveness addressing Coordinators, Managers,
individual and organizational dimensions. Administrators
Administrative Associate Provides opportunities for full time faculty to temporarily Full-time Faculty Vice President of
Assignment perform specific administrative or research projects. Use Academic and
special skills and talents and bring faculty perspectives Student Services
directly into an administrative setting.
Administrative Professionals Provides information and skill-building courses specific to Administrative CPOD
Program the needs of office support professionals. Professionals
Adjunct Faculty Success Forum Focuses on syllabus design, lesson organization, Part-time Faculty CTL
preparation for the first class, and instructional resources
in a three-hour class.
Developing the Skillful Introduces new and aspiring managers to fundamental Any employee who aspires CPOD
Supervisor managerial concepts and skills. to or is new to a
Facilitative Leadership ® Explores the relationship between leadership and All MC employees CPOD
participation and offers a proven method for turning
obstacles into opportunities in a three-day class.
Fellowship Program for Full-Time Provides a theme-related fellowship encouraging Full-time Faculty (by CTL
Faculty innovative teaching practices, which have included active application)
learning, technology-enhanced instruction, and service
Title Description Eligibility Contact
Leadership Development Develops the knowledge and skills that permit participants Administrators, Staff, CPOD
Institute (LDI) to apply leadership in their current positions. Faculty
MC Learns Provides interactive experiences and dynamic learning All MC employees Vice President for
opportunities that celebrate the joy of collaborating with Learning and
colleagues and students as MC focuses on enhancing its Academic
role as a “learning college”. Effectiveness
MC Management Exposes managers and supervisors to the skills and Any employee who has CPOD
competencies necessary to manage effectively. formal management and
Orientation Programs Provides an overview of collegewide operations, policies, New Administrators, CPOD
procedures, and benefits in designated programs for Faculty, Staff
staff, faculty, and administrators.
Orientation to Teaching at MC Orients new faculty in three classes that occur during the New Full-time Faculty CTL
new faculty orientation program to building a syllabus,
meeting the class for the first time, and CTL professional
Part-time Faculty Fellowship Provides a semester-long, paid fellowship on the topic of Part-time Faculty (by CTL
Program “Fundamentals of Good Teaching Practice”. Includes an application)
online component and four in-person sessions.
Professional Development Semester-long series on topics such as effective planning Full-time Faculty in their first CTL
Program for New Faculty and teaching, teaching in a multicultural classroom, three years at the college
instructional variety, classroom assessment techniques,
using technology in instruction, action research, and
evaluating student learning.
Technology Training Provides training in managing job information resources Administrators, Faculty, CPOD
more effectively. Staff
Title Description Eligibility Contact
Tuition Waiver (TW) Program Allows faculty and staff, under certain conditions, to enroll Full-time Staff and Faculty Human Resources
in courses for credit at Montgomery College without and non-bargaining part-
paying tuition. WD&CE courses cannot be paid with TW time employees immediately
funds (use EAP). upon employment at MC
Staff Performance Reviews Enables managers and employees to plan and design Supervisors and Regular CPOD
annual professional development plans. Staff
Workshops, Short Courses and Provides professional, leadership, and management skill- Administrators, Faculty, CPOD, CTL
Conferences building in various competencies in addition to current Staff
teaching and learning practices.
External Programs & Opportunities
Faculty Development (Retraining) Enables faculty to receive appropriate education Full-time Faculty in Dean/Human
Program necessary for teaching in another designated discipline. designated disciplines Resources
Supports involvement with ACE Fellows, KELLOGG Administrators, Full-time Provost, Vice
Fellowships and Opportunities National Fellowship Program, Leadership Montgomery, Faculty, and Staff who meet Presidents’ offices
International Institute for Leadership Development, and program guidelines and Human
National Hispana Leadership Institute. Available upon Resources
recommendation of the President’s Cabinet.
Foundation Grants Program Encourages and supports participation in state, regional, Full-time Faculty and Staff Institutional
and national conferences, associations, and meetings. Advancement
Graduate Program Cohorts Provides a doctoral program in community college Administrators, Faculty, CPOD
leadership with classes offered at MC. Admission is Staff
through Morgan State University.
Professional Development Leave Encourages academic study or other activity leading to Administrators, Full-time CPOD
and Sabbatical Leave professional growth. Faculty, Staff
Smithsonian Fellows Allows research fellowships with Smithsonian mentors to Full-time Faculty Humanities Institute
gain new knowledge and incorporate museum resources
into course curricula.
Title Description Eligibility Contact
Educational Assistance Program Assists eligible College personnel with educational Administrators, Full-time Human Resources
(EAP) expenses, including continuing education courses, in Faculty, and Staff after 6
order to help them perform more effectively in their months of employment
current job or prepare them for higher-level
Travel Reimbursement and Reimbursement for travel to meetings, conferences or Full-time Faculty and Staff Unit Head or Account
Professional Meeting Leave training programs which meet College goals and Manager
CPOD Center for Professional & Organizational Development
Provides professional, leadership, and management skill-building opportunities and technology training classes
to use the College’s resources effectively.
CTL Center for Teaching and Learning
Supports scholarly and pedagogical research; designs, develops, and implements faculty activities focusing on
teaching effectiveness and using technology resources as appropriate.
Educational Assistance Program (EAP) and Tuition Waiver (TW)
Tuition waiver for Montgomery College credit courses and tuition reimbursements are provided to facilitate the continued growth and education of
our employees. These benefits are only available to full-time and part-time non-bargaining employees.
Education Assistance Program (EAP)
The purpose of the Educational Assistance Program (EAP) is to assist all eligible employees with educational expenses in order to (a) help them
perform more effectively in their current job classifications through improved knowledge and skills; and (b) help them in preparing for higher level
responsibilities in the College by virtue of broadened capabilities.
Tuition Waiver - Employee Only
The purpose of the tuition waiver plan is to allow eligible full-time regular and part-time non-bargaining employees to enroll in credit courses at
Montgomery College. Noncredit Continuing Education courses are excluded from tuition waiver coverage for employees but may be covered in
accordance with EAP regulations, as appropriate. Fees for courses taken at Montgomery College under the Tuition Waiver Plan which meet EAP
regulations may also be covered under the Educational Assistance Program (EAP).
In accordance with Maryland State law, tuition is waived at time of enrollment for Montgomery College courses approved in advanced under this
policy and taken during non-working hours. Tuition waiver is limited to a space available basis.
All fees for courses taken at Montgomery College that are job, career, or degree-related would also be eligible for 100% reimbursement. Course
fees, only for courses taken at another college, which are job, career, or degree-related would also be reimbursed.
Tuition Waiver - Dependent/Spouse
Tuition Waiver for Dependent/Spouse is available to dependent and spouse of full-time staff and full-time faculty with benefits.
No waiting period.
Courses for which credit is earned at Montgomery College are eligible. Remedial classes (no credits earned) are not eligible.
Domestic partners are not eligible for this benefit (as they do not qualify as a dependent under the IRS Tax code).
Earn a passing grade and the associated credit for the course.
No limit to the number of courses.
No schedule limitation.
Only the Tuition cost is waived. Fees/books are not waived.
Dependent/Spouse relationship will be determined by information in the Office of Human Resources. If information is not available, MC
employee will be requested to submit documentation.
Courses that are not satisfactorily completed may not be retaken using the Tuition Waiver benefit.
Frequently Asked Questions - EAP and Tuition Waiver (FAQ’s)
When am I eligible for EAP and tuition waiver?
Full or part-time employees (with benefits) are eligible for EAP after 6 months at the College. Full-time and part-time non-bargaining employees
(with benefits) are eligible for TW at time of employment (no waiting period).
What is the maximum benefit for EAP?
EAP funds run on a fiscal year basis (7/1/07 – 6/30/08). For FY08, the individual limit for full-time faculty is $1,735.00. Additionally, for full-time
faculty members taking graduate coursework beyond the Master’s degree level, the maximum EAP benefit can exceed the $1,735.00 such that
total reimbursement would be equal to the University of Maryland College Park rate for in-state tuition and fees for graduate coursework up to a
maximum of six (6) graduate credits per academic year. For full-time bargaining staff, the amount is $1,670.00 for those not taking graduate or
undergraduate coursework. Additionally, for full-time bargaining staff enrolled in graduate or undergraduate coursework beyond the Associate’s
degree level, the maximum EAP benefit can exceed the $1,670.00 by an amount such that total reimbursement would be equal to the University of
Maryland College Park rate for in-state tuition and fees for graduate or undergraduate coursework for each credit, up to a maximum of six (6)
credits. For full-time non-bargaining staff, the amount is $1,735.00 for those not taking graduate or undergraduate coursework. For non-
bargaining full-time staff enrolled in graduate or undergraduate coursework beyond the Associate’s Degree level, the maximum EAP benefit can
exceed the $1,735.00 by the amount equal to the University of Maryland College Park rate for in-state tuition and fees for graduate or
undergraduate coursework for each credit, up to a maximum of six credits.
Part-time staff EAP benefits are prorated.
Can I take a tuition waiver course during my lunch hour?
No. A requirement for a tuition waiver course is that the meeting time of the course is outside of your working hours. Also, the official lunch break
of the College is 30 minutes.
What does EAP cover?
EAP will cover the cost of tuition or registration fee for a course, workshop and/or seminar. It will also cover any required books and supplies for
the course, workshop or seminar.
Will EAP cover examination fees, meals or travel expenses?
How do I request use of EAP/TW?
Complete an online eTWEAP form found on the HR Website.
Does the course or workshop need to be work related in order to use EAP and TW?
To use EAP, the course, workshop or seminar must be work-related, a requirement in a work-related degree program, or preparing you for higher–
level duties or another career here at the College. Tuition Waiver courses do not need to be job-related. However, to be reimbursed for fees and
books, they must meet the EAP criteria.
If I make a change to my approved/EAP/TW request, do I need to let HR know?
Yes. You need to notify HR of any changes or cancellation. It may impact future EAP/TW benefits.
Will I need to send in to HR a certificate of completion when I have completed the course, workshop or seminar?
What if the vendor does not provide a certificate at the end of the program/course?
In this situation, you may send in a name badge, copy of an agenda or program of the course, workshop or seminar.
Are EAP funds taxable?
Can I audit a class under tuition waiver?
No, you will need to earn the credit associated with the class to be eligible for tuition waiver.
Can I take a continuing education course under tuition waiver?
No. Tuition waiver applies to only credit courses.
MC Wellness Connection (Wellness Program) - Fiscal Year 2008
The goals of the Wellness Program are to enhance the health, productivity and well being of Montgomery College employees and to obtain long-
range reduction and/or control of health care costs.
All employees with benefits, their spouses and retirees from the college are eligible to participate in the Healthier Lifestyles programs. However,
student employees and faculty and staff without benefits cannot participate.
Fees and Enrollment
The fee is $30/semester or $90/year for each course. This fee is eligible for EAP reimbursement. The fee to use the Fitness Center is $50 per
If EAP is not being utilized the fee can be paid to the Cashier’s Office. Bring a copy of the receipt to the course instructor when you attend the first
class or wellness session. If you wish to use EAP to pay for the course, you may submit an EAP form for approval and not pay the fee. The EAP
forms need to be properly filled out for approval.
The college is also now reimbursing employees through EAP for memberships at outside gyms. Employees must provide proof of attendance
(minimum of 10 times per month) in order to be reimbursed. For details, please see the Frequently Asked Questions (FAQ) section of the
Wellness Connection website.
For a schedule of current classes available on each campus contact -- Rowena D’Souza, (240) 567-5370,
email@example.com. The schedule is also on the HR website at www.mcinfonet.org.
Using EAP to pay for MC Wellness Courses
1. Prior to enrolling in a Healthier Lifestyle class, employees need to properly fill out an EAP form (found on the eTWEAP section of the HR
Website). Check to make sure that the form includes the course title, campus, time, and dates. Incomplete forms will be returned by Human
Resources for completion. Only the classes led by instructors are eligible for reimbursement. The classes are $30/class/semester.
2. The form is submitted to the supervisor for its review and approval.
3. The approved EAP form is sent to Human Resources (HR) for review and approval.
4. The HR approved EAP form is returned to the employee.
5. The employee will bring a copy of the form to either the instructor of the course or the campus coordinator for registration in the course.
Employees who register for multiple classes need only leave a copy with one of the instructors.
6. All Healthier Lifestyles participants need to fill out a Registration/Waiver/Informed Consent Form.
7. Healthier Lifestyles Coordinators will verify participation with Human Resources at the end of each semester.
8. Due to regulations, this process must be completed each semester.
9. If you register but fail to attend the class, a refund will be requested.
10. If you wish, you may continue to pay the cashier and submit the receipt with the completed EAP form for reimbursement. A copy of the
cashier receipt needs to be submitted to either the class instructor or campus coordinator.
Montgomery College is an equal opportunity institution, committed to fostering a diverse academic community among its student body, faculty, and
staff. The College is committed to providing an environment in which all persons are provided the opportunity for employment and/or participation
in academic programs, and other College activities free from any form of discrimination or harassment as prohibited by federal regulations and
Faculty/Staff Assistance Program
A Faculty Staff Assistance Program (FSAP) is a confidential assistance program designed to help you with life issues and situations where
professional guidance may be desired.
Balancing the demand of work and personal life can be challenging. To help you succeed, First Advantage FSAP provides comprehensive
resources and services to help you meet your personal, family, and work challenges.
Provided as a free benefit by Montgomery College, the FSAP is staffed by experienced Masters-level professional who can help find solutions to
many different kinds of problems you and your dependents face.
How will the FSAP help you?
The FSAP can help you with most personal problems that happen at home or work. Some of these include:
Feelings of sadness or anxiety
Family pressures (children, teens, older relatives, etc)
Alcohol and/or drug problems
What happens when you meet with the FSAP professional?
You will talk with one of the professional about what is troubling you. Once he or she learns more about your situation, the professional will
recommend specific ways to help. Sometimes several additional sessions between you and the FSAP professional will be necessary – the
number of additional sessions is dependent upon the nature of the problem and the number of sessions available to you.
In other instances, the FSAP professional will recommend a counselor or agency in your community that specializes in the help you need. IN all
cases, your FSAP professional will stay in touch with you to make sure you are getting the necessary assistance.
How confidential is the FSAP?
All information regarding your participation in the program is confidential except as governed by state and federal laws and regulations. Instances
where your emotional conditions makes you a threat to self or others, suspected child or elder abuse, and, in some states, spousal abuse are
examples of cases that require reporting.
The college will not even know that you participated in the FSAP unless you give your written consent.
Sometimes a supervisor may recommend that you contact the FSAP if there has been a noticeable decline in job performance. If you decide to
follow the recommendation, your supervisor will only be informed that the initial contact was made – no information about your conversation will be
given to your supervisor without your written permission.
Will FSAP services cost me anything?
Your First Advantage FSAP is provided by your employer at no cost to you. You will not be charged for any services provided to you by the FSAP
staff. If a counselor or agency in your community is recommended, your FSAP professional will assist you in finding one which is covered by your
health benefits program or a community program that will be affordable.
How do I contact the FSAP?
To use this free and confidential service, simply call them at any time. The team of FSAP professionals will answer your call promptly 24-hours a
day, seven days a week. To take advantage of these confidential services, call 1-800-935-9551. Hearing impaired? Dial 1-800-855-2881, then
connect to 1-800-935-9551.
Who may use the Program?
YOU – as an employee of Montgomery College – for counseling and education.
SUPERVISORS – for consultation and training.
Montgomery College will withhold state taxes from residents of Maryland, Virginia, the District, West Virginia and Pennsylvania. There is no form
for Pennsylvania; a flat rate will be withheld automatically. Residents of any other state must complete the non-resident section of the Maryland
form (MW507). It will be necessary for those non-resident individuals to make estimated payments to the state of residence. You may not claim
more than 10 Federal/14 Maryland exemptions without the IRS or Income Tax Division being notified of your exemptions. Blank tax forms are
available in Human Resources, the Payroll Office or can be downloaded using the links at the HR web site.
Direct Deposit is available and highly encouraged for those employees that wish to have their paychecks directly deposited into their bank
accounts and ensuring that paychecks are delivered in the most efficient manner regardless of weather conditions.
Forms are available in Payroll for deductions to purchase EE U.S. Savings Bonds through payroll deduction. Only employees with benefits are
eligible for participation. There are plans to begin offering the highly desirable I Bonds soon. Stay tuned.
Forms are available in Payroll to change your allocation (deduction) to the Montgomery County Teachers Federal Credit Union. You must initially
join the Credit Union in person (you will need to make a $5 deposit and sign papers). Subsequent changes to the allocation may be made at the
Payroll Office. Allocation (a separate payroll deduction which shows up on your pay stub) is restricted to employees eligible for benefits. All
employees can have his/her pay direct deposited to the Credit Union.
Each Friday is either a pay day or pay period end day. Time sheets should be completed on the web and submitted for approval before the
department deadlines. The final cut off for submission and approval is noon on the pay period end date. Check with your supervisor for the exact
procedure for your department. Contact the Payroll Office (x 75330, x 75331) if you have any questions.
Each check/advice lists the current pay data as well as year to date information and leave balances. Advices are mailed to the permanent
address on file in Human Resources. Checks are sent to the Cashier’s Office on each campus to be picked up by the department for staff or
placed in full time faculty mailboxes. Social Security is listed in two parts – FICA and Medicare.
There is a FAQ section pertaining to the payroll at the HR web site. If you have additional questions or would just like to stop in and say hello, we
are located in room 255 in the Mannakee Building. Our phone number is x 75330.
Facilities and Services
Certain physical education facilities and equipment are available at no cost to full-time and part-time employees. These include the weight room,
pool, tennis courts, track and bicycles.
The bookstore offers a number of services to the college community including a wide range of school and art supplies along with academically
priced software. In addition, bookstores will special order any book(s).
The Early Learning Center, located on each of the three campuses, provides high-quality care for children ages 2 through 6 of students, staff and
faculty. Each center is licensed by the state of Maryland and accredited by the National Association for the Education of Young Children.
Cafeterias, snack shops, and vending machines are conveniently located on each of the campuses.
Automatic Teller Machine (ATM)
Chevy Chase Bank
An Automatic Teller Machine (ATM) is located on each Campus.
Employees are able to use any of the resources offered by the library. In addition to research information, the library maintains a large number of
popular books including many of those on the current best seller list.
Paydays are bi-weekly. Your first paycheck is a physical paycheck and must be picked up at the cashier’s office of the campus where you are
located. Paychecks are encouraged to be direct deposited into a checking or savings account.
United Buying Services
Save on buying new cars, trucks, furniture, and cellular service. See the book on services available for review in the Office of Human Resources
or call UBS at 410-792-9070.
Montgomery College - Office of Human Resources Web Sites
Banner Web for Employee Services
This Web site allows users to view their personal HR/Payroll information from the data tables of the College's administrative Banner
database system. Banner Web for Employee Services contains information on your benefits and deductions, current and past jobs, tax
forms, pay information and pay stubs and additional payroll information going back to 1/1/96, the date Banner HR/Payroll went live.
Access the site through the College’s MyMC portal at http://mymc.montgomerycollege.edu.
Web Time Entry is also on the Banner Web for Employee Services site and is also accessed through MyMC. Web Time Entry is utilized
by College staff, administrators, temporary and student employees who enter their time on the Banner Web for Employee Services site.
Access is through MyMC, then click on the Time Entry link on the left.
When using the Banner Web for Employee Services site for the first time, follow the directions on the MyMC home page which will provide
you with instructions on obtaining your account information online.
You are strongly encouraged to quickly change your six-digit date-of-birth PIN default value to a more easily remembered - and secure -
six-digit number. When you first enter the secured area of Banner Web, click on the Personal Information link to change your PIN. Do
not use your six-digit date-of-birth.
Please make sure you keep a secure record of any changes you may make to your PIN. If you misplace your PIN and need to have it
reset, call your academic department if you are a faculty member. If you are a staff member, call the IT Help Desk (240-567-7222) or the
Office of Human Resources (240-567-5353), Monday through Friday, 8:30 a.m. - 5:00 p.m.
Vurv - MC’s Employment Opportunities Self Service Web Sites
All internal and external applicants must apply online on the College’s Employment Opportunities Web sites.
The job vacancy pages on the internal site will clearly note when a position is available to internal employees only.
Internal Employment Site https://insidejobs.montgomerycollege.edu
External Employment Site https://jobs.montgomerycollege.edu
Procedures and tips for Internal applicants
MC employees who receive benefits apply for position vacancies via the internal site.
MC employees who do not receive benefits apply via the external site.
The same online application is used by all staff, administrators, faculty and temporary employees.
Applicants create only one online application – and reapply for additional position vacancies with that same application.
You can edit your application at any time.
Save your e-mail ID and password to access your application again.
The closing date indicates the deadline for receipt of online applications. Job postings are removed from the site on the vacancy’s closing
date and can no longer be accessed.
The recruitment process can take up to three months.
PC requirements for access to the Employment Opportunities Web Sites
You are encouraged to use the Internet Explorer (IE) browser, version 5.0 or higher.
If you use the Netscape browser, you must use version 4.75 or higher.
Note: The Netscape browser has been unreliable for interactive Web sites.
This system is a secure site. Click Yes/Next to pass through the Certificate screens.
The MC Employment sites are not Mac accessible.
OHR Web Site
The College’s OHR Web site is separate from the Banner Web for Employee Services site.
The OHR Web site is accessed via your MyMC portal at http://mymc.montgomerycollege.edu. The Human Resources link is available via
Quick Links on your MyMC home page and on the Employee page.
This site contains almost all OHR forms and documents produced by the Recruitment, Employment, Benefits, Retirement, Systems,
Wellness, Employee and Labor Relations areas of the department. The College's Faculty and Staff Labor Contracts are also available on
Center for Professional and Organizational Development Web Site
The Center for Professional and Organizational Development has an Internet site that lists the various programs, services, and resources
available to MC employees through the Office as well as Collegewide.
This site is not password protected and is available on the College's public Internet site at
Access to the OHR Web Sites
Please call the IT Help Desk at 240-567-7222 if you are having problems with the use of your PC, MyMC access, Banner Web access, or your
MS Explorer or Netscape Web browser at work.
Human Resources Directory
Chief Human Resources Officer Telephone
Vivian M. Lawyer, Chief Human Resources Officer 567-5358
Susana Gilardi, Senior Administrative Aide 567-5382
Sherri Bokor, Administrative Assistant 567-5358
Pat Holland, Human Resources Specialist (supports OIT) 567-3053
Lynda S. von Bargen, Deputy Chief Human Resources Officer 567-5370
Lynette Evans, Senior Administrative Aide 567-5352
Rowena D’Souza, Human Resources Specialist 567-5370
Bridgid Harchick, Human Resources Associate 567-7301
(Worker’s Comp, Disability Leave, LWOP, FMLA, ADA, Advanced Sick Leave Requests, Property & Casual Insurance,
Brenda Salas, Rockville Wellness Coordinator 567-7982
Keith Federman, Germantown Wellness Coordinator 567-6932
Mercedes Santos, Takoma Park/Silver Spring Wellness Coordinator 567-3967
Employment (Recruitment, ID Cards, Short-term Temporaries, Initial Salary Placement)
Denise Fitzgerald, Human Resources Manager 567-5366
Cheryl Arnold, Coordinator of Applications 567-5372
Lawrence Watson, Human Resources Associate/Receptionist 567-5353
Toni Odgen, Human Resources Associate 567-1725
Elaine Doong, Human Resources Specialist 567-5364
Maria Bedenbaugh, Human Resources Specialist 567-7138
Sharon Parker, Human Resources Specialist 567-7206
Phillip Daniels, Human Resources Manager 567-5351
Joan Howard, Human Resources Specialist 567-7243
Ana Awwad, Human Resources Specialist 567-4248
Benefits (EAP/TW, Retirement, Insurance, Sick Leave)
Karen Bass, Human Resources Manager 567-5359
Suzanne Redding, Human Resources Specialist 567-5354
Carrie Garvin, Human Resources Associate 567-5369
Paula Hadzima, Human Resources Associate 567-5365
Records (Change of Address, Personnel Records, Individual Pay Rate, Performance Evaluation Schedule, Verification of Employment)
Mary Kay Hinkle, Human Resources Associate 567-5375
Angela Howard, Human Resources Associate 567-5360
Tracey Romney, Human Resources Associate 567-5363
Center for Professional and Organizational Development (Professional Development Leave, Training, Supervisory Roundtables)
Krista Leitch Walker, Director of Professional Development 567-4280
Mary Beth Liller, Senior Administrative Aide 567-4274
Carmen D’Agostino, Human Resources Manager (Internal Development Programs) 567-4275
Deonna Mills-Humphress, Human Resources Associate 567-4281
Cynthia Mauris, Human Resources Specialist 567-4278
Ellamarie Campbell, Human Resources Specialist 567-4296
Andrew Ryan, Manager, Technical Training and Resources 567-4279
Lisa Borg, Human Resources Associate 567-4272
Lois Anderson, IT Systems Coordinator 567-4271
Dan Gutwein, Instructional Multimedia Specialist 567-4276
HR Systems and Reporting
Kamaria Jackson, HR Systems and Reporting Manager 567-5350
Sue Riedel, HR/Payroll Systems Analyst 567-5356
Vacant, HR/Web Systems Analyst 567-8042
Employee and Labor Relations
Vacant, Director of Employee and Labor Relations 567-5380
Vacant, Senior Administrative Aide 567-5396
L. Scott McRae, Human Resources Specialist 567-5361
Vacant, Human Resources Specialist 567-5009
Employee Benefit Vendors
Vendor Contact Phone Number(s) Web Sites
ING Retirement Services Harry Schiavone 703-449-2917 www.ingretirementplans.com
BeniSource 800-815-3023, option 4
800-584-4185 FAX www.benisource.com
CIGNA Health Care Member 800-CIGNA24 www.CIGNA.com
Delta Dental 800-932-0783 www.wekeepyousmiling.com
Caremark 888-790-4266 www.caremark.com
Gallagher Bassett, Inc. (Worker’s 301-944-6300
Equitable/AXA Advisors Mark S. Purisch 301-840-1551 www.equitable.com
Faculty/Staff Assistance Program 800-935-9551
First Advantage www.fadv.com/eapsap
Kaiser Permanente 301-816-6344 www.kaiserpermanente.org
Legal Resources 800-728-5768 www.legalresourcesplan.com
MD State Retirement/Pension 410-225-4030
MD State Retirement/Pension 800-492-5909
General Information www.sra.state.md.us
Montgomery County Teacher's 301-948-9880
Credit Union www.mctfcu.org/
TIAA-CREF 800-842-2733 www.tiaa-cref.org
United Buying Service Baltimore 410-792-9070 www.ubs4cars.com/
VALIC Robert G. Keller 800-892-5558 x88422 www.aigvalic.com
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
NOTICE OF PRIVACY PRACTICES
CONFIDENTIALITY OF YOUR HEALTH CARE INFORMATION
This notice is required by law to tell you how Delta Dental and its affiliates ("Delta Dental") protect the confidentiality of your health care information in our
possession. Protected Health Information (PHI) is defined as any individually identifiable information regarding a patient's healthcare history; mental or physical
condition; or treatment. Some examples of PHI include your name, address, telephone and/or fax number, electronic mail address, social security number or other
identification number, date of birth, date of treatment, treatment records, x-rays, enrollment and claims records. Delta Dental receives, uses and discloses your
PHI to administer your benefit plan or as permitted or required by law. Any other disclosure of your PHI without your authorization is prohibited.
We must follow the privacy practices that are described in this notice, but also comply with any stricter requirements under federal or state law that may apply to
our administration of your benefits. However, we may change this notice and make the new notice effective for all of your PHI that we maintain. If we make any
substantive changes to our privacy practices, we will promptly change this notice and redistribute to you within 60 days of the change to our practices. You may
also request a copy of this notice anytime by contacting the address or phone number at the end of this notice. You should receive a copy of this notice at the time
of enrollment in a Delta Dental program, and we will notify you of how you can receive a copy of this notice every three years.
Permitted Uses and Disclosures of Your PHI
We are permitted to use or disclose your PHI without your prior authorization for the following purposes. These permitted uses and/or disclosures include
disclosures to you, uses and/or disclosures for purposes of health care treatment, payment of claims, billing of premiums, and other health care operations. If your
benefit plan is sponsored by your employer or another party, we may provide PHI to your employer or that sponsor for purposes of administering your benefits.
We may disclose PHI to third parties that perform services for Delta Dental in the administration of your benefits. These parties are required by law to sign a
contract agreeing to protect the confidentiality of your PHI. Your PHI may be disclosed to an affiliate that performs services for Delta Dental in the administration of
your benefits. These affiliates have implemented privacy policies and procedures and comply with applicable federal and state law.
We are also permitted to use and/or disclose your PHI to comply with a valid authorization, to notify or assist in notifying a family member, another person, or a
personal representative of your condition, to assist in disaster relief efforts, and to report victims of abuse, neglect, or domestic violence. Other permitted uses
and/or disclosures are for purposes of health oversight by government agencies, judicial, administrative, or other law enforcement purposes, information about
decedents to coroners, medical examiners and funeral directors, for research purposes, for organ donation purposes, to avert a serious threat to health or safety,
for specialized government functions such as military and veterans activities, for workers compensation purposes, and for use in creating summary information that
can no longer be traced to you. Additionally, with certain restrictions, we are permitted to use and/or disclose your PHI for underwriting. We are also permitted to
incidentally use and/or disclose your PHI during the course of a permitted use and/or disclosure, but we must attempt to keep incidental uses and/or disclosures to
a minimum. We use administrative, technical, and physical safeguards to maintain the privacy of your PHI, and we must limit the use and/or disclosure of your PHI
to the minimum amount necessary to accomplish the purpose of the use and/or disclosure.
Examples of Uses and Disclosures of Your PHI for Treatment, Payment or Healthcare Operations
Such activities may include but are not limited to: processing your claims, collecting enrollment information and premiums, reviewing the quality of health care you
receive, providing customer service, resolving your grievances, and sharing payment information with other insurers. Additional examples include the following.
Uses and/or disclosures of PHI in facilitating treatment.
For example, Delta Dental may use or disclose your PHI to determine eligibility for services requested by your provider.
Uses and/or disclosures of PHI for payment.
For example, Delta Dental may use and disclose your PHI to bill you or your plan sponsor.
Uses and/or disclosures of PHI for health care operations.
For example, Delta Dental may use and disclose your PHI to review the quality of care provided by our network of providers.
Disclosures Without an Authorization
We are required to disclose your PHI to you or your authorized personal representative (with certain exceptions), when required by the U. S. Secretary of Health
and Human Services to investigate or determine our compliance with law, and when otherwise required by law. Delta Dental may disclose your PHI without your
prior authorization in response to the following:
Order of a board, commission, or administrative agency for purposes of adjudication pursuant to its lawful authority;
Subpoena in a civil action;
Investigative subpoena of a government board, commission, or agency;
Subpoena in an arbitration;
Law enforcement search warrant; or
Coroner's request during investigations.
Disclosures Delta Dental Makes With Your Authorization
Delta Dental will not use or disclose your PHI without your prior authorization if the law requires your authorization. You can later revoke that authorization in
writing to stop any future use and disclosure. The authorization will be obtained from you by Delta Dental or by a person requesting your PHI from Delta Dental.
Your Rights Regarding PHI
You have the right to request an inspection of and obtain a copy of your PHI. You may access your PHI by contacting the appropriate Delta Dental office.
You must include (1) your name, address, telephone number and identification number and (2) the PHI you are requesting. Delta Dental may charge a reasonable
fee for providing you copies of your PHI. Delta Dental will only maintain that PHI that we obtain or utilize in providing your health care benefits. Most PHI, such as
treatment records or X-rays, is returned by Delta Dental to the dentist after we have completed our review of that information. You may need to contact your
health care provider to obtain PHI that Delta Dental does not possess.
You may not inspect or copy PHI compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, or PHI that is otherwise
not subject to disclosure under federal or state law. In some circumstances, you may have a right to have this decision reviewed. Please contact the privacy office
as noted below if you have questions about access to your PHI.
You have the right to request a restriction of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your
request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You
may not limit the uses and disclosures that we are legally required or allowed to make.
You have the right to correct or update your PHI. This means that you may request an amendment of PHI about you for as long as we maintain this
information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of
disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. If your PHI was sent to us by
another, we may refer you to that person to amend your PHI. For example, we may refer you to your dentist to amend your treatment chart or to your employer, if
applicable, to amend your enrollment information. Please contact the privacy office as noted below if you have questions about amending your PHI.
You have the right to request or receive confidential communications from us by alternative means or at a different address. We will agree to a
reasonable request if you tell us that disclosure of your PHI could endanger you. You may be required to provide us with a s tatement of possible danger, a
different address, another method of contact or information as to how payment will be handled. Please make this request in writing to the privacy office as noted
You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right does not apply to disclosures for purposes
of treatment, payment, or health care operations or for information we disclosed after we received a valid authorization from you. Additionally, we do not need to
account for disclosures made to you, to family members or friends involved in your care, or for notification purposes. We do not need to account for disclosures
made for national security reasons or certain law enforcement purposes, disclosures made as part of a limited data set, incidental disclosures, or disclosures made
prior to April 14, 2003. Please contact the privacy office as noted below if you would like to receive an accounting of disclosures or if you have questions about
You have the right to get this notice by e-mail. You have the right to get a copy of this notice by e-mail. Even if you have agreed to receive notice via e-mail,
you also have the right to request a paper copy of this notice.
You may complain to us or to the U. S. Secretary of Health and Human Services if you believe that Delta Dental has violated your privacy rights. You may file a
complaint with us by notifying the privacy office as noted below. We will not retaliate against you for filing a complaint.
Delta Dental of New York offers and administers fee-for-service programs in New York. Delta Dental of Pennsylvania and its affiliates offer and administer fee for-
service dental programs in Delaware, Maryland, Pennsylvania, West Virginia and the District of Columbia, and prepaid vision programs in West Virginia. Delta
Dental of Pennsylvania's affiliates are Delta Dental of Delaware; Delta Dental of the District of Columbia; Delta Dental of W est Virginia and Delta Vision of West
You may contact the Privacy Department at the address and telephone number listed below for further information about the complaint process or any of the
information contained in this notice.
Address: Delta Dental
One Delta Drive
Mechanicsburg, Pennsylvania 17055
This notice is effective on and after July 1, 2006.