Information about options available for full time employees are included on this page. If you have questions about your options, please contact Dr. Brett Gilliland at bgilliland@tiuu11.org or by calling 814-542-2501 x192 or 717-899-7143 x192

Submit TIU-45 for any new enrollment or change to existing coverage. All individuals being added must be listed (including the employee) with complete data in section C. You may fax or mail the form back. Please do not email forms. Premium shares for all coverages in 18-19 will remain the same as they were in 17-18.
SCROLL DOWN FOR VARIOUS PLANS

FORMS

Name Title
1) TIU45InsuranceCoverage06-15-2017.docx 1) TIU45InsuranceCoverage06-15-2017.docx TIU 45 Insurance Coverage Form
2) TIU45BInsOtherCvgRev4-5-17.docx 2) TIU45BInsOtherCvgRev4-5-17.docx Other Insurance Coverage Details
3) Spouse Qualification Medical Plans.docx 3) Spouse Qualification Medical Plans.docx Qualification form for spouse inclusion on medical coverage
4) DisabledDependentCertification.pdf 4) DisabledDependentCertification.pdf Disabled Dependent Designation for Medical Coverage
5) HSA Enrollment Form.pdf 5) HSA Enrollment Form.pdf HSA Enrollment – Account Set-up Form
6) HSA Change Form.pdf 6) HSA Change Form.pdf HSA Change Request for Existing Account
7) HTFLifeBeneficiaryForm.pdf 7) HTFLifeBeneficiaryForm.pdf GTL Beneficiary Designation Form

MEDICAL COVERAGE INFORMATION:
We offer two options for medical coverage, both are PPO plans through Highmark Blue Cross Blue Shield.
The prescription plan formulary is the same for both, though the cost for individual prescriptions will depend on which plan you select.

Standard PPO
This is a traditional PPO with individual deductible of $750 and family deductible of $1500.

Name Title
1) TIU Grid PPO 2018.docx 1) TIU Grid PPO 2018.docx Traditional PPO Benefit Grid 18-19
2) TIU SBC PPO 2018.pdf 2) TIU SBC PPO 2018.pdf Traditional PPO Summary of Benefits and Coverage 2018-2019
3) MedPPOBenefitBooklet2017.pdf 3) MedPPOBenefitBooklet2017.pdf Traditional PPO Booklet
4) Rx Tuscarora PPO 2017-18.pdf 4) Rx Tuscarora PPO 2017-18.pdf 18-19 Prescription Plan for Standard PPO (no change from 17-18)

High Deductible PPO
This is a qualified high deductible plan with an option to participate in a Health Savings Account. The deductible level for the QHDHP is $1350 for individual level coverage and $2700 for all other levels of coverage. This deductible level is set by the IRS and is the lowest level permitted for the current year for a high deductible plan. TIU will make a one time contribution to your health savings account at the beginning of the plan year (or a prorated amount for mid-year enrollments)
Video clips about the Health Savings Accounts

Name Title
1) TIU Grid HDHP.pdf 1) TIU Grid HDHP.pdf QHDHP Benefits Grid 18-19
2) TIU SBC HDHP.pdf 2) TIU SBC HDHP.pdf High Deductible Health Plan 2018-2019 Summary of Benefits and Coverage
3) MedHDHPBenefitBooklet2017.pdf 3) MedHDHPBenefitBooklet2017.pdf Qualified High Deductible Plan Booklet
4) Rx Tuscarora HDHP 2017-18.pdf 4) Rx Tuscarora HDHP 2017-18.pdf Prescription Coverage for QHDHP 18-19 (no change from 17-18)
5) TIUHDHPRev0606.pdf 5) TIUHDHPRev0606.pdf HDHP with HSA Summary – Smooth Sailing
6) HDHD-HSA05-13-2018.pdf 6) HDHD-HSA05-13-2018.pdf QHDHP Health Savings Account Summary
7) 2018 Health Savings Account Sample.pdf 7) 2018 Health Savings Account Sample.pdf HSA Example
8) Health Care Eligible HSA Exp.pdf 8) Health Care Eligible HSA Exp.pdf Examples of Eligible Expenses for HSA Reimbursements
9) HSA Enrollment Form.pdf 9) HSA Enrollment Form.pdf Health Savings Account Enrollment Form

Rx N Go
Rx N Go is a pharmacy option available to participating members in either of the medical coverages. This pharmacy may provide certain generic medications at no cost, shipped direct to you. For people on the standard PPO, their full formulary is available at no cost. For individuals on the High Deductible plan, all preventive generics in their formulary are at no cost.

Name Title
RX n GO Information.pdf RX n GO Information.pdf Rx N Go General Information (prescription option for select generic meds)
RX n GO Pharmacy Profile Form.pdf RX n GO Pharmacy Profile Form.pdf Rx N Go Profile Form

Teledoc
Teledoc is available to anyone participating in either of the medical plans offered. To use the service you must set up your account and provide medical history in order to assist in treatment. Information about Teledoc was mailed (or is mailed) to all qualified participants. You will need information in that mailing to initialize your account. If you do not have the initial mailing, please contact Cindy Felisberto for assistance.

Name Title
Teladoc How to Register.pdf Teladoc How to Register.pdf Teledoc Account Set-up Process
Teladoc Member Material.pdf Teladoc Member Material.pdf About Teledoc

General Medical Resources

Name Title
1) General Premium Shares.docx 1) General Premium Shares.docx General Employee Premium Share Rates for 18-19
2) Coverage Cost for Head Start 18-19.docx 2) Coverage Cost for Head Start 18-19.docx Premium Share Rates for HS/EHS/PKC 18-19
3) Middle Management Premium Shares.docx 3) Middle Management Premium Shares.docx Middle Management Premium Share Rates 18-19
4) 18-19GenMedRatesHSACont.pdf 4) 18-19GenMedRatesHSACont.pdf General Medical Share and TIU HSA Contribution 18-19
5) 2018PreventiveSchedule_HMK.pdf 5) 2018PreventiveSchedule_HMK.pdf 2018 Preventative Schedule

VISION COVERAGE INFORMATION:
Vision coverage is provided through VBA (effective July 1, 2018).

Name Title
1) TIU VISION GROUP 4536 Benefit Summary.pdf 1) TIU VISION GROUP 4536 Benefit Summary.pdf Vision Plan Summary 2018-19
2) 4 Step Flyer Updated.pdf 2) 4 Step Flyer Updated.pdf 4 Steps To Use Your Vision Benefits
3) VBA Beyond Benefits Flyer Updated.pdf 3) VBA Beyond Benefits Flyer Updated.pdf More Than Typical Coverage!

DENTAL COVERAGE INFORMATION:
Dental coverage is provided through Delta Dental of PA.

Name Title
1) DentalSBC2018.pdf 1) DentalSBC2018.pdf Dental Plan Coverage 18-19
DeltaDentalOnTheGo.pdf DeltaDentalOnTheGo.pdf Mobile App information, including ID card
DeltaDentalPaperless.pdf DeltaDentalPaperless.pdf On line access to benefit statements and more

SUPPLEMENTAL OPTIONS:

YOU MAY ADD SUPPLEMENTAL COVERAGES AT ANY TIME. NEW FULL TIME EMPLOYEES HAVE 30 DAYS FROM START DATE FOR A GUARANTEED ENROLLMENT. ALL OTHERS MUST COMPLETE THE EVIDENCE OF INSURABILITY TO ADD COVERAGE.
We offer supplemental options for Short and Long Term Disability (income replacement plans) and additional life insurance, at the employee’s expense. Spouse and children may also be added if voluntary life is selected for the employee. These coverages are through The Hartford. For enrollment information or other questions, please contact the Benefits Specialist.

Name Title
1) VolLifeADDSTDLTDPlanSummary.pdf 1) VolLifeADDSTDLTDPlanSummary.pdf Voluntary Options through The Hartford
2) TIUCalcSheetVolLifeLTDSTD.xlsx 2) TIUCalcSheetVolLifeLTDSTD.xlsx Rate Calculation Sheet for coverages through The Hartford
3) HartfordEnrollmentForm.pdf 3) HartfordEnrollmentForm.pdf The Hartford Enrollment Form for Voluntary Life, STD, LTD
4) EOI.pdf 4) EOI.pdf Evidence of Insurability for Voluntary plans through The Hartford
5) HTFLifeBeneficiaryForm.pdf 5) HTFLifeBeneficiaryForm.pdf Beneficiary Designation Form
6) Updated Supplemental Life.pdf 6) Updated Supplemental Life.pdf Voluntary – Supplemental Life Insurance Plan
7) Updated LTD 2 All Other EEs.pdf 7) Updated LTD 2 All Other EEs.pdf Voluntary Long Term Disability Income Protection
8) Updated Short Term Disability.pdf 8) Updated Short Term Disability.pdf Voluntary Short Term Disability Income Protection Plan