........ TABLE OF CONTENTS........

Introduction

How Individual Choice Works

Individual Choice at a Glance

Tax Advantages of Participating
in Individual Choice

Individual Choice Benefit Options

Medical Benefits

Dental Benefits

Life Insurance

Dependent Life Insurance

Accident Insurance

Long-Term Disability
(LTD) Insurance

Flexible Spending Accounts

Enrolling in Individual Choice

• Who is Eligible?
• Naming a Beneficiary
• Enrollment Process is NOT Completed
• If Both Family Members Work at IC
• Changing your Decisions
• COBRA Continuation Coverage
• New Employees
• Important Tax and Benefit Information

Glossary

Important Contact Information

ENROLLING IN INDIVIDUAL CHOICE

WHO IS ELIGIBLE?

If you are an active employee eligible for Ithaca College benefits, you are eligible to participate in Individual Choice. You also may enroll your eligible dependents, including

• your spouse or qualified domestic partner^*;
• unmarried children up to age 19^** who are dependent on you, including stepchildren and legally adopted children;
• unmarried children between the ages of 19 and 25^** who are full-time students enrolled in an accredited school and who continue to be dependent on you;
• unmarried children who are older than the age dependent coverage would otherwise terminate and who are incapable of self-sustaining employment because of mental illness, developmental disability, or mental retardation, as defined in the New York State Mental Hygiene Law, or because of physical handicap. The condition must have occurred before the child reached age 19 at which dependent coverage would otherwise have terminated and currently be enrolled under an Ithaca College sponsored plan. The child’s disability must be certified by a physician. In addition to this certification, the plan has the right to check rather a child is and continues to qualify as an incapacitated child.

Please contact the benefits department to schedule an appointment to enroll in the plan of your choice.

^* With the exception of dependent life insurance.

^** The age limit is reached on the day of the child’s birthday.

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NAMING A BENEFICIARY

If you are newly hired or if you want to change your current beneficiary designation for your life and/or accident insurance benefits, it is imperative that you keep your life insurance beneficiariy designation current. In order to elect a beneficiary, you must:

• Fill out the Add Beneficiary/Contact form
• Submit the form to the Office of Human Resources
• Designate your Beneficiaries online via Employee Self Service

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IF YOU DO NOT COMPLETE THE ENROLLMENT PROCESS

If a new employee or an employee who is newly eligible for benefits fails to complete the enrollment process within 30 days, no credits are given, and no coverage is in effect.

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IF BOTH FAMILY MEMBERS WORK AT ITHACA COLLEGE

If you are married to a benefit eligible Ithaca College employee, or if both you and your qualified domestic partner are eligible employees, each of you must complete the enrollment process. If you have eligible dependents you wish to cover, you must elect shared family coverage and use the rates for that level. If there are no eligible children, each member must elect "employee only" coverage.

No person may be covered as both an employee and a dependent, and no person may be covered as a dependent of more than one employee.

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CHANGING YOUR DECISIONS

Under a "cafeteria" plan, current IRS regulations require that the benefit elections you make remain in effect throughout the entire plan year. However, participants may be permitted to change their pretax elections during the year if they have a "change in status."

Election changes resulting from a change in status must meet a "consistency" requirement — thus, any election change must be on account of and correspond with a change in status affecting eligibility for employer plan coverage. For example, for divorce, legal separation, death, or loss of a dependent, an employee may cancel coverage for the spouse or ex-dependent, but may not be allowed to make other changes.

Allowable changes in status under current IRS regulations include:

• Change in marital status, including marriage, divorce, legal separation, annulment, or death of spouse.
• Change in number of dependents, including birth, death, adoption, and placement for adoption. This extends to dependents who become newly eligible for plan coverage because of a plan amendment.
• Change in employment status of the employee, spouse, or dependent, including commencement or termination of employment, change in worksite, commencement or return from a leave of absence, gain or loss of benefit eligibility by a dependent.
• Change in residence of the employee, spouse, or dependent. This might include a child moving away to attend college and losing eligibility for a region-specific plan.
• Dependent meeting or ceasing to meet the plan's definition of "dependent," such as attainment of a specified age or ceasing to be a student.

Corresponding changes to payroll will not be made until appropriate elections are processed. To change your contribution to a flexible spending account during the year, you or an eligible dependent must have had a "change in status" as described above. In addition, the following status changes also qualify:

• Dependent care account only: change in dependent care provider’s rates (unless the dependent care provider is your or your spouse’s relative) or switching of provider.
• Dependent care account only: your dependent otherwise ceases to be eligible.
• Health care account only: entitlement to Medicare or Medicaid.

You must change your elections within 30 days after the life-status change takes place if it involves adding yourself or an eligible dependent to your benefits. For a life-status change that constitutes a COBRA qualifying event, (one in which you take a dependent off your coverage) you have 60 days to change your elections.

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NOTICE OF RIGHT TO CONTINUE GROUP HEALTH COVERAGE

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed later. After a qualifying event, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary." You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay the full cost for COBRA continuation coverage.

If you are an employee of Ithaca College, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:

• Your hours of employment are reduced (loss of benefit eligibility), or
• Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee of Ithaca College, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:

• Your spouse dies;
• Your spouse's hours of employment are reduced (loss of benefit eligibility);
• Your spouse's employment ends for any reason other than his or her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

• The parent-employee dies;
• The parent-employee's hours of employment are reduced (loss of benefit eligibility);
• The parent-employee's employment ends for any reason other than his or her gross misconduct;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the plan as a "dependent child."

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When is COBRA Coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, [ ass if Plan provides retiree health coverage: commencement of a proceeding in bankruptcy with respect to the employer,] or the employee’s becoming entitled to Medicare benefits (under Part A, Part b or both), the employer must notify the Plan administrator of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs.

How is COBRA Provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee’s becoming entitle to Medicare benefits ( under Part A, Part B or both), your divorce or legal separation or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other then the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee’s hours, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

• Disability extension of 18-month period of continuation coverage: If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total of 29 months. The disability would have to have started at some time before the 60^th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage.
• Second Qualifying event extension of 18-month period of continuation coverage: If your family experiences another qualifying event while receiving 10 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 10 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or the former employee dies, becomes entitled Medicare benefits ( under Part A, Part B or both), or gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan has the first qualifying event not occurred.

If You Have Questions

Questions concerning your plan or your COBRA continuation or your COBRA continuation rights should be addresses to the contact identified below. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPPA), and other laws affecting group health plans, contact the nearest Regional or Distract Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) In your area or visit the EBSA website at www.dol.gov/ebsa.

Keep your Plan Informated of Address Changes

In order to protect your family’s rights, you should keep the Plan Administrator informed of any changes in the addresses of the family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

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NEW EMPLOYEES

Any eligible employee hired during the plan year will have the opportunity to enroll in the Individual Choice program.

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IMPORTANT TAX AND BENEFIT INFORMATION

Individual Choice will affect your Social Security tax and other benefits as follows:

Social Security

Flexible Spending Account payments made with before-tax dollars reduce the amount you pay in Social Security taxes, therefore contributions to an an FSA may cause your benefits from Social Security to be reduced. For most people, the effect will be minimal.

Pay-Related Benefits

Any reduction of your pay that results from before-tax contributions into the Flexible Spending Account(s) or to pay for additional benefit coverages does not reduce the total pay used to calculate your benefits. In other words, your benefits will be based on your regular base pay.

TIAA/CREF

If you participate in the TIAA/CREF basic retirement plan, the College's contribution will be based on your actual base salary and will not be reduced because of your participation in Individual Choice.

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