Vision Care Plan
 

Eligibility and Plan Participation

ELIGIBILITY
You are eligible to participate in the Vision Care Plan described in this section if you are an active, full-time or part-time employee of the Company who is regularly scheduled to work for at least 20 hours per week. 

Participation in the Vision Care Plan is entirely voluntary. To participate, you must enroll and make the required before-tax payroll deduction contributions towards the cost of your coverage. 

COVERAGE FOR YOUR ELIGIBLE DEPENDENTS
You can provide your eligible dependents with Vision Care Plan coverage. Your eligible dependents include: 

  • your lawful spouse or domestic partner;
  • each unmarried child from birth to age 19 who is primarily dependent upon you for support and maintenance; or
  • each unmarried child at least 19 years of age to 25 years of age who is primarily dependent upon you for support and maintenance and who is a full-time student; or
  • each unmarried child at least 19 years of age who is primarily dependent upon you for support and maintenance because the child is incapable of self-sustaining employment by reason of mental incapacity or physical handicap; who was so incapacitated and is a covered person under the group insurance policy on his or her 19th birthday; and who has been continuously so incapacitated since his or her 19th birthday. 

Definition of “Spouse”: In order to qualify as an eligible dependent, your spouse must be legally married to you in accordance with the state in which you reside. 

Definition of “Child”: For Plan purposes, a child includes a stepchild, a legally adopted child, a child legally placed in your home for adoption and a child under your legal guardianship. 

To be considered a full-time student, a child must be enrolled for at least the minimum number of weekly class hours that the school defines as full-time status. 

Disabled Dependent Child: The Insurance Company may ask for proof of a disabled child’s incapacity or dependency two months prior to the date that child’s coverage may otherwise have ended.

The Insurance Company may also ask for the same proof again, but not more often than once a year after the disabled child’s coverage has been continued for two years. 

Definition of “Domestic Partner”: For Plan purposes, a domestic partner is an adult who is in a committed relationship with you, and you and the Domestic Partner are mutually responsible for one another financially and otherwise.

To qualify as a domestic partner, all of the following conditions must be met: 

  • you and your domestic partner are over the age of 18 and are mentally competent to enter into contracts;
  • you and your domestic partner reside in the same household;
  • you and your domestic partner are not related by blood;
  • you and your domestic partner are not married to any third party;
  • you and your domestic partner are of the same or opposite sex;
  • you and your domestic partner have a committed relationship with each other for no less than 12 months;
  • intend to continue the relationship indefinitely, and have no such relationship with any other person; and
  • you and your domestic partner are not claiming dependent status for the primary purpose of gaining insurance coverage under Plan. 

WHEN YOUR COVERAGE BEGINS
If you want to participate in the Vision Care Plan, you must enroll within 30 days of the date that you are hired. If you enroll within 30 days of the date that you are hired, coverage for you and your eligible dependents will begin as of your hire date. 

Actively at Work
You must be actively at work on the date your coverage begins. You are considered to be “actively at work” if you are performing the duties of your job at the Company’s place of business or at any other place that the Company’s business requires you to go. If you are not actively at work on the date that your participation would otherwise begin, your participation will be postponed until you are actively at work. 

If you do not enroll for Vision Care Plan coverage within 30 days of the date on which you are first eligible to do so, you will have to wait until the next annual open enrollment period to enroll. There is an exception to this rule if you have a Change in Status as described below.

COVERAGE LEVELS
You can choose one of the following coverage levels for your Vision Care Plan benefits:

  • Individual
  • Two Person
  • Family

PAYING FOR YOUR BENEFITS
You pay the cost of your Vision Care Plan benefits. The cost to you will depend on the level of coverage you select. 

Your contributions towards the cost of your coverage are made through convenient before-tax payroll deductions. These contributions come out of your pay before federal and (in most cases) state and local taxes are deducted, so they will reduce your taxable income. 

You will receive a description of the Vision Care Plan’s payroll deduction cost when you are hired and during the annual open enrollment period. You can also visit the Company Intranet or contact Human Resources at ext. 52222 for additional information concerning the cost of Plan participation.

ANNUAL OPEN ENROLLMENT PERIOD
In the fall of each year, the Company sponsors an open enrollment period. During this period, you can elect to enroll in, change, or cancel your Vision Care Plan coverage. 

If you do not make any changes during the annual open enrollment period, your current level of coverage will automatically continue. 

Any change you make during the annual open enrollment period (for example, changing from Individual to Family coverage) will go into effect on the next January 1. This election will remain in effect for the next calendar year, unless you have a Change in Status. 

For example, assume that you elect to cancel your Vision Care Plan coverage during the 2017 annual open enrollment period. This election will go into effect on January 1, 2018 and will remain in effect for the 2018 calendar year. You cannot change this election until the next annual open enrollment period, unless you have a Change in Status. 

CHANGE IN STATUS
In general, you cannot enroll in, change, or cancel your Vision Care Plan coverage during the year, unless you have a Change in Status. For plan purposes, you are considered to have a Change in Status in the event of: 

  • your marriage or divorce;
  • the death of your spouse, former spouse, domestic partner, or child;
  • the birth or adoption of a child;
  • loss of a dependent’s eligibility to participate in the Plan (for example, due to age);
  • the employment or termination of employment of your spouse, former spouse or domestic partner;
  • the switching from part-time to full-time employment of your spouse, former spouse or domestic partner;
  • you, your spouse, former spouse or domestic partner taking an unpaid leave of absence;
  • a significant change in your health coverage that is attributable to your spouse’s, former spouse’s, or domestic partner’s employment;
  • a dependent’s involuntary loss of other health care coverage; or
  • a court’s order for you to cover a child under a Qualified Medical Child Support Order (QMCSO – see below for details). 

Effective Date
Your election to enroll in, change, or cancel your Vision Care Plan coverage will go into effect as of the date of the change, provided that you make this election within 30 days of that date of the change. 

For example, assume that you have Individual coverage, and you get married during the year. In this case, you can choose to cover your new spouse, provided that you make this election within 30 days of your date of marriage.

If you do not enroll in or make changes to your Vision Care Plan coverage within 30 days of the date that a Change in Status occurs, you will have to wait until the next annual open enrollment period to enroll in or make Vision Care Plan coverage changes.

Cancelling Coverage
If you have a Change in Status, you can also elect to cancel your Vision Care Plan coverage. If you elect to cancel your coverage, you cannot restore it until the next annual open enrollment period, unless you have another Change in Status.

LEAVES OF ABSENCE

Family and Medical Leave Act (FMLA): You may elect to continue your Vision Care Plan coverage during an authorized Family and Medical (FMLA) leave of absence. If you are in an unpaid status or receiving disability pay, the contributions you would otherwise have paid towards the cost of your coverage will be suspended during the first four months of leave. (Please refer to the repayment options described below.) 

You have two options for repayment of your contributions: 

  • You can pay your contributions during your leave via check. Checks should be made payable to “Tufts Health Plan” and mailed to: Benefit Specialist, Tufts Health Plan, 705 Mount Auburn Street, Watertown, MA 02472.
  • You can pay your contributions upon your return to work. You will receive an e-mail from Human Resources informing you of the amount you need to repay. You will be given the option of paying this amount either via Payroll (in one pay period or over a few pay periods) or writing a check for the whole amount.  

If you do not return from your leave of absence, you will be responsible for any benefit contributions you did not make during your leave. Tufts Health Plan will deduct the amount you owe from your last check. If you do not receive a last check, a bill will be sent directly to your home and you will be required to pay the entire amount within 14 calendar days. 

You should contact Human Resources for more information concerning the continuation of your benefit coverage during an authorized FMLA leave. 

Other Leaves of Absence
You may elect to continue your Vision Care Plan coverage during a temporary leave of absence for non-FMLA reasons. If you are in an unpaid status or receiving disability pay, the contributions you would otherwise have paid towards the cost of your coverage will be suspended during your temporary leave period. Your repayment options are described in the FMLA section above. 

You should contact Human Resources for more information concerning the continuation of your coverage during a leave of absence. 

Military Leave: Reservists who are called to active duty with the Armed Forces of the United States have special benefit continuation and reemployment rights under the law (see Administrative Information). In addition, the federal Family and Medical Leave Act (FMLA) was amended to add two new leave rights related to military service, effective January 16, 2009: 

  • Active Duty Leave: Eligible employees are entitled to up to 12 weeks of leave because of “any qualifying exigency” due to the fact that the spouse, son, daughter, or parent of the employee is on active duty, or has been notified of an impending call to active duty status, in support of a contingency operation.
  • Injured Service Member Leave: An eligible employee who is the spouse, son, daughter, parent, or next of kin of a covered service member who is recovering from a serious illness or injury sustained in the line of duty on active duty is entitled to up to 26 weeks of leave in a single 12-month period to care for the service member. The employee is entitled to a combined total of 26 weeks for all types of FMLA leave in the single 12-month period.

QUALIFIED MEDICAL CHILD SUPPORT ORDER (QMCSO)
If a Qualified Medical Child Support Order (QMCSO) is issued for your child, that child will be eligible for coverage as required by the order. You should notify Human Resources and elect coverage for the child as soon as reasonably possible following the issuance of a QMCSO. 

A QMCSO is a judgment, decree or order (including approval of a settlement agreement) issued by a court of competent jurisdiction that satisfies all of the following: 

  • The order specifies your name and last known address, and the child's name and last known address;
  • The order provides a description of the coverage to be provided, or the manner in which the type of coverage is to be determined;
  • The order states the period to which it applies; and
  • The order specifies each plan to which it applies. 

A QMCSO may not require the health insurance policy to provide coverage for any type or form of benefit not otherwise provided under the policy. You can obtain a copy of the rules governing QMCSOs from Human Resources. 

WHO INSURES YOUR BENEFITS?
Your Vision Care Plan is insured through a group insurance policy issued by the Combined Insurance Company of America.