5.7 Group Health Insurance

Revised July 2010, 2022

Kenyon College is interested in the health and well-being of both you and your family. Accordingly, a comprehensive health insurance program is available for benefit-eligible employees, their spouses, and/or same- or opposite-sex domestic partners and their children. 

Participation in the College's health insurance program is optional and becomes effective on the first day of eligible employment. All active full-time employees of Kenyon College who are regularly working at least 1,000 hours in a twelve-month period are eligible to participate. Details on enrollment and eligibility can be found on the Office of Human Resources website and in the employee handbook.

Premiums are based on salary levels. Please see the Human Resources webpage for current premiums and rates for participation.

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Revised July 2010

The following benefits are provided, as further defined and limited in the Summary Plan Description provided by Kenyon College.

Please note that the Benefit Year is July 1 - June 30.

Medical Benefits Schedule — Premium Plan

The maximum lifetime benefit amount is $2,000,000 (combined for both Premium Plan and Basic Plan options, including the prescription drug benefits).

Note: The maximums listed below are the total for Network and Non-Network expenses. For example, if a maximum of 60 days is listed twice under a service, the Benefit Year maximum is 60 days total which may be split between Network and Non-Network providers.

Deductible, per benefit year:

  • Per covered person: $250*
  • Per family unit: $500*

*For network and non-network providers.

The network deductible amounts will be combined with the non-network deductible amounts.

The Benefit Year deductible is waived for the following Covered Charges: services with a per-visit co-payment.

Co-payments:

Service Network Non-network
Physician visits $15 n/a
Preventive care $15 $15

Maximum out-of-pocket amount, per benefit year:

Type Network Non-network
Per covered person $1,250 $2,250
Per family unit $2,500 $4,500

The network out-of-pocket amounts will be combined with the non-network out-of-pocket amounts.

The Plan will pay the designated percentage of Covered Charges until out-of-pocket amounts are reached, at which time the Plan will pay 100% of the remainder of Covered Charges for the rest of the Benefit Year unless stated otherwise.

The following charges do not apply toward the out-of-pocket maximum:

  • Non-Precertification penalties
  • Co-payments
  • Amounts over Usual and Reasonable Charges
  • Charges for prescription drugs under the Prescription Drug Program

Covered Charges:

Note: "after the deductible" is abbreviated below as AD.

Inpatient hospital services Network Non-network
Room, board, misc. expenses 80% AD 60% AD
Intensive care unit 80% AD 60% AD
Outpatient hospital services Network Non-network
Surgical facilities 80% AD 60% AD
Other outpatient services 80% AD 60% AD
Physician services Network Non-network
Inpatient visits 80% AD 60% AD
Emergency room visits 80% AD Paid same as in-network
Office visits 100% AD 60% AD
Surgery 80% AD 60% AD
Anesthesia 80% AD Paid same as in-network
Allergy testing 80% AD 60% AD
Allergy serum & injections 80% AD 60% AD
Diagnostic testing Network Non-network
X-ray and lab 80% AD 60% AD
Radiology/pathology interpretation 80% AD Paid same as in-network
Preventative care Network Non-network
Routine well adult care** 100% after co-payment 60% after co-payment
$350 Benefit Year maximum per covered person
Well newborn nursery care 80% AD 60% AD
Routine well child care*** 100% after co-payment 60% after co-payment
$350 Benefit Year maximum per covered person

**Routine well adult care includes, but is not limited to: routine physical examination, pap smear, mammogram, PSA screening, routine diagnostic testing, immunizations, vision screenings, hearing screenings, and routine colonoscopy charges.

***Routine well child care includes, but is not limited to: routine physical examination, laboratory tests, x-rays, hearing tests, vision tests, and immunizations.

Additional services Network Non-network
Emergency room visit 80% AD 60% AD
Skilled nursing facility 80% AD 60% AD
Home health care 80% AD 60% AD
Private duty nursing 80% AD 60% AD
Hospice care 80% AD 60% AD
Ambulance service 80% AD Paid same as in-network
Mental disorders/substance abuse Paid based on type of service Paid based on type of service
Organ/tissue transplants 80% AD
$250,000 Lifetime maximum (including charges for transplant-related Prescription Drugs) combined with the Lifetime maximum for the Basic Plan.		 60% AD
$250,000 Lifetime maximum (including charges for transplant-related Prescription Drugs) combined with the Lifetime maximum for the Basic Plan
Other medical services & supplies 80% AD 60% AD

Prescription Drug Benefit Schedule — Premium Plan

Prescription drug deductible, per benefit year:

  • Per covered person: $50
  • Per family unit: $150
Pharmacy option Network Non-network
Generic drugs (31-day supply) 20% after deductible Prescriptions are only covered at participating pharmacies.
Brand name drugs (31-day supply) 20% after deductible
$150 maximum co-payment		 Prescriptions are only covered at participating pharmacies.
Mail order option Network Non-network
Generic drugs (90-day supply) $15 co-payment Not applicable
Formulary brand name drugs (90-day supply) $30 co-payment Not applicable
Non-formulary brand name drugs (90-day supply) $45 co-payment Not applicable

Note: Deductibles for prescription drugs do not apply toward meeting the Deductible or Out-of-Pocket maximums under the medical portion of this Plan, but charges for covered Prescription Drugs do apply to the $2,000,000 Maximum Lifetime Benefit Amount.

Medical Benefits Schedule — Basic Plan

The maximum lifetime benefit amount is $2,000,000 (combined for both Premium Plan and Basic Plan options, including the prescription drug benefits).

Note: The maximums listed below are the total for Network and Non-Network expenses. For example, if a maximum of 60 days is listed twice under a service, the Benefit Year maximum is 60 days total which may be split between Network and Non-Network providers.

Deductible, per benefit year:

  • Per covered person: $500*
  • Per family unit: $1,000*

*For network and non-network providers.

The network deductible amounts will be combined with the non-network deductible amounts.

The Benefit Year deductible is waived for the following Covered Charges: services with a per-visit co-payment.

Co-payments:

Service Network Non-network
Physician visits $20 n/a
Preventive care $20 $20

Maximum out-of-pocket amount, per benefit year:

Type Network Non-network
Per covered person $3,500 $5,500
Per family unit $7,000 $11,000

The network out-of-pocket amounts will be combined with the non-network out-of-pocket amounts.

The Plan will pay the designated percentage of Covered Charges until out-of-pocket amounts are reached, at which time the Plan will pay 100% of the remainder of Covered Charges for the rest of the Benefit Year unless stated otherwise.

The following charges do not apply toward the out-of-pocket maximum:

  • Non-Precertification penalties
  • Co-payments
  • Amounts over Usual and Reasonable Charges
  • Charges for prescription drugs under the Prescription Drug Program

Covered Charges:

Note: "after the deductible" is abbreviated below as AD.

Inpatient hospital services Network Non-network
Room, board, misc. expenses 70% AD 50% AD
Intensive care unit 70% AD 50% AD
Outpatient hospital services Network Non-network
Surgical facilities 70% AD 50% AD
Other outpatient services 70% AD 50% AD
Physician services Network Non-network
Inpatient visits 70% AD 50% AD
Emergency room visits 70% AD Paid same as in-network
Office visits 100% AD 50% AD
Surgery 70% AD 50% AD
Anesthesia 70% AD Paid same as in-network
Allergy testing 70% AD 50% AD
Allergy serum & injections 70% AD 50% AD
Diagnostic testing Network Non-network
X-ray and lab 70% AD 50% AD
Radiology/pathology interpretation 70% AD Paid same as in-network
Preventative care Network Non-network
Routine well adult care** 100% after co-payment 50% after co-payment
$350 Benefit Year maximum per covered person
Well newborn nursery care 70% AD 50% AD
Routine well child care*** 100% after co-payment 50% after co-payment
$350 Benefit Year maximum per covered person

**Routine well adult care includes, but is not limited to: routine physical examination, pap smear, mammogram, PSA screening, routine diagnostic testing, immunizations, vision screenings, hearing screenings, and routine colonoscopy charges.

***Routine well child care includes, but is not limited to: routine physical examination, laboratory tests, x-rays, hearing tests, vision tests, and immunizations.

Additional services Network Non-network
Emergency room visit 70% AD 50% AD
Skilled nursing facility 70% AD 50% AD
Home health care 70% AD 50% AD
Private duty nursing 70% AD 50% AD
Hospice care 70% AD 50% AD
Ambulance service 70% AD Paid same as in-network
Mental disorders/substance abuse Paid based on type of service Paid based on type of service
Organ/tissue transplants 70% AD
$250,000 Lifetime maximum (including charges for transplant-related Prescription Drugs) combined with the Lifetime maximum for the Basic Plan.		 50% AD
$250,000 Lifetime maximum (including charges for transplant-related Prescription Drugs) combined with the Lifetime maximum for the Basic Plan
Other medical services & supplies 70% AD 50% AD

Prescription Drug Benefit Schedule — Basic Plan

Prescription drug deductible, per benefit year:

  • Per covered person: $75
  • Per family unit: $225
Pharmacy option Network Non-network
Generic drugs (31-day supply) 20% after deductible
$10 minimum co-payment		 Prescriptions are only covered at participating pharmacies.
Brand name drugs (31-day supply) 20% after deductible
$10 minimum co-payment
$200 maximum co-payment		 Prescriptions are only covered at participating pharmacies.

Notes: If a brand name drug is purchased when a generic is available, the Covered Person will pay the brand name Co-payment and the difference in cost between the generic and brand name drug.

Deductibles for prescription drugs do not apply toward meeting the Deductible or Out-of-Pocket maximums under the medical portion of this Plan, but charges for covered Prescription Drugs do apply to the $2,000,000 Maximum Lifetime Benefit Amount.

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Revised July 1998, 2013

As a Kenyon College benefits eligible employee, you may enroll an unmarried same- or opposite-sex domestic partner and/or your domestic partner's child(ren) in the Kenyon College health insurance plan.

To enroll yourself and your domestic partner and/or your domestic partner's child(ren), you must:

  1. Complete the regular Medical Plan enrollment form.
  2. Complete, sign and have your partner sign the Certification of Domestic Partnership form.

Definition of a Domestic Partner

Kenyon College defines domestic partner as the partner of an eligible employee or retiree who is of the same or opposite sex, sharing a long-term committed relationship of indefinite duration with the following characteristics:

  • Living together for at least six months.
  • Having an exclusive mutual commitment similar to that of marriage.
  • Financially responsible for each other's well-being and debts to third parties. This means that you have entered into a contractual commitment for that financial responsibility or have joint ownership of significant assets (such as home, car, bank accounts) and joint liability for debts (such as mortgages or credit cards.)
  • Neither partner is married to anyone else nor has another domestic partner.
  • Partners are not related by blood closer than would bar marriage in the state of their residence.

Eligibility Requirements for Your Domestic Partner's Children

In order for your partner's child to be claimed as a dependent under Kenyon College's plan, the child must meet all of the following requirements:

A. The child(ren) of the employees domestic partner must be the legal tax dependents of the employee under IRS Sec. 152.

Legal tax dependent is defined as follows:

  • is a citizen of the United States, Mexico, Canada, the Canal Zone, or the Republic of Panama;
  • is a member of your household for the year, had his or her principal place of abode in your home for the year;
  • by engaging in the relationship, does not violate local law;
  • receives over half of his or her support for the year from you. Support includes food, shelter, clothing, medical and dental care, and education; and
  • the dependent's gross income must be less than the federal personal exemption amount unless the dependent is under age19 OR a full-time student (enrolled as a full-time student for at least five months during the year), under age 24.

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Revised July 1997

If an employee needs to change his or her coverage due to a change in his or her family status (i.e., marriage or the birth or adoption of a child, addition of a domestic partner, etc.) the employee should contact the Office of Human Resources within thirty-one days of the event.

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(revised July 2010)

Medical Insurance During a Sabbatical. A faculty member on sabbatical leave may continue participation in the health insurance program on a regular active-member basis for a period not to exceed twelve (12) months providing he or she was enrolled in the health plan prior to the beginning of the sabbatical.

Insurance Premium Payment During Leaves of Absence. Kenyon College will continue to pay its share of health insurance premiums for employee coverage and dependent coverage for a maximum of twelve (12) weeks during a family/medical Leave. While you are on any other type of unpaid leave of absence from Kenyon, you may continue your medical insurance through COBRA continuation coverage. Please consult with the Office of Human Resources for details.

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Revised July 2010, Sept. 2011

When employees retire, they and their eligible dependents may continue enrollment in the College's group health plans subject to the following conditions. The earliest age an employee may retire and keep the health insurance benefits is age 59 ½.

If an employee retires before age 65, he or she may stay on the Kenyon College health plan and pay the same premiums as active employees if at least ten years of continuous service while enrolled in the health plan prior to the date of retirement were completed. An early retiree may not add a spouse, partner or dependent(s) to the Kenyon College health plan after the date of early retirement. However, if the spouse/partner/dependent(s) of the early retiree was already enrolled in the health plan during the ten consecutive years immediately prior to the date of the employee’s early retirement, they may also continue on the plan until the early retiree reaches age 65. COBRA continuation coverage will be offered if the enrollment criteria described above is not met. 

Employee retiring at age 65 or older (or when turning 65 having retired early as described above) will be eligible for the Emeriti Health Insurance Plan Options and the Emeriti Reimbursement Benefit if you satisfy the criteria for Retirement Eligibility under the Plan. You have met these criteria if you have attained age 59½ or over while employed by the College with at least 10 years of continuous service or age 65 with at least 5 years of continuous service. 

Having met Retirement Eligibility criteria for the Emeriti Plan, you will be able to enroll in the Emeriti Health Insurance following termination of service with the College, attaining age 65, and enrolling in Medicare Part A and B. If your spouse or domestic partner is also age 65 or older and enrolled in Medicare Part A and B, he/she may also enroll when you do in the same Emeriti Health Insurance Plan Option you have elected. If your spouse or eligible children are not Medicare-eligible, they can enroll in Emeriti's pre-65 Health Insurance Plan Options when you enroll. You will also be able to utilize the Emeriti Reimbursement Benefit to pay for any qualified out-of-pocket medical expenses, including other health insurance, after termination with the College. All of the Emeriti Health Account assets from both your Employer's contributions and your own contributions can be used to pay for these benefits.

Health Insurance for Eligible Dependents After the Death of a Retired Member

In the event of the death of a retired employee who is under the age of 65 and enrolled on the Kenyon College Health Plan, the surviving spouse or domestic partner and eligible dependents may continue to be enrolled for one year from the date of the retiree’s death. Coverage will terminate earlier if the surviving spouse remarries or eligible dependents lose their dependent status. Continuation of coverage beyond twelve (12) months is addressed under the section titled COBRA.

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Revised July 2010

During an authorized leave of absence for medical reasons, the College will continue to pay its portion of the health insurance premiums if the member continues to receive his/her compensation providing that compensation does not continue beyond twelve (12) months after the member's medical leave began. The member must have been enrolled in the health plan prior to the commencement of the medical leave of absence and the member must continue to pay his/her portion of the premium. Continuation of coverage beyond twelve (12) months is addressed under the section titled COBRA.

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Revised July 2010

Disabled employees and their eligible dependents may continue enrollment in the plan at the same contribution levels as active employees for one year (12-months from the date of Disability). Continuation of coverage beyond twelve (12) months is addressed under the section titled COBRA. To be treated as "disabled," the employee must be certified as totally disabled under the TIAA Total Disability Plan and the Social Security Administration or the State of Ohio Worker's Compensation Bureau. If the employee becomes disabled while actively employed but having already met the eligibility requirements to be a retiree or early retiree under the Kenyon Health Plan, they will be covered under those provisions.

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Revised July 2010

In the event of the death of an active employee who was enrolled on Kenyon's health insurance plan, the spouse or domestic partner and eligible dependents may continue to be enrolled for a period of one year from the date of the employee’s death at the same contribution levels as active employees. Coverage will terminate earlier if the surviving spouse remarries or eligible dependents lose their dependent status. Continuation of coverage beyond twelve (12) months is addressed under the section titled COBRA.

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Revised July 1997

This federal regulation states that if employees lose health insurance coverage due to a reduction in hours or termination of employment (for reasons other than gross misconduct), they and their eligible dependents can continue that coverage for up to eighteen months from the date of loss of coverage. (In certain situations, such as the covered person's total disability during the first sixty days of the COBRA period, the continuation of coverage would extend up to twenty-nine months.)

Your insurance will terminate when the insurance policy terminates, when you fail to make an agreed contribution to premium when due, when you cease to be eligible for coverage under the terms of our group insurance program, when you cease to be eligible for benefits with Kenyon, or when you are no longer employed by Kenyon. Kenyon College may, by continuing to pay the premium, keep your insurance in effect for a brief period if you cease to be an eligible employee for any reason other than resignation, dismissal, or failure to meet the terms of eligibility of our group insurance program.

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Revised July 2009, April 2013

Participation begins on the date of eligible employment and is optional. Employees can choose to reduce their gross salaries by a specified amount. The dollars are placed in one or both of the accounts mentioned below. Allocating dollars to the spending accounts results in a lower tax base.

Example: An employee earning $25,000 allocates $2,000 to the Dependent Care Account and $1,000 to the Medical Expense Account. The employee pays federal, state and Social Security taxes on $22,000. Dollars withdrawn from the accounts are distributed on a tax-free basis.

Some expenses payable from these accounts are the following:

  • Dependent Care Account: Expenses incurred in obtaining care for children under thirteen or a spouse or other dependent who is mentally or physically incapable of self-care and who lives with you.
  • Medical Expense Account: Dental expenses, eye exams, glasses, or any expense not covered by a health insurance plan.

Employees must use caution in allocating dollars to these accounts, since all monies must be used by the end of the plan year. The plan year begins July 1 and ends June 30. If there are funds left in the accounts, the employee forfeits the monies. A new election form must be completed each year during the annual enrollment period in May.

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