5.7 Group Health Insurance

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. There is no open enrollment for health insurance. Enrollment must take place at time of employment; when a life event occurs (birth or adoption of a child, marriage or domestic partnership; or loss of coverage from another plan) or during the special, one-time enrollment period no earlier than ten years prior to the employees expected retirement date. (Employee age 49 ½ but less than age 55 could elect to enroll in Kenyon's plan so their 10-year enrollment requirement would be met at retirement.)

Premiums are based on salary levels.

(revised July 2010)

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(revised July 2011)

This is a brief summary of your health plan See the Summary Plan Description (SPD) benefit booklet for details. If there is any difference between this summary and the SPD, the SPD benefit booklet will prevail.

Medical Benefits

Benefit Option PREMIUM PLAN BASIC PLAN
  In Network
You Pay		 Out of Network
You Pay		 In Network
You Pay		 Out of Network
You Pay
Benefit Year Deductible
Benefit year is 7/1-6/30		 Per Person: $250
Family Max: $500		 Per Person: $500
Family Max: $1,000
Out of Pocket Maximum
If a person pays this amount in a benefit year due to the deductible and coinsurance, the plan will pay 100% for the rest of the benefit year		 Per Person: $1,250
Family Max: $2,500		 Per Person: $2,250
Family Max: $4,500		 Per Person: $3,500
Family Max: $7,000		 Per Person: $5,500
Family Max: $11,000
Overall Annual Maximum $2,000,000 $2,000,000
Office Visit (OV) $15 co-pay
Deductible Waived		 40% after deduc $20 co-pay
Deductible Waived		 n/a
Hospital Charges
Inpatient or Outpatient		 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Emergency Room
ER Physician		 20% after deduc
20% after deduc		 40% after deduc
20% after deduc		 30% after deduc
30% after deduc		 50% after deduc
30% after deduc
Physical Therapy, Speech Therapy, Occupational Therapy 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Ambulance 20% after deduc 30% after deduc
Durable Medical Equipment 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Home Health Care 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Skilled Nursing Facilities 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Lab & X-ray 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Outpatient Surgery 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Mental/Nervous/Substance Abuse Same as any other illness: paid based on type of services received Same as any other illness: paid based on type of services received
Preventive Care Benefits
Deductible Waived

Includes well child care, adult routine physical exams, colonoscopies, immunizations, mammograms and pap tests		 $15 co-pay $15 co-pay then 40% of balance

Max of $350 per Benefit Year		 $20 co-pay $20 co-pay then 50% of balance

Max of $350 per Benefit Year
Hospice Care 20% after deduc 40% after deduc 30% after deduc 50% after deduc
Spinal Adjustment Therapy 20% after deduc 40% after deduc 30% after deduc 50% after deduc

RX Coverage

Benefit Option PREMIUM PLAN BASIC PLAN
Benefit Year Deductible $50 per person/$150 per family $75 Per Person/$225 per Family
After Deductible:
Retail (30 Day Supply)
Coinsurance (you pay)

20% ($150 max)

20% ($10 min/ $200 max)
Mail Order (90 day supply)
Generic Co-pay
Preferred Brand Co-pay
Non-Preferred Co-Pay
$15 co-pay
$30 co-pay
$45 co-pay
No Coverage

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(revised July 1998, April 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 they were 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)

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, they 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, they 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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