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Administrative Manual - 205 Benefits

205.03 Health Insurance Plans

JSA/JLab provides medical, dental, and retiree medical insurance coverage for eligible employees, and continuing coverage under the medical and dental plans for terminated employees.

  1. MEDICAL INSURANCE PLANS
    1. Policy

      JSA/JLab offers a choice of group medical insurance plans to eligible employees and contributes a substantial portion of the premium. All regular and term employees are required to participate in one of the plans or certify that they are covered under a comparable medical insurance plan.

    2. Eligibility
      1. All regular and term employees who are normally scheduled to work at least 20 hours a week are eligible to participate in coverage upon employment or date of transition to an eligible status. Enrollment must occur within 30 days of eligibility or the eligible employee must wait until the next annual open enrollment period. When an employee waives enrollment due to other coverage (e.g. spouse has coverage) and that coverage ends, special enrollment may be allowed provided the employee requests it within 30 days after their other coverage ends.
      2. Dependents such as spouse and children are eligible for coverage. Medical plans may vary the requirements for children between the ages of 19 and 24.
      3. Employees on Inactive-Disability status (see Policy 205.01 D.2.a.) who are enrolled in a JLab medical plan when placed on Inactive-Disability status, together with their eligible dependents, may continue their medical coverage under the same plan in which they were enrolled when Inactive-Disability status was initiated for as long as they remain disabled and are receiving long-term disability benefits from the Lab's LTD insurance, Workers' Compensation or Social Security. JSA/JLab will continue paying its portion of medical premiums until the employee reaches age 65 and eligibility for Medicare and/or JSA/JLab retiree benefits. The disabled employee must apply for any Social Security and Medicare coverage for which he/she may be eligible.
      4. In the event of the death of an Inactive-Disability employee, any insurance coverage provided by JSA/JLab for his/her dependents will cease. Said dependents will be eligible for coverage under COBRA.
      5. If at any time after twelve months from the date of disability, while on LTD, the employee decides to discontinue health benefits coverage under the Lab's plan, he/she will be terminated, any accrued vacation will be paid out, and he/she will be eligible for COBRA.
      6. Disabled employees who were not enrolled in a JLab medical benefits plan at the time they were placed on Inactive-Disability status will not be able to enroll.
      7. A change to an ineligible employment status, voluntary resignations and terminations, which are not deemed for gross misconduct, qualify an employee for benefit continuation under COBRA. See further details under C. below.
      8. Employees may elect to change coverage during the annual open enrollment.
    3. Premiums

      JSA/JLab pays approximately 75% of premiums for the medical plans. The employee portion of the premium may vary between plans due to the cost of plan and may be paid on a pre-tax or after-tax basis.

    4. Plan Provisions

      Four different group health insurance plans are offered which include major medical, hospitalization, prescription drug program and mental and substance abuse rehabilitation. The plans vary in maximum out-of-pocket limitations, deductibles, and use of co-payments and co-insurance, so careful review of plan materials against employee need or expectation is warranted. Generally, the plan options are:

      1. The preferred provider organization (PPO) plan offers a choice within an extensive network of health care providers.
      2. Two health maintenance organization (HMO) plans are offered and require participants to go through a designated Primary Care Physician for all services, and use hospitals within the HMO network.
      3. The indemnity plan offers a full choice of medical providers and hospitals.

      Enrollment categories include employee only, employee plus one child, employee and spouse, or employee plus family.

  2. DENTAL INSURANCE
    1. Policy

      JSA/JLab offers a dental insurance plan to eligible employees. Participation is optional.

    2. Eligibility
      1. All regular and term employees who are normally scheduled to work at least 20 hours a week may participate as of date of hire or transition to an eligible status. Enrollment must be within 31 days of eligibility or the eligible employee must wait until the next open enrollment period. Dependents such as spouse and children up to age 19 are eligible for coverage. Children who are full-time students may be eligible up to the end of the month in which they reach age 23.
      2. Employees may elect to change coverage during the annual open enrollment.
      3. Employees on Inactive Disability status (see Policy 205.01 D.) may continue the same dental coverage they had as active employees for as long as they remain disabled and receiving benefits from LTD, Workers' Compensation or Social Security. JSA/JLab will continue paying its portion of dental premiums until the employee reaches age 65 and/or retirement eligibility.
    3. Premiums

      JSA/JLab pays approximately 75% of the premiums for the dental plan. The employee portion of the premium may be deducted from payroll on a pre-tax or after-tax basis.

    4. Plan Provisions

      Plan participants are not billed for covered charges which exceed the allowable charge when using the network of participating dentists. When using a non-network dentist, the insurance company pays the participant the allowable charge and the participant has the responsibility of payment to the dentist.

  3. CONTINUING COVERAGE (COBRA)
    1. Policy

      JSA/JLab offers continuing coverage of medical and dental insurance for terminated employees who participated in a plan when they were employees of JSA/JLab. The program is compliant with the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and other applicable statutes.

    2. Plan Provisions
      1. When medical and dental coverage ends due to termination (for reasons other than gross misconduct), or because of reduction of hours or transition to an ineligible employment status, the employee and his/her dependents may be eligible to continue current coverage by paying the full premium, plus an amount allowed by law for administrative costs, for a prescribed period of time. In addition, should the employee participant die, divorce, have a child who no longer qualifies as a dependent, or qualify for Medicare, dependents may continue coverage for a prescribed period.
      2. Benefits under COBRA's continued coverage are exactly the same as those provided if coverage had continued. Any future changes in the plan's cost or benefits apply to participants of continued coverage.
      3. Qualified beneficiaries of continued coverage need to be aware of the circumstances that may extend the prescribed period and are responsible for informing the Benefits Office of these circumstances.
  4. RETIREE MEDICAL BENEFITS
    1. Policy

      JSA/JLab provides a retiree medical insurance plan for eligible regular and term employees.

    2. Eligibility

      To be eligible for retiree medical coverage the employee participant of a Laboratory medical insurance plan must meet all of the following requirements:

      1. Be at least age 55 or older,
      2. Have five (5) years of continuous active service immediately preceding separation date,
      3. Have the sum of total active service and age equal or exceed 70,
      4. Join the retiree medical benefits plan within 30 days of retirement and remain in the plan without a break in service,
      5. Enroll in Medicare Part A and B if eligible,
      6. Be eligible to participate in the medical insurance program at the time of separation from JSA/JLab, and
      7. Remain in the same pre-retirement program unless:
        1. The program is not offered in the region to which the retiree is moving, in which case the retiree may change to a JLab program which is offered in that area; or
        2. The retiree is enrolled in the Sentara Optima HMO program and reaches age 65, in which case the retiree is no longer eligible for that program, but may change to any of the other three programs.

        Eligible dependents may also enroll with the retiree.

    3. Premiums

      JSA/JLab pays approximately 50% of the cost of premiums for the retiree medical plan.


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