IU Tobacco-free Wellness Health Reimbursement Arrangement (HRA) Plan

Important Notice about this plan:

As of 2011, the HRA plan is discontinued. Participants had the 2011 calendar year to use any remaining HRA balance by submitting claims to Nyhart. Participants have until April 17, 2012, to submit claims for reimbursement. You can check your current balance at iutsb.nyhart.com or by calling Nyhart at 1-800-284-8412.

Eligibility

All full-time appointed employees of Indiana University can elect participation in the Tobacco-free Wellness HRA Plan.

Plan Provisions

The Tobacco-free Wellness HRA is an employer-paid account set up under Internal Revenue Service regulations that allow preferential tax treatment for contributions. The account is funded entirely by the university. Neither IU contributions to nor reimbursements from an HRA are considered taxable income to the employee.

To participate in the Tobacco-free Wellness HRA Plan, employees must sign an affidavit each year during Open Enrollment indicating that they do not use tobacco products and will not during the upcoming year. For each employee who enrolls, the university will contribute $10 a month to an HRA account set up in her or his name.

Employees who are not tobacco-free at the time of Open Enrollment may still enroll in the Wellness HRA by agreeing to the following:

Complete the Quit for Life™ tobacco cessation program by June 1, 2010*; and
Complete the follow-up survey six months from the quit date.

IU contributions will be discontinued at any time an employee has failed to honor the affidavit.

Tobacco includes any form of tobacco products that are smoked (e.g., cigarettes, cigars, pipes), applied to the gums (dipping and chewing tobacco), and/or inhaled, as snuff.

*Program completion is defined as completing at least three calls with your Quit Coach.

Eligible Expenses

Reimbursements from the Tobacco-free Wellness HRA will be allowed for IRS-approved medical expenses incurred by the employee, such as deductibles, copays, non-covered medical expenses, and over-the-counter medications.

Examples of IRS-allowed expenses*
- Deductibles and co-payments
- Routine care/physical exams
- Certain over-the-counter items
- Transportation for medical services
- Weight-loss programs prescribed by a physician for a specific diagnosis
- Stop-smoking programs
- Hearing aids and related expenses
- Prescriptions, including birth control pills
- Dental care and orthodontia
- Acupuncture

*For HDHP PPO & Health Savings Account participants, reimbursements are limited to dental and vision services, and other services only after the HDHP deductible is met.

Examples of expenses not allowed by the IRS:
- Individual or group medical premiums
- Expenses covered by an insurance or government program
- Cosmetic procedures
- Retin-A (unless for medical diagnosis), Rogaine and any other medicines prescribed for cosmetic purposes
- Expenses related to long-term care (personal and custodial care)

Plan Contributions

The Tobacco-free Wellness HRA Plan is funded entirely by Indiana University.

Enrollment Provisions and Coverage Period

The HRA Plan is offered on a tax year basis, and elections for participation in reimbursement accounts expire automatically at the end of each calendar year. Employees must enroll in the Wellness HRA Plan each November during Open Enrollment to be eligible for benefits the following year. Employees will not be enrolled in reimbursement accounts without taking specific action for enrollment each year.

Continuing employees must enroll each year during the Open Enrollment period in November for participation the following year in a reimbursement account.

Account Balances and Claims

Unused year-end account balances up to a $240 maximum will carry over into the next year. Terminating employees—and employees whose participation in the plan ends due to transferring to an ineligible position—will be able to use their balance through the end of the calendar year in which they terminate or transfer. Employees who are part of a reduction in force will have additional time to use their balance.

Claims will only be paid from the HRA account for the amount of contributions accumulated at the time of the claim. Claims can be submitted online, by fax, or by mail to Nyhart. Claims for reimbursement may be filed at any time during the Plan year (January 1 through December 31).

Claims will only be honored for services rendered during the Plan year.

For Employees Enrolled in both the Tobacco-free Wellness HRA and TSB Plans, Nyhart will reimburse claims using Tax Saver Benefit (TSB) funds first since they do not roll over. Employees will be able to view their HRA and TSB accounts side by side on the Nyhart Web site. The TSB-HRA card may be used for HRA claims as well as TSB plan claims.

If you have questions about allowable expenses or making a claim, contact The Nyhart Company Claim Center at 800-284-8412.

Customer Service Contacts:

The Nyhart Company

For questions concerning qualified expenses, claims and reimbursement account balances:
8415 Allison Pointe Boulevard, Suite 300
Indianapolis, IN 46250-4201
Phone: 800-284-8412
Fax: (888) 887-9961
Web site: iutsb.nyhart.com
E-mail:

To mail or fax claims:
Attn: Claim Reimbursement
The Nyhart Company, Inc.
8415 Allison Pointe Boulevard, Suite 300
Indianapolis, IN 46250-4201
Fax: (888) 887-9961

Benefit plan information on these web pages is in a summary format and is not intended to replace actual plan documents. Indiana University reserves the right to amend or terminate all or any part of any benefit plan.