2023
EMPLOYEE BENEFITS GUIDE
2 | 2023 EMPLOYEE BENEFITS GUIDE
Inside This Guide
Who is Eligible? 3
Who Can I Cover Under My Plan? 4
Employee Self-Service & Enrollment Information 5
Understanding Your Medical Plan Options 6
Medical Plans At-A-Glance 7
Prescription Drug Benefits 8
Wellness Incentive Program 9
Independence Wellness Programs 10
Smoking Cessation Program 11
Vision Care Plan 12
Dental Benefits 14
Dental Plan Comparison 15
Disability Benefits 20
Basic Life and AD&D Insurance 22
Supplemental Life Insurance 23
Flexible Spending Accounts 24
403 (b) Tax Sheltered Annuity Plan 25
Defined Contribution Plan 26
Additional Benefits 27
Voluntary Benefits 31
Contacts 33
Legal Notices 34
Bi-Weekly Contributions 16
Cooper University Health Care is
committed to excellence for patients,
the community and especially you, our
outstanding Team Members. Without
you, our success would not be possible.
That’s why we provide a comprehensive
and competitive benefits program to
help give you peace of mind and
financial security.
Questions?
If you have questions regarding benefit
eligibility, dependent coverage or how to enroll
in benefits, email the Benefits Department at
[email protected] or contact the
Conner Strong & Buckelew Benefits Member
Advocacy Center (Benefits MAC) at 800-563-9929
or www.connerstrong.com/memberadvocacy.
For complete plan details, see your summary plan
descriptions available on Employee Self-Service (ESS).
2023 EMPLOYEE BENEFITS GUIDE | 3
Generally, you are eligible to participate
in the Cooper University Health Care Benefits
Program as explained below. However,
eligibility for certain benefits may be different.
• If you are a non-union Team Member, authorized
to work at least 35 hours per week, you are eligible
to participate the first day of the month following
your date of hire.
• If you are a union Team Member, authorized to
work at least 36 hours per week, you are eligible
to participate the first day of the month following
your date of hire.
• If you are a part-time non-union Team Member
authorized to work between 20 and 34.9 hours
per week, you may participate on the first of the
month following three months of service.
• If you are a part-time union Team Member
authorized to work between 20 and 35.9 hours
per week, you may participate on the first of the
month following three months of service.
• If you are a Baylor Team Member, you may
participate on the first of the month following
your date of hire. You are eligible to participate in
a medical PPO plan, dental and vision plans only.
• If your date of hire is the 1st of the month as
a full-time or Baylor Team Member your benefits
will be effective on the 1st of the month.
• If you transfer from a non-benefit eligible position
to a benefit eligible position, your benefits will
become effective the 1st of the month following
your date of transfer for full-time positions.
If transferring to a part-time position, your
benefits will become effective the 1st of the month
following three months from the date of transfer.
See your summary plan description or contact
the Benefits Team with questions regarding
eligibility for specific benefits.
Who is eligible?
IMPORTANT:
Team Members hired 1/1/2018
or thereafter may not enroll a
spouse in medical coverage if
they are offered group medical
coverage through their employer.
If you elect spousal coverage,
you will be required to attest that
your spouse does not have group
coverage available to him/her.
4 | 2023 EMPLOYEE BENEFITS GUIDE
Who can I cover under my plan?
At the time you are eligible, your dependents are also eligible to participate; however,
dependent documentation must be provided to enroll your spouse and/or children in the
plan (birth certificates, marriage certificates and a copy of your 1040 tax form are required
for eligible dependents).
Lawful Spouse
An individual who is married to a Participant in a legally recognized civil or religious
Civil Union Partner
A partner in a civil union pursuant to New Jersey state law or any other state or
commonwealth law applicable to the civil union of same-sex partners.
Domestic Partner
Certified in accordance with New Jersey law as each other’s sole same-sex domestic
partner (or opposite-sex, if you and your domestic partner are both age 62 or older) and
intend to remain so indefinitely; are not related by blood; are not legally married to any
other person or in another domestic partner relationship; are at least 18 years of age and
are mentally competent to consent to the domestic partnership; and are financially
interdependent and have resided together continuously for at least 12 months and
intend to continue to reside together indefinitely.
Dependent Children
For Medical, Dental, Vision and Child Life Insurance Coverages
• Children up to age 26 — including natural children, legally adopted children or
children who have been placed with you pending final adoption (a child is
considered to have been placed with a participant for adoption when the
participant has assumed and retained a legal obligation for total or partial support
of the child in anticipation of adoption); stepchildren or foster children who live
with you in a parent/child relationship; other minor children who live with you in a
parent/child relationship for whom I (or my spouse/qualified domestic or civil union
partner) have been appointed legal guardian (not legal custody) — until the end of
the month in which they reach age 26, regardless of marital status, student status
and tax dependent status.
• Disabled child over the age of 26 if following conditions are satisfied:
− Is unmarried
− Is mentally or physically incapable of earning his/her own living
− Became disabled prior to reaching the plan’s dependent children coverage age
limit
− Is dependent on me for support and maintenance.
DEPENDENTS ELIGIBLE TO ENROLL
2023 EMPLOYEE BENEFITS GUIDE | 5
A Few Tips:
Have personal information on hand, such as Social
Security numbers and birth dates of dependents.
• Use the navigation buttons on each page (not your
browser’s BACK arrow) to move around the site.
How to Enroll in Benefits
• you complete the entire enrollment process,
click Continue to process the changes.
• Print your confirmation statement upon completing
your enrollment. Print a reference page for your
records; click Yes and print your reference page.
Choose Your Benefits Carefully
The elections you make during the open enrollment
period will stay in effect for the entire year unless you
have a Qualified Life Event.
Making Plan Changes
Unless you have a qualified change in status, you
cannot make changes to the benefits you elect until
the next Open Enrollment period. Qualified changes
in status include: marriage, divorce, status change,
birth or adoption of a child, change in child’s
dependent status, death of qualified dependent,
change in residence due to an employment transfer
for you or your spouse/domestic partner,
commencement or termination of adoption
proceedings, or change in your spouse’s/domestic
partner’s benefits or employment status.
You must notify the Benefits Department within
31 days of experiencing a qualified change in
status. Please refer to the Qualifying Life Event
form available in ESS.
BENEFITS
• View/add dependents
• Benefits enrollment
(annual and new hire)
• Rehire benefits enrollment
• Newly eligible benefits enrollment
Family status change (inquires only)
• Carrier/Vendor website links
• Leave balances Forms
• TSA Information
• EOI Short and Long Forms
• Insurance Claim Forms
• Tuition Forms and Instructions
PAYROLL INFORMATION
• Review/update direct deposit
• Paycheck
• Review/update tax withholdings
• W-2 information
CHANGE PASSWORD
Employee Self-Service
& Enrollment Information
Employee Self-Service (ESS)
Employee Self-Service (ESS) is Cooper University
Health Care’s online benefit management tool that
you can utilize year round. From enrolling in benefits
to checking payroll information and downloading
claim forms, ESS uses technology to give you the
answers you need, when you need them.
Here are some examples of what’s available on ESS:
Accessing ESS
From Work: From a Cooper computer go to the Pulse
(Cooper’s Intranet) and click on the Employee Self-Service
link under the Frequently Used Links section.
From Home: To access the portal at home from a private
computer type this entire location into your Internet
browser address: https://remote.cooperhealth.edu.
Enter your User ID and Password.
• User ID: last name, hyphen, first name
(i.e.smith-anne) in all lowercase letters
• Password: a unique password provided by Cooper
IT in all lower case letters
Please note that the link above will only work if you are
connected to the Cooper Network. If you have trouble
logging on, please contact the Cooper IT Help Desk at
856.968.7166.
6 | 2023 EMPLOYEE BENEFITS GUIDE
Understanding your
Medical Plan Options
You have three medical plans that include Express
Scripts prescription drug coverage:
• Cooper Basic PPO Plan
• Cooper Core PPO Plan
• Cooper Standard PPO Plan
Cooper Core/Standard PPO Plans
Administered by Independence Administrators
The Core and Standard PPO plans provide three
benefit tiers to help you minimize your out-of-pocket
cost.
• TIER 1: Cooper University Health Care Network
Cooper doctors, providers and facilities – offers
care with lower out-of-pocket costs
• TIER 2: Independence Administrators Network
Preferred providers who participate in
Independence Administrators’ nationwide network,
includes PA, NJ and DE. Deductible and
coinsurance may apply
• TIER 3: Out-of-Network
All other health care providers and facilities that
are not Cooper University Health Care providers
and do not participate with Independence
Administrators
IMPORTANT NOTES:
• Lab work performed by LabCorp and Cooper
University Health Care is covered at 100%
• All benefit plans cover preventive care services
at 100% in-network
Cooper Basic PPO Plan
This plan offers the flexibility of in and out-of-network
benefits. With this option, your annual premium is the
lowest of the three plan options.
• Independence Administrators Network
Deductible and coinsurance may apply
• Out-of-Network
Higher deductibles and coinsurance may apply
To find participating Independence
Administrators providers call 1.844.864.4352
or visit www.myibxtpabenefits.com.
Waive Medical Coverage
If you have medical coverage from another group
plan, such as your spouse’s plan, you may waive
medical coverage through Cooper University Health
Care via ESS.
Please remember to provide a copy of your current
medical identification card to the Human Resources –
Benefits Team. If you do not waive medical benefits
and provide a copy of your identification card,
you will be enrolled in the Cooper Core PPO Plan –
Employee Only coverage and will not receive
the non-tobacco user discount. You may either
scan or email your documentation to
HRBenefitsDocumentation@cooperhealth.edu
or fax to 856.968.8519.
Cooper offers multiple health plans that offer the freedom to use any provider. However,
your out-of-pocket costs will vary and may be significantly lower when choosing Cooper
or Independence Blue Card network providers.
2023 EMPLOYEE BENEFITS GUIDE | 7
Medical Plans At-A-Glance
BASIC PPO CORE PPO STANDARD PPO
IN-NETWORK BENEFITS
INDEPENDENCE
ADMINISTRATORS NETWORK
COOPER UNIVERSITY
HEALTH CARE NETWORK
INDEPENDENCE
ADMINISTRATORS NETWORK
COOPER UNIVERSITY
HEALTH CARE NETWORK
INDEPENDENCE
ADMINISTRATORS NETWORK
Benefit Period
Calendar Year Calendar Year Calendar Year Calendar Year Calendar Year
Deductible (Individual/Family)
$5,000/$10,000 None $3,000/$9,000 None $3,000/$9,000
Coinsurance (% Plan Pays)
60% after deductible 100% 100%
Out-of-Pocket Maximum
(Individual/Family)
$6,450/$12,900 $6,450/$12,900 $6,450/$12,900
Lifetime Maximum
Unlimited Unlimited Unlimited Unlimited Unlimited
Preventive Care Services
100% 100% 100% 100% 100%
Primary Care/Specialist Office Visits
60% after deductible 100% $50 copay $15 copay $35 copay
Behavioral Health
(Office Visit/Outpatient Visit)
60% after deductible 100% 100% 100% 100%
Short-Term Rehab Visits
(PT / OT / Speech)
60% after deductible 100% $50 copay 100% $35 copay
Chiropractic Care
60% after deductible N/A $30 copay (30 visits) N/A $35 copay (30 visits)
Diagnostic Radiology/Lab
60% after deductible 100% 70% after deductible 100% 70% after deductible
Infertility Services
60% after deductible 100% 70% after deductible 100% 70% after deductible
Urgent Care
60% after deductible 100% $50 copay $15 copay $35 copay
Emergency Room
60% after deductible $125 copay
Outpatient Hospital Care
60% after deductible 100% 70% after deductible 100% 70% after deductible
Inpatient Hospital Care
60% after deductible 100%
$1,000 copay per day,
then 70% after deductible
100%
$1,000 copay per day,
then 70% after deductible
OUT-OF-NETWORK BENEFITS
Deductible (Individual/Family)
$10,000/$20,000 $5,000/$15,000 $5,000/$15,000
Out-of-Pocket Maximum
(Individual/Family)
$15,000/$30,000 $14,000/$42,000 $10,000/$30,000
Coinsurance (% Plan Pays)
60% after deductible 50% after deductible 50% after deductible
$175 copay
70% after deductible 70% after deductible
Infertility Covered Under Tier 1 and Tier 2
Cooper offers a lifetime maximum benefit of $20,000 for all fertility services combined
except: diagnosis and surgical correction of cryopreservation of embryos, including
monthly fees for monitoring and storage. In vitro Fertilization limited to two (2) attempts
per calendar year. Infertility Services are covered at the cost share for performed service.
8 | 2023 EMPLOYEE BENEFITS GUIDE
Prescription Drug Benefits
COOPER CORE & STANDARD PLANS ONLY
NETWORK PHARMACIES
MANDATORY MAIL-ORDER FOR ALL MAINTENANCE MEDICATIONS
AFTER INITIAL AND THREE ADDITIONAL RETAIL REFILLS
PRESCRIPTION DRUGS - THREE-TIER COPAYS RETAIL PHARMACY
EXPRESS SCRIPTS OR WALGREEN SMART 90 PROGRAM
Generic Drug
Coinsurance is the greater of 20% of prescription cost or $10
Max. $150 copay
Coinsurance is the greater of 20% of prescription cost or $20
Max. $300 copay
Brand Name Formulary Drug
Coinsurance is the greater of 20% of prescription cost or $25
Max. $150 copay
Coinsurance is the greater of 20% of prescription cost or $50
Max. $300 copay
Brand Name Non-Formulary Drug
Coinsurance is the greater of 20% prescription cost or $40
Max. $150 copay
Coinsurance is the greater of 20% prescription cost or $80
Max. $300 copay
COOPER BASIC PPO PLAN
Prescription Drugs are covered at 60% until deductible is met. Once deductible is met you will pay 40% until the out-of-pocket maximum is met.
Once the out-of-pocket maximum is met the plan pays 100%. Mandatory Mail-Order applies.
Direct Meds Inc. at Camden
Direct Meds Inc. is a full-service pharmacy
offering prompt prescription services located
in the Roberts Pavilion. Direct Meds Inc.
accepts all third party insurances.
One Cooper Plaza, Camden, NJ 08103
Hours of operation: Mon-Fri: 9 a.m. – 8 p.m.
Tel: 856.966.0980 • Fax: 856.966.0984.
Medical coverage under the Cooper Basic PPO, Cooper Core PPO and Cooper Standard
PPO plans includes prescription drug coverage through Express-Scripts. The prescription
Drug plan offers two ways to purchase your medications – through a participating pharmacy
or by mail-order.
2023 EMPLOYEE BENEFITS GUIDE | 9
Wellness Incentive Program
STEP 1: NON–TOBACCO USER
• You must be a non- tobacco user and enroll in
a Cooper PPO Plan (Basic, Core or Standard).
• If you attested to being a non-tobacco user during
the Open Enrollment process, you will be credited
as completing the non- tobacco user requirement.
• If you are a newly hired Team Member from
November 1 through October 31 and attested to
being a non-tobacco user during your new hire
benefits enrollment, you will be credited as
completing the non- tobacco user requirement.
• If you are a tobacco user and your tobacco status
changes during the plan year, you must sign the
Non- Tobacco User Certification Form that is
located on Employee Self-Service > My Benefits
> Non- Tobacco/Tobacco Info and return the
document to HRbenefi[email protected]
or fax to 856.968.8519.
STEP 2: ROUTINE ANNUAL PHYSICAL
• You must have an annual routine physical with
a physician or a Biometric Screening.
• Must see a non-specialty physician to be
considered under the Program
• Cannot combine the routine physical with a
follow- up for medical treatment
• This visit should be coded by the provider as
preventive care. No copays or deductibles apply.
• Newly hired Team Members or Team Members
whose job requires an annual physical through
WORKNET from November 1 to October 31 will
be credited as completing the Annual Physical
requirement.
STEP 3: WELL-BEING ASSESSMENT
• The Personal Health Assessment takes about 20
minutes to complete. You will receive a wellness
score that provides an overview of your healthy
habits and areas for making healthy changes.
• Log on to www.myibxtpabenefits.com. If this is
your first visit to the new website, you will need to
register. Please have your identification card on
hand as you will need your member ID.
• Access Health & Well-Being tab. Select
“Complete my Well-being Profile”
Cooper is pleased to offer a Wellness
Incentive Program to all Team Members
enrolled in the Cooper Basic, Core or
Standard PPO Plans. To be eligible, you
must complete all three steps listed below
between November 1 through October 31.
Upon successful completion, you will not
be charged for one bi-weekly medical plan
payroll deduction at the end of the
calendar year.
10 | 2023 EMPLOYEE BENEFITS GUIDE
Independence Wellness Programs
Medical coverage under the Cooper Basic, Core and Standard PPO Plans includes
individual wellness programs, offered through Independence Administrators. The wellness
programs are designed to help you and your families achieve and maintain good health.
You can access wellness program materials electronically through the Cooper Policy
Network (CPN).
Reimbursement Programs
Fitness: Up to $150
Weight Watchers: Up to $150
• Smoking Cessation: Up to $150
upon completion of smoking cessation program.
Helpful Tips
Bicycle Safety: “
Child Safety:
Poison Prevention:
• Stress Management: How to take control of stress
Baby Beginnings
Baby Beginnings is a maternity management
program specifically designed to help plan members
successfully manage their health before, during and
after their baby is born. Services include:
• nurse to help manage high-risk
pregnancies
To learn how the Baby Beginnings program can
help support you, connect with an Independence
Administrators representative at 1.888.206.1315.
Achieve Well-Being
Your well-being journey is personal. Whether you
want to eat healthier, manage stress better, be more
active or just get some more sleep, your goals are
unique to you.
Build your personal path to achieve your health
goals Visit myibxtpabenefits.com or download the
myibxtpabenefits Mobile app to start your well-being
journey!
Achieve Well-being from Independence
Administrators is a motivating and personalized set
of well-being tools and resources that can help you
achieve what’s important to you in a way that’s simple,
easy and fun.
myibxtpabenefits.com
• and encouraging emails
2023 EMPLOYEE BENEFITS GUIDE | 11
The Optum, Quit-For-Life Program is the nation’s leading tobacco cessation program and is
the only externally validated phone-based tobacco treatment program in the country. The
program treats each tobacco user as a unique individual. Treatments are tailored to each
person’s specific needs and attributes so that participation in the program is most likely to
result in a successful quit.
Smoking Cessation Program
When you enroll in the program you will receive:
• Up to five planned telephone coaching sessions
• An evaluation survey call at six months after
enrollment
• Unlimited toll free access to Quit Coaches who
will offer as much or as little support as you need
• Free nicotine replacement therapy (patch/gum)
mailed directly to your home if appropriate
• Recommendations on type, dose and duration
of medication if appropriate (including patch
and gum)
• Access to Web Coach™, an online community
where you can get information and support from
other people in the program
The Optum Quit for Life Program is a $350 value
and will be paid for by Cooper University Health Care.
This includes the coaching sessions, access to Web
Coach and nicotine replacement products (patch or
gum) if recommended by your Quit Coach.
We at Cooper University Health Care want you to be
healthy and happy for life. Quitting tobacco usage is
the most important step you can take towards good
health. For more information about the Optum
Quit-For-Life Program or to enroll in the program,
call 1.866.QUIT4LIFE or sign up by logging onto
Quitnow.net.
If you successfully complete the Quit-For-Life
program, you could become eligible for the Wellness
Incentive Program and pay less per pay by attesting
to non-tobacco use.
12 | 2023 EMPLOYEE BENEFITS GUIDE
Vision Care Plan
The Vision care benefit is offered as a
stand-alone benefit that is administered
through EyeMed.
Using EyeMed Vision Providers
With EyeMed Vision providers, all you need to do
is call the doctor’s office or participating provider
to schedule an appointment. Identify yourself as an
EyeMed Vision member and a Cooper University
Health Care Team Member and provide them your
Social Security number or your member ID number
located on your EyeMed Vision ID card. They will
take care of the paperwork for you. When you visit
a PLUS Provider, you get access to a supersized set
of benefits. See the next page for more details.
Look for participating and PLUS Providers at
www.eyemed.com.
Vision Plan ID Cards
Once enrolled in EyeMed Vision you will get a
personalized vision ID card with your name, member
ID, group name, as well as your exam and materials
copay amounts. Although it is not necessary to have
an ID card when you receive vision services, the ID
card is available for your convenience.
Filing Claims
For services provided by out-of-network vision care
providers, please complete an out-of-network claim
form, located on the Cooper Policy Network and
ESS, with a copy of your paid, itemized receipt.
• Fax to: 1.866.293.7373
• Mail to:
First American Administrators, Inc.
Attention: OON Claims
P.O. Box 8504
Mason, OH 45040-7111
2023 EMPLOYEE BENEFITS GUIDE | 13
IN-NETWORK OUT-OF-NETWORK REIMBURSEMENT
Exam
$10 copay Up to $40
Frames
$0 copay, $130 allowance, 20% off balance over $130 Up to $45
Lenses
Single Vision Lenses
Bifocal Lenses
Trifocal Lenses
Standard Progressive Lenses
Premium Progressive Lenses
$25 copay
$25 copay
$25 copay
$90
$90, 80% of charge less $120 allowance
Up to $40
Up to $60
Up to $80
Up to $60
Up to $60
Lens Options*
UV Treatment
Tint (solid and gradient)
Standard Plastic Scratch Coating
Standard Polycarbonate
Standard Polycarbonate—children under 19
Standard Anti-Reflective Coating
Polarized
Other Add-Ons and Services
$15 copay
$15 copay
$0 copay
$40 copay
$0 copay
$45 copay
20% off retail price
20% off retail price
N/A
N/A
Up to $11
N/A
Up to $28
N/A
N/A
N/A
Contact Lenses (in lieu of eyeglasses)
Conventional
Disposable
Medically Necessary
$0 copay, $105 allowance, 15% off balance over $105
$0 copay, $105 allowance, plus balance over $105
$0 copay, paid in full
Up to $105
Up to $105
Up to $210
Laser Vision Correction
Lasik or PRK from US Laser Network
15% off retail price or 5% off promotional price N/A
Frequency
Vision Exam
Lenses or Contacts
Frames
Once every 12 months
Once every 12 months
Once every 24 months
EyeMed
Plus Providers
Visit a PLUS Provider for access to a supersized set
of benefits. These benefits include:
• $0 Exam copay
• Extra cash to spend on frames
All PLUS provider perks are built right into your
vision benefits, no promo codes, coupons, or
paperwork are needed.
Eye360 Enhancements
• Eye360 features a $0 eye exam and an additional
$50 frame allowance at PLUS Providers
• Use the frame and contact lens allowance in the
same benefit year - worth up to an extra $130
• Separate contact lens fit & follow-up coverage
(leaving the entire allowance for materials)
Vision Care Plan
* Amounts shown are paid for by member and added to the base price of the lens.
14 | 2023 EMPLOYEE BENEFITS GUIDE
Cooper offers dental benefits through
Delta Dental and Sun Life. Delta’s network
is a large, national network, so your dentist
may already be a network dentist. When
you make an appointment, be sure to
identify yourself as a Delta Dental member
and reconfirm that the dentist is a Delta
Preferred network participant.
There are three dental plans to choose from:
• Delta Preferred PPO plan
• Delta Buy-Up PPO plan
• Sun Life DMO
In addition, you have the option to waive dental
coverage entirely.
Cooper pays a percentage of dental coverage for you
and your family. Your costs are outlined in the section
called “Your 2023 Dental Contributions”.
Delta Preferred Plan
With the Delta Preferred Plan, you have the flexibility
to see any dentist you choose; however, your benefits
are greater if you stay in the Delta network. If you
choose to go to an out-of-network provider, the plan’s
payment will be based on the Usual, Customary and
Reasonable (UCR) charge. You’ll pay your deductible,
if applicable, plus co-insurance and any amounts that
exceed UCR. For 2023, the annual calendar year
maximum has increased to $1,500.
Be sure to show your dental ID card when you receive
services. Dental claim forms are also available on ESS.
Delta Buy-Up Plan
The Delta Dental Buy-Up Plan gives you higher
coverage for certain dental services — such as 100%
for basic and 80% for crowns. There is also an added
benefit of orthodontia for adults and dependents with
a lifetime orthodontia benefit maximum of $2,000
per person. For 2023, the annual calendar year
maximum has increased to $2,000.
To find a participating Delta Dental provider, call
1.800.335.8265 or visit www.deltadentalnj.com
and click on “Looking for a Dentist” then
“Delta Dental PPO”.
Sun Life Dental Plan
The Sun Life Plan is a dental maintenance
organization (DMO), which means the plan only pays
benefits for services you receive from dentists who are
in the Sun Life network. Some of the features offered
through the Sun Life Plan include:
• You select from a list of participating providers.
• Some services are covered at 100% while others
have a small copay for diagnostic, preventive and
restorative care.
• No age limit for orthodontia.
• No annual deductible and no maximum limit.
• Refer to the Sun Life fee schedule located in ESS.
PLEASE NOTE: New Sun Life members should
contact Assurant with their in-network Sun Life office
selection. If you do not make a dental office selection,
Assurant will assign one for you based on your zip
code. You will not receive an ID card with this dental
option.
To find a participating Sun Life network provider
in your area, call 1.800.443.2995 or visit
www.slfserviceresources.com.
Dental Benefits
2023 EMPLOYEE BENEFITS GUIDE | 15
DELTA PREFERRED PPO PLAN DELTA BUY-UP PPO PLAN
DELTA DENTAL PPO DELTA DENTAL PREMIER OUT-OF-NETWORK* DELTA DENTAL PPO DELTA DENTAL PREMIER OUT-OF-NETWORK*
Calendar Year Deductible
(waived on Preventative & Diagnostic)
$25 individual / $50 family
Calendar Year Maximum
(per patient)
$1,500 $2,000
Preventive & Diagnostic Services
Exams, Cleanings, Bitewing X-rays
(each twice in a calendar year), Fluoride
Treatment (once in a calendar year,
children to age 19)
Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
Basic Services
Fillings, Extractions, Endodontics
(root canal), Periodontics, Oral Surgery,
Sealants
Plan pays 80% Plan pays 50% Plan pays 50% Plan pays 100% Plan pays 80% Plan pays 50%
Major Services
Crowns, Gold Restorations, Bridgework,
Full and Partial Dentures
Plan pays 50% Plan pays 50% Plan pays 50% Plan pays 80% Plan pays 50% Plan pays 50%
Separate Orthodontia Deductible
(per patient)
$50 $50
Orthodontia Benefits
Plan pays 50% Plan pays 50% Plan pays 50% Plan pays 50% Plan pays 50% Plan pays 50%
Orthodontia Lifetime Maximum
$1,500 individual (child only) $2,000 individual (child and adult coverage)
$25 individual / $50 family
* Out-of-network benefits are based on the Usual, Customary and Reasonable (UCR) charge. You’ll pay your deductible, if applicable, plus co-insurance and any amounts that exceed UCR.
Dental Plan Comparison
Information about
the Assurant (Sun
Life) Dental DMO
plan as well as the
plan’s fee schedule
can be found on ESS
16 | 2023 EMPLOYEE BENEFITS GUIDE
MEDICAL & PRESCRIPTION DRUG PLAN CONTRIBUTIONS
ANNUAL BASE SALARY / TIER BASE HOURLY RATE EMPLOYEE EMPLOYEE + CHILD EMPLOYEE + CHILDREN EMPLOYEE + SPOUSE/PARTNER EMPLOYEE + FAMILY
BASIC PLAN
Tier 1: < $41,226 < $19.82
$10.39 $20.24 $29.68 $28.32 $34.76
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$20.78 $35.42 $51.94 $49.56 $60.83
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$77.93 $116.06 $170.24 $162.42 $199.38
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$83.82 $122.43 $179.58 $171.32 $210.32
Tier 5: $175,011+ $84.14+
$119.48 $179.60 $263.42 $251.33 $308.51
CORE PLAN
Tier 1: < $41,226 < $19.82
$46.62 $68.09 $99.87 $95.29 $116.94
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$60.65 $90.29 $132.43 $126.35 $155.07
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$127.37 $191.34 $280.64 $267.77 $328.62
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$149.60 $224.45 $329.19 $314.09 $385.48
Tier 5: $175,011+ $84.14+
$175.89 $257.52 $377.70 $360.36 $442.28
STANDARD PLAN
Tier 1: < $41,226 < $19.82
$190.52 $278.31 $408.19 $389.47 $478.06
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$190.52 $278.31 $408.19 $389.47 $478.06
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$190.52 $278.31 $408.19 $389.47 $478.06
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$205.97 $300.88 $441.29 $421.05 $516.83
Tier 5: $175,011+ $84.14+
$257.46 $376.10 $551.61 $526.30 $646.04
DENTAL PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE +FAMILY
Delta Dental Buy-Up
$5.17 $9.28 $9.37 $13.54
Delta Dental Preferred
$1.88 $3.19 $3.76 $4.50
Sun Life Dental
No cost to you
VISION CARE PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE +FAMILY
EyeMed Vision Care Plan
$2.23 $4.47 $4.25 $6.58
BI-WEEKLY CONTRIBUTIONS
(Full-Time Team Members)
Bi-Weekly Contributions
Full-Time Team Members (NON-TOBACCO USER)
2023 EMPLOYEE BENEFITS GUIDE | 17
DENTAL PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE + FAMILY
Delta Dental Buy-Up
$11.81 $22.59 $20.14 $30.85
Delta Dental Preferred
$4.69 $7.98 $9.39 $11.27
Sun Life Dental
$1.99 $3.36 $3.36 $4.80
VISION CARE PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE + FAMILY
EyeMed Vision Care Plan
$2.23 $4.47 $4.25 $6.58
BI-WEEKLY CONTRIBUTIONS
(Part-Time Team Members)
Bi-Weekly Contributions
Part-Time Team Members (NON-TOBACCO USER)
MEDICAL & PRESCRIPTION DRUG PLAN CONTRIBUTIONS
ANNUAL BASE SALARY / TIER BASE HOURLY RATE EMPLOYEE EMPLOYEE + CHILD EMPLOYEE + CHILDREN EMPLOYEE + SPOUSE/PARTNER EMPLOYEE + FAMILY
BASIC PLAN
Tier 1: < $41,226 < $19.82
$10.39 $93.06 $208.79 $180.43 $236.67
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$20.78 $103.45 $219.18 $201.60 $282.13
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$77.93 $160.60 $276.33 $258.75 $339.28
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$83.82 $207.82 $381.42 $355.06 $475.86
Tier 5: $175,011+ $84.14+
$119.48 $243.48 $417.08 $390.72 $511.52
CORE PLAN
Tier 1: < $41,226 < $19.82
$46.62 $143.13 $278.25 $257.04 $333.19
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$60.65 $157.16 $292.28 $271.76 $365.69
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$127.37 $223.88 $359.00 $338.48 $432.41
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$149.60 $294.37 $497.05 $466.27 $607.17
Tier 5: $175,011+ $84.14+
$175.89 $320.66 $523.34 $492.56 $633.45
STANDARD PLAN
Tier 1: < $41,226 < $19.82
$190.52 $313.43 $485.50 $532.40 $706.18
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$190.52 $313.43 $485.50 $532.40 $706.18
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$190.52 $313.43 $485.50 $532.40 $706.18
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$205.97 $390.33 $648.44 $720.52 $978.34
Tier 5: $175,011+ $84.14+
$257.46 $441.82 $699.93 $795.15 $1,034.63
18 | 2023 EMPLOYEE BENEFITS GUIDE
MEDICAL & PRESCRIPTION DRUG PLAN CONTRIBUTIONS
ANNUAL BASE SALARY / TIER BASE HOURLY RATE EMPLOYEE EMPLOYEE + CHILD EMPLOYEE + CHILDREN EMPLOYEE + SPOUSE/PARTNER EMPLOYEE + FAMILY
BASIC PLAN
Tier 1: < $41,226 < $19.82
$35.39 $45.24 $54.68 $53.32 $59.76
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$45.78 $60.42 $76.94 $74.56 $85.83
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$102.93 $141.06 $195.24 $187.42 $224.38
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$108.82 $147.43 $204.58 $196.32 $235.32
Tier 5: $175,011+ $84.14+
$144.48 $204.60 $288.42 $276.33 $333.51
CORE PLAN
Tier 1: < $41,226 < $19.82
$71.62 $93.09 $124.87 $120.29 $141.94
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$85.65 $115.29 $157.43 $151.35 $180.07
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$152.37 $216.34 $305.64 $292.77 $353.62
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$174.60 $249.45 $354.19 $339.09 $410.48
Tier 5: $175,011+ $84.14+
$200.89 $282.52 $402.70 $385.36 $467.28
STANDARD PLAN
Tier 1: < $41,226 < $19.82
$215.52 $303.31 $433.19 $414.47 $503.06
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$215.52 $303.31 $433.19 $414.47 $503.06
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$215.52 $303.31 $433.19 $414.47 $503.06
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$230.97 $325.88 $466.29 $446.05 $541.83
Tier 5: $175,011+ $84.14+
$282.46 $401.10 $576.61 $551.30 $671.04
DENTAL PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE +FAMILY
Delta Dental Buy-Up
$5.17 $9.28 $9.37 $13.54
Delta Dental Preferred
$1.88 $3.19 $3.76 $4.50
Sun Life Dental
No cost to you
VISION CARE PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE +FAMILY
EyeMed Vision Care Plan
$2.23 $4.47 $4.25 $6.58
BI-WEEKLY CONTRIBUTIONS
(Full-Time Team Members)
Bi-Weekly Contributions
Full-Time Team Members (TOBACCO USER)
2023 EMPLOYEE BENEFITS GUIDE | 19
DENTAL PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE + FAMILY
Delta Dental Buy-Up
$11.81 $22.59 $20.14 $30.85
Delta Dental Preferred
$4.69 $7.98 $9.39 $11.27
Sun Life Dental
$1.99 $3.36 $3.36 $4.80
VISION CARE PLAN CONTRIBUTIONS
EMPLOYEE ONLY EMPLOYEE + CHILD(REN) EMPLOYEE + SPOUSE / PARTNER EMPLOYEE + FAMILY
EyeMed Vision Care Plan
$2.23 $4.47 $4.25 $6.58
MEDICAL & PRESCRIPTION DRUG PLAN CONTRIBUTIONS
ANNUAL BASE SALARY / TIER BASE HOURLY RATE EMPLOYEE EMPLOYEE + CHILD EMPLOYEE + CHILDREN EMPLOYEE + SPOUSE/PARTNER EMPLOYEE + FAMILY
BASIC PLAN
Tier 1: < $41,226 < $19.82
$35.39 $118.06 $233.79 $205.43 $261.67
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$45.78 $128.45 $244.18 $226.60 $307.13
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$102.93 $185.60 $301.33 $283.75 $364.28
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$108.82 $232.82 $406.42 $380.06 $500.86
Tier 5: $175,011+ $84.14+
$144.48 $268.48 $442.08 $415.72 $536.52
CORE PLAN
Tier 1: < $41,226 < $19.82
$71.62 $168.13 $303.25 $282.04 $358.19
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$85.65 $182.16 $317.28 $296.76 $390.69
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$152.37 $248.88 $384.00 $363.48 $457.41
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$174.60 $319.37 $522.05 $491.27 $632.17
Tier 5: $175,011+ $84.14+
$200.89 $345.66 $548.34 $517.56 $658.45
STANDARD PLAN
Tier 1: < $41,226 < $19.82
$215.52 $338.43 $510.50 $557.40 $731.18
Tier 2: $41,226 - $77,230 $19.82 - $37.13
$215.52 $338.43 $510.50 $557.40 $731.18
Tier 3: $77,251 - $113,298 $37.14 - $54.47
$215.52 $338.43 $510.50 $557.40 $731.18
Tier 4: $113,318 - $174,990 $54.48 - $84.13
$230.97 $415.33 $673.44 $745.52 $1,003.34
Tier 5: $175,011+ $84.14+
$282.46 $466.82 $724.93 $820.15 $1,059.63
BI-WEEKLY CONTRIBUTIONS
(Part-Time Team Members)
Bi-Weekly Contributions
Part-Time Team Members (TOBACCO USER)
20 | 2023 EMPLOYEE BENEFITS GUIDE
Disability Benefits
The Cooper University Health Care Benefits
Program helps provide financial security
through its STD and LTD. Together, the
Short-Term Disability and Long-Term
Disability Plans provide a high level of
income protection.
New Jersey Temporary Disability
Benefits (TDB) / Short-Term
Disability (STD)
All Team Members of Cooper University Health
Care are eligible for STD benefits. STD benefits are
provided by the New Jersey Temporary Disability
Income Plan. Coverage under the plan is automatic.
There is no waiting period to be eligible for the
plan. However, you must have worked for at least
20 calendar weeks (“base weeks”) in New Jersey
covered employment in which you earned $200 or
more, or have earned $10,000 or more in such
employment during the 52 weeks (“base year”)
immediately before the week in which you became
disabled (for any New Jersey employer) before you
are eligible to receive benefits. Beginning with the
eighth consecutive calendar day for illness,
disability benefits will replace up to 85% of your
salary, up to the maximum benefit as determined
by the New Jersey Commissioner of Labor.
Disability payments are made until you recover, or
for up to 26 weeks, whichever occurs first. You may
not receive benefits for more than 26 weeks in any
52-week period for any reason. All claim decisions
are made by New Jersey Division of Temporary
Disability Insurance.
Phone: 609.292.7060
Fax: 609.984.4138
www.mynjleavebenefits.nj.gov
Family Leave Insurance
Team Members of Cooper University Health Care
are eligible for New Jersey Family Leave Insurance
benefits (also known as “FLI”). A small deduction is
taken from your paycheck for this benefit and
coverage is automatic.
Benefit payments under this plan will begin for
claims filed on or after July 1, 2009. However, you
must have worked for at least 20 calendar weeks
(“base weeks”) in New Jersey covered employment
in which you earned $200 or more, or have earned
$10,000 or more in such employment during the
52 weeks (“base year”) immediately before the
week you filed a claim for paid family leave before
you are eligible to receive benefits. Paid family
leave benefits will replace 2/3 of your average
weekly wage, up to 85% of your salary. All claim
decisions are made by New Jersey Division of
Temporary Disability Insurance. Visit
https://myleavebenefits.nj.gov/labor/myleaveben
efits for more information.
Voluntary Short Term Disability
Plan
Cooper offers a voluntary STD program as a
supplement to the New Jersey Temporary Disability
Benefits (NJ TDB) program. This voluntary program
will cover you for up to 66 2/3% of your annual
income.
You should consider how much Extended Sick
Leave (ESL) you have, because you can choose
among 3 different waiting periods (30, 60, and 90
days). The longer the waiting period you choose,
the lower your premium is. Remember, Cooper
allows you to supplement any NJ TDB benefits with
ESL, up to 100% of salary, so choose a waiting
period that makes sense based on your ESL
balance. You can view your ESL and PTO balances
on the ESS website or check your most recent
pay-stub.
2023 EMPLOYEE BENEFITS GUIDE | 21
LTD Benefits
If you remain out of work for more than 180
continuous days due to a covered illness or
accident, you are eligible for LTD benefits as long
as you are considered totally disabled. The 180
continuous days are called, the elimination period.
All claim decisions are made by third party plan
administrator.
Amount of Benefit
The LTD Plan is designed to ensure that you receive
up to 60% of your monthly earnings while you’re
disabled. Monthly earnings means your basic
monthly salary on the date just before your total
disability, excluding any overtime pay, bonuses,
commissions or any other special compensation.
If you qualify as having income from another source,
the LTD plan assures that your combined disability
income from all sources will equal no more than
60%. In no event will you receive a monthly benefit
from the plan that is less than $100. The maximum
monthly benefit available under the group plan is
$10,000 for physicians and up to an additional
$5,000 under an individual Long-Term Disability
policy. The limit is $15,000 for staff Team Members.
Example of How LTD Benefits Work
Let’s assume that you earn $30,000 a year (or
$2,500 a month), become disabled for longer than
six months, and receive Primary Social Security
disability benefits. Your plan benefit would be
calculated as follows:
In this example, you would receive a total monthly disability income
of $1,500 — i.e. $930 from Social Security and $570 from the LTD Plan.
Note: You must be completely and totally disabled for at least 12 consecutive months
to be eligible to receive Social Security Disability benefits. If you do not qualify for
Social Security Disability Benefits, the $1,500.00 monthly benefit would be paid
entirely through the Long Term Disability Plan.
Workers’ Compensation
If you are injured or become ill as a result of a
work-related incident, you are eligible to receive
treatment under workers’ compensation. Your
medical expenses are covered as long as the
incident is compensable and is reported in a timely
manner. Failure to report your claim may result in
a denial of the benefit.
You must notify your department manager of
the incident and complete an Event and Activity
Reporting System (EARS) report under Team
Member Incident report. Followed by the EARS
report, you may then schedule an appointment with
Worknet for evaluation. If the incident occurs at
night or on the weekend, medical treatment is
available through the Emergency Room, but an
EARS report must still be completed.
If it is determined by Occupational Health or
another authorized Cooper affiliated medical
provider that you are unable to work as a result of
your injury/illness, salary continuation is available.
To be eligible, you must be out of work for seven
calendar days.
Beginning with your first day out, workers’
compensation benefits will replace 70% of your
salary up to a maximum weekly benefit.
In addition, if you are unable to perform job duties
required by your position, but you are still able to
work with modifications or restrictions, a Human
Resources representative will work with you to
arrange an alternative assignment.
You can find workers’ compensation information
on the Pulse by selecting the Cooper Policy
Network (CPN) click on Human Resources from the
drop down menu, then select Policies
and Procedures.
Disability Benefits
60% x $2,500
Minus Primary Social Security Benefit
LTD Plan Benefit
= $1,500
- $930
= $570
22 | 2023 EMPLOYEE BENEFITS GUIDE
Basic Life and AD&D Insurance
Basic Life/Accidental Death and
Dismemberment (AD&D) Insurance
Cooper offers Basic life and accidental death and
dismemberment (AD&D) insurance through New
York Life that gives you the security of knowing you
and/or your dependents will have some financial
resources to meet expenses in the event of a
serious accident or death. Life insurance benefits
provide income to your beneficiaries in the event of
your death from any cause. AD&D insurance can
provide income for you in the event of an accidental
loss of a limb or sight or for your family in the event
of your accidental death.
Cooper provides, at no cost to you, basic life
insurance equal to one times your annual base
pay, rounded to the next higher $1,000, up to
a maximum benefit of $600,000.
In addition, as part of basic life insurance, you
receive AD&D coverage equal to an additional one
times your annual base pay rounded to the next
higher $1,000, (up to $600,000) if you die as the
result of an accident. AD&D coverage may also pay
a benefit to you for an accidental loss. See the
summary plan description for details.
Coverage amounts for basic life and AD&D
insurance are rounded to the next $1,000. For
example, If your salary is $23,600, the minimum
amount of basic life insurance you would have is
$24,000 ($23,600, rounded to the next $1,000 =
$24,000). Plus an additional $24,000 in AD&D
coverage.
Your basic life insurance and AD&D coverage may
change during the year if your base-pay changes.
About Taxable Income
and Life Insurance
The IRS requires employers who provide (i.e., pay
for) more than $50,000 of life insurance coverage to
calculate the “value of the coverage” over $50,000
as taxable income (computation is based on a
published IRS table). For Cooper Team Members,
this extra taxable income affects those enrolled in
basic life insurance whose base annual salary
exceeds $50,000 (because your basic life insurance
benefit is rounded up to the next $1,000 your actual
benefit is $51,000).
Beneficiary Designation
You should review your beneficiary information
at least once a year to make sure everything is
current. Even though you may have the same
beneficiary, they might have changed addresses.
A regular beneficiary review each year will make
sure you capture these changes.
Certain life events such as marriage or the birth of a
child or divorce should also trigger a review of your
beneficiary information.
All beneficiary forms are available via Employee
Self-Service Benefits > Life Insurance >
Beneficiary Designation. Forms can be emailed
to hrBenefits@cooperhealth.edu.
Basic and Supplemental life insurances are portable
when you leave Cooper. You can request a packet
from New York Life through the Benefits Team
within 31 days from the date you leave.
Having Life Insurance is very important as well as planning where the proceeds will go once a person dies. You
want to make sure your family is protected and therefore proper estate planning and having a Will is one of
the most important documents you can have. Cooper offers you a Legal Plan on a voluntary basis that includes
Will preparation. Please visit VBCooper.com and click on https://www.coopervb.com/benefit-enhancements;
Click on Benefits Tour: Click on Voluntary Benefit Programs and scroll down to Pre-Paid Legal Services.
2023 EMPLOYEE BENEFITS GUIDE | 23
Supplemental Life Insurance
for You
You have the option of purchasing supplemental life
insurance up to five times your annual base pay in
increments of $10,000. Your supplemental life
amount will be rounded down to the next $10,000
of coverage and will be subject to a maximum of
$1,000,000. The overall maximum benefit (basic and
supplemental life combined) is $1,600,000.
Your bi-weekly premium is calculated on the amount
of supplemental life insurance you elect, your age,
and your current pay.
Insurance benefits will be reduced by half once the
Team Member reaches 70 years of age.
Spouse Supplemental Life
You have the option to purchase Spouse Life
Insurance in the amount of $5,000 to $25,000,
in $5,000 increments. Your bi-weekly, after-tax
premium will be calculated based on the amount
of coverage you elect and your spouse’s or
domestic/civil union partner’s age. You will be the
beneficiary of the policy. Please note: Spouse Life
Insurance election cannot be more than 100% of
the Team Member’s life insurance amount.
Child Supplemental Life Insurance
You may also purchase Child Life Insurance for your
eligible dependent children in the amount of $5,000
or $10,000. Benefits to be paid:
• Live birth to 14 days - $1,000
• 14 days to 6 months - $1000
• 6 months to 26 – full benefit
You will be the beneficiary of the policy.
Note: You may cover your dependent children up to the age of 26.
During initial enrollment as a new Team Member,
you may purchase supplemental life insurance for
the first time (up to $1,000,000). A Medical
Evidence of Insurability (EOI) will be required for
Team Members initially (including new Team
Members) enrolling with a combined benefit of
basic and supplemental life insurance exceeding
$800,000.
You can apply for additional benefit options only
during an annual enrollment period or within 31
days of a change in status. Evidence of insurability is
required for any amount of life insurance. Evidence
of insurability is not required for accidental death
and dismemberment insurance.
If you can answer “NO” to 5 questions on the EOI
Short Form, then the application is approved and
coverage can be granted.
If you answer “YES” to any of the 5 questions on the
EOI Short Form, then you must complete Unum’s
EOI Long Form, which must be reviewed and
approved by Unum before coverage can become
effective.
If the EOI Long Form is not submitted or Unum
does not approve it, you will revert back to the level
of coverage you held prior to the change or
enrollment.
If you are electing or increasing Supplemental Life
and meet the criteria explained above, please
complete the EOI Short Form. If you answer “YES”
to any of the questions on the short form you will
need to complete an EOI Long Form. EOI Short
and Long forms can be found on ESS.
Supplemental Life Insurance
24 | 2023 EMPLOYEE BENEFITS GUIDE
Flexible Spending Accounts
Use It or Lose It
The FSA plan year runs from January 1, 2023 to
December 31, 2023. You should contribute the
amount of money you expect to pay out-of-pocket
for eligible expenses for the plan year. The
Healthcare FSA offers a rollover amount. This means
that enrolled members are able to carry over up
to $610 from your 2023 balance into the 2024
calendar year. NOTE: The Dependent Care FSA
does not offer a rollover amount. However, it does
have a 2 ½ month grace period. This means that
Team Members will have until March 15, 2024 to
incur eligible expenses and will have until
March 31, 2024 to submit claims for reimbursement.
Healthcare FSA
Healthcare FSA funds can be used to pay for out-of-
pocket healthcare expenses incurred by you and
your dependents. Eligible expenses include office
visit copays, non-cosmetic dental procedures,
prescription drugs, eyewear, LASIK eye surgery
and more. You can contribute up to the maximum
amount allowed by the IRS.
Dependent Care FSA
The Dependent Care FSA is used for expenses
related to the care of eligible dependents.
Eligible expenses include Au Pair, baby-sitting
or dependent care to allow you to work or actively
seek employment, day camps, preschool or after
school programs, and adult/eldercare for adult
dependents.
The maximum that you can contribute to the
Dependent Care FSA is $5,000 if you are a single
employee or married filing jointly. If you are a
married employee filing separately the maximum
you can contribute is $2,500.
For questions about your spending accounts,
contact Health Equity at 855.692.2959 or
www.healthequity.com/wageworks.
Commuter Benefits
The Commuter benefit through RideECOSelect
allows you to set aside up to $300 per month
(on a pre-tax basis) for Transit and $300 per
month for Parking expenses. Transit expenses
include mass transit, train, subway, bus fares, ferry
rides. Parking expenses includes expenses incurred
at or near your work location or near a location from
which you commute using mass transit. Funds
cannot be transferred between the transit and
parking accounts. Changes to your monthly
contribution must be made by the 1st of the month
prior to the month in which the contribution applies.
The last payroll deduction of the month pertains to
the pass for that current month. You'll receive a
debit card that can be used to pay for qualified
transit and parking expenses
The Commuter benefits account does not have
a use-it-or-lose-it provision.
To learn more, visit ESS or go to
www.rideecoselect.com.
Flexible Spending Accounts (FSA) allow you to set aside pre-tax dollars to pay for
eligible healthcare, dependent care and parking/transit expenses.
2023 EMPLOYEE BENEFITS GUIDE | 25
403(B) Tax Sheltered Annuity Plan
Cooper University Health Care sponsors a 403(b)
Tax Sheltered Annuity (TSA) Plan that allows you
to save for your retirement by making pre-tax
contributions for the purchase of a tax sheltered
annuity or custodial mutual fund shares under
section 403(b) of the Internal Revenue Code. Your
contributions to the plan are not taxed until you
withdraw the funds from the plan (usually at
retirement when your tax bracket may be lower).
All Team Members are eligible for a 403(b) TSA
from date of hire. As a way to jumpstart your
retirement savings, all Team Members of Cooper
University Health Care will have 3% of your
compensation automatically deducted from your
pay each payroll period and contributed to your
account under the plan with Fidelity Investments.
Any amount you contribute to the plan through
this automatic deduction (or based on your own
elections) will be held in the plan and invested on
your behalf. You are always 100% vested in the
value of your contributions.
New Fidelity enrollees will be invested in the
Freedom Fund aligned closest to the year of their
65
th
birthday. This investment option has been
determined to be appropriate with a goal of
preserving account balance and providing for a
reasonable rate of return. You may change your
investment option by contacting Fidelity.
You may establish a TSA at any time during the
year. You can change the amount you are
contributing – increase or decrease – at any time.
You may stop contributing to the plan at any time
by contacting Fidelity. Quarterly statements can be
viewed online unless the participant chooses to
request paper statements mailed to the home. If the
participant does not make an election then the
quarterly statement will be provided online.
The Benefits of a TSA
• Convenience. Your contributions are
automatically deducted from your paycheck.
• Tax savings now. Your pre-tax contributions are
deducted from your pay before income taxes
are taken out. It could mean more money in
your take-home pay versus saving money in a
taxable account.
• Portability. You can roll over eligible savings
from a previous employer into this plan. You can
also take your plan vested account balance with
you if you leave the company.
• Investment options. You have the flexibility to
select from investment options that range from
more conservative to more aggressive, making
it easy for you to develop a well- diversified
investment portfolio.
Visit www.fidelity.com/atwork for more
information or call 1.800.343.0860 to schedule an
appointment with a Fidelity Representative.
TAX YEAR DEFERRAL LIMIT
ADDITIONAL CATCH-UP CONTRIBUTION
FOR TEAM MEMBERS AGE 50 AND OLDER
TOTAL DEFERRAL LIMIT FOR TEAM MEMBERS
AGE 50 AND OLDER
2022
$20,500
$6,500 $27,000
2023
$22,500
$7,500 $30,000
NOTE: If you have contributed to a 403(b) or 401(a) during the current year through a prior employer, you
need to contact the Human Resources Department with the amount previously contributed to avoid having
your contributions exceed the allowable IRS limits for the year.
How Much You Can Save
You may contribute from 1% to 70% of your pay. However, federal law also sets an annual maximum.
Please refer to the following IRS website for updated information: www.irs.gov.
26 | 2023 EMPLOYEE BENEFITS GUIDE
Defined Contribution Plan
There are three different types of contributions under the Defined Contribution Plan.
The following is an overview of each- who’s eligible, how each contribution works and
how it’s invested.
Type of Contribution You Are Eligible If… Description How It’s Invested
Basic Contribution
Are a regular employee of Cooper
University Health Care (or one of its
participating affiliates), who is at least 21
years of age with one year of service, and
have worked at least 1,000 hours.
If you work at least 1,000 hours during the
year and are still employed on December 31,
Cooper contributes 1% of base pay (subject to
the IRS compensation limit) to your defined
contribution retirement plan account after the
end of each year.
Basic contributions are invested at your
election in one or more of the funds
offered under the Defined Contribution
Retirement Plan.
Matching Contribution
You are eligible if you qualify for the
Plan’s basic contribution and make
pre-tax contributions to the 403 (b) Plan.
Cooper will make contribution to your
Defined Contribution Retirement Plan
account equal to 50% of the first 5% of your
base pay you defer (subject to the IRS
compensation limit) in the 403 (b) plan.
These contributions are made regularly
throughout the year.
Though matching contributions are
determined based on what you contribute
to the 403 (b) Plan, these contributions
must be invested in one or more of the
funds offered under the Defined
Contribution Retirement Plan. They are no
invested in the same amount as any 403
(b) contributions you make.
Rollover Contribution
Qualify for the plan’s basic contribution.
Generally, you can rollover money from
another employer’s tax-qualified
retirement plan. A rollover must be made
within 60 days after you receive your
distribution or it must be a direct rollover
from your previous employer’s plan.
Rollover contributions are invested at
your election in one or more of the funds
offered under the Defined Contribution
Retirement Plan.
NOTE: Union RNs should review their union contract.
How to Retire
When you are ready to retire from Cooper University
Health Care, you may need to consider the following:
• 403 (b) Tax Sheltered Annuity (TSA) Account —
when you are ready to retire, contact Fidelity directly
at 1.800.343.0860 to discuss your options.
• Defined Contribution Retirement Plan (DC Plan) —
when you are ready to retire, contact your plan
administrator directly to discuss your options.
• Defined Benefit Retirement Plan (“frozen pension”) —
once you have determined when your last day of work
will be, contact the plan administrator, Cooper Pension
Center at 877.716.7812, no more than 90 days prior
to that date. Please be aware that the final benefit
calculation process may take several weeks. The benefit
calculation is first done by our actuaries; you will need
time to review the options and return the forms to
Human Resources. The trustee then will need time to
process the first check.
If you are terminating employment to go to another
employer, you can follow the same instructions for the
403(b) and DC Plans. Your benefit will be automatically
processed under the frozen pension plan and will be
mailed to your home address.
Deciding About Medicare Coverage?
Medicare by Savoy will help you decide whether to
enroll in Medicare Part A and Part B when you retire
(if you haven't already); decide whether you need
additional coverage (Medicare Advantage, Medigap);
or decide whether you need Medicare prescription
drug coverage (Part D).
For additional information about retirement benefits,
please visit ESS or contact Medicare by Savoy at:
• Call 833.600.6727 (Monday – Friday, 9am – 5pm)
• Email experts@medicarebysavoy.com
2023 EMPLOYEE BENEFITS GUIDE | 27
Carebridge/Employee Assistance
The Employee Assistance Program (EAP) provides
free, confidential short-term counseling, information
and referral services for a wide range of problems,
such as family and relationship concerns, caring for
elderly parents, or managing stress and change.
The EAP provides six confidential consultations per
year — including counseling, assessment and problem
resolution — for you and members of your immediate
family at no cost to you. You may continue services
through Carebridge after the initial 6 consultations,
based on the benefit plan in which you are enrolled.
You may access EAP services through Carebridge
Corporation by calling 800.437.0911, emailing
[email protected] or by visiting
www.myliferesource.com (Access Code: WBPNF).
Adoption Assistance Policy
The Adoption Assistance Benefit provides financial
assistance toward eligible expenses incurred in the
adoption of a child under age 18. With this benefit,
you may be reimbursed up to a maximum of $1,000
for the expense of adopting an eligible child (up to
two children per Team Member per calendar year).
Benefits will be paid once the child is placed in the
home. “Placed” is the date the child becomes a
member of the household and not the date of the final
adoption which may be some time after the child has
actually been living with the adopting parent(s).
The eligible expenses for reimbursement under the
Adoption Assistance Plan are:
• Adoption agency fees
• Placement fees
• Lawyer’s fees (including other required legal fees)
• Temporary foster care charges which are paid to
the foster care provider immediately preceding
the placement of the child in the home of the
adopting family
In addition, when adopting children, you will be
provided up to five days of paid leave from your
eligible Extended Sick Leave (ESL) bank to manage
activities related to the adoption. These days should
be used within 30 days of the child’s placement in
the home.
There are certain expenses excluded under the
Adoption Assistance Plan. These include, but are not
limited to, travel expenses for the child or adoptive
parent(s), medical fees (child’s natural mother) and any
expenses incurred to obtain guardianship or custody
of one’s natural child, stepchild or foster child. Please
refer to the Adoption Assistance Policy on Employee
Self-Service and the Cooper Policy Network.
Additional Benefits
28 | 2023 EMPLOYEE BENEFITS GUIDE
Additional Benefits
Cooper Solutions
Cooper Solutions is an errand and convenience
service offered as a Team Member benefit. Their on-
site customer services in Camden may include, but are
not limited to:
• Dry cleaning
• Flower orders
• Jewelry repair
• Gift shopping
• Shoeshine and repair
• Bakery goods
• Gift baskets
• Internet research
In addition, you can get discounted prices for:
• Trips
• Theme parks
• Movie tickets
• Plays and Broadway shows
• Sporting events
• Special rates for AAA, Dell computer, and fitness
facilities
Please contact Cooper Solutions at 856.968.8820
for more information on services.
Paid Time Off (PTO)
Cooper University Health Care’s Paid Time Off (PTO)
Program is a flexible time-off system that combines
vacation, personal, holiday, and sick days into one
easy-to-understand plan. You accrue hours each year
based on your position, status, and length of service
— 200, 240, or 280 hours each year (PTO hours are
prorated for part-time Team Members).
All Team Members working at least 20 hours per week
are eligible for PTO benefits. You begin accruing
hours on your date of hire, but you cannot use PTO
until you have been employed for three full months
(except for holidays during the probationary period).
You may carry over from one year to the next, any
earned, unused, unpaid PTO days up to a maximum
of your annual accrual rate.
Accrual Rate/80 hours X Total Regular Paid Hours
Per Pay Period (Maximum of 80)
= Accrual Rate per Pay Period
Team Members who terminate their employment may
be eligible to receive a payout of their unused PTO. In
order to be eligible, Team Members must be
employed with Cooper for one year and provide
adequate notice. Adequate notice is four weeks for
management/supervisors/professionals and two weeks
for all other Team Members. Please refer to the Paid
Time Off policy on the Cooper Policy Network for
more information.
periods after your termination
to process the payout.
PAID TIME OFF (PTO) ACCRUAL
Years of Service
Executive
Management
Accrual Rate
Sr. Director, Director,
Manager, Supervisor, and
Professional Accrual Rate
All Others
Accrual Rate
0–5 10.77 9.23 7.69
6– 10 10.77 10.77 9.23
11 or more 10.77 10.77 10.77
Accrual rates are based on an 80-hour pay period. Actual accruals are determined by
the “regular” hours paid each pay period (up to the maximum full-time limit of 80
regular hours per pay period).
2023 EMPLOYEE BENEFITS GUIDE | 29
Extended Sick Leave (ESL)
In addition to Paid Time Off, Cooper offers Extended
Sick Leave (ESL) to all benefits-eligible Team Members
working at least 20 hours per week. ESL can provide
you with added protection against long- term illness.
ESL may be used to supplement short-term disability
benefits when you’re on an approved Medical Leave of
Absence for your own health condition. In addition, ESL
may be used to supplement Workers’ Compensation
benefits, Bereavement Pay and Adoption Assistance.
You can accrue up to 40 hours per year (prorated for
part-time Team Members). Your accrual is unlimited and
carries over at the end of every calendar year. You
begin to accrue ESL from your date of hire, but you
cannot use ESL until you have completed 12 months
of employment.
EXTENDED SICK LEAVE (ESL) ACCRUAL TABLE
Years of Service All Team Members
All 1.54
How ESL Benefits Are Paid
ESL benefits are paid at your base rate of pay. The
amount of ESL hours paid in any one pay period
will not exceed the number of hours in your regular
biweekly schedule. ESL hours are not counted as
hours worked, and are not eligible for shift differential
payment or PTO accrual.
Note: ESL does not have a cash value and will not
be paid out if a Team Member leaves Cooper.
Additional Benefits
Parking
Cooper University Health Care offers you a
convenient pre-tax feature to pay for your regular
parking expenses when commuting to or from work. If
you park at one of the Cooper garages as part of your
regular commute, parking fees are deducted from
your paycheck before taxes are calculated, which
lowers your taxable income. This feature allows you
the flexibility of payroll deduction and additional
money in your pocket through tax savings.
If you have parking questions, please contact the
Parking Department at 856.342.2498.
Cooper Employee Lactation
Support (CELS) Program
As a Team Member of Cooper University Health Care,
your decision to continue breastfeeding your baby
once you return to work is something Cooper
wholeheartedly supports. In its effort to join the
global Baby-Friendly Hospital Initiative, sponsored
by the World Health Organization and the United
Nations Children’s Fund, Cooper has created the
Cooper Employee Lactation Support (CELS) program
to help give new mothers the information,
confidence, and skills they need to successfully
initiate and continue breast-feeding their babies.
Cooper Team Members are an integral part of the
program’s success. As part of this initiative, Cooper
has created Lactation Lounges located throughout
the Cooper University Health Care campus and
satellite locations.
For more information or to participate in the CELS
program, please call Cooper’s Lactation Consultant
directly at 856.342.3283.
30 | 2023 EMPLOYEE BENEFITS GUIDE
Additional Benefits
Tuition Assistance
Cooper University Health Care believes that
ongoing education is important, both personally
and professionally. If you are a benefit eligible, full-
time or part-time Team Member authorized to work at
least 20 hours per week, you are eligible for Tuition
Assistance, as long as you complete:
• Three full months of employment before the start
date of the course.
• The Tuition Assistance Application form with the
appropriate signatures.
• The course and receive a grade “C” or better for
undergraduate courses; a grade of “B” or better
for graduate courses to qualify for assistance.
The Tuition Assistance Program pays benefits as
explained in the chart below.
To apply for the Tuition Assistance Program, go to
cooperuniversityhealthcare.tap.edcor.com.
You are offered two options to receive tuition
assistance. The first option allows you to register for
classes and receive reimbursement upon successful
completion of the course(s), along with submission
of grades within 45 days after course completion.
The second option offers you a voucher payment
for courses. This is available to benefit eligible Team
Members who have completed one year of service.
With the advance payment option, you register for
classes, and will receive tuition assistance prior to
completing the class. After successful completion
of the course for which payment was made, you
are required to submit a copy of your grade report.
Failure to submit a copy of the grade report within
45 days after course completion will result in a
payroll deduction to recover the cost of the
assistance provided.
Notice of Taxation
According to the IRS regulation (IRS 127(s) (2) monies
received for tuition reimbursement/assistance beyond
$5,250 per calendar year are taxable. Therefore, the
last $250 of the $5,500 graduate tuition assistance will
be taxed. It is important to note that it is possible that
you will be taxed on more than $250. You will need to
carefully plan and be aware of how your request is
processed.
Staff Development
Staff Development program provides up to $500
annually (calendar year) for the cost of certification
fees/exams, recertification fees/exams, related books
and materials and/or continuing education fees
related to your job. The policy and application can be
found on the CPN under “Staff Development”.
IF YOU ARE A:
Full-time Team Member
Up to $3,500 for Undergraduate courses
Up to $5,500 for Graduate courses
Part-time Team Member
(at least 20 hours per week)
Up to $1,750 for Undergraduate courses
Up to $2,750 for Graduate courses
YOU ARE ELIGIBLE FOR (PER CALENDAR YEAR):
2023 EMPLOYEE BENEFITS GUIDE | 31
Auto and Homeowners’ Insurance
The voluntary auto and homeowners’ insurance
program provided by USI Affinity is available to all
benefit eligible Team Members working at least 20
hours or more per week. You may apply for this
voluntary benefit at any time by calling USI Affinity at
877.396.3800. Please remember to mention that you
are a Cooper University Health Care Team Member to
qualify for discounts and payroll deductions.
Long-Term Care
Cooper University Health Care has partnered with
John Hancock Life Insurance Company to offer long-
term care insurance to all eligible Team Members and
their eligible dependents, parents and parents-in-law.
Eligible family members may elect coverage even if
the Cooper Team Member does not. Long-term care
insurance can help protect your assets and your family
from the high cost of long-term care services.
John Hancock is one of the pioneers in the long-term
care insurance market and has over 140 years’
experience providing a range of insurance products.
To learn more learn more about this exciting benefit,
please contact Kevin Bressler at 610.783.6970 or
Pre-Paid Legal Services
The voluntary pre-paid legal services plan provided
by Countrywide is available to regular full time and
regular part time Team Members working at least
20 hours per week through the convenience of
payroll deduction. Whether you are closing on a
house, facing a traffic violation, drafting a will or
dealing with a debtor/creditor matter or family law
matter, the Legal Services Plan can provide you and
your family legal advice and if necessary, legal
representation at a discounted rate on a variety of
legal matters.
Enroll by visiting
https://www.coopervb.com/benefit-enhancements;
Click on Benefits Tour; Click on Voluntary Benefit
Programs and scroll down to Pre-Paid Legal Services.
Voluntary Benefits
32 | 2023 EMPLOYEE BENEFITS GUIDE
Additional Benefits
Voluntary Universal Life
Universal Life Insurance by TransAmerica offers
financial protection at a fixed interest rate with a
guarantee that coverage will continue as long as
premiums are paid. You can purchase supplemental
life insurance for yourself, your spouse and/or children.
This coverage builds cash value and is 100% portable
with premiums paid through the convenience of
payroll deduction.
Additional Plan Features:
• Guaranteed Issue amounts up to: Employee
$150,000, Spouse $50,000, Child $25,000
• Coverage available for spouse, children, and
grandchildren
• Riders include Long Term Care, Terminal Illness &
Waiver of Monthly Deductions due to layoff
Voluntary Critical Illness
NJ Insurance by TransAmerica (Critical Events)
To help cover out-of-pocket costs related to the care
and treatment of a critical illness or cancer, you and
your dependents have the opportunity to enroll in a
Critical Illness Insurance program. This plan pays a
lump sum benefit in the event of a diagnosis of a
covered critical illness. The plan is Guaranteed Issue
and is 100% portable with premiums paid through the
convenience of payroll deduction.
Additional Plan Features:
• Plan pays once for each covered critical illness
including heart attack, stroke, and cancer, organ
failure, Alzheimer’s and more…
• Employee chooses $10k or $20k benefit
amount- 50% benefit for Spouse & Child –
All Guaranteed Issue
• No waiting period
• Benefits are payable in addition to any other
insurance coverage
• Riders include Cancer, Occupational HIV, 100%
Recurrent Critical Illness (pays for a recurrence of
a previous illness) and $50
Voluntary Accident Insurance
To help cover the cost of unforeseen events requiring
medical care and out of pocket expenses, Voluntary
Accident Insurance by TransAmerica is available to you
and your dependents. This plan is designed to help
with out-of-pocket medical expenses associated with
an accidental injury. The plan is 100% portable with
premiums paid through the payroll deduction.
Additional Plan Features:
• 24-hour coverage for accidental injuries and death
• Employee, spouse and children can be covered
• Guaranteed Issue: Employees and dependents
qualify for coverage regardless of health
• Benefits payable in addition to other insurance
• benefits for hospital admission and surgery
• $50 Annual Wellness Benefit for one annual health
screening test for covered employee and spouse
• Optional Disability Income riders available
including spouse coverage
• Optional Accident-Only Disability Income Rider
Team Member contributions for voluntary
benefits vary based on the amount of
coverage and your age. Coverage effective
February 1 of the current plan year.
2023 EMPLOYEE BENEFITS GUIDE | 33
Visit www.cooperhealth.org/doctors for a full list of benefit providers and resources.
BENEFIT CONTACT PHONE / FAX WEBSITE / EMAIL
Benefits Member Advocacy (Benefits MAC)
Conner Strong & Buckelew 800.563.9929 www.connerstrong.com/memberadvocacy
Medical
Independence Administrators
Group # 007271
844.864.4352 www.myibxtpabenefits.com
Prescription Drug
Express Scripts Group# COOPERX 800.711.0918 www.express-scripts.com
Vision
EyeMed Group# 9826850 866.723.0514 www.eyemed.com
Dental
Delta Dental Group# 3593
SunLife Group# 902942
800.335.8265
800.443.2995
www.deltadental.com
www.slfserviceresources.com
FSA
Health Equity / Wageworks 855.692.2959 www.healthequity.com/wageworks
COBRA
Health Equity / Wageworks 866.681.5050 http://benedirect.wageworks.com
Life and Disability
Basic & Voluntary Life Policy #FLX980509
Basic AD&D Policy #OK980514
LTD Policy # LK980390
STD Policy #VDT980229
800.421.0344 www.mynylgbs.com
Smoking Cessation
Optum Quit for Life 1.866.QUIT.4.LIFE www.Quitnow.net
Auto & Homeowners’ Insurance
USI Affinity 855.874.0888 N/A
Universal Life, Accident & Critical Illness
Transamerica 866-586-6528 transamerica.com/employee-benefits
Pre-Paid Legal Services
Countrywide Pre-Paid Legal Services 800.550.LAWS www.countrywideppls.com
Long-Term Care
John Hancock 866.471.4072 [email protected]
Workers’ Compensation
AmeriHealth Casualty, Inc. 866.441.5326 N/A
Employee Assistance Program (EAP)
Carebridge 800.437.0911
www.myliferesource.com Access Code: WBPNF
email: [email protected]
NJ Temporary Disability
& New Jersey Family Leave Insurance
State of New Jersey
Phone: 609.292.7060
Fax: 609.984.4138
https://myleavebenefits.nj.gov/worker/tdi/
Retirement–Deferred Contribution Plans
Fidelity 800.343.0860 www.fidelity.com/atwork
OTHER COOPER DEPARTMENTS
Benefits
Tuition Reimbursement
Tuition Questions Edcor 1.888.867.7025 N/A
Employment Verification
The Work Number Employer Code: 19455 800.367.5690 www.theworknumber.com
HR Compensation
HRIS
Payroll
Paycheck Questions 856.382.6559 [email protected]
Contacts
34 | 2023 EMPLOYEE BENEFITS GUIDE
Legal Notices
Availability of Summary Health Information
As an employee, the health benefits available to you represent a significant component
of your compensation package. They also provide important protection for you and
your family in the case of illness or injury.
You will receive a Summary of Benefits and Coverage (SBC) during Open Enrollment
period. These documents summarize important information about all health coverage
options in a standard format. Please contact Human Resources if you have any
questions or did not receive your SBC.
COBRA Continuation Coverage Rights
The right to COBRA continuation coverage was created by a federal law, the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can
become available to you when you would otherwise lose your group health coverage. It
can also become available to other members of your family who are covered under the
Plan when they would otherwise lose their group health coverage. For additional
information about your rights and obligations under the Plan and under federal law, you
should review the Plan’s Summary Plan Description or contact the Plan Administrator.
HIPAA/CHIP Special Enrollment Notice
Loss of other Coverage (excluding Medicaid or a State Children’s Health Insurance
Program). If you decline enrollment for yourself or for an eligible dependent (including
your spouse) while other health insurance or group health plan coverage is in effect, you
may be able to enroll yourself and your dependents in this plan if you or your
dependents lose eligibility for that other coverage (or if the Company stops contributing
toward your or your dependents’ other coverage). However, you must request
enrollment within 30 days after your or your dependents’ other coverage ends (or after
the employer stops contributing toward the other coverage).
Loss of coverage for Medicaid or a State Children’s Health Insurance Program. If
you decline enrollment for yourself or for an eligible dependent (including your spouse)
while Medicaid coverage or coverage under a state children’s health insurance program
is in effect, you may be able to enroll yourself and your dependents in this plan if you or
your dependents lose eligibility for that other coverage. However, you must request
enrollment within 60 days after your or your dependents’ coverage ends under Medicaid
or a state children’s health insurance program (CHIP).
New dependent by marriage, birth, adoption, or placement for adoption. If you
have a new dependent as a result of marriage, birth, adoption, or placement for
adoption, you may be able to enroll yourself and your new dependents. However, you
must request enrollment within 30 days after the marriage, birth, adoption, or
placement for adoption. If you request a change due to a special enrollment event
within the applicable timeframe, coverage will be effective the date of birth, adoption or
placement for adoption. For all other events, coverage will be effective the first of the
month following your request for enrollment.
Eligibility for Medicaid or a State Children’s Health Insurance Program. If you or
your dependents (including your spouse) become eligible for a state premium
assistance subsidy from Medicaid or through a state children’s health insurance program
(CHIP) with respect to coverage under this plan, you may be able to enroll yourself and
your dependents in this plan. However, you must request enrollment within 60 days
after your or your dependents’ determination of eligibility for such assistance.
To request special enrollment or obtain more information, contact Human Resources
Newborns’ and Mothers’ Notice
Under federal law, group health plans and health insurance issuers offering group health
insurance generally may not restrict benefits for any hospital length of stay in
connection with childbirth for the mother or the newborn child to less than 48 hours
following a vaginal delivery, or less than 96 hours following a cesarean section.
However, the plan or issuer may pay for a shorter stay if the attending physician (e.g.,
your physician, nurse, [or midwife], or a physician assistant), after consultation with the
mother, discharges the mother or newborn earlier.
Also, under federal law, plans and insurers may not set the level of benefits or out-of-
pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a
manner less favorable to the mother or newborn than any earlier portion of the stay.
In addition, a plan or issuer may not, under federal law, require that a physician or other
health care provider obtain authorization for prescribing a length of stay of up to 48
hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out-
of-pocket costs, you may be required to obtain precertification. For information on
precertification, contact your plan administrator.
Women's Health and Cancer Rights Act Notice
If you have had or are going to have a mastectomy, you may be entitled to certain
benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For
individuals receiving mastectomy-related benefits, coverage will be provided in a
manner determined in consultation with the attending physician and the patient, for:
•all stages of reconstruction of the breast on which the mastectomy was performed;
•surgery and reconstruction of the other breast to produce a symmetrical appearance;
•prostheses; and treatment of physical complications of the mastectomy, including
lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance
applicable to other benefits. If you have any questions, please speak with Human
Resources.
Premium Assistance Under Medicaid and the
Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health
coverage from your employer, your state may have a premium assistance program that
can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or
your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these
premium assistance programs but you may be able to buy individual insurance
coverage through the Health Insurance Marketplace. For more information, visit
www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a
State listed below, contact your State Medicaid or CHIP office to find out if premium
assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think
you or any of your dependents might be eligible for either of these programs, contact
your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to
find out how to apply. If you qualify, ask your state if it has a program that might help
you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as
well as eligible under your employer plan, your employer must allow you to enroll in
your employer plan if you aren’t already enrolled. This is called a “special enrollment”
opportunity, and you must request coverage within 60 days of being determined
eligible for premium assistance. If you have questions about enrolling in your employer
plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA
(3272).
If you live in one of the following states, you may be eligible for assistance paying your
employer health plan premiums. The following list of states is current as of July 31, 2022.
Contact your State for more information on eligibility –
2023 EMPLOYEE BENEFITS GUIDE | 35
Legal Notices
ALABAMA – Medicaid
Website: http://myalhipp.com/
Phone: 1-855-692-5447
ALASKA – Medicaid
The AK Health Insurance Premium Payment Program
Website: http://myakhipp.com/
Phone: 1-866-251-4861
Email: CustomerService@MyAKHIPP.com
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS – Medicaid
Website: http://myarhipp.com/
Phone: 1-855-MyARHIPP (855-692-7447)
CALIFORNIA - Medicaid
Health Insurance Premium Payment (HIPP) Program
http://dhcs.ca.gov/hipp
Phone: 916-445-8322
Fax: 916-440-5676
Email: [email protected]
COLORADO - Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus
(CHP+)
Health First Colorado Website: https://www.healthfirstcolorado.com/
Health First Colorado Member Contact Center:
1-800-221-3943/ State Relay 711
CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plus
CHP+ Customer Service: 1-800-359-1991/ State Relay 711
Health Insurance Buy-In Program (HIBI): https://www.colorado.gov/pacific/hcpf/health
-insurance-buy-program
HIBI Customer Service: 1-855-692-6442
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/flmedicaidtplrecovery.com/hipp/
index.html
Phone: 1-877-357-3268
GEORGIA – Medicaid
GA HIPP Website: https://medicaid.georgia.gov/health-insurance-premium-payment-
program-hipp
Phone: 678-564-1162 Press 1
GA CHIPRA Website: https://medicaid.georgia.gov/programs/third-party- liability/
childrens-health-insurance-program-reauthorization- act-2009-chipra
Phone: 678-561-1162 Press 2
INDIANA – Medicaid
Healthy Indiana Plan for low-income adults 19-64
Website: http://www.in.gov/fssa/hip/
Phone: 1-877-438-4479
All other Medicaid
Website: https://www.in.gov/medicaid/
Phone 1-800-457-4584
IOWA – Medicaid and CHIP (Hawki)
Medicaid Website: https://dhs.iowa.gov/ime/members
Medicaid Phone: 1-800-338-8366
Hawki Website: http://dhs.iowa.gov/Hawki
Hawki Phone: 1-800-257-8563
HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp
HIPP Phone: 1-888-346-9562
KANSAS – Medicaid
Website: https://www.kancare.ks.gov/
Phone: 1-800-792-4884
KENTUCKY – Medicaid
Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website:
https://chfs.ky.gov/agencies/dms/member/Pages/kihipp.aspx
Phone: 1-855-459-6328
Email: [email protected]
KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx
Phone: 1-877-524-4718
Kentucky Medicaid Website: https://chfs.ky.gov
LOUISIANA – Medicaid
Website: www.medicaid.la.gov or www.ldh.la.gov/lahipp
Phone: 1-888-342-6207 (Medicaid hotline) or 1-855-618-5488 (LaHIPP)
MAINE – Medicaid
Enrollment Website: https://www.maine.gov/dhhs/ofi/applications-forms
Phone: 1-800-442-6003 TTY: Maine relay 711
Private Health Insurance Premium Webpage:
https://www.maine.gov/dhhs/ofi/applications-forms
Phone: -800-977-6740 TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIP
Website: https://www.mass.gov/masshealth/pa
Phone: 1-800-862-4840
TTY: 617-886-8102
MINNESOTA – Medicaid
Website: https://mn.gov/dhs/people-we-serve/children-and-families/health-care/
health-care-programs/programs-and-services/other-insurance.jsp
Phone: 1-800-657-3739
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 1-573-751-2005
MONTANA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP
Phone: 1-800-694-3084
Email: HHSHIPPP[email protected]
NEBRASKA – Medicaid
Website: http://www.ACCESSNebraska.ne.gov
Phone: (855) 632-7633
Lincoln: (402) 473-7000
Omaha: (402) 595-1178
NEVADA – Medicaid
Medicaid Website: http://dhcfp.nv.gov
Medicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – Medicaid
Website: https://www.dhhs.nh.gov/oii/hipp.htm
Phone: 603-271-5218
Toll free number for the HIPP program: 1-800-852-3345, ext 5218
NEW JERSEY – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/
dmahs/clients/medicaid/
Medicaid Phone: 609-631-2392
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
36 | 2023 EMPLOYEE BENEFITS GUIDE
NEW YORK – Medicaid
Website: https://www.health.ny.gov/health_care/medicaid/
Phone: 1-800-541-2831
NORTH CAROLINA – Medicaid
Website: https://medicaid.ncdhhs.gov/
Phone: 919-855-4100
NORTH DAKOTA – Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-844-854-4825
OKLAHOMA – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
OREGON – Medicaid
Website: http://healthcare.oregon.gov/Pages/index.aspx
http://www.oregonhealthcare.gov/index-es.html
Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid
Website: https://www.dhs.pa.gov/Services/Assistance/Pages/HIPP-Program.aspx
Phone: 1-800-692-7462
RHODE ISLAND – Medicaid and CHIP
Website: http://www.eohhs.ri.gov/
Phone: 1-855-697-4347, or 401-462-0311 (Direct RIte Share Line)
SOUTH CAROLINA - Medicaid
Website: https://www.scdhhs.gov
Phone: 1-888-549-0820
SOUTH DAKOTA - Medicaid
Website: http://dss.sd.gov
Phone: 1-888-828-0059
TEXAS - Medicaid
Website: http://gethipptexas.com/
Phone: 1-800-440-0493
UTAH – Medicaid and CHIP
Medicaid Website: https://medicaid.utah.gov/
CHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669
VERMONT– Medicaid
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
VIRGINIA – Medicaid and CHIP
Website: https://www.coverva.org/hipp/
https://www.coverva.org/en/famis-select
Phone: 1-800-432-5924
WASHINGTON – Medicaid
Website: https://www.hca.wa.gov/
Phone: 1-800-562-3022
WEST VIRGINIA – Medicaid and CHIP
Website: http://mywvhipp.com/
https://dhhr.wv.gov/bms/
Medicaid Phone: 304-558-1700
CHIP Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
WISCONSIN – Medicaid and CHIP
Website: https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
Phone: 1-800-362-3002
WYOMING – Medicaid
Website: https://health.wyo.gov/healthcarefin/medicaid/programs-and-eligibility/
Phone: 800-251-1269
To see if any other states have added a premium assistance program since July 31, 2022,
or for more information on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Legal Notices
2023 EMPLOYEE BENEFITS GUIDE | 37
Insurance Marketplace Notice
PART A: General Information
When key parts of the health care law take effect in 2014, there will be a new way to
buy health insurance: the Health Insurance Marketplace. To assist you as you
evaluate options for you and your family, this notice provides some basic
information about the new Marketplace and employment based health coverage
offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your
needs and fits your budget. The Marketplace offers "one-stop shopping" to find and
compare private health insurance options. You may also be eligible for a new kind
of tax credit that lowers your monthly premium right away. Open enrollment for
health insurance coverage through the Marketplace begins in October 2013 for
coverage starting as early as January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your
employer does not offer coverage, or offers coverage that doesn't meet certain
standards. The savings on your premium that you're eligible for depends on your
household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings
through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain
standards, you will not be eligible for a tax credit through the Marketplace and may
wish to enroll in your employer's health plan. However, you may be eligible for a
tax credit that lowers your monthly premium, or a reduction in certain cost-sharing
if your employer does not offer coverage to you at all or does not offer coverage
that meets certain standards. If the cost of a plan from your employer that would
cover you (and not any other members of your family) is more than 9.5% of your
household income for the year, or if the coverage your employer provides does not
meet the "minimum value" standard set by the Affordable Care Act, you may be
eligible for a tax credit.
1
Note: If you purchase a health plan through the Marketplace instead of accepting
health coverage offered by your employer, then you may lose the employer
contribution (if any) to the employer-offered coverage. Also, this employer
contribution -as well as your employee contribution to employer-offered coverage-
is often excluded from income for Federal and State income tax purposes. Your
payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check
your summary plan description or contact the insurance carrier’s customer service
number located on your ID card. The Marketplace can help you evaluate your
coverage options, including your eligibility for coverage through the Marketplace
and its cost. Please visit HealthCare.gov for more information, including an online
application for health insurance coverage and contact information for a Health
Insurance Marketplace in your area. To get information about the Marketplace
coverage, you can call the government’s 24/7 Help-Line at 1-800-318-2596 or go to
https://www.healthcare.gov/marketplace/individual/.
PART B: Information about Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your
employer. If you decide to complete an application for coverage in the Marketplace,
you will be asked to provide this information. This information is numbered to
correspond to the Marketplace application.
3. Employer Name
The Cooper Health System
4. Employer Identification Number (EIN)
21-0634462
5. Employer Address
One Cooper Plaza
6. Employer phone number
856-342-2403
7. City
Camden
8. State
NJ
9. Zip Code
08103
10. Who can we contact about employee health coverage at this job?
Benefits
11. Phone number (if different from above)
12. Email address
1
An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.
Legal Notices
This booklet provides a brief summary of the benefits available for the 2023 plan year; it is not a complete description. Complete benefits information can be found in the
summary plan description, legal plan contracts or plan documents, available from the Human Resources Department. If there is any difference between the information in
this booklet, any verbal description you receive, and the legal plan documentation, the legal documents will govern. Cooper University Health Care reserves the right to
amend or terminate these plans at any time for any reason.
