Health, Dental, & Vision

Health Insurance Plan

We offer you and your eligible family members several health insurance options:

  • Tufts HMO Value Plan
  • Tufts Advantage HMO Plan
  • Tufts Advantage HMO Saver Plan
  • Carelink PPO (for out-of-state employees)

We also offer dental and vision plans. Each option includes comprehensive benefits to protect you against the medical expenses from illness or injury. We've included tools and resources that our employees will need to make informed decisions about their medical care needs and to choose an appropriate health plan.

Here's an overview of Lesley's health insurance options. If there is a discrepancy between the descriptions here and official plan documents and policies, the plan documents and policies govern. Lesley reserves the right to change its benefit plans at any time.

  • Health and Dental Plan Eligibility and Participation

    All eligible Lesley University employees can participate in our health and welfare benefit programs. Employees (except students) are considered eligible if they are regularly scheduled to work at least 17.5 hours per week (Adjunct Faculty hours per week are based on hours worked during the look back period).

    Additionally, a temporary employee who works at least 17.5 hours per week and is scheduled to work 3 months or longer is considered an eligible employee. Eligible employees may participate in health and welfare benefits as of the first day of the month following date of hire, if they have completed the appropriate enrollment form(s). Coverage ends on the last day of the month following the date of termination.

    Family Eligibility

    An eligible employee may enroll eligible family members in the health or dental insurance programs. Eligible family members include:

      • Spousal equivalent (with proper documentation).
      • Former spouse until the former spouse remarries or until such time as may be specified in the divorce judgment.
      • Dependents are covered through the day before the dependent’s 26th birthday, or two years after the dependent loses federal tax dependent status under the IRS Code, whichever occurs first.
      • Dependents age 26 or older who:
        1. Are incapable of self-sustaining employment by reason of a physical or mental handicap (disability); and
        2. Was covered by the health and welfare benefits you have selected or any of its affiliates before turning 26 (or has had continuous group health insurance coverage from the onset of the disability to the date of enrollment); or
      • Dependent child under the age of 26 for whom you or your spouse is the court-appointed legal guardian. Proof of guardianship must be submitted prior to enrollment; or
      • The child of an eligible dependent as defined above, until such time as your eligible dependent no longer qualifies.

        Refer to information regarding COBRA, as it may apply to eligible dependents upon loss of group-sponsored health insurance coverage.

        Enrolling in the Health Plan

        An eligible employee can enroll in a health plan within 30 days after date of hire by completing a Tufts Health Plan Enrollment form (Dynamic Form).

        Lesley University offers 2 types of health coverage levels.

        1. Individual (employee)
        2. Family (employee and eligible family member(s))


        Employees can make changes to their health or dental plan elections during open enrollment. Open enrollment usually occurs in the fall, and all changes are effective January 1 of the following year.

        Changes during the course of a year are allowed only if a qualifying event occurs.

      • Health Plan Costs

        Employee Contributions*

        Monthly Individual Coverage Rates

        Monthly Employee Plus One Coverage Rates

        Monthly Family Coverage Rates

        Bi-Weekly Individual Coverage Rates

        Bi-Weekly Employee Plus One Coverage Rates

        Bi-Weekly Family Coverage Rates

        Tufts HMO Value
        $168.36 $370.36 $606.06 $84.18 $185.18 $303.03
        Tufts Advantage  HMO
        $154.34 $339.58 $555.66 $77.17 $169.79 $277.83
        Tufts Advantage HMO Saver
        $95.92 $237.38 $384.10 $47.96 $118.69 $192.05
        Carelink PPO Rate A**
        $171.22 $376.70 $616.42 $85.61 $188.35 $308.21
        Carelink PPO Rate B**
        $205.48 $445.20 $719.16 $102.74 $222.60 $359.58

        *In effect from 01/01/17 - 12/31/17

        **PPO Rate-A applies to employees who reside outside of Tufts area of service and do not have the option of electing HMO Value or HMO Advantage plans.

        **PPO Rate-B applies to employees who reside within the Tufts area of service and choose PPO coverage while being eligible for HMO Value and HMO Advantage plans.

        Part-Time Employees Pro-Rated Subsidy***

        Lesley University offers benefits to part-time employees who are regularly scheduled to work at least 17.5 hours a week in a department where a full-time person is regularly scheduled to work 35 hours/ week; or to part-time employees who are regularly scheduled to work at least 20 hours/week in a department where a full-time person is regularly scheduled to work 40 hours/ week. The University shares the cost of benefit premiums with part-time employees on a prorated basis.

        Health Insurance

        The University shares the cost of the health insurance on a prorated basis, depending on the number of hours a part-time employee is regularly scheduled to work. This prorated percentage is determined against a Full-Time Equivalent (FTE).

        FTE Full-Time Equals 35 Hours a Week Full-Time Equals 40 Hours a Week Percentage Provided Part-Time Employees
        .5, but less than .6 Scheduled to work at least 17.5 hours a week Scheduled to work at least 20 hours a week 50 percent of Lesley's Subsidy for Full-Time Employees
        .6, but less than .7 Scheduled to work at least 21.0 hours a week Scheduled to work at least 24 hours a week 60 percent of Lesley's Subsidy for Full-Time Employees
        .7, but less than .80   Scheduled to work at least 24.5 hours a week Scheduled to work at least 28 hours a week 70 percent of Lesley's Subsidy for Full-Time Employees
        .80 or more Scheduled to work 28.0 hours a week or more Scheduled to work 32 hours a week or more 100 percent of Lesley's Subsidy for Full-Time Employees

        ***For actual costs, please contact Human Resources at 617.349.8784.

      • Health Plan Qualifying Events

        Throughout the course of a plan year, certain qualifying events may occur which allow employees to add, change, or terminate health or dental plan elections. To make any changes, notify your human resources representative within 30 days of the qualifying event date for these changes to be effective.

        These qualifying events must result in you, your spouse, same-sex spousal equivalent, or your qualified dependent gaining or losing eligibility for health insurance coverage. Proper documentation surrounding any of these events is required.

        If you do not notify Human Resources within 30 days of the qualifying event date, employees will need to wait until the open enrollment period to make changes to health plan elections.

        Qualifying Events

        • Change in legal marital status, including marriage, death of spouse, divorce, legal separation, or annulment.
        • Change in number of dependents, including a change due to birth or adoption.
        • Change in employment status of employee, spouse, or dependent including a beginning or termination of employment, beginning or termination of an unpaid leave of absence, or a change in employment status (e.g. exempt to non-exempt).
        • If a dependent satisfies or ceases to satisfy the requirements for coverage due to reaching a certain age or student status.
        • If employee, spouse, spousal equivalent, or eligible dependent changes his or her place of residence, but only if such change affects the persons eligibility for coverage.


        Contact your Human Resources representative for information about qualifying events, as this list is not inclusive of all qualified change in status events.

      • Compare Health Plans

        Tufts Health Plan Comparisons

        HMO Value

        The Health Maintenance Organization (HMO) Value option allows members to choose a Primary Care Physician (PCP) from an extensive network of doctors which provide or authorize all of your care (except in an emergency or in certain cases of self-referral).

        Your PCP will be the primary liaison between you and any specialists you might see within the network. Tufts requires that you call your PCP first when seeking medical services, unless it is an emergency. There are no deductibles for medical services; however, there is a deductible for prescription drug benefits.

        Review the Summary of Benefits and Coverage for HMO Value for 2017 (PDF).

        Advantage HMO

        The HMO Advantage plan requires members to pay an upfront annual deductible prior to coverage for any diagnostic, inpatient, or outpatient procedure. There is a separate deductible for prescription drugs. After deductible is met, the member is covered in full with no co-payment for most services.

        Review the Summary of Benefits and Coverage for HMO Advantage for 2017 (PDF).

        Advantage HMO Saver Plan

        The HMO Advantage Saver plan is similar to HMO Advantage. It requires members to pay an upfront annual deductible prior to coverage for any diagnostic, inpatient, or outpatient procedure. However, the deductibles and out-of-pocket limits are significantly higher than with the HMO Advantage.

        Everything except preventive care is subject to the deductible on this plan. After deductible is met, the member pays a 35 percent co-insurance amount for most covered services.

        Review the Summary of Benefits and Coverage for HMO Advantage Saver for 2017 (PDF).

        Carelink PPO

        Carelink PPO allows members to visit any healthcare provider within the Tufts network and the national CIGNA Open Access Plus network with no prior authorization from their primary care physician. Members have the added benefit of coverage outside of the network.

        For visits with a non-covered healthcare provider, the member must pay an annual out-of-pocket deductible. A separate deductible for prescription drug benefits must be met before benefits become payable. Once the deductible is met, the member is covered at 80 percent of the Tufts equivalent rate for out-of-network services.  Out-of-pocket maximums for the Carelink PPO plan are $1,500/member or $3,000/family.

        Review the Summary of Benefits and Coverage for Carelink PPO for 2017 (PDF).

      • COBRA Benefits

        Your health and dental insurance coverage ends the last day of the month in which you terminate employment from the University. For example, if your last day of work is March 1, your group health insurance coverage will end at midnight on March 31.

        The deductions owed for the month will be taken out of your last paycheck. You have the option of electing COBRA insurance for you and your dependents for a period of 18 to 36 months. Crosby Benefit Systems, our administrator for COBRA insurance, will send you information on how to elect COBRA coverage, associated costs, and payment information.

        Any questions associated with COBRA should be directed to your human resources representative or Crosby Benefit Systems at 800.462.2235

        Learn More

      • Glossary of Terms

        Refer to the benefits summary for the plan(s) you have chosen for specific information about the costs, services associated with each of these general terms described below.

        Co-Insurance

        The percentage of covered expenses paid by you each year after you have met applicable deductibles. Services that require deductibles and co-insurance are indicated in your benefits summary.

        Co-Payment

        A dollar amount that you need to pay each time you see your PCP or specialist within the network.

        Covered Expenses

        Expenses that are covered (paid for) either partially or fully by your plan.

        Deductible

        An annual amount that you need to pay out of pocket to receive specific services under the plan that you have chosen. Once applicable deductibles have been paid, your plan will cover services you receive either on a partial or full basis.

        Emergency Care

        Care received for medical emergencies (heart attack, stroke, loss of consciousness, broken bones, etc.). Emergency care typically is given in an emergency room and treats the acute condition. Any follow up care needed (including admission to the hospital) is typically not considered emergency care.

        In-Network Care

        Care received within the approved network as described by the health plan option covering you.

        Lifetime Maximum Benefit

        The amount the plan will pay in benefits for each covered person in a lifetime.

        Medically Necessary Services

        Services that are deemed as necessary to treat a condition, illness, etc. by the generally accepted standards of medical practice. These services are usually determined as medically necessary by your Primary Care Physician.

        Out-of-Network Care

        Care received outside of the approved network, as described by the health plan option covering you. Generally, when receiving care out of the network, additional costs must be paid by the member receiving services (such as deductibles and co-insurance). If you have selected the HMO option, you will need a referral to see a health care provider other than your PCP for services in or out of the network.

        Out-of-Pocket Limit

        Your out-of-pocket maximum is designed to protect you against high medical expenses, and includes any deductibles and/or co-insurance that you have paid during the year. Once your out-of-pocket limit has been reached, you are not responsible for paying additional amounts for services received. Out-of-pocket limits only pertain to covered services and amounts within the usual and customary limits.

        Primary Care Physician (PCP)

        Your primary care physician (PCP) is a health care professional that you choose to coordinate all of your health services, visits, etc. Each plan has a network of physicians that you can select by looking on the web page of the plan that you choose, or in hard copy directories available in the Human Resources Department. Your PCP is considered your primary doctor and, as such, will be the first point of contact in understanding your health care needs and history. Your PCP will make arrangements for you to see specialists outside of his/her specialty if necessary. Typically, your PCP will refer you to a provider within the same hospital group in which they are affiliated. Note that you must choose a PCP if you are a member of either the POS or HMO plan.

        Reasonable and Customary

        Reasonable and customary fees represent the range of usual fees for comparable services charged by the medical or dental professionals in a geographic area. If your provider charges more than the reasonable and customary fee, you will be responsible for paying the difference. Usual and customary fees do not apply to the HMO.

      • Retiree Health Plans

        To be eligible to participate in a Lesley-sponsored retiree health plan, you have to be classified as a retiree of Lesley and be age 65 or older. (If you retire before age 65, you may enroll in one of the available health plans upon reaching age 65.)

        Coverage is also available to the eligible spouse of a Lesley retiree.

        The University offers 2 types of retiree health plans, as described below:

        • Tufts HMO Prime RX Plus Plan
          This plan works like a traditional HMO (Health Maintenance Organization) and acts as a replacement for Medicare Parts A, B and D. In addition to providing coverage for doctors’ office visits, hospitalization, and prescription drugs, this plan covers annual check-ups, routine eye exams with up to $150 toward the cost of eye wear, hearing exams with fixed or discounted pricing on hearing aids, and other benefits not available when enrolled in traditional Medical.
        • Tufts Medicare Preferred Supplement/PDP Plus Plan
          This plan is also referred to as a “Medigap” plan because it covers “gaps” in original Medicare coverage such as deductibles and coinsurance. You must be enrolled in Medicare Parts A, B & D. However, with the Medicare Preferred Supplement plan, Medicare Part A deductible for hospitalization, Medicare Part B deductible for medical and hospital out-patient expenses and 20% coinsurance are covered. In addition, this plan includes a Prescription Drug Plan that is more comprehensive than what’s available with traditional Medical.

        Health Plan Rates for 2017

        Tufts HMO Prime Rx Plus Plan: $302/per month
        Tufts Medicare Preferred Supplement/PDP Plus Plan: $352

        If you have any questions about your eligibility or about the plans, contact the Tufts New Member Sales Queue at 1.800.246.2400 or Lesley Human Resources at hr@lesley.edu.

      Dental Plans

      We offer employees and their eligible family members 2 Delta Dental insurance options Delta PPO Plus Premier, and DeltaCare.

      Each plan's services, and procedures for obtaining the services, vary. These variations are outlined in the dental plans comparison. This information provides our employees with the tools and resources necessary to make informed decisions about their (and their family's) dental care needs, and to select a plan to meet these needs.

      If there is a discrepancy between the descriptions here and the official plan documents and policies, the documents and policies govern. Lesley reserves the right to change its benefit plans at any time.

      • Delta PPO Plus Premier

        In-Network Coverage and Co-Payment

        Under Delta PPO Plus Premier, preventative and diagnostic services require co-insurance payments and/or deductibles depending on whether the services are classified by Delta PPO Plus Premier as Type I (preventive), Type II (basic restorative), or Type III (major restorative). Type I services are covered in full (100%). Type II and III services require that you pay a $50 deductible for individual coverage and $150 for family coverage before receiving benefits from the plan. After this deductible has been satisfied, Delta PPO Plus Premier requires a 20 percent co-insurance payment for Type II services, and a 50 percent co-insurance payment for Type III services. A comprehensive listing of the services covered under each tier can be found in the Delta PPO Plus Premier benefit summary available in the Human Resources Department.

        Unlike DeltaCare, Delta PPO Plus Premier provides no coverage for orthodontia services. Additionally, Delta PPO Plus Premier requires that you pay a deductible for services you receive. An important thing to be aware of as well is that a benefit maximum of $1,000 exists per person per calendar year. This means that Delta PPO Plus Premier will not pay for any costs you incur during a calendar year that exceed $1,000. Please refer to the Delta PPO Plus Premier benefit summary for more information. Because of this, Delta PPO Plus Premier recommends that you ask your dentist for a pre-treatment estimate for procedures expected to exceed $300. With this information, Delta PPO Plus Premier will be able to figure out any out-of-pocket costs that you might incur.

        Out-of-Network Coverage

        Delta PPO Plus Premier provides coverage for out-of-network services, but benefits received are much lower than coverage received in-network. They are dependent upon the usual and customary fees available in the geographic area in which they are received. Review the benefit plan summary description for more information.

      • DeltaCare II

        Choosing a Primary Care Dentist

        Lesley's participation in Delta Dental's DeltaCare Plan provides the option to choose from more than 750 participating dentists. Of these, you and your family members (if applicable) choose a Primary Care Dentist (PCD) who will be your primary service provider.

        Lists of eligible providers can be found through Delta Dental or in directories located in Lesley's Human Resources Department. Your PCD coordinates all dental care services. They will be the first point of contact in understanding your dental care needs and history.

        If your PCD leaves the network at any time during the plan year, DeltaCare will reassign you to a dentist in your general geographic area. If you are not comfortable with the PCD Delta Dental has selected for you, call them at 800.327.6277 to select another PCD.

        In-Network Coverage and Co-Payment

        Under DeltaCare, most preventative and diagnostic services under this plan are covered 100 percent as long as they are considered in-network. Other services require co-payments payable directly to the dentist.

        Find applicable co-payments in the DeltaCare Benefit Plan Summary (PDF), or in the Human Resources Department.

        DeltaCare also covers services received for orthodontia care. For a list of these services and co-payments, refer to your benefits summary. DeltaCare does not require that you pay any annual maximums or network deductibles for services you receive.

        Out-of-Network Coverage

        DeltaCare provides coverage for out-of-network services, but benefits received are much lower than coverage received in-network. The DeltaCare co-payment schedule does not apply if you go out-of-network, and that out-of-network benefits are based upon the dentist's charge or the usual and customary fee for the service. Review the DeltaCare Benefit Plan Summary (PDF) for more information.

      • Compare Dental Plans

        Compare Costs

        Monthly Individual Coverage Rates

        Monthly Employee Plus One Coverage Rates

        Monthly Family Coverage Rates

        Bi-Weekly Individual Coverage Rates

        Bi-Weekly Employee Plus One Coverage Rates

        Bi-Weekly Family Coverage Rates

        Delta Care II
        $22.42   $71.70 $11.21   $35.85
        Delta PPO Plus Premier
        $38.00   $115.14 $19.00   $57.57

        Delta PPO Plus Premier is a great choice for employees who value access, flexibility and freedom of choice. Care is available from approximately 6,900 dentists in Massachusetts (over 96 percent of practicing dentists in Massachusetts).

        Delta Care II is a great choice for employees who value managed care and prevention. Employees choose a "primary care dentist" who directs and coordinates all primary and specialty care. Please note that the provider you choose is not guaranteed to stay in the plan during your enrollment, and therefore you may have to be flexible in choosing other providers.

        Compare Services

          Delta PPO Plus Premier
        (5,300 dentists in Massachusetts, 1,580 PPO dentists in Massachusetts, 202,618 combined Nationwide)
        Delta Care II
        (750 dentists in Massachusetts, 39,000 DeltaCare dentists Nationwide)
         
        Type I Services    
        Diagnostic 100 percent coverage co-payment schedule*
        Preventive 100 percent coverage co-payment schedule*
        Type II Services
        Restorative 80 percent coverage co-payment schedule*
        Oral Surgery 80 percent coverage $1,000 per personal annual calendar year maximum
        Periodontics 80 percent coverage $1,000 per personal annual calendar year maximum
        Endodontics 80 percent coverage $1,000 per personal annual calendar year maximum
        Prosthetic Maintenance 80 percent coverage co-payment schedule*
        Emergency Dental Care 80 percent coverage co-payment schedule*
        Type III Services
        Major Restorative 50 percent coverage co-payment schedule*
        Prosthodontics 50 percent coverage co-payment schedule*
        Calendar Year Deductible 
        (Type II and Type III Services)
          $50 per individual, $150 per family None for in-network, $100 for out-of-network
        Calendar Year Maximum
          $1,000 per person $1,000 maximum applies to Oral Surgery, Endodontics and Periodontics
          Fourth Quarter Carry Forward Deductible.  
        Orthodontia
          Not covered Benefits based upon 24 months of active treatment. Refer to DeltaCare co-payment brochure.
          Dependents are covered until age 26. Dependents are covered until age 26.

        *All services must be provided by a Delta Care primary care dentist and are subject to the Delta Care Patient co-payment schedule available from Human Resources or through Delta Dental. Limited out-of-network benefit, subject to a $100 per person deductible applicable to all services.

      • Enrolling in a Dental Plan

        An eligible employee can enroll in the dental plan within 30 days after their date of hire by completing a Delta Dental Enrollment Form (Dynamic Form). You can also get an enrollment form from the Human Resources Department.

        Lesley University offers 2 types of dental coverage levels:

        1. Individual (employee)
        2. Family (employee and eligible family member(s)


        Employees can also make changes to their health or dental plan elections during open enrollment. Open enrollment usually occurs in the fall, and all changes are effective January 1 of the coming year

        Changes during the course of a year are allowed only if a qualifying event occurs. Review the section on Qualifying Events for more information.

      Vision Plans

      Lesley University offers its benefit eligible employees two voluntary vision plans provided through EyeMed. EyeMed provides coverage through a national network of eye wear retail chain stores such as LensCrafters, Pearl Vision, Sears Optical, and Target Optical as well as private practicing optometrists and ophthalmologists, all at a very reasonable cost to you and your family.

      • Vision Benefits for In-Network Services

         

        High Option (Materials Only)

        Medium Option (Eye Exam + Materials)

        Eye Exam: N/A $10 co-pay once every 12 months
        Lenses: $25 co-pay once every 12 Months $25 co-pay once every 12 months
        Frames: $140 allowance once every 24 months $120 allowance once every 24 months
        Contact Lenses* $155 allowance once every 12 months $135 allowance once every 12 months

        *(in lieu of lenses)

      • Monthly Premium Costs

        The voluntary vision plan is 100% paid for by employees. Monthly pre-tax premium and bi-weekly contributions are as follows:

          High Option (Materials Only) Medium Option (Eye Exams + Materials)
        Monthly Employee $6.56 $5.68
        Monthly Employee Plus One $12.44 $10.80
        Monthly Family $18.24 $15.84
        Bi-Weekly Employee $3.28 $2.84
        Bi-Weekly Employee Plus One $6.22 $5.40
        Bi-Weekly Family $9.12 $7.92
      • Enrolling in a Vision Plan

        Employees' initial opportunity to enroll is upon becoming benefits-eligible. In  most cases, this is the first of the month after date of hire.

        After this initial offering, an employee can only enroll/change/terminate vision coverage during open enrollment (effective the upcoming calendar year), or due to a qualifying event.

        Eyemed Vision Enrollment Form (Dynamic Form)

        For a detailed summary of the vision plans, contact Human Resources at hr@lesley.edu or call 617.349.8787. Find a provider at www.eyemedvisioncare.com or call 1.866.299.1358.