|
Participating in the Medical Plan
You can easily check which health care providers participate in the various JPMorgan Chase Medical Plan options by using the Enrollment Decision Toolkit on the Benefits Web Center via My Rewards @ Work, or by accessing the individual Medical Plan option's web site. You also can request a print copy at any time by contacting the appropriate Medical Plan option and requesting information from a Service Representative.
Please Note: You should always check with your health care provider to ensure that he or she plans to continue participating in the network of the Medical Plan option you choose. If your health care provider decides to leave the network, it does not qualify as an event that allows you to change coverage during the year.
The general guidelines for participating in the JPMorgan Chase Medical Plan are described in this section.
Eligibility
Your participation in the JPMorgan Chase Medical Plan is optional. In general, you are eligible to participate if you are:
-
A U.S. dollar-paid employee who receives salary or earns draw, commissions, or production overrides ("salaried employee");
-
Regularly scheduled to work 20 or more hours per week; and
-
Employed by JPMorgan Chase & Co. or one of its subsidiaries to the extent that such subsidiary has adopted the plan.
Please Note: An individual classified or employed in a work status other than as a common law salaried employee by his/her employer, such as an:
-
Independent contractor/agent (or its employee),
-
Hourly-paid employee,
-
Intern, and/or
-
Occasional/seasonal, leased, or temporary employee
is not eligible to participate in the plan regardless of whether an administrative or judicial proceeding subsequently determines this individual to have instead been a common law salaried employee.
Medical Plan Options
You can choose your medical coverage from among the following options, depending on your zip code.
-
Point-of-Service (POS) High Option*;
-
Point-of-Service (POS) Low Option*;
-
Health Maintenance Organization (HMO) Option;
-
Exclusive Provider Organization (EPO) Option;
-
Consumer Driven Health Option (CDHO);
-
Traditional Indemnity Option; and
-
No Coverage.
* In some areas, your Medical Plan option administrator may refer to these options as a Preferred Provider Organization (PPO).
Coverage Categories
When you enroll in the Medical Plan, your coverage level is based on the dependents you enroll and includes the following coverage categories:
-
Employee Only;
-
Employee Plus One Adult;
-
Employee Plus Child(ren); and
-
Employee Plus One Adult Plus Child(ren).
Important Note on Dependent Eligibility
You are responsible for understanding the dependent eligibility rules and abiding by them. Each year during annual benefits enrollment, you must review your covered dependents and confirm that they continue to meet the eligibility requirements. JPMorgan Chase reserves the right to conduct dependent eligibility audits at any time. Such audits help ensure that dependents who have been certified for coverage during the annual enrollment process continue to meet plan rules for eligibility. As a result, you may be asked to provide documentation of eligibility for your covered dependents at any time. It is important that you review both the dependent eligibility rules and the status of your dependents on file, and make any necessary adjustments during your designated enrollment period or within 31 days of a qualified change in status (e.g., birth of a child, gain or loss of other coverage, etc.) The results of any audit could affect any prior claims that have been paid, as well as your dependent's eligibility for coverage under the JPMorgan Chase Benefits Program, including COBRA continuation coverage.
Your Eligible Dependents
Your eligible dependents under the Medical Plan — and under certain other plans as referenced in those plan sections of this Guide — include:
-
Your spouse to whom you're legally married or a domestic partner (see "Domestic Partners" for more information);
-
Your and/or your spouse/domestic partner's unmarried dependent children up to the end of the month in which they reach:
Please Note: You may continue coverage for an unmarried dependent child who is not capable of supporting himself or herself due to a mental or physical disability that began before the age limits described above and who is fully dependent on you for financial support.
If JPMorgan Chase also employs or employed your spouse, domestic partner, or dependent child, he or she can be covered as an employee or as your dependent, but not as both. If you want to cover your eligible dependent child(ren), you or your spouse/domestic partner (but not both of you) may elect to provide this coverage.
Dependent Age Exceptions under the HMO Option
The dependent eligibility guidelines described here may be superseded by state mandates that govern minimum dependent eligibility requirements within a particular state. If you are enrolled in an HMO Option (as defined by JPMorgan Chase) in one of these states, the state mandates will govern the eligibility rules for dependents. Known exceptions to the JPMorgan Chase eligibility rules are noted below. Please check with your HMO Option administrator for more details. Please Note: The dependent age exceptions do not apply if you are enrolled in an EPO Option.
-
If you are an unmarried child living in Colorado, then the maximum age is 25 where coverage ends at the end of the month.
-
If you are an unmarried child living in Florida, then the maximum age is 25 where coverage ends at the end of the year.
-
If you are an unmarried child living in Indiana, then the maximum age is 24 where coverage ends at the end of the year.
-
If you are an unmarried child living in Louisiana, then the maximum age is 21 if not a full-time student or age 24 if a full-time student. Grandchildren can be covered up to the end of the month in which they reach age 21.
-
If you are an unmarried child living in Massachusetts, then the maximum age is 21 where coverage ends at the end of the day you reach age 21.
-
If you are an unmarried child living in New Jersey, then the maximum age is 30 where coverage ends at the end of the month.
-
If you are an unmarried child living in New Mexico, then the maximum age is 25 where coverage ends at the end of the month.
-
If you are an unmarried child living in Texas, then the maximum age is 25 where coverage ends at the end of the month.
-
If you are an unmarried child living in Utah, then the maximum age is 26 where coverage ends at the end of the month.
-
If you are an unmarried grandchild under age 18 living in Wisconsin, you can be covered until the month your parent (who is a covered child) turns 18.
-
For all other states, the maximum age is 23 if a full-time student.
Dependent Children
"Children" include your natural children, stepchildren, children of your domestic partner, legally adopted children, and children under your legal guardianship who are principally dependent on you for support. For example, children you may claim on your tax return as dependents or for whom you provide more than 50% of their support. "Children" also include a child under age 18 who lives with you and for whom (1) adoption proceedings have already begun and (2) you have the legal obligation to support (in whole or in part).
Federal law requires that any child of a plan participant who is an alternate recipient under a Qualified Medical Child Support Order (QMCSO) will be considered as having a right to dependent coverage under the JPMorgan Chase Medical Plan (and Dental Plan). In general, QMCSOs are state court orders requiring a parent to provide medical support to an eligible child, for example, in the case of a divorce or separation. For a detailed description of the procedures for a QMCSO, contact the Benefits Call Center.
Please Note: If you are covering the child of a domestic partner who is not a tax dependent, imputed income for that child may be applied.
Domestic Partners
In addition to the dependents previously listed, you may also cover a "domestic partner" as an eligible dependent under the Medical Plan — and under certain other plans as referenced in those plan sections of this Guide — if you're not currently covering a spouse. You generally must cover your domestic partner under the same option you choose.
For the purposes of the Medical Plan, you and your domestic partner must:
-
Be age 18 or older;
-
Have lived together for at least six months and have a serious, committed relationship;
-
Be financially interdependent;
-
Not be related to each other in a way that would prohibit legal marriage; and
-
Not be legally married to, or the domestic partner of, anyone else;
OR
-
Have registered as domestic partners pursuant to a domestic partnership ordinance or law of a state or local government, or under the laws of a foreign jurisdiction.
In addition, you can enroll children of a domestic partner, as long as they meet the eligibility requirements of being your dependent children under the Medical Plan as described under " Your Eligible Dependents", and the domestic partner is also enrolled. If your domestic partner is not enrolled, you generally may only cover their child(ren) if you have adopted them.
Please Note: Not all the HMOs allow domestic partner coverage. If you currently cover a domestic partner, it's your responsibility to ensure that your option allows for domestic partner coverage. You must certify your request to cover a domestic partner before coverage can begin.
For more information on covering a domestic partner, please contact the Benefits Call Center to request a copy of the Domestic Partner Coverage Guide, or refer to the Domestic Partner Coverage Guide available on Company Home > HR & Personal > Pay & Benefits > Library.
Based on the availability of more favorable tax treatment in certain states, employees who certify that their domestic partner and/or domestic partner's children are tax-qualified in the following states (based on the individual state's requirements) will no longer be subject to state imputed income tax related to benefits coverage for their domestic partner:
-
California
-
Connecticut
-
Massachusetts
-
New Jersey
-
Oregon
-
Vermont
-
Washington, D.C.
The rules for federal imputed income tax will remain unchanged.
Cost of Coverage
You and JPMorgan Chase share the cost of coverage under each of the Medical Plan options. You pay for coverage with before-tax dollars.
The amount you pay depends on the level of your total annual cash compensation, the medical option you choose, your regional cost category, the number and type of eligible dependents you cover, and your and/or your covered dependents' smoker status. For some of our medical plan options, where you live will also determine how much your pay for coverage.
Total Annual Cash Compensation
"Total annual cash compensation" is your base salary plus applicable job differential pay (e.g., shift pay) as of each August 1, plus any cash earnings from any incentive plans (e.g., annual bonus, commissions, draws, overrides, and special recognition payments or incentives) that are paid to or deferred by you for the previous 12-month period ending each July 31. Overtime is not included. For purposes of determining the Medical Plan contribution pay tier that applies to you, your total annual cash compensation is recalculated as of each August 1 to take effect the following January 1 and will remain unchanged throughout the year. For most employees hired on or after August 1, total annual cash compensation will be equal to base salary plus job differentials.
Separate definitions may apply to employees in certain sales positions who are paid on a draw-and-commission basis. If this situation applies to you, you will be notified.
The chart below shows the levels of total annual cash compensation used to determine Medical Plan contributions.
|
Total Annual Cash Compensation Levels Used to Determine Medical Plan Contributions
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please Note: Your employment status is measured as of August 1 and remains unchanged for purposes of determining Medical Plan contributions for the next calendar year.
Medical Option
An Important Note on Dependent Coverage
If your spouse or domestic partner is also employed by JPMorgan Chase, he or she can be covered as an employee or as your dependent, but not as both. If you want to cover your eligible dependent children, you or your spouse/domestic partner (but not both of you) can choose to provide this coverage.
Employee contributions will also vary due to the type of Medical Plan option and the level of coverage the option provides.
Covered Dependents
Your costs will vary based on which of the following coverage levels you choose:
-
Employee Only;
-
Employee Plus One Adult;
-
Employee Plus Child(ren); and
-
Employee Plus One Adult Plus Child(ren).
Smoker Status
Employees and their covered dependents who do not smoke pay less for medical coverage. Each year, employees must verify their status as a non-smoker or smoker, as well as the status of all covered dependents under the applicable plans. To be considered a non-smoker and pay lower, non-smoker rates under the applicable plans for a plan year, you and/or any covered dependents must be smoke-free for at least 12 months as of January 1 of that plan year, or complete an approved smoking cessation program. If you continue to smoke, you will need to complete an approved smoking cessation course annually to continue to qualify for the lower, non-smoker rates. You and all your covered dependents (adult and children) must be non-smokers to qualify for lower, non-smoker rates.
Please Note: In your first calendar year of employment, you will be assigned non-smoker rates for your and your dependents' coverage even if you declare yourself and/or your dependent(s) a smoker, because you may not have had an opportunity to complete a smoking cessation course in order to qualify for the lower non-smoker rates. In subsequent years, however, you will be eligible for non-smoker rates only if you have been smoke-free for 12 months (as of January 1) or if you complete a smoking cessation course, as described in the preceding paragraph.
However, if you were hired on or after October 1, for the current plan year and the following plan year you will be assigned non-smoker rates for your and your dependents' coverage even if you declare yourself a smoker, because you may not have had an opportunity to complete a smoking cessation program in order to qualify for the lower non-smoker rates.
You'll receive more information regarding the opportunity to update your smoker status during each annual benefits enrollment period.
For more information on the Smoking Cessation Program, please go to Company Home > HR & Personal > Life & Well-Being > Personal Health > Smoking Cessation Program.
Under the JPMorgan Chase Benefits Program, a person who has smoked any type of tobacco product (e.g., cigarettes, cigars, or a pipe) regardless of the frequency or location (this includes daily, occasionally, socially, at home only, etc.) in the 12 months preceding any January 1 is considered a "smoker." This definition does not pertain to users of tobacco products that are not smoked, such as chewing tobacco or snuff.
Regional Cost Categories
Costs for medical care differ across the United States. To ensure equity in how our Medical Plan options are priced, JPMorgan Chase applies the concept of geographic cost differences to the POS High and Low Options and the CDHO. (The HMO and EPO options are already priced based on geographic differences.) Under the POS High and Low Options and the CDHO, each state or region is assigned to a "Regional Cost Category," based on the cost of health care for that region in relation to the national average.
The Regional Cost Category for your home state or region will be a factor in determining your Medical Plan contributions, along with the Medical Plan option you choose, your total annual cash compensation, the number and type of eligible dependents you cover, and the smoker status for you and your covered dependents.
The following chart shows the different Regional Cost Categories for Medical Plan coverage under the POS High and Low Options and the CDHO.
|
Regional Cost Categories
|
|
|
Regional Cost Category 1:
Colorado, Georgia, Kansas, Kentucky, Missouri, New York (excluding Metro New York), Southern Texas, Utah
|
Regional Cost Category 2:
Arizona, California, Delaware, Southern Illinois, Maryland, Oklahoma, Pennsylvania, Northern Texas, Virginia, Washington, D.C.
|
Regional Cost Category 3:
Florida, Northern Illinois (including Chicago), Massachusetts, Michigan, Ohio, and all other locations not individually listed
|
Regional Cost Category 4:
Connecticut, Louisiana, Metro New York, New Jersey
|
Regional Cost Category 5:
Indiana, Southeast Texas, West Virginia, Wisconsin
|
When Contributions Begin
Your contributions toward the cost of coverage start when your coverage begins. Your contributions are automatically deducted from your pay in equal installments (unless retroactive payments are required).
If you have coverage but are away from work because of an unpaid leave of absence, you will be directly billed for any required contributions on an after-tax basis.
If you become totally and permanently disabled and are eligible for benefits from the JPMorgan Chase Long-Term Disability (LTD) Plan, you're treated as having "benefits eligible" status for certain benefits. In the case of the Medical Plan, you'll be eligible to continue coverage while receiving benefits from the LTD Plan. You'll pay for coverage with after-tax dollars on a direct-bill basis.
Cost for Domestic Partner Coverage
Enrolling a Domestic Partner
For more information on enrolling and the tax consequences of covering a domestic partner, please refer to the Domestic Partner Coverage Guide available on Company Home > HR & Personal > Pay & Benefits > Library.
If you're covering a domestic partner as described in " Your Eligible Dependents", there are some cost implications of which you should be aware. Specifically, in many cases a "Domestic Partner" will not satisfy the definition of "Dependent" under the Internal Revenue Code (IRC). As a result, federal law requires JPMorgan Chase to report the entire value of the medical coverage for a "Domestic Partner" as taxable income to you. The entire value of this coverage includes the amount that both you and JPMorgan Chase contribute towards the cost of coverage.
Please Note: If you are covering the child of a domestic partner who is not a tax dependent, imputed income for that child will be applied.
Favorable Tax Treatment in Certain States
Based on the availability of more favorable tax treatment in certain states, employees who certify that their domestic partner and/or domestic partner's children are tax-qualified in the following states (based on the individual state's requirements) are not subject to state imputed income tax related to benefits coverage for their domestic partner:
-
California
-
Connecticut
-
Massachusetts
-
New Jersey
-
Oregon
-
Vermont
-
Washington, D.C.
Please Note: In order to be eligible for this state income tax treatment, you must contact the Benefits Call Center to certify that your domestic partner and partner's child(ren) (if applicable) qualify for this tax treatment.
For more information, please refer to the Domestic Partner Coverage Guide, which describes the eligibility requirements and enrollment process for domestic partner coverage under the JPMorgan Chase Benefits Program. You can view the Guide at Key Resources > 2008 Domestic Partner Guide via the "Expatriate Benefits" page on HR & Personal.
How to Enroll
Participation in the Medical Plan is optional.
|
If You:
|
What You Need to Do to Enroll:
|
|
|
During an annual benefits enrollment period, you can make your elections through the Benefits Web Center via My Rewards @ Work or via the Benefits Call Center. At the beginning of each enrollment period, you'll receive instructions on how to enroll.
You'll also receive information about the choices available to you and their costs at that time. You need to review your available choices carefully and enroll in the option that best meets your needs. You can't change your choices during the year unless you have a qualified change in status. Please see " Qualified Change in Status" for more information.
|
Are a Newly Hired Employee
|
If you've just joined JPMorgan Chase and are enrolling for the first time, you need to make your choices through the Benefits Web Center via My Rewards @ Work or via the Benefits Call Center within 31 days of your date of hire if you are a full-time employee, and within 31 days prior to becoming eligible if you are a part-time employee. Part-time employees will receive their enrollment materials within 31 days prior to becoming eligible and can enroll at that time. You can access your benefits enrollment materials online via Company Home > HR & Personal > Pay & Benefits > Enrollment Materials. (In most cases, a copy of these materials will also be sent to you via interoffice mail. However, you do not need to wait for these materials to arrive to make your enrollment elections online.)
|
Have a Change in Work Status or Qualified Change in Status
|
If you're enrolling during the year because you're a newly eligible employee due to a work status change or you have a qualified change in status, you'll have 31 days from the date of the change in status (including the birth or adoption of a child, etc.) to make your new choices through the Benefits Web Center via My Rewards @ Work or via the Benefits Call Center and speaking with a Service Representative. Please see " Qualified Change in Status" for more information.
|
If You Do Not Enroll
|
If You:
|
What Happens If You Do Not Enroll:
|
|
|
If you're already participating in the Medical Plan and do not change your elections or cancel coverage during the annual benefits enrollment period, you'll keep the same coverage for the following plan year that you had before the annual benefits enrollment period (if available) or you will be assigned coverage by JPMorgan Chase. However, you'll be subject to any changes in the plan and coverage costs.
|
Are a Newly Hired or Newly Eligible Employee
|
If you're a new hire or newly eligible employee and do not enroll within the designated 31-day eligibility period, coverage for certain benefits will be effective as of the date you contact the Benefits Call Center. Please see " Qualified Change in Status" for more information.
|
Have a Qualified Change in Status
|
If you have a qualified change in status that allows you to enroll in the Medical Plan mid-year and you do not enroll within the designated 31-day period (including the birth or adoption of a child, etc.), coverage for certain benefits will be effective as of the date you contact the Benefits Call Center. Please see " Qualified Change in Status" for more information.
|
When Coverage Begins
|
If You:
|
When the Coverage You Elect Begins:
|
|
|
The coverage you elect during the annual benefits enrollment period takes effect at the beginning of the following plan year (January 1).
|
Are a Newly Hired or Newly Eligible Employee
|
The coverage you elect as a new hire takes effect as follows:
-
If you are a full-time employee, coverage begins on the first of the month following your date of hire.
-
If you are a part-time employee regularly scheduled to work at least 20 but less than 40 hours per week, coverage begins the first of the month following 90 days from your date of hire.
|
Have a Change in Work Status or Experience a Qualifying Event
|
The coverage you elect as a result of a qualifying event (such as marriage, divorce, or the birth or adoption of a child or a work-related event such as adjustment to your regularly scheduled work hours that results in a change in eligibility) will take effect as of the day of the qualifying event, if you enroll within 31 days of the event and you have already met the plan's eligibility requirements.
|
Please Note: The Point-of-Service (POS) High and Low Options, most Health Maintenance Organization (HMO) Options and Exclusive Provider Organization (EPO) Options, the CDHO, and the Traditional Indemnity Option cover pre-existing conditions. So, your coverage under these options begins as soon as you're eligible and enroll. If you miss the 31-day deadline, coverage for certain benefits will be effective as of the date you contact the Benefits Call Center.
Qualified Change in Status
The Medical Plan elections you make during the annual benefits enrollment period will stay in effect through the following plan year (or the current plan year if you enroll during the year as a newly eligible employee). However, you may be permitted to change your elections before the next annual benefits enrollment period if you have a qualified change in status. Please Note: Any changes you make during the year must be consistent with your qualified change in status.
If you have a qualified change in status and want to change your elections, please see the Benefits Status Change Guide available on Company Home > HR & Personal > Pay & Benefits > Library, which includes details on how to make changes. This Guide is also available on request through the Benefits Call Center. You need to enroll through the Benefits Web Center via My Rewards @ Work or via the Benefits Call Center within 31 days of the qualifying event for benefits to be effective on the date of the event. If you miss the 31-day deadline, coverage for certain benefits will be effective as of the date you contact the Benefits Call Center. Otherwise, you will not be able to make the change in coverage until the following annual benefits enrollment period.
Please Note: Documentation of eligibility isn't always required when you enroll but may be requested at any time by JPMorgan Chase or the claims administrator.
If you have questions during the year about qualifying events and what the allowed benefit changes are, please visit the Benefits Web Center via My Rewards @ Work, or contact the Benefits Call Center and speak with a Service Representative.
Qualified changes in status for eligible dependents under the Medical Plan are listed in the following table.
|
Medical Plan Changes for Qualified Change in Status
|
|
Event
|
Medical Plan Changes
|
|
|
|
|
You have, adopt, or obtain legal guardianship of a child*
|
|
You and/or your covered dependents gain other benefits coverage*
|
Cancel coverage for you and/or your covered dependents who have gained other coverage
|
You and/or your eligible dependents lose other benefits coverage*
|
|
You get legally separated or divorced
|
Cancel coverage for your former spouse and/or dependent children who are no longer eligible
|
A covered family member dies*
|
Cancel coverage for your deceased dependent and any dependent children who are no longer eligible
|
A dependent child is no longer eligible*
|
Cancel coverage for your dependent child
|
You move out of a Medical Plan option service area and your current option is no longer available
|
Change Medical Plan option for you and your covered dependents. (Please Note: In this situation, you will be assigned new coverage by JPMorgan Chase based on your new service area. However, you will have the ability to change this assigned coverage within 31 days of the qualifying event.)
|
|
|
You add a newly eligible domestic partner
|
-
Add coverage for you, your domestic partner, and any eligible dependent children.
-
Change Medical Plan option.
-
Change Medical Plan option for you and your covered dependents if your current plan does not allow for domestic partner enrollment.
|
You end a domestic partner relationship
|
Cancel coverage for your domestic partner and your domestic partner's eligible dependent children who are no longer eligible.
|
* Applies to domestic partner relationship.
Please Note: Your deadline to report a qualifying event may be extended to 60 days if your newly eligible dependent dies prior to adding them to coverage. Please contact the Benefits Call Center if this situation applies to you.
High Performance Networks
Many of our Medical Plan options designate a select number of their participating providers to be part of a "high performance network." This is a special network that provides access to physicians who have proven to provide high-quality and cost-effective care. If you choose to use these providers, you may have lower medical costs, better outcomes, or both. Visit your Medical Plan option administrator's web site for more information.
|
