OPEN ENROLLMENT GUIDE

Transcription

1 2018 BENEFITS OPEN ENROLLMENT GUIDE GUIDE October 25 November 8, 2017 For members of HUCTW who retired on or after 7/5/11 and members of ATC, Local 26, HUPA, HUSPMGU, or SEIU who retired on or after 9/4/14

2 MAKE IT YOUR HARVARD BENEFITS OPEN ENROLLMENT OCTOBER 25 NOVEMBER 8, 2017 WHAT S INSIDE Explore your benefits...3 Compare your medical plans...4 Dental and Supplemental Life Glossary IF YOU WANT TO MAKE A CHANGE Please call Harvard Human Resources Benefits at between 9:00 a.m. and 5:00 p.m. ET Monday through Friday, or benefits@harvard.edu to request the necessary forms. No action is required if you do not want to make any changes. 2 Benefits Open Enrollment is October 25 November 8, 2017

3 EXPLORE YOUR BENEFITS Harvard Benefits Open Enrollment is your opportunity to review and make changes to your health and welfare benefit elections for Please take the time to read through this brochure to make sure you understand the full spectrum of benefits available to you. During Open Enrollment, you can make the changes noted below to your benefits. Any changes are effective January 1, Change, elect, or drop medical coverage. Add or drop an eligible dependent. Drop dental coverage. If you drop this coverage, you will not be able to re-enroll at a later date. If you do not make any changes, your 2017 elections will carry over to Have questions for your health plan? ELECTION FORMS MUST BE POSTMARKED BY WEDNESDAY, NOVEMBER 8! Call Harvard University Group Health Plan at or visit hughp.harvard.edu. Call Harvard Pilgrim Health Care at or visit harvardpilgrim.org. For more information, visit hr.harvard.edu/open-enrollment-2018/retiree-benefits-open-enrollment 3

4 WHAT S NEW EFFECTIVE JANUARY 1, 2018 FOR RETIREES UNDER AGE 65 WHO WERE MEMBERS OF HUPA, HUSPMGU, OR SEIU CUSTODIANS AND RETIRED ON OR AFTER 9/4/14 1. The copayment for office visits and therapy visits (acupuncture, chiropractic, physical/occupational therapy, etc.) will be $ The Harvard Pilgrim Health Care (HPHC) Preferred Provider Organization (PPO) plan is being eliminated. If you are currently enrolled in the HPHC PPO and do not choose a different medical plan during Open Enrollment, you will automatically be enrolled in the HPHC Point-of-Service (POS) plan for The Health Maintenance Organization (HMO) and POS plans will have new copayments for hospital services and high-tech imaging. 4. Out-of-network deductibles and out-of-pocket maximums are changing in the POS plan. 5. A fourth salary tier for monthly premium contributions for those who retired with a full-time equivalent (FTE) salary of less than $55,000 will be added. FOR RETIREES UNDER AGE 65 WHO WERE MEMBERS OF HUCTW AND RETIRED ON OR AFTER 7/5/11 AND WHO WERE MEMBERS OF ATC AND RETIRED ON OR AFTER 9/4/14 1. The copayment for office visits and therapy visits (acupuncture, chiropractic, physical/occupational therapy, etc.) will be $25. FOR ALL 2. Effective January 1, 2018, you will be able to get up to a 90-day prescription filled at any CVS pharmacy (at retail copayment costs). 4 Benefits Open Enrollment is October 25 November 8, 2017

5 COMPARE YOUR MEDICAL PLANS Harvard offers you a choice of several medical plans, listed below. YOUR MEDICAL PLAN OPTIONS Harvard offers subsidized medical coverage from Harvard University Group Health Plan (HUGHP) and Harvard Pilgrim Health Care (HPHC). You may select individual or family coverage from the following types of plans: HMO With an HMO, you select a primary care physician (PCP), who coordinates your care and can provide you with referrals to in-network specialists. Out-of-network care is not covered, except in certain emergency situations. POS As with an HMO, you designate a PCP. However, you have the flexibility to use out-of-network providers with higher out-of-pocket costs. PPO With this plan, you can go to any health care professional you choose inside or outside your network, without a PCP referral. This plan, offered only through HPHC, is only available to retirees of certain unions who reside outside Massachusetts (see below). What s your medical plan eligibility? RETIREE UNDER AGE 65 YOU ARE ELIGIBLE FOR: HMO POS PPO Who was a member of HUCTW and retired on or after 7/5/11 or was a member of ATC, HUPA, HUSPMGU, or SEIU Custodians and retired on or after 9/4/14 Who was a member of Local 26 or SEIU Arboretum and retired on or after 9/4/14 For more information, visit hr.harvard.edu/open-enrollment-2018/retiree-benefits-open-enrollment 5

6 COMPARE YOUR MEDICAL PLANS Retirees under age 65 who were members of HUCTW and retired on or after 7/5/11 or who were members of ATC, HUPA, HUSPMGU, or SEIU Custodians and retired on or after 9/4/14 OUT-OF-POCKET MAXIMUM INDIVIDUAL FAMILY Medical $2,000 $6,000 Prescription Drug $4,600 $7,200 IN-NETWORK HMO POS MEMBER COSTS Inpatient Hospital $100 copayment $100 copayment Outpatient Hospital $100 copayment $100 copayment Emergency Room $100 copayment $100 copayment Preventive Care as Defined by Affordable Care Act Covered in full Covered in full Office Visits PCP and Specialist $25 copayment $25 copayment Physical/Occupational Therapy (limited to 60 visits per calendar year) Chiropractic Care (limited to 18 visits per calendar year) Acupuncture (limited to 20 visits per calendar year) High-Tech Imaging (e.g., MRI, PET scan, CT scan) $25 copayment $25 copayment $25 copayment $25 copayment $25 copayment $25 copayment $50 copayment $50 copayment Mental Health/Substance Abuse Inpatient: $100 copayment per admission Outpatient: $25 copayment Inpatient: $100 copayment per admission Outpatient: $25 copayment Outpatient Diagnostic Labs/X-Rays Covered in full Covered in full 6 Benefits Open Enrollment is October 25 November 8, 2017

7 OUT-OF-NETWORK POS DEDUCTIBLE Per Individual $750 Family Maximum $2,500 OUT-OF-POCKET MAXIMUM Per Individual $2,500 Prescription drug costs While the copayments for prescriptions drugs are not changing, some medications may change tiers on the plan s preferred drug list (also called a formulary) and therefore have different costs. You will receive a separate communication from OptumRx if any of your current medications will move to a higher tier or if there will be changes to the need for prior authorization or quantity limits. Also, effective January 1, 2018, you will be able to get up to a 90-day prescription filled at any CVS pharmacy, at the retail copayment costs below. Family Maximum $7,500 MEMBER COSTS PRESCRIPTION DRUG COSTS GENERIC PREFERRED BRAND NON- PREFERRED BRAND Member-Paid Coinsurance 30% after out-of-network deductible Retail at participating pharmacy (up to 30-day supply) Mental Health/ Substance Abuse Inpatient: 30% coinsurance Outpatient: 20% coinsurance, no deductible IN-NETWORK $7 $20 $45 Mail order through OptumRx (up to 90-day supply) $14 $50 $110 OUT-OF-NETWORK (POS ONLY) Submit receipt to be reimbursed cost minus applicable in-network copayment. For more information, visit hr.harvard.edu/open-enrollment-2018/retiree-benefits-open-enrollment 7

8 COMPARE YOUR MEDICAL PLANS Retirees under age 65 who were members of SEIU Arboretum and retired on or after 9/4/14 IN-NETWORK HMO POS PPO (HPHC Only) OUT-OF-POCKET MAXIMUM PER INDIVIDUAL FAMILY MAXIMUM PER INDIVIDUAL FAMILY MAXIMUM PER INDIVIDUAL FAMILY MAXIMUM MEDICAL ONLY $2,000 $6,000 $2,000 $6,000 $2,000 $6,000 PRESCRIPTION DRUG $4,600 $7,200 $4,600 $7,200 $4,600 $7,200 MEMBER COSTS Inpatient Hospital Covered in full Covered in full Covered in full Outpatient Surgery Covered in full Covered in full Covered in full Emergency Room $75 copayment (waived if admitted) $75 copayment (waived if admitted) $75 copayment (waived if admitted) Preventive Care as Defined by Affordable Care Act Covered in full Covered in full Covered in full Office Visits PCP and Specialist $20 copayment $20 copayment $20 copayment Chiropractic Care (limited to 18 visits per calendar year) $20 copayment $20 copayment $20 copayment Physical Therapy (limited to 60 visits per calendar year) $20 copayment $20 copayment $20 copayment Acupuncture (limited to 20 visits per calendar year) $20 copayment $20 copayment $20 copayment Lab and X-Rays Covered in full Covered in full Covered in full Mental Health/Substance Abuse Inpatient: Covered in full Outpatient: $20 copayment Inpatient: Covered in full Outpatient: $20 copayment Inpatient: Covered in full Outpatient: $20 copayment 8 Benefits Open Enrollment is October 25 November 8, 2017

9 OUT-OF-NETWORK POS PPO (HPHC Only) DEDUCTIBLE Per Individual $750 $750 Family Maximum $2,500 $2,500 OUT-OF-POCKET MAXIMUM Per Individual $2,500 $2,500 Prescription drug costs While the copayments for prescription drugs are not changing, medications may change tiers on the plan s preferred drug list (also called a formulary) and therefore have different costs. You will receive a separate communication from OptumRx if any of your current medications will move to a higher tier or if there will be changes to the need for prior authorization or quantity limits. Also, effective January 1, 2018, you will be able to get up to a 90-day prescription filled at any CVS pharmacy, at the retail copayment costs below. Family Maximum $7,500 $7,500 PLAN PAYS Mental Health/ Substance Abuse Chiropractic Care (limited to 18 visits per calendar year) Inpatient: 80% of allowed amount Outpatient: 80% of allowed amount; deductible does not apply 80% of allowed amount Inpatient: 80% of allowed amount Outpatient: 80% of allowed amount; deductible does not apply 80% of allowed amount PRESCRIPTION DRUG COSTS IN-NETWORK GENERIC PREFERRED BRAND NON- PREFERRED BRAND Retail at participating pharmacy (up to 30-day supply) $7 $20 $45 Mail order through OptumRx (up to 90-day supply) $14 $50 $110 Physical Therapy (limited to 60 visits per calendar year) 80% of allowed amount 80% of allowed amount OUT-OF-NETWORK (POS AND PPO ONLY) Submit receipt to be reimbursed cost minus applicable in-network copayment. For more information, visit hr.harvard.edu/open-enrollment-2018/retiree-benefits-open-enrollment 9

10 COMPARE YOUR MEDICAL PLANS Retirees under age 65 who were members of Local 26 and retired on or after 9/4/14 IN-NETWORK HMO POS PPO (HPHC Only) OUT-OF-POCKET MAXIMUM PER INDIVIDUAL FAMILY MAXIMUM PER INDIVIDUAL FAMILY MAXIMUM PER INDIVIDUAL FAMILY MAXIMUM MEDICAL ONLY $2,000 $6,000 $2,000 $6,000 $2,000 $6,000 PRESCRIPTION DRUG $4,600 $7,200 $4,600 $7,200 $4,600 $7,200 MEMBER COSTS Inpatient Hospital Covered in full Covered in full Covered in full Outpatient Surgery Covered in full Covered in full Covered in full Emergency Room $40 copayment (waived if admitted) $40 copayment (waived if admitted) $40 copayment (waived if admitted) Preventive Care as Defined by Affordable Care Act Covered in full Covered in full Covered in full Office Visits PCP and Specialist $15 copayment $15 copayment $15 copayment Chiropractic Care (limited to 18 visits per calendar year) $15 copayment $15 copayment $15 copayment Physical Therapy (limited to 60 visits per calendar year) $15 copayment $15 copayment $15 copayment Acupuncture (limited to 20 visits per calendar year) $15 copayment $15 copayment $15 copayment Lab and X-Rays Covered in full Covered in full Covered in full Mental Health/Substance Abuse Inpatient: Covered in full Outpatient: $15 copayment Inpatient: Covered in full Outpatient: $15 copayment Inpatient: Covered in full Outpatient: $15 copayment 10 Benefits Open Enrollment is October 25 November 8, 2017

11 OUT-OF-NETWORK POS PPO (HPHC Only) DEDUCTIBLE Per Individual $500 $250 Family Maximum $2,000 $500 OUT-OF-POCKET MAXIMUM Per Individual $2,000 $1,000 Prescription drug costs While the copayments for prescription drugs are not changing, medications may change tiers on the plan s preferred drug list (also called a formulary) and therefore have different costs. You will receive a separate communication from OptumRx if any of your current medications will move to a higher tier or if there will be changes to the need for prior authorization or quantity limits. Also, effective January 1, 2018, you will be able to get up to a 90-day prescription filled at any CVS pharmacy, at the retail copayment costs below. Family Maximum $5,000 $2,000 PLAN PAYS Mental Health/ Substance Abuse Chiropractic Care (limited to 18 visits per calendar year) Inpatient: 80% of allowed amount Outpatient: 80% of allowed amount; deductible does not apply 80% of allowed amount Inpatient: 80% of allowed amount Outpatient: 80% of allowed amount; deductible does not apply 80% of allowed amount PRESCRIPTION DRUG COSTS IN-NETWORK GENERIC PREFERRED BRAND NON- PREFERRED BRAND Retail at participating pharmacy (up to 30-day supply) $5 $15 $40 Mail order through OptumRx (up to 90-day supply) $10 $35 $100 Physical Therapy (limited to 60 visits per calendar year) 80% of allowed amount 80% of allowed amount OUT-OF-NETWORK (POS AND PPO ONLY) Submit receipt to be reimbursed cost minus applicable in-network copayment. For more information, visit hr.harvard.edu/open-enrollment-2018/retiree-benefits-open-enrollment 11

12 MONTHLY RATES Retirees under age 65 who were members of HUCTW and retired on or after 7/5/11 or who were members of ATC, HUPA, HUSPMGU, or SEIU Custodians and retired on or after 9/4/14 For retired members of HUPA, HUSPMGU, and SEIU Custodians who retired on or after 9/4/14, effective January 1, 2018, salary tiers are changing and we will introduce a new salary tier for those who retired with a full-time equivalent (FTE) salary of less than $55,000. Retired members of HUCTW and ATC (as described above) already have these salary tiers. Your salary tier is based on your FTE salary on the date you retired. MONTHLY COST BY SALARY TIER TIER 1 LESS THAN $55,000 TIER 2 $55,000 $74,999 TIER 3 $75,000 $99,999 TIER 4 $100,000 AND ABOVE INDIVIDUAL FAMILY INDIVIDUAL FAMILY INDIVIDUAL FAMILY INDIVIDUAL FAMILY HMO Harvard University Group Health Plan (HUGHP) $85 $230 $98 $265 $131 $354 $164 $442 Harvard Pilgrim Health Care (HPHC) $98 $266 $111 $301 $144 $390 $177 $478 POS HUGHP $118 $320 $131 $355 $164 $444 $197 $532 HPHC $132 $359 $145 $394 $178 $483 $211 $ Benefits Open Enrollment is October 25 November 8, 2017

13 TIER 1: LESS THAN $70,000 TIER 2: $70,000 $95,000 TIER 3: MORE THAN $95,000 INDIVIDUAL FAMILY INDIVIDUAL FAMILY INDIVIDUAL FAMILY Retirees under age 65 who were members of SEIU Arboretum and retired on or after 9/4/14 HMO Harvard University Group Health Plan (HUGHP) $101 $271 $134 $362 $168 $460 Harvard Pilgrim Health Care (HPHC) $115 $310 $148 $401 $182 $491 POS HUGHP $135 $365 $168 $456 $202 $546 HPHC $150 $404 $183 $495 $217 $585 PPO (for employees who reside outside Massachusetts) HPHC $150 $404 $183 $495 $217 $585 Retirees under age 65 who were members of Local 26 and retired on or after 9/4/14 HMO Harvard University Group Health Plan (HUGHP) $102 $276 $136 $368 $170 $460 Harvard Pilgrim Health Care (HPHC) $115 $312 $149 $404 $183 $496 POS HUGHP $135 $367 $169 $459 $203 $551 HPHC $150 $406 $184 $498 $218 $590 PPO (for employees who reside outside Massachusetts) HPHC $150 $406 $184 $498 $218 $590 Your salary tier is based on your FTE salary on the date you retired. For more information, visit hr.harvard.edu/open-enrollment-2018/retiree-benefits-open-enrollment 13

14 GLOSSARY DENTAL AND SUPPLEMENTAL LIFE Here s a quick refresher on commonly used medical/dental terms: An ALLOWABLE CHARGE is the dollar amount typically considered payment in full by an insurance company and an associated network of health care providers. COINSURANCE is the amount you pay, as a percentage of the cost of your allowed services, after you reach the deductible until you reach the plan s out-of-pocket maximum. A COPAYMENT (COPAY) is a fixed amount you pay for a health care service or prescription drugs. A DEDUCTIBLE is the amount you owe before your insurance begins covering certain services such as hospitalization or outpatient surgery. An OUT-OF-POCKET MAXIMUM is the most you pay per plan year for health care expenses, including prescription drugs. Once this limit is met, the plan pays 100% for the remainder of the plan year. DENTAL MONTHLY COSTS FOR RETIREE DENTAL PLAN INDIVIDUAL $52.31 FAMILY $ SUPPLEMENTAL LIFE INSURANCE For retired hourly employees, Supplemental Life Insurance coverage is reduced by 35% on July 1 following your 65th birthday. For all other retirees, Supplemental Life Insurance coverage is reduced by 35% on July 1 following your 66th birthday. For all retirees, group coverage ends on July 1 following your 70th birthday. At that time, you will be offered the option to continue coverage with an individual plan. AGE MONTHLY COST PER $1,000 OF INSURANCE $ $ $ $0.594 A PREMIUM is the amount you pay for insurance, using pretax or post-tax dollars. (Note: In most cases, Harvard pays a portion of the premium.) 14 Benefits Open Enrollment is October 25 November 8, 2017

15 HAVE QUESTIONS? WE CAN HELP. Simply any time, or call any business day between 9:00 a.m. and 5:00 p.m. ET. CONFIRMATION OF YOUR 2018 OPEN ENROLLMENT ELECTIONS You will receive a confirmation of your elections in late November from Harvard if you made changes. Please open and review this notification immediately, as all requested corrections must be postmarked by Friday, December 15, No corrections will be accepted after this date. Election forms must be postmarked by WEDNESDAY, NOVEMBER 8! For more information, visit hr.harvard.edu/open-enrollment-2018/retiree-benefits-open-enrollment 15

16 Election forms must be postmarked by WEDNESDAY, NOVEMBER 8! For members of HUCTW who retired on or after 7/5/11 and members of ATC, Local 26, HUPA, HUSPMGU, or SEIU who retired on or after 9/4/14 This brochure has been designed to acquaint you with the features of the 2018 benefit plans. We have made every attempt to summarize these programs accurately. If there is any inconsistency between this brochure and Harvard s formal plans and contracts, the actual provisions of each plan will govern. Copyright 2017 Harvard University. All Rights Reserved.