Annual Enrollment for Employee Benefits

Transcription

1 Annual Enrollment for Employee Benefits Important Benefit Changes Each employee and retiree with medical coverage should review and/or set a tobacco user status for yourself and all dependents enrolled in medical coverage otherwise you and your covered dependents may be considered tobacco-users and will be charged an additional monthly premium, beginning September 1, The additional charge is 30 for an employee, 30 for a covered spouse, and 30 for one or more covered children who use tobacco products. You must be tobacco-free for at least 3 months prior to September 1, 2012, to be considered a non-tobacco user. If you cover a dependent on any A&M System insurance plan and have not previously been asked to verify the eligibility of your dependents by providing documentation, you must provide this documentation and re-add your dependents to coverage if you make ANY annual enrollment change. Certain documents are required, depending on whether you cover a spouse or children, and whether your children are your biological children, step-children, etc. The ibenefits System will tell you which documents are required and will allow you to upload scanned documents from your desktop. Your dependents will not have coverage September 1 unless you provide the requested documentation. The Scott & White Health Plan (SWHP) will no longer be offered as of September 1, If you are currently enrolled in the SWHP, you and any currently enrolled dependents will automatically be moved to the A&M Care plan unless you change your health coverage during annual enrollment. BlueCross BlueShield has a toll-free number for Scott & White members to get additional information about the A&M Care plans: Medco, the A&M Care prescription drug carrier, has a website for Scott & White members to get information about coverage for specific drugs: accesscode=tamrxben14597 A&M Care Plan Changes The premiums for the coming plan year have decreased. The A&M Care plan will now cover one routine eye exam per person, per year, for a 45 copay. the A&M Care plan, administered by BlueCross BlueShield (BCBS), will be using the A&M Systemassigned UIN as your BCBS member number. All enrolled members will receive a new BCBS ID card(s). Grad Plan Changes The premiums for the coming plan year have increased. The plan has been expanded to become compliant with federal health care reform rules. This includes removing the maximum coverage limits for drugs, providing preventive care at 100% (in-network) and removing the pre-existing limitations for members under age 19.

2 Important Checklist Review/make changes to your benefits for by logging on to ibenefits through Single Sign On. Be sure to submit any changes before August 1, You can make additional changes once you submit your online document by using the recall button in ibenefits. Be sure to resubmit your document. Make sure your address is correct in HR Connect. This is the address carriers will use to send ID cards and plan information. Log into HRConnect through Single Sign On and click on the Personal Data tab. Flexible Spending Accounts, Health Care and/or Dependent Daycare do not automatically continue. You must enroll for the new plan year and redesignate both the debit card and direct deposit if you would like to enroll in or continue those options. If you have a debit card, the card is good through the valid thru date on the card, but you must re-elect this option each year to use the card for any purchase after September 1, Remember, you cannot add or drop coverage for yourself or any dependents during the plan year unless you have certain Changes in Status. Update your beneficiary designations in ibenefits. Entering your beneficiaries into the database will make it easier to update them as needed, online. You can also do this anytime. When you make any benefit changes, you will receive an confirmation. If you do not have an address in HRConnect, you will receive a confirmation letter in the mail. Be sure these are the benefits you elected for For more information: click here to see the Employee Benefits Guide review your plan description booklets at publications contact your Human Resources office Carrier Phone Numbers and Websites 2 BlueCross BlueShield A&M Care DeltaCare USA Dental HMO Delta Dental - A&M Dental EyeMed Vision Graduate Student Health Plan Cigna Insurance Long-Term Disability Medco - A&M Care prescription drug vendor Minnesota Life Insurance PayFlex - Flexible Spending Accounts

3 Annual Enrollment Meeting Schedule City Date Time System Member Location San Antonio 7/9 9 am - 2 pm TAMU-San Antonio One University Way College Station 7/10 1:30 pm - 4 pm AgriLife* Centeq Building College Station 7/11 10 am - 2 pm TAMU & System Offices Benefits Fair - Rudder Tower 301, Breakout session presentations, Rudder Tower 308 Kingsville 7/11 9 am & 2 pm TAMU-Kingsville Memorial Student Union Building, Room 219A Weslaco 7/12 10:30 am TAMU-Weslaco Citrus Center, Conference Center 1 Stephenville 7/12 9 am & 2 pm Tarleton Thompson Student Center Ballrooms Killeen 7/13 9 am - noon Central Texas Founder's Hall, 1001 Leadership Place For ; English & Spanish ; English & Spanish Corpus Christi 7/16 9 am - 4 pm TAMU-Corpus Christi University Center Ballroom Bryan/ College Station Bryan/ College Station 7/16 9 am - noon 7/16 1:30-4:30 pm AgriLife, HSC, TEES, TTI AgriLife, HSC, TEES, TTI Brazos Center Brazos Center Employees Commerce 7/17 9 am - 4 pm TAMU-Commerce Sam Rayburn Student Center, Conference Room B Employees College Station 7/17 10 am - 2 pm TAMU & System Offices Benefits Fair - General Services Complex (GSC), Assembly Room 101A, Breakout Session presentations - (GSC), Assembly Room 101B ; English & Spanish Commerce 7/18 9 am - 4 pm TAMU-Commerce Sam Rayburn Student Center, Conference Room B Lufkin 7/18 9 am - noon Texas Forest Service Angelina County Extension Office Canyon 7/18 10 am - 2 pm TAMU-West Texas ANS, Room 101 Texarkana 7/19 10 am - 2 pm TAMU-Texarkana University Center, 1st Floor Lobby Dallas 7/19 11 am - 1 pm BCD - Dallas Baylor College of Dentistry, 6th Floor Lobby Galveston 7/20 10 am - 2 pm TAMU-Galveston 1001 Texas Clipper Road, Banquet Room off Dining Room Employees College Station 7/23 9 am - 10:30 am Texas Forest Service 200 Technology Way, Suite 1105B Laredo 7/24 9 am & 2 pm TAMIU Western Hemispheric Trade Center, Room 116 Prairie View 7/24 9 am - 11 am 1 pm - 4 pm PVAMU John B. Coleman Library, Room 108 Houston 7/25 11:00 AM HSC/IBT-Houston Alkek Building, Room 1119 Merkel (near Abilene) 7/26 9 am - 11 am 1 pm - 3:30 pm Texas Forest Service Texas Forest Service Office Employees *AgriLife - TTVN meetings will be broadcast at various locations throughout the state. These meetings are hosted by AgriLife, but employees & retirees of all System Members are welcome to participate at the connected TTVN sites. The originating site will be at Centeq Research Plaza (CTQ) building in College Station. 3

4 The health plan chart below shows your share of the cost of a service. For example, 30% means you pay 30% (coinsurance) of the cost up to the out-of-pocket limit and the plan pays 70% after applicable deductibles. 30/visit means you pay 30 (copayment) for each office visit. Provisions Regions offered A&M Care 700 Network/Out-of-Network benefits BlueCross BlueShield of Texas (BCBSTX) has networks in all 50 states and provides coverage worldwide. Pre-existing condition limitations Out-of-service-area restrictions Deductibles Out-of-pocket maximum In-hospital care Emergency room Office visits Lab/X-rays Surgery Chiropractic care Vision/Hearing/Speech Physical therapy Durable medical equipment Home health care Skilled nursing facility (not including custodial care) None Emergency care Network benefit; must notify BCBSTX within 48 hours. Nonemergency care Out-of-network benefit unless you go to a BCBS provider in that area. Network: 700/person/plan year Out-of-Network: 1,400/person/plan year; 700/hospital Network: 5,000/person/plan year, 10,000/family/plan year Out-of-Network: 10,000/person/plan year Network: 30% after deductible Out-of-Network: 700/admission, then 50% Network: 30% after deductible Out-of-Network: 30% after deductible if emergency; otherwise 50% after deductible Network: 30/visit for Primary Care Physician (PCP) visits; 45 for specialists; certain expensive surgeries 30% after deductible Out-of-Network: 50% after deductible Network: Benefit depends on setting and procedure; see plan description book or call BCBSTX for details Out-of-Network: 50% after deductible Network: 30% after deductible (inpatient and outpatient) Out-of-Network: 50% after deductible (inpatient and outpatient) Network and out-of-network: In physician s office, see office visit Network: 45/visit, 30 visits/plan year Out-of-Network: 50% after deductible, 30 visits/plan year Vision - Network: 45/visit, One routine preventive vision exam/per person/per plan year Vision - Out-of-Network: Routine preventive vision exams not covered Hearing Illness/accident coverage only Network: 45/visit Out-of-Network: 50% after deductible Network: 30% after deductible Out-of-Network: 50% after deductible Network: 30% after deductible; 60 visits/person/plan year Out-of-Network: 50% after deductible; 60 visits/person/plan year Network: 30% after deductible; 60 days/person/plan year Out-of-Network: 50% after deductible; 60 days/person/plan year Mental health Inpatient Outpatient Network: Inpatient 30% after deductible Outpatient 30/visit Out-of-Network: Inpatient 50% after deductible Outpatient 50% after deductible Prescription drugs How does this health plan work? Member Services phone number/website After you meet the 50/person/plan year prescription drug deductible (three-person maximum): 30-day supply: 10/generic, 35/brand-name formulary, 60/brand-name nonformulary; brand-name copayment + difference between brand-name and generic when generic is available 90-day supply: Two copayments required if purchased by mail-order; three if purchased through certain retail pharmacies. Medco (800) ; This plan is a preferred provider organization (PPO). If you live in a network area, you may choose any provider in a BlueCross BlueShield network to receive the highest level of coverage. You will receive benefits for services from an out-of-network provider, but your cost will be higher. BlueCross BlueShield of Texas (866) ; for information on networks outside Texas (800) 810-BLUE (2583) Bold type indicates items that will change for the new plan year. 4

5 The health plan chart below shows your share of the cost of a service. For example, 20% means you pay 20% (coinsurance) of the cost up to the out-of-pocket limit and the plan pays 80% after applicable deductibles. 25/visit means you pay 25 (copayment) for each office visit. Provisions Regions offered Pre-existing condition limitations Out-of-service-area restrictions Deductibles Out-of-pocket maximum In-hospital care Emergency room Office visits Lab/X-rays Surgery Chiropractic care Vision/Hearing/Speech Physical therapy Durable medical equipment Home health care Skilled nursing facility (not including custodial care) Mental health Prescription drugs How does this health plan work? Member Services phone number/website Available worldwide; outside U.S. benefits paid at 80% 20% up to 1,000 benefit for an existing condition for 12 months; continuous coverage before enrollment offsets limitation period. No pre-existing condition limitation for those under age 19. None 100/person; 300/family; in or out-of-network; waived at student health center; Annual exam is no cost 3,000/person/plan year; 6,000 maximum/family/plan year 20% (network)/40% (out-of-network) after deductible Graduate Student Health Plan After deductible, 250 copayment plus 20% (network)/40% (out-of-network) 25/visit plus 20% (network)/40% (out-of-network); covered in full at student health center 20% (network) after deductible/40% (out-of-network) after deductible 20% (network) after deductible/40% (out-of-network) after deductible 25/visit plus 20% (network)/40% (out-of-network), when medically necessary due to accident or illness 25/visit plus 20% (network)/40% (out-of-network), when medically necessary due to accident or illness 25/visit plus 20% (network)/40% (out-of-network); must be within 60 days of being released for rehabilitation 20% (network) after deductible/40% (out-of-network) after deductible No benefit No benefit Inpatient - 20% (network)/40% (out-of-network) after deductible; Outpatient - 25/visit plus 20% (network)/40% (out-of-network), 15 at student health center; Medco RX drug card 15/generic, 25/brand name, 35/single source drug - no maximum Generic Drug A medication duplicated by another company once the patent expires Brand Name Drug A medication developed by a pharmaceutical company Single Source Drug A brand name drug without a generic equivalent This plan is for graduate student employees only. Students must be taking at least six credit hours or otherwise be working toward a degree. It is a preferred provider organization (PPO). You may choose any provider in the network to receive the highest level of coverage. You receive benefits for services provided by an out-of-network provider, but your cost will be higher. You will be reimbursed 100% for services you receive at a student health center. (800) or Bold type indicates items that will change for the new plan year. 5

6 Monthly Premiums Effective Sept. 1, 2012 Basic Life The premium for this plan is usually paid by the employer contribution. Basic Life 3.97 Alternate Basic Life.529 per 1,000 Health The following chart applies to you if you are a full-time employee (work at least 40 hours per week) or retiree: Employee Only Employee & Spouse Employee & Child(ren) Employee & Family Total Cost Your Cost Total Cost Your Cost Total Cost Your Cost Total Cost Your Cost A&M Care The following chart applies to you if you are a part-time employee (work 20 to 39 hours per week): A&M Care Employee Only Employee & Spouse Employee & Child(ren) Employee & Family Total Cost Your Cost Total Cost Your Cost Total Cost Your Cost Total Cost Your Cost Graduate Student Health Plan , Dental A&M Dental PPO DeltaCare USA Dental HMO Vision Optional Life Dependent Life AD&D Long-Term Disability Employee Employee Employee Employee Only & Spouse & Child(ren) & Family Employee Only Employee & Spouse Employee & Child(ren) Employee & Family If your birthday falls between and and you will move to a higher cost category, you must pay the higher premium for the entire year. Monthly rate per 1,000: Age No-tobacco Tobacco Age No-tobacco Tobacco rate rate rate rate under and older Plan A: Spouse: Employee age-based rate per 1,000 of coverage; Child:.06 per 1,000 of coverage Plan B: 1.37/month (flat rate) Plan C: ½ Alternate Basic Life premium; (1/10 if no spouse is covered) Monthly rate per 10,000: Employee Only.14 Employee & Family.24 Monthly rate per 100/monthly pay: Non-tobacco rate.192 Tobacco rate.249 Flexible Spending Account Debit Card (Health Care Account only) 9.00/year 6

7 Premium Worksheet 1. Health: Enter premium amount. The employer contribution has already been deducted. 2. Dental: Enter premium amount. 3. Vision: Enter premium amount. 4. Optional Life: Take your annualized salary, multiply by your coverage amount (½, 1, 2, 3, 4, 5 or 6), and round down to the nearest thousand (maximum is 1,000,000). Divide by 1,000: your age-based premium of = 5. Alternate Basic Life: Divide your coverage amount by 1,000:.529 = 6. Dependent Life: Plan A Premium: Your Optional Life premium (see #4) (spouse coverage amt/1000) + (child coverage amt/1000 X.06) = Plan B Premium: 1.37/month (flat rate) Plan C Premium: Your Alternate Basic Life premium (see #5).5 (.1 if covering children only) = 7. Accidental Death and Dismemberment: Choose your coverage amount and divide by 10,000: your premium of = (Maximum coverage is the greater of 250,000 or 10 times your annual salary, not to exceed coverage of 800,000.) 8. Long-Term Disability: Divide your annual salary by 12. Divide that number (or 12,307, if less) by 100: your premium of = 9. Long-Term Care: Use the premium shown in HRConnect. Employee coverage + Spouse coverage = 10. Spending Accounts: Enter Health Care Account monthly contribution + Dependent Day Care Account monthly contribution = 11. YOUR TOTAL MONTHLY COST (Add 1 through 10) = Complete items 12 and 13 if you do not have A&M System health coverage but certify that you have other health coverage: 12. Employer Contribution: Enter the total of your premiums shown above for Dental (line 2), Vision (line 3), Alternate Basic Life (line 5), AD&D (line 7) and Long-Term Disability (line 8) or (92.55 if part-time), whichever is less. 13. YOUR TOTAL MONTHLY OUT-OF-POCKET COST (Subtract line 12 from line 11)= * * * * The premiums may increase based on your salary. Include only premiums you choose to pay using the employer contribution. 7

8 Age 65 and Still Working Although many factors dictate whether your A&M System health plan or Medicare will be primary or secondary, in general, coverage is determined by the status of the A&M health plan policy holder. If the policy holder is working at the A&M System, regardless of age, the A&M System health plan will be primary to Medicare for you and your spouse (if your spouse is covered under your plan). Click here for more information. If you, and your spouse are covered under Medicare and an A&M System health plan, let your health providers know who is primary and secondary, especially if you re still working. A letter of Creditable Coverage for Medicare Part D (prescription drug coverage) is available online at or from your Human Resources Office. Medicaid and the Children s Health Insurance Program (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in Texas call , visit or 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, you can contact your State Medicaid or CHIP office or dial KIDS NOW or visit to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer s health plan is required to permit you and your dependents to enroll in the plan as long as you and your dependents are eligible, but not already enrolled in the employer s plan. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. For more information on special enrollment rights, you can contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services EBSA (3272) , Ext