Graduate Student Insurance Comparison Summary Student Insurance Plan vs. Employer Group Insurance Program

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1 Graduate Student Insurance Comparison Summary Student Insurance Plan vs. Employer Group Insurance Program Revised 08/20/2015 Graduate Student employees may choose between the Student Insurance Plan administered by the Student Health Center and the Employer Group Benefits Program administered by the Human Resources Office. Also, some graduate students may already be covered by insurance outside the University and not enroll in either option offered by Texas State. In any case, we encourage graduate students to review this comparison summary to help make an educated decision. One important difference which may factor in the decision to enroll in the Student Insurance Plan instead of the Employer Group Benefits Program is a 60 day waiting period for coverage. For the Employer Group Benefits Program, graduate students have a 30-day period to complete enrollment forms. Health coverage will begin the first of the month following 60 days. For example, if a graduate student is hired on September 1 st, coverage will be effective on November 1 st as long as the enrollment forms are submitted in September. The Employer Group Benefits Program also provides optional coverage such as dental, term life insurance, short or long-term disability, accidental death and dismemberment, and dependent term life without a waiting period. Graduate students can enroll in the Student Health Insurance Plan and enroll in only the optional coverage with the Employer Group Benefits Program. If you are an International Student, on a non-immigrant Visa, you are required to have coverage on your first day of school. The Student Insurance Plan is the only choice which provides health insurance coverage the first day of school. You will have to enroll and purchase this plan on your own by the first day of class. Below you will find comparison charts on premiums, health coverage, prescription drug plan, and optional coverage with the Employer Group Benefits Program and the Student Insurance Plan. Payment Options: The Student Insurance Plan offers the following options: 1. Annually 2. By semester (Fall, Spring, Spring/Summer, Summer and Summer II options only) 3. You can purchase just for the summer even if you only attend school in the spring and were enrolled in the optional Student Health Insurance Plan. 4. You can purchase on-line 5. Installment option for voluntary enrollment (Annual and Spring/Summer plan (for new students in the spring)) with monthly payments by bank draft. The Employer Group Benefits Program payments are through payroll deduction. Page 1 of 6

2 PREMIUM COMPARISON Employer Program HealthSelect (Annual Cost) Student Health Plan (Annual Cost) Employee Only $3, ($288.27/ mo) $3,208 Employee + Spouse $9, ($783.63/ mo) $10,901 Employee + Child $7, ($619.95/mo) $6,709 (1 child) $7,289 (all children) Emp + Spouse + Child $13, ($1,115.31/mo) $14,402 (1 child) $14,982 (all children) Tobacco Certification Yes = $30 per mo, per person (max $90) N/A Dental DHMO (Monthly Cost) Dental Choice (Monthly Cost) Employee Only $9.59 $24.28 Student Health Plan (Optional limited dental coverage is available. You must have purchased the student plan to be eligible to purchase.) Call for information: Academic Health Plans or Employee + Spouse $19.17 $48.56 Employee + Children* $23.01 $58.28 Employee + Family* $32.59 $82.56 Other Network Dentists only Any Dentist Employee Only Employee + Family Other Vision Benefit (included in HealthSelect coverage) No extra cost No extra cost $40 Co-pay for routine eye exam. Discounts available with UHC Vision Student Vision Plan Discount only, except for pediatric vision. Call BCBSTX for information Page 2 of 6

3 Student Insurance Plan and enrollment information: Student Insurance Toll free (855) (enrollment and eligibility questions) BCBSTX Toll free (855) (benefits and claim questions) Texas State Student Health Center (512) NEW: Minimum credit hour requirement to enroll in the student health plan o 9 hours for undergraduate students o 3 hours for graduate students This health plan year has designated enrollment periods. Fall &/or Annual Plan: 7/15/ /24/2015 Spring 2016: 12/1/2015 3/21/2016 Summer /1/2016 7/15/2016 Fall coverage must be purchased by October 24th. Students can no longer purchase the insurance at any time during the year, unless they have a Qualifying Event - change in status and lose coverage under another health care plan. Details can be found in the plan brochure (pg. 3). Students must enroll in the Student Health Plan by 8/23/2015 to have coverage effective on 8/23/2015. Employer Group Benefits Program contact: Texas State Human Resources Benefits Office JC Kellam Building, Room 360 or call (512) Page 3 of 6

4 HEALTH COVERAGE COMPARISON Employer Program (HealthSelect) Network (United Healthcare) In-Patient Care Co-pay $150/day up to 5 days Non-Network Student Plan (BCBSTX) Network (BlueChoice PPO Network) Non-Network $150/day up to 5 $0 $0 days Coinsurance 20% 40% Deductible + 20% Deductible + 40% Outpatient Care Office Visit Copay $25 PCP $40 Specialist 40% after $500 deductible 40% Subject to deductible $30 for Primary and Specialty Care (100% of allowable amount after copayment) $0 $0 Outpatient Surgery co-pay $100 each day surgery $100 each day surgery Coinsurance 20% Deductible + 40% Deductible + 20% Deductible + 40%, Emergency Room Co-pay $ % Deductible + 40% Emergency Care & Accidental Injury: 80% of Allowable after $150 copayment (deductible waived) Non-emergency Care: 80% of Allowable after $150 copayment (deductible waived) Emergency Care & Accidental Injury: 80% of Allowable after $150 copayment (deductible waived) Non-emergency Care: Deductible+40% of allowable amount. X-rays, lab, etc. 20% Deductible + 40% Deductible + 20% Deductible + 40% Deductible $0 $500/$1500 $500 student $1,500 family Maximum Benefit None None Unlimited $1,000 student $3,000 family Extended Benefit COBRA for up to 18 months See Plan brochure for information on Extension of Benefits after Termination (pg. 5) and Continuation of Coverage (pg. 6). Additional Information Employer Program: Page 4 of 6

5 PRESCRIPTION DRUG (RX) PLAN COMPARISON This comparison shows that if you purchase your prescriptions from the Student Health Center (SHC), your expense will be the same or less than the employer group program. If you go outside of the SHC, you will have a one-time $150 pharmacy deductible and a copay of $20 generic, $40 preferred brand-name or $60 non-preferred brand-name for a network pharmacy. Employer Group Program (Caremark) Retail Retail Maintenance Mail Order (90 day) At SHC Student Plan (SHC) Retail Generic $10 $10 $30 $10 Prime Therapeutics Network Pharmacy: pharmacy deductible and a copay of $20 generic. Preferred Name Brand Out-of-Network Pharmacy: deductible+40% $35 $45 $105 $25 Prime Therapeutics Network Pharmacy: pharmacy deductible and a copay of $40 preferred brand. Out-of-Network Pharmacy: deductible, copay of $40+40% Non-preferred Name Brand $60 $75 $180 N/A Prime Therapeutics Network Pharmacy: pharmacy deductible and a copay of $60 non-preferred brand. Out-of-Network Pharmacy: deductible, $60 copay +40% Deductible $50 $50 $50 None $150 Retail pharmacy deductible Maximum Unlimited prescriptions or cost Unlimited Page 5 of 6

6 OPTIONAL COVERAGE Employer Group Program Student Plan Term Life Insurance Yes, up to 4 x annual salary No Dependent Term Life Yes, $5000 policy No Insurance Accidental Death & Dismemberment Yes, up to $200,000 Call BCBSTX for information. Short Term Disability Yes No Long Term Disability Yes No Repatriation/Medical Evacuation (required for International Students on non-immigrant Visa) Not available $30/person/semester to purchase rider only; otherwise included in basic plan Page 6 of 6

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