FACULTY AND STAFF 2015 Healthcare Benefits Open Enrollment Faculty and Staff The Open Enrollment period for calendar year 2015 health/dental/vision plan, Flexible Spending Account, Health Savings Account and Retirement Medical Savings Account enrollments and changes will take place from November 10 through December 1, 2014. Your Open Enrollment elections will take effect on January 1, 2015. ACTION MUST BE TAKEN DURING OPEN ENROLLMENT TO: Continue covering your dependents on your health or dental-only plan Change your health plan or coverage level Enroll in or cancel the Vision Buy-Up coverage Enroll/re-enroll in a Flexible Spending Account (FSA) Enroll/re-enroll in the Health Savings Account (HSA) Enroll in, change or cancel your Retirement Medical Savings Account (RMSA)
What s New For 2015 Health Plan Changes A new program called WUDirect is being introduced, effective 1/1/15, to provide Washington University health plan participants priority access for initial appointments with Washington University s network of over 1300 physicians. In addition to receiving world-class medical care, seeing a WUDirect physician will help lower your out-of-pocket costs through reduced co-pays and co-insurance, as reflected below. See pages 6-7 for a detailed health plan comparison. Physician Office Services HMO/POS Plans (non-preventive) Primary Care Physician WUDirect provider - $15 Other network provider - $25 Specialist WUDirect provider - $25 Other network provider - $40 Page 2 PPO Plans (including HDHP) WUDirect provider 10% Other network provider 20% WUDirect provider 10% Other network provider 20% Starting 1/1/2015, you will be able to access a listing of WUDirect providers on-line at https://wudirect.wustl.edu. Most appointments for Washington University health plan participants will be scheduled within two weeks or less. If, however, patient records and/or pre-appointment testing are required in advance of the appointment, scheduling may take longer. If you have difficulty scheduling an appointment within the above time frame, you may contact a WUDirect scheduling assistant for help in securing a more timely appointment. The phone number for the WUDirect scheduling assistant will be posted on the WUDirect website listed above. ID Cards As a result of the above changes, new ID cards for 2015 will be issued by UnitedHealthcare and Anthem BCBS to participants of all plans except the UHC HDHP. New ID cards will be issued by Advantica Dental and Express Scripts only to those who are newly enrolling or have a health plan or coverage level change. To avoid a delay in receiving your new ID cards, please verify that your home address is correct in HRMS. Prescription Drug Plan Changes Co-insurance percentages, subject to minimum and maximum payment amounts, will replace the existing standard co-payments for preferred brand (Tier 2) and non-preferred brand (Tier 3) drugs for participants of all health plans except the High Deductible Health Plan, as follows: Retail Up to a 30-day Supply Tier 2 (preferred brand) 25% $40 min. - $80 max. Tier 3 (non-preferred brand) 50% $60 min. - $120 max. Mail-Order Up to a 90-day Supply 25% $100 min. - $200 max. 50% $150 min. - $300 max. For Tier 2 or Tier 3 brand drugs, you will now pay 25% or 50% of the contracted cost of the drug. Your required payment will not be less than the stated minimum or more than the stated maximum dollar amount. To determine the amount you will pay out-of-pocket for your medications in 2015, you can price a medication on Express Scripts Open Enrollment website at www.express-scripts.com/wustl. While the co-payment for most generic (Tier 1) drugs will remain at $10 retail/$25 mailorder, the co-payment for generic drugs used to treat diabetes and heart disease (high cholesterol and hypertension) will be reduced to $4 retail/$10 mail-order.
Page 3 The co-pay for specialty drugs (high-cost drugs, including oral, topical, infused and injectable drugs that are used to treat rare or complex diseases) will be increased to $100 per 30-day supply. A new calendar year out-of-pocket maximum of $2,500 individual/$5,000 family will apply to the prescription drug plan, limiting your total out-of-pocket costs for your/your family s medications. Express Scripts 2015 formulary changes - A number of brand name drugs that are currently covered under our prescription drug plan will no longer be covered and other drugs will move from one tier level to another. Participants whose drugs will either no longer be covered or will move from Tier 2 (preferred brand) to Tier 3 (non-preferred brand) will receive notification directly from Express Scripts within the next few weeks. Generally, only those drugs that have clinically appropriate lower cost alternatives will be impacted. A copy of Express Scripts 2015 Preferred Drug List Exclusions can be found on the Prescription Drug page of the HR/Benefits website at http://hr.wustl.edu. Health Premium Structure The health premium structure will change from three coverage tiers to four coverage tiers: individual only, individual + child(ren), individual + spouse/domestic partner, and family coverage. The correct coverage category has been selected for you based on your current healthcare enrollment status. However, if you need to enroll or cancel dependents, you will need to take further action during this Open Enrollment period. See health premium schedules on page 8. Salary Threshold for Health Plan Premiums and Spouse Surcharge The salary threshold for determining health plan premiums and applicability of the Spouse/Domestic Partner Health Premium Surcharge for employees eligible for full-time health premiums will increase from $40,000 to $41,000. See health premium schedules on page 8. The amount of the monthly Spouse/Domestic Partner surcharge will remain $80. Employer Shared Responsibility (ESR) The Employer Shared Responsibility provision of the Affordable Care Act (ACA) requires employers with 50+ employees to provide affordable minimum essential health coverage to employees who work an average of 30 hours or more per week. WUSTL s health plans will be subject to these provisions effective January 1, 2015. Per IRS guidelines, WUSTL has implemented the Look-Back Measurement Method for measuring hours worked. A measurement period for WUSTL employees has been established from October 3, 2013 through October 2, 2014 to determine if an employee has worked on average 30 hours or more per week. The IRS regulation requires employers to review actual paid hours. If an employee works the average minimum paid hours of 30 per week during the measurement period, the employee will be offered full-time health insurance for the upcoming calendar year (January 1, 2015 through December 31, 2015), otherwise known as the stability period. During the stability period the employee will continue to be eligible for full-time health insurance as long as they remain employed in a regular faculty or staff position, regardless of the number of hours they work during the stability period. The measurement period is calculated annually for the next upcoming stability period. The stability period is consistent with our health plan year, January 1 through December 31.
Your personalized open enrollment page in HRMS will reflect the health insurance premiums that are applicable to you based on the number of hours you worked during the measurement period. If you met the 30-hour standard threshold during the measurement period, the health insurance premiums displayed for you will be the full-time premium rates. It s important to note that only health insurance eligibility rules are impacted by this new legislation. Eligibility rules for all other benefit plans offered through WUSTL will remain unchanged. Health Savings Account (HSA) Changes The maximum annual contribution will increase from $3,300 to $3,350 for individual coverage and from $6,550 to $6,650 for family coverage (Individual + Spouse/Partner, Individual + Child/ren, or Family). To encourage greater participation in the High Deductible Health Plan and the Health Savings Account, the University will increase its annual HSA contribution for employees enrolled in family coverage from $400 to $800. Did You Know? Open enrollment does not apply to the Life Insurance or 403(b) Retirement Savings Plans. If you are enrolled in a WUSTL health plan, you cannot enroll your family members in Dental-Only coverage. Your covered dependents must be enrolled in exactly the same coverage as you. Basic vision coverage through VSP is included automatically with enrollment in any WUSTL health plan. You can, however, elect to purchase VSP s Buy-Up coverage. If you elect the vision Buy-Up coverage, you must cover the same dependents under that option as are covered under your health plan. VSP providers can locate you in VSP s system using your nine-digit VSP member ID, which is your six-digit WUSTL ID preceded by three zeros. If you fail to verify your dependents covered on your health/dental or dental-only plan during Open Enrollment, you will be included in the annual Dependent Audit and will be required to provide verifying documentation to keep your dependents covered. If you participated in the Health Care FSA or the Health Savings Account (HSA) in 2014 and re-enroll for 2015, you will not receive a new CYC healthcare payment card. Since the card is valid for three years, your 2015 election will be loaded onto your existing card. If you are enrolled in the Health Care FSA for 2014 and enroll in the HSA for 2015, you must have a $0 balance in your FSA as of December 31, 2014 or your HSA enrollment will be delayed until April 1, 2015. You may click the I Have No Changes button on your personalized benefit enrollment page in HRMS Employee Self Service to continue your Individual Only health/dental and/or RMSA election for 2015. Open enrollment elections must be finalized by midnight on Monday, December 1, 2014. For your convenience, ConnectYourCare (CYC), UnitedHealthcare, Anthem Blue Cross Blue Shield, Express Scripts, and WebMD offer apps available through your smartphone s App Store so that you may access your information on the go. Page 4
Page 5
Health Plan Comparison The following comparison is a summary of the benefits of the health/dental plans offered at Washington University and is not intended to replace the plan documents/summary plan descriptions (SPD) which are available on the HR website at http://hr.wustl.edu. For specific plan details and exclusions see the plan document/spd. Annual Calendar UnitedHealthcare UnitedHealthcare UnitedHealthcare Anthem BCBS Anthem BCBS Year Deductible CHOICE HMO CHOICE PLUS POS HDHP PPO EXCEL PPO BASIC PPO Individual In-Network None None $1,500 $500 $750 Out-of-Network N/A $300 $1,500 $500 $750 Family In-Network None None $3,000 $1,500 $2,250 Out-of-Network N/A $900 $3,000 $1,500 $2,250 Out-Of-Pocket Maximum (Incl. co-pays, deductibles, co-ins.) UnitedHealthcare CHOICE HMO UnitedHealthcare CHOICE PLUS POS UnitedHealthcare HDHP PPO Anthem BCBS EXCEL PPO Anthem BCBS BASIC PPO Individual In-Network $1,500 $1,500 $2,750 $2,000 $3,250 Out-of-Network N/A $3,300 $4,000 $3,500 $5,750 Family In-Network $3,000 $3,000 $5,500 $4,000 $6,500 Out-of-Network N/A $6,600 $8,000 $7,000 $11,500 Co-Payment/ UnitedHealthcare CHOICE HMO UnitedHealthcare CHOICE PLUS POS UnitedHealthcare HDHP PPO Anthem BCBS EXCEL PPO Anthem BCBS BASIC PPO Co-Insurance Chiropractic/ Spinal Manipulation In-Network $40 $40 20% 20% 20% Durable Medical In-Network 20% 20% 20% 20% 20% Equipment Emergency Room Care $150 (waived if admitted) Covered as In-Network 20% Covered as In-Network Inpatient Hospital, Rehab, Skilled Nursing In-Network $300 $300 20% 20% 20% Lab & X-Ray Services PREVENTIVE In-Network $0 $0 $0 $0 $0 NON-PREVENTIVE In-Network 10% 10% 20% 20% 20% MAJOR RADIOLOGIC In-Network 20% 20% 20% 20% 20% DIAGNOSTIC Maternity PRENATAL OFFICE VISIT In-Network $0 $0 $0 $0 $0 LAB TESTS/ULTRASOUND In-Network 10% 10% 20% 20% 20% INPATIENT DELIVERY In-Network $300 $300 20% 20% 20% Mental Health & Substance Use Disorders In-Network $300 $300 20% 20% 20% IN-PATIENT OUT-PATIENT In-Network WUDirect - $25 WUDirect - $25 WUDirect - 10% WUDirect - 10% Other - $40 Other - $40 Other - 20% Other - 20% ABA Therapy O/P In-Network WUDirect - $25 WUDirect - $25 WUDirect - 10% WUDirect - 10% for Autism Other - $40 Other - $40 Other - 20% Other - 20% O/P WUDirect - 10% Other - 20% WUDirect - 10% Other - 20% Page 6
Co-Payment / UnitedHealthcare UnitedHealthcare UnitedHealthcare Anthem BCBS Co-Insurance CHOICE HMO CHOICE PLUS POS HDHP PPO EXCEL PPO Office Visit PRIMARY CARE In-Network WUDirect - $15 WUDirect - $15 WUDirect 10% WUDirect 10% Other - $25 Other - $25 Other - 20% Other - 20% SPECIALIST In-Network WUDirect - $25 WUDirect - $25 WUDirect - 10% WUDirect - 10% Other - $40 Other - $40 Other - 20% Other - 20% Anthem BCBS BASIC PPO WUDirect 10% Other - 20% WUDirect - 10% Other - 20% Preventive Exams In-Network $0 $0 0% 0% 0% Surgery IN-PATIENT In-Network $0 $0 20% 20% 20% OUT-PATIENT In-Network $150 $150 20% 20% 20% Therapy Services PT/OT/Speech In-Network WUDirect - $25 WUDirect - $25 WUDirect - 10% WUDirect - 10% Other - $40 Other - $40 Other - 20% Other - 20% Urgent Care In-Network $35 $35 20% 20% 20% Co-Payments/ Co-Insurance Express Scripts Prescription Drug Plan All health plans except UnitedHealthcare HDHP WUDirect - 10% Other - 20% UnitedHealthcare HDHP PPO 30-Day Retail 90-Day Mail-Order 30-Day Retail 90-Day Mail Order Tier One $10* $25* Tier Two 25% 25% $40 min - $80 max $100 min - $200 max Tier Three 50% 50% $60 min - $120 max $150 min - $300 max Specialty Drugs $100 per 30-day supply *For generic drugs used to treat diabetes and heart disease (high cholesterol and hypertension), co-pay is $4 retail, $10 mail-order. 20% co-insurance after deductible VSP Vision Service Plan Co-Payment & Discounts Basic Coverage 1 Buy-Up Coverage 2 Routine Eye Exam In-Network $20 co-pay $20 co-pay Per Calendar Year Out-of-Network Allowance up to $50 Allowance up to $50 Per Calendar Year: PRESCRIPTION EYEGLASSES In-Network 20% discount on lenses and frames/ Allowance up to $50 $40 co-pay (single vision, lined bifocal, trifocal lenses) Frames- $150 allowance ($170 for featured brands) + 20% discount Out-of-Network Allowance up to $50 $50-$100 allowance, based on product OR CONTACTS In-Network Allowance up to $50 $150 allowance for eyeglass frames or contact lenses Out-of-Network Allowance up to $50 Allowance up to $105 Contact Lens Exam & Fitting 15% discount on exam fee 15% discount Exam fee not to exceed $60 Advantica Dental PPO Plan Annual Calendar Individual In-Network $50 Out-of-Network $50 Year Deductible Family In-Network $150 Out-of-Network $150 Employee Co-Insurance Preventive Care In-Network 0% Out-of-Network 3 10% Basic Services In-Network 20% Out-of-Network 3 40% Major Services In-Network 50% Out-of-Network 3 50% Orthodontia In-Network 50% Out-of-Network 3 50% Benefit Plan Maximums Calendar year benefit maximum per person (excludes orthodontia) $1,500 Orthodontia lifetime maximum (employees; covered dependents up to age 26) $1,250 1 Included with health plan 2 Excludes Euclid Power Plant Bargaining Unit Employees 3 Out-of-network benefits are based on Advantica s fee schedule Page 7
2015 Monthly Health Premiums & Surcharge The monthly premiums for the five health plan options include medical, dental, prescription drug and basic vision coverage and are effective January 1, 2015 through December 31, 2015. You may elect Dental Only if you do not need health plan coverage; however, your covered dependents must be enrolled in the same coverage as you. The vision Buy-Up Option is only available if you are enrolled in a health plan. Tier One Faculty & Staff Eligible for Full-Time Health Premiums Earning less than $41,000 INDIVIDUAL ONLY INDIVIDUAL + CHILD/REN INDIVIDUAL + SPOUSE/PARTNER FAMILY UHC Choice HMO $39.79 $205.87 $215.59 $304.44 UHC Choice Plus POS 61.55 286.99 300.54 452.08 UHC High Deductible PPO 9.01 28.18 31.00 60.26 Anthem BCBS Excel PPO 82.24 317.52 332.51 495.55 Anthem BCBS Basic PPO 22.42 65.47 71.20 139.38 Dental Only 2.53 5.27 5.33 9.26 Vision Buy-Up 6.53 14.04 13.09 22.44 Tier Two Faculty & Staff Eligible for Full-Time Health Premiums Earning $41,000 or more INDIVIDUAL ONLY INDIVIDUAL + CHILD/REN INDIVIDUAL + SPOUSE/PARTNER FAMILY UHC Choice HMO $53.60 $269.34 $284.80 $404.63 UHC Choice Plus POS 85.02 388.77 411.08 619.94 UHC High Deductible PPO 14.11 40.84 47.35 90.68 Anthem BCBS Excel PPO 118.11 449.68 475.48 710.27 Anthem BCBS Basic PPO 32.85 91.46 103.83 201.92 Dental Only 2.53 5.27 5.33 9.26 Vision Buy-Up 6.53 14.04 13.09 22.44 Faculty & Staff Eligible for Part-Time Health Premiums INDIVIDUAL ONLY INDIVIDUAL + CHILD/REN INDIVIDUAL + SPOUSE/PARTNER FAMILY UHC Choice HMO $256.98 $569.30 $643.51 $923.43 UHC Choice Plus POS 336.57 744.54 841.96 1,219.20 UHC High Deductible PPO 156.37 330.09 374.43 542.75 Anthem BCBS Excel PPO 454.01 969.70 1,101.04 1,586.84 Anthem BCBS Basic PPO 203.73 411.76 470.16 696.97 Dental Only 5.06 10.53 10.66 18.51 Vision Buy-Up 6.53 14.04 13.09 22.44 Employees Eligible for Full Time Health Premiums Employees who work an average of 30 hours or more per week, as determined in accordance with the provisions of the Affordable Care Act, will be eligible for full time health premiums starting in 2015 (See Employer Shared Responsibility on page 3). Spouse/Domestic Partner Surcharge In addition to the regular health insurance premium, a monthly surcharge of $80 will apply if you are eligible for full-time health premiums, your annual wages are $41,000 or more, you elect to cover your spouse or domestic partner under your WUSTL health plan, and your spouse or domestic partner: is employed on a full-time basis outside of Washington University, and has health insurance coverage available through his/her place of employment. Page 8
Savings Accounts - FSA, HSA and RMSA Flexible Spending Accounts (FSA) FSAs are a great way to pay for out-of-pocket health care and child care expenses on a pre-tax basis. You can contribute up to $2,550 in calendar year 2015 to the Health Care FSA to pay for eligible out-of-pocket health care expenses such as health, dental, prescription drug, or vision plan deductibles, co-pays and coinsurance, eyeglasses, contact lenses and hearing aids. The minimum annual contribution is $120. Enrollment in a WUSTL health/dental plan is not required to participate in the health care FSA. You can contribute up to $5,000 per household in calendar year 2015 to the Dependent Care FSA to pay for eligible dependent care expenses such as licensed day-care, preschool or babysitting services. The minimum annual contribution is $120. To be eligible, services must be rendered for the sole purpose of allowing the parents to work or attend school full-time. Current participants - Don t forget to re-enroll in the FSA plans if you want to participate in 2015. Health Savings Account (HSA) (Not Available to Retirees Returning to Work) If you are enrolled in the UHC High Deductible Health Plan (HDHP), take charge of your current and future health care costs by opening an HSA. WUSTL s HSA allows you to pay for out-ofpocket health care expenses on a pre-tax basis. HSA balances roll over from year to year and your earnings grow tax free. When you retire you may use the balance in your account to pay for out of pocket retiree health care expenses. The IRS regulates HSA plans; therefore, many of the plan design features are a result of those regulations. WUSTL will make a contribution of $400 annually to your HSA account if you are enrolled in individual coverage under the HDHP and you contribute a minimum annual amount based on your wages. WUSTL will contribute $800 annually to your HSA account if you are enrolled in family coverage under the HDHP and you contribute a minimum annual amount based on your wages. The required minimum annual contribution is $200 if you earn less than the IRS stipulated Highly Compensated Employee Threshold (HCT) 1 for 2015 or $400 if you earn at or more than the HCT for 2015. The maximum annual election amount for 2015 is $3,350 for an individual and $6,650 for a family. The University contribution of $400 will reduce your maximum allowed contribution to $2,950 for an individual and the University contribution of $800 will reduce your maximum allowed contribution to $5,850 for a family. HSA participants who will be age 55 or older in calendar year 2015 may elect to make an additional catch-up contribution of up to $1,000. Current HSA participants - Don t forget to re-enroll in the HSA if you want to participate in 2015. ConnectYourCare (CYC) will continue to be WUSTL s FSA and HSA administrator for 2015. Register on www.connectyourcare.com for on-line access to your FSA/HSA account(s). 1 The Highly Compensated Employee Threshold for 2014 is $115,000. The 2015 threshold has not been announced as of publication date. Page 9
Retirement Medical Savings Account (RMSA) (Not Available to Retirees Returning to Work) The RMSA provides you the opportunity to save for the significant cost of retiree health care in a tax favored way while you are still working. Upon retirement at age 55 or older, you may use your accumulated RMSA funds to pay for retiree health plan premiums (including COBRA premiums), Medicare premiums, long-term care insurance premiums and other qualified outof-pocket medical, dental, prescription drug and vision expenses and not be taxed. You can elect the annual amount (minimum of $120) that you want to contribute to the RMSA. Your contributions are deducted from your paycheck throughout the year on an after-tax basis, and the investment earnings on those contributions grow tax-free. Current RMSA participants - To continue your current annual election amount, re-enrollment is not necessary. To learn more about WUSTL s FSA, HSA and RMSA plans, please attend an employee informational meeting (see page 12) or visit our website at http://hr.wustl.edu. Page 10
Dependent Eligibility Verification & On-Line Enrollment Dependent Eligibility Verification WUSTL requires annual verification of dependent eligibility if you are enrolled in a University health insurance or dental only plan and are covering one or more dependents. The verification of dependent eligibility is conducted as part of the annual open enrollment process to ensure that health benefits are being provided fairly and consistently to eligible dependents. If you are currently covering one or more dependents or will add a spouse, domestic partner or child to your health/dental coverage during open enrollment, you must complete the dependent eligibility verification no later than December 1, 2014 in order to cover your dependents as of January 1, 2015. On-Line Enrollment On line enrollment and dependent eligibility verifications will be available through HRMS Employee Self Service from November 10, 2014 until midnight on December 1, 2014. A link to HRMS Employee Self Service can be found on the home page of the Human Resources websites: http://hr.wustl.edu or http://medschoolhr.wustl.edu. To enroll or make changes to your benefits on line, you will need to log in to your personalized benefits page in HRMS Employee Self Service using your WUSTL Key and password. You will only be presented with the benefit plan options that you are allowed to enroll in or change. When you have logged in, select Benefits and then Open Enrollment, and follow the instructions. To assist you, an on line tutorial and answers to frequently asked questions (FAQs) are available on the open enrollment page in HRMS Employee Self Service. If you don t have your WUSTL Key or password, please contact the Help Desk at (314) 935-5707. You may make changes to your open enrollment elections on line until the December 1 st deadline. When you select Finalize, your changes are submitted to the Benefits Office. A confirmation statement of your enrollment will be available for you to print. Please keep a copy of this statement for future reference to make sure all of your elections were entered correctly. You may make on line changes to the following plans: Health/Dental Vision Buy-Up Option Health Care Flexible Spending (FSA) Child Care Flexible Spending (FSA) Health Savings Account (HSA) Retirement Medical Savings Account (RMSA) During the first week of December you will receive an email confirmation that your enrollments/changes have been finalized for the upcoming calendar year. A link to the Benefits Summary page in HRMS Employee Self Service will be included in the email so that you may review your benefit elections effective January 1, 2015. While on-line enrollment is the preferred method for making your open enrollment changes and verifying dependent eligibility, paper enrollment is still an option. Open enrollment forms and the dependent verification affidavit may be obtained from the HR websites or by contacting either Benefits Office. Forms must be received by the Benefits Office no later than December 1, 2014. Page 11
Employee Meetings Schedule Open enrollment meetings are a great opportunity for you to learn more about your benefits and the open enrollment process. If you have questions regarding your benefits or if you would like to learn more about how to enroll on-line, please feel free to attend one of the open enrollment meetings listed below. Pre-registration is not necessary. Danforth Campus Thursday, November 6 10:00 a.m. 11:30 a.m. Anheuser Busch Hall, Bryan Cave Moot Courtroom (No. 310) Tuesday, November 11 2:00 p.m. 3:30 p.m. Danforth University Center (DUC) Room 234 Medical School Campus Tuesday, November 4 10:00 a.m. 11:30 a.m. McDonnell Science Bldg, Erlanger Auditorium Wednesday, November 5 2:30 p.m. 4:00 p.m. Children s Hospital Auditorium, 3 rd Floor Tuesday, November 11 9:00 a.m. 10:30 a.m. McDonnell Science Bldg, Cori Auditorium West Campus Tuesday, November 4 2:30 p.m. 4:00 p.m. Multi-Purpose Room 350 North Campus Wednesday, November 5 10:00 a.m. 11:30 a.m. Conference Room 1312 Information on Your Health Care Benefits Uniform Explanation of Health Care Benefits A standard Summary of Benefits and Coverage (SBC) is available for each of the five health plans offered by the University. Each SBC provides a uniform description of covered benefits, cost sharing provisions, coverage limitations and coverage examples that illustrate the cost of care for certain medical conditions. The SBCs are posted on the Health Plan Comparisons page of the HR/Benefits website at http://hr.wustl.edu. To request paper copies of the SBCs, please contact the Benefits office at (314) 935-3211. Health Insurance Marketplace Coverage Options Individuals have an option to purchase private health insurance through the public Health Insurance Marketplace that was established in connection with health care reform. For more information on coverage options available through the Health Insurance Marketplace, please visit www.healthcare.gov. For comparison purposes, information on your health plan options through Washington University is contained in this Open Enrollment brochure, as well as on the Health Plan Comparisons page of the HR/Benefits website at http://hr.wustl.edu. Page 12
Premium Assistance under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you are eligible for health insurance coverage from Washington University, some states (including the State of Missouri) have premium assistance programs that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren t eligible for Medicaid or CHIP, you won t be eligible for these premium assistance programs; but, you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in the State of Missouri, you may contact Missouri s Medicaid office by phone at 573-751-2005 or on-line at http://www.dss.mo.gov/mhd/participants/pages/hipp.htm 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, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or go to www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible for coverage under the University s health plans, the University must allow you to enroll in a University health plan if you aren t already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in the University s plan, contact the University s Benefits Office or the Department of Labor at www.askebsa.dol.gov or at 1-866-444- EBSA (3272). To see if any other states have a premium assistance program, or for more information on special enrollment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565 Page 13
Notice of Creditable Coverage Important Notice from Washington University in St. Louis about Your Prescription Drug Coverage and Medicare Note: The following information applies only to individuals who are entitled to Medicare benefits. You may disregard this information if neither you nor any of your covered dependents are entitled to Medicare benefits. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Washington University in St. Louis (the University ) and about your options under Medicare s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current prescription drug coverage with the University and Medicare s prescription drug coverage: 1) Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2) The University has determined that the prescription drug coverage offered by the University is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, because you have creditable prescription drug coverage through the University, you can delay enrolling in a Medicare drug plan until you leave the University and/or are no longer eligible for University benefits. (Please note that the University s Medicare Supplement Plan for retirees age 65 or older does NOT include prescription drug coverage. So, it is important that you consider enrolling in a Medicare drug plan at that time in order to have continuous prescription drug coverage.) If you lose your current creditable prescription drug coverage you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. Page 14
Notice of Creditable Coverage (cont d) What Happens to your Current Coverage If You Decide to Join a Medicare Drug Plan? If you decide to join a Medicare drug plan, your current coverage under the University s Prescription Drug Plan will not be affected. There will be no coordination of benefits between your current coverage and coverage under a Medicare drug plan. Because you have creditable prescription drug coverage through the University, you can delay enrolling in a Medicare drug plan until you leave the University and/or are no longer eligible for University benefits. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with the University and do not join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may increase by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information about This Notice or Your Current Prescription Drug Coverage Contact your Benefits Office at (314)-935-7745 (Danforth Campus) or (314)-362-9341 (Medical School Campus). You can find additional information about the University s Prescription Drug plan benefits on the prescription drug plan page of the University s Human Resources website at: http://hr.wustl.edu. NOTE: You ll receive this notice each year and if the prescription drug coverage through the University changes. You also may request a copy of this notice at any time. For More Information about Your Options under Medicare Prescription Drug Coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (For Missouri residents, contact CLAIM at 1-800-390-3330 or www.missouriclaim.org for personalized help) Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call 1-800-772-1213 (TTY 1-800-325-0778). Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Page 15
Contact Information You are encouraged to attend an open enrollment meeting to learn about the various benefits in which you may enroll and/or that you may change during open enrollment. A schedule of meetings is located on page 12. If you still have questions, please email or call a Benefits Representative listed below. Due to the tremendous volume of calls and email messages during open enrollment, if you must leave a message we will make every effort to respond to your question within 24 hours. Benefit Office Contacts MEDICAL SCHOOL BENEFITS OFFICE CAMPUS BOX 8002 FAX (314) 362-2500 Sandy Allen allensa@wustl.edu (314) 362-4929 Pam Guntli guntlip@wustl.edu (314) 362-4925 Mary Ulett mary.ulett@wustl.edu (314) 362-9341 DANFORTH BENEFITS OFFICE CAMPUS BOX 1190 FAX (314) 935-8198 Jennifer Gang jennifergang@wustl.edu (314) 935-7745 Matthew Roser matthew.roser@wustl.edu (314) 935-3211 Peggy Heck peggyheck@wustl.edu (314) 935-5931 For assistance using the online enrollment feature please contact: Medical School Sandy Allen allensa@wustl.edu (314) 362-4929 Danforth Matthew Roser matthew.roser@wustl.edu (314) 935-3211 Vendor Contacts Advantica (Dental) www.advanticabenefits.com 1-800-501-3471 Anthem Blue Cross and Blue Shield www.anthem.com 1-800-843-6447 ConnectYourCare (FSA and HSA) www.connectyourcare.com 1-866-347-7276 Express Scripts (Drug Plan) www.express-scripts.com/wustl 1-877-880-1877 TIAA-CREF (RMSA) www.tiaa-cref.org 1-877-554-1004 United HealthCare www.myuhc.com 1-800-382-2599 VSP (Vision) www.vsp.com 1-800-877-7195 This brochure provides an overview of your benefit options. The complete provisions of the plans are set forth in the plan documents and summary plan descriptions which are available on the Plan Documents page of the Human Resources website at http://hr.wustl.edu. If the information in this brochure is inconsistent with the plan documents, the plan documents will govern. This brochure is not intended as a contract of employment or a guarantee of current or future employment. The plan sponsor(s) reserve the right to amend or terminate each plan at any time. Page 16