Transcript Health Plans - The Medical University of South Carolina

Welcome!
Dee Crawford, Benefits & Records Manager
Patrice Gordon, Benefits Specialist (A-D)
Lisa Beattie, Benefits Administrator (E-M)
LaDeidra Berry, Benefits Administrator (N-Z)
Benefits Fax and Email
792-4674, [email protected]
792-9679, [email protected]
792-5922, [email protected]
792-5924, [email protected]
792-9533, [email protected]
Topics to be Covered
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Retirement Plans
Flexible Spending Plans/MoneyPlu$
Health, Dental and Vision Insurance
Life Insurance
Long Term Disability Insurance
Long Term Care Insurance
Retirement Plan Participation
Mandatory Participation
• Classified Employees and Faculty
• Employees with current SCRS accounts
(active or inactive)
Optional Participation
• Research Grant employees
• Residents and Postdoctoral Scholars
• Employees with annual salaries less than $1200
Retirement Plans
South Carolina Retirement System (SCRS)
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Defined Benefit Plan
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Benefit based on service
Optional Retirement Plan (ORP)
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Defined Contribution Plan
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Benefit based on investments
The pre-tax contribution amount is set by SC Public Employee
Benefit Authority. Contributions will increase to 7.5% on
7/1/2013 and 8% on 7/1/2014.
Quick Overview
SCRS Plan
•The SCRS plan pays a monthly check for life
•Retirement eligibility with 8 yrs earned service
•Full benefits: age 65 or rule of 90
•Reduced benefits: age 60
•Disability Retirement: based upon approval
ORP Plan
•Employer contributes 5%, vested immediately
•Vendor Choice: VALIC, MetLife, Mass Mutual and TIAA CREF
•Must be 59 ½ to withdraw funds without penalty
Benefit With Either Plan
•Death Benefit: life insurance that is equal to 1x salary, after 1 yr of service
•Eligible to continue health insurance at retirement if certain criteria are met
Retirement Plan Participation
You have 30 days from your hire date to select a plan.
If you are required to participate, you will automatically default to
SCRS if you do not make a selection within 30 days.
If you have the opportunity to participate and do not select a plan,
you will automatically default to Non-Membership.
If you select or are defaulted to Non-Membership, you will only be
eligible to select a retirement plan if you are assigned to a
position that requires participation.*
Per SC Code of Laws, election of membership is permanent until
you separate employment.
*this means you cannot decide to participate at a later time during residency if you
choose non-membership at the time you are hired
Retirement Open Enrollment
• January 1st - March 1st each
year
• If currently enrolled in ORP,
may irrevocably elect to switch
to SCRS if by March 1st if it is
at least 12 months from your
initial enrollment, but no more
than 60 months
• May switch ORP vendors
Retirement
Please review the “Select Your Retirement” brochure
and the video on the MUSC Residents website for
detailed information on each plan.
Insurance Guidelines
Effective Date
• July 1, 2013 (for residents
who begin employment 7/1)
Initial New Hire Period
• May make a change to any
insurance within 31 days of
your hire date
*THE INFORMATION CONTAINED IN THIS
PRESENTATION IS MEANT TO BE AN OVERVIEW.
EMPLOYEES ARE RESPONSBILE FOR READING BENEFIT
DETAILS FOUND IN THE INSURANCE BENEFITS GUIDE
Insurance Guidelines
Family Covered by State Insurance
• The State Employee Insurance
Program does not allow an
employee to cover their spouse or
children on health, dental or life
insurance if they are covered by
another State Insurance Plan.
• This guideline results in lower
premiums for the entire family!
Transfer from another
State Entity
• If you have less than a 15
day break in service, you
must continue the same
coverage you had with
your previous employer.
MONEYPLU$
Enables you to deduct
certain expenses
before Federal, State,
and FICA taxes are
calculatedresulting in higher take
home pay and
lowering your taxable
income!
MONEYPLU$
Pre-tax Insurance Premiums (Eligible Immediately)
• Pays health, dental, and optional life* premiums before taxes
• ($.28 monthly administration fee)
• *Pre-tax premiums up to $50,000 in optional life coverage
Dependent Care Spending Account (Eligible Immediately)
• Allocate pre-tax funds to reimburse for dependent care expenses for children
age 12 and younger($5,000 maximum)
• $3.14 monthly administration fee
• Expenses incurred in the calendar year and money not reimbursed is lost
Medical Spending Account (Eligible after 1 year of employment and must wait
until October of that year to enroll)
• Allocate pre-tax funds to pay for you/family’s eligible
medical, dental, and prescription expenses ($2,500 maximum)
• $3.14 monthly administration fee
• All remaining funds at calendar year-end not used by
March 15th of the following year are forfeited.
MONEYPLU$
Health Savings Account
• Only eligible if enrolled in the State Savings Plan
• Save money for qualified medical expenses with an interest bearing
checking account with Wells Fargo
• ($20/yr or $2.00 /month admin fee)
• Account funds roll from year to year; make a change to the contribution
amount at any time
• Eligible to keep this account if you leave employment with MUSC
• Employees may also use a Limited-Use Medical Spending Account
annually to pay for dental and vision expenses.
• There are two steps to enroll in an HSA:
• Complete Section A on the FBMC form in your packet and return to HR
• You must also enroll online with Wells Fargo to open the account,. Complete
the application online, print and mail to the appropriate address.
• The Employer ID needed is 002470000000000.
Insurance Guidelines
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The State Savings and Standard Health Plans require notification within 24 hours of
any specific diagnosis, injury or illness. It is the subscribers responsibility to call
Medi-Call to notify the insurance. There are monetary penalties for failure to obtain
certification when required. You must also notify them within the 1st trimester of
pregnancy.
BlueChoice HMO Plan require specialist referrals. HMO subscribers should contact
their insurance plan when they receive their card to select a Primary Care Physician.
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The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires
employers to offer all employees and/or their eligible dependents continuing group
health and dental insurance for up to 18 months if they meet specific qualifications.
• COBRA coverage requires payment of full premiums
• Letter of COBRA coverage sent to all new employees and exiting employees
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Pre-existing Conditions
• Conditions diagnosed within 6 months prior to the effective date of coverage will
not be covered for 12 months, UNLESS…
• a certificate of health coverage is provided showing 12 months of prior coverage
(with less than a 62 day break)
Health Plans
Information to consider when choosing a health insurance plan:
1. Consider the monthly premium rates
2. How often do you go to your physician and or hospital
(Physical Exams) ?
3. Do you prefer freedom of choice with the provider or
having a Primary Care Physician?
4. How often and where do you travel?
Health Plans
Please review the “Comparison of Health Plan Benefits”
on the MUSC Residents website
Detailed information on each plan
may also be found in the
Insurance Benefits Guide.
Tobacco Surcharge
Effective January 1, 2010, the SC Budget and Control Board has approved a
monthly surcharge be added to the health insurance premiums of tobacco users.
The State Health Plan and BlueChoice HMO are self-insured. All
premiums are placed in a fund and used to pay claims. Illnesses caused and
contributed to by tobacco use cost this fund an estimated $75 million each year.
The subscriber is charged based on the level of health insurance.
• Enrollee Only: $40/ month
• Enrollee/Child(ren): $60/month
• Enrollee/Spouse: $60/month
• Family: $60/month
Employees are required to certify whether they, or anyone covered on their
insurance, are tobacco users. A non-tobacco user is someone who has not
used tobacco within the past six months. Tobacco use is smoking tobacco in
such forms as a cigarette, pipe or cigar, or using smokeless tobacco, such as
snuff or chewing tobacco (nicotine chewing gum is excluded).
Tobacco Surcharge
If you fail to complete the certification you will automatically be
charged the tobacco-user premium based on your level of health
insurance coverage. Once the certification is completed, the lower
premium will be effective the first of the month after the
certification is received.
-If a subscriber certifies that all dependents covered are non-tobacco
users and it is determined that you or any of your covered
dependents have used tobacco products within the past six months
or started using tobacco products after the date of your certification
as non-tobacco user(s), and you did not notify EIP, you will be
subject to penalties including, but not limited to:
-Payment of the additional surcharge, plus a 10-percent penalty, for
each month since your last certification
-Elimination of the out-of-pocket maximum for the current and the
subsequent year.
Tobacco Surcharge
MUSC and EIP care about your health and would like
everyone to be eligible for the non-tobacco-user
premium. Help is always available for those who
want to quit using tobacco.
Please see your orientation packet for information on
tobacco cessation programs available through MUSC
and the health insurance providers.
Mental Health & Substance Abuse*
• Must use In-Network Providers
• Each health plan has a specific network
• Visits are subject to co-payments
• Pre-Authorization is necessary
* included in medical premiums
Prescription Drug Benefits*
31 day supply (retail)
Generic, Preferred, Non-Preferred
Mail Order Available- Extended 90 day supply of
prescriptions for a discounted rate.
The Ashley Avenue and Rutledge Tower Pharmacy will honor the 90
day rate for the Standard Health Plan.
* included in medical premiums
Vision Care Discount Program
Vision Care Discount Program
• Is free for all State Employees and their dependents.
• The program offers you discounted vision care
services. Participating providers have agreed to charge
no more than $60 for a routine eye examination and
give a 20% discount on all eyewear (except disposable
contact lenses).
State Vision
Plan
The Vision Plan is available for
a low monthly premium.
Please review the MUSC
Residents Website for more
information.
Employees may access network
providers at:
www.eyemedvisioncare.com.
The State Dental Plan
Class I - Preventive Services
• 100% of Allowable Charges
Class II - Basic Services
• 80% of Allowable Charges with $25
deductible
Class III - Prosthetics
• 50% of Allowable Charges with $25
deductible (excludes implants)
Class IV – Orthodontia
• 50% of Fee Schedule
• $1000 Lifetime Benefit (dependents
under age 19)
• The yearly maximum for each
dependent is $1,000.
• Allowable Charge - The maximum
amount paid for a covered service.
Dental Plus
• Raises the allowable charge to an
amount higher than on the basic
plan
• Combined benefit year maximum
benefit is now $2,000 per
dependent
• Same coverage as carried on State
Dental Plan
• NO additional orthodontia
benefits
• Employee must pay the basic and
plus premiums
Dental Premiums
Please review the Classes of Dental Procedures and Dental
Premiums on the MUSC Resident website.
Basic
Life Insurance
• Free with enrollment in any health plan
• $3,000 coverage
Optional Term
Life Insurance
• As a new hire, an employee may select up to 3 times their current salary,
without providing medical evidence
• Employee may select up to $500,000 if medical evidence is approved
• Premiums based on coverage and age
• Accidental Death and Dismemberment Benefits
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Accidental Death equal to amount of life insurance
Dismemberment Benefits (see IBG for schedule of benefits)
Seat Belt (25% ) and Air Bag (5%) Riders for automobile accidental death
Felonious Assault Benefit
Day Care Benefit- the lesser of 5% of the face value or $10,000 per year, 2-year max
Education Benefit- the lesser of 5% of the face value or $5000 per year, 4-year max
• Repatriation Benefit
• Accelerated Death Benefit (under age 60)
• Will preparation and estate resolution services at no charge
Optional Life Premiums
Life insurance premiums can be found on the
MUSC Residents website.
Dependent
Life Insurance
Spouse
Dependent Child(ren)
With Employee Coverage
•$15,000
•$10,000 or $20,000-with no medical
evidence needed
•Premium is $1.24 for any
number of children
•May increase up to 50% of employee’s
coverage or $100,000 -if medical
evidence is approved
Without Employee Coverage
•Only $10,000 or $20,000
•Premium is based on amount of
coverage and employee’s age
Dependent Life Premiums
Dependent life insurance premiums can be found
on the MUSC Residents website.
Spouse life insurance premiums are based on the
employee’s age.
Basic Long Term Disability
• Free with enrollment in any health insurance plan
• Monthly benefits
• 62.5% of base salary
• Maximum monthly benefit is $800 per month
(annual salaries over $15,000 will exceed the
monthly benefit)
• 90 day waiting period
• Benefits are coordinated with other group benefits
- Sick Leave, Annual Leave, Retirement, Social
Security, Workers’ Compensation, etc.
• Pre-existing conditions will not be covered for 12
months from date of coverage.
Supplemental
Long Term Disability
• Premium based on salary and age.
• Monthly benefits
• 65% of base salary up to $147,692/year.
• Maximum monthly benefit is $8,000 per month.
• Minimum monthly benefit is $100 per month.
• 90 or 180 day waiting period
• Benefits are coordinated with other group benefits Sick Leave, Long Term Disability, Retirement,
Social Security, Workers’ Compensation, etc.
• Pre-existing conditions will not be covered for 12
months from date of coverage.
Supplemental
Long Term Disability
The rates for Supplemental Long Term Disability
can be found on the MUSC Residents website.
Supplemental Benefits
• Additional benefits not provided by the state Employee
Insurance Program available through supplemental
providers
• Benefits include Short Term Disability, Whole Life
Insurance, Hospitalization Benefits, Cancer Insurance,
Accident Insurance
• Premiums are available for payroll deduction
• Visit the Benefits website at for list of approved
companies
• May enroll at any time of the year
Long Term Care
Insurance
• Coverage available for self, spouse, or parents
• No medical evidence needed for employee if enrolled within the first 31
days of hire
• Cost of coverage based on the age and benefit of insured
• Eligibility is based on the inability to perform two of six (two of five with
the Disability Model) activities of daily living - bathing, dressing, eating,
transferring, continence & toileting, or have a severe cognitive impairment
such as Alzheimer’s
• Choose a daily benefit amount. This is the maximum amount of coverage
your plan will pay for each day.
• Benefits begin after a once-in-a-lifetime 90 day period
• Benefits may be used towards the cost of at home care, in an assisted
living facility, adult day care, nursing home or hospice.
• May continue coverage at the same group rates if you change jobs.
• Please contact your Benefits Counselor for more information.
Changes to Employee Benefits
Initial Changes
 (31 Days from Date of Employment)
 Change Health Insurance Carrier
 Add/Drop health or dental coverage for yourself or dependents
 Add/Drop Optional and Dependent Life, Supplemental Long Term
Disability, or Long Term Care Insurance
Qualifying Event Changes
 (31 Days from Date of Event)
 Marriage
 Separation/Divorce
 Birth or Adoption
 Death
 Employment Change of Spouse
 Dependency Change for Children-children eligible to be covered until age
26 if they are not available for other employer coverage
Year Round Allowable Changes
The following changes are allowed anytime during the year
with medical evidence of good health:
• Add/Increase Dependent Spouse Life Insurance
• Add/Increase Supplemental Long Term Disability
• Add/Increase Long Term Care
The following changes are allowed anytime during the
year:
• Enroll in or change HSA contributions
• Change H.M.O. Physician
• Drop Dependent Life, Supplemental Long Term
Disability, or Long Term Care Insurance
• Change beneficiaries
Insurance Enrollment Periods
OCTOBER 1st – OCTOBER 31st
Changes made during October will be effective January 1st of
the following year, including any premium changes
Annual Enrollment
Open Enrollment
Change health plans (ie: BlueChoice to
Change health plans (ie: CIGNA to Standard)
Standard)
Enroll/Re-enroll in Medical Spending,
Enroll/Re-enroll in Medical Spending,
Dependent Care or Health Savings Accounts Dependent Care or Health Savings Accounts
Any Special Changes Allowed by Insurance Any Special Changes Allowed by Insurance
Carriers
Carriers
*If enrolled in pretax feature,
*If enrolled in pre-tax feature,
add/drop/increase/decrease optional life add/drop/increase/decrease optional life
Add/drop state vision plan for yourself or Add/drop state vision plan for yourself or
dependents
dependents
Add/drop yourself or dependents from
Health or Dental
Add/drop Dental Plus
Returning Enrollment Forms
Please return all forms in the packet from Human Resources as
directed in the instructions. Even if you are undecided on some
selections, please sign and return the forms to the Benefits Office.
Our counselors will process your paperwork and meet you at
Orientation to obtain information that was incorrect or omitted.
If you need assistance selecting your benefits, please do not hesitate
to contact your counselor for more information. We look forward
to meeting you in person at Orientation!