Transcript Document

University of California
Postdoctoral
Scholar
Benefits Plan
Agenda

Open Enrollment

Postdoc Titles and Title Codes

Review of Benefits & Plan Design Changes

Review of the Open Enrollment Process

Postdoctoral Scholars (PDS) Contributions for the
HMO and PPO Medical Plans Effective 1-1-2013

Q&A
Introduction
The Postdoctoral Scholar Benefits Plan
(PSBP)
 The University of California has partnered with
Garnett-Powers & Associates to administer the PSBP
on a system wide basis.
 As of January 1, 2005 the system wide University of
California Postdoctoral Scholar Benefits Plan was
made available to Postdoctoral Scholars (PDS) at UC.
 The PSBP is a comprehensive package of benefits
designed to closely match the benefits offered to the UC
Faculty and Staff .
What is Open Enrollment?
Open Enrollment is the period of time the University sets up
each year to allow eligible postdocs to choose from the plans
available to them.
What changes can be made
during Open Enrollment?
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Change from the medical HMO to the PPO plan or vice
versa.
Change from the dental HMO to the POS plan or vice versa.
Add eligible family members.
Enroll in or terminate coverage for the medical, dental
and/or vision plans.
Postdoc Title Codes
 Title Code 3252 - Postdocs paid through the UC payroll
system have been appointed in the title “Postdoctoral
Scholar-Employee”.
 Title Code 3253 - Postdocs paid a stipend have been
appointed in the title “Postdoctoral Scholar-Fellow”.
 Title Code 3254 - Postdocs paid directly from an
extramural agency have been appointed in the title
“Postdoctoral Scholar-Paid Direct”.
Note: The title of a Postdoctoral Scholar appointment is determined by
the requirements of the funding agencies.
Benefits Offered Through PSBP
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Medical Insurance – Health Net HMO and PPO
Dental Insurance – Health Net HMO and Principal
POS
Vision Insurance – Health Net/EyeMed PPO
Life and AD&D Insurance – Standard Insurance
Short Term Disability Insurance – Standard
Insurance
Voluntary Long Term Disability Insurance –
Standard Insurance
SelectPlus/Sittercity
Plan Design Changes and Updates
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If a plan was in place on March 23, 2010 and the plan does not make any major
changes at their annual renewal then the plan is considered
“grandfathered”. The PSBP medical plans are grandfathered plans. This means
that many of the provisions of the new healthcare law, do not apply to
grandfathered plans, including the access to most birth control items at no cost
to the covered individual.
All birth control prescriptions will still be covered the same as they are
currently with the exception of implantable contraceptive devices. (For
example, an IUD) on the HMO plan.
The dental HMO plan has lowered the cost of crowns.
The dental PPO plan has now changed to a Point-of-Service (POS) plan.
The percentage contribution amount required by a postdoc to pay for the HMO
medical plan remained the same for plan year 2013.
The amount required for a postdoc to pay for the medical contribution for the
PPO plan was lowered for plan year 2013.
Effective April 1, 2013, the PSBP will terminate the last day of the month that a
postdoc was active.
MEDICAL
INSURANCE
What is an HMO Plan?
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Under the HMO model, the member chooses a Primary Care Physician (PCP)
contracted with the HMO plan at the time of enrollment (provider directory links
are available on the GPA website). A PCP will automatically be assigned to you at
the time of your enrollment. You can choose a PCP for each family member by
calling the insurance company to request a PCP change. Your PCP becomes your
healthcare “gatekeeper”.

If the member is in need of treatment from a Specialist or is in need of an InPatient or Out-Patient procedure, he/she must obtain a referral from their PCP
prior to any type of consultation or treatment (except in the case of an emergency).
If the referral is not obtained, no benefits will be paid.
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There is no Out-of-Network benefit (except in the case of an emergency).
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HMO premiums as well as the out of pocket expenses (i.e. deductible, co-payments,
etc.) tend to be lower than their PPO counterpart due to the contractual element of
“capitation”.*
* Capitation: The PCP is compensated by the HMO plan in the form of a monthly
capitation fee for each member that signs up with him/her at the time of
enrollment. The PCP has agreed to provide all primary care, as well as the cost for
most Labs & X-rays for that capitated fee.
What is a PPO Plan?
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When covered under a PPO plan, the member will not be assigned to a
Primary Care Physician (PCP) at the time of enrollment.
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The PPO plan offers more flexibility than the HMO plan. As a result, the
out-of-pocket costs tend to be higher.
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There is an In-Network and Out-of-Network component.
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The In-Network benefits (deductible, coinsurance, etc.) will be greater
than the Out-of-Network benefits.
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At the time of service, the member has the ability to seek care from a
Specialist, without having to obtain a referral from a PCP.
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The contractual agreement between the PPO Plan and the Provider is on
a “discounted fee for service” basis. This means that the provider who
participates in the network has agreed to provide their service on an
agreed upon discounted fee. The Provider who is not in the network will
not agree to that discounted fee and will typically charge a “Reasonable
and Customary” fee. There is no “capitation” in a PPO contract.
PSBP Medical HMO Plan
Health Net of California
Medical Benefits
Health Net HMO
Postdoctoral Scholar Pays
Physician Office Visit:
Hospitalization:
Inpatient
Outpatient
Pregnancy
Prescription Drugs:
Generic
Brand Name
Non-Formulary
Emergency Room Visits:
Health Evaluation:
Mental Health :
Inpatient
Outpatient
Annual Maximum Out of Pocket:
Individual
Family
Annual Deductible:
Individual
Family
Lifetime Maximum:
$10 Copay
No Charge
No Charge
No Charge
$10 Copay
$20 Copay
$35 Copay
$35 Copay (waived if admitted)
$10 Copay
No Charge
$10 Copay
$1,500
$4,500
None
None
Unlimited
PSBP Medical PPO Plan
Health Net of California
Medical Benefits
Physician Office Visit:
Hospitalization:
Inpatient
Outpatient
Pregnancy
Prescription Drugs:
Generic
Brand Name
Non-Formulary
Emergency Room Visits:
Routine Physical Exam:
Mental Health (Severe):
Inpatient
Outpatient
Annual Maximum Out of Pocket:
(Does not include deductible)
Annual Deductible:
Individual
Family
Lifetime Maximum:
Health Net PPO (In-Network)
Postdoctoral Scholar Pays
Health Net PPO (Out of Network)*
Postdoctoral Scholar Pays
$20 Copay
40%
$250 Copay then 20%
$0 Copay
$250 Copay then 20%
$250 Copay then 40%
40%
$250 Copay then 40%
$10 Copay
$25 Copay
$35 Copay
20%
$20 Copay
50% + $10 Copay
50% + $25 Copay
50% + $35 Copay
40%
40%
$250 Copay then 20%
$0 Copay
$1,500 Individual
$4,500 Family
$250 Copay then 40%
40%
$1,500 Individual
$4,500 Family
None
None
$200
$600
Unlimited
*Out of Network reimbursement based on limited fee schedule.
Wellness Programs
The following benefits are included in your Health Net Medical plan:
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Health Net offers Text4Baby, a free service that provides free text
messages up to 3 times a week with information to assist you
through your pregnancy and your baby’s first year. In order to
register, text BABY to 511411.
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If you are pregnant, or thinking of starting a family, the Decision
Power Healthy Baby Take 5 Maternity Program offered through
Health Net provides you valuable information to assist you in
having a healthy pregnancy and delivering a healthy baby. Many
subjects are covered through a series of videos, offering
information on exercise, nutrition, weight management,
breastfeeding and other important aspects of pregnancy.
Wellness Programs, cont.
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Decision Power is a program through Health Net that offers a
variety of methods to track possible health risks and identify
potential problems. The goal of this program is to assist through
online coaching with a guide to pregnancy, tobacco use, weight
management, nutrition and stress reduction.
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If you wish to make the healthy decision to quit smoking, Smoking
Cessation offers a plan to help you kick the habit with the
assistance of either online or telephone support.
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Lose Weight is another health-wise program offered through
Decision Power that keeps you motivated to lose weight, offers
healthy eating choices and counseling from a health coach.
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To access detailed information about these valuable programs, go
to www.garnett-powers.com/postdoc/wellness .
DENTAL
INSURANCE
PSBP Dental DHMO Plan
Health Net of California
Dental Benefits
Deductible:
Diagnostic and Preventative Care:
Routine Oral Exams
Routine Teeth Cleanings
Routine X-Rays
Health Net DHMO
Postdoctoral Scholar Pays
None
No charge
No charge
No charge
Basic Procedures:
Fillings
Oral Surgery
Endodontics
Periodontics
Varies up to $80 copay
Varies up to $130 copay
Varies up to $150 copay
Varies up to $300 copay
Major Procedures:
Crowns
Varies up to $200 copay
Orthodontics:
Comprehensive Treatment- Child
Comprehensive Treatment- Adult
$1,950 copay plus start-up fees and retention
$2,250 copay plus start-up fees and retention
Annual Maximum:
Unlimited
What is a POS Plan?
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When covered under a Point-of-Service (POS) plan, the member will not be assigned
to a Primary Care Dentist at the time of enrollment.
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The POS plan offers more flexibility than the HMO plan. As a result, the out-ofpocket costs tend to be higher.
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There are two In-Network options. An Exclusive Provider Organization (EPO) and
a Preferred Provider Organization (PPO). There is also an Out-of-Network option.
The In-Network benefits (deductible, coinsurance, etc.) will be greater than the Outof-Network benefits.
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The contractual agreement between the POS Plan and the Provider is on a
“discounted fee for service” basis. This means that the provider who participates in
the network has agreed to provide their service on an agreed upon discounted fee.
The Provider who is not in the network sets their own fees and these fees are often
higher than what is considered “Reasonable and Customary” fees.
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The EPO discounts up to 50% and the PPO discounts up to 30% for procedures
performed by participating providers, greatly reducing your out-of-pocket costs.
The calendar year maximums are combined for the EPO and PPO at $1,700.00 per
person. The calendar year maximum for out-of-network is $1,500.00 per person.
PSBP Dental POS Plan
Principal Financial Group
Principal EPO/PPO (In-Network)
Postdoctoral Scholar Pays
Principal PPO (Out-of-Network)
Postdoctoral Scholar Pays
Calendar Year Deductible:
None
$50 per person, waived for
Diagnostic and Preventative Care
Diagnostic and Preventative Care:
Routine Exams
Routine Teeth Cleanings
Routine X-Rays
No charge
No charge
No charge
No Charge, except for the amount of
the dentist’s fee that exceeds
Principal’s scheduled allowance
Basic Procedures:
Fillings
Endodontics
Non-Surgical Periodontics
Simple Oral Surgery
10%
10%
10%
10%
20% of the scheduled allowance,
after the deductible is met, plus
the amount of the dentist’s fee that
exceeds Principal’s scheduled
allowance
Major Procedures:
Crowns
Bridgework
Dentures
Complex Oral Surgery
50%
50%
50%
50%
50% of the scheduled allowance,
after the deductible is met, plus the
amount of the dentist’s fee that
exceeds Principal’s scheduled
allowance
Orthodontia (Adult and Child):
$1,000 Lifetime Maximum
50%
50% of the scheduled allowance,
after the deductible is met, plus
the amount of the dentist’s fee
that exceeds Principal’s scheduled
allowance
VISION
INSURANCE
PSBP Vision PPO Plan
EyeMed through Health Net of California
Vision Benefits
Health Net PPO (In-Network)
Postdoctoral Scholar Pays
Health Net PPO (Out of Network)
Postdoctoral Scholar Allowance
Exam with Dilation (if necessary):
$0 Copay
Up to $40
Standard Plastic Lenses:
Single Vision
Bifocal
Trifocal
Lenticular
$10 Copay
$10 Copay
$10 Copay
$10 Copay
Up to $40
Up to $60
Up to $80
Up to $80
$0 Copay, $120 retail allowance
for any frame, plus 20% off
balance over allowance
Up to $45
Frames:
Lens Options:
UV Coating
Tint (solid and gradient)
Standard Scratch Resistant
Standard Progressive
Conventional Contact Lenses:
$15
$15
$15
$45
N/A
N/A
N/A
N/A
$105 allowance toward contacts,
plus 15% discount off balance over
allowance
Up to $105
Frequency:
Examination
Lenses or Contact Lenses
Frame
Once Every 12 Months
Once Every 12 Months
Once Every 24 Months
LIFE AD&D
INSURANCE
AND
PSBP Life Insurance
and
Accidental Death & Dismemberment Plan
The Standard Insurance Company
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The plan pays $50,000 in the event of a death.
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The plan pays an additional $50,000 in the event of an Accidental Death.
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AD&D Seat Belt Benefit – Up to $10,000 is payable for death as a result of a car
accident while wearing a seat belt.
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Accelerated Benefit Provision – Allows eligible members who are terminally ill
to receive an early allocation of up to 75% of their group life insurance benefit.
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All Postdoctoral Scholars (Title Code 3252, 3253 and 3254) are automatically
enrolled in the Life and AD&D insurance.
SHORT -TERM
DISABILITY INSURANCE
PSBP
Short-Term Disability Plan
The Standard Insurance Company
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The plan will pay 70% of the first $1,429 weekly pre-disability earnings.
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The maximum weekly benefit is $1,000 per week.
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The minimum benefit is $25.00.
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The benefit waiting period is 0 days for disability caused by an accidental
injury and 7 days for disability caused by sickness or pregnancy.
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The maximum benefit period is 180 days.
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The plan covers non-occupational disability only.
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All Postdoctoral Scholars (Title Code 3252, 3253 and 3254) are
automatically enrolled in the STD plan.
Repatriation & Medical
Evacuation Coverage
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International Postdocs and their
dependents are not required to purchase
supplemental coverage for their J1 and
J2 Visa requirements. The PSBP ShortTerm Disability plan satisfies these
requirements even if the Postdoc waives
the medical, dental, or vision coverage.
Voluntary LONG -TERM
DISABILITY INSURANCE
PSBP Voluntary Long-Term Disability Plan
The Standard Insurance Company
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This benefit is voluntary and is paid 100% by the Postdoctoral Scholar. This
benefit is not an open enrollment choice and is only available during your
period of initial eligibility. If you decide to enroll at a later date, you will have to
complete a medical questionnaire and you may be declined or approved. This
process may take as long as fifteen weeks.
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The Benefit Waiting Period is 180 days of disability. This program starts when
the Short Term Disability ends.
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The plan will pay 60% of the first $7,500 of your monthly pre-disability
earnings.
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The maximum monthly benefit is $4,500. This benefit is reduced by deductible
income such as workers’ compensation.
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Once approved, benefits are payable each month while you are disabled up to
age 65. The benefit maximum is graded according to the Age Discrimination
Employment Act, if you are disabled after age 62.
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The Long Term Disability Insurance Monthly Premium is $7.95.
SelectPlus/Sittercity
Search for caregivers using a direct search based
on criteria important to you, or post a job and
have candidates apply to you
 Read profiles and reviews of caregivers
 Check caregivers’ references
 View background checks for the candidates you
prefer
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The Open Enrollment
Process
The Open Enrollment Process
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The PDS should go to the Garnett-Powers & Associates website at
www.garnett-powers.com/postdoc/ and click on the “Enrollment” link and
then the sub link “Open Enrollment”.
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You may qualify to make open enrollment changes through At Your
Service Online (the university’s online enrollment system) even if you did
not enroll through AYSO initially.
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The PDS should then click on the “Open Enrollment Instructions” link
and print them out for assistance with completing the enrollment form
properly. The instructions will guide you through the appropriate parts of
the form that need to be completed to reflect your changes for 01/01/13.
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Once the instructions are in hand, click on “Open Enrollment Form”.
The enrollment form must be completed online.
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When the enrollment form is complete, the PDS must confirm that s/he
has read and understands the “COBRA Initial Notification” as required
by federal regulations.
The Open Enrollment Process, cont.
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Please submit your completed enrollment form with your open enrollment
changes to your appropriate campus contact no later than 5:00pm
November 20, 2012.
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If changes are made at open enrollment, ID cards will be mailed to the
Postdoctoral Scholar’s home address.
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If you are not making any changes, you do not need to take any action.
Your current enrollment will remain the same.
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If the PDS (Title Code 3252, 3253 and 3254) chooses not to participate in
the PSBP, s/he must complete the waiver portion of the enrollment form
and turn it into the Departmental Postdoc Administrator.
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All PDS (Title Code 3252, 3253 and 3254) will be enrolled for the Short
Term Disability and Life Insurance plans.
Postdoc Contributions
PDS Monthly Contributions
For The HMO Medical Plan
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Effective 1-1-2013 the PDS will make the following monthly
contribution if enrolled in the Medical HMO Plan:
Coverage Type
Monthly Contribution
Postdoc Only
$8.50
Postdoc + Spouse or Domestic Partner
$30.59
Postdoc + Child(ren)
$14.87
Postdoc + Spouse + Child(ren)
$38.87
PDS Monthly Contributions
For The PPO Medical Plan
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Effective 1-1-2013 the PDS will make the following
monthly contribution if enrolled in the Medical PPO
Plan:
Coverage Type
Monthly Contribution
Postdoc Only
$20.00
Postdoc + Spouse or Domestic Partner
$40.00
Postdoc + Child(ren)
$40.00
Postdoc + Spouse + Child(ren)
$60.00
The Collection Process
Postdoctoral Scholars with sufficient funds,
will have their contributions deducted from
their checks via the payroll system.
 Postdoctoral Scholars with insufficient
funds, will have their contributions collected
via invoice through GPA.
 GPA will collect contributions for the HMO
and PPO Medical plans and the Voluntary
Long Term Disability plan.

Family Member Eligibility
Family member eligibility requirements are the same as the family
member eligibility requirements for the UC Faculty and Staff plans.
The major family member categories are the following:

Spouse
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Natural or adopted child or children to age 26 for medical plans
(unless eligible to continue coverage because of disability). Adult
age children are not eligible to enroll if they are eligible for their
own employer-sponsored plan.
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Same-sex domestic partner
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Opposite-sex domestic partner (per AB205)
Note:
When two family members are employed through the UC,
duplicate coverage is not allowed.
Garnett-Powers & Associates (PSBP)
Forms Processing
Enrollment, Change, Cancellation or Waiver Forms
for Postdocs:
Please send to:
Nelson Hall
[email protected]
643-7546
UCB Information Sources
UCB Postdoctoral Benefits Coordinator:
Nelson Hall
2199 Addison St., Room 192, Berkeley, CA
94720-3540
510-643-7546
[email protected]
Information Sources
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Website: Garnett-Powers’ PSBP website
www.garnett-powers.com/postdoc
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Toll Free Phone: Garnett-Powers’ PSBP
customer service
800-254-1758
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Email Address: Garnett-Powers’ email address
[email protected]