This year is different Your 2015 Annual Enrollment Decision Guide

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Your 2015
Annual En
rollment
Decision G
uide
Annual Enrollment:
October 20 - 31, 2014
This year is different
You must select and submit a medical plan choice or waive
coverage during this year’s Annual Enrollment. If you take no
action by October 31, you and your currently enrolled family
members will be defaulted to the Healthy Savings Plan on an
after-tax basis effective January 1, 2015.
What’s inside
What’s new for 2015
1
What you need to do
1
Earn up to $450 in
wellness incentives
2
Your 2015 medical plan options
4
Healthy Savings Plan
4
Custom Network Plan
5
PPO Plan
6
Prescription drug coverage
7
Compare your medical
plan options
8
HSAs and FSAs: what’s
the difference?
10
Resource list
12
What’s new for 2015
This year, the University of Missouri is taking a new
approach to our medical plan offerings – designed to slow
the growth of health care costs for faculty and staff as well
as the university, and reward you for a healthy lifestyle. You
will see an innovative new plan in Columbia, changes to
our existing medical plans and employee contributions, and
expanded wellness incentives.
Medical plan changes
New, more descriptive plan names for our
medical options:
• Healthy Savings Plan: formerly myOptions Health Plan
• PPO Plan: formerly myChoice Health Plan
Healthy Savings Plan changes:
• University contribution to Health Savings Account:
º Self only: $400
º Self & spouse: $800
º Self & child(ren): $800
º Family: $1,200
Custom Network Plan: This is a new option for those who
live and/or work in the Columbia area. The plan offers a
focused network of providers – most affiliated with the
University of Missouri Heath System.
PPO Plan changes:
• Deductible
º In-network: $350/person; $1,050/family
º Non-network: $700/person; $2,100/family
• Out-of-Pocket Maximum:
º In-network: $3,600/person; $7,200/family
º Non-network: $7,500/person; $15,000/family
º Prescription drugs: $3,000/person; $6,000/family
• Elimination of discounted physician copay for using
university providers
New medical and vision plan employee contributions:
see enclosed premium insert for details.
Up to $450 in wellness incentives
The university is increasing its commitment to your health with
new wellness resources and rewards. See page 2 for details.
Active enrollment required—take action to make
sure your coverage for 2015 is the right fit for you
Unlike previous years, you must select and submit a medical
plan choice or waive coverage. Both you and the university
contribute a significant amount toward your medical
coverage. With this kind of investment, you should make
sure you enroll in the medical option that best suits your
needs. If you take no action by October 31, 2014,
you and your currently enrolled family members will
be defaulted to the Healthy Savings Plan for 2015
and pay taxes on the premiums. If you previously
waived coverage and do not waive coverage or select
a medical plan, you will default to employee only
coverage and pay taxes on the premiums.
What you need to do
Understand your options
• Read this Decision Guide and use the myBenefit Decision
Center in myHR at http://myhr.umsystem.edu to compare
the medical plans.
• Attend a Town Hall, department or one-on-one education
session, or watch an annual enrollment video. Visit http://
umurl.us/2015AE for information.
• Go to http://umurl.us/2015WELL to learn more about our
new wellness incentives.
Take action
• Enroll online through the University of Missouri’s myHR
at http://myhr.umsystem.edu. Annual Enrollment runs
from October 20 to 31, 2014. You need to take action by
October 31, 2014; otherwise you will be defaulted to the
Healthy Savings Plan and pay taxes on the premiums.
(See page 4 for details.)
• Learn more about and start earning your 2015 Wellness
Incentive by visiting http://umurl.us/2015WELL. You’ll be
asked to make the wellness pledge during the enrollment
process. (See page 2 for details.)
• Provide Proof of Relationship for any dependents you are
adding to your benefit plans. View proof of relationship
requirements at https://uminfopoint.umsystem.edu/sites/
hr/Benefits/ProofofRelationship.pdf.
After enrollment
• Watch your home mail in early December for a
Confirmation of Elections Statement and verify that your
elections match the changes you submitted during Annual
Enrollment. You’ll receive ID cards for your medical plan
by the end of the year. Be sure to use your new card when
visiting your provider after January 1, 2015.
1
Educate yourself.
Invest in yourself.
Earn up to $450 in
wellness incentives.
The university is introducing exciting changes to the
wellness program for 2015 that reward your efforts toward
living healthfully – with up to $450 in your paycheck!
It starts with making a Wellness Pledge…
When you enroll for 2015 benefits, you’ll be asked to sign a
“Wellness Pledge” or decline to participate in the program.
Making the pledge is a new (and required) step toward
earning up to $450 in wellness incentives. Note that taxes
will be withheld from this amount.
My Wellness Pledge
1. I pledge to wear a seatbelt 100% of the
time while in a motor vehicle.
2. I pledge to increase my knowledge
of healthy eating.
3. I pledge to become aware of applicable
preventive medical and dental exams
for myself and my family.
4. I pledge to exercise regularly.
…Then take additional action to earn
your reward
1. Complete the rest of the activities on the “Educate
Yourself” list to earn 150 points by April 30, 2015, and
receive $150 in your May 2015 paycheck.
2. Complete additional activities that you choose from the
“Invest in Yourself” list to earn 300 points by September
30, 2015, and receive another $300 in your October 2015
paycheck.
For details and to get started, visit http://umurl.us/2015WELL.
Who has access to your information?
The Personal Health Assessment and biometric information
that you provide in Tier 1 are stored in a third-party data
system maintained by Cerner Corporation and protected
by the Health Insurance Portability and Accountability
Act (HIPAA). This information is not shared with Coventry,
UM’s medical administrator. The data is de-identified and
accumulated to provide collective information that assists
the university in developing programs to address general
health behaviors and prevalent health issues.
Here’s how it all works together:
Educate Yourself (Tier 1)
Complete all 150 points from these activities by April 30, 2015, to earn $150
Healthy Activity
Activity Points
Maximum Points
Make my Wellness Pledge 50
50
Complete my Online Personal Health Assessment 50
50
Complete my Biometric Health Screening 50
50
Invest in Yourself (Tier 2)
Complete all 300 points from these activities by September 30, 2015, to earn an additional $300
You must complete Tier 1 to be eligible for the Tier 2 incentive.
Healthy Activity
Activity Points
Maximum Points
Get my Flu Shot 50
50
Remain Tobacco-free or Complete a Tobacco Cessation Program 100
100
Complete a Personal Health Action Plan
10
50
Take an Online Wellness Workshop
25
150
Listen to Mindfulness Meditation or Yoga Recordings
10
100
Complete a UM Mindfulness-Based Stress Reduction Course*
100
100
Participate in a Weight Watchers Program for at least 3 months 100
100
Complete a UM Eat for Life Course*
100
100
Engage in Physical Activity, On or Off Campus 10 100
Walk 1 Million Steps 100
200
Bike 500 Miles 100 200
©
* Only first-time participants in these courses may earn activity points.
Federal law requires the university to provide an alternative
for any employee who has a health condition or disability
that makes it unreasonably difficult (or medically
inadvisable) to attempt to meet a standard in a wellness
program. If you think you might be unable to meet a
program standard due to your health status or disability,
contact [email protected] to discuss how this
applies and the alternatives available to you.
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We understand that quitting tobacco can be a difficult
process. That’s why we’re letting you know about this a
year in advance – so you have the time to take action.
To help you get started, our 2015 wellness program
described above offers you 100 points towards your Tier 2
incentive for remaining tobacco-free or participating in a
tobacco cessation program. Visit http://umurl.us/tobacco
to learn about available tobacco cessation programs.
3
Your 2015
medical
plan options
The university offers you a choice of three medical
plan options:
• Healthy Savings Plan
• NEW: Custom Network Plan
• PPO Plan
How the plan works
The Healthy Savings Plan covers the same medical services
as the other medical plan options, and you’ll have access
to the same broad provider network as the PPO Plan. The
main difference is in how the plan works.
This section provides a summary of the plans; refer to
pages 8-9 for a side-by-side comparison. Visit http://umurl.
us/2015AE to view a plan comparison video.
• The university contributes to an HSA for you. Your HSA
can be used for eligible medical, prescription, dental
and vision expenses. If you don’t spend all the money
in your HSA in 2015, it will roll over and can be used in
future years.
• The university contribution to your HSA is based on your
coverage level:
º Self only: $400
º Self & spouse: $800
º Self & child(ren): $800
º Family: $1,200
• You have the choice of seeing in-network or
out-of-network providers. If you stay in-network, your
costs may be much lower.
Healthy Savings Plan
The Healthy Savings Plan offers lower premiums than
your other medical options, along with the opportunity to
benefit from a Health Savings Account (HSA), which can
help reduce your taxable income and provide a health care
financial nest egg for the future. Although your deductible
will be higher, part of that cost is covered by university
contributions to your HSA.
Are you eligible for this plan?
Any benefit-eligible employee can choose this plan.
• In-network preventive care is covered at 100% (meaning
there is no charge to you and no deductible applies).
Preventive care includes annual physical exams (including
associated lab and X-ray services), immunizations and
well-child care. You can find preventive care guidelines at
www.ummedcvty.com.
• As you incur other covered expenses, you can use your
HSA funds or pay directly until you meet your annual
deductible. The in-network deductible is:
º $1,500 for single coverage
º $3,000 for family coverage
• After you meet the deductible, you’ll pay 10% of the
cost of covered in-network services until you reach the
out-of-pocket maximum, which includes deductibles,
coinsurance and prescription drug charges.
• Once you meet your annual out-of-pocket maximum, the
plan will pay 100% of covered expenses for the rest of
the calendar year.
See page 10 for more details on HSAs and page 8 for more
Healthy Savings Plan coverage details.
Custom Network Plan – For those who live or
work in the Columbia area
If you live or work in the Columbia area, the Custom Network
Plan offers you an attractive combination of low premiums,
comprehensive coverage and a high-quality provider network
affiliated with the University of Missouri Health System.
Are you eligible for this plan?
To enroll in the Custom Network Plan, you must live or work
in one of the following counties:
• Audrain
• Boone
• Callaway
• Cole
• Cooper
• Howard
• Moniteau
• Osage
• Randolph
About network providers
This innovative network gives you access to University of
Missouri Health Care and Capital Region Medical Center
providers, clinics and hospitals, as well as others. Visit
www.ummedcvty.com to see the list of network providers.
How the plan works
With this plan, you have the choice of seeing in-network or
out-of-network providers. If you stay in-network, your costs
may be much lower.
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• You’ll pay no deductible for in-network services or
prescription drugs.
• In-network preventive care is covered at 100% (meaning
there is no charge to you and no deductible applies).
Preventive care includes annual physical exams (including
associated lab and X-ray services), immunizations and
well-child care. You can find preventive care guidelines at
www.ummedcvty.com.
• Your in-network office visit copayment will be only $5
for non-specialists and $25 for specialists. You’ll also
have access to Mizzou Quick Care Clinics at each of the
Columbia Hy-Vee stores for only a $5 copayment.
• Once you meet your annual out-of-pocket maximum,
the plan will pay 100% of eligible expenses (including
coinsurance and copayments) for the rest of the
calendar year.
• If you do not currently have a university provider, you can call
573-884-0432 on an ongoing basis to help identify primary
care and specialty physicians.
See page 8-9 for more coverage details.
PPO Plan
The PPO Plan has the same Coventry provider network as
before. You’ll pay higher premiums than for the other two
plans. Unlike the Custom Network Plan, you’ll need to pay a
deductible even if you use in-network providers.
Are you eligible for this plan?
Any benefit-eligible employee can choose this plan.
How the plan works
With this plan, you have the choice of seeing in-network or
out-of-network providers. If you stay in-network, your costs
may be much lower.
• In-network preventive care is covered at no charge
(meaning there is no charge to you and no deductible
applies). Preventive care includes annual physical
exams (including associated lab and X-ray services),
immunizations and well-child care. You can find
preventive care guidelines at www.ummedcvty.com.
• For most covered expenses, you’ll pay out of your pocket
until you reach the annual deductible. The in-network
deductible is:
º $350/person
º $1,050/family
• Your in-network office visit copayment will be $15 for
non-specialists and $25 for specialists. There will no longer
be a discount under this plan for using university providers.
• For in-network retail prescription drugs, you’ll pay a $75
deductible plus a copayment or coinsurance.
• Once you meet your annual out-of-pocket maximum, the
plan will pay 100% of expenses (including deductibles,
coinsurance and copayments) for the rest of the
calendar year.
See page 9 for more coverage details.
Prescription drug coverage
How the Custom Network and PPO plans cover prescription drugs
Custom Network Plan
PPO Plan
Retail Prescriptions
(up to 31-day supply)
No deductible
Formulary Generic: greater of $7
copay or 20% coinsurance
Formulary Brand: greater of $15
copay or 20% coinsurance
Non-Formulary Brand: greater of
$30 copay or 50% coinsurance
$75 deductible
Formulary Generic: greater of $7
copay or 20% after deductible
Formulary Brand: greater of $15
copay or 20% after deductible
Non-Formulary Brand: greater of $30
copay or 50% after deductible
Mail Order Prescriptions
(up to 90-day supply)
Includes University of
Missouri Health System
Pharmacies
No deductible
Formulary Generic: greater of $15
copay or 20% coinsurance
Formulary Brand: greater of $30
copay or 20% coinsurance
Non-Formulary Brand: greater of
$60 copay or 50% coinsurance
No deductible
Formulary Generic: greater of $15
copay or 20% coinsurance
Formulary Brand: greater of $30
copay or 20% coinsurance
Non-Formulary Brand: greater of $60
copay or 50% coinsurance
Prescription Drug
Out-of-Pocket Maximum
$3,000/person
$6,000/family
$3,000/person
$6,000/family
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Under the Healthy Savings Plan, you benefit from the prescription drug
discount but pay the full cost of covered prescription drugs until you
meet the deductible. After you meet the deductible, you pay 10% of
covered prescription costs until you reach the combined medical and
prescription drug out-of-pocket maximum. At that point, the plan pays
100% of covered prescription costs for the rest of the calendar year.
7
Compare your medical plan options
2015 coverage cost and contributions overview
Self
Self & Spouse
Healthy
Savings Plan
Custom
Network Plan
PPO
Plan
Healthy
Savings Plan
Custom
Network Plan
PPO
Plan
Annual Premium
$1,020
$1,380
$1,824
$2,040
$2,760
$3,648
Annual Wellness Incentive
Opportunity
-$450
-$450
-$450
-$450
-$450
-$450
Annual University Contribution
to Health Savings Account
-$400
$0
$0
-$800
$0
$0
Your Net Annual Cost*
$170
$930
$1,374
$790
$2,310
$3,198
*Does not include out-of-pocket costs for medical and prescription drugs. Use the myBenefit Decision Center in myHR to compare plan out-of-pocket costs.
What you pay for in-network covered expenses in 2015*
Healthy Savings Plan
Custom Network
In-Network
Out-of-Network
In-Network
$1,500/single coverage
$3,000/family coverage
$3,000/single coverage
$6,000/family coverage
$0
$0
30% after deductible
$0
Primary Care Office Visit
10% after deductible
30% after deductible
$5 copay (includes
Mizzou Quick Care)
Specialist Office Visit
10% after deductible
30% after deductible
$25 copay
Urgent Care
10% after deductible
30% after deductible
$50 copay
Lab & X-ray
10% after deductible
30% after deductible
No charge
Outpatient Visit
10% after deductible
30% after deductible
$100 copay/visit
Inpatient Visit
10% after deductible
30% after deductible
$300 copay/confinement
($0 copay for maternity delivery)
Emergency Room
10% after deductible
30% after deductible
$100 copay/visit
Medical Plan Out-of-Pocket Limit
(Deductible, copays & coinsurance)
N/A
N/A
$3,600/person
$7,200/family
Prescription Drug Out-of-Pocket
Limit*
N/A
N/A
$3,000/person
$6,000/family
Combined Medical & Prescription
Drug Out-of-Pocket Limit*
$3,000/single coverage
$6,000/family coverage
$6,000/single coverage
$12,000/family coverage
N/A
Deductible
Preventive Services
Self & Child(ren)
Self, Spouse & Children
Healthy
Savings Plan
Custom
Network Plan
PPO
Plan
Healthy
Savings Plan
Custom
Network Plan
PPO
Plan
$1,740
$2,352
$3,096
$2,856
$3,864
$5,112
-$450
-$450
-$450
-$450
-$450
-$450
-$800
$0
$0
-$1,200
$0
$0
$490
$1,902
$2,646
$1,206
$3,414
$4,662
Plan
PPO Plan
Out-of-Network
In-Network
Out-of-Network
$500/person
$1,500/family
$350/person
$1,050/family
$700/person
$2,100/family
30% after deductible
$0
20% after deductible
30% after deductible
$15 copay
20% after deductible
30% after deductible
$25 copay
20% after deductible
30% after deductible
$50 copay
20% after deductible
30% after deductible
No charge after annual deductible
20% after deductible
30% after deductible
$100 copay/visit after deductible
20% after deductible
30% after deductible
$300 copay/confinement
after deductible
20% after deductible
$100 copay/visit after deductible
$100 copay/visit after deductible
$100 copay/visit after deductible
$7,500/person
$15,000/family
$3,600/person
$7,200/family
$7,500/person
$15,000/family
$3,000/person
$6,000/family
$3,000/person
$6,000/family
N/A
N/A
* The Custom Network Plan and PPO
Plan have separate out-of-pocket
limits for medical and prescription
drug expenses. However, the
Healthy Savings Plan combines
medical and prescription drug
out-of-pocket limits. See page 7 for
details on prescription drug benefits.
9
HSAs and FSAs:
what’s the
difference?
Health Savings Account
If you enroll in the Healthy Savings Plan, you have the
option of adding your own money to your Health Savings
Account (HSA), along with the university’s contribution.
Are you eligible for this account?
You can have an HSA only if you are enrolled in the Healthy
Savings Plan. You cannot have an HSA if:
• You are covered by another health plan (including
Medicare).
• You are claimed as a dependent on someone else’s
tax return.
• You or your spouse are enrolled in a Health Care FSA.
How the HSA works
• You contribute to the HSA on a pre-tax basis, so you save
money on taxes.
• Your maximum contribution*, after the university’s
contribution, is based on your coverage level:
º Self only: $2,950/year
º Self & spouse: $5,850/year
º Self & child(ren): $5,850/year
º Family: $5,450/year
*Age 55 and older may contribute an additional $1,000/year.
• You receive a debit card that you can use to pay for
eligible expenses once funds are available in your account.
• You have online access to your HSA, similar to a checking
account. You can instantly see your account balance and
track and pay your expenses.
• You can invest your HSA funds in select mutual funds,
once your account balance is over $2,000.
• Your HSA funds and any earnings are tax-free as long
as you use them for eligible medical, prescription drug,
dental and vision expenses.
• If you don’t use your entire HSA balance during the
calendar year, it will roll over for use in future years.
• If you leave the university, you take your HSA money
with you.
• If you are selecting this plan during Annual Enrollment,
your HSA will be established on January 1, and the
university contribution will be available within three to
four weeks after your HSA is established.
• If you are currently enrolled in an FSA and switching to
an HSA for the next plan year, you must use all your FSA
funds by December 31 of the current plan year. If you
have funds left over, you can still enroll in the HSA, but
you cannot carry over any funds from the FSA, and the
university cannot contribute to your HSA until after April 1.
Flexible Spending Accounts
You have the option of enrolling in the Health Care and/or
Dependent Care Flexible Spending Accounts (FSAs) to
help pay for health and dependent care expenses with
pre-tax dollars. Use the myBenefit Decision Center in
myHR at http://myhr.umsystem.edu to help estimate your
contributions. You must enroll in the FSAs each year – your
elections do not carry over.
Are you eligible for these accounts?
You can only enroll in the Health Care FSA if you select
the Custom Network Plan or PPO Plan. If you enroll in the
Healthy Savings Plan, you’ll have a Health Savings Account
(HSA) instead.
You can enroll in the Dependent Care FSA no matter which
medical option you choose.
How the FSAs work
There are two separate FSAs (Health Care and Dependent
Care) but they work the same way:
• You contribute to the accounts on a pre-tax basis, so you
save money in taxes.
• Your maximum contribution is:
º Health Care FSA: $2,500/year
º Dependent Care FSA: $5,000/year
• You can submit your claims online or via fax and have
your reimbursements deposited directly into your
preferred account.
• You can use the Health Care FSA for eligible medical,
prescription drug, dental and vision expenses.
• You can use the Dependent Care FSA for eligible
dependent care expenses.
• You have online access to your FSA, so you can instantly
track your expenses and account balance.
• You can use your Health Care FSA funds from January
1 of the current plan year through March 15 of the next
plan year. However, if you are changing from an FSA to an
HSA, all FSA funds must be used by December 31. Due to
increased claims submissions at year-end, be sure to
submit claims early since reimbursements can take longer
than the normal two business days.
• Funds not used by March 15, 2015, cannot be rolled over.
• If you leave the university, the money stays in your
account through the end of the plan year. However, you
may only use it for eligible expenses incurred before your
termination date.
For details, visit the University of Missouri myTotal Rewards
website at www.umsystem.edu/totalrewards.
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Resource list
For more information about your medical choices and how to enroll…
Description
How to Find
Resource
myBenefit Decision Compare medical plan benefits and costs, Visit myHR at http://myhr.umsystem.edu
estimate HSA and FSA contributions
Center
Annual Enrollment
webpage
Annual Enrollment information, videos
and other resources
Visit http://umurl.us/2015AE
One-on-one support Learn about medical plan options
Visit http://umurl.us/2015AE to make an
individual appointment
To contact plan providers…
Benefit
Administrator
Phone
Website
800-613-7721 www.ummedcvty.com
Medical Plans
Coventry
Prescription Drugs
Custom Network and PPO Plans: 800-955-1201 www.express-scripts.com
Express Scripts
Accredo (specialty drugs)
Healthy Savings Plan: Coventry 800-378-7040 www.ummedcvty.com
(through Medco)
573-884-1312 www.wellness.umsystem.edu
Healthy for Life
Healthy for Life Wellness
Program
Flexible Spending Accounts
Health Savings Account
800-659-3035 www.asiflex.com
ASI
Health Equity
877-372-5383 www.healthequity.com
To contact your campus benefits representative…
Campus
Phone
Email
MU, UM System, MUHC
573-882-2146
[email protected]
UMKC
816-235-1621
[email protected]
Missouri S&T
573-341-4241
[email protected]
UMSL
314-516-5639
[email protected]
This Annual Enrollment Decision Guide provides a summary of various plans included in the
University of Missouri System benefit program effective January 1, 2015. Complete details of the
plans are included in the University of Missouri Collected Rules and Regulations (CRR) and policies. If
there is a difference between this Annual Enrollment Decision Guide and the CRR, then the CRR will
govern in every instance. In addition, the University of Missouri System reserves the right to change
or terminate the benefits program, individual plans or any provisions of any plans at any time.
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Columbia
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