1. Garnett-Powers & Associates (GPA)
The University of
Southern California
Postdoctoral Scholar
Benefit Program
OpenEnrollment
Plan Year
June 25th through July 18th , 2014
Presented by
Garnett-Powers & Associates (GPA)

2. Agenda The Role of GPA and the Insurance Carriers
Review of all Benefits, Rates and Plan
Designs
Explanation of Online Open Enrollment
Process
Q & A

3. The Role of GPA and the Insurance Carriers
GPA is the broker/administrator and
customer service provider.
We design, market, implement and
administer benefit programs for
Postdoctoral Scholars at many campuses
throughout the United States.
We are not the insurance carrier.
The insurance carrier provides the actual
benefits, access to the providers and pays
the claims associated with your care.

4. What is Open Enrollment?
Open Enrollment is an annual period of time designated to allow current
enrollees the opportunity to make changes to their coverage that are
otherwise not allowed throughout the rest of the year, unless you
experience a qualifying life event.
Open Enrollment also allows those postdocs who initially waived coverage
to now enroll, including dependents.
Examples of qualifying life events are:
Marriage
Divorce
Birth of a child
Death of a dependent
Adoption or placement of adoption of a child
Loss of coverage
Dependent arrival in the U.S.
Dependent loss of eligibility due to attainment of age 26.

5. What is Open Enrollment? (Continued)
All postdocs currently enrolled in the USC Postdoctoral Scholar Benefit Program have the option of making the following changes during the Open Enrollment Period from June 25th – July 18th, 2014:
Change from the HMO Medical and/or Dental plan to
the POS Medical and/or Dental plan, or vice versa.
Enroll in the voluntary vision plan if previously
waived.
If you previously waived either yourself and/or your
family members, you/they may enroll in the program at
this time.
All changes will be effective August 1st, 2014.
If you are not changing your current enrollment, no
action is necessary.

6. Postdoctoral Scholar Benefit Program
Eligibility for the
Postdoctoral Scholar Benefit Program
The program is mandatory for the following Postdoc job codes:
Postdoctoral Fellows in job code
Postdoctoral Scholar - Fellowship Trainees in job
code
Postdoctoral Scholar – Teaching Fellows in job
code
Postdoctoral Scholar – Research Associates in job
code
If you are in one of the above job titles/job codes and you
wish to waive coverage for this program, you must provide
proof of comparable coverage.
Please either fax or your coverage documentation to
the fax number or address listed on the GPA website.

7. Benefits Offered Through the Postdoctoral Scholar Benefit Program
Plan Name
Insurance Type
Company
HMO
Medical
POS
Dental
PPO
Vision (Voluntary)
Life and AD&D
Life
STD and LTD
Disability

8. Benefit Plan/Rate Changes for
Plan Year 2014/2015
The Aetna medical HMO and POS plan rates will
increase by 5%.
The dental HMO/POS, voluntary vision, life and
disability plan rates will remain the same.
The HMO medical plan annual out-of-pocket
maximum has been enriched to include pharmacy
expenses effective 8/1/2014, as mandated by health
care reform.
The POS medical plan annual out-of-pocket
maximum has been enriched to include the
deductible, copayments and pharmacy expenses
effective 8/1/2014, as mandated by health care
reform.

9. MEDICAL INSURANCE Provided by

10. What is an HMO Plan?
Under the HMO model, the member must choose a Primary
Care Physician (PCP) contracted with the HMO plan at the
time of enrollment (provider directory links are available on the
GPA website).
Each family member may have a different PCP, who acts as
your healthcare “gatekeeper”.
You may change your HMO PCP once a month if you are
not satisfied with your current choice.
If the member is in need of treatment from a Specialist or is in
need of an In-Patient 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.
There is no Out-of-Network benefit (except in the case of an
emergency).

11. New HMO ID Cards
Beginning 8/1/2014, current HMO members will start to receive new HMO ID cards as part of the plan’s migration to a new, simpler platform.
The new HMO ID card will include:
– New member number beginning with a ‘W’.
– Member Services phone number and claims mailing address.
– Health plan product name and group number (control
number) will be on the front of the ID card.
Future member Explanation of Benefits (EOBs) will have a new look making it easier for members to understand claim activity.

12. Postdoctoral Scholar Benefit Program Aetna HMO Medical Plan
Medical Benefits In-Network Postdoc Pays   Physician Office Visit $20 Copay Specialist Office Visit $20 Copay Hospitalization: Inpatient $250 Copay per admission Outpatient $100 Copay per visit Pregnancy $250 Copay per admission Prescription Drugs: Tier 1 $10 Copay Tier 2 $20 Copay Tier % Copay Emergency Room Visits $100 Copay Urgent Care $50 Copay Routine Physical Exam $0 Routine Gynecological Exams $0 Routine Mammograms $0 Mental Health Outpatient $20 Copay Inpatient $250 Copay per admission Annual Out-of-Pocket Maximum* $1,000 Individual *includes pharmacy expenses eff. 8/1/14 $3,000 Family Deductible: Individual n/a Family n/a Lifetime Maximum Unlimited For more detailed plan design information go to:

13. What is a POS Plan?
The Point of Service (POS) plan offers more flexibility and
choice than the HMO plan due to the In-Network and Out-of-Network
selection you make at the time you seek services.
The Plan offered through Aetna functions exactly like a PPO
plan, but offers the opportunity of selecting a PCP for In-Network
services.
The In-Network benefits (copays/coinsurance) will be covered at
a higher level than the Out-of-Network benefits.
At the time of service, you have the ability to seek care
from a Specialist, without having to obtain a referral from a PCP.
The contractual agreement between the POS Plan and the In-
Network Provider is on a “discounted fee for service” basis.
You will pay more out-of-pocket when you seek services Out-of-
Network because those physicians are not providing the
contracted discounts as the In-Network physicians.

14. Postdoctoral Scholar Benefits Program Aetna POS Medical Plan
Medical Benefits In-Network Out-of-Network Postdoc Pays Postdoc Pays   Physician Office Visit $10 Copay 50% Specialist Office Visit $10 Copay 50% E-Visits to PCP/Specialists 1 $10 Copay 50% Walk-in Clinics 2 $10 Copay 50% Hospitalization: Inpatient 10% $500 Copay + 50% Outpatient 10% 50% Pregnancy 10% $500 Copay + 50% Prescription Drugs: Tier 1 $10 Copay $10 Copay + 50% Tier 2 $25 Copay $25 Copay + 50% Tier 3 50% Copay 50% Copay Emergency Room Visits $100 Copay + 10% $100 Copay + 10% Urgent Care $50 Copay $50 Copay Routine Physical Exam $0 50% Routine Gynecological Exam $0 50% Routine Mammograms $0 50% Mental Health Outpatient $10 Copay 50% Inpatient 10% $500 Copay + 50% For more detailed plan design information go to:

15. Postdoctoral Scholar Benefits Program Aetna POS Medical Plan (continued)
Annual Out-of-Pocket Maximum* $1,000 Individual $10,000 Individual $3,000 Family $30,000 Family Deductible: Individual n/a n/a Family n/a n/a Lifetime Maximum Unlimited Unlimited *Includes deductible, copayments & pharmacy expenses eff. 8/1/ – An E-visit is an online internet consultation between a physician (with the technical capability) and an established patient about a non-emergency healthcare matter. 2 – Walk-in Clinics are network, free-standing health care facilities typically found within preferred pharmacies like Walgreens and CVS. They are an alternative to a physician's office visit for treatment of unscheduled, non-emergency illnesses and injuries and the administration of certain immunizations. It is not an alternative for emergency room services or the ongoing care provided by a physician. Neither an emergency room, nor the outpatient department of a hospital, shall be considered a Walk-in Clinic For more detailed plan design information go to:

16. Summaries of Benefits and Coverage
The PPACA requires that you be notified that the
Summaries of Benefits and Coverage for your
medical plans will be available on our website
no later than June 25th , 2014.
The Summaries of Benefits and Coverage follow
the recommended guidelines of PPACA in a
standardized format to make them easier to read
and comprehend to better serve you in making
your plan selections.
You may request a paper copy at no charge by
calling the toll-free number on your new ID card.
You may also print a copy directly off of the GPA
website.

17. Prescriptions – Mail Order Pharmacy
You can order maintenance medications through Aetna’s
Rx Home Delivery for chronic conditions as asthma,
arthritis, diabetes, high cholesterol and heart conditions.
Under the HMO Plan, this service provides you up to a 90 day supply
of these medications after a copay of $20 for generic, $40 for
brand-name, and 50% for non-formulary brand name
drugs.
Under the POS plan, this service provides you up to a 90 day supply of
these medications after a copay of $20 for generic, $50 for brand-
name, and 50% for non-formulary brand name drugs.
Please click on Aetna RX Home Delivery/Order Form on
the website for more information, as well as directions on
how to order your prescriptions.
Please visit for
important information regarding the prescription
coverage.

18. Wellness Programs
AetnaNavigator - This is an online member portal that allows
you to view your medical visits and claims status, print
temporary ID cards and gain access to more important
information.
Once you have your member ID, you may register
for access to this site. There will be instructions on the website to
assist you.
Beginning Right – Provides a pregnancy risk survey and a
wealth of information to assist you with when either you or your
spouse become pregnant.
GlobalFit – Offers discounts to a nationwide network of fitness
clubs.
Health Connections – Discounts are offered through this
program for spas, health foods and fitness clothing.
Stress Management – Information available for better mental
and physical health.

19. Urgent Care The hospital emergency room is to be used only if the
situation is life threatening.
The Urgent Care Center should be used as often as
possible to avoid additional charges.
The Urgent Care Center is open 24 hours and is
available to treat most non-life threatening
emergencies, as broken bones (not multiple fractures),
wounds not bleeding profusely, fevers and flu
symptoms.
The copay is less: HMO Plan - $100 copay for
emergency room vs $50 copay for urgent care.
POS Plan - $100 copay +10% for emergency room vs $50 copay for urgent care.
There are 10 Urgent Care Centers within 10 miles of the University Park Campus in the HMO network, and 18 Urgent Care Centers in the POS network within 10 miles of the University Park Campus.

20. Walk-In Clinics The Walk-In Clinic is an in-network, free-standing
health care facility that is an alternative to a
physician’s office for treatment of unscheduled, non-
emergency illnesses and injuries and administration
of certain immunizations.
It is not an alternative for the emergency room or the
outpatient department of a hospital.
It is generally found in a retail location as CVS or
Walgreens.
If you use a Walk-In Clinic on the Medical POS plan,
you will pay $10 in-network.
There are 3 Walk-In Clinics within 10 miles of campus in the POS network.
Walk-In Clinics are not covered under the HMO plan.

21. Health Care Reform
The Patient Protection and Affordable Care Act (ACA) was
signed into law on March 23, 2010.
The ACA requires that most people that are either citizens or
legal residents to have health insurance coverage, or to pay a tax
beginning in 2014 if they do not.
The intent of the ACA is to make health care coverage available to the millions that are uninsured in the U.S.
All states are required to offer a Health Care Exchange, either
through the federal government, on their own or through a
partnership between the state and the federal government.
California has its own exchange called Covered California.
U.S. citizens and most legal residents are eligible for plans on
the exchange.

22. Health Care Reform (Continued)
There are differing levels of coverage and cost, as well as several insurance carriers offering the plans.
In order to be eligible for the Premium Tax Credit, also known as a subsidy, a person must meet certain eligibility requirements:
The employer offers coverage where the plan
design does not meet the coverage requirements
of the ACA.
Certain poverty-level income conditions are met.
The cost of employee-only coverage exceeds 9.5%
of an employee’s W-2 wages.

23. Health Care Reform (Continued)
Important ACA Information Specifically for Enrollees in the USC-PBP:
All of the USC-PBP plans meet or exceed the legal requirements of the ACA.
To the best of our knowledge, the cost of single coverage for the HMO does not exceed 9.5% of an eligible postdoc’s wages/stipend.
It is highly unlikely that anyone enrolled in the USC-PBP medical coverage will be eligible for a subsidy through the exchange.
For more information, please visit the Covered California site at

24. DENTAL INSURANCE Provided by
and

25. Postdoctoral Scholar Benefit Program California Dental HMO Plan
Annual Maximum: Unlimited
In-Network
Postdoc Pays
Calendar Year Deductible None
Diagnostic and Preventive Care
-Routine Exams No Charge
-Teeth Cleanings No Charge
-X-Rays No Charge
Basic Procedures
-Fillings $0 - $65 Copay
-Endodontics $0 - $200 Copay
-Periodontics $20 - $275 Copay
-Oral Surgery $0 - $100 Copay
Major Procedures
-Crowns $75 - $300 Copay
-Bridgework $100 - $600 Copay
-Dentures $100 - $600 Copay
Orthodontia
-Adolescent $1,775 Copay
-Adult $1,975 Copay
For more detailed plan design information go to:

26. Accessing the POS Network
The Principal POS (Point of Service) plan offers comprehensive coverage,
adding an additional tier of benefits as an option for your care, called the
EPO Tier.
EPO indicates “Exclusive Provider Organization”.
A POS plan incorporates three tiers for delivery of care and you choose the
tier you desire at the time of service:
The EPO Tier: There are no deductibles in this tier, with preventive covered at 100%, basic covered at 90% and major covered at 60%. This tier offers you the maximum amount of savings when you seek dental care. EPO dentists are generally PPO dentists.
2. The PPO Tier: This tier offers you the flexibility of seeking service
from a PPO dentist, at a higher out-of-pocket cost than the EPO tier.
3. Non-Network Tier: This tier allows you to seek care from any non-
network provider.

27. Postdoctoral Scholar Benefit Program Principal Financial Group Dental POS Plan
EPO Network
Postdoc Pays
None 0%
10%
40%
50%
PPO Network
Postdoc Pays
$50 per individual*
$150 per family* 0%
20%
40%
50%
*Deductible waived for Preventive care
Out-of-Network
Postdoc Pays
$50 per individual
$150 per family 0%
20%
40%
50%
Annual Maximum $1,500 per person
Calendar Year Deductible
Diagnostic and Preventive Care
-Routine Exams
-Teeth Cleanings
-X-Rays
Basic Procedures
-Fillings
-Endodontics
-Periodontics
-Oral Surgery
Major Procedures
-Crowns
-Bridgework
-Dentures
Implant Benefits
-$1,000 Lifetime Maximum
For more detailed plan design information go to:

28. Accessing the Out-of-Network Tier
An example of how seeking out-of-network services can
impact your out-of-pocket costs:
Porcelain Crown on a molar - We will estimate that the usual, customary
and reasonable charge is considered $800.
Per the out-of-network benefit structure, you will pay 40% (your
coinsurance) toward that crown, which would be $320.
In addition, if the out-of-network dentist performing your crown services
charges more than what is considered usual, customary and reasonable,
you will pay the $320 PLUS any additional amount that the dentist wishes to
charge. So, if the dentist charged $900 for the crown in total, you would pay
a total of $420 for the crown, which includes the extra $100 that the dentist
charged above what is considered usual, customary and reasonable.
Using the out-of-network tier costs you more because the dentists do not
discount their services per a provider contract, whereas those contracts do
reduce your out-of-pocket costs in the EPO and in-network PPO tier.
When you access care out-of-network, you and the insurance carrier
incur more costs, consequently affecting the overall pricing of the plan.
Principal has a robust EPO and PPO network.

29. VOLUNTARY VISION INSURANCE Provided by

30. Postdoctoral Scholar Benefit Program Voluntary EyeMed PPO Vision Plan
Vision Benefits In-Network Out-of-Network Postdoc Pays Postdoc Pays   Eye Exam (every 12 months) $10 Copay up to $30 Allowance Frames (every 24 months) $130 Allowance up to $65 Allowance (20% off remaining balance) Lenses (every 12 months) Single $0 Copay up to $25 Allowance Bifocal $0 Copay up to $40 Allowance Trifocal $0 Copay up to $63 Allowance Contact Lenses (materials only) $130 Allowance up to $104 Allowance (15% off remaining balance) For more detailed plan design information go to:

31. LIFE/AD&D, SHORT-TERM DISABILITY and LONG-TERM DISABILITY INSURANCE Provided by

32. Postdoctoral Scholar Benefit Program Life and Accidental Death & Dismemberment Insurance
The plan pays $10,000 in the event of a death.
An additional benefit of $10,000 is paid for AD&D if the
death is due to an accident.
Postdoctoral Scholars holding J-1 Visa status will have the
$10,000 medical evacuation and $7,500 of repatriation of
mortal remains coverage necessary to fulfill the visa
requirements included in their Life and AD&D policy.
In addition, family members holding J-2 Visa status will also
be covered for the medical evacuation and repatriation, even
if the Postdoctoral Scholar waives medical and/or dental
coverage.

33. Postdoctoral Scholar Benefit Program Short-Term Disability Insurance (STD)
Postdoctoral Scholars – Fellowship Trainees in job code
and Postdoctoral Scholar – Teaching Fellows in
job code are eligible and automatically enrolled in
the STD.
The Short-Term Disability plan will provide a weekly
benefit of 70% of your pre-disability earnings.
The maximum weekly benefit will not exceed $1,500.
If approved, benefits for an accident or sickness (non-
work related) will become payable after you have been
continuously disabled for 8 days.
The maximum benefit period for benefits to be payable is
52 weeks.

34. Postdoctoral Scholar Benefit Program Long-Term Disability Insurance (LTD)
All postdocs are eligible and automatically enrolled in the
LTD.
The Long-Term Disability plan will provide a weekly
benefit of 66.67% of your pre-disability earnings.
The maximum monthly benefit will not exceed $5,000.
If approved, benefits for an accident or sickness (non-
work related) will become payable after you have been
continuously disabled for 365 days.
The maximum benefit period for benefits to be payable is
age 65 or Social Security Normal Retirement Age.

35. 2014 / 2015 Monthly Rates and Contributions
Total Monthly Cost
Institutional Cost
Postdoc Cost
Postdoc Increase
Health Plan HMO
Postdoc
$343.76
$274.14
$69.62
$3.31
Postdoc + Child(ren)
$639.41
$509.91
$129.50
$6.17
Postdoc + Spouse/Partner
$718.46
$572.95
$145.51
$6.93
Postdoc + Spouse/Partner + Child(ren)
$1,017.54
$811.46
$206.09
$9.82
Health Plan POS
$486.03
$387.60
$98.44
$4.69
$904.02
$720.92
$183.09
$8.71
$1,015.81
$810.08
$205.74
$9.80
$1,438.66
$1,147.28
$291.38
$13.88
Dental HMO
$14.44
$9.67
$4.77
$0.00
$26.67
$13.33
$13.34
$24.44
$12.22
$37.78
$12.85
$24.93
Dental POS
$51.71
$34.65
$16.60
$106.32
$53.15
$51.74
$103.73
$51.86
$50.47
$163.77
$55.69
$105.18
Vision
$8.06 NA
$16.11
$15.31
$23.69
DISABILITY - LONG & SHORT TERM PLANS
$31.10
LIFE INSRUANCE (10K)
$1.45

36. The Open Enrollment Process
Go to the Garnett-Powers & Associates website
at and click on “Open Enrollment”.
Next, click on the “Open Enrollment Form Instructions” link and print
them out for assistance with completing the open enrollment
form properly.
Once the instructions are in hand, go directly to the “Open Enrollment
Form Login” link. This will take you to a login page where under “Returning User” you will provide your address and your previously created unique password.
You will be taken to the Postdoc Dashboard where you will be able to view your current enrollment and also complete your Open Enrollment Form with any desired benefit changes.
Please check all plans in which you wish to be enrolled for Plan Year
Once complete, you will click “Submit and Create Printable
Enrollment Form” which will send your form to our secure database and
also allow you to print a copy of your enrollment form for your records.

37. The Open Enrollment Process (Continued)
If you choose or switch to the Aetna Medical HMO, you must select a
Primary Care Physician (PCP) for all participating family
members. Provider directory links are available on the GPA
website. Please enter the 6-digit PCP number for yourself and all
enrolling family members.
If you choose or switch to the California Dental DHMO, you must
select a Primary Care Dentist for you and your enrolling family
members. Please enter the 4-digit number for yourself and all
An will be sent no later than July 30th, 2014 confirming
your new enrollment status.
ID cards for any new coverage will be mailed to your home directly from
the Insurance Carriers (Aetna Medical , California Dental, Principal
Dental and EyeMed Vision).

40. Family Member Eligibility
Family member eligibility requirements are the same as the family member eligibility requirements for the
University of Southern California faculty/staff plans.
The Major Family Member Categories Are:
Spouse
Natural or adopted children to age 26 regardless of student
status.
Stepchildren may be included if they live with the Postdoc and
are supported at more than 50% and claimed as a tax
dependent.
Same-sex domestic partner. The required Declaration of
Domestic Partnership form, found on the GPA website, must be
completed, notarized, signed and forwarded to Garnett-Powers
& Associates.

41. Garnett-Powers & Associates, Inc.
Information Sources
For general inquiries and customer service regarding
enrollment, benefit questions and ID cards, you should
contact:
Garnett-Powers & Associates, Inc.
Website:
Toll Free Phone:
Fax #:
Address:

42. Thank you for joining us today!
Questions?