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Health Care Open Enrollment (coverage effective 1/1/2010)

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Presentation on theme: "Health Care Open Enrollment (coverage effective 1/1/2010)"— Presentation transcript:

1 Health Care Open Enrollment (coverage effective 1/1/2010)

2 Benefit Summary You may review your current benefits summary by:
Clicking on myUT at the top of the homepage Sign in to myUT Click on Benefit Summary in the left-hand column of the Employee tab Then click the select button

3 Open Enrollment Pharmacy will now be bundled with medical for both campuses (no longer available as a stand alone election except for AFSCME) Main Campus Full re-enrollment Health Science Campus

4 Open Enrollment Website
No packets will be mailed – post card notification only If you do not have computer access, you can pick up a packet in HR Click on Open Enrollment Option Read general directions Click on either Main Campus, Health Science Campus Non-Union or AFSCME Click each needed form and type in the information, then print the form and go on to the next form to complete Turn in all completed forms at one time as one packet to Human Resources HR is located on the Main Campus in the Transportation Center and is open M-F 7:30 AM to 5:00 PM

5 Main Campus Health Insurance Choices…
Ohio Benefit Administrators/FrontPath PPO 90/10 FrontPath & PHCS networks – (Promedica & Mercy) 70/30 Out-of-network Paramount Employer Select 100 UTMC, UTP, UT community faculty The following teaching facilities: Defiance, Flower, Fostoria, Lima, Toledo Hospital & Toledo Children’s Hospital for inpatient services and outpatient surgeries Tier 1 list is available on the website 90/10 Paramount & PHCS networks Medical Mutual of Ohio CDHP 100 UTMC & UTP 90/10 MMO (Mercy & Paramount) & PHCS (and Cofinity for Michigan) networks

6 Health Science Campus Health Insurance Choices…
Paramount Employer Select 100 UTMC, UTP, UT community faculty The following teaching facilities: Defiance, Flower, Fostoria, Lima, Toledo Hospital & Toledo Children’s Hospital for inpatient services and outpatient surgeries Tier 1 list is available on the website 90/10 Paramount & PHCS networks 70/30 Out-of-network Medical Mutual of Ohio CDHP 100 UTMC & UTP 90/10 MMO (Mercy & Paramount) & PHCS (and Cofinity for Michigan) networks

7 Main Campus OBA/FrontPath Co-Pays
FrontPath & PHCS Networks Out of Network Office Visit Co-Pay: $15 Office Visit covered 70% after deductible Specialist Visit Co-Pay: $30 Specialist Visit covered 70%

8 Main Campus OBA/FrontPath Deductibles
FrontPath & PHCS Networks Out of Network $100 Single $200 Single + 1 $300 Family $300 Single $600 Single + 1 $900 Family 90% Coverage 70%

9 Main & Health Science Campus Paramount ES Co-Pays
Tier 1 UTMC & Tier 1 Providers Tier 2 Paramount & PHCS Networks Tier 3 Out of Network Office Visit Co-Pay: $10 Co-Pay: $20 Office Visit covered 70% after deductible Specialist Visit Co-Pay: $25 Specialist Visit Co-Pay: $35 Specialist Visit covered 70% after deductible

10 Main & Health Science Campus Paramount ES Deductibles
Tier 1 UTMC & Tier 1 Facilities Tier 2 Paramount & PHCS Networks Tier 3 Out of Network No Deductible $100 Single $150 Single + 1 $200 Family $500 Single $750 Single + 1 $1,000 Family 100% Coverage 90% 70%

11 Paramount ES 2010 Changes No longer requires selection of Primary Care Physician (PCP) No longer requires referrals Rates have decreased 11% Non-network co-insurance now 70%/30% rather than 60%/40%

12 What is a Consumer Directed Health Plan?
Consumer Directed Health Plans (CDHPs) are made up of three elements: 1. A health plan 2. A fund or account that you can use to help pay for qualified, out-of-pocket medical expenses (known as a Health Savings Account or HSA) 3. Interactive tools and information to help you make more informed health care decisions Cannot be enrolled in another health plan as secondary unless it is also a high deductible health plan. No one enrolled in the CDHP may be covered by Medicare. 12

13 How Much May I Contribute to my HSA?
The University of Toledo contributions ($800/single, $1,600/family) will be accessible on January 4th in 2010. You may contribute by payroll deduction on a pre-tax basis. Payroll contributions you make are prorated over 24 pay periods but can be changed throughout the year by contacting UT HR. Your HSA contribution limits are $3,050 for persons with individual coverage and $6,150 for persons with family coverage. This includes contributions made by UT. Individuals age 55 to 64 may contribute an additional $1,000 annually 13

14 Using Your HSA: You may use HSA funds towards your medical plan deductible or any coinsurance or copayments. You may use your HSA funds for qualified health care expenses as allowed by the IRS. The following list provides some typical examples: Medical deductibles Braces Dental care Contact lenses Prescription drugs Hearing aids LASIK eye surgery Eyewear 14

15 CDHP Design Highlights
Deductible $1,200 Single $2,400 Family Health Savings Account Employer Contribution $800 Single $1,600 Family

16 CDHP Highlights Meet the plan deductible then pay coinsurance
Prescription drug costs count towards deductible Out-of-pocket maximum limits amount you pay annually Preventive care not subject to the deductible and covered at 100% with UTMC providers, 90% with MMO Providers

17 What is an HSA? Must be enrolled in HSA-compatible health plan to open & contribute to HSA Pay for Qualified Medical expenses with Tax Free dollars No use it or lose it provision – like Flexible Spending Accounts Your balance plus investment earnings carry over year to year - Tax Free Note: Can also make rollovers from FSAs, HRAs and Archer MSAs © 2009 Wells Fargo Bank, N.A. All rights reserved. For public use. 17 17

18 Triple tax savings* Increase your spending and savings power
Pay for qualified medical expenses tax free Interest and investment earnings are tax free Contributions are pre-tax or tax deductible * All taxes are at the federal level. State taxes vary. Please consult a tax advisor. 18 18

19 Increase your buying power
Your HSA Contribution Tax savings from your HSA contribution* Increased Buying Power $500 $125 $625 $1,000 $250 $1,250 $2,000 $2,500 By using your HSA to pay for qualified medical expenses—from insurance copayments, doctor’s fees and dental work to prescription and over-the-counter medications—you can increase the power of your healthcare spending dollars. For example, when you contribute money to your HSA to pay for out-of-pocket medical expenses tax-free, you can increase your total buying power. The money you would have normally paid on income tax can be contributed to your HSA and used to pay for more qualified medical expenses now, or saved for future use. Once you put money in your HSA, it’s yours to use, save and grow tax-free. This example is for illustrative purposes only. Tax consequences may differ based on individual circumstances. Please consult your tax advisor regarding your individual situation. This chart assumes all distributions are used for qualified medical expenses. *Estimated federal tax savings of 25% based on 2008 tax table for a single taxpayer with income of $60,000. For more information, go to and click on “Health Savings Accounts (HSAs).” Please consult your tax advisor. 19 19

20 What you receive with your new Wells Fargo HSA
If you elect the Medical Mutual product a Wells Fargo HSA will be opened in your name You will receive a confirmation letter mailed to your home, including: Web site information Toll-free customer service number Your Visa HSA Debit Card card will arrive separately Activate the card before you use it Sample of the envelope the HSA Visa Debit card comes in.

21 Rollover process to Wells Fargo for Employees with an existing HSA account
Employee completes and signs Wells Fargo rollover form provided in packet. Send completed form to University of Toledo Human Resources Benefits. Money will be transferred to Wells Fargo HSA for new plan enrollment year. Questions contact: (University of Toledo HR) wellsfargo.com/hsa

22 University Medical Center
MMO CDHP Plan Plan Design Feature Tier 1 University Medical Center Tier 2 MMO Network Providers Tier 3 Out of Network UT HSA Contribution $800 Single $1,600 Family Employee HSA Contribution $2,250 Single $4,550 Family Deductible $1,200 Single $2,400 Family Out-of-Pocket Maximum (Includes Deductible) $2,000 Single $4,000 Family Coinsurance (Most Services) Subject to deductible 100% 90% / 10% 70/30 Preventive Care Not subject to deductible 70% / 30%

23 CDHP Prescription Drug Coverage
When you fill prescriptions you pay the cost of the prescription until the deductible has been met. Once the deductible has been met you pay the copay or coinsurance detailed below: Prescription Drugs 30 day supply 90 day supply UT pharmacies or at any MMO network Pharmacy. Deductible does not apply to certain preventive medications. $5 generic 20% formulary (up to $80 max per prescription) 30% non-formulary $10 generic (up to $200 max per prescription) Once the out-of-pocket maximum has been met, all prescriptions are covered at 100%.

24 Preventive Drugs (partial listing) not subject to CDHP deductible
Antiasthmastics drugs & supplies Antidiabetic drugs & supplies Antiemetics/antivertigo agents Antiestrogens Anti-infectives Antimalarials Anti-ulcer agents Antivirals Blood Thinning Agents Contraceptives, oral Estrogen replacement products Gout High Cholesterol drugs Hypertension drugs Osteoporosis drugs Prenatal vitamins Prescription vitamins Smoking Cessation medications

25 Spousal/Domestic Partner Provision (for full-time and part-time employees)
Does not apply to the MMO CDHP Must be completed annually if covering a spouse/domestic partner on health insurance For Spouse to be Primary: Unemployed, Self-Employed, Retired, No other benefits offered Or makes less than $25,000/yr and benefits cost more than $75/month for a single plan Spouse may be Secondary HSC AFSCME will continue to use existing HSC spousal/domestic partner provision

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28 Please note… If you and your spouse are both employed by UT and are both eligible for benefits coverage, you may either enroll together on one form or separately on individual forms, but not both. Your dependent children may only be enrolled on one form, either yours or your spouses, but not both.

29 Dependent Coverage For dependents age (25 for the CDHP), they must be claimed as an IRS dependent by the UT employee, be a full time student and unmarried to be eligible for benefits. As long as a dependent meets this criteria they may remain covered on your plans until the end of the year in which they reach age 24 (25 for the CDHP). A Dependent Verification Affidavit must be completed annually. Same requirements will be used for Fee Waiver eligibility. Dependents under age 19 do not need a form.

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31 Prescription AFSCME will remain on current HSC plan
SXC changing their name to “Informed Rx a division of SXC” Bundled with Medical Coverage (except for AFSCME) Co-pays go by tiers Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand Formulary can be found at

32 Prescription Cost Sharing
UT 30-day supply co-pays: (except for AFSCME) TIER 1: $6.60 per prescription TIER 2: $16.50 per prescription TIER 3: $33.00 per prescription

33 Prescription Cost Sharing
UT 90-day supply co-pays: (except for AFSCME) TIER 1: $16.50 per prescription TIER 2: $30.80 per prescription TIER 3: $61.10 per prescription

34 Prescription Cost Sharing
Main Campus Retail co-pays for a 30 day supply: Tier 1: $11 Tier 2: 20% Tier 3: 40% Health Science Campus Non-Union Retail co-pays: Tier 1: Only a 10 day emergency supply is Tier 2: Only a 10 day emergency supply is Tier 3: Only a 10 day emergency supply is

35 Dental Plan AFSCME will remain on current HSC plan
Enhanced for HSC non-union (same plan as MC except for annual maximum) Preventive Services covered at 100% 2 cleanings in 12-month period Minor & Major work covered at 80% $100 deductible per calendar year per person Orthodontia (dep <19) at 60% ($1500 lifetime max) Main Campus $3,000 annual max per person Health Science Campus $1,500 annual max per person

36 HSC Dental (Non-Union)
Current New per person per year max $750 $1,500 crowns 50% 80% periodontic services oral surgery prosthodontic services implants orthodontic services 60% ortho lifetime limit $500 deductible $50 $100

37 HSC Dental (Non-Union)
Old Charged 50/50 crown $ 800 $400 employee cost New 80/20 $160 oral surgery $1,200 $600 $240 old cap $ 750 new cap $1,500

38 Vision Coverage AFSCME will remain on current HSC plan
Enhanced for HSC non-union (same plan as MC) Eye examination with a $10 co-pay once every 24 months Every 12 months for students & children Prescription lenses once every 24 months Frames/Contacts allowance of $120 every 24 months

39 HSC Vision (Non-Union)
Current New exam $15 $10 lens (student & child) every 24 mo every 12 mo exam (student & child) Contacts/lenses (student & child)

40 Flexible Spending Account
Must be set up annually Allows you to set aside additional money on a pre-tax basis May be used for out-of-pocket medical and/or dependent care expenses You will be reimbursed for charges incurred once claim form is submitted Reimbursements may be direct deposited Account DOES NOT rollover Reminder: If electing MMO CDHP medical coverage, you are only eligible for dependent care.

41 Main Campus Employee Clinic
Location: Main Campus Medical Center Phone Number: Clinic Hours: Monday - Friday 8:15 am - 11:00am and 1:00pm - 4:00 pm Can generally be seen the same day, if not then within 24 hours No office visit co-pay

42 Health Science Campus Employee Clinic
Location: Room 2410, Dowling Hall Phone Number: (419) Clinic Hours: Monday - Friday 7:30 am - 4:30 pm Can generally be seen the same day, if not then within 24 hours No office visit co-pay

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49 HIPAA additional changes
Due to additional changes to HIPAA that were effective 9/23/2009, you will need to contact the vendors personally when you have a claims issue Benefits vendor contact information is available on the benefits website or on the back of your ID card

50 Open Enrollment Website
Please remember Open Enrollment runs from October 15 to November 13. All forms must be turned into HR and time stamped by 5:00 pm on November 13. Any questions that may come up can be ed to


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