Presentation on theme: "The Role of GPA and the Insurance Carriers Review of all Benefits, Rates and Plan Designs Explanation of Online Open Enrollment Process Q & A."— Presentation transcript:
The Role of GPA and the Insurance Carriers Review of all Benefits, Rates and Plan Designs Explanation of Online Open Enrollment Process Q & A
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.
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.
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 25 th – July 18 th, 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 1 st, If you are not changing your current enrollment, no action is necessary.
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.
Plan NameInsurance TypeCompany HMOMedical POSMedical HMODental POSDental PPOVision (Voluntary) Life and AD&DLife STD and LTDDisability
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.
MEDICAL INSURANCE MEDICAL INSURANCE Provided by
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).
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.
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 350% 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: Individualn/a Familyn/a Lifetime MaximumUnlimited For more detailed plan design information go to:
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.
Medical BenefitsIn-Network Out-of-Network Postdoc PaysPostdoc Pays Physician Office Visit$10 Copay50% Specialist Office Visit$10 Copay50% E-Visits to PCP/Specialists 1 $10 Copay50% Walk-in Clinics 2 $10 Copay50% Hospitalization: Inpatient10%$500 Copay + 50% Outpatient10%50% Pregnancy10%$500 Copay + 50% Prescription Drugs: Tier 1$10 Copay$10 Copay + 50% Tier 2$25 Copay$25 Copay + 50% Tier 350% Copay50% Copay Emergency Room Visits$100 Copay + 10%$100 Copay + 10% Urgent Care$50 Copay$50 Copay Routine Physical Exam$050% Routine Gynecological Exam$050% Routine Mammograms$050% Mental Health Outpatient$10 Copay 50% Inpatient 10% $500 Copay + 50% For more detailed plan design information go to:
Annual Out-of-Pocket Maximum*$1,000 Individual$10,000 Individual $3,000 Family$30,000 Family Deductible: Individualn/an/a Familyn/an/a Lifetime MaximumUnlimitedUnlimited *Includes deductible, copayments & pharmacy expenses eff. 8/1/14 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:
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 25 th, 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.
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.
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.
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.
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.
The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 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.
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.
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
DENTAL INSURANCE DENTAL INSURANCE Provided by and
Annual Maximum: Unlimited In-Network Postdoc Pays Calendar Year Deductible None Diagnostic and Preventive Care -Routine ExamsNo Charge -Teeth CleaningsNo Charge -X-RaysNo 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:
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: 1.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.
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: 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%
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.
VOLUNTARY VISION INSURANCE VOLUNTARY VISION INSURANCE Provided by
Vision BenefitsIn-Network Out-of-Network Postdoc PaysPostdoc Pays Eye Exam (every 12 months)$10 Copayup to $30 Allowance Frames (every 24 months)$130 Allowanceup to $65 Allowance (20% off remaining balance) Lenses (every 12 months) Single$0 Copayup to $25 Allowance Bifocal$0 Copayup to $40 Allowance Trifocal$0 Copayup to $63 Allowance Contact Lenses (materials only)$130 Allowanceup to $104 Allowance (15% off remaining balance) For more detailed plan design information go to:
LIFE/AD&D, SHORT-TERM DISABILITY and LONG-TERM DISABILITY INSURANCE LIFE/AD&D, SHORT-TERM DISABILITY and LONG-TERM DISABILITY INSURANCE Provided by
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.
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.
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.
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 Postdoc$486.03$387.60$98.44$4.69 Postdoc + Child(ren)$904.02$720.92$183.09$8.71 Postdoc + Spouse/Partner$1,015.81$810.08$205.74$9.80 Postdoc + Spouse/Partner + Child(ren)$1,438.66$1,147.28$291.38$13.88 Dental HMO Postdoc$14.44$9.67$4.77$0.00 Postdoc + Child(ren)$26.67$13.33$13.34$0.00 Postdoc + Spouse/Partner$24.44$12.22 $0.00 Postdoc + Spouse/Partner + Child(ren)$37.78$12.85$24.93$0.00 Dental POS Postdoc$51.71$34.65$16.60$0.00 Postdoc + Child(ren)$106.32$53.15$51.74$0.00 Postdoc + Spouse/Partner$103.73$51.86$50.47$0.00 Postdoc + Spouse/Partner + Child(ren)$163.77$55.69$105.18$0.00 Vision Postdoc$8.06NA$8.06$0.00 Postdoc + Child(ren)$16.11NA$16.11$0.00 Postdoc + Spouse/Partner$15.31NA$15.31$0.00 Postdoc + Spouse/Partner + Child(ren)$23.69NA$23.69$0.00 DISABILITY - LONG & SHORT TERM PLANS$31.10 NA LIFE INSRUANCE (10K)$1.45 NA
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.
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 enrolling family members. An will be sent no later than July 30 th, 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).
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.
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: