2019 20 Benefits Open Enrollment - Central Michigan ...
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2019 – 20 Benefits Open Enrollment
2019-20 Benefits Update
Staff, Fixed Term Faculty, Medical Faculty & Post-
Doctoral Research Fellows
Benefits Open Enrollment – Elections Required
MANDATORY
Open Enrollment
for 2019-20
• IMPORTANT! All benefit-eligible Benefit Year
faculty and staff will be required to actively
elect benefits online via CMU Choices for:
– Dental: Default to CORE plan (D100/50/50), if enrolled
– Vision: Default to no coverage
– Flexible Spending Account (FSA): Election required
each plan year
– Health Savings Account (HSA): Election required each
plan year
What’s News & What’s Changing for 2019-20
• BCBSM PPO2 Medical Plan
– Increase annual deductible
Current 2019-20
In-Network Out-Network In-Network Out-Network
Single $400 $800 Single $500 $1,000
Family $800 $1,600 Family $1,000 $2,000
– Increase annual out-of-pocket maximum
Current 2019-20
In-Network Out-Network In-Network Out-Network
Single $1,600 $3,800 Single $2,000 $4,000
Family $3,200 $7,600 Family $4,000 $8,000
– Doctor office visit & urgent care copay increasing $10 ($20 to $30 per
visit)
• No changes to the Advantage HDHP and PPO1 medical plans
- Confidential -
4
What’s News & What’s Changing for 2019-20
• CVS / Caremark Prescription Coverage (PPO 1 / PPO2)
– Adopt Advanced Control Specialty Formulary in an effort to
control the rising cost of specialty drugs
– If you are impacted by this change, CVS / Caremark will contact
you and your doctor directly
• Coverage Enhancements: Designed to align with our
continued efforts and support of a Culture of Health
– CVS Caremark Prescription Plan (PPO1 / PPO2): 0% copay for
preventive medication on the generic drug list
– Dental Core & Buy Up Plans: Preventive Advantage benefit – all
preventive care, incl. exams, cleaning, x-rays and fluoride
treatment cost WILL NOT be deducted from annual benefit
maximum
What’s News & What’s Changing for 2019-20
• Health Care Flexible Spending Account (FSA)
– Increase annual contribution limit from $2,650 to $2,700
– Rollover Rule Update: Add a $25 minimum rollover balance
• Health Savings Account (BCBS Advantage HDHP Participants)
– University HSA contributions will continue for 2019-20 benefit
year
» Single Coverage: $107.16 annual contribution
» Two Person Coverage: $221.88 annual contribution
» Family Coverage: $271.32 annual contribution
What’s the Best Plan for You?
All Your BCBSM Medical Options Provide:
• In-network preventive care that’s free to you
• The same provider network
• Coverage for the same eligible expenses
The Only Difference: How and How Much You Pay
Premium Cost Share Out-of-Pocket Costs
(deducted from your pay) (deductible, coinsurance, copays)
A fixed cost, no matter how much or how • Varies by the amount of care you need
little you use the plan • Capped by your out-of-pocket
maximum
- Confidential -
7
Medical / Prescription Monthly & Annual Costs
Comparing Medical / Prescription Plan Options
Medical / Prescription Plan Options Advantage HDHP PPO2 PPO1
97.5% CMU 91.7% CMU 82.6% CMU
Premium Cost Share
2.5% Employee 8.3% Employee 17.4% Employee
Employee Single $13.78 $ 49.46 $115.52
MONTHLY 2-Person $28.53 $102.38 $239.11
Cost Share Family $34.87 $125.14 $292.26
Single $107.16
University ANNUAL
2-Person $221.88 Not Available Not Available
HSA Contribution
Family $271.32
Benefit Summary: In-network benefits
Medical Network BCBS BCBS BCBS
Prescription Network BCBS CVS Caremark CVS Caremark
Preventive care $0 (plan pays 100%) $0 (plan pays 100%) $0 (plan pays 100%)
$1,350 member $500 member $200 member
Annual deductible (7/1-6/30)
$2,700 family** $1,000 family $400 family
Coinsurance None 20% after deductible None
Office visit (primary, specialist,
$0 after deductible $30 copay $20 copay
chiropractic)
Urgent care visit $0 after deductible $30 copay $20 copay
Emergency room visit $0 after deductible $100 copay $100 copay
10%/20%/30%
Prescription 10%/20%/30% 10%/20%/30%
after deductible
Annual out-of-pocket maximum $3,350 member $4,000 member $2,800 member
(medical & prescription combined) $6,700 family $8,000 family $5,600 family
**The full family deductible must be met under a two-person or family contract before benefits are paid for any person on the contract.
This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions,
and limitations are documented in the certificate and amendments.
Advantage HDHP vs. PPO2 Claim Example 2
• Maggie is single and injures her hip on a ski vacation.
The injury requires surgery. The costs associated with
her procedure total $60,000. Maggie also has 6
monthly follow-up visits with her orthopedic specialist
for check-ups on her injury. What does Maggie pay?
Advantage HDHP Plan
PPO Plan
Deductible $1,350.00
Deductible $ 500.00
Coinsurance
Coinsurance
(0% to OOPM) $0
(20% to OOPM) $1,500.00
Office Visits $0
Office Visits $ 0
Maggie’s Cost* $1,350.00
Maggie’s Cost* $2,000.00
CMU HSA Contribution ($ 107.16)
Maggie’s Premium Cost $ 593.52
Maggie’s Premium Cost $ 165.36
Maggie’s Total Cost $2,593.52
Maggie’s Total Cost $1,408.20
*Libby could also use additional pre-tax health care FSA funds to
pay the claims costs
Maggie could also use her own additional pre-tax HSA funds to
pay the claims cost.
9
Advantage HDHP vs. PPO2 Claim Example 2
• Libby is married and has 4 kids. During the year, they
had 6 visits to the pediatrician ($175 each) and had to
fill 9 preferred brand name prescriptions ($100 each).
She and her husband Jack went to the doctor 4 times
during the year. How much did they spend during the
year?
Advantage HDHP Plan PPO2 Plan
6 x $175 Office Visit $1,050.00 6 x $30 OV copay $180.00
Tier 2 Rx (9 x $100) $ 900.00 Tier 2 Rx (9 x $20) $180.00
4 x Online Visit (4 x $49) $ 196.00 4 x Online Visit (4 x $5) $ 20.00
Libby’s Cost* $2,146.00 Libby’s Cost* $ 380.00
VU HSA Contribution ($ 271.32) Libby’s Premium Cost* $1,501.68
Libby’s Premium Cost $ 418.44 Libby’s Total Cost $1,881.68
Libby’s Total Cost $2,293.12
*Libby could also use additional pre-tax HSA funds to pay the *Libby could also use additional pre-tax health care FSA funds to
claims cost. pay the claims costsKnow Where to Go
Know where
to go when
you need
medical care
and receive
the best
treatment
with the
lowest out-of-
pocket costs.Blue Cross Online Visits • Online Visits allows you to have face-to-face conversations with a doctor on your computer or mobile device • It’s especially convenient on nights and weekends when your doctor’s office or urgent care isn’t open • Provides access to in-network, board-certified doctors and licensed behavioral health professionals • Allows doctors to ePrescribe utilizing local pharmacies (where applicable) • Costs $5 copay (for PPO1/PPO2) and $49 (for Advantage HDHP) for an online doctor visit • To get started, visit www.bcbsmonlinevisits.com or call 844-606-1608
CMU Primary Health Care Services
• Health care services includes:
– Routine care and physicals
– Acute and chronic illness management
– Allergy injections and immunizations
– Gynecological exams
– Basic cardiac screening
– Sports medicine
– Cosmetic services
– Full service lab testing
• Same-day appointment and walk-in availability
• Clinic services can be billed to your BCBSM or
MESSA insurance
• Schedule appointments by phone: 989-774-7585
13C.H.I.P. Injury Rehabilitation Services
• C.H.I.P. rehabilitation services include:
– Rehabilitation of musculoskeletal injuries (e.g. sprains,
strains, contusions, spasms)
– Pre- and post-operative injuries
– Conditioning & long-term maintenance programs for
chronic injuries
– Some of the treatments available include: ice packs, heat
packs, ultrasound, electronic muscle stimulation,
Acuscope/Myopulse, stretches, resistive exercises, range
of motion exercises, and warm and cold whirlpool
• No cost for regular full-time and part-time employees,
spouses / OEIs and dependents 16 years of age and older
• Hours are Monday – Friday from 8am – noon and 1pm – 5pm
• A prescription is required for treatment
• Schedule appointments by phone: 989-774-3198
14What’s News & What’s Changing for 2019-20
• New claims administrator:
• Dental plan options remain the same plans: Core
(100-50-50) Plan and Buy-Up (100-75-50-50) Plan
• No longer a passive PPO network
– Dental providers are either in-network or out-of-network
– Out-of-network claims will be processed at 100% UCR
– To find an in-network dentist, go to
www.guardiananytime.com and click “Find a Provider” in
the upper navigation
• New ID cards will be mailed to employee’s
home in the middle of June
- Confidential -
15Dental Monthly & Annual Costs
Comparing Dental Plan Options
(Staff, Fixed Term Faculty, Medical Faculty, Post Docs)
Dental Plan Options Core Plan Buy-up Plan
100/50/50 100/75/50/50
85% CMU 49.5% CMU
Premium Cost Share
15% Employee 50.5% Employee
Employee Single $ 4.88 $28.30
Monthly 2-Person $10.06 $57.48
Cost Share Family $12.55 $74.64
Benefit Summary: In-network Benefits (No changes)
Annual Single $50
deductible 2-Person $100 None
(7/1-6/30) Family $150
Maximum annual benefit
$1,000 per person $1,500 per person
(7/1-6/30)
Class 1: Preventive Services 100% (no deductible) 100%
Class 2: Basic Services 50% after deductible 75%
Class 3: Major Services 50% after deductible 50%
50%
Class 4: Orthodontic Service None $2,000 lifetime maximum
(children 19 years or younger)
per person
This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions,
and limitations are documented in the certificate and amendments.Dental Treatment in Progress
• Any treatment incurred on or after July 1, 2019 will be a
claim processed under the Guardian plan
• A dental service is incurred on the date the:
– Root canal: tooth is opened
– Crown, inlay/onlay, bridgework: tooth is initially prepared
– Dentures: first impression is made
– All other covered charges: services are received
• Orthodontia: Guardian will prorate the total treatment
fee and the length of treatment and consider benefits
from the effective date – July 1, 2019 – forward
– Total benefit paid between the two claims administrators will
not exceed the $2,000 lifetime orthodontia maximum
– Example: A child used $1,000 under the Meritain Health plan.
The benefit available after July 1, 2019 will be the lesser of
$1,000 or 50% of the total prorated amountWhat’s News & What’s Changing for 2019-20
• Same vision carrier:
– Largest nationwide network of participating providers
– Voluntary participation – you decide whether or not to
enroll for this benefit & pay the fully monthly premium
• Two vision plan options:
– Standard plan
– Premium plan
• In- or Out-of-network eye doctor? Visit
www.vsp.com
• No ID Cards
– Use SSN to verify eligibility
- Confidential -
18Vision Monthly & Annual Costs
Comparing Vision Plan Options
(Staff, Fixed Term Faculty Lecture II/III, Medical Faculty, Regular Faculty)
Vision Plan Options Standard Plan Premium Plan
Employee Single $ 6.40 $ 9.97
Monthly 2-Person $12.82 $19.96
Cost Share Family $20.62 $32.12
Benefit Summary (In-network Payment Level)
Well Vision Exam $20 copay $0 Copay
Frame Allowance (Allowance $120 or $170 for featured $175 or $225 for featured
or contacts OR frames) brands brands
$20 copay for single vision, $20 copay for single vision,
Lenses lined bifocal/trifocal, lined bifocal/trifocal,
standard progressives standard progressives
Contacts (Allowance on
$120 $175
contacts OR frames)
This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions,
and limitations are documented in the certificate and amendments.Not sure which plan is right for you?
Or do you want to learn more?
• Try using the ALEX tool!
– ALEX is an easy to use, on-line, decision
support tool!
• Fun and interactive
• Shows you most likely and worst case cost scenarios
• Accessible from any internet connected device
• Includes medical/prescription, dental, vision,
life/AD&D, disability and FSA/HSA
• Check out ALEX online at
https://www.myalex.com/cmu/2019Reminder: Working Spouse / OEI Rule*
Working spouse / OEI is required to enroll in the medical coverage
offered through their employer to be added to a CMU medical plan
• Here’s How It Works
– If your spouse / OEI is eligible for, but does not to enroll in, their own
employer’s group medical and dental plans, they WILL NOT be eligible
for CMU medical and dental coverage
– If your spouse / OEI is enrolled in their employer’s plan, you may add
them as a dependent to CMU medical and dental plan, but the CMU
plan will pay secondary coverage ONLY
– If you enroll in both plans, benefits under each plan are coordinated.
The total reimbursement from both plans cannot be more than the
allowable benefit under the CMU plan
*Applies to staff, fixed term faculty, medical faculty and post-doctoral research fellows.REMEMBER
Questions? You MUST enroll
between April 22
–Call 989-774-3661 and May 3, 2019
–Email benefits@cmich.edu
–Website: www.cmich.edu/openenrollment
ENROLL BY FRIDAY, MAY 3rd, 5 P.M. (ET)
No changes can be made after 5 p.m. on May 3rdThank you for attending.
Consider a Flexible Spending Account (FSA)
Use tax-free dollars to pay eligible health care and dependent
care expenses
General Purpose Health FSA Limited Purpose Health FSA Dependent Care FSA
Medical, Rx, dental and vision expenses Dental and vision expenses only Dependent day care expenses
Maximum annual contribution: $2,700 Maximum annual contribution: Maximum annual contribution: $5,000
Use to pay: Out-of-pocket medical, Rx, $2,700 (or $2,500 if married filing separately)
dental and vision expenses Use to pay: Out-of-pocket dental and Eligible Dependents: Children under age
(deductibles, copays, eyeglasses, dental vision expenses only 13 or another dependent who relies on
work, etc.) you for more than half of his or her
Up to $500 annual rollover
Up to $500 annual rollover support, such as a disabled elderly
Not available if you enroll in the BCBS Not available if you enroll in the parent. The dependent must live in the
Advantage HDHP or MESSA ABC HSA- BCBS PPO1 or PPO2 and MESSA same principle residence as you at least
Saver plan and elect to receive or make Choices 10-20 or Choices Saver or do half the year.
contributions to an Health Savings not elect to receive or make
Eligible Expenses: Qualified day care
Account (HSA) contributions to an HSA
expenses such as a day care or eldercare
Available only if you enroll in the BCBS Available only if you enroll in the center, babysitters, after school
PPO1 or PPO2 and MESSA Choices 10- BCBS Advantage HDHP or MESSA ABC programs and day camps.
20 or Choices Saver or do not elect to HSA-Saver plan and elect to receive
Not available for health care expenses
receive or make contributions to an HSA or make contributions to an Health
Savings Account (HSA) or residential homes.
Estimate carefully: use or lose itGuardian Find a Provider
Smile – Finding a dentist in
Guardian network is easy
1. Go to guardiananytime.com
2. Click on “Find a Provider” in
the upper navigation
3. Click the “Search Providers”
button
4. Choose the “Find a Dentist”
tab
• Select the PPO as the
Plan Type
• Enter your search
parameters
5. Customize your search by
distance, specialty and
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