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Human Resources
Benefits
Medical
Please
note, all pharmacy and medical insurance cards have been issued
to Saint Louis University plan participants. Please remember that
as of January 1, 2009, medical plan participants will have a separate
pharmacy card issued by Express Scripts (ESI). If you have misplaced
your cards, or did not receive new insurance cards, instructions
on how to obtain new cards is listed below:
ESI
website at https://member.express-scripts.com.
As a new member you will have to Activate your account which you
can do using your social security number as your member ID number.
The ESI
Reimbursement form is also available for prescriptions paid
for out of pocket. A temporary ID card is also available.
Coventry
participants can contact customer service at 800-977-3246 or by
logging onto their website at www.ghp.com;
UnitedHealthcare participants may contact UHC at 866-633-2474 or
by accessing their website at https://www.myuhc.com/.
You will need to register on these websites using your member ID
or Social Security Number to create a log-in.
Effective
January 1, 2009, the addition of out-of-network benefits will be
available under Group Health Plan (GHP), which will be known as
Coventry Missouri, and United Health Care (UHC). Coventry and UHC
will continue to be the University claims administrators and network
providers. They will provide two levels of insurance protection:
one will be a Primary option, which will provide core coverage and
the second option, a PLUS plan that will provide enhanced coverage.
Coventry and
UHC will offer nation-wide networks, which will allow employees
who are traveling, students away at college, and retirees access
to in-network facilities and in-network benefits. All plans will
also allow for out-of-network benefits; however, a higher deductible
and co-pay will apply.
The new health
plan design recognizes the excellence of our SLUCare physicians
and encourages our employees to use them. A new favorable SLUCare
physician co-payment structure will be implemented. The co-pay for
a SLUCare primary care physician office visit will be $10; and for
a SLUCare specialist office visit will be $20. The co-pay for non-SLUCare
primary care physician office visit will be $20, and non-SLUCare
specialist office visit will be $30.
In May 2008
the SLUFit program was implemented, therefore reimbursement for
the Simon Recreation Center membership fees will no longer be reimbursed
under the health insurance plan wellness benefit. Detailed information
about the SLUFit program can be obtained at
http://www.slu.edu/services/HR/forms/Wellness_Plan_Document.pdf
Your enrollment
in a health plan has been defaulted into the plan that most closely
resembles the type of plan for which you are currently enrolled.
GHP members have been defaulted to Coventry PLUS Plan. UHC Choice
Plus POS plan members have been defaulted to UHC Primary Plan. UHC
Choice HMO plan members, have been defaulted to the UHC PLUS plan.
Those efaulted to a plan will have the same level of coverage you
currently have: single, two-person, family or joint.
Helpful Web
sites:
Preview formulary and prescription benefit information prior to
January 2009.
ESI - https://member.express-scripts.com/preview/saintlouisuniversity
ESI pharmacy locator http://www.express-scripts.com/custom/dj6/pharmacy.html
Physician search in the Coventry nationwide network, select Coventry
Missouri under product selection. Coventry - www.ghp.com
Physician search in the UHC nationwide network, select UHC Choice
Plus under product selection. United Health Care -www.myuhc.com
To search for
UHC mental health or substance abuse provides - www.liveandworkwell.com.
If you have any questions regarding your health insurance benefits,
please contact the benefits office at benefits@slu.edu or 314-977-2360.
University
Medical Plans Effective January 1, 2009
For
a complete comparison of the University medical plans and key changes
effective January 1, 2009, please view the revised Schedule
of Benefits.
MEDICAL
PLAN PAYROLL DEDUCTIONS
Effective January 1, 2009 - December 31, 2009
| Biweekly |
CoventryPlus
(formerly
GHP HMO)
|
Coventry Primary (new plan)
|
UHC
PLUS
(formerly UHC HMO)
|
UHC
PRIMARY
(formerly UHC POS)
|
| Employee
|
$16.62 |
$8.77 |
$16.62 |
$8.77 |
| Two-person |
$112.15 |
$75.23 |
$112.15 |
$75.23 |
| Family |
$166.15 |
$116.77 |
$166.15 |
$116.77 |
| Joint |
$128.77 |
$84.00 |
$128.77 |
$84.00 |
| Monthly |
CoventryPlus
(formerly
GHP HMO)
|
Coventry
Primary (new plan)
|
UHC
PLUS
(formerly UHC HMO)
|
UHC
PRIMARY
(formerly UHC POS)
|
| Employee
|
$36.00 |
$19.00 |
$36.00 |
$19.00 |
| Two-person |
$243.00 |
$163.00 |
$243.00 |
$163.00 |
| Family |
$360.00 |
$253.00 |
$360.00 |
$253.00 |
| Joint |
$279.00 |
$182.00 |
$279.00 |
$182.00 |
Important facts about your medical
plan:
Medical
open enrollment will now take place in November of each year.
- You have 31 days from date of
hire to enroll yourself and any eligible family members in a
medical plan.
- Your medical plan is retro-effective
to your date of hire, unless you are covered by a collective
bargaining agreement, in which your effective date may differ.
- You must submit a Health
Insurance Coverage Waiver if you do not wish to have
medical insurance coverage with the University.
- Once enrolled, you cannot change
medical plans until Open Enrollment. Medical Open Enrollment
changes are effective on January 1.
- After your initial 31-day enrollment
period, the only time to enroll yourself or add a dependent
to your plan is at open enrollment, or upon a qualifying event,
including birth, adoption, marriage, or loss of coverage under
a different plan. These changes must be made within 31 days
of the qualifying event.
- Eligible dependents are:
- your spouse, unless legally
separated or divorced
- each of your single children.
The term "children" also includes any such
person related to you by blood or marriage, or for whom
you have legally adopted or assumed a legal obligation,
and any other child, if that child lives in your household
in a parent-child relationship and is dependent upon
you for support.
- children are eligible
for coverage up until their 19th birthday unless a full-time
student. If a full-time student, children can be covered
until age 24 or possibly until their 25th birthday if
they meet the eligibility requirements under WFTRA.
A
copy of The
Women's Health and Cancer Rights Act of 1998 is available
for your review.
University
Medical Plans Effective January 1, 2008 Terminates Effective
December 31, 2008
For
a complete comparison of the University medical plans effective
January 1, 2008, please view the revised Schedule
of Benefits.
Medical
Plan Rates Effective July 1, 2007 through December 31, 2008
| Biweekly |
UHC Choice Plus
|
UHC Choice HMO
|
GHP-ASO
(previously CMR)
HMO
|
| Employee
|
$98.10 |
$43.09 |
$8.78 |
| Two-person |
$184.25 |
$151.45 |
$86.48 |
| Family |
$304.98 |
$198.51 |
$115.67 |
| Joint |
$183.08 |
$86.17 |
$17.57 |
| Monthly |
UHC
Choice Plus
|
UHC
Choice HMO
|
GHP-ASO
(previously CMR)
HMO
|
| Employee
|
$212.54 |
$93.35 |
$19.03 |
| Two-person |
$399.22 |
$328.15 |
$187.37 |
| Family |
$660.78 |
$430.11 |
$250.62 |
| Joint |
$396.67 |
$186.71 |
$38.06 |
PAYROLL
DEDUCTION CATEGORIES
| Employee |
no
benefit for dependents |
| Two
Person |
includes
the employee and one dependent* |
| Family |
includes
the employee and two or more dependents* |
| Joint |
the
cost of dependent benefits when the spouse of an employee is
also a full time employee of the University enrolled in the
same plan |
*As
a result of the Working Families Tax Relief Act of 2004 (WFTRA),
the definition of an eligible dependent must be modified. If your
children or other dependents are covered under the Saint Louis University
Welfare Benefit Plan's medical, dental, and dependent care plans,
please note that, on and after January 1, 2005, the definition of
dependent under Federal tax laws has changed. The medical, dental
and dependent care plans use the definition of dependent under Federal
tax laws as their standard for determining whether your children
or other dependents are entitled to benefits. Effective January
1, 2005, these plans are amended to reflect the new Federal rule.
In order for your children to be eligible for coverage under a medical
plan, they must satisfy the definitions of eligible dependents in
those plans as described in detail in the WFTRA
document.
New
Pharmacy Benefit Manager Effective January 1, 2009
If
your do not receive or if you lost or misplaced your Express Scripts
(ESI) permanent ID card, you may print one using the following
link: Temporary ID Information.
You may visit the ESI website https://express-scripts.com to print
out or order an ESI membership card. Please use the ESI
Rembursement form for prescriptions paid for out of pocket.
Express
Scripts (ESI) will be the University's new Pharmacy Benefits
Manager (PBM) effective January 1, 2009. ESI is one of the largest
PBM's in the country and they have an impressive record of customer
satisfaction. ESI headquarters are in St. Louis and they were
very interested in working with another premier St. Louis institution,
Saint Louis University.
Although particular
medications may fall within a different co-pay tier, the pharmacy
co-pay amounts will remain as follows:
Generic -
$10.00
Preferred brands - $25.00
Non-preferred brands - $40.00
You may view
the ESI Formulary which
will be effective on January 1, 2009 by clicking on the link.
You may view
the pharmacy listing for
the state of Missouri, pharmacy
listing for the state of Illinois, and the network
participation by chain by clicking on the link as well.
ESI's network
has more than 50,000 independent and chain pharmacies nationwide,
including but not limited to: Walgreens, Target, Medicine Shoppe,
Dierberg's and Schnuck's. You can find a list of covered pharmacies
by calling 888-778-8755 or at
http://www.express-scripts.com/custom/dj6/pharmacy.
Until December
31, 2008, before your coverage begins, you can use Express Preview
- an online tool that gives you personalized information about
your benefits ahead of time. You can estimate your prescription
costs for the coming year and discover ways to save money with
generics and Home Delivery. Express Preview is available at https://member.express-scripts.com/preview/saintlouisuniversity.
While co-pays
will remain the same ($10 for generics, $25 for preferred brands,
$40 for non-preferred brands) the formulary will change. If
YOU choose a brand-name drug, you will pay your co-payment plus
the difference in cost between the generic and the brand-name
drug. Please review the ESI website and the formulary so that
you will know how much your current prescriptions will cost next
year.
For more information
about your prescription benefits, please call 888.778.8755. You'll
be able to find information on prescription drugs, drug-industry
news and much more.
The
following information was included in the welcome packet that
you received in the mail:
Home
Delivery Information
Express
Scripts Home Delivery Form
Generic
Preferred Program
Specialty
Preferred Medication Information
Important
facts about your medical plan:
- You have 31 days from date of
hire to enroll yourself and any eligible family members in a
medical plan.
- Your medical plan is retro-effective
to your date of hire, unless you are covered by a collective
bargaining agreement, in which your effective date may differ.
- You must submit a Health
Insurance Coverage Waiver if you do not wish to have
medical insurance coverage with the University.
- Once enrolled, you cannot change
medical plans until Open Enrollment. Medical Open Enrollment
changes are effective on July 1.
- After your initial 31-day enrollment
period, the only time to enroll yourself or add a dependent
to your plan is at open enrollment, or upon a qualifying event,
including birth, adoption, marriage, or loss of coverage under
a different plan. These changes must be made within 31 days
of the qualifying event.
- Eligible dependents are:
- your spouse, unless legally
separated or divorced
- each of your single children.
The term "children" also includes any such
person related to you by blood or marriage, or for whom
you have legally adopted or assumed a legal obligation,
and any other child, if that child lives in your household
in a parent-child relationship and is dependent upon
you for support.
- children are eligible
for coverage up until their 19th birthday unless a full-time
student. If a full-time student, children can be covered
until age 24 or possibly until their 25th birthday if
they meet the eligibility requirements under WFTRA.
Public
Health Inurance Options
Following
is new legislative notices related to your medical insurance rights
under COBRA:
Additionally,
the link to the following letter notifies female employees and their
dependent of additional rights pertaining their medical coverage:
For a complete comparison
of the current University medical plans, please view the Schedule
of Benefits.
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