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Human Resources
Benefits
Medical
United Health Care
(UHC) has replaced Healthlink effective January 1, 2008. The
change to UHC mirrors the former University Primary Medical Plan
(UPMP) and Healthlink HMO plan as closely as possible. The three
medical options available as of January 1, 2008 are UHC Choice
Plus, UHC Choice HMO and GHP-ASO HMO.
The new UHC Choice Plus
and UHC Choice HMO have replaced the current UPMP and Healthlink
HMO plans, respectively. Additionally, there has been no premium
increase. The former UPMP rates are charged for the UHC Choice
Plus plan and the former Healthlink HMO rates are charged for
the UHC Choice HMO plan.
The most significant
change from Healthlink to UHC is related to participating providers.
The Healthlink and UHC networks are different, therefore you will
need to ensure that your provider is in the UHC network, or you
will want to select a new participating provider from the UHC
network. Check the UHC website at www.myuhc.com
to learn if your providers are in the UHC network, or contact
your providers' offices to ensure that they accept the UHC plan
you choose. When searching
for a provider online, choose the plan “United Healthcare
Choice Plus” when searching for the PPO (POS) plan and “United
Healthcare Choice” when searching for the HMO plan. For
providers of UHC mental health services, visit www.liveandworkwell.com.
Click here
for more detailed instructions on searching for a provider.
Please be advised, any
employee who had UPMP or the Healthlink HMO plan and did not make
a selection in October for a medical insurance option, was
defaulted into the UHC plan that is most like their former plan:
UPMP participants were defaulted to the UHC Choice Plus plan.
Healthlink HMO participants were defaulted to the UHC Choice HMO
plan.
Following
is the detailed information regarding the UHC plans available
as of January 1, 2008. Please note: There have been no changes
in the GHP-ASO HMO plan design.
University
Medical Plans Effective January 1, 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
| 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.
Walgreens
Health Initiatives (WHI)
Pharmacy Benefit Manager
The
prescription drug plan for all medical plan participants is administered
by one Pharmacy Benefits Manager, Walgreens
Health Initiatives (WHI). Effective July 1, 2005, the drug co-pay
requirements are $10/$25/$40, for generic, preferred, and non-preferred
brand drugs, respectively.
WHI participates with both pharmacy
chain stores and independent pharmacy stores. To search for
an independent or chain pharmacy, please use www.walgreenshealth.com,
and enter 514698 as the 6-digit Rxgrp Number.
Additionally, WHI has a mail
order pharmacy option.
For information on medications, you may view the Drug
Formulary, arranged alphabetically. For prior authorization
of medications, please call WHI at 1-800-207-2568. Please use the
WHI Prescription
Reimbursement Claim Form for prescriptions that were paid for
out of pocket.
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.
University
Medical Plans Terminated December 31, 2007
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University
Primary Medical Plan
(HealthLink Open Access III)
The University Primary Medical
Plan (HealthLink Open Access III) option offers flexibility
to participants with both in-network or out-of-network medical
services. The HealthLink Open Access III network of hospitals
and physicians is the established network for the plan. A
higher benefit level is provided when using in-network services
and providers.
|
Summary
Plan Description |
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|
|
Wellness
Account Info
|
| Schedule
of Benefits |
|
Vision
Care
Epoch
Access Information
|
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HealthLink
Open Access I
(HMO)
The HealthLink HMO option offers
access to participating HealthLink services and providers,
while maintaining an HMO level of benefits. A Primary Physician
does not need to be selected in advance, as long as the provider
is in the HealthLink HMO network. Additionally, referrals
to HealthLink HMO specialists are not required.
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| Summary
Plan Description |
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|
| Schedule
of Benefits |
| Vision
Care |
|
Epoch
Access Information
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For a complete comparison
of the current University medical plans, please view the Schedule
of Benefits.
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