|
Human Resources
Benefits
Medical
Effective
January 1, 2010, Saint Louis University employees will have United
Healthcare (UHC) as their exclusive third-party administrator of
medical plan benefits. UHCs nationwide network will continue to
provide two levels of insurance protection: one will be a Primary
option that will provide core coverage, and the second option a
Plus Plan that will provide enhanced coverage. Both plans will also
allow for out-of-network benefits; however, a higher deductible
and co-pay will apply to out-of-network services. For a complete
comparison of the University medical plans and changes effective
January 1, 2010, please view the 2010
Schedule of Benefits. The only plan benefit change for the 2010
Plan Year is that the lifetime maximum on both medical plans will
be limited to $5 million. There will be no premium increase for
employees for the 2010 Plan Year.
MEDICAL
PLAN PAYROLL DEDUCTIONS
Effective January 1, 2010 - December 31, 2010
| Biweekly |
UHC
Plus Plan
|
UHC Primary Plan
|
| Employee
|
$16.62
|
$8.77
|
| Two-person |
$112.15
|
$75.23
|
| Family |
$166.15
|
$116.77
|
| Joint |
$128.77
|
$84.00
|
| Monthly |
UHC
Plus Plan
|
UHC
Primary Plan
|
| Employee
|
$36.00
|
$19.00
|
| Two-person |
$243.00
|
$163.00
|
| Family |
$360.00
|
$253.00
|
| Joint |
$279.00
|
$182.00
|
Participation
in a United Healthcare benefit will reduce your taxable income.
Since this is a pre-tax benefit, your income is reduced by the above
dental premiums prior to social security (FICA), Federal, State,
and City taxes being assessed.
University
Medical Plans
Effective
January 1, 2010
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.
UHC Nation-wide Network Physician search:
www.myuhc.com
You will find
a "Find a Physician or Facility" link under "Links
and Tools" in the upper right-hand column. On page one, Select
a Search Type, choose the radio button next to "Search for
a Physician" and press continue. On the second page, under
section 2. Select a Plan, use the drop-down box to choose "United
Healthcare Choice Plus." Then, continue your search choice
by location or name.
Selection UHC Choice Plus under Product Selection
To search for
UHC mental health or substance abuse provides: www.liveandworkwell.com.
The
Benefit Office is partnering with the SLUCare Department
of Family and Community Medicine for a new wellness program exclusive
for our employees and their dependents called SLUCare Medical
Home. The program is ideal for those who recognize the value of
protecting their health and welcome the support of the health professionals
best equipped to help. It is an excellent option for those who don't
have a primary care physician, want to change doctors, or have chronic
medical conditions such as diabetes, hypertension or weight problems.
The SLUCare Medical Home will be open five days and two evenings
a week beginning in January 2010. A representative of SLUCare
Medical Home will be present during the open enrollment sessions
to explain the program in detail, or more information may be obtained
at 977-3500. There will be a link on the open enrollment screens
on Self-Service Banner for employees who would like to enroll in
this program. You may also e-mail the SLUCare Medical Home
at familymed@slu.edu.
The Pharmacy
Benefit Manager continues to be Express Scripts (ESI). Pharmaceutical
co-payments will remain the same. Medical Plan participants will
have a separate pharmacy card issued by ESI. If you have misplaced
your cards, or did not receive a new pharmcy cards, instructions
on how to obtain new one may be found on the ESI website at
https://member.express-scripts.com.
To activate an account, the employee social security
number is the member ID number. The ESI
Reimbursement form is also available for prescriptions paid
for out of pocket. A temporary
ID card is also available for those awaiting new membership
card, or those awaiting a replacement for a lost/misplaced card.
In
an effort to continue cost savings for our employees and the University,
we will introduce several different programs through Express
Scripts (ESI) during 2010. ESI will send employees information
corresponding to relevant program(s) as follows:
Step Therapy
Programs: Step Therapy is a program that makes prescription
drugs more affordable for our members and helps our organization
control the rising costs of medications. In the step therapy program,
drugs are grouped in categories, based on cost.
Front Line Drugs: These Step One medications are generic
drugs proven safe, effective, and affordable. These drugs should
be tried first because they can provide the same health benefit
as more expensive drugs, at a lower cost.
Back Up Drugs: Step Two and Step Three drugs are brand
name drugs such as those you see advertised on television. There
are lower cost brand drugs (Step 2) and higher cost brand drugs
(Step 3). Back up drugs always cost more. Step Therapy is developed
under the guidance and direction of independent doctors, pharmacists
and other medical experts. For more information on how Step Therapy
works and how it benefits you, watch this short video at www.steptherapyfacts.com.
Select Home Delivery: ESI will reach out to our members
to enroll you in the home delivery program automatically. Members
may opt out of the program at anytime. If you are currently
filling maintenance prescriptions at a local pharmacy, please
look for communications from Express Scripts regarding this exciting
program.
Curascript Exclusive: Curascript is a specialty pharmacy
that provides injectable, oral and infused specialty medications.
Specialty medications are used to treat complex conditions such
as multiple sclerosis, rheumatoid arthritis, cancer, etc. These
complex and costly medications usually require special storage
and handling and may not be readily available at your local drug
store. Sometimes these medications have side effects that require
monitoring by a trained pharmacist or nurse. Curascript focuses
on providing these medications, while offering excellent clinical
services and support to you and your caregivers. If you are currently
taking a specialty medication, please look for communication from
ESI regarding this new program.
There are several
federal mandates that will be implemented in 2010 as follows:
Mental
Health Parity Act: Under this law, employees seeking treatment
for mental health and substance abuse will have the same benefits
as an employee seeking treatment for any other illness or injury.
The visit and dollar limits on these types of treatment will be
removed.
Michelle's
Law: Under this law, the plan will provide coverage for dependents
in college to continue coverage during a medically necessary leave
of absence from classes for the earlier of one year after the
date the leave began, or the date the coverage would otherwise
have ceased due to the limiting age of 25 or s/he no longer being
a full-time student.
GINA (Genetic
Information and Non-discrimination Act): This law prohibits
group health plans from collecting genetic information and discriminating
in enrollment and cost of coverage based on an individual's genetic
information which includes family medical information.
For 2009
claims, Coventry Missouri customer service may be contacted at 800-977-3246,
or by logging onto their website at www.ghp.com.
Health
plan design recognizes the excellence of our SLUCare physicians
and encourages our employees to use them. In 2009, a new favorable
SLUCare physician co-payment structure will be implemented. The
co-pay for a SLUCare primary care physician office visit is $10;
and for a SLUCare specialist office visit the co-payment is $20.
The co-pay for non-SLUCare primary care physician office visit is
$20, and non-SLUCare specialist office visit is $30. In addition,
if you have difficulty obtaining an appointment with a SLUCare physician,
a SLUCare phone line has been established for employees to call
for assistance---977-3500.
In May 2008
the SLUFit program was implemented. Since that time, reimbursement
for the Simon Recreation Center membership fees are no longer be
reimbursed under the health insurance plan wellness benefit. Detailed
information about the SLUFit program can be obtained by clicking
here.
Helpful Web
sites for 2009 coverage are:
ESI pharmaceutical benefits effective 1/1/2009
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 Missouri Physician Nation-wide Network Search
www.ghp.com (Select Coventry
Missouri under product selection)
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 and Terminating December 31, 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.
| 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.
Express
Scripts (ESI)
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) is the University's 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.
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.
|
