|
Participation in a health insurance plan is not automatic.
An employee must select a plan and complete an enrollment
application. Completed applications must be received in the
Payroll Department within 30 days of your hire date. Changes
to healthcare coverage may be made once each year at our open
enrollment period in November. Changes due to a "life
event" (marriage, birth of a child, divorce, etc) must
be made within 30 days of the event.
Indemnity Plan
Full-time clerical and maintenance employees are eligible,
after 30 days of employment, to participate in the Indemnity
Plan through Cigna HealthCare. The Indemnity Plan, often referred
to as "Fee for Service" or "Traditional Health
Insurance", is made up of two parts, a Base Plan and
Major Medical Coverage. You may choose to enroll in the Base
Plan or in the Major Medical Plan or in both.
Part One: Base Plan
These benefits are primarily for hospital expenses and are
reimbursed at 100% up to the plan limitations
- Hospital Benefit - Semiprivate rate for up to 120 days
- Physical Therapy
- Pre-Operative Testing Benefits
- Surgical Benefits
- Anesthesia
- Surgical Assistance Benefit
- Physicians Benefit (In-hospital)
- Consultations
- Diagnostic X-Ray and Radioactive Therapy
- Hospice Care
The University will pay the full cost of single coverage
and 90% towards family membership.
Pre-certification, is required for all
in-patient services. That is, the insurance company must be
notified, in advance, of all non-emergency hospitalizations.
All amounts above what the Base Plan pays can be submitted
for reimbursement under the Major Medical coverage if both
parts of the Indemnity Plan have been selected.
Part Two:Major Medical Expense Insurance
This part of the Indemnity Plan is intended to supplement
the Base Plan. The objective of Major Medical Coverage is
to absorb the impact of extraordinary medical expenses not
reimbursed under the Base Plan.
Each insured individual is covered initially for a maximum
of $1,500,000.00. Major Medical is provided for spouses, qualified
domestic partners, unmarried children under 19 and dependent
children from ages 19 to 23 who are full-time students.
Safeguards are designed to keep major medical benefits and
costs within reasonable bounds. The following features help
to do this by screening out smaller claims and their disproportionately
higher handling costs, and by giving each insured individual
an interest in the size of his own medical bills:
A deductible amount of $100.00 per participant,
up to a $300.00 family maximum, consisting of any benefits
payable under the Base Plan, plus a cash deductible paid by
the insured individual for covered expenses.
Co-insurance of 20% is paid by the individual
participant. That is, the Major Medical Plan pays 80% of the
Covered Expenses above the deductible amount and the participant
pays 20%.
Health Maintenance Organizations (HMOs)
After 30 days of employment full-time clerical and certain
maintenance employees are eligible to join a Health Maintenance
Organization instead of the traditional health insurance offered
by Cigna HealthCare.
HMO's offer comprehensive health care through group medical
centers or through participating doctors in private practice.
Coverage is usually provided for most medical expenses including
routine physical examinations, eye care and prescriptions.
There are no claim forms to submit and out-of-pocket expenses
are usually nominal. HMOs feature small co-payments for medical
services such as office visits and laboratory tests and for
prescriptions.
The University will pay the full costs of single or family
coverage. Brochures and further information may be obtained
from the Payroll Department.
Point-of-Service Program
After 30 days of employment full-time clerical and certain
maintenance employees are eligible to join a Point-of-Service
Program. Point-of-Service is offered in addition to the Base
Plan and Major Medical coverage (Indemnity Plan) and the Health
Maintenance Organizations (HMOs).
Point of Service plans combine the features of traditional
health care insurance and HMO's. A participant chooses a primary
physician and follows the referral system as in an HMO, but
retains the option to choose a physician or treatment out
of the network (Out-of-Plan/Out-of-Network). Out-of-Network
services are covered under the traditional claims process.
That is, a claim form is submitted to the insurance company
for the out-of-network treatment. The participant is reimbursed
at a specified percentage after a deductible the same as in
an Indemnity Plan. Point of Service plans are considered by
many to be the best option in healthcare. They combine the
"best of both worlds" incorporating the convenience
and low out-of pocket expenses of a HMO with the freedom and
flexibility of an indemnity plan.
The University will pay the full costs of single or family
coverage. Brochures and further information may be obtained
from the Payroll Department.
|
