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“I do not think there is any other quality so essential to success of any kind as the quality of perseverance.” – John D. Rockefeller. The University Of. Chicago. Postdoctoral Researcher Benefits Plan. Open Enrollment – Plan Year 2014 November 1 st through November 16 th , 2013.
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“I do not think there is any other quality so essential to success of any kind as the quality of perseverance.” – John D. Rockefeller The University Of Chicago Postdoctoral Researcher Benefits Plan Open Enrollment – Plan Year 2014 November 1st through November 16th, 2013 Effective January 1, 2014
AGENDA Review of Benefit & Plan Designs Explanation of Open Enrollment Process Q & A
Meet Your Postdoctoral ResearcherBenefit Program Representative! Mr. Steven L. Birt, Jr. is a graduate of Vanguard University of Southern California, holding a Bachelor’s degree in Business Management and is a licensed insurance agent.He has 5 years of experience as a Garnett-Powers & Associates university services account representative, and is eager to assist you with any enrollment, benefits or billing questions you may have in regards to the Postdoctoral Researcher Benefit Program.His wife Katherine, and daughter Claire, join Steven in wishing you a wonderful holiday season along with a happy & healthy 2014!
The University of Chicago has partnered with • Garnett-Powers & Associates to administer the Postdoctoral • Researcher Benefits Plan (PRBP). • University of Chicago PRBP is available to all Postdoctoral • Researchers. Visiting scholars (Postdoc Indicator 910xxx) whose stay at the campus is longer than 30 days, are also • eligible. • The PRBP is a package of benefits designed to closely match • the benefits offered to the University of Chicago faculty & • staff. • Medical premiums have increased by 20.1% for 2014. • Vision insurance has been added for 2014! • You may view the new rates at: • www.garnett-powers.com/uchicago by clicking on “Enrollment”, • then “2014 Monthly Rates/Contributions”. The Postdoctoral Researcher Benefits Plan
All University of Chicago Postdoctoral Researchers/Visiting Scholars have the option of the following during the Open Enrollment periodFrom November 1st – November 16th, 2013: • If you are currently enrolled in the PPO medical plan, you • may switch to the HMO medical plan as long as you are in the • HMO service area. • If you are currently enrolled in the HMO medical plan, you • may switch to the PPO medical plan. • If you are currently enrolled in the Principal Dental High Plan, • you may switch to the Principal Dental Low Plan, or vice • versa. • You may enroll in the new VSP vision insurance plan at this time. • If you previously waived either yourself and/or your family • members, you may enroll yourself and your family members • at this time. What is Open Enrollment?
Benefits offered through thePostdoctoral ResearcherBenefit Program
Under the HMO model, the member must choose a Primary • Care Physician (PCP) contracted with the HMO plan at the • time of enrollment (provider directory links are available on • the GPA website). Each family member can have a different • PCP. Your PCP becomes your healthcare “gatekeeper”. • You are allowed to change your PCP once a month if you are • not satisfied with your current choice. • If the member is in need of treatment from a Specialist or is in • need of an In-Patient or Out-Patient procedure, he/she must • obtain a referral from their PCP prior to any type of • consultation or treatment. If the referral is not obtained, no • benefits will be paid. • There is no Out-of-Network benefit (except in the case of an • emergency). What is an HMO plan?
Beginning 1/1/2014, Magellan Health Services will no longerbe utilized by BCBSIL for substance use disorder treatment.As a result, the following changes apply: HMO Plan change in 2014 • Members will no longer be able to self refer through Magellan Health Services. • Members will need to coordinate care with their PCP’s.
Postdoctoral Researcher Benefit ProgramBCBSIL HMO Medical PlanMedical BenefitsIn-NetworkScholar PaysPhysician Office Visit $10 Copay Specialist Office Visit$20 Copay Hospitalization: Inpatient $250 Copay per admission Outpatient $0 Maternity $250 Copay per admission Prescription Drugs: Tier 1 $7 Copay Tier 2 $15 Copay Tier 3 $30 CopayEmergency Room Visits $75 Copay (waived if admitted) Routine Physical Exam $0 Mental Health Outpatient $10 Copay Inpatient $250 Copay per admission Annual Maximum Out of Pocket $1,500 Individual (Does not include deductible) $3,000 Family Deductible: Individual n/a Family n/a Lifetime Maximum Unlimited For more detailed plan design information go to: www.garnett-powers.com/uchicago
There is an In-Network and Out-of-Network component. • The In-Network benefits will be greater than the Out-of- • Network benefits. • At the time of service, the member has the ability to seek care • from a Specialist, without having to obtain a referral from • a PCP. • The contractual agreement between the PPO plan and the • Provider is on a “discounted fee for service” basis. This means • that the provider who participates in the network has agreed to • provide their service on an agreed upon, discounted fee. The • Provider who is not in the network will not agree to that • discounted fee and will typically charge a “Reasonable and • Customary” fee. What is a PPO plan?
There are two primary PPO plan changes that begin on1/1/2014: PPO Plan changes in 2014 • There is now an Out of Pocket maximum, in the preferred network: $1,000 – Individual $2,000 – Family • The following services now apply toward the Out of Pocket maximum: 1) Annual Deductible 2) Emergency Room copay 3) Office Visit copays
Postdoctoral Researcher Benefit ProgramBCBSIL PPO Medical PlanMedical Benefits In-Network Out-of-NetworkScholar PaysScholar PaysPhysician Office Visit $15 Copay 50%*Specialist Office Visit$15 Copay 50%*Hospitalization: Inpatient $0* $300 Copay | 50%* Outpatient $0* 50%* Pregnancy $0* $300 Copay | 50%*Prescription Drugs:Prescription Drug Card Tier 1 $7 Copay Tier 2 $15 Copay Tier 3 $30 CopayEmergency Room Visits $75 Copay $75 CopayRoutine Physical Exam $0 50%*Mental Health Outpatient $15 Copay 50%* Inpatient $0* $300 Copay | 50%*Annual Maximum Out of Pocket $1,000 Individual $10,000 Individual(Does not include deductible) $2,000 Family $20,000 FamilyDeductible: Individual $250 $5,000 Family $500 $10,000Lifetime Maximum Unlimited Unlimited * Subject to DeductibleFor more detailed plan design information go to: www.garnett-powers.com/uchicago
The PPACA requires that you be notified that the Summaries of Benefits and Coverage for your medical plans will be available on the GPA website as of November 1st. • The Summaries of Benefits and Coverage follow the recommended guidelines of PPACA in a standardized format to make them easier to read and comprehend to better serve you in making your plan selections. • You may request a paper copy at no charge by calling the toll-free number on your new ID card. • You may also print a copy directly from the GPA website. Summaries ofBenefits and Coverage
The hospital emergency room is to be used only if the situation is life threatening. • The Immediate (Urgent) Care Center should be used as often as possible to avoid additional charges. • The Immediate Care Center is open 24 hours and is available to treat most non-life threatening emergencies, as broken bones (not multiple fractures), wounds not bleeding profusely, fevers and flu symptoms. • The difference in copay is substantial: $75 copay for emergency room vs$10 for HMO immediate care ($0 on in-network PPO). • There are 8 Immediate Care Centers in the immediate Chicago area. Emergency Services
Due to PPACA, certain preventive health benefits have been added to all non-grandfathered plans as of January 1st, 2013. • Routine gynecological care exams were already covered at no copay with PPACA, as well as routine adult physical exams and mammograms. • Additions are, but not limited to: Pre-natal maternity, screening for gestational diabetes, HPV DNA testing, screening and counseling for interpersonal and domestic violence, contraceptive methods and counseling, as well as breastfeeding support, supplies and counseling. • Contraceptives refers to FDA approved, generic drugs and devices. Women’s PreventiveHealth Benefits
BlueAccess – This is an online member portal. Once you have • your member ID, you may register for access to this site. You • may view your medical visits and claims status, print • temporary ID cards, and gain access to other important • informational sources. • Special Beginnings – This program provides valuable info for • expectant mothers, providing resources and tools dedicated • to the health of mother and baby. A 24 hour, toll free number • staffed by maternity nurses is also available. • Liveon Health Portal – This is an online health resource • providing information and tools designed to help you maintain • your health (Replacing Personal Health Manager). • More info on wellness programs may be found at: • http://www.garnett-powers.com/uchicago/wellness.htm Wellness Programs
onmytime – Self directed courses that allow you to work atyour own pace to reach your health goals. Information onnutrition, fitness, weight management, tobacco cessationand stress. • onmyway – Health Assessment. A personal wellness report isprovided upon completion of the health assessment. Youranswers help tailor the Liveon portal with programs that canhelp you reach your goals. • Life Points Program – Earn points by taking part in wellnessactivities. Points can be redeemed in an online shopping mall. • Fitness Program – 8,000 participating gyms with unlimitedaccess. Month to month memberships. Bonus Life Points forweekly visits. Wellness Programs, cont.Liveon Health Portal
In order to access physician care at the University of Chicago Medical Center, you will need to choose the PPO medical plan as your health care plan. Due to the UCMC billing procedures, it’s important for you to please note the following prior to seeking care: • You will pay more out of pocket to access a physician or medical care provider at the UCMC than if you choose a physician that is not located in the UCMC facility. • The UCMC bills facility physician visits as outpatient procedures, due to certain facility usage charges, therefore making the annual in-network deductible of $250 applicable. • When visiting a UCMC physician on site, you will be responsible for the total charge of the physician visit, up to the $250 deductible. For instance, if the physician visit costs $135, you will pay the $135, not just the usual in-network physician visit charge of $15. • You will satisfy your in-network $250 deductible first as described above, as well as pay a $15 copay for the first and each additional visit. • Once you have satisfied the in-network $250 deductible (or the $500 total for family), you will not have to pay any additional fees with the exception of the $15 for future office visits and any copays for prescriptions for the rest of the calendar year. • The deductible would have to be satisfied with each new calendar year when you seek service at the UCMC. Important Information RegardingServices at the University of Chicago Medical Center
Postdoctoral Researcher Benefit ProgramDental Low Option PPO Annual Maximum $5,000 per person In-Network Out-of-Network Scholar PaysScholar Pays Calendar Year DeductibleNone $75 per person / $225 per family Diagnostic and Preventative Care -Routine Exams No charge 30% + any amount over Usual, -Teeth Cleanings Customary, Reasonable (UCR) -X-Rays Basic Procedures -Fillings 20% 60% + any amount over UCR -Endodontics -Periodontics -Oral Surgery Major Procedures -Crowns 50% 70% + any amount over UCR -Bridgework -Dentures Orthodontia (child only) -$1,500 Lifetime Maximum 50% 60% + any amount over UCR For more detailed plan design information go to: www.garnett-powers.com/uchicago
Postdoctoral Researcher Benefit ProgramDental High Option PPO Annual Maximum $1,500 per person In-Network Out-of-Network Scholar PaysScholar Pays Calendar Year Deductible$60 per person, $180 per family $60 per person / $180 per family (Waived for diagnostic and (Waived for diagnostic and Preventive Care) Preventive Care) Diagnostic and Preventative Care -Routine Exams No charge 0% + any amount over UCR -Teeth Cleanings -X-Rays Basic Procedures -Fillings 20% 20% + any amount over UCR -Endodontics -Periodontics -Oral Surgery Major Procedures -Crowns 50% 50% + any amount over UCR -Bridgework -Dentures Orthodontia (child only) -$1,000 Lifetime Maximum 50% 50% + any amount over UCR For more detailed plan design information go to: www.garnett-powers.com/uchicago
Postdoctoral Researcher Benefit ProgramVoluntary Vision Plan In-Network Out-of-Network Postdoc PaysPostdoc Allowance Exam with Dilation (if necessary):$0 Exam Copay Up to $45 Standard Lenses: -Single Vision $20 Up to $30 -Bifocal Materials Up to $50 -Trifocal Copay Up to $65 Frames:$150 retail allowance for Up to $70 any frame at a retail chain; 20% off amount over your allowance Lens Options: -UV Coating N/A -Tint (solid and gradient) Available N/A -Standard Polycarbonate at a N/A -Standard Anti-Reflection discount N/A *Contact Lenses:$130 Allowance up to $105 Allowance Frequency:Exam, Lenses & Contact Lenses– Once every 12 months. Frames – Once every 24 months. *Contact lenses may be chosen in lieu of eyeglasses. For more detailed plan design information go to: www.garnett-powers.com/uchicago
Postdoctoral Researcher Benefit Program Life Insurance and Accidental Death & Dismemberment (AD&D) Plan • The plan pays $12,000 in the event of a death. • An additional benefit of $12,000 is paid for AD&D if the death • is due to an accident. • Postdoctoral Researchers holding J-1 Visa status will have • the medical evacuation and repatriation of mortal remains • coverage necessary to fulfill the visa requirements included in • their Life and AD&D policy. In addition, family members • holding J-2 Visa status will also be covered for this benefit • even if the Postdoctoral Researcher waives Medical or Dental • coverage.
This is not an open enrollment option; however, if you would • like to purchase additional life insurance, you can apply by • completing a Medical History Statement, found on the GPA • website under ‘Life and AD&D Insurance’. The acceptance of • your application is subject to medical underwriting. • Additional Life coverage can be purchased in increments of • $10,000, to a maximum of $200,000. • Accelerated Benefit Provision – Allows eligible members, who • are terminally ill to receive an early allocation of up to 75% of • their group life insurance benefit. • Rates for Additional Life coverage will automatically be • calculated for you on the enrollment form in Section 5b on the • GPA website. Postdoctoral Researcher Benefit Program Voluntary Supplemental Life Insurance
In order to make changes to your enrollment for Plan Year 2014 • please follow these steps. Please note that all changes made • to your current enrollment will take effect January 1st, 2014: • Go to the Garnett-Powers & Associates website at • www.garnett-powers.com/uchicago and click on “Enrollment”, • then the sub-link “Open Enrollment”. • Click on the “Open Enrollment Instructions” link and print them • out for assistance with completing the Open Enrollment Form • properly. • Once the instructions are in hand, go directly to the “Open • Enrollment Form”. • You will need your Chicago ID and previously created unique • unique password to enter the site. • You may view your current enrollment and make the • plan changes you desire online. Please choose all plans in • which you wish to be enrolled for Plan Year 2014. Once • complete, you may print a copy for your records. The Open Enrollment Process
Once you access the Open Enrollment Form, you may make • the changes mentioned earlier regarding switching to another • plan. • Please check all plans in which you wish to be • enrolled for Plan Year 2014. • Please update your Life Insurance beneficiary information. • If you choose the Medical HMO, you must choose a Primary • Care Physician for all enrolling family members. Provider • Directory links are available on the GPA web site. Please • enter the 3-digit Medical Group number, as well as the 9-digit • Primary Care Physician number for yourself and all enrolling • family members. The Open EnrollmentProcess, cont.
An electronic version of the enrollment form will be submitted • to the Garnett-Powers & Associates’ secure website for • enrollment & billing purposes. • An e-mail will be sent no later than November 30th confirming • your new enrollment status. Please make sure the e-mail • address that appears on your enrollment form is correct. • ID cards will be mailed to your home directly from the • Insurance Carriers regarding any plan changes you make • (BlueCrossBlueShield Medical and/or Principal Dental). • All Postdoctoral Researchers and Visiting Scholars will be • enrolled in the Life Insurance and Accidental Death & • Dismemberment plans. • If you are not making any changes to your enrollment, you do • not need to take any action. Your current enrollment will • remain the same for Plan Year 2014. The Open Enrollment Process, cont.
Visiting Scholar Requirements(Postdoc Indicator 910xxx) • If a Visiting Scholar holding J1 Visa status chooses to waive • out of the plan, they must fax/e-mail proof of coverage (i.e.a • copy of their insurance ID card) to Garnett-Powers & • Associates to verify that their coverage satisfies the J1 Visa • requirements. • Minimum J1 Visa Requirements are: • $50,000 per accident/illness in medical coverage • An annual deductible of no more than $500 • Copayments that do not exceed 25% • All Visiting Scholars will be automatically enrolled in the • University sponsored Basic Life and AD&D plan which • includes the Medical Evacuation and Repatriation of Mortal • Remains coverage required by their J1 Visa (includes J2 • dependents).
For general inquiries and customer service regarding • enrollment, benefit questions and ID cards, you should • contact: • Garnett-Powers & Associates, Inc.Website: • www.garnett-powers.com/uchicago • Toll Free Phone: • 800-261-7109 • Fax #: • 949-583-2929 • Email Address: • prbp@garnett-powers.com Information Sources