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Postdoctoral Insurance Plan Open Enrollment - Plan Year 2011

Postdoctoral Insurance Plan Open Enrollment - Plan Year 2011 (November 1 st , 2010 thru November 30 th , 2010) Effective January 1 st , 2011. Agenda. Introduction Review of Benefits and Plan Designs Explanation of Open Enrollment Process Review of Dependent Contribution Worksheet Q & A.

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Postdoctoral Insurance Plan Open Enrollment - Plan Year 2011

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  1. Postdoctoral Insurance Plan Open Enrollment - Plan Year 2011 (November 1st, 2010 thru November 30th, 2010) Effective January 1st, 2011

  2. Agenda • Introduction • Review of Benefits and Plan Designs • Explanation of Open Enrollment Process • Review of Dependent Contribution Worksheet • Q & A

  3. IntroductionThe Postdoctoral Insurance Plan • The University of Pennsylvania Postdoctoral Insurance Plan was implemented on March 1st, 2007, available to all Postdoctoral Scholars. • The University has partnered with Garnett-Powers & Associates to provide both administrative services and customer service for this program. • The Postdoctoral Insurance Plan is a comprehensive package of benefits designed to closely match the benefits offered to the UPENN faculty and staff.

  4. Benefits Offered Through The Postdoctoral Insurance Plan • POS Medical Insurance – Aetna • PPO Medical Insurance - Aetna • DHMO Dental Insurance – Aetna • PPO Dental Insurance - Aetna • PPO Vision Insurance – UnitedHealthcare • Life and AD&D Insurance - Aetna

  5. MEDICALINSURANCE

  6. What is a Point of Service Plan (POS)? A POS offers two tiers of benefits - “ In- Network” and “Out-of-Network”. Under the POS model, the member does not need to choose a Primary Care Physician (PCP). Each family member may have a separate in-network physician. You are allowed to change your physician once a month if you are not satisfied with your current choice. You do not need a referral to see a specialist. The POS allows you to seek services out-of-network, but at much higher out-of-pocket costs.

  7. What is a PPO Plan? • The member does not have to choose a PCP. • 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.

  8. Medical Plan Changes for Plan Year 2011 Some benefit changes have been made to the POS medical plan to control premium costs. Health Care Reform has mandated some changes to benefit levels on both the POS and the PPO medical plans.

  9. Medical Plan Changes for Plan Year 2011, cont Aetna POS Medical Plan Changes: 20102011 Physician/Specialist Copays: $15/$20 $20/$30 Emergency Room Copay: $50 $75 In/Out of Network Hospital Copay/ Coinsurance: $100/$100-50% $250/$250-50% In/Out of Network Outpatient Surgery Copay/Co-insurance: $0/50% $100/50%

  10. Medical Plan Changes for Plan Year 2011, cont. Health Care Reform has mandated the elimination of cost sharing for most preventive care services. Some of those are: 20102011 Aetna POS Medical Plan: In-Network Routine Adult Physical Exam and Well Child Exam Copays: $15 $0 In-Network Routine Gynecological Exam and Mammogram Copays: $15 $0 Aetna PPO Medical Plan: In-Network Routine Adult Physical Exam and Well Child Exam Copays: $25 $0 In-Network Routine Gynecological Exam Copay: $30 $0

  11. Premium Changes on POS and PPO Medical Plans for Plan Year 2011 • Aetna POS Medical Plan: Rates: 20102011 Postdoc Only: $287.78 $323.96 Postdoc + 1: $604.33 $680.32 Postdoc + 2 or more: $938.15 $1056.11 • Aetna PPO Medical Plan: Rates: Postdoc Only: $394.96 $454.11 Postdoc + 1: $829.41 $953.63 Postdoc + 2 or more: $1287.55 $1480.39

  12. Health Care Reformand Your Medical Plans • The Patient Protection and Affordable Care Act of 2010 was signed into law on March 23, 2010. • Your plans are not considered “grandfathered”, which means the mandated provisions of the law will apply to your medical plans. • Benefit changes are highlighted in yellow on the plan benefit pages. • Following are the changes to your Aetna medical plans: • Benefits for certain preventive health care services and screenings must be provided without imposing any cost- sharing requirements.

  13. Health Care Reformand Your Medical Plans, cont. • Following are the changes to your Aetna medical plans, cont: • Coverage of adult children has been extended to age 26 regardless of whether the child is a tax dependent, student, or resides with or receives financial support from the parent. Adult age children (19-26) are excluded if they are eligible to enroll in an employer-sponsored health plan other than the group health plan of either of the child’s parents. • Regarding the above provision, individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in the medical plans offered through Aetna. • You may request enrollment for such children during the Open Enrollment period of November 1st – November 30th, 2010. Enrollment will be effective as of January 1st, 2011.

  14. Postdoctoral Insurance PlanAetna POS Medical Plan Medical Benefits In-Network Out-of-NetworkPostdoc PaysPostdoc PaysPhysician/Specialist Office Visit:$20 /$30Copay 50%*Hospitalization: Inpatient $250 Copay50% after $250 Copay* Outpatient $100 Copay 50%* Pregnancy $250 Copay50% after $250 Copay*Prescription Drugs: Tier 1 $10 Copay $10 + 50% Copay Tier 2 $15 Copay $15 + 50% Copay Tier 3 $30 Copay $30 + 50% CopayEmergency Room Visits:$75 Copay$75 Copay Urgent Care:$20 Copay 50%*Routine Physical Exam:$0 50%*Mental Health: Outpatient $30 Copay 50%* Inpatient $250 Copay50% after $250 Copay*Deductible: Individual n/a $5,000 Family n/a $10,000 Annual Maximum Out of Pocket: $0 Individual $10,000 Individual(Does not include deductible) $0 Family $20,000 FamilyLifetime Maximum: UnlimitedUnlimited * Subject to Deductible

  15. Postdoctoral Insurance Plan Aetna PPO Medical Plan Medical BenefitsIn-Network Out-of-NetworkPostdoc PaysPostdoc PaysPhysician/Specialist Office Visit: $25/$30 Copay 30%*Hospitalization: Inpatient 10%* 30%* Outpatient 10%* 30%* Pregnancy 10%* 30%*Prescription Drugs: Tier 1 $10 Copay $10 + 30% Copay Tier 2 $15 Copay $15 + 30% Copay Tier 3 $30 Copay $30 + 30% CopayEmergency Room Visits: $50 Copay $50 Copay Urgent Care: $25 Copay 30%*Routine Physical Exam:$0 30%*Mental Health: Outpatient $30 Copay 30%* Inpatient 10%* 30%*Deductible: Individual $200 $500 Family $600 $1,500 Annual Maximum Out of Pocket: $2,500 Individual $3,000 Individual(Does not include deductible) $7,500 Family $9,000 FamilyLifetime Maximum: Unlimited Unlimited* Subject to Deductible

  16. Mail Order Pharmacy • You may fill your maintenance prescriptions through mail order. • Mail order forms and instructions are available on Aetna Navigator as well as the GPA website. • The copays (3 months worth of Rx) are: Generic Formulary: $20 Brand Formulary: $30 Generic or Brand, Non-Formulary: $60

  17. Aetna Wellness Programs • Beginning Right – A program to assist moms-to-be with materials on prenatal care, labor and delivery, as well as newborn care and pregnancy risk surveys to identify any potential problems. • Global Fit – Save on fitness club memberships and exercise equipment, with preferred discounts within the GlobalFit network. • Several programs may be viewed on the website at www.garnett-powers.com/upenn/wellness.htm . • To see all programs Aetna offers, visit www.aetna.com and register for Aetna Navigator. • Aetna Navigator secure member website provides numerous services, as finding the cost for tests and procedures, reviewing your claim status details, ordering ID cards and a myriad of other services that can assist you in managing your healthcare.

  18. DENTALINSURANCE

  19. Postdoctoral Insurance Plan DHMO Dental PlanAetna Insurance CompanyDental BenefitsPostdoctoral Scholar PaysDeductibleNoneDiagnostic and Preventative CareRoutine Oral Exams (4 x per year) No chargeRoutine Teeth Cleanings (2 x per year) No chargeRoutine X-Rays No chargeBasic ProceduresFillings Varies up to $80 copayOral Surgery Varies up to $130 copay Endodontics Varies up to $280 copay Periodontics Varies up to $300 copay Major Procedures Crowns Varies up to $400 copay OrthodonticsComprehensive Treatment- Child $1,945 copay plus start-up fees and retentionComprehensive Treatment- Adult $1,945 copay plus start-up fees and retentionAnnual MaximumUnlimited

  20. Postdoctoral Insurance Plan PPO Dental PlanAetna Insurance Company Annual Maximum $1,500In-Network Out-of-NetworkPostdoc PaysPostdoc PaysCalendar Year Deductible $50 Individual / $150 Family $50 Individual / $150 Family Diagnostic and Preventative Care- Routine Exams 0% 20% of UCR - Teeth Cleanings - X-Rays Basic Procedures- Fillings 20% 50% of UCR- Endodontics- Periodontics- Oral Surgery Major Procedures- Crowns 50% 50% of UCR- Bridgework - Dentures Orthodontia (child only)- $2,000 Lifetime Maximum 50% 50% of UCR

  21. VISIONINSURANCE

  22. Postdoctoral Insurance Plan PPO Vision Plan UnitedHealthcare Vision Vision BenefitsIn-Network Out of Network Postdoctoral Scholar PaysPostdoctoral Scholar Allowance Exam with Dilation (if necessary) $10 Exam Copay Up to $40 Standard Lenses: Single Vision $25 Up to $40 Bifocal Materials Up to $60 Trifocal Copay Up to $80 Lenticular Up to $80 Frames $130 retail allowance for Up to $45 any frame, plus discount off balance over allowance Lens Options: UV Coating N/A Tint (solid and gradient) Available N/A Standard Polycarbonate at a N/A Standard Progressive discount N/A Standard Anti-Reflection N/A Contact Lenses $105 Allowance Up to $105 Allowance Frequency: Examination Once Every 12 Months Lenses or Contact Lenses Once Every 12 Months Frame Once Every 12 Months

  23. LIFE AND AD&DINSURANCE

  24. Postdoctoral Insurance Plan Life Insurance and Accidental Death & Dismemberment (AD&D) PlanAetna Insurance Company • The plan pays $50,000 in the event of a death. • The plan pays an additional $50,000 in the event of an Accidental Death. • The plan provides both postdocs and their dependents the medical evacuation and repatriation benefits necessary to satisfy the J1 & J2 Visa requirements. The $10,000 of Medical Evacuation Insurance and $7,500 of Repatriation of Mortal Remains Insurance required will be covered beginning January 1st, 2008 through this benefit.

  25. Life and AD&D Insurance, cont. • 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. • Financial counseling and investment services – All beneficiaries can receive free financial counseling from Chase Investment Services Corporation. • Free Web-based legal information and discounted legal services – The Legal Reference Program offers access to free and discounted legal services. Visit www.ichooselegal.com for more information.

  26. The Open Enrollment Process All currently enrolled Postdoctoral Scholars have the option of the following during the Open Enrollment Period from November 1st – November 30th, 2010. We encourage all postdocs to make their elections prior to November 19th, 2010 in order to receive your ID cards by January 1st, 2011.: • If you are currently enrolled in the Medical POS, you may switch to the Medical PPO. • If you are currently enrolled in the Dental DHMO, you may switch to the Dental PPO, or vice versa. • If you previously waived either yourself and/or your family members, they may be added at this time. • Please Note: If you are currently enrolled in the Medical PPO you may switch to the Medical POS as long as you are in the Medical POS service area. Please call our office for assistance.

  27. The Open Enrollment Process, cont. In order to make changes to your enrollment for Plan Year 2011 please follow these steps. Please note that all changes made to your current enrollment will take effect January 1st, 2011: • Go to the Garnett-Powers & Associates website at www.garnett-powers.com/upenn 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 Penn ID and previously created unique password to enter the site. Once there, you may view your current enrollment and make the plan changes you desire online. Once complete, you may print a copy for your records.

  28. The Open Enrollment Process, cont. • Once you access your online Open Enrollment Form you may do the following: • Make the changes mentioned earlier regarding switching to medical PPO and/or dental PPO if desired. Please check all plans in which you wish to be enrolled for Plan Year 2011. • Enroll yourself and/or your eligible dependents if you previously waived. • Switch from the PPO plan to the POS plan if you are not living outside of the POS service area. • Update your Life Insurance beneficiary information. If nothing has changed, you may leave this section as is.

  29. The Open Enrollment Process, cont. • If you previously waived dental, or now desire to switch to the dental HMO, you must choose a Primary Care Dentist, for all participating family members. One will not be automatically selected for you. Provider directory links are available at the GPA website. • If you are making a change to either the medical PPO or dental PPO plan, and your department will be paying the upcharge (the difference between HMO and PPO), please complete a Dependent Contribution Worksheet. • If you are adding dependents to any plan and the department will be paying for the dependents, please complete a Dependent Contribution Worksheet. • To obtain the form, click on “Dependent Contribution Worksheets” found in the Enrollment section on the website. Please use the ‘PDCW 2011’ for the Open Enrollment changes described above. Both you and your Department Administrator must sign the form. Please either e-mail or fax the form to our office.

  30. The Open Enrollment Process, cont. • When you click ‘Submit’ on the Open Enrollment Form, an electronic version of the enrollment form will be submitted to the Garnett-Powers & Associates’ secure website for data entry. • An e-mail will be sent no later than December 18th 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. You will not receive an ID card for the Vision Plan. • All Postdoctoral Scholars will be enrolled in the Life Insurance and Accidental Death & Dismemberment plans.

  31. Family Member EligibilityFamily member eligibility requirements are the same as the family member eligibility requirements for the UPENN faculty/staff plans. The major family categories are: • Spouse • Natural or adopted child or children to age 26 for medical plans (unless eligible to continue coverage because of disability). Adult age children (19-26) may be excluded if they are eligible to enroll in an employer-sponsored plan other than the group plans of either of the child’s parents Stepchildren may be included, if they live with the Postdoctoral Scholar, are supported by the Postdoctoral Scholar at more than 50% and claimed as a tax dependent. • Same-sex domestic partner. The required Domestic Partner Affidavit (located on the GPA website under ‘Enrollment’) must be notarized and forwarded to Garnett-Powers & Associates.

  32. Information Sources For general inquiries and customer service regarding enrollment, benefit questions and ID cards, please contact: Garnett-Powers & Associates, Inc. • Website: www.garnett-powers.com/upenn • Toll Free Phone: 800-319-9557 • Fax #: 949-583-2929 • Email Address: pdinsplan@garnett-powers.com

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