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Annual Enrollment

Annual Enrollment . 2011-2012 Plan Summaries. A&M System Health Plans (Employees). A&M Care Plan Scott & White Health Plan (in some areas) Graduate Plan. A&M System Health Plans (Retirees). A&M Care Plans A&M Care 65 PLUS Scott & White Health Plan (in some areas). A&M Care.

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Annual Enrollment

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  1. Annual Enrollment 2011-2012 Plan Summaries

  2. A&M System Health Plans (Employees) • A&M Care Plan • Scott & White Health Plan (in some areas) • Graduate Plan

  3. A&M System Health Plans (Retirees) • A&M Care Plans • A&M Care • 65 PLUS • Scott & White Health Plan (in some areas)

  4. A&M Care • A&M Care Plan: $700 deductible • Coinsurance: Plan pays 70%, Member Pays 30% • Office Visit Copayments: $30 PCP; $45 Specialist

  5. A&M Care (Retirees) • A&M Care Plan: $700 deductible • 65 PLUS: $500 deductible

  6. A&M Care • Network benefits—Live in a network area and use a network provider • Out-of-Network benefits—Live in a network area and use an out-of-network provider • Non-Network benefits—Live outside a network area or have Medicare

  7. A&M Care: What You Pay • Network • Office visit: $30 for PCP; $45 for specialist, PCP referral not required • Hospital services: • A&M Care: 30% after plan-year deductible

  8. A&M Care: What You Pay • Out-of-Network • Office visit: 50% after plan-year deductible • Hospitalization: 50% after plan-year and hospital deductibles

  9. A&M Care: What You Pay • Non-Network • Most services: 30% after plan-year deductible

  10. Health Maintenance Organizations (HMOs) Scott & White Health Plan • Must live or work in an eligible ZIP code to enroll • Office visit copayment • $30 PCP • $45 Specialist • $350 Deductible • 80/20 Coinsurance

  11. Health Maintenance Organizations (HMOs) The Scott & White Health Plan • Some vision and hearing coverage available with • Requires selection of a primary care physician • Must use HMO doctors/hospitals except in emergency

  12. Other A&M System Benefits • A&M Dental • DeltaCare USA Dental HMO • Vision • Basic Life/Basic AD&D • Alternate Basic Life • Optional Life • Dependent Life • Optional AD&D • Long-Term Disability • Long-Term Care • Flexible Spending Accounts • American Hearing Aid Associates • Marsh Optional Benefits • GMS Relocation Services

  13. A&M Dental • Preventive: 100%; no deductible • Basic: 80% after deductible • Major: 50% after deductible • Orthodontia: 50% after deductible • Delta PPO and Premier Network dentists’ charges lower than non-network dentists • Maximum allowable limits apply

  14. A&M Dental • Deductible: $75/person, $225/family per plan year • Maximum benefits: $1,500/person per plan year • Maximum orthodontic benefits: $1,500/person per lifetime

  15. DeltaCare USA Dental HMO • Must use DeltaCare USA general dentist • General dentist must refer to specialist • No deductible or maximum benefit • Orthodontia: Max 24 mos of treatment • You pay set fee for other services • $ 5 copay for cleanings and $8 copay for amalgam fillings through a network dentist

  16. Vision • Eye exam: • Network: You pay $10 • Non-Network: Plan pays up to $50 • Eyeglasses: • Network: You pay $15 for lenses every plan year and frames every other plan year, plus any frames cost over the frames allowance • Non-Network: Limited benefits

  17. Vision • Contact lenses: • Network: Up to $150 every plan year • Non-Network: Up to $150 every plan year • Surgery: • Network: 15% discount off retail cost and 5% off promotional cost • Non-Network: No benefit • Additional Material Discount Program • 40% Discount on an additional pair of glasses • 1-855-862-4300 for participating providers

  18. Life Insurance • Basic Life/Basic AD&D • Alternate Basic Life • Optional Life • Dependent Life • Optional Accidental Death and Dismemberment (AD&D) • Beneficiaries • Living Access benefit

  19. Basic Life/Basic AD&D • $7,500 life coverage on you • $5,000 life coverage on your eligible dependent children • $5,000 AD&D coverage on you • Included with all A&M System health plans

  20. Alternate Basic Life • Can purchase only if no A&M System health coverage, but certify other coverage • Can use the employer contribution • Cannot elect if you buy Optional Life

  21. Alternate Basic Life • Employees: $50,000 or 7 times your pay, whichever is less, in coverage on you • Retirees: $50,000 or your Optional Life amount, whichever is less, in coverage on you – reduces to $30,000 at age 80 • $5,000 life coverage on your eligible dependent children • $5,000 AD&D coverage on you

  22. Optional Life • Employees: • Coverage of ½, 1, 2, 3, 4, 5 or 6 times annual salary on you • Maximumis $1 million • Retirees • When you retire your Optional Life amount is reduced to $100,000 • Reduction at age 70 to $60,000 and to $30,000 at age 80.

  23. Optional Life • Cost is based on age and tobacco use • Evidence of good health required to increase coverage or enroll in coverage • Cannot elect if have Alternate Basic Life

  24. Dependent Life • Three plans: Plan A, Plan B or Plan C • Plan A covers: • Spouse amounts of: $25,000, $50,000, $75,000, $100,000, $150,000, or $200,000 • Each child: $10,000 • Plan B covers spouse and each child: • $5,000/life; $5,000 AD&D • Plan C covers: • Spouse: 50% of your Alternate Basic Life • Each child: 10% of your Alternate Basic Life

  25. Life Enhancements • Travel Assistance • Legal Services • Beneficiary Financial Counseling

  26. Optional AD&D • Coverage for yourself/yourself & family • Employees: Multiples of $10,000 • Up to $250,000, regardless of pay • Up to 10 times pay or $800,000 maximum • Retirees: Multiples of $10,000 • Up to $200,000 if younger than 70 • Up to $60,000 if 70 or older

  27. Optional AD&D • Dependents: Percentage of your coverage amount • Spouse: 50% and Children: 10% • Spouse only: 60% • Children only: 15%

  28. Optional AD&D • Pays benefits for death or certain injuries resulting from an accident. • Pays full coverage amount or a percentage depending on the extent of loss.

  29. Optional AD&D • Education benefit • Felonious assault benefit • Child care benefit • Medical continuation • Coma benefit

  30. Long-Term Disability • Pays a benefit of 65% of your pay, reduced by other benefits you receive • Reduced by Social Security, workers’ compensation, Federal Civil Service and most other group disability benefits • Reduced by TRS or ORP benefits if you receive payment

  31. Long-Term Disability • Maximum monthly benefit is $8,000 • Minimum monthly benefit is $100 or 10% of your benefit before deductions • Benefits for partial disability • Benefits begin after 90 days of disability • Benefits continue until the greater of the Benefit Duration or Social Security Normal retirement Age • Mental health limited to 24 months • No Evidence of Good Health Required

  32. Long-Term Disability • Workplace accommodation benefit • Cost based on pay, tobacco use • Pre-existing condition definition: A sickness/ injury for which you have received treatment, care, services, or taken medication during the 90 days before LTD coverage begins. • To receive coverage for a pre-existing condition, you must be in the plan 12 months or go 90 days after coverage begins without receiving care/medication.

  33. Long-Term Care • You choose from five maximum benefit levels • $100/day • $150/day • $200/day • $250/day • $300/day • Waiting period: 90 days/nursing facility;15 days/other care

  34. Long-Term Care • To receive benefits, you must be: • unable to perform at least 2 activities of daily living without assistance • require supervision due to a severe cognitive impairment • Six activities of daily living: bathing, continence, dressing, eating, using a toilet and transferring

  35. Long-Term Care • Eligible persons: • Employees and retirees • Spouses • Parents and parents-in-law • Grandparents • Children 18 and older • Portability • Cost depends on age

  36. Flexible Spending Accounts • Must re-enroll each year • Can set aside before-tax dollars to pay health and dependent day care costs • Separate health/day care accounts—no transfers • Can change elections only if you have a Change in Status • Must use it or lose it • No monthly administrative fee

  37. Health Care Account • Can be used for health care expenses not paid by health, dental or vision plan • Can pay medical, dental, vision and hearing expenses even if you don’t have insurance. • Can pay deductibles, coinsurance and copayments • Annual maximum: $4,800 • Monthly minimum: $20 • Money available at start of plan year

  38. Debit Card • If you elect to use the debit card, it costs $9/year • Money comes right out of the Health Care Flexible Spending Account • No paper claims • Keep receipts

  39. Dependent Day Care Account • Can be used to pay for: • Care of a child 12 or younger • Care of an older person with physical or mental disability • Only care that allows you to work • Annual maximum: $5,000 • Monthly minimum: $40 • Money available as you contribute to plan from paychecks

  40. Flexible Spending Accounts • File health claims with your health and dental plans first if you have health/dental insurance • Cannot use for over-the-counter medications, unless prescribed by a doctor. • Cannot take both tax credit/deduction and use Spending Accounts

  41. American Hearing Aid Associates • 30% hearing aid discounts or $250 discount at AHAA providers • Hearing aid price includes: • Testing, fitting and routine maintenance • Quarterly cleanings and adjustments • Yearly audiometric screenings • Yearly hearing aid evaluations • First-year warranty • Repair/loss and damage replacement • Batteries for life of instrument

  42. American Hearing Aid Associates • Show A&M System identification • No premiums or forms • Spouse, children, parents and grandparents are eligible • www.AHAAnet.com or (800) 984-3272

  43. Global Mobility Solutions • Home sale assistance • Van line assistance • Home finding assistance • Special mortgage program • Temporary housing assistance

  44. GMS Relocation Network • Web site relocation tools: www.gmsmobility.com • Relocation coach – Lori Herbert • Call (800) 617-1904 Ext. 8850

  45. Marsh PersonalPlans • Besides the core benefits available to you, Marsh’s PersonalPlans offers additional services that may be of interest. • Auto Insurance • Homeowner’s/renters’ insurance • Identity Theft • Pet Insurance • Health Insurance Mart

  46. Marsh PersonalPlans Marsh PersonalPlans provides: • A broad selection of products and services from highly rated providers • Personalized help from licensed insurance professionals • Free, no obligation quotes by phone or on-line • An information rich web-site • Strict security standard • Visit the website:www.tamuspersonalplans.com or call 1-866-814-7516 for more information

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