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Total Rewards frequently asked questions

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Will retiree insurance change for current retirees on 1/1/18?

Changes to retiree insurance eligibility and subsidies, effective in 2018, have little effect on current retirees. All current retirees, as well as their spouses and other dependents, who are enrolled in UM’s insurance plan(s) will:

  • Retain their UM insurance coverage—including medical, dental, life, and vision insurance.
  • Retain the current subsidy from UM—including subsidies for spouses and other dependents.

In other words, if you are a current retiree, the changes being communicated to active employees do not impact you. For a list of all current plans available to retirees—including dental, vision, and life—visit the retiree benefits overview on the Total Rewards website.

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How will retiree insurance change for current faculty and staff on January 1, 2018?

Under the approved changes, employees’ eligibility for retiree insurance benefits, as well as their eligibility for a UM System premium subsidy, will be different depending on their age and years of service. Visit the Changes to retiree insurance webpage for general information on eligibility, or access the resources below, which can be especially helpful in determining how you will be affected:

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What research was conducted to support the changes to retiree insurance?

The Retiree Medical Study provided the research on which the Total Rewards Advisory Committee (TRAC) made its deliberations when developing its retiree insurance recommendations, which have since been approved. For more information, access the Retiree Medical Study webpage or the Changes to retiree insurance webpage.

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When deciding which Access Category I am in, does UM round my age and years of service?

Effective January 1, 2018, employee’s eligibility for the university’s retiree insurance plans will change. Eligibility will differ based on whether an employee falls into Access Category A, B, C, or D. The Access Category you are assigned to is based on whole numbers; partial years are not counted. For example, if you are age 50.5 and have 5.5 years of service, you drop the half a year on each and add 50 and 5. In this example, the calculation is 50 + 5 = 55. It’s not 50.5 + 5.5 = 56.

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How does an employee become eligible for UM retiree insurance right now?

Prior to 1/1/2018, or for those employees in Access Category A, an employee is eligible for retiree insurance if he/she is:

  • Eligible for retirement* and
  • Enrolled in a UM insurance plan prior to retirement

This is the structure of retiree insurance benefits and applies to any employee retiring before January 1, 2018, or any employee in Access Category A. Changes to retiree insurance take effect on January 1, 2018, and change eligibility criteria. Read about how eligibility criteria changes in 2018.

* Learn about current retirement eligibility criteria by watching the Retirement eligibility and the defined Benefit Plan on-demand online seminar.

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What tools are available to help me with my retirement decision?

If you're interested in tools that can help you decide if it is better to retire before retiree insurance benefit options change or to wait until later, the university has many resources to support you.

In summer of 2016, UM mailed personalized retirement estimates to employees who wanted to better understand their retirement options. To better understand your retirement options now, you may use UM’s Retirement Calculator to estimate what your pension payout would be if you retired at different points in time.

The decision of whether and when to retire is an individual decision and involves many factors, including pension benefits, other retirement savings, medical coverage options, and an individual’s own career and personal aspirations. UM cannot provide retirement advice, but both Fidelity and TIAA offer free, objective retirement guidance and education on every campus. Visit the Changes to retiree insurance webpage for tools and resources.

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If I have a sick or vacation time accrued, what happens to it when I retire?

When you retire, you will receive day-for-day service credit for accrued sick leave, and there is no cap on sick leave accruals. 

For unused accrued vacation time, you will receive service and salary credit. Unused accrued vacation time is paid out over time at retirement; there are caps on vacation accrual based on your accrual rate. 

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What happens to my service credit if I become disabled in 2017, prior to retiree insurance changes?

The years of service credit necessary to retire and to enroll in retiree insurance will be measured the same way in 2018 as it has always been. In other words, the changes to retiree insurance have no effect on how service credit is accrued.

Under the changes to retiree insurance that go into effect on January 1, 2018, each employee is placed in an access category based on the employee’s status as of December 31, 2017, whether an employee is on Long Term Disability (LTD) or not. If an employee was vested before going on LTD, his/her service credit up to and including December 31, 2017, will be counted. If an employee is NOT vested when the LTD leave begins, he/she will not accrue service credit up to and including December 31, 2017.

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I’m in Category B with 19 years of service on 1/1/18. Can I enroll in ret. insurance after 1/1/18?

If retiring on or after 1/1/18, you must work to age 60 and attain 20 years of service to be eligible for retiree insurance. Category B employees who work to age 60 and attain 20 years of service can enroll in the university’s retiree insurance plans, regardless of what date the employee reaches those two benchmarks.

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I’ve heard I can only retire at certain times of the year; is that true?

If you are in a 9-month appointment, you may retire on 3/1 or 9/1. All others can retire on any day of the year after meeting the eligibility requirements to be a retiree.

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If spouses work for UM, what if one retires while eligible for ret. insurance and the other doesn’t?

If a spouse loses his or her eligibility for a UM benefit(s), the retiree may add the spouse as a dependent for retiree insurance benefits. Please keep in mind, the newly covered spouse is eligible only for continued coverage under the same programs he or she was enrolled in as an eligible employee. Additionally, such a change must be made within 31 days after the change in status.

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How do I maximize my Express Scripts prescription drug benefit?

In order to make the most of your prescription drug benefit through Express Scripts, it’s a good idea to use FDA-approved generic drugs whenever possible. If you are taking a brand-name drug that is not on the plan’s preferred drug list (called a “formulary”), ask your doctor if a preferred- brand drug or a generic would be right for you.

Similarly, fill prescriptions through a retail pharmacy in the Express Scripts network, or via home delivery from the Express Scripts PharmacySM. (Filling a greater than a 32 day supply of maintenance prescriptions at a University pharmacy is the same copay as home delivery.) Of course, many local pharmacies offer other low-cost generic programs, so it’s always a good idea to compare prices at all pharmacies to ensure the best price.

(This FAQ answer provided by Express Scripts.)

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What’s the difference between generic and brand-name prescription drugs?

FDA-approved generic drugs must meet the same U.S. Food and Drug Administration (FDA) standards of quality and purity as brand-name drugs. FDA-approved generic versions have the same active ingredients as their brand-name counterparts are equal in strength and dosage. Sometimes drug manufacturers use different inactive ingredients in generic versions, which may affect its shape, color, size or taste.

(This FAQ answer provided by Express Scripts.)

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How can I find out if my doctor or other provider participates in Medicare?

To find out if your provider participates in Medicare, you can ask your provider or can visit the Medicare.gov website at www.medicare.gov/physiciancompare/search.html to search for your doctor. You can find additional information about Medicare, including the CMS “Medicare and You” brochure, on the Medicare.gov website at www.mymedicare.gov or by calling Medicare at 1-800-MEDICARE. TTY users should call 1-877-486-2048, 24 hours a day, seven days a week.

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What info is needed for me to be enrolled in one of the new UHC Group Medicare Advantage plans?

There is certain information you must provide and actions you must take before you can be enrolled in the new university-sponsored Medicare Advantage plans. Although sponsored by the university, because this coverage replaces your current Medicare Part A and Part B coverage, your enrollment must be approved by the Centers for Medicare and Medicaid (CMS) – the federal agency that is responsible for the administration of Medicare Advantage plans – before coverage becomes effective. CMS will approve enrollment into a Medicare Advantage plan if an individual: 

  • Is enrolled in Medicare Parts A and B,
  • Provides a Health Insurance Claim Number (HICN)/Medicare Claim Number,
  • Has a permanent U.S. street address (no P.O. Box) on file, and
  • Is not within the 30-month coordination period for end-stage renal disease.

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Why do I need to provide my HICN/Medicare Claim Number and street address when I enroll?

This is a critical step in continuing your university retiree medical coverage. If you have already provided your HICN/Medicare Claim Number to the university and have a current permanent U.S. street address on file with the university, you will not need to provide this information again. For most individuals, the university has the information.

Under CMS rules, individuals must provide the following information before CMS will approve their enrollment in a Medicare Advantage plan such as the university-sponsored UHC Group Medicare Advantage plans:

  • Health Insurance Claim Number (HICN)/Medicare Claim Number
  • Street Address (other than a P.O. Box)

To facilitate the collection of this information, the university will be contacting those Medicareeligible retirees and their covered Medicare-eligible dependents who do not have HICNs/Medicare Claim Numbers and/or street addresses on file with instructions on how to provide that information.

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How can I check if the university has my Health Insurance Claim Number (HICN)/Medicare Claim Number?

The university will send out a letter requesting this information from those retirees or their eligible dependents who do not already have HICNs on file with the university.

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What if I don’t enroll in Medicare Parts A and B?

The Centers for Medicare and Medicaid Services (CMS) require you to be enrolled in Medicare Parts A and B, and that you continue to pay your Part B premium (as you do today if you are already enrolled in Medicare), to participate in a Medicare Advantage plan such as the new university-sponsored UHC Group Medicare Advantage plans. Therefore, to remain eligible for your university retiree medical coverage, you must remain enrolled in Medicare Parts A and B. If you are a pre-1990 university retiree, or retired from the Federal Civil Service or the Missouri State Retirement System and have not previously enrolled in Medicare or are not eligible to enroll in Medicare, please contact that the university to discuss your plan options.

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If I am already enrolled in a Medigap plan, can I still enroll in the Medicare Advantage plan?

Medigap (Medicare Supplement) plans are intended to supplement Medicare parts A&B. Since the university-sponsored Medicare Advantage plans replace Medicare, you would not receive any benefits from your Medigap (Medicare Supplement). Therefore, there may be no value in continuing your Medigap (Medicare Supplement) plan.

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If I am enrolled in another Medicare Advantage plan, can I enroll in the university-sponsored plan?

No. CMS does not allow retirees to enroll in two Medicare Advantage plans. You will need to choose between your current plan and the university-sponsored UHC Group Medicare Advantage plans; you cannot be covered under both. 

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How are the Healthy Savings, Custom Network, and PPO plans different?

The Healthy Savings Plan is an IRS-qualified high-deductible health care plan that offers a lower premium with a higher deductible. Because it is qualified by the IRS, it can be paired with a Health Savings Account (HSA) to offset your higher deductible. Plus, the university contributes to your HSA (if you are an active employee) to help pay the higher deductible and eligible out-of-pocket medical, dental, and vision expenses. You may choose to contribute to your HSA, too, up to the IRS maximums, but you do not have to do so to earn the university contribution.

The Custom Network Plan and the PPO Plan are similar to one another in how they are structured. The Custom Network Plan is offered only in specific regions, however. See the Custom Network Plan webpage for information on eligibility. The Custom Network offers a network that is specially selected to keep costs low and offers the mid-level of monthly premiums if you are comparing against the other two plans, but the lowest deductible ($0 for in-network services). The PPO Plan has the same nationwide network as the Healthy Savings Plan and has the highest premium but a lower deductible.

Generally speaking, with both the Custom Network and the PPO Plan, you will pay less per medical service than with the Healthy Savings Plan until you meet the respective deductibles. The Custom Network Plan and the PPO Plan have a higher out-of-pocket maximum than the Healthy Savings Plan.

The Custom Network Plan and PPO Plan can be paired with a Health Care Flexible Spending Account (FSA) to offset out-of-pocket expenses. Any plan can be paired with a Dependent Care FSA.

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I am an LTD recipient enrolled in Medicare, will I need to enroll in the university-sponsored plans?

Long Term Disability (LTD) recipients will not enroll in the University-sponsored UHC Group Medicare Advantage plans for 2017. They will continue to be eligible to remain enrolled in the medical plans offered to active employees: the PPO Plan, Custom Network Plan, and Healthy Savings Plan.

Plan options for LTD recipients in 2018 will be different; stay tuned for more Annual Enrollment information.

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How are large discount stores able to offer generic prescription drugs for $4.00?

Nationwide discount stores often offer “in the door” pricing which allows them to offer lower costs on certain drugs to promote shopping at their location. You have the option of considering purchasing your prescriptions at different locations. Finding out what the price is at multiple locations is a great way to check that you are getting the best price, but don’t forget to factor in the cost of driving to multiple locations versus getting your prescriptions all one place or through mail order.

(This FAQ answer provided by Express Scripts.)

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Will I still need two ID cards to see healthcare services?

No. When receiving care under your university-sponsored UHC Group Medicare Advantage plan, you will only need to use one medical ID card – your Medicare Advantage ID card – instead of two – your Medicare ID card and the ID card for your university-sponsored plan. Beginning in 2017, you will only need to present your new Medicare Advantage ID card when you receive medical services. You will not need to show your original Medicare ID card, although you should keep it in a safe place for your records. Note that you will still need to use your Express Scripts prescription ID card to obtain prescriptions.

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How does the deductible and out-of-pocket maximum work with the Healthy Savings Plan?

The deductible is the total amount members are required to pay each year before the plan begins to pay a benefit. Under the Healthy Savings Plan, if you have individual coverage, you must satisfy the individual deductible before any benefit will be paid. If you have family coverage (two or more are covered), you and/or your dependents must satisfy the family deductible before any benefits will be paid for any member.

Both medical and pharmacy (prescription drug claims) expenses combined accumulate toward a single Healthy Savings Plan deductible and maximum out-of-pocket amount, which is different than the other two insurance plans--the PPO Plan and Custom Network Plan have separate medical and pharmacy deductibles and out-of-pocket limits.

See the Healthy Savings Plan webpage for details about specific deductibles for a given calendar year.

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Will I have the same ID card as my covered eligible dependent?

No. You each will receive your own university-sponsored Medicare Advantage ID card – with your own unique ID number – from UHC in December.

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What are the options available under the new university-sponsored UHC Group Medicare Advantage Plan?
  • The university-sponsored Medicare Advantage Base Plan, or
  • The university-sponsored Medicare Advantage Enhanced Plan.

Both plans offer the same flexibility to see providers in or out of network at the same cost, $0 deductible, no requirement to select a primary care provider, and a referral is not necessary to see a specialist. The university-sponsored Medicare Advantage Base Plan is primarily a co-payment plan, while the university-sponsored Medicare Advantage Enhanced Plan has no member out-of-pocket expense for covered services. However, you do pay an additional premium cost for the Enhanced Plan.

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How does the deductible and out-of-pocket maximum work with the Custom Network Plan?

The deductible is the total amount members are required to pay each year before the plan begins to pay a benefit. Under the Custom Network Plan, there is a $0 deductible (i.e, no deductible) for in-network services. For out-of-network services, each member must meet the individual deductible, or three family members may meet their deductible to reach the maximum family deductible, before a benefit will be paid for any covered member.

Separate deductibles exist for medical expenses and prescription drug expenses.

See the Custom Network Plan webpage for details about specific deductibles for a given calendar year.

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Will there be separate deductibles for Medicare Part A, Part B, and the university-sponsored plans?

No. With the new university-sponsored UHC Group Medicare Advantage plans, you are no longer subject to the Medicare Parts A and B deductibles. If you are enrolling in the university-sponsored Medicare Advantage Base Plan, there is no annual deductible. If you are enrolling in the university-sponsored Medicare Advantage Enhanced Plan, you will no longer have an annual deductible to satisfy either.

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How will the deductible work under the university-sponsored Medicare Advantage Base Plan?

Under the university-sponsored Medicare Advantage Base Plan, most covered services are not subject to an annual deductible or co-insurance. This means that for most covered services, you only will pay your share of the cost – generally a copay – when you receive services. For those covered services that do not have a co-payment assigned, you will only pay the applicable co-insurance for that service since there is no annual deductible. Here’s an example: Let’s say you need a walker on January 2, 2017, which is considered durable medical equipment and is subject to the $0 deductible and co-insurance. The walker costs $110. There is no annual deductible and your coinsurance for the walker is 20%. You would pay $22 or 20% of the $110. In this case, the plan would pay $88.

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How does the deductible and out-of-pocket maximum work with the PPO Plan?

The deductible is the total amount members are required to pay each year before the plan begins to pay a benefit. Under the PPO Plan, each member must meet the individual deductible, or three family members may meet their deductible to reach the maximum family deductible, before a benefit will be paid for any covered member.

Separate deductibles exist for medical expenses and prescription drug expenses.

See the PPO Plan webpage for details about specific deductibles for a given calendar year.

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Will my vision coverage be affected as a result of this change?

No, your vision coverage will remain the same. Please visit http://umurl.us/vision for more information on the University’s Vision Plan.

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Will my dental coverage be affected as a result of this change?

No, your dental coverage will remain the same and will continue to be administered by Delta Dental. Please visit http://umurl.us/dental for more information on the university’s Dental Plan.

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Do the university-sponsored UHC Group Medicare Advantage plans include coverage for hearing aids?

The university-sponsored Medicare Advantage plans include a $500 hearing aid allowance every 36 months. Members will submit a claim to UHC and be reimbursed up to the $500 amount.

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Will retirees still be able to use the hearing aid discount available from TruHearing through VSP?

If a member uses the discount provided by the TruHearing program, they may still submit a claim for reimbursement up to $500 to UHC. Please visit http://umurl.us/hearing for more information on TruHearing.

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Is there a difference in reimbursement between original Medicare and Medicare Advantage plans?

The university-sponsored Medicare Advantage plans are employer-sponsored group Medicare Advantage plans; therefore, members are not limited to utilizing network providers and can see any Medicare-willing provider. Non-network providers are reimbursed up to the Medicare-allowed amount. Therefore, a non-network provider will receive the same reimbursement as they receive under original Medicare. See the chart in question 1 to determine how your claim will be processed for providers who accept Medicare but are not in the UHC Group National PPO Network.

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When pricing my prescriptions, why should I consider generics or preferred brand-name drugs?

You may save money since generics or preferred brand-name drugs usually cost less than non-preferred brand-name drugs. There are generic versions to many brand-name drugs and many new generics become available on a regular basis. Check with your doctor if a lower-cost generic or preferred brand-name drug would be the right option for you.

(This FAQ answer provided by Express Scripts.)

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Are some Medicare Advantage plans restrictive? Do the university-sponsored plans have restrictions?

The university-sponsored UHC Group Medicare Advantage plans are employer-sponsored group Medicare Advantage plan; therefore, the plans do not carry the same limitations as individual Medicare Advantage plans have, such as, limited service areas, network restrictions, limited benefits, etc. The UHC Group Medicare Advantage plans represent a national solution that offers in- and out-of-network coverage at the same copay for members. You are not restricted to a limited service area. You do not need to select a primary care physician, and no referral is needed to see a specialist. The plans cover all of the benefits of Original Medicare and also have some added benefits and clinical programs to help members manage their health more effectively. You still retain the rights and protections of Medicare.

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What does it mean that the university-sponsored Medicare Advantage plans are “medically managed”?

Just as the university plans do now, the university-sponsored UHC Group Medicare Advantage plans will include programs and outreach designed to help retirees and their covered Medicare dependents receive preventive care and generally live a healthy lifestyle. Upon enrolling in one of the UHC Group Medicare Advantage plans, you may receive a call from UHC to discuss your care needs. Please accept this call as it helps ensure that UHC can best support your medical care needs. In cases where more serious care is needed or chronic conditions exist, the university-sponsored UHC Group Medicare Advantage plans will help retirees and their covered eligible dependents actively manage those conditions and help ensure they have access to appropriate resources to help them treat the condition. You have the ability to opt-out of these services if you desire.

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Can I still get a second opinion without a referral under the Medicare Advantage Plans?

Members can receive a second opinion, if needed. Members are not limited to utilizing network providers and can see any Medicare-willing provider.

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What is Form 1095-C?

The 1095-C is titled “Employer-Provided Health Insurance Offer and Coverage.” It is a form you will receive from any employer required to offer health insurance coverage to you, your spouse, and/or other dependents for all or a portion of the tax year, whether you enrolled in the employer’s coverage or not. UM will mail the 1095-C to the home address of employees, retirees, and others who were offered medical insurance during the tax year. It is important that you share it with any listed covered dependents who are filing a tax return separately from you.

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Do ALL copays and coinsurance go toward the Maximum-Out-of-Pocket (MOOP)? If not, which do?

Out-of-pocket amounts such as co-payments or co-insurance for Medicare-covered services all count towards the maximum out-of-pocket. Non-Medicare services, such as routine podiatry, routine vision, and routine chiropractic service, do not apply toward MOOP.

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Who should receive Form 1095-C?

Form 1095-C is mailed to benefit-eligible (i.e., average of 30 hours or more per week) faculty and staff who worked all or part of the tax year, to non-Medicare Advantage retirees, to non-Medicare dependents of Medicare Advantage retirees and to recipients of COBRA or Long Term Disability.

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I received a Health Survey from UHC. Do I need to complete it? Will it affect my coverage or costs?

After your enrollment is effective in one of the university-sponsored UHC Group Medicare Advantage plans, you will receive a Health Survey. The Health Survey is a short questionnaire asking general questions about your health, and responding to the survey allows UHC to identify and recommend wellness and health-improvement programs for which you might qualify. UHC will attempt to reach you two times by phone to complete the survey, or if you wish, you may complete the survey on paper and return it to UHC. This survey is optional and your participation will not affect your coverage or your costs, but we encourage you to complete it as it will help UHC guide you toward programs and information that could be helpful to you.

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When should I receive Form 1095-C?

All employees have the option of receiving an electronic Form 1095-C. If an employee opts for an electronic form by December 31, that person will be able to view and print it from myHR around the middle of January. The University will postmark paper forms by the end of January (or early February if the end of January falls on a weekend) to employees who opt for a paper form. Please allow 10 business days for delivery. Those who opt for an electronic form will not have a paper form generated.

You may not need to wait until Form 1095-C arrives to complete your taxes. UM cannot provide tax advice. To learn more, we recommend you consult a tax advisor or read the IRS' FAQs about this form and whether it is necessary to wait.

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Can I drop my coverage under the university-sponsored UHC Group Medicare Advantage plans?

Yes, you will be able to change your election and opt out of a university-sponsored UHC Group Medicare Advantage plan during Annual Enrollment or at any time during the year. If you drop or cancel your coverage, you will not be able to re-enroll at a later date. 

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How do I opt for an electronic Form 1095-C?

If you have not already opted into receiving electronic 1095-C forms, the University will send you an end-of-the-year email asking you to choose to receive Form 1095-C electronically. Instructions for opting in or out will be included in that email. You must choose to opt in or opt out before midnight, December 31. Also, at any time, you may log into myHR to change opt in/opt out status: Select the “Benefits” tile and in the left-hand menu, scroll down and choose “1095-C Consent.” From there, provide or remove electronic consent. The consent status on file as of December 31 will be the status used for 1095-C generation (electronic or paper form).

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I didn’t receive my Form 1095-C. How can I obtain a reprint?

Form 1095-C will be postmarked for delivery by the US Postal Service by the end of January for each previous tax year. Please allow 10 business days for delivery. Also, you can print a copy through myHR. After navigating to myHR, select the “Benefits” tile and in the left-hand menu, scroll down and select “View Form 1095-C.” From there, you’ll select the year you’d like to view. If you have not received your 1095-C form by mid- to late-February, and do not have access to myHR, please contact the HR Service Center to request a reprint.

Note: You may not need to wait until Form 1095-C arrives to complete your taxes. UM cannot provide tax advice. To learn more, we recommend you consult a tax advisor or read the IRS' FAQs about this form and whether it is necessary to wait.

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