Go to navigation Go to content
opener

Total Rewards frequently asked questions

Browse FAQs or filter by topic, audience, or program.

Audience
Program
Topic
 
Under the Affordable Care Act, how should FTE be calculated when a course is shared by professors?

To calculate the full-time equivalency (FTE) for the Patient Protection and Affordable Care Act (PPACA), follow the agreed upon methodology of 3 1/3 worked hours per each credit hour taught for the course, and prorate the worked hours among the multiple professors based on the distribution of teaching effort.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

Link to this FAQ

Why are e-cigarettes included as part of the definition of tobacco?

We looked at similar programs offered by higher education institutions and elsewhere in the industry, and the inclusion of e-cigarettes is common. Secondly, due to lack of regulation, e-cigarette companies are not mandated to disclose product ingredients or health effects. Additional research is needed to determine what ingredients e-cigarettes contain and the health implications they have on users.

Link to this FAQ

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.)

Link to this FAQ

Who decides what drugs are covered in the ExpressScripts Step Therapy program?

Step therapy is developed under the guidance and direction of independent, licensed doctors, pharmacists and other medical experts. Together with Express Scripts — the company chosen to manage your pharmacy benefit plan — they review the most current research on thousands of drugs tested and approved by the FDA for safety and effectiveness. Then they recommend appropriate prescription drugs for the step therapy program, and your organization’s pharmacy benefit plan chooses the drugs that will be covered. (This FAQ answer provided by ExpressScripts.)

Link to this FAQ

I have a newborn; Can/should I complete the Tobacco Attestation with the Family Status Change form?

No, the Tobacco Attestation is not required to be completed for newborn children, and adding a newborn does not allow you to change your tobacco status.

Link to this FAQ

If I go on military leave, can I continue to receive my benefits?

Yes. If you are a fully benefit-eligible employee who has completed your probationary period, you can stay enrolled in some or all of the benefits in which you are already enrolled if you pay the amount that would normally have been deducted from you paycheck for you monthly premiums*.

*Note that the university's plans have a specific war exclusion. For details, see the appropriate plan’s Summary Plan Description (SPD) under the forms and guides section of the military leave: information on university benefits page.

Link to this FAQ

Under what conditions can I change my tobacco status mid-year to earn the discount?

There are two conditions that will allow you to change your tobacco status midyear:

  • Family Status Change – If you experience a family status change, or FSC, in which you remove tobacco using dependent(s) (child or spouse/sponsored adult dependent) and you and all other covered dependents are tobacco free, then you will qualify for the discount at that time. Your contributions would change to the discounted rate on the first of the month following the family status change if you submit the required paperwork within 31 days of the event.
  • Midyear Recertification – All faculty and staff who are currently in a non-discount status and become tobacco free or enroll in a tobacco cessation program before June 30 have the opportunity to qualify for the discounted rates from July 1 – December 31 of the plan year. Complete and submit the Midyear Attestation if you qualify.

Link to this FAQ

What is the teaching equivalency for courses taught on less than a 16-week standard semester?

The teaching equivalency for the Patient Protection and Affordable Care Act (PPACA), 3 1/3 hours worked per credit hour taught, remains the same: 1 credit hour taught equals 3 1/3 worked hours, regardless of the time period the class covers.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

Link to this FAQ

If I am currently in a tobacco cessation program, when can I recertify again?

You must recertify with the Midyear Attestation by June 30 and again during Annual Enrollment each year.

Link to this FAQ

What if I choose to suspend coverage while I’m on military leave?

If you choose to suspend coverage while on leave, you must resume your coverage within 31 days of your return to benefit-eligible university employment. If you suspend coverage, coverage is also suspended for all your dependents. Upon your return to work, the coverage for your dependents may be resumed along with your own coverage.

If you choose to suspend coverage while on military leave, coverage is also suspended for your dependents. However, you may enroll your family in a separate military health plan for dependents if you are called to active duty for more than 30 days. Immediately contact the appropriate Armed Forces personnel for information related to these plans, or visit Tricare for more information.

When you do return to benefit-eligible university employment, coverage for your dependents may be resumed along with your own coverage.

Link to this FAQ

Can dependents on active duty be covered under university benefits?

Dependents (including spouses) on active duty are not eligible for the university's medical or dental insurance coverage.

Link to this FAQ

I’m enrolling in a tobacco cessation program. When can I get a discount on my insurance premiums?

If you are enrolling in a cessation program, or re-enrolling in a cessation program, you must be tobacco free for at least 3 months or enrolled in a new tobacco cessation program prior to submitting your tobacco attestation.

Please keep in mind that if you begin using tobacco products at any time during the plan year, you must submit a new tobacco attestation to your Campus Benefit Representative or the HR Service Center at the time you begin using the product(s).

Link to this FAQ

What happens when I return to work from a leave of absence due to active duty?

When you return from a military leave of absence, you will be compensated at the rate of pay you would have received had you continued working during the period of leave. All time spent on a military leave of absence will be counted with previous university experience in calculating seniority and compensation.

If you become physically or mentally unqualified to perform the duties of your former position, you shall be offered employment in a position for which you are qualified.

Use the table below to find out how and when to return to work, based on your type and length of military leave:

Annual training session or emergency mobilization (1-30 days) Emergency mobilizations (31-180 days) Emergency mobilizations (181+ days)

Return to work the first regularly scheduled work day that would fall eight (8) hours after the person returns home.

An application for re-employment must be submitted no later than 14 days after completion of service.

 

An application for re-employment must be submitted no later than 90 days after completion of service; and the employee is qualified to perform the duties of the position.

Learn more about your options when taking a military leave of absence from a university job.

Link to this FAQ

How should employees with both teaching and non-teaching assignments record hours under PPACA?

For the Patient Protection and Affordable Care Act (PPACA), employees that have both teaching and non‐teaching responsibilities (e.g., a part‐time academic employee who teaches classes and also works in a research lab), use the full-time equivalency (FTE) to determine the hours worked. The FTE should include the credit given using the teaching equivalency(3 1/3 hours worked per credit hour taught), as well as a reasonable estimation of the hours spent doing non‐teaching assignments.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

Link to this FAQ

How should hours for teaching clinical courses be tracked under the Affordable Care Act (PPACA)?

Hours worked in a clinical setting should be tracked in the same manner as a variable-hour, non‐teaching exempt employee by recording actual worked hours using a non‐pay time reporting code in the time reporting system.

Link to this FAQ

Where can I get information on tobacco cessation programs?

The Total Rewards website has information for each of the campuses regarding cessation programs with local resources.

Link to this FAQ

If I start using tobacco, when do my contributions change from discount to non-discount?

Contributions would change to the non-discounted rate on the first of the month following the date you submit your revised tobacco attestation.

Link to this FAQ

What happens if I’m not a tobacco user but I marry a tobacco user mid-year?

 If you begin covering your new spouse on your medical plan, your premiums will change from discounted rates to non-discounted tobacco rates beginning the first of the month following the date of marriage. You will be required to sign a benefit change form, a new attestation, and provide proof of relationship.

Link to this FAQ

How should hours for teaching clinical courses be tracked under the Affordable Care Act (PPACA)?

For the Patient Protection and Affordable Care Act (PPACA), hours worked in a clinical setting should be tracked in the same manner as a variable-hour, non‐teaching exempt employee: by recording actual worked hours using a non‐pay time reporting code in the time reporting system.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

Link to this FAQ

What happens if I’m not a tobacco user but my dependent child is?

You will need to mark "tobacco user" on the Tobacco Attestation and pay the non-discounted premium rates.

Link to this FAQ

I’m in the step therapy program. Why couldn’t I fill my prescription at the pharmacy?

The first time you submit a prescription that isn’t for a front-line drug, your pharmacist should inform you that with step therapy you need to first try a front-line drug if you’d rather not pay full price for your prescription drug.

To receive a front-line drug:

  • Ask your pharmacist to call your doctor and request a new prescription.

OR

  • Contact your doctor to get a new prescription.

Only your doctor can change your current prescription to a first-step drug covered by your program.

 

If you have more questions, you can log in and go to www.StepTherapyFacts.com to watch informative videos or call the Express Scripts Pharmacy at the number on your ID card. (This FAQ answer provided by ExpressScripts.)

Link to this FAQ

What if I need more than the Employee Assistance Program’s short-term counseling sessions?

The Employee Assistance Program (EAP) is designed help university employees with personal or work-related problems by providing short-term counseling (up to 5 sessions).  EAP practitioners are trained in assessment. If it is determined that more than five sessions are needed, the practitioner will provide employees with a referral within the community. EAP practitioners attempt to ensure sure all referrals are covered by insurance, or if money is a concern, to help employees locate counseling services that are offered at a sliding fee or reduced rate. Visit the Employee Assistance Program webpage for more information.

Link to this FAQ

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.)

Link to this FAQ

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.

Link to this FAQ

Why must covered dependents be tobacco free? What if only one dependent isn’t tobacco-free?

All dependents covered by the employee’s medical insurance plan must be tobacco free. The goal of this discount program is to encourage healthier living with a reduced risk of cancer and other conditions associated with tobacco use. Also, the university is seeking to reduce the costs of medical insurance for all employees. These goals can best be achieved by encouraging a family-wide cessation of tobacco use – especially because smoking is one of the most common forms of tobacco use and secondhand smoke has health risks just like smoking does. (See the Health Effects of Secondhand Smoke from the Centers for Disease Control and Prevention).

Link to this FAQ

Is there a specific set of job codes that fall into teaching academics?

There is some work being done on academic titles, so it may be possible in the future, but at this time there is no consistent way to distinguish a teaching academic from a non‐teaching academic by title alone. The same title has been used for both teaching and non‐teaching roles, as well as for both fully benefit-eligible and non‐benefit-eligible positions.

Link to this FAQ

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.

Link to this FAQ

Why is “full-time equivalency (FTE)” not an accurate way to determine medical eligibility?

While full-time equivalency (FTE) is currently reported in job data, using FTE does not meet one of the safe harbor methods for tracking hours. The three safe harbor methods are (a) track actual hours, (b) days worked equivalency – credit eight hours worked for any day in which the employee works one hour, or (c) weeks worked equivalency – credit 40 hours worked for any week in which the employee works one hour. Using FTE for teaching academics is appropriate because it is based on an agreed upon documented methodology which is being applied consistently as allowed by the regulations.

Visit the Patient Protection and Affordable Care Act (PPACA) page for more information.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

How do departments ensure time entered by variable-hour, exempt, non-teaching employees is accurate?

Reports are being provided to departments to allow reconciliation of the full-time equivalency (FTE) in the PeopleSoft HR system with the time recorded by variable-hour exempt employees in the time reporting system.

Link to this FAQ

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.

Link to this FAQ

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. 

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

Is women’s preventative health care covered by my insurance plan?

Yes, preventive health care—such as mammograms, screenings for cervical cancer, prenatal care, and other services—is covered at no cost to the employee if you are enrolled in a university medical insurance plan and the visit to your health care provider is not part of a preexisting condition diagnosis or treatment.

Link to this FAQ

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.)

Link to this FAQ

How do I know which front-line drug my doctor should prescribe for my ExpressScripts Step Therapy?

Only your doctor can make that decision. Go to Express-Scripts.com for a list of your plan’s front-line drugs. Give this drug list to your doctor so he or she will know which drugs are covered.

 

If you have more questions, you can call the Express Scripts Pharmacy at the number on your ID card. (This FAQ answer provided by ExpressScripts.)

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ

Must supervisors approve the time that variable-hour, exempt, non-teaching employees enter?

No. The time entry for variable-hour, exempt employees is required in order to meet the “proof of hours worked” requirement under PPACA; it does not determine what an employee is paid. Reports are provided to departments on a monthly basis to allow them to review the hours worked that the employee enters into time-reporting and reconcile that with the full-time equivalency (FTE) listed for the employee in the HR system.

Link to this FAQ

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.

Link to this FAQ

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.

Link to this FAQ