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Total Rewards frequently asked questions

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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.

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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.

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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.

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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.)

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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.

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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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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).

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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.

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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 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.

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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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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.

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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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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.

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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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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.)

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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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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.

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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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What is the coverage area for the Custom Network Plan?

Employees who live and/or work in specific counties are covered by the Custom Network Plan. See the coverage map on the Custom Network Plan webpage.

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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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What providers are in-network under the Custom Network Plan?

The Custom Network Plan is able to keep costs low by partnering with a select network of providers. For example, in the Columbia Custom Network, providers are primarily from MU Health, and in the St. Louis Custom Network consists primarily of providers affiliated with Mercy Health System. To see the list of providers, log in to your myUHC.com account, where UnitedHealthcare keeps a list of providers and facilities associated with each medical insurance plan. If you do not yet have a myUHC account, you may also visit the comparison website that UnitedHealthcare created specifically for the UM System.

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How much does the Employee Assistance Program (EAP) cost?

There is no cost for Employee Assistance Program (EAP) services. 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).

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. If a referral is necessary to a counselor in the community, the cost of covering that service is the responsibility of the employee.

Visit the Employee Assistance Program webpage for more information.

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I’m in the ExpressScripts Step Therapy program; what if I need a prescription filled immediately?

If you’ve just started taking a prescription drug regularly or if you’re a new plan member, you may be informed at your pharmacy that your drug isn’t covered. If this should happen and you need your medication right away, you can talk with your pharmacist about filling a small supply of your prescription right away. (You may have to pay full price for this quantity of the drug.) Then, to ensure your medication will be covered by your plan, ask your doctor to write you a new prescription for a front-line drug. Remember: only your doctor can change your prescription to a front-line drug.

If you have more questions, you can go to 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.)

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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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How does the department verify hours for PPACA if supervisors are not required to approve hours?

For the Patient Protection and Affordable Care Act (PPACA), reports will be provided to the departments to allow them to reconcile the full-time equivalency (FTE) in the Peoplesoft HR system with the recorded hours in the time reporting system. Remember that tracking the hours worked is to determine whether an individual is eligible to be offered medical coverage and does not determine pay or the workforce needs of the department. It is the departments’ responsibility to manage staffing.

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What are the tax-favored accounts for health care expenses?

There are two tax-favored accounts available. Which you use will depend on what medical plan you choose. The two accounts are a Health Savings Account (HSA) and a Health Care Flexible Spending Account (FSA). The HSA is available to those people enrolled in an IRS-qualified high-deductible health plan. The only university medical plan that qualifies is the Healthy Savings Plan. The Health Care FSA is available to those employees enrolled in the Custom Network Plan or the PPO Plan, or those benefit-eligible employees who are not enrolled in any university medical plan. More information is available on the understanding your HSA and understanding your FSA webpages.

(Keep in mind that a Dependent Care FSA is different than a Health Care FSA. A Dependent Care FSA is available to every benefit-eligible employee, regardless of which medical plan you choose.)

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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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How often should the full-time equivalency (FTE) be adjusted to reflect actual hours worked?

Reports will be provided monthly, and the FTE in PeopleSoft should be averaged over the measurement period.

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What is an HSA?

If you choose the Healthy Savings Plan and are not covered by another plan (including Medicare) or claimed on another’s taxes, you are eligible to set up a Health Savings Account (HSA) to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. The account is owned and managed by the employee/retiree, and funds remain in the account from year to year if not used for qualified (medical , dental, and/or vision) expenses. Penalties may apply when funds are withdrawn to pay for anything other than qualifying expenses. If you leave the university, the funds in the account go with you. Both you and the university can make pre-tax contributions to the account if you are an active faculty or staff member; retirees can make after-tax contributions to the account. The university makes an annual contribution to active employees' HSAs regardless of whether you make a contribution yourself, for as long as you are enrolled in the Healthy Savings Plan. If you change your insurance plan (to the Custom Network Plan or PPO Plan) in a given year, the university will stop contributions. While you will keep what's in your HSA, you will have to pay an administration fee to keep the HSA as-is. Learn more at Understanding your HSA.

Link to this FAQ