2019 –20 benefits open enrollment...tier 2 rx (9 x $20) $180.00 4 x online visit (4 x $5) $ 20.00...

2019 – 20 Benefits Open Enrollment

2019-20 Benefits UpdateStaff, Fixed Term Faculty, Medical Faculty & Post-

Doctoral Research Fellows

Benefits Open Enrollment – Elections Required

• IMPORTANT! All benefit-eligible faculty and staff will be required to activelyelect benefits online via CMU Choices for:– Dental: Default to CORE plan (D100/50/50), if enrolled– Vision: Default to no coverage– Flexible Spending Account (FSA): Election required

each plan year– Health Savings Account (HSA): Election required each

plan year

MANDATORYOpen Enrollment

for 2019-20Benefit Year

What’s News & What’s Changing for 2019-20

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• BCBSM PPO2 Medical Plan

– Increase annual deductible

– Increase annual out-of-pocket maximum

– Doctor office visit & urgent care copay increasing $10 ($20 to $30 per visit)

• No changes to the Advantage HDHP and PPO1 medical plans

Current 2019-20In-Network Out-Network In-Network Out-Network

Single $400 $800 Single $500 $1,000 Family $800 $1,600 Family $1,000 $2,000

Current 2019-20In-Network Out-Network In-Network Out-Network

Single $1,600 $3,800 Single $2,000 $4,000 Family $3,200 $7,600 Family $4,000 $8,000

What’s News & What’s Changing for 2019-20• CVS / Caremark Prescription Coverage (PPO 1 / PPO2)

– Adopt Advanced Control Specialty Formulary in an effort to control the rising cost of specialty drugs

– If you are impacted by this change, CVS / Caremark will contact you and your doctor directly

• Coverage Enhancements: Designed to align with our continued efforts and support of a Culture of Health– CVS Caremark Prescription Plan (PPO1 / PPO2): 0% copay for

preventive medication on the generic drug list– Dental Core & Buy Up Plans: Preventive Advantage benefit – all

preventive care, incl. exams, cleaning, x-rays and fluoride treatment cost WILL NOT be deducted from annual benefit maximum


• Health Care Flexible Spending Account (FSA)

– Increase annual contribution limit from $2,650 to $2,700

– Rollover Rule Update: Add a $25 minimum rollover balance

• Health Savings Account (BCBS Advantage HDHP Participants)

– University HSA contributions will continue for 2019-20 benefit

year

» Single Coverage: $107.16 annual contribution

» Two Person Coverage: $221.88 annual contribution

» Family Coverage: $271.32 annual contribution

What’s the Best Plan for You?

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All Your BCBSM Medical Options Provide:• In-network preventive care that’s free to you• The same provider network• Coverage for the same eligible expenses

The Only Difference: How and How Much You PayPremium Cost Share(deducted from your pay)

Out-of-Pocket Costs(deductible, coinsurance, copays)

A fixed cost, no matter how much or how little you use the plan

• Varies by the amount of care you need• Capped by your out-of-pocket

maximum

Medical / Prescription Monthly & Annual Costs

This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions, and limitations are documented in the certificate and amendments.

Comparing Medical / Prescription Plan Options

Medical / Prescription Plan Options Advantage HDHP PPO2 PPO1

Premium Cost Share 97.5% CMU 2.5% Employee

91.7% CMU 8.3% Employee

82.6% CMU 17.4% Employee

Employee MONTHLY Cost Share

Single 2-Person

Family

$13.78 $28.53 $34.87

$ 49.46 $102.38 $125.14

$115.52 $239.11 $292.26

University ANNUAL HSA Contribution

Single 2-Person

Family

$107.16 $221.88 $271.32

Not Available

Not Available

Benefit Summary: In-network benefits Medical Network Prescription Network

BCBS BCBS

BCBS CVS Caremark

BCBS CVS Caremark

Preventive care $0 (plan pays 100%) $0 (plan pays 100%) $0 (plan pays 100%)

Annual deductible (7/1-6/30) $1,350 member $2,700 family**

$500 member $1,000 family

$200 member $400 family

Coinsurance None 20% after deductible None Office visit (primary, specialist, chiropractic) $0 after deductible $30 copay $20 copay

Urgent care visit $0 after deductible $30 copay $20 copay Emergency room visit $0 after deductible $100 copay $100 copay

Prescription 10%/20%/30% after deductible 10%/20%/30% 10%/20%/30%

Annual out-of-pocket maximum (medical & prescription combined)

$3,350 member $6,700 family



**The full family deductible must be met under a two-person or family contract before benefits are paid for any person on the contract.

Advantage HDHP vs. PPO2 Claim Example 2• Maggie is single and injures her hip on a ski vacation.

The injury requires surgery. The costs associated with her procedure total $60,000. Maggie also has 6 monthly follow-up visits with her orthopedic specialist for check-ups on her injury. What does Maggie pay?

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PPO Plan

Deductible $ 500.00Coinsurance (20% to OOPM) $1,500.00Office Visits $ 0Maggie’s Cost* $2,000.00Maggie’s Premium Cost $ 593.52Maggie’s Total Cost $2,593.52

Maggie could also use her own additional pre-tax HSA funds to pay the claims cost.

Advantage HDHP Plan

Deductible $1,350.00Coinsurance (0% to OOPM) $0Office Visits $0Maggie’s Cost* $1,350.00CMU HSA Contribution ($ 107.16)Maggie’s Premium Cost $ 165.36Maggie’s Total Cost $1,408.20

*Libby could also use additional pre-tax health care FSA funds to pay the claims costs

Advantage HDHP vs. PPO2 Claim Example 2

• Libby is married and has 4 kids. During the year, they had 6 visits to the pediatrician ($175 each) and had to fill 9 preferred brand name prescriptions ($100 each). She and her husband Jack went to the doctor 4 times during the year. How much did they spend during the year?

PPO2 Plan

6 x $30 OV copay $180.00Tier 2 Rx (9 x $20) $180.004 x Online Visit (4 x $5) $ 20.00

Libby’s Cost* $ 380.00Libby’s Premium Cost* $1,501.68

Libby’s Total Cost $1,881.68

Advantage HDHP Plan

6 x $175 Office Visit $1,050.00Tier 2 Rx (9 x $100) $ 900.004 x Online Visit (4 x $49) $ 196.00

Libby’s Cost* $2,146.00VU HSA Contribution ($ 271.32)Libby’s Premium Cost $ 418.44

Libby’s Total Cost $2,293.12

*Libby could also use additional pre-tax HSA funds to pay the claims cost.

*Libby could also use additional pre-tax health care FSA funds to pay the claims costs

Know Where to Go

Know where to go when you need

medical care and receive

the best treatment with the

lowest out-of-pocket costs.

Blue Cross Online Visits

• Online Visits allows you to have face-to-face

conversations with a doctor on your computer or

mobile device

• It’s especially convenient on nights and weekends

when your doctor’s office or urgent care isn’t open

• Provides access to in-network, board-certified

doctors and licensed behavioral health professionals

• Allows doctors to ePrescribe utilizing local

pharmacies (where applicable)

• Costs $5 copay (for PPO1/PPO2) and $49 (for

Advantage HDHP) for an online doctor visit

• To get started, visit www.bcbsmonlinevisits.com or call 844-606-1608

CMU Primary Health Care Services• Health care services includes:

– Routine care and physicals– Acute and chronic illness management– Allergy injections and immunizations– Gynecological exams– Basic cardiac screening– Sports medicine– Cosmetic services– Full service lab testing

• Same-day appointment and walk-in availability• Clinic services can be billed to your BCBSM or

MESSA insurance• Schedule appointments by phone: 989-774-7585

13

C.H.I.P. Injury Rehabilitation Services• C.H.I.P. rehabilitation services include:

– Rehabilitation of musculoskeletal injuries (e.g. sprains, strains, contusions, spasms)

– Pre- and post-operative injuries– Conditioning & long-term maintenance programs for

chronic injuries– Some of the treatments available include: ice packs, heat

packs, ultrasound, electronic muscle stimulation, Acuscope/Myopulse, stretches, resistive exercises, range of motion exercises, and warm and cold whirlpool

• No cost for regular full-time and part-time employees, spouses / OEIs and dependents 16 years of age and older

• Hours are Monday – Friday from 8am – noon and 1pm – 5pm• A prescription is required for treatment• Schedule appointments by phone: 989-774-3198

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• New claims administrator:• Dental plan options remain the same plans: Core

(100-50-50) Plan and Buy-Up (100-75-50-50) Plan

• No longer a passive PPO network

– Dental providers are either in-network or out-of-network

– Out-of-network claims will be processed at 100% UCR

– To find an in-network dentist, go to

www.guardiananytime.com and click “Find a Provider” in

the upper navigation

• New ID cards will be mailed to employee’s

home in the middle of June

http://www.guardiananytime.com/


Comparing Dental Plan Options(Staff, Fixed Term Faculty, Medical Faculty, Post Docs)

Dental Plan Options Core Plan100/50/50

Buy-up Plan100/75/50/50

Premium Cost Share 85% CMU15% Employee

49.5% CMU50.5% Employee

Employee MonthlyCost Share

Single 2-Person Family

$ 4.88$10.06$12.55

$28.30$57.48$74.64

Benefit Summary: In-network Benefits (No changes)Annual deductible (7/1-6/30)


$50$100$150

None

Maximum annual benefit (7/1-6/30)

$1,000 per person $1,500 per person

Class 1: Preventive Services 100% (no deductible) 100%Class 2: Basic Services 50% after deductible 75%Class 3: Major Services 50% after deductible 50%

Class 4: Orthodontic Service (children 19 years or younger)

None50%

$2,000 lifetime maximum per person

Dental Monthly & Annual Costs

Dental Treatment in Progress• Any treatment incurred on or after July 1, 2019 will be a

claim processed under the Guardian plan• A dental service is incurred on the date the:

– Root canal: tooth is opened– Crown, inlay/onlay, bridgework: tooth is initially prepared– Dentures: first impression is made– All other covered charges: services are received

• Orthodontia: Guardian will prorate the total treatment fee and the length of treatment and consider benefits from the effective date – July 1, 2019 – forward – Total benefit paid between the two claims administrators will

not exceed the $2,000 lifetime orthodontia maximum– Example: A child used $1,000 under the Meritain Health plan.

The benefit available after July 1, 2019 will be the lesser of $1,000 or 50% of the total prorated amount


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• Same vision carrier: – Largest nationwide network of participating providers– Voluntary participation – you decide whether or not to

enroll for this benefit & pay the fully monthly premium• Two vision plan options:– Standard plan– Premium plan

• In- or Out-of-network eye doctor? Visit www.vsp.com

• No ID Cards– Use SSN to verify eligibility

http://www.vsp.com/


Comparing Vision Plan Options(Staff, Fixed Term Faculty Lecture II/III, Medical Faculty, Regular Faculty)

Vision Plan Options Standard Plan Premium Plan

Employee MonthlyCost Share


$ 6.40$12.82$20.62

$ 9.97$19.96$32.12

Benefit Summary (In-network Payment Level)

Well Vision Exam $20 copay $0 Copay

Frame Allowance (Allowance or contacts OR frames)

$120 or $170 for featured brands

$175 or $225 for featured brands

Lenses$20 copay for single vision,

lined bifocal/trifocal, standard progressives

$20 copay for single vision, lined bifocal/trifocal, standard progressives

Contacts (Allowanceoncontacts ORframes) $120 $175

Vision Monthly & Annual Costs

Not sure which plan is right for you?Or do you want to learn more?

• Try using the ALEX tool!– ALEX is an easy to use, on-line, decision

support tool!• Fun and interactive• Shows you most likely and worst case cost scenarios• Accessible from any internet connected device• Includes medical/prescription, dental, vision,

life/AD&D, disability and FSA/HSA• Check out ALEX online at

https://www.myalex.com/cmu/2019

• Here’s How It Works– If your spouse / OEI is eligible for, but does not to enroll in, their own

employer’s group medical and dental plans, they WILL NOT be eligible for CMU medical and dental coverage

– If your spouse / OEI is enrolled in their employer’s plan, you may add them as a dependent to CMU medical and dental plan, but the CMU plan will pay secondary coverage ONLY

– If you enroll in both plans, benefits under each plan are coordinated. The total reimbursement from both plans cannot be more than the allowable benefit under the CMU plan

Working spouse / OEI is required to enroll in the medical coverage offered through their employer to be added to a CMU medical plan

Reminder: Working Spouse / OEI Rule*

*Applies to staff, fixed term faculty, medical faculty and post-doctoral research fellows.

Questions?–Call 989-774-3661–Email [email protected]–Website: www.cmich.edu/openenrollment

ENROLL BY FRIDAY, MAY 3rd, 5 P.M. (ET)No changes can be made after 5 p.m. on May 3rd

REMEMBERYou MUST enroll between April 22 and May 3, 2019

mailto:[email protected]

http://www.cmich.edu/openenrollment

Thank you for attending.

Consider a Flexible Spending Account (FSA)

Use tax-free dollars to pay eligible health care and dependent care expenses

General Purpose Health FSA Limited Purpose Health FSA Dependent Care FSAMedical, Rx, dental and vision expenses Dental and vision expenses only Dependent day care expenses

Maximum annual contribution: $2,700Use to pay: Out-of-pocket medical, Rx, dental and vision expenses (deductibles, copays, eyeglasses, dental work, etc.) Up to $500 annual rollover Not available if you enroll in the BCBSAdvantage HDHP or MESSA ABC HSA-Saver plan and elect to receive or make contributions to an Health SavingsAccount (HSA) Available only if you enroll in the BCBS PPO1 or PPO2 and MESSA Choices 10-20 or Choices Saver or do not elect to receive or make contributions to an HSA

Maximum annual contribution: $2,700

Use to pay: Out-of-pocket dental and vision expenses onlyUp to $500 annual rollover

Not available if you enroll in the BCBS PPO1 or PPO2 and MESSA Choices 10-20 or Choices Saver or do not elect to receive or make contributions to an HSA

Available only if you enroll in the BCBS Advantage HDHP or MESSA ABC HSA-Saver plan and elect to receive or make contributions to an Health Savings Account (HSA)

Maximum annual contribution: $5,000 (or $2,500 if married filing separately)

Eligible Dependents: Children under age 13 or another dependent who relies on you for more than half of his or her support, such as a disabled elderly parent. The dependent must live in the same principle residence as you at least half the year. Eligible Expenses: Qualified day care expenses such as a day care or eldercare center, babysitters, after school programs and day camps. Not available for health care expenses or residential homes.

Estimate carefully: use or lose it

Guardian Find a ProviderSmile – Finding a dentist in Guardian network is easy

1. Go to guardiananytime.com2. Click on “Find a Provider” in

the upper navigation3. Click the “Search Providers”

button4. Choose the “Find a Dentist”

tab• Select the PPO as the

Plan Type• Enter your search

parameters5. Customize your search by

distance, specialty and language spoken

http://www.guardiananytime.com/

2019 –20 benefits open enrollment...tier 2 rx (9 x $20) $180.00 4 x online visit (4 x $5) $ 20.00...

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