Making Plans for FY13 Insurance elections
Rita Garland, UM Benefits Specialist, HRS
Terri Phillips, Assoc Vice President, HRS
April 30, 2012
May 23, 2012
MUS health insurance is a self funded plan:
We cover 100% of the costs of medical, dental,
and vision coverage through the revenues
received by the plan – we are not an insurance
company – we are an employee benefit plan.
During FY2013 our benefit plan is projected
to spend $70 million to provide medical,
dental, and prescription drug coverage to our
MUS Employee Group Benefit Plan provides medical,
dental, and prescription drug benefits for 18,000
individuals (including our 8,400 employees and
Ourbenefit plan is funded through the employer
contribution (generally 80%) and premium
contributions for dependents and retirees (about
Lastyear we made significant adjustments to our
plan which have successfully narrowed the gap
between funding and expenditures.
Our administrative expenses are currently about 5%
of plan costs (commercial insurance is capped at
15%) – it would cost us more money to buy
The employer contribution (state share) will remain
at $733 for the coming plan year.
The Montana University System (MUS) uses
the state share (currently $733.00) to pay the
full cost of covering a single employee, and
to subsidize a portion of the cost of
dependent and retiree coverage for those on
The amount of subsidy, and how it is
allocated, will continue to be reviewed by the
Inter Units Benefit Committee (IUBC) and
adjusted as necessary.
Benefit Part of Insurance Add Dependents?
Medical Mandatory for EE No
Dental Plan Mandatory for EE No
Life Insurance Mandatory for EE No
Long Term Disability Mandatory for EE No
Vision Plan optional Yes
Supplemental AD&D optional Yes
Optional Supplemental optional No
Optional Supplemental optional Yes
Dependent Life Ins
Long Term Care with UNUM (pg 27 Choices book):
• UNUM sells Long Term Care insurance;
• UNUM has decided to exit that market BUT has
determined that they will continue to hold and service
the clients they currently have;
• Existing groups who have LTC policies with UNUM will
remain unchanged. The MUS plan with UNUM will
continue to be offered as it has in the past.
• MUS will continue to monitor the status and financial
health of UNUM and the group LTC product.
Managed Care Plans
NEW! PacificSource is a new managed care plan – this
plan has acquired a portion of the New West Health
If you are currently covered by New West then you
will automatically roll to PacificSource as your managed
care plan – they will have the same provider network
as New West (although we always advise you to check
every year and make sure that your providers are still
included on the plan you wish to choose).
You can choose to move to one of the other medical
plans if you do not want PacificSource.
Managed Care Plans:
Add Acupuncture and Naturopathic benefit
(15 visits per year combined).
Add Bariatric Surgery benefit (must meet
criteria – contact MUS benefits office for
Add Travel benefits (requires prior
authorization – previously was only available
Moms enrolled in the WellBaby program will be
provided a breast pump as part of that program.
Generic oral contraceptives will be covered at
An updated fee schedule for diagnostic and
preventive services will be implemented.
Premium plan – most preventive and diagnostic
codes no longer count toward the $1,500
Basic plan only covers preventive care – no
extractions of impacted teeth are covered on this
NEW! Adoption assistance flexible spending
account will be available.
QCC Oncology program ends June 30, 2012 –
contact MUS Benefits office for more
Vision Plan – 11.5% rate reduction – benefits
Flex Administration fee - $2.50 per month
beginning with new plan year.
IRS change to regulations - can only put
$2,500 into a Flex Health account.
Healthy Montana Kids is available for MUS
The State of Montana will enroll the children of Montana
University System and State of Montana employees in the
Healthy Montana Kids program.
This is a graduated program based on household income
and number of dependents – it could provide savings for
For more information, contact your campus HR office or
go to www.hmk.mt.gov or call 1-877-543-7669.
The MUS plan does maintain a hardship fund for members
who are not able to enroll in the Healthy Montana Kids plan.
You must apply for Healthy Montana Kids and be rejected by
that plan in order to apply for the hardship fund.
If you received benefits from the hardship fund in the past
plan year you must re-apply for that fund again this coming
plan year – it is not an automatic continuation from the prior
year. HRS has contacted current recipients to reapply.
Criteria and forms are at http://www.mus.edu/choices/
This year our plan is in a “Closed Enrollment” year
You cannot add any dependents to either medical or dental
plans unless you have a qualifying event (see next slide). If
you have a qualifying event you must go to the UM Human
Resources office to make a change.
You can delete a dependent from your medical or dental
plan during this change period BUT you will not be able to
add them back on in the future unless you have a qualifying
event (or until such time that we have another open
You can add a dependent to vision. You will need to go to
the UM Human Resources office to do so. Complete the
rest of your CHOICES online.
Qualifying Events occur:
Upon hire, new employees will have 30 days to enroll eligible dependents
Within 63 days of a family status change (marriage, divorce, legal separation,
attestation of a domestic partnership, death, etc.) plan members may enroll or
drop a dependent
Within 63 days of the birth, adoption, or affidavit of intent to adopt, plan
members may add a dependent child
Within 63 days of the loss of eligibility for reasons other than non-payment of
premiums (e.g. loss of job, elimination of other coverage, becoming ineligible for
programs such as Medicaid or HMK, or other significant adverse event), plan
members may add a dependent
Remember, if you delete an
eligible dependent during
this enrollment period from
your medical or dental plan
you will not be able to add
them back in the future
without a qualifying event!
Managed Care copays (flat dollar amounts that you
pay for services) remain the same – for example:
$15/office visit for in network providers.
from an out-of-network provider have a
35% coinsurance on any plan.
An out-of-network provider can balance bill the
difference between the allowable amount and the
amount they charge.
Make a list of the medical providers (hospitals
and doctors) that you currently use or
anticipate using in the plan year ahead
(July 1, 2012 – June 30, 2013).
Look up your medical providers (hospitals and
doctors) in the various networks to see if
they are member providers. Make note of the
plans that have all or most of your providers
Compare the monthly medical premium for
each plan that has your providers “in
Consider if you would switch medical
providers, if needed, to choose a less
The pharmacy plan (URx) is the same for all
medical plans so it does not factor into your
Employee Employee & Employee & Employee &
Spouse Children Family
Traditional 673 905 882 1137
Blue Cross 575 774 754 972
Pacific Source 591 795 774 998
Allegiance 612 823 802 1033
Actual rates are printed in the CHOICES booklets pg 4
Traditional Plan Traditional Plan Managed Managed
In Network Out of Network Care in Care Out of
Annual $1,000/person $1,000/person $ 500/person $ 750/person
Deductible $2,250/family $2,250/family $1,000/family $1,750/family
Combined with Separate from
in-network in network
Annual $5,000/person $5,000/person $2,500/person $4,250/person
Coinsurance $11,250/family $11,250/family $5,000/family $9,500/family
Max Combined with Separate from
in-network in network
St. Patrick Community
Hospital is “In Medical Center
Network” is “Out of
The schedule of Annual Benefit Election events and
important dates was sent out as an email – please
post/share that information in your department with
those without email access. It is also on the HRS
Choices workbooks were sent through campus mail
April 16, 2012.
If you need to add a dependent to your vision plan you
will need to talk with UM Human Resources directly –
this cannot be done on-line.
YouMUST complete the on-line process if you have a
Flex account and want to continue your Flex account.
Come to LA139 Computer Lab for on-line election
assistance – check the emailed schedule or HRS
website for scheduled times in the lab.
follow the instructions for using on-line election
process that are available on the HRS website.
Youwill log in to Cyberbear using your NetID number
on-line election process – hit the
complete button when you are done.
Print out a signature page.
Reviewthe information on your signature page
to make sure it is what you signed up for
When you are sure your selections are correct on
the signature page then sign the page and submit it
Signedsignature pages are due on Friday, June 1,
2012, in HRS EL 252 by 5pm.
1. The medical plan monthly costs have
changed – the plan you were in last year
may no longer be the best plan for you.
2. If you want to have a Flex Health account or
Flex Dependent Care account you MUST
sign up for that EVERY year – it does not roll
3. The health care providers that you use may or may
not still be “in network” for the plan you were in
last year. Providers change.
4. Your goal is to stay “in network” to make the best
use of your money – going “out of network” will
cost you more.
5. Check your mailing address while in Cyberbear
and make sure that it is correct.
6. If you have excess employer contribution that you
want to put into a flexible spending account you
MUST MAKE that election – it does not happen
7. New West is no longer a managed care option – if
you make no selection you will be automatically
moved to PacificSource – use this opportunity to
make an informed choice.
Stay “in-network” – you will experience a
Allegiance (Traditional and Managed Care)
Blue Cross/Blue Shield 1-800-820-1674,
Pacific Source 1-877-590-1596,
MAPP 1-888-873-8049 (*)
(*) retiree plan only
Take this opportunity to make sure that your
listed beneficiaries are correct:
For final wages, sick and annual leave payouts:
verify your Decedents Warrant form
For Retirement or Supplemental Retirement
Accounts: complete forms specific to plan
For Life Insurance and AD&D: check/update
This is very vital information when it is needed!
New Lab Vendor -It Starts With Me –
They will be on-campus May 30, 31 & June 1.
To complete the UM WellCheck process – see
HRS website for information on registering.
Look shortly for email information on
WellHeart and WellWeight program.
Take Control – Diabetes Program – email for
info at firstname.lastname@example.org
For more Wellness information – check out