RETIREE RESOURCE GUIDE 2005-2006

RETIREE RESOURCE GUIDE 2005-2006 A PLANNING TOOL FOR EMPLOYEES AND RETIREES OF THE UNIVERSITY OF TEXAS SYSTEM OVERVIEW This booklet provides the information you need to begin planning for your retirement. Please use it as a tool to assist you in making decisions that best meet your benefit needs. Summaries of the available benefits for plan year 2005-2006 (September 1, 2005 - August 31, 2006), eligibility requirements, and enrollment restrictions are contained in this booklet. For additional information, you may visit the UT System Group Benefits website at www.utsystem.edu/egi/, contact your campus Benefits Office or the Teachers Retirement System (TRS) to discuss your benefits options with a benefits professional. Web site addresses and Customer Service telephone numbers for each insurance plan and campus Benefits Office are listed in the back of this booklet. Please read all material carefully and discuss your options and any questions with your campus Benefits Office staff. Additional benefits, such as retiree email, parking and library privileges, may be available to you at your campus. DISCLAIMER Please note the information provided in this booklet is for educational purposes only and is not meant to provide advice. In the event of a discrepancy between this booklet and any information obtained from the Teacher Retirement System of Texas or other state or federal agency, the information directly from the other agency should be considered the correct information. 1 TABLE OF CONTENTS Retirement Insurance Eligibility ....................................................................... 2 Retirement Programs ...................................................................................... 3 Teacher Retirement System (TRS) ..................................................................................................................... 3 Optional Retirement Program Participants ....................................................................................................... 11 UT Saver Supplemental Retirement Savings Programs ................................................................................... 11 Medicare and Social Security ......................................................................... 13 Medicare Part D ................................................................................................................................................ 13 Notice of Creditable Coverage....................................................................... 15 Social Security............................................................................................... 19 Retirees with TriCare..................................................................................... 21 Returning to Work After Retirement .............................................................. 22 The Basics .................................................................................................... 23 HIPAA .............................................................................................................................................................. 27 HIPAA .............................................................................................................................................................. 27 Monthly Out of Pocket Insurance Premiums for Retirees ................................................................................ 28 Medical ............................................................................................................................................................. 32 MEDICAL PLAN COMPARISON CHART ................................................................................................... 36 Medicare Coordination of Benefits................................................................................................................... 47 Dental................................................................................................................................................................ 49 Vision................................................................................................................................................................ 52 Life Insurance ................................................................................................................................................... 54 Long Term Care................................................................................................................................................ 55 Frequently Asked Questions.......................................................................... 57 Benefit Offices .............................................................................................. 60 INSURANCE CONTACTS.............................................................................................................................. 61 Retirement Contacts ..................................................................................... 62 State and Federal Retirement System Contact Information.............................................................................. 62 Federal Insurance Programs.............................................................................................................................. 63 Rev. 4/2006 2 Retirement Insurance Eligibility Legislation passed by the 79th Legislature resulted in many changes to the retirement rules. The following is a summary of retirement eligibility rules for insurance purposes. 1. Individuals who met the requirements in Texas Insurance Code Section 1601.102(b)(1)-(3) and retired as an annuitant (for ORP you do not have to be an annuitant) on or before August 31, 2003, may participate as a retired employee in group insurance benefits if: 1. the individual had at least 3 years of service with UT for which the individual was eligible to participate in the group insurance plan; and 2. the individual's last state employment before retirement was with UT; and 3. the individual retired under the jurisdiction of: • the Teacher Retirement System of Texas; or • the Employees Retirement System of Texas; or • the Optional Retirement Program established by Chapter 830, Texas Government Code; or • any other federal or state statutory retirement program to which The University of Texas System has made employer contributions. 2. Those individuals who were employed with The University of Texas System or who were eligible to retire on August 31, 2003, but chose not to retire as an annuitant until after August 31, 2003, must still meet the criteria described above. 3. Individuals that began work on or after September 1, 2003, and who subsequently retire as an annuitant, must meet the following criteria in order to be eligible for UT group retirement benefits: a. the individual has at least 10 years of UT service; and b. the individual's last state employment before retirement was with UT; and c. the individual retires under the jurisdiction of: • the Teacher Retirement System of Texas; or • the Employees Retirement System of Texas; or • the Optional Retirement Program established by Chapter 830, Texas Government Code; or • any other federal or state statutory retirement program to which The University of Texas System has made employer contributions. d. the individual meets the rule of 80 with at least 10 years total creditable service, or the individual has10 years total creditable service and is age 65. Rev. 4/2006 3 Retirement Programs The University of Texas System provides a number of vehicles that you can use to save for retirement. In addition to mandatory participation in the Teacher Retirement System of Texas (TRS) or Optional Retirement Program (ORP), you can enroll in a Tax-Sheltered Annuity Program (UTSaver TSA) or the Deferred Compensation Plan (UTSaver DCP). You are eligible for retirement benefits with TRS on your first day of employment, and in ORP if employed in an ORPeligible position. You may enroll in the UTSaver TSA or UTSaver DCP at any time. For more information regarding your retirement options contact your campus benefits office or log on at http://www.utretirement.utsystem.edu/. Teacher Retirement System (TRS) Accessing your TRS account Your TRS account information is confidential and can only be accessed by you. TRS active members with valid passwords can now obtain access to their most recent Annual Statement of Account through the TRS website. Online Access: Active members may request a password by downloading form TRS 608I online at http://www.trs.state.tx.us. Print out the form, complete it fully, and then sign the form before a notary public before mailing the original, completed form back to TRS (do not send a copy or fax). After TRS receives this form, your password will be mailed to you. You will be able to use the password to log in for the first time. You must change your TRS-issued password to another password (8 - 10 alpha-numeric characters) of your own choosing. Telephone Access: You may also access account information from the TRS Automated Telephone System by requesting a PIN Authorization Form TRS 590 either from the TRS website above, or by calling 1-800-223-8778. The TRS 590 form will be mailed to your address on file with TRS the next working day. Complete the PIN Authorization Form and sign before a notary public. Return the original notarized form to TRS. Once TRS receives and processes your authorization form, they will mail a randomly selected, four-digit PIN to your address on file. Please note PIN authorizations are not the same as Passwords and will only give access to the automated telephone account information at this time. Rev. 4/2006 4 INFORMATION FOR ACTIVE TRS MEMBERS Earning and Purchasing Service Credit Benefits payable from TRS are determined by a formula using the participant’s age, salary, and years of creditable service. The greater the number of creditable years of service, the greater the retirement benefit will be. A year of creditable service is earned anytime you work in a TRSeligible position as defined by TRS for the greater of 90 days; 4 ½ months; or for teacher or teacher-type positions, for a full semester of longer than 4 months during a school year. TRS also allows the purchase of unreported TRS-eligible service, substitute service, out-of-state service, military service, developmental leave and previously withdrawn service. Check the TRS Benefits Handbook for full definitions and limitations for each category. TRS members who have 50 days (400 hours) of accumulated, unused sick leave as of the last day of employment before retirement may purchase one year of additional service credit may be purchased for a lump sum equal to the actuarial present value of the additional benefit. Contact TRS to determine the cost of any special service. State law may limit the total amount of service credit which may be purchased. Section 415 of the Internal Revenue Code also limits the amount of money which may be voluntarily contributed in a year to TRS toward a purchase. However, those who roll money directly from another qualified retirement account, such as a 403b or 401k, will not encounter this annual IRS limit. Members may use installment payments for certain types of service purchases. Please contact TRS for more information regarding types of special service purchases and payment options. Transfer of Credit Between TRS and ERS An active TRS or ERS member or beneficiary of an active member who has at least three years service credit in the present system may transfer credit from the previous system upon retirement and retire under the rules of the system to which credit was transferred. Interested individuals should contact TRS for complete information. Rev. 4/2006 5 Death and Survivor Benefits for Active Members Active members are covered by death benefits beginning the first day of employment. Your beneficiary may select one of up five different payment plans, including a lump sum of twice the annual salary up to $80,000.00. Additionally, a lump sum death benefit of $160,000 may be available to an active member employed in a TRS-covered position who dies due to a physical assault during the performance of regular duties. INFORMATION FOR TERMINATED OR SEPARATED EMPLOYEES Refunds Refunds of TRS deposits are available only to those who have terminated employment and do not become employed in any other TRS-eligible position (or receive a promise of such employment) prior to the completion of the refund. Complete the TRS-6 form (available for download at www.trs.state.tx.us) and take it to your campus Benefits Office. Your Benefits Office will confirm your termination status and send the form to TRS. Unless rolled over to another qualified plan, refunds will be paid directly to you and taxes will be withheld. There may also be a 10% tax penalty. Rollovers If you request a rollover to another qualified plan on the TRS-6 form, TRS will send additional forms with instructions after receiving the TRS-6. Complete the forms and return the originals to TRS. The receiving plan trustee or representative must certified on the additional forms that it is eligible to receive the rollover. Rollovers go directly to the custodian and not to the TRS member. Inactive or Dormant Accounts In the event of separation from employment, your TRS-account will continue to accrue 5% interest per year. For members with less than 5 years of creditable service, the interest will accrue for 5 years, after which time the account will become dormant and cease to accrue interest. For those members who are vested with five or more years, the account will continue to accrue interest until the member chooses to take an annuity (in accordance with the requirements for retirement below) or to refund the account. Rev. 4/2006 6 INFORMATION FOR RETIREES For those members who maintain their TRS account, they may be eligible to receive valuable retirement benefits such as: Disability Retirement: For members with Less than 10 years of service credit— In the event you become totally and permanently disabled before you have earned 10 years of service credit, TRS provides a $150 monthly disability benefit payable for the number of months of employment under TRS, the duration of your disability, or the duration of your life, whichever is less. In determining the duration of the disability payments, you will be credited with 12 months of service for every year of service credit. For any year in which you did not render a creditable year of service, the actual number of months will be counted to determine the duration of your payment. This benefit is subject to any reduction required by law and is eligible for rollover tax treatment. Example of Disability with less than 10 years: You started worked for 3 years and 3 months under TRS. Upon your disability, you will receive $150.00 per month for a total of 40 months (3 years and 4 months) For members with 10 or more years of service credit— If you become totally and permanently disabled, disability benefits are payable based on the length of your service and your salary. If you qualify for disability retirement and have at least 10 years of service credit, you are entitled to a monthly annuity that is not reduced due to early age. You may select a standard annuity or one of five payment plans described in our TRS handbook. Your monthly payments will be calculated using the formula for determining a standard annuity with a minimum standard annuity amount of $150.00. If you select a payment plan other than the standard annuity, your monthly annuity will be reduced. This benefit is also subject to any other reduction required by law. Rev. 4/2006 7 Service Retirement: To be eligible to retire and receive a lifetime monthly service retirement annuity (normal age or early age), you must: • • • • • have at least five years of service credit, meet the eligibility requirements for age and service, terminate employment, complete the required break in service, and apply for retirement. Normal-Age Service Retirement When a member meets the requirements for a normal-age service retirement and applies to retire, the retiree is entitled to receive a payment of a lifetime monthly annuity. The annuity is calculated according to the standard annuity benefit formula in effect when the member retires. Under current law, you will meet the age and service requirements for normal-age service retirement when: You are age 65 with five or more years of service credit; or Your age and years of service credit total 80; and You have at least five years of service credit. Early-Age Service Retirement Reductions When a member meets the requirements for an early-age service retirement and applies to retire, the retiree is entitled to receive a payment of a lifetime monthly annuity. The annuity is calculated according to the standard annuity benefit formula in effect when the member retires, but permanently reduced for early age according to actuarial tables. Under current law, you meet the age and service requirements for early-age service retirement when you do not yet meet the normal-age service retirement requirements but: You are at least age 55 with five or more years of service credit; or You are any age below age 50 with 30 or more years of service credit. Retirement annuities are based on the member's age, total years of creditable service and the average salary for the highest five salaried Rev. 4/2006 8 years (for those who meet the grandfathered requirements as of August 31, 2005, the highest three salaried years will be used. Please contact TRS to determine if you meet the grandfathered requirements). The Standard Annuity provides the greatest monthly amount for the Retiree but is discontinued upon the death of the Retiree. Choosing one of the five other options will reduce the Standard Annuity but will include other benefits. Other Retirement Benefits The Partial Lump-Sum Option (PLSO) - effective September, 1999 - is for active TRS participants who are eligible for an unreduced standard annuity. The option is selected at the time of retirement. The Deferred Retirement Option Plan (DROP) - was a pre-retirement benefit provision for active employees who were eligible to retire with unreduced benefits and who had at least 25 years of creditable service. However, DROP was discontinued after December 31, 2006, for new participation. Only those participants who were already in DROP may continue their participation. Death And Survivor Benefits For Retirees As a retiree, you must designate your beneficiary on a form prescribed by and received by TRS before your death. Please contact TRS for the appropriate form. It is not necessary that the beneficiary designated to receive the death and survivor benefit also be the same beneficiary designated to receive an optional form of annuity. In addition to any joint and survivor or guaranteed period annuity that may be payable under an optional form of payment which you elect, your beneficiary is entitled to receive a lump sum death and survivor benefit payment of $10,000. This benefit is payable on the death of either a service or disability retiree receiving a monthly annuity. In lieu of the $10,000 death and survivor benefit, an eligible beneficiary may receive: • • If the beneficiary is the retiree’s spouse or dependent parent, the beneficiary may choose a $2,500 lump sum payment plus $250 per month beginning when the beneficiary reaches age 65. If the beneficiary is the spouse of the decedent and has one or more minor children or has custody of one or more minor children of the decedent, the beneficiary may choose a $2,500 Rev. 4/2006 9 o lump sum payment plus a monthly benefit of $350 payable until the youngest child reaches age 18, followed by a lifetime monthly benefit of $250 beginning when the spouse reaches age 65. If the beneficiary or beneficiaries are the retiree’s dependent children under the age of 18, the children’s guardian may elect to receive for them a $2,500 lump sum payment plus a monthly benefit of $350 which is payable for so long as two or more children are under age 18 or a monthly benefit of $250 which is payable as long as one child is under age 18. Beneficiaries of disability retirees who retired before September 1, 1992, and are receiving a standard disability retirement annuity may elect to receive either the lump sum death and survivor benefits as described above or the benefits payable at the death of an active member. Complete information regarding all death benefit payment options are available in the TRS Benefits Handbook. Revoking Retirement Retirement may be revoked anytime before the date TRS makes the first annuity payment. Retirement Checklist 1. Notify your department or school in writing of your intent to retire at least 90 days before your retirement date. At the same time, contact your campus Benefits Office to ensure your benefit elections can be processed well before your retirement date. 2. Contact TRS at 1-800-223-8778 to submit a “Request for Estimate of Retirement Benefits” form (TRS 18). The TRS 18 can be taken over the phone by a benefit counselor, or submitted in writing. You should request a packet at least 6 months before your estimated retirement date. Once you receive your packet, complete the following requirements as described in your retirement packet: • “Application for Service Retirement” form (TRS 30) • Send copies of birth records for you and your primary beneficiary. Write your name and Social Security number on your and your beneficiary's birth records. • Complete purchase of special service credit. • “Notice of Final Deposit Before Retirement” form (TRS 7) • “Direct Deposit Request/Annuity Payment EFT Exemption Rev. 4/2006 10 Certificate” form (TRS 278) “Income Tax Withholding Form” (TRS 228A) “Application for Disability Retirement” form (TRS 59) if applicable “Statement of Member in Claim for Disability Retirement” form (TRS 59A) if applicable “Statement of Attending Physician in Claim for Disability Retirement” form (TRS 58) if applicable • Give form TRS 7 to your local benefits office, which must complete the form and mail it to TRS. • Complete all of the other forms in the packet and return them directly to TRS as soon as possible before your retirement date. 3. Choose your group insurance options, including medical, dental, vision and life coverage, by completing an Insurance Enrollment Form, available from your campus Benefits Office. Your Benefits Officer will then provide you with enrollment materials for the plan you have selected. Please note that this paperwork must be completed even if you are continuing a plan that you have had as an active employee. 4. Terminate employment by the effective date of your retirement. 5. Contact the Social Security Administration regarding your eligibility for Social Security benefits. You may contact Social Security toll-free at 1800-772-1213 or obtain more information at www.ssa.gov. Request "TRS Benefit Information" form (TRS 562) from TRS if you need to provide this to the Social Security Administration. 6. If you are 65 or older at the time of your retirement, and have not already done so, you have a 7-month window in which to contact the Social Security Administration (SSA) to enroll for Medicare. The enrollment window begins three months prior to your retirement and ends four months after your retirement. You will not be required to pay a penalty to SSA for late enrollment in Medicare Part B if you enroll during this 7-month time period. If you turn 65 after you have retired, you also have a 7-month window in which to enroll for Medicare. This enrollment window begins three months before your 65th birthday and ends four months after. If you don't enroll during the enrollment window, you will have to wait until the subsequent “general enrollment period," held annually from January 1 through March 31 for coverage starting in July. Be sure to Rev. 4/2006 • • • • • • 11 enroll in Medicare Part B. If you do not, you are required to pay the portion that Medicare would have paid for Part B covered items under both medical plans available to you. If you are under age 65 and are eligible for Medicare benefits because of a disability, the same conditions apply as if you were age 65. Without Medicare, you could incur large out-of-pocket medical costs. 7. If you are an ORP participant, complete the ORP retirement certification form, available from your campus Benefits Office. 8. Carefully review your conversion options for life insurance and long term care insurance. For disability retirement, consider your life insurance premium waiver option. 9. Contact your Retirement Plan and Tax Sheltered Annuity Program (TSA) carrier(s) to make payment arrangements for your retirement pension. Explore your insurance and conversion options. Contact numbers for current ORP and TSA vendors are located at the back of this book and can also be found at http://www.utretirement.utsystem.edu/. Note: TRS may include additional forms if applicable. “Instructions for Service Retirement” form (TRS 31) and/or “Instructions for Disability Retirement” form (TRS 31A) will be included to help you complete your application. Please include your Social Security number on any document or correspondence to TRS. Optional Retirement Program Participants The Optional Retirement Program is offered to certain eligible employees as an alternative to TRS. The ORP does not provide death or survivor benefits or disability retirement benefits described above for TRS participants. In the event of death or retirement, after contacting your benefits office regarding health and life insurance options, you or your beneficiary should contact your selected vendor directly in order to discuss your retirement distribution options. UT Saver Supplemental Retirement Savings Programs In addition to TRS or ORP as described in this booklet, UT employees may also participate in the UTSaver 403(b) Tax Sheltered Annuity Plan, or the UTSaver 457(b) Deferred Compensation Plan. Rev. 4/2006 12 Comparison of the UTSaver DCP and UTSaver TSA Eligibility Maximum annual deferral for 2006 Multiple plans annual deferral maximum Age 50+ Catch-up Provisions UTSaver DCP All employees 100% of 457(b) eligible compensation or $15,000* per year, whichever is less. UTSaver TSA 100% of 403(b) eligible compensation or $15,000* per year, whichever is less. You may defer a maximum of $15,000* in 2006 to each plan. After 2006, amounts will be adjusted for inflation. If you are age 50 or older, you may contribute an additional $5,000* in 2006 above the maximum annual deferral amount. You may not use this provision in the UTSaver DCP while using the Special Catch Up Provision. You may defer an additional $15,000* if you have If you have 15 years of service with the U.T. unused deferrals in previous years when you were System and previous deferrals have averaged eligible for a 457(b) Plan. You may participate only in less than $5,000 per year, you may defer an the three years before the taxable year in which you additional $3,000 above the annual maximum. attain normal retirement age. Cannot be used with The additional deferral may not exceed a lifetime the Age 50+ Catch-up Provision. maximum of $15,000. Can be used with the Age 50+ Catch-up Provision. Loans may be approved for $1,000 to $50,000 or one-half of your account balance. Your UTSaver DCP vendor may assess a loan fee. Subject to approval by the U.T. System, withdrawals may be available for sudden and unexpected illness or accident, loss of property due to casualty, or other similar extraordinary and unforeseeable circumstances. Loans may be available to the extent provided by the annuity contract or custodial account. Subject to approval by your UTSaver TSA vendor, withdrawals may be available for unreimbursed medical expenses, purchase of a primary residence, tuition expenses, or prevention of a foreclosure or eviction from your primary residence. Other Catch-up Provisions Loans Financial Hardship/ Unforeseeable Emergency** Transfer of funds to purchase service Rollovers If eligible***, you may use UTSaver DCP or TSA funds to purchase permissive service credit under ERS or TRS. If eligible, you may roll funds into another eligible retirement plan (including an IRA). If your UTSaver DCP account has less than $5,000, You may take a distribution from your has been inactive for two years and you have never UTSaver TSA after age 59 1/2 while still before received an in-service distribution in the employed without a 10% early withdrawal UTSaver DCP, you may be eligible for a voluntary in- penalty. service distribution. Any time after separation from employment or at age 70 1/2. You may take a distribution after separation from employment but prior to age 59 1/2 without a 10% early withdrawal penalty. You may roll over funds into other types of employersponsored plans, IRAs or other eligible options. For an eligible rollover distribution, 20% of the amount automatically must be withheld for federal taxes unless you make a direct rollover to an eligible retirement plan or IRA. Any time after seperation from employment, at age 59 1/2, or at age 70 1/2. You may roll over funds into other types of employer sponsored plans, IRAs or other eligible options. For an eligible rollover distribution, 20% of the amount automatically must be withheld for federal taxes unless you make a direct rollover to an eligible retirement plan or IRA. Distributions while employed Distribution after separation from employment Required Minimum Distributions (RMD) must begin: On or before April 1 of the calendar year following the latter of the calendar year in which you reach age 70 1/2 or the calendar year in which you retire. *Ceiling is adjusted each year per cost-of-living index. Amount shown is for 2005. **Please refer to IRS website for 457 and 403(b) information on hardship withdrawals. ***Please contact TRS to verify all information regarding service purchases. Distributions or withdrawals have tax consequences. You should contact your financial or tax advisor before initiating one. This document provides only the key features of the UTSaver DCP and UTSaver TSA. In the event that the plan document differs from or provides further detail no included in any other documents or agreements, the plan document will control. For more information go to www.utretirement.utsystem.edu or contact your benefits office. Rev. 4/2006 13 Medicare and Social Security Medicare Medicare is your primary coverage if you are not working and your secondary coverage if you are working in a benefits-eligible position (at least 20 hours per week for at least 4-½ months). Medicare Part A inpatient hospitalization insurance is free if you have contributed to Social Security for 40 quarters (10 years). Medicare Part B helps pay for doctor's services and outpatient hospital care as well as some other expenses and requires a monthly premium. If you have not yet retired, you will not need Medicare Part B until you do so. At least 3 months before you retire you should contact your local Social Security office to file an application for Medicare Part B. It is important for UT System retirees age 65 and older to enroll in both Medicare Part A and Part B to receive the highest level of benefits on their health insurance plans. If you are not working and delay enrollment in Part B, you are subject to surcharges on the monthly Medicare premium when you do enroll. If you are receiving Social Security benefits, you will be automatically enrolled in Medicare Part A and Part B. The Social Security Administration will send you an enrollment package that contains information about Medicare, a questionnaire and a Medicare identification card. If you want both Parts A and B, you may sign the Medicare card and keep it. If you do not want Part B coverage at that time, you must put an X in the refusal box on the back of the Medicare card form, sign the form and return it with the card to the Social Security Administration. You will be sent a new Medicare card showing that you have Part A only. Then, shortly before you retire, you should contact your local Social Security Administration office to enroll in Part B. Medicare Part D Medicare Part D is a new prescription drug coverage program that will be available to people who qualify for Medicare Part A or Medicare Part B. The benefits provided by the UT drug plan have been examined by consulting Rev. 4/2006 14 actuaries and have been determined to be comparable to or better than the benefits provided by Medicare Part D. Most Medicare-eligible participants in the UT drug plan should NOT enroll in a Medicare Part D prescription drug plan since, for most people, the UT prescription drug coverage will provide better benefits at a lower out-of-pocket cost. However, certain very low-income individuals who qualify for financial assistance could benefit from Medicare Part D and may receive savings on premiums, copayments and coinsurance. If you think you might qualify for financial assistance, you may want to enroll in Medicare Part D. Financial assistance will be available to Medicare beneficiaries with incomes up to 150% of the Federal Poverty Level (FPL) and limited resources. The FPL is set each year. OEB does not make this determination or set the guidelines. To determine if you qualify for financial assistance with Medicare Part D, you should contact the Social Security Administration (SSA) at 1-800-772-1213 (TTY 1-800-325-0778) or visit SSA online at www.socialsecurity.gov. There will be no change in the medical or prescription drug coverage provided under the U. T. health plans as a result of Medicare Part D. You will still be eligible to receive your current medical and prescription drug benefits under UT whether or not you enroll in a Medicare Part D prescription drug plan. However, you cannot use both your UT drug plan and a Medicare prescription drug plan for the same prescription. It is important to know that if you drop or lose your coverage under UT and don’t enroll in Medicare Part D within 63 days after your current UT coverage ends, you may be required to pay more to enroll in Medicare prescription drug coverage later. More detailed information about Medicare plans that offer prescription drug coverage will available in the “Medicare & You 2006” handbook. You should get a copy of the handbook in the mail from Medicare. You may also be contacted directly be approved Medicare prescription drug plans. More information about Medicare prescription drug plans is available from www.medicare.gov. Rev. 4/2006 15 Notice of Creditable Coverage IMPORTANT NOTICE FROM THE UNIVERSITY OF TEXAS SYSTEM OFFICE OF EMPLOYEE BENEFITS (OEB) ABOUT YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE PART D Please read this notice carefully and keep it where you can find it. No action is required of you at this time. You are getting this notice because you are enrolled in a health insurance plan offered by The University of Texas System (UT). You have prescription drug coverage through your enrollment in your health plan whether it is UT SELECT or HMO Blue Texas, both administered by Blue Cross Blue Shield of Texas. This notice provides: • Important information about your current prescription drug coverage • Answers that will assist you in deciding whether you should purchase prescription drug coverage under the new Medicare Part D program • Contact numbers for more information • A document that you can use later to avoid a penalty for late enrollment in Medicare Part D prescription drug program Q. A. Q. A. WHAT IS MEDICARE PART D? Medicare Part D is a prescription drug coverage that will be available to people who qualify for Medicare Part A or Medicare Part B. HOW DOES PRESCRIPTION DRUG COVERAGE PROVIDED THROUGH UT COMPARE TO MEDICARE PRESCRIPTION DRUG COVERAGE? The benefits provided by the UT drug plan have been examined by consulting actuaries and have been determined to be comparable to the benefits provided by Medicare Part D. This allows OEB to send you this “Notice of Creditable Coverage.” SHOULD I ENROLL IN MEDICARE PART D? Q. Rev. 4/2006 16 A. Most Medicare-eligible participants in the UT drug plan should NOT enroll in a Medicare prescription drug plan since, for most people, the UT prescription drug coverage will provide better benefits at lower cost. If you qualify for financial assistance you could benefit from Medicare Part D and you would get savings on premiums, copayments and coinsurance. If you think you might qualify for this assistance you may want to enroll in Medicare Part D. Q. A. IS MEDICARE PART D FREE? No. If you enroll in a Medicare prescription drug plan, you will pay a premium of about $37 per month for 2006. The amount will likely increase each year. You will also have to pay the Medicare Part D deductibles and copayments. For calendar year 2006, the deductible is $250. Q. HOW WILL MEDICARE PART D WORK? A. Medicare Part D coverage will be offered through private prescription drug plans that have been approved by Medicare. All Medicare prescription drug plans will offer a standard level of coverage set by Medicare. Some plans might also offer more coverage for a higher monthly premium. If you enroll in a Medicare prescription drug plan, you will receive a drug card that you will present to your pharmacy to cover a portion of your prescription drug costs. WILL MEDICARE PART D HAVE ANY EFFECT ON COVERAGE PROVIDED UNDER THE UT? No. There will be no change in the medical or prescription drug coverage provided under the UT as a result of Medicare Part D. You will still be eligible to receive all of your current medical and prescription drug benefits under the UT whether or not you enroll in a Medicare prescription drug plan. IF I DECIDE TO ENROLL IN MEDICARE PART D, DO I HAVE TO DROP MY UT COVERAGE? No. You are not required to drop your UT coverage. If you use your UT drug card you will pay the regular UT deductibles and copays. Rev. 4/2006 Q. A. Q. A. 17 You cannot use both your UT drug card and a Medicare prescription drug card for the same prescription. Q. WILL I HAVE BETTER PRESCRIPTION DRUG COVERAGE IF I HAVE BOTH MEDICARE PART D AND MY CURRENT UT DRUG COVERAGE? No. As noted above, you cannot use both plans for the same prescription. You would have to choose whether to get a prescription filled under your UT coverage or Medicare Part D coverage. Medicare Part D benefits do not coordinate benefits with your current UT prescription drug plan. WHY IS CREDITABLE COVERAGE IMPORTANT TO MEDICAREELIGIBLE PARTICIPANTS IN THE UT DRUG PLAN? Since you have Creditable Coverage under UT, the Social Security Administration has said that you will not have to pay a penalty if you join a Medicare Part D prescription drug plan later. Since you have Creditable Coverage under UT, you can choose to join a Medicare prescription drug plan at a later date without a penalty. Q. A. HOW DO I KNOW IF I QUALIFY FOR FINANCIAL ASSISTANCE WITH MEDICARE PART D? Financial assistance will be available to Medicare beneficiaries with incomes up to 150% of the Federal Poverty Level (FPL) and limited resources. The FPL is set each year. OEB does not make this determination or set the guidelines. To determine if you qualify for financial assistance with Medicare Part D, you should contact the Social Security Administration (SSA) at 1-800-772-1213 (TTY 1-800-325-0778) or visit SSA online at www.socialsecurity.gov. Q. MOST UT PARTICIPANTS ARE ENCOURAGED NOT TO ENROLL IN MEDICARE PART D FOR 2006. WHAT ABOUT 2007? A. Q. A. Rev. 4/2006 18 A. Pay close attention to the Medicare Part D information OEB sends to you. If you need to enroll in Medicare Part D for 2007, OEB will notify you in advance. You should also know that if you drop or lose your coverage under UT and don’t enroll in Medicare Part D within 63 days after your current UT coverage ends, you may be required to pay more to enroll in Medicare prescription drug coverage later. Q. A. WHERE CAN I GET MORE INFORMATION? More detailed information about Medicare plans that offer prescription drug coverage will be available in the “Medicare & You 2006” handbook. You will get a copy of the handbook in the mail from Medicare. You may also be contacted directly by approved Medicare prescription drug plans. You can also get more information about Medicare prescription drug plans from the following places: • Visit http://www.medicare.gov for personalized help, • Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) • Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. NOTE: You may receive this notice at other times in the future such as before the next period you can enroll in Medicare Part D prescription drug coverage, and if this coverage changes. You also may request a copy of this notice Rev. 4/2006 19 Social Security Each employee of The University of Texas System is required by law to participate in the Social Security Program. Benefits under Social Security include: Employees should check current Social Security Retirement Benefits. regulations to determine the age at which they may retire and receive full benefits. Generally, you may retire as early as age 62 and receive partial Social Security benefits, or receive full benefits as indicated on the chart below: Year of Birth 1937 or earlier 1938 1939 1940 1941 1942 1943--1954 1955 1956 1957 1958 1959 1960 and later Full Retirement Age 65 65 and 2 months 65 and 4 months 65 and 6 months 65 and 8 months 65 and 10 months 66 66 and 2 months 66 and 4 months 66 and 6 months 66 and 8 months 66 and 10 months 67 Age 62 Reduction Months 36 38 40 42 44 46 48 50 52 54 56 58 60 Monthly % Reduction .555 .548 .541 .535 .530 .525 .520 .516 .512 .509 .505 .502 .500 Total % Reduction 20.00 20.83 21.67 22.50 23.33 24.17 25.00 25.84 26.66 27.50 28.33 29.17 30.00 Disability Benefits. An employee becoming disabled before age 65 is entitled to a disability income which is generally the same as the retirement benefit would be if 65 years of age. Rev. 4/2006 20 Survivor Benefits. Survivor benefits are payable to a dependent spouse and children. In addition, a lump sum death benefit is also payable to the spouse only upon request. Faculty members who are age 62 and who teach only nine months should check current Social Security regulations to determine eligibility for drawing Social Security payments. Retiring employees should visit their local Social Security Administration Office. Instructions will be given for filing an application which must be accompanied by a birth certificate or other proof of age. In some cases, a copy of a marriage license may be required. It is recommended that the last W-2 form be shown to Social Security at the time of your visit. The initial contact should be made at least three months prior to the actual retirement date if you have checked your Social Security account for accuracy. Be sure you understand Social Security regulations about working after you retire. Rev. 4/2006 21 Retirees with TriCare TriCare is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. Active duty members and their families; retirees and their families; and survivors of all uniformed services who are not eligible for Medicare are all eligible for TriCare. The correct coordination of benefits is that Medicare will be your primary insurance, UT will be secondary, and TriCare will be third. If you receive services in a Veteran’s Administration facility, your UT plan will assume Medicare benefits (because the Veterans Administration will not file a claim to Medicare), and only pay 20% of the allowed amount. Veteran's Administration facilities are reimbursed by federal dollars that will cover 80% of the charges. Therefore, if you have TriCare in addition to Medicare Parts A and B and a UT sponsored health insurance plan, you may need to decide if this additional coverage is necessary. Rev. 4/2006 22 Returning to Work After Retirement TRS Returning to work during the month after retirement will cancel a TRS member’s retirement. A pre-existing agreement to return to work in what would be considered a benefits-eligible position may also make you ineligible for retirement. Depending on the circumstances, a minimum amount of time between the date of retirement and the date of re-employment (e.g., one calendar year) may be required, and your annuity as a retiree may be suspended if the post-retirement employment exceeds certain limits (generally half-time service or six months of full-time service in a year ). Once retired, TRS members will not be permitted to make active contributions to the system even if they return to work in what would otherwise be considered a benefitseligible position. TRS should be contacted for further details on annuity suspension during post-retirement employment. ORP An “ORP retiree,” as defined by Chapter 25, Rules and Regulations of the Texas Higher Education Coordinating Board, is an individual who participated in the Optional Retirement Program while employed in a public campus of higher education in Texas and who established retiree status by enrolling in retiree health insurance provided by the Employees Retirement System of Texas, The University of Texas System, or the Texas A&M University System, regardless of whether currently enrolled. In accordance with Chapter 25, ORP retirees who later return to employment in Texas public institutions of higher education are not eligible to make further ORP contributions to their existing ORP account. This restriction applies even if you discontinue your retiree insurance, return to employment in what would otherwise be considered a benefitseligible position, and/or re-enroll in active employee insurance (if permitted under the plan). ORP retirees who enrolled in retiree health insurance on or before June 1, 1997 are exempt from this provision. Institutional policies vary concerning whether these “grandfathered” individuals receive ORP contributions upon returning to work in what would otherwise be considered a benefits-eligible position. However, individuals who establish ORP retiree status after June 1, 1997 will never again be eligible to participate in ORP as active contributing participants. Rev. 4/2006 23 The Basics Eligibility You are eligible for benefits as a retiree if you meet the requirements listed on pages 4-5. Eligible Dependents You may also enroll your eligible dependents under plans offered by UT System. Your eligible dependents include: • • • • • Your legally married spouse, or person with whom you have filed a Declaration of Informal Marriage Your unmarried child under age 25, including Stepchildren Adopted children Children for whom you are the legal guardian Your unmarried child is not required to be enrolled in school. Your unmarried grandchild under age 25, • For UT Select, the natural parent must also be enrolled. • For HMO coverage, the natural parent does not need to be enrolled, but your grandchild must be claimed by you as a dependent for tax purposes at the time of enrollment. • Your child over age 25, if determined by OEB to be medically incapacitated. Examples of dependents who are not eligible for coverage include: • • • • • • • • Your common-law spouse, unless you have obtained a Declaration of Informal Marriage Your same-sex partner Your former spouse Your married child Your child over age 25, if not medically incapacitated Foster children covered by another government program, unless required by law Any child for whom you have Power of Attorney only Any dependent insured by another UT employee or retiree Rev. 4/2006 24 Any dependent insured by another plan that receives State of Texas contributions • Any dependent who is active in the Armed Forces of any country • The University of Texas System’s insurance plans are designed to enable you to cover your dependents at a substantial savings of the actual cost of coverage. However, some employees may have enrolled certain people who are not considered eligible dependents. You may be selected for a random review of your dependents’ eligibility. If selected, you may be asked to documentation to verify their relationship to you. These documents may include Marriage and Birth Certificates, Qualified Medical Support Orders and Income Tax Returns. Texas Government Code § 667.005 states: "The total state contribution toward the person's group insurance is limited to the amount specified in the General Appropriations Act for a full-time active employee." Therefore, if you are currently insured as an employee or retiree of any Texas state agency or institution of higher education, or certain public schools, and are also eligible for coverage by The University of Texas System, you must choose only one of those coverages. BASIC COVERAGE PACKAGE UT provides eligible retirees with the following coverage: • UT SELECT Medical Plan, with Prescription Drug Coverage (Subscriber only) • $3,000 Basic Group Term Life Insurance (Subscriber only) Optional Coverage You may select the following Optional Coverages for you and your eligible dependents: • Dental Insurance • Vision Insurance • Voluntary Group Term Life Insurance Coverage (in addition to the Basic Group Term Life Insurance) • Accidental Death and Dismemberment Insurance (in addition to the Basic Accidental Death and Dismemberment Insurance) • Long Term Care Rev. 4/2006 25 UT Flex, AD&D, Short Term and Long Term Disability coverages are not available to retirees, even if you return to UT employment after retirement. Evidence of Insurability Evidence of Insurability (EOI) is the record of a person's past and current health events. EOI is used by insurance companies to verify whether a person meets the definition of good health. An EOI form is required to: • Enroll in medical coverage that was not elected during your initial 31-day benefit election period. Retired employees can show proof of other group medical coverage during Annual Enrollment, EOI will be waived for UT SELECT medical. • Add certain dependents to medical coverage who were previously eligible, but not enrolled during your initial 31-day benefit election period. (If these certain dependents can show proof of other active group medical coverage during Annual Enrollment, EOI will be waived for the UT SELECT medical plan.) • Reinstate terminated or waived medical coverage, unless proof of other active group medical coverage can be provided during Annual Enrollment • Increase employee, retiree and spouse life insurance coverage • Add Short Term Disability • Add Long Term Disability • Add Long Term Care Change of Status You have 31 days from the date of a qualifying Change of Status event to notify your campus Benefits Office and change your benefit selections. If you do not make your changes during the 31-day Status Change period, your changes cannot be made until the next Annual Enrollment period in July, to be effective the following September 1. Evidence of Insurability may be required for some benefit changes if you wait until the Annual Enrollment following your Change of Status event. The list below includes common examples of qualified Status Changes: • Marriage, divorce, annulment, legal separation, or spouse's death • Birth, adoption, medical child support order, or dependent's death Rev. 4/2006 26 Significant change in residence if the change affects your or your dependents' current plan eligibility • Starting or ending employment, starting or returning from unpaid leave of absence, or a change of job status (e.g., from part-time to full-time) • Change in dependent eligibility (e.g. marriage or reaching age 25) • Change in coverage or cost of other benefit plans available to you and your family • Your benefit selection changes must be consistent with your Change in Status. For questions regarding Status Changes, please contact your campus Benefits Office. Continuation of Group Coverage (COBRA) If you or your dependents are no longer eligible for coverage, UT will offer you the option to continue coverage for any UT medical, dental, vision plan, and in some cases, your UT FLEX Flexible Spending Account(s). You are responsible for the full premium for elected COBRA coverages. For information regarding the conditions for continuation of coverage, please contact your campus Benefits Office. If you are enrolled in the Fort Dearborn Voluntary Group Term Life, The Hartford Long Term Disability and/or the CNA Long Term Care plans, you may also be able to access a conversion benefit provided as part of these plans. To do so, you must obtain the required form(s) from your campus Benefits Office and forward them to the insurance company within 31 days of the end of the month in which your benefits-eligibility status changes or terminates. Rev. 4/2006 27 HIPAA The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes certain requirements on group health plans, including: • Limitations on pre-existing condition exclusion periods; • Special enrollment periods for individuals (and dependents) losing other coverage; • Prohibitions against discriminating against individual participants and beneficiaries based on health status; • Standards relating to benefits for mothers and newborns; and • Parity in the application of certain limits to mental health benefits HIPAA also permits certain self-funded, governmental group health plans the right of exemption from certain provisions of this federal law. The Office of Employee Benefits has elected to exempt The University of Texas System’s selffunded health plan (UT SELECT) from most of the HIPAA provisions listed above. Pre-existing condition limitations are no longer included in the UT SELECT plan. The fully-insured HMO plans described in this booklet are not exempt from the HIPAA requirements. Dependents who are not enrolled in UT SELECT or a fully-insured HMO during their initial period of eligibility may be subject to EOI requirements when later enrolling in UT SELECT. Late dependent enrollment in a fully-insured HMO does not require EOI. UT SELECT does not have annual or lifetime maximums. Serious Mental Illness (as defined in Chapter 1601 of the Texas Insurance Code) will be treated as any other illness under UT SELECT. Although the University is exempt from the HIPAA provisions relating to hospital stays for mothers and newborns, it is our intent to satisfy all the requirements for maternity and newborn benefits as set out in HIPAA regulations. For a copy of the UT System Notice of Privacy Policy, please go to: http://www.utsystem.edu/egi/hipaa/HIPAAnotice.pdf. Rev. 4/2006 28 Monthly Out of Pocket Insurance Premiums for Retirees HEALTH PLAN OUT-OF-POCKET COST PER MONTH: Subscriber Subscriber & Plans Available Only Spouse All Areas: UT SELECT $0 $142.05 Austin Area: HMO Blue $0 $157.65 Dallas/Ft Worth Area: HMO Blue $0 $156.94 El Paso Area: HMO Blue $0 $150.51 Houston Area: HMO Blue $0 $156.74 San Antonio Area: HMO Blue $0 $138.69 Corpus Christi Area: HMO Blue $0 $143.83 FULL-TIME EMPLOYEES & RETIREES ONLY Subscriber & Subscriber & Child(ren) Family $148.57 $164.88 $164.15 $157.42 $163.93 $145.05 $150.43 $279.75 $310.47 $309.08 $296.40 $308.68 $273.12 $283.24 DENTAL PLAN OUT-OF-POCKET COST PER MONTH: Subscriber Subscriber & Plans Available Only Spouse All Areas: UT DENTAL SELECT (Delta 26.41 50.14 Dental) Austin, Dallas, El Paso, Galveston, Houston & San Antonio: Assurant Dental HMO 10.73 17.97 Subscriber & Child(ren) 55.27 Subscriber & Family 78.59 24.50 28.78 VISION OUT-OF-POCKET COST PER MONTH: Plans Available – All Areas Superior Vision Subscriber Only 7.22 Subscriber & Spouse 11.20 Subscriber & Child(ren) 11.46 Subscriber & Family 18.48 Rev. 4/2006 29 Enter Elected Coverage Amount: Retirees 1 •Select from the following options and enter here (see below). $7,000 $10,000 $25,000 $50,000 Note: For those retired employees of the System, who retired through the 1993 one-time retirement option, enter the amount of coverage currently in place. Divide total in C by 1,000 to determine units of $1,000 for premium calculation. Enter here. Refer to Retiree Rate Chart below. Enter the rate that corresponds with your age on September 1, 2005. To determine the premium cost per month, multiplyD x E. 2 If you are electing the $10,000 Family Coverage option, enter $2.87 (see below). Otherwise, enter zero. RETIREE RATE CHART Age of Subscriber on 9/01/05 Rate per $1,000 Coverage < 35 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 and over 1 $0.046 $0.060 $0.084 $0.129 $0.200 $0.314 $0.476 $0.858 $0.894 If you are increasing your life coverage amount or are electing spouse coverage amounts above $10,000, Evidence of Insurability (EOI) will be required. Provides coverage of $10,000 for each covered dependent. 2 LONG TERM CARE (LTC) OUT-OF-POCKET COST PER MONTH Plans Available– All Areas CNA Age PLAN A Basic Benefit with Guaranteed Benefit Increase Option PLAN B Basic Benefit with Lifetime Automatic Benefit Increase Option (Inflation Rev. 4/2006 30 Protection) $100 BENEFIT 5.64 6.68 8.00 10.84 13.16 14.00 14.88 15.72 16.64 17.72 18.80 20.04 21.32 22.68 24.44 26.20 28.40 30.92 33.80 37.28 40.76 44.68 49.04 53.88 59.52 64.84 70.20 75.12 79.72 85.40 91.32 98.84 107.48 116.92 127.68 140.44 155.80 173.92 194.36 216.96 $125 BENEFIT 7.05 8.35 10.00 13.55 16.45 17.50 18.60 19.65 20.80 22.15 23.50 25.05 26.65 28.35 30.55 32.75 35.50 38.65 42.25 46.60 50.95 55.85 61.30 67.35 74.40 81.05 87.75 93.90 99.65 106.75 114.15 123.55 134.35 146.15 159.60 175.55 194.75 217.40 242.95 271.20 $150 BENEFIT 8.46 10.02 12.00 16.26 19.74 21.00 22.32 23.58 24.96 26.58 28.20 30.06 31.98 34.02 36.66 39.30 42.60 46.38 50.70 55.92 61.14 67.02 73.56 80.82 89.28 97.26 105.30 112.68 119.58 128.10 136.98 148.26 161.22 175.38 191.52 210.66 233.70 260.88 291.54 325.44 $100 BENEFIT 16.96 20.08 23.56 30.92 35.96 37.64 39.40 41.16 43.00 45.36 47.56 50.04 52.68 55.40 58.96 62.48 66.72 71.52 76.72 83.08 89.24 96.04 103.88 112.56 122.68 131.76 140.36 147.36 153.00 160.12 167.48 177.88 190.68 204.96 221.56 241.32 264.84 292.16 322.68 355.80 $125 BENEFIT 21.20 25.10 29.45 38.65 44.95 47.05 49.25 51.45 53.75 56.70 59.45 62.55 65.85 69.25 73.70 78.10 83.40 89.40 95.90 103.85 111.55 120.05 129.85 140.70 153.35 164.70 175.45 184.20 191.25 200.15 209.35 222.35 238.35 256.20 276.95 301.65 331.05 365.20 403.35 444.75 $150 BENEFIT 25.44 30.12 35.34 46.38 53.94 56.46 59.10 61.74 64.50 68.04 71.34 75.06 79.02 83.10 88.44 93.72 100.08 107.28 115.08 124.62 133.86 144.06 155.82 168.84 184.02 197.64 210.54 221.04 229.50 240.18 251.22 266.82 286.02 307.44 332.34 361.98 397.26 438.24 484.02 533.70 Rev. 4/2006 <25 2529 3034 3539 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 31 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 241.32 267.24 294.48 $100 BENEFIT 320.56 350.88 380.00 414.40 452.04 492.80 530.56 572.68 613.48 647.08 679.52 717.32 301.65 334.05 368.10 $125 BENEFIT 400.70 438.60 475.00 518.00 565.05 616.00 663.20 715.85 766.85 808.85 849.40 896.65 361.98 400.86 441.72 $150 BENEFIT 480.84 526.32 570.00 621.60 678.06 739.20 795.84 859.02 920.22 970.62 1,019.28 1,075.98 390.96 427.56 465.28 $100 BENEFIT 500.04 540.36 577.60 621.56 669.00 719.48 764.00 813.24 858.88 893.00 924.12 961.20 488.70 534.45 581.60 $125 BENEFIT 625.05 675.45 722.00 776.95 836.25 899.35 955.00 1,016.55 1,073.60 1,116.25 1,155.15 1,201.50 586.44 641.34 697.92 $150 BENEFIT 750.06 810.54 866.40 932.34 1,003.50 1,079.22 1,146.00 1,219.86 1,288.32 1,339.50 1,386.18 1,441.80 Rev. 4/2006 32 Medical Medical Plan Options UT offers UT SELECT, a self-funded medical PPO plan, and HMO Blue Texas, a fully insured HMO plan, both administered by Blue Cross and Blue Shield of Texas, Inc. Your Coverage Option Letter will indicate which medical plan(s) are available to you. Medical plans available based upon residential address UT SELECT PPO HMO Blue Texas Service Area Austin Corpus Christi Available Dallas/Fort Worth Worldwide El Paso Houston San Antonio Yes Emergency Services only1 No Yes Dependents Living Out of Area Yes Evidence of Insurability Yes2 (for previously eligible dependents) Transitional Benefits Yes 1 Regular benefits apply when services are received from network providers and facilities within the service area. 2 If proof of other group coverage can be provided during Annual Enrollment, EOI will be waived. Contact your campus Benefits Office for assistance with EOI applications. IMPORTANT If you live in Galveston County and are employed at UT MD Anderson Cancer Center or UT Health Science Center-Houston and currently enrolled Rev. 4/2006 33 in HMO Blue, you and your covered dependents may choose to continue participation in HMO Blue. Transitional Benefits If you decide to change your medical plan during Annual Enrollment and you are currently being treated for a chronic or ongoing medical condition, you may be eligible for Transitional Benefits. This means if your doctor is a contracting provider with your current medical plan but is not a contracting provider with your new plan, you may be allowed to continue seeing your current doctor for up to 3 months, and your claims will be paid at your new plan’s Network benefit level. Transitional Benefits give you the opportunity to find a new Network provider while not risking the loss of medical care. Some medical conditions that are eligible for Transitional Benefits consideration include: • Pregnancy (if you are in your 3rd trimester on September 1 for UT SELECT and 2nd trimester on September 1 for HMO Blue Texas)** • Cancer • Heart Failure • Diabetes • Physical Therapy • Allergy Treatments • Organ Transplant • Behavioral Health Care A Transition of Care form, available at your campus Benefits Office or online at www.utsystem.edu/egi, must be completed and mailed to the new Medical Plan administrator (listed at the end of this booklet) for consideration. New UT SELECT Plan Features Beginning September 1, 2005, UT SELECT will offer disease management programs from Blue Cross and Blue Shield of Texas for health and medical decision-making and self-management. The disease management programs Rev. 4/2006 34 are available at no additional cost and can address the conditions listed below from early stages or mild symptoms to chronic cases with the most severe symptoms. • • • • • • • • Asthma Diabetes Coronary artery disease Congestive heart Failure Chronic obstructive pulmonary disease–chronic bronchitis, emphysema Metabolic syndrome–high blood pressure, high cholesterol Lower back pain End stage renal disease Also new for UT SELECT: CareWise 24-Hour NurseLine – a staff of trained, experienced registered nurse counselors available 24/7 to answer health care questions and provide information about a wide variety of health care issues and medical, nonemergencies. To talk to a CareWise nurse, call toll-free: 1-888-315-9473. Special Beginnings® – a comprehensive prenatal program that helps mothers take better care of themselves and their babies. The program assesses pregnancy risk level and provides close monitoring through a series of calls from an experienced obstetrical nurse from pregnancy through six weeks after delivery. To enroll or ask questions about the program, call toll-free: 1-800462-3275. Blue Access® for Members Blue Access for Members offers you and your family better tools for better health. Just log onto www.bcbstx.com/ut and select the link for Blue Access for Members. Then click on the My Health tab, then on the Mayo Clinic* logo to research specific health conditions, get advice on how to start an exercise program, or start a program to stop smoking or lose weight. You can also take the Mayo Clinic Health Risk Assessment (HRA), a confidential tool that helps you learn more about your individual health risks. Select the link, Take the HRA now! and follow the prompts to complete the assessment. When you’re finished, you’ll receive a personalized health report online, complete with confidential feedback on possible health issues and how to address them. Rev. 4/2006 35 The relationship between Blue Cross and Blue Shield of Texas and Mayo Clinic is solely that of independent contractors. You may read additional information about plan features and exclusions in the Medical Plan certificates available from your campus Benefits Office or online at www.utsystem.edu/egi. UT SELECT PPO (medical coverage) (Blue Cross Blue Shield of Texas) www.bcbstx.com/ut/ (866) 882-2034 8:00 AM - 5:00PM CST HMO Blue Texas (Blue Cross Blue Shield of Texas) www.bcbstx.com/ut/ (888) 322-2379 7:30 AM - 6:00 PM CST Rev. 4/2006 36 MEDICAL PLAN COMPARISON CHART September 1, 2005 - August 31, 2006 FOR HMO COVERAGE, ALL CARE MUST BE PROVIDED OR AUTHORIZED BY THE MEMBER’S PRIMARY CARE PHYSICIAN. Coverage Evidence of Insurability Required for Previously Eligible Dependents Annual Deductible Annual Out of Pocket Maximum (Includes Deductibles and Coinsurance only) Pre-existing Condition Limitation Hospital – Semi-private Room and Board Outpatient or Same Day Surgery Physician Office Visits Prenatal and Postnatal Care Hospital Inpatient surgery (physician charges) Surgical Assistant Hospital Obstetrical Care HMO Blue Texas Network No UT SELECT PPO Out of Network Out of Area Yes (unless covered under another group medical plan at time of application) $250/person $750/family (applicable when coinsurance is required) $1,750/person $5,250/family No $100 Copay/day ($500 max/admission) then 80% Plan/20% Member $100 Copay then 80% Plan / 20% Member FCP $25 Copay Specialist $30 Copay $25 Copay (initial visit only) 80% Plan / 20% Member 80% Plan / 20% Member $100 Copay ($500 max/admission) then 80% $500/person $1,500/family (applicable when coinsurance is required) $4,000/person $12,000/family No 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member $250/person $750/family (applicable when coinsurance is required) $1,750/person $5,250/family No 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member None $2,500/person $5,000/family No $100 Copay/day ($500 max/admission) $200 per Occurrence PCP $25 Copay Specialist $30 Copay $25 Copay (initial visit only) Included in Hospital Copay Included in Hospital Copay Included in Hospital Copay Rev. 4/2006 37 Coverage Office Surgery Skilled Nursing/Convalescent Facility Radiologist, Pathologist, and Anesthesiologist Allergy Testing Hospice Care Services Home Health Care Services Physical Rehabilitation Therapy Laboratory Services Diagnostic X-Rays, Therapeutic Radiology, Mammography Hospital Emergency Room Ambulance Service Chemical Dependency Inpatient Treatment (max 30 days/yr) Chemical Dependency Outpatient Treatment (max 20 visits/yr) Serious Mental Illness Inpatient Serious Mental Illness Outpatient HMO Blue Texas Network PCP $25 Copay Specialist $30 Copay No Copay (max. 180 days) No Copay PCP $25 Copay Specialist $30 Copay No Copay No Copay PCP $25 Copay Specialist $30 Copay No Copay No Copay $100 Copay (waived if admitted) $100 per Occurrence $100 Copay/Day ($500 max/admission) PCP $25 Copay Specialist $30 Copay $100 Copay/Day ($500 max/admission) PCP $25 Copay Specialist $30 Copay FCP $25 Copay Specialist $30 Copay 80% Plan / 20% Member (max. 180 days) 80% Plan / 20% Member FCP $25 Copay Specialist $30 Copay 80% Plan / 20% Member (max. 90 visits/yr) 80% Plan / 20% Member (max. 120 visits) 80% Plan / 20% Member (max. 20 visits/yr) Included in Office Visit Copay Included in Office Visit Copay $100 Copay (waived if admitted) 80% Plan / 20% Member $100 Copay/day ($500 max/admission) then 80% Plan / 20% Member FCP $25 Copay Specialist $30 Copay $100 Copay/day ($500 max/admission) then 80% Plan / 20% Member FCP $25 Copay Specialist $30 Copay UT SELECT PPO Out of Network 60% Plan / 40% Member 60% Plan / 40% Member (max. 180 days) 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member (max. 90 visits/yr) 60% Plan / 40% Member (max. 120 visits) 60% Plan / 40% Member (max. 20 visits/yr) 60% Plan / 40% Member 60% Plan / 40% Member $100 Copay (waived if admitted) 80% Plan / 20% Member 60% Plan / 40% Member Out of Area 75% Plan / 25% Member 75% Plan / 25% Member (max. 180 days) 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member (max. 90 visits/yr) 75% Plan / 25% Member (max. 120 visits) 75% Plan / 25% Member (max. 20 visits/yr) 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 60% Plan / 40% Member 75% Plan / 25% Member 60% Plan / 40% Member 60% Plan / 40% Member 75% Plan / 25% Member 75% Plan / 25% Member Rev. 4/2006 38 Coverage Mental Illness Inpatient (other than Serious Mental) Mental Illness -Outpatient HMO Blue Texas Network $100 Copay/Day ($500 max/admission) 30 day max/yr PCP $25 Copay Specialist $30 Copay (max. 25 visits/yr.) Dependents up to age 6, no charge for injection only PCP $25 Copay Specialist $30 Copay PCP $25 Copay Specialist $30 Copay 80% Plan / 20% Member 80% Plan / 20% Member PCP $25 Copay Specialist $30 Copay $100 Copay/day ($500 max/admission) then 80% Plan / 20% Member (max. 30 days/yr) FCP $25 Copay Specialist $30 Copay (max. 20 visits/yr.) Dependents up to age 6, no charge for injection only UT SELECT PPO Out of Network 60% Plan / 40% Member (max. 30 days/yr) 60% Plan / 40% Member (max. 20 visits/yr.) Dependents up to age 6, no charge for injection only Out of Area 75% Plan / 25% Member (max. 30 days/yr) 75% Plan / 25% Member (max. 20 visits/yr.) Dependents up to age 6, no charge for injection only Immunizations Preventive Health Services - periodic health assessments, well baby, annual well woman exam Birth Control Management Durable Medical Equipment Prosthetic Devices Speech and Hearing Therapy FCP $25 Copay Specialist $30 Copay FCP $25 Copay Specialist $30 Copay 80% Plan / 20% Member 80% Plan / 20% Member 80% Plan / 20% Member (max. 60 visits/yr) 60% Plan / 40% Member 75% Plan / 25% Member 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member 60% Plan / 40% Member (max. 60 visits/yr) 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member 75% Plan / 25% Member (max. 60 visits/yr) Rev. 4/2006 39 NETWORK - Network benefits are available to enrollees living in Texas and certain areas of New Mexico and Washington, D.C. who receive services from providers who have a network contract agreement with BCBSTX. Network benefits may also be available when services are rendered by providers outside of Texas if that provider has a network contract agreement with the Blue Cross and Blue Shield plan in the state services were rendered. Network providers have agreed to charge only up to the BCBSTX allowed amount. You are responsible for applicable deductibles, copays and/or coinsurance. OUT OF NETWORK - Out of Network benefits are available to enrollees living in Texas and certain areas of New Mexico and Washington, D.C. who receive services from providers who do not have a network contract agreement with BCBSTX. When receiving services from Out of Network providers, you may be responsible for applicable deductibles, copays and/or coinsurance, as well as any amounts exceeding the BCBSTX allowed amount. OUT OF AREA - Out of Area benefits are available only to those enrollees who reside outside of Texas and who do not reside in certain areas of New Mexico and Washington, D.C. Pharmacy Benefits Your Pharmacy benefits under UT SELECT are administered by Medco Health Solutions. Pharmacy Benefits for HMO Blue Texas are administered by Prime Therapeutics. Both Pharmacy benefit plans require a $50 annual deductible per person, per plan year. Generic Drugs are medications sold under a standard name that by law must have the same active ingredients and are subject to the same U.S. Food and Drug Administration (FDA) standards for quality, strength and purity as their brand name Rev. 4/2006 40 counterpart. Generic drugs usually cost less than brand name drugs. Preferred Drugs are a list of brand name medications preferred for their clinical effectiveness and opportunities to help contain participant and plan costs. The list of preferred medications is available on each Plan administrator's web site (listed at the end of this section). Non-Preferred Drugs are brand name medications that are not on the Preferred Drug list because there are effective and less expensive alternatives available. These medications require the highest Copayments. Copayments for both plans are the same, but each plan may have different medications on its Preferred and Non-Preferred Drug lists. Please compare each plan's Preferred Drug list with any medications you or your dependents are currently taking. The Preferred Drug lists are available online at http://www.utsystem.edu/egi/providers.asp. UT SELECT and HMO Blue Texas Pharmacy Benefits Annual Deductible $50/person/year (Deductible does not apply to medical plan deductible) Access Options Generic Drug Copayment Preferred Drug Copayment Non-Preferred Drug Copayment $40 Retail Network Pharmacy: Up to a 30day supply*. Refills allowed as prescribed. $10 $25 (Good option for new prescriptions) Home Delivery Pharmacy: Up to a 90$20 $50 day supply*. Refills allowed as prescribed. (Best option for maintenance medication) *Copayments will not be pro-rated if you receive less than the 30- or 90-day supply. If you choose to purchase a Brand Name Drug when there is a less expensive Generic alternative, you must pay the difference between the cost of the Brand Name drug and the Generic drug plus your Copayment. Sometimes the cost difference is quite large. Here is an example of how you would be reimbursed if you had already met your $50 annual deductible: $80 Rev. 4/2006 41 Cost of Brand Name Drug Less cost of Generic Equivalent Plus cost of Generic Copayment Your Payment $150 -$55 +$20 $115 The UT SELECT Prescription Drug Plan administered by Medco Health Solutions also offers a small benefit for Out of Network pharmacies. You will pay the full cost of your prescription and send a claim form and your receipt to Medco. Your reimbursement will be based on your total cost, minus the UT discount, the applicable annual deductible and Copayment. The HMO Blue Texas plan does not include a benefit for Out of Network pharmacies. If you purchase prescriptions from an Out of Network pharmacy, you will be responsible for the full cost of your prescription. Be sure to check with your Prescription Drug carrier to decide which plan covers your medications at the lowest expense to you. The following is a comparison of how the 25 most purchased drugs are classified by each Prescription Drug plan. Rev. 4/2006 42 HMO BLUE Texas Lipitor Preferred Preferred Synthroid Non-Preferred Preferred Hydrocodone Generic Generic Zithromax Preferred Preferred Hydrochlorothiazide Generic Generic Zocor Preferred Non-Preferred Nexium Preferred Preferred Linisopril Generic Generic Toprol XL Preferred Preferred Ambien Preferred Non-Preferred Zyrtec Preferred Non-Preferred Allegra Preferred Preferred Norvasc Preferred Preferred Amoxicillin Generic Generic Zoloft Preferred Preferred Atenolol Generic Generic Fosamax Preferred Non-Preferred Premarin Preferred Preferred Lexapro Non-Preferred Preferred Trimterene w/HCTZ Generic Generic Flonase Preferred Preferred Singulair Preferred Preferred Effexor XR Preferred Preferred Furosemide Generic Generic Celebrex Preferred Preferred These classifications are subject to change depending on new drugs approved by the FDA and patent expirations. DRUG NAME UT SELECT Rev. 4/2006 43 MEDCO FORMULARY FIRST COVERAGE REVIEW Formulary First Coverage Review is a program that promotes Generic and Preferred brand medications as first line therapy. Therapeutically equivalent Generic or Preferred brands are required before non-preferred drugs unless the physician provides clinical support for the Non-Preferred drug. This program focuses on prescriptions written for the following medications: • • • • • Prevacid Aciphex Prilosec Protonix Effective May, 2006, Zegerid will be added to the program Member benefits: • You lower your out-of-pocket cost by using the OTC, Generic or Preferred brand. • Your physician must approve any change or provide clinical explanation for the non-preferred drug. UT SELECT Medications requiring authorization prior to initial prescription (Contact Medco to request a Managed Prior Authorization) Human Growth Hormones: Hormone Agents: Immune Globulins: Anti-Virals Anti-Obesity Agents: Protropin, Humatrope, Geref, Genotropin, Norditropin, Nutropin, Saizen, Serostim Crinone 8%, Lupron, Factrel, Lutrepulse, Synarel Gamimune, Gammagard, Gammar-IV, Sandoglobulin, Venoglobulin Acyclovir, Famvir, Valtrex, Zovirax Xenical, Meridia, Tenuate & generics, phentermine Rev. 4/2006 44 Acne & other dermatologicals: Accutane, Retin-A, Avita Medications requiring authorization to obtain additional supplies (Contact Medco Health to request a Managed Rx Coverage) Onychomycosis Therapy: Antidepressant Therapy: Smoking Deterrents: Sporanox, Lamisil, Diflucan Wellbutrin SR, Lexapro (new users only) Zyban, Prostep, Nicotrol NS, Habitrol Medco also offers Health Management programs for certain participants, based on your prescription history. The Health Management programs are included as part of the UT SELECT prescription drug program and are available at no additional cost. The Health Management programs provide educational materials and expert knowledge about many chronic medical conditions including: • Diabetes • Hypertension • Respiratory Disease HMO Blue Texas’ Pharmacy benefits are administered by Prime Therapeutics. Prime Therapeutics is a national Prescription Benefits Manager (PBM) owned by a number of not-for-profit Blue Cross and Blue Shield plans. You may read additional information about pharmacy plan features and exclusions in the Medical Plan certificates available from your campus Benefits Office or online at www.utsystem.edu/OEB. UT SELECT PPO Pharmacy Benefits (Medco Health Solutions, Inc.) www.medcohealth.com (800) 818-0155 24 hours a day HMO Blue Texas (Blue Cross Blue Shield of Texas) www.bcbstx.com/ut/ (888) 322-2379 7:30 AM - 6:00 PM CST Rev. 4/2006 45 UT SELECT and Medicare The University of Texas System urges all retired employees and dependents to enroll in Medicare Part B when they become eligible. If you are a retired employee or will soon become a retired employee and are age 65 or over, you must have Medicare Part B to receive the maximum benefits available from a UT medical plan option. In most instances, if you are age 65 or over and are working in a position for at least 20 hours per week, your UT medical plan will be primary, and Medicare Part B, if elected, will be secondary. Medicare Part B may be primary for some Medicareeligible active employees with certain medical conditions. Consult with your local Social Security Administration office to learn what illnesses qualify for Medicare Part B coverage prior to turning age 65. If you are retired and also eligible for Medicare, Medicare becomes your primary payer and pays your medical claims first. UT SELECT pays second. If you choose a doctor who accepts Medicare assignment, you will not be responsible for any difference between the billed charge and the Medicare allowed amount. You become eligible for Medicare at age 65. As an eligible retiree, you have the option of enrolling in Part A and refusing Part B coverage. But if you initially decline Part B, you will have to pay a premium surcharge if you ever re-apply for coverage later. If you decline Medicare Part B, you will be required to pay the portion that Medicare would have paid for Part B-covered items. If you are under age 65 and eligible for Medicare benefits because of a disability, the same conditions apply as if you were age 65. Rev. 4/2006 46 In order to assure that your claims are correctly processed, you should contact Blue Cross and Blue Shield of Texas and report your Medicare Health Insurance Claim (HIC) number and the effective dates of Medicare Parts A and B immediately upon enrollment. If you are enrolled in Medicare and your doctor accepts Medicare assignment: The doctor may be in or out of the UT SELECT Network UT SELECT will pay 100% of benefits approved but not paid by Medicare (subject to UT SELECT plan limitations) • • • No Deductibles No Copayments No Coinsurance When you are an inpatient at a facility that accepts Medicare assignment, UT SELECT will pay your Medicare inpatient deductible, and the $100 per day Copay ($500 maximum) will not apply. If your doctor does not accept Medicare assignment: • • • • • Network and out-of-network benefits apply UT SELECT will coordinate with Medicare Deductibles may apply Copayments may apply Coinsurance may apply The chart on the following page shows you exactly how UT SELECT and HMO Blue coordinate benefits with Medicare: Rev. 4/2006 Medicare Coordination of Benefits Provider Accepts Medicare Assignment BCBSTX InNetwork Provider Service Covered by Medicare Medicare Pays UT SELECT Pays (Subject to plan limitations) HMO Blue Pays1 HMO Blue Member Pays UT SELECT Member Pays Y Y Y 80% MC Allowed 20% MC Allowed 0 Y N Y 80% MC Allowed 20% MC Allowed 80% of BCBS Allowed after $250 Deductible or 100% after Copay, whichever is applicable 60% of BCBS Allowed after $500 Deductible 20% MC Limiting Charge after $250 Deductible 20% MC Limiting Charge after $500 Deductible 80% of BCBS Allowed after $250 Deductible or 100% after Copay, whichever is applicable 60% of BCBS Allowed after $500 Deductible 2 0 Y Y N 0 20% of BCBS Allowed after $250 Deductible or 100% after Copay, whichever is applicable $500 Deductible+40% of BCBS Allowed+Difference between Billed Charge and BCBSTX Allowed $500 Deductible Y N N 0 N Y Y 80% MC Limiting Charge3 80% MC Limiting Charge 0 N N Y $500 Deductible N Y N 20% of BCBS Allowed after $250 Deductible or 100% after Copay, whichever is applicable $500 Deductible+40% of BCBS Allowed+Difference between Billed Charge and BCBSTX Allowed 20% MC Allowed after applicable Copay 20% MC Allowed after applicable Copay 100% of BCBS Allowed after applicable Copay 100% of BCBS Allowed after applicable Copay 20% MC Limiting Charge after applicable Copay 20% MC Limiting Charge after applicable Copay 100% of BCBS Allowed after applicable Copay 100% of BCBS Allowed after applicable Copay Copay if applicable Copay if applicable Copay if applicable Copay if applicable Copay if applicable Copay if applicable Copay if applicable N N N 0 Copay if applicable UT SELECT and HMO Blue Retiree w/Medicare Part A and Part B 1 2 All services are subject to HMO Blue referral and authorization requirements. The difference between BCBS Allowed and Billed Charges may be paid if that amount is in available COB Savings. 3 A Provider who does not participate with Medicare may not bill more than the Medicare Limiting Charge (115% of MC Allowed). Page 48 Out-of-Country Claims Since there is no Medicare allowable for services provided outside of the United States (except in certain areas of Canada and Mexico), there is no coordination of benefits, and UT SELECT pays as the primary payer. You may be responsible for Deductibles, Copayments or Coinsurance Amounts. Medicare-Eligible Retirees with VA Benefits Federal laws prohibit the duplication of federally funded health insurance benefits. Therefore, if you are a Medicare-eligible retiree and receive services from a Veteran's Administration facility, UT SELECT will assume a secondary liability and pay 20% of the charges, regardless of an actual Medicare payment. Veteran's Administration facilities are reimbursed by federal dollars that will cover 80% of the charges. Rev. 4/2006 Page 49 Dental Depending on where you live, you may have a choice between UT DENTAL SELECT, the self-funded dental plan, managed by Delta Dental, or Assurant Employee Benefits (formerly Fortis), a fully-insured dental HMO plan. Your campus Benefits Representative will tell you which plans are available to you. The following chart shows which portion of the dental charges you are expected to pay and the service areas for each dental plan option: UT Dental Select Benefits Summary ASSURANT Dental Service UT DENTAL 1 SELECT Austin Dallas/Ft. Worth Available Service Area El Paso Worldwide Galveston Houston San Antonio 4 Annual Deductible $25 per Person None Oral Exam, X-rays, $0 $0-5 Cleanings Fluoride $0-5, up to $0, up to age 19 Treatment age 18 Sealants $0, up to age 14 $7, per tooth Space Maintainers $0, up to age 14 $60-75 Fillings 20% $8-60 Extractions 20% $9-80 Root Canals 20% $95-175 5 Periodontics 20% $0-200 Crowns, Jackets $235 (lab 50% and Cast fees may also Restorations apply $295-350 Bridges and (lab fees may 50% Dentures also apply) Rev. 4/2006 Page 50 Orthodontics 50%, $1,250 Lifetime benefit per person Out-of-Network Yes Benefits Maximum Annual $1,250 None Benefit 1 Reimbursement is based on a percentage of the contracted allowable amount 2 Excludes Oral exams, x-rays, cleanings, fluoride treatments, sealants, space maintainers and specialist consultations 3 Scaling, root planing and treatment of gum disease UT DENTAL SELECT Highlights: • • • • • • • 25% discount of Dentist Retail Fee, no lifetime maximum Limited to Emergencies You may see Network (Delta Preferred or Delta Premier) or Out-of-Network dentists DeltaPreferred Option dentists charge reduced contract fees No pre-approval needed to change dentists No referral needed to see a specialist 130,000 dental locations nationwide Delta Dental pays network dentists directly Dental work in progress not covered Assurant DMO Highlights: • • • • • • • • • No claim forms No deductibles No maximum annual benefit No maximum lifetime benefit for orthodontics Dental work in progress not covered Primary Family Dentist required for each family member No exclusions for pre-existing conditions No balance billing No referrals needed for Network specialists Rev. 4/2006 Page 51 You may read additional information about plan features and exclusions in the Dental Plan certificates available from your campus Benefits Office or online at www.utsystem.edu/egi. UT Dental Select (Delta Dental) www.deltadentalins.com/universityoftexas (800) 893-3582 or (800) 521-2651 6:15 AM - 6:30 PM CST Assurant Dental DMO www.assurantemployeebenefits.com (800) 443-2995 7:00 AM - 6:00 PM CST Rev. 4/2006 Page 52 Vision Fully insured Vision Care benefits is offered by Superior Vision Care. Summary of Vision Care Benefits Covered Services1 Comprehensive eye exam by an ophthalmologist or optometrist Standard lenses (per pair)Plastic (CR39), clear, uncoated Frames Contact Lenses 1 Network Benefits Covered in full after a $35 copay, but does not include the contact lens exam or fitting fees2 Covered in full Out-of-Network Benefits Up to $42 (ophthalmologist) Up to $37 (optometrist) Up Up Up Up Up Up Up to to to to to to to $32 (Single vision) $46 (Bifocal) $61 (Trifocal) $84 (Lenticular) $53 $210 (Non-elective)3 $100 (Elective)3 Covered up to $140 Covered in full (Non-elective)3 Up to $125 retail (Elective)3 Only one comprehensive exam is covered per plan year. Only one pair of eyeglass lenses and one set of frames or one contact lens allowance is covered per plan year. 2 Comprehensive eye exam is subject to a $35 copay (in-network only). 3 Contact lenses in lieu of eyeglass lenses and one set of frames. Contact Lenses Contact lenses are a covered benefit to members who have one or more of these medical conditions: • Aphakia • Pseudo-aphakia • Anisometropia • Kerataconus • When visual acuity cannot be corrected to 20/70 in the better eye except through the use of contact lenses. Contact lenses are also covered for those who prefer to wear contacts instead of glasses. LASIK and other Eye Surgery Superior Vision offers a 20% discount off the Usual and Customary prices for LASIK surgery. This discount is provided through specially contracted ophthalmologists (Look for ‘RF’ in the Provider Directory). • Blepharoplasty (eyelid surgery) is also available for the 20% discount. • Rev. 4/2006 Page 53 Additional Features 20% discount on upgrades and add-ons to the eyeglass lens benefit from Network providers • 10% discount on charges above the allowance for cosmetic (not medically necessary) contact lenses from Network providers • 20% discount on additional purchases of eyeglasses • 10% discount on additional purchases of contact lenses. • NOTE: These discounts are not available at Wal-Mart Vision Centers. You may read additional information about plan features and exclusions in the Vision Plan certificate available from your campus Benefits Office or online at www.utsystem.edu/egi. Superior Vision www.superiorvision.com (800) 507-3800 M-F 5:00 AM - 6:00 PM PST Sat 8:00 AM - 1:00 PM PST Rev. 4/2006 Page 54 Life Insurance Fort Dearborn Life Insurance Company (FDL) is the administrator for the Group Term Life options available to you and your dependents. FDL offers the following plan options: • • Retiree Basic Group Term Life Retiree Voluntary Group Term Life You will be permitted to elect from Retiree Voluntary Group Term Life amounts of $7,000, $10,000, $25,000 or $50,000. Voluntary Group Term Life coverage is no longer offered based on your date of retirement or your length of service with UT. However, if you choose to increase your coverage, satisfactory Evidence of Insurability will be required for these changes to take effect. The following chart lists the various options available to you and your dependents: Basic Group Term Voluntary Group Term Life Life $3,000 $7,0001,2 (Provided as part of $10,0001,2 Retiree the Basic Package at $25,0001,2 $50,0001,2 no cost to you.) The Voluntary Group Term Life amount will be in addition to the Basic Group Term Life coverage. NOTE: You must be enrolled in a UT medical plan to be enrolled in the Basic GTL coverage. 2 Evidence of Insurability is required for retirees who were previously eligible but did not elect the Voluntary Group Term Life or to increase the Voluntary Group Term Life. Plan Features of the Voluntary Group Term Life Insurance: • You are eligible for an Accelerated Payment Benefit (up to 50% of your coverage amount) if you become terminally ill. • The Voluntary Group Term Life plan does not pay benefits for death by suicide during the first two years of coverage. Rev. 4/2006 Member Page 55 You may read additional information about plan features and exclusions in the Group Term Life Plan certificate available from your campus Benefits Office or online at www.utsystem.edu/egi. Fort Dearborn Life Insurance Company www.fdl-life.com/ut (866) 628-2606 M-F 8:00 AM - 5:00 PM CST Long Term Care Long Term Care (LTC) insurance is offered to you through CNA. LTC is available to you, your spouse, adult children (25 years and older), parents, grandparents, parents-in-law and grandparents-in-law. LTC insurance provides funds for necessary services when an individual becomes incapable of caring for themselves. Covered services can vary depending on the individual’s condition and can range from assistance in the home with day-to-day activities to care provided in a nursing home. Your eligible family members may apply without you having applied for coverage. However, only the premium(s) for you and your spouse may be deducted from your UT paycheck. Other enrolled family members are required to pay CNA directly. Long Term Care Benefit Summary $100 $125 Daily Maximum Nursing Home Benefit Daily Maximum for Community Based Care Lifetime Maximum Benefit • $150 $75 $50 $72.50 $182,500 $228,125 $273,750 There are three choices for the maximum daily nursing home benefit of $100, $125 and $150. This is the most that would be payable for each day of care in a nursing home. • The Lifetime Maximum benefit is equal to 1,825 times the Daily Maximum Nursing Home Benefit selected. This is also the number of days in a 5 year time period. • You may elect either the Guaranteed Benefit Increase Option, which will offer periodic opportunities to increase your existing coverage or the Rev. 4/2006 Page 56 optional Lifetime Automatic Benefit Increase (ABI). If ABI is chosen, on each anniversary of your coverage effective date CNA will increase your benefit amount in effect by 5%. A person becomes eligible for LTC benefits when they are certified chronically ill by a licensed healthcare practitioner. Chronically ill means the person is unable to perform two or more activities of daily living (bathing, continence, dressing, eating, toileting, transferring) for 90 days without substantial assistance or supervision. Chronically ill can also mean that an individual has a severe cognitive impairment that can cause threats to the individual's health and safety without a great deal of supervision. The waiting period for benefits is 90 days, starting on the first day of chronic illness and ending 90 calendar days later. Premiums are waived once a person begins to receive benefits. For additional information, or to order a complete package of information including enrollment materials, please call CNA Customer Service at (888) 8250353. Additional information is also available at www.ltcbenefits.com (password: utsguest). CNA Group Long Term Care (888) 825-0353 www.ltcbenefits.com 8:00 AM – 6:00 PM, EST password: utsguest Rev. 4/2006 Page 57 Frequently Asked Questions General What is Premium Sharing? Premium sharing is the monthly contribution provided by the State of Texas and campus toward group insurance premiums of an enrolled employee or qualified retiree. The amount of premium sharing is determined by the Texas Legislature on a bi-annual basis in the Appropriations Act. What is Evidence of Insurability (EOI)? EOI is documentation of a person's medical history to determine whether the person meets the carrier's definition of good health. For information about when EOI is required, see page X. Medical What is a deductible? A deductible is the amount of out-of-pocket expenses that you must pay for health services before other expenses are payable by the plan. (Copayments are not included in the deductible.) What is a copayment? A copayment is a payment made by you in lieu of deductibles and coinsurance. For HMO plans, deductibles and coinsurance do not apply. What is coinsurance? Coinsurance refers to the cost amount that you share in hospital and medical expenses after the deductible is met. For example, your coinsurance for network care under the UT SELECT plan is 15%. How do I find out what providers (doctors, hospitals, etc.) are in a specific health plan? You can obtain a copy of the plan's printed provider directory. However, provider changes can occur at any time; therefore, we recommend that you call your plan's customer service number or check your plan's online provider directory at www.utsystem.edu/egi to learn the most current provider information. Rev. 4/2006 Page 58 If I enroll in an HMO, will I be covered if I have an emergency while traveling outside the service area? Yes. The Texas Department of Insurance (TDI) requires state licensed HMOs to provide coverage for emergencies, as defined by TDI. If I change health plans this year, will the new plan honor my old prescription? Retail prescriptions will be honored; however, you will need a new prescription for the mail order pharmacy. If I am currently being treated for a chronic medical condition and change health plans this year, will I be allowed to continue to use my current doctor? Transition benefits are available for certain medical conditions including pending transplants, home health and hospice care, behavioral health and chemical dependency, high risk pregnancies, pregnancies that are in the third trimester on September 1, and those conditions currently being overseen by case management. This means that you may continue to use your current provider and receive network benefits for 90 days following the effective date of your new plan. You must complete a Transitional Benefits form (available at www.utsystem.edu/egi) and submit it to your new insurance carrier. Dental If I enroll in the Assurant Dental plan, do I have to select a primary dentist? Yes. However, you may be treated by a network specialist (i.e. Endodontist, Orthodontist) without a referral from your primary dentist. Vision Why can't I get both eyeglasses and contacts under the Superior Vision plan? Coverage for both eyeglasses and contacts would substantially increase your premiums. This limitation is intended to keep your premiums affordable. Life Can I change my beneficiary for my Basic/Voluntary Term Life Insurance? Yes. Beneficiary designations for you and your dependents may be changed at any time. The Beneficiary Designation Form can be obtained at your campus Benefits Office or at www.utsystem.edu/egi. You must return the completed form to your campus Benefits Office. Rev. 4/2006 Page 59 Long Term Care What is Long Term Care? Long Term Care provides coverage for some or all of your long term care costs for a limited time. Nursing home care is an example of a service covered by Long Term Care. FLEX If my spouse is still an active employee of The UT System, are my medical expenses deductible under Flex? Although retirees are not eligible to participate in the UT Flex plan, eligible medical expenses can be reimbursed under your spouse’s plan if you are a qualified dependent as defined by IRS rules. Under these rules, you need not be your spouse’s dependent under the medical plan. For more detailed information, you may wish to consult your tax expert. Rev. 4/2006 Page 60 Benefit Offices UT Health Science Center Houston 7000 Fannin UCT 10th Floor Houston, TX 77030 Phone: (713) 500-3830 Fax: (713) 500-3124 UT El Paso Administration Building, Room 216 500 West University Avenue El Paso, TX 79968 Phone: (915) 747-5202 Fax: (915) 747-5815 UT Arlington Office of Human Resources J.D. Westel Bldg 1225 W Mitchell, Ste 212 Arlington, TX 76019 Phone: (817) 272-5554 Fax: (817) 272-5798 UT Brownsville Human Resources UTB/TSC Cortez 129 80 Fort Brown Brownsville, TX 78520 Phone: (956) 544-8205 Fax: (956) 982-0175 UT Dallas Mail Station AD 35 P.O. Box 830688 Richardson, TX 78083-0688 Phone: (972) 883-2221 Fax: (972) 883-2158 UTMB Correctional Managed Care 6 miles south of Tennessee Colony off FM 645 Tennessee Colony, TX 75880 Phone: (903) 928-2217 x3163 Phone: (903) 928-2217 x3409 UT MD Anderson Cancer Center Physical Address: 2450 Holcombe Boulevard Benefits, Unit 634 Houston, TX 77021 Mailing Address: HR Benefits, Unit 634 PO Box 301402 Houston, TX 77230-1402 Phone (713) 745-6947 Fax: (713) 745-7160 UTMB Correctional Managed Care 3009 A Highway 30, West (I-45) Huntsville, TX 77340 Phone: (936) 437-3512 Fax: (936) 437-3511 UT Health Center Tyler 11937 US Highway 271 Tyler, TX 75708-3154 Phone: (903) 877-7784 Fax: (903) 877-2845 UT System Administration 702 Colorado St., Ste. 1.104 Austin, TX 78701 Phone: (512) 499-4797 Fax: (512) 499-3588 UT Health Science Center San Antonio 7703 Floyd Curl Drive, MSC 7972 San Antonio, TX 78229-3900 Phone: (210) 567-2610 Fax: (210) 567-6791 UT Austin P.O. Drawer V Austin, TX 78713 Phone: (512) 471-4343 or Toll Free (800) 687-4178 Fax: (512) 471-5034 UT Southwestern Medical Center Dallas 5323 Harry Hines Blvd Dallas, TX 75390-9023 Phone: (214) 9820 or (214) 648-9830 Fax: (214) 648-9891 UT Pan American PSO 111 1201 W University Drive Edinburg, TX 78539-2999 Phone: (956) 381-2551 Fax: (956) 381-2340 UT Permian Basin 4901 East University Boulevard Odessa, TX 79762 Phone: (915) 552-2747 Fax: (915) 552-3747 UT San Antonio 5723 University Heights Blvd Ste 500 San Antonio, TX 78249-0610 Phone: (210) 458-4250 Fax: (210) 458-7890 UT Tyler 3900 University Boulevard Tyler, TX 75799 Phone: (903) 566-7358 Fax: (903) 565-5690 HRCMC Galveston 301 University Boulevard Galveston, TX 77555-1006 Phone: (409) 747-2619 Fax: (409) 763-1915 UTMB 301 University Galveston, TX 77555-0140 Phone: (409) 772-2630 Fax: (409) 772-2754 UTMB Correctional Managed Care 1500 State School Road Gatesville, TX 76598 Phone: (254) 865-8901 x164 Fax: (254) 865-8901 x340 UTMB Correctional Managed Care Two Circle Drive Sugarland, TX 77478 Phone: (281) 490-1146 Fax: (281) 491-8498 UTMB Correctional Managed Care HC02 Box 967 Beeville, TX 78102 Phone: (361) 362-6357 Fax: (361) 362-6355 Rev. 4/2006 Page 61 INSURANCE CONTACTS Plan/Plan Administrator UT SELECT PPO medical (Blue Cross Blue Shield of Texas) Group 71778 UT SELECT PPO prescription (Medco Health Solutions, Inc.) Group UTSYSRX HMO Blue Texas (Blue Cross Blue Shield of Texas) Group 71779 UT FLEX (PayFlex Systems) UT Dental Select (Delta Dental) Assurant Dental DMO Group CX86 Superior Vision Group 056856 Group Term Life (Fort Dearborn Life) Group GFZ71778 Death and Dismemberment (Fort Dearborn Life) Short Term Disability and Long Term Disability (The Hartford) STD Group 83127660 LTD Group 83098970 Long Term Care (CNA) Group 0010025TQ Claims Address P.O. Box 660044 Dallas, TX 75266 PAID Prescriptions P.O. Box 2277 Lee Summitt, MO 640632277 P.O. Box 660044 Dallas, TX 75266-0044 P.O. Box 3039 Omaha, NE 68103-3039 P.O. Box 1809 Alpharetta, GA 30023 P.O. Box 830949 Birmingham, AL 35283-0949 P.O. Box 967 Rancho Cordova, CA 95741 P.O. Box 655403 Dallas, TX 75265-5403 P.O. Box 655403 Dallas, TX 75265-5403 Telephone/Hours (866) 882-2034 8:00 AM - 5:00PM CST (800) 818-0155 24hrs a day 7 days a week (888) 322-2379 7:00 AM – 5:00 PM CST P (866) 887-3539 F (877) 230-4283 (800) 893-3582 or (800) 521-2651 6:15 AM - 6:30 PM CST (800) 443-2995 7:00 AM - 6:00 PM CST (800) 507-3800 M-F 5:00 AM - 6:00 PM PST Sat 8:00 AM - 1:00 PM PST (866) 628-2606 M-F 8:00 AM - 5:30 PM CST (866) 628-2606 M-F 8:00 AM - 5:00 PM CST Web site www.bcbstx.com/ut/ www.medcohealth.com www.bcbstx.com/ut/ www.utflex.com www.deltadental.com www.assurantemployeebenefits.com www.superiorvision.com www.fdl-life.com/ut www.fdl-life.com/ut P.O. Box 946710 Maitland, FL 32794-6710 (800) 303-9744 8:00 AM - 8:00 PM EST www.thehartfordgroupbenefits2.com (User ID: ‘uni101”, Password, “contract” Continental Casualty Attn: LTC Claims P.O. Box 946760 Maitland, FL 32794-6760 (888) 825-0353 7:00 AM - 5:00 PM CST Rev. 4/2006 www.ltcbenefits.com (password: utsguest) Page 62 Retirement Contacts ORP Vendors ING 800 873-5518 www6.ingretirementplans.com/SponsorExtranet/UTexas/ Fidelity 1-800-343-0860 www.mysavingsatwork.com/atwork.htm Great-West 888-404-4032 opt 3 www.greatwest.com/ Lincoln 800-454-6265 8:00 AM-8:00 PM EST www.lfg.com MetLife Resources (Please note that Citistreet/Travelers is now part of Metlife Resources.) 800 236-8489. http://www.metlife.com/Applications/Corporate/WPS/CDA/PageGenerator/0,1674,P3814,00.html TIAA-CREF 1 800-842-2888 www.tiaa-cref.org/ AIG VALIC 800-448-2542 (option 3) http://www.aigvalic.com/prilabel2003/utorp.nsf/contents/home State and Federal Retirement System Contact Information Railroad Retirement Board 800-808-0772 9:00 AM-3:30 PM www.rrb.gov Employees Retirement System of Texas Customer Service Division 18th and Brazos Streets P. O. Box 13207 Austin, Texas 78711-3207 Phone (512) 476-6431 or (512) 867-7711, in the Austin Area (877) 275-4377, toll-free outside of Austin www.ers.state.tx.us/ Teacher Retirement System of Texas 1000 Red River St. Rev. 4/2006 Page 63 Austin, Texas 78701 512-542-6400 (800) 223-8778 TRS TDD (512) 542-6444 or (800) 841-4497 www.trs.state.tx.us/ Social Security Administration 800-772-1213 www.ssa.gov Federal Insurance Programs Medicare General Information (800) MEDICARE www.medicare.gov Medicaid Texas Department of Health Austin, Texas 78756-3199 Toll free: 1-888-963-7111 (512)458-7111 TDD (512)458-7708 http://www.hhsc.state.tx.us Texas Department on Aging - TX's SHIP 800-252-9240 http://www.tdoa.state.tx.us TriCare Senior Pharmacy Program (877) DOD-MEDS http://www.tricare.osd.mil/pharmacy/seniorpharmacy.cfm Tricare for Life (888) DOD-LIFE (866) DOD-LIFE (Spanish) http://www.tricare.osd.mil/ Rev. 4/2006