Sept. 1 benefit changes announced

This Annual Enrollment, many employees and retirees will see increases in their Sept. 1 health premiums, but they’ll also see benefit enhancements and lower premiums in most other plans. The enhanced benefits and reduced premiums are the results of new insurance carriers taking over all plans except the A&M Care medical plans and Life insurance plan.

Here’s what you can expect Sept. 1:

Health plan premiums

Premiums for most plans and coverage categories will increase with a few exceptions:

• Premiums will decrease for those in the Scott & White employee and spouse, employee and children, and employee and family categories.
• Premiums also will decrease slightly for those in the Graduate Student Health Plan employee-only category.
• Premiums will remain the same for full-time employees in the A&M Care 1250 employee-only category and the 65 PLUS retiree-only category.

A&M Care Health Plan

• The plans will still be administered by BlueCross BlueShield of Texas and PharmaCare.
• Network providers will be available in Coryell County.
• The plan will cover maternity benefits for dependent daughters.

Graduate Student Health Plan

• The plan insurer will change from UniCare to Combined Insurance Plans.
• The lifetime maximum benefit will decrease from $1,000,000 to $500,000.
• The plan will pay 80 percent of charges instead of 90 percent at network providers and 60 percent instead of 80 percent at non-network providers.
• Services received at student health centers will be covered at 100 percent with no deductible.  Also, prescriptions purchased at the centers will cost $15.
• Prescription drug copayments will change from $15 generic/$25 brand-name plus 10 percent to $15 plus 20 percent for any covered drug (except at student health centers).
• In most cases, students must be taking at least six credit hours or otherwise be working toward a degree to be eligible for coverage.

HMOs

• Scott & White, Humana, FirstCare and Mercy will again be offered.

Dental Coverage

• A&M Dental PPO and Dental HMO coverage will be provided by Delta Dental rather than CIGNA. 
• Premiums will decrease slightly for both plans.
• A&M Care Dental PPO plan benefits will still cover preventive care at 100 percent, basic care at 80 percent and major restorative at 50 percent, with a $1,500 maximum for annual plan expenses and for orthodontic benefits. However, two levels of providers will be available. PPO providers will discount their fees by about 30 percent, and Premier providers will discount their fees by about 20 percent. Both PPO and Premier providers will file claims for you, and you will not be liable for any costs over reasonable and customary fees. You can also use a non-network provider and receive regular plan benefits based on the provider’s full fees.
• Delta has PPO contracts with several dentists in Laredo and Kingsville.
• Delta is working with current network dentists as well as additional dentists to ensure that this change does not reduce the number of network providers. An up-to-date list of providers should be available by the start of Annual Enrollment.

Vision Plan

• The plan will be administered by Spectera instead of Superior Vision. The network will be similar to Superior Vision’s network and include TSO, Wal-Mart and EyeMasters.
• Premiums will decrease.
• Although the copayment for frames and lenses will increase to $25, the cost for scratch coating, polycarbonate lenses, basic progressive lenses, tints and UV coating will be covered in full.
• The annual allowance for contact lenses will increase from $120 to $150.
• Non-network benefits will increase.
• Spectera will pay benefits for exams, eyeglass lenses and contact lenses once every plan year rather than every 12 months, and for frames once every other plan year rather than every 24 months.
• If you are enrolled in a health plan that provides partial coverage for eye exams, Spectera will pay a benefit secondary to that plan.

Life

• Ft. Dearborn will remain the Life plan carrier.
• Optional Life and Dependent Life premiums will increase.
• You will have to provide evidence of good health to increase your Optional Life coverage level by any increment to five or six times salary. Currently, this is required only when increasing coverage to six times salary. You will not have to provide evidence of good health to increase coverage by one salary increment to two, three or four times salary.
• Beneficiary assistance services will be available to all Life participants at no cost. This includes grief counseling and financial counseling.

Optional AD&D

• The plan will be administered by Ft. Dearborn instead of The Hartford.
• Premiums will decrease.
• The plan will include a childcare benefit that pays an additional 3 percent of your coverage amount per child (up to $5,000/year) for surviving children younger than 13.
• The plan will pay an additional 3 percent of your coverage amount (up to $4,500/year) for continuation of medical coverage.
• The plan will include a coma benefit that pays up to an additional 1 percent of your coverage amount each month for one year.

Long-Term Disability

• The plan will be administered by MetLife instead of The Hartford.
• Premiums will decrease.
• Coverage for organic brain diseases (including schizophrenia, bipolar disorder and Alzheimer’s) will not be limited to 24 months.

Long-Term Care

• John Hancock will take over administration of this plan from CNA on Jan. 1, 2007. Information about enrollment options will be included with your Annual Enrollment materials. Employees currently enrolled in the plan will receive transition information in the fall.

Enhancements to the plan include:

• Restoration of benefits. If you use part or all of your benefits and then recover, benefits will be fully restored once you have used no benefits for 24 consecutive months.
• Return of premium. If you have not used any benefits and die before age 65, your premiums will be returned in full to your beneficiary. Partial return of premiums is available up to age 75.
• Benefits for alternate care facilities, such as assisted living, will increase.
• An alternate plan that provides automatic inflation protection will be available.
• Siblings may join the plan on their own, just like parents, grandparents and adult children.

Flexible Spending Accounts (Tax Saver Spending Accounts)

• The Flexible Spending Account program will be administered by PayFlex instead of Tax Saver Plan.
• Through PayFlex’s extensive web site, you will find detailed claim information and a wide array of web tools, including calculators that can help you estimate how much to contribute to your spending accounts.
• You will be able to use your UIN (rather than Social Security Number) to file claims and log on to the web site.
• The overall administrative fee will decrease; however, the A&M System will no longer pay a portion of the fee. Participants will pay the full $3.75 monthly fee instead of the current partial fee of $2.50.
• Debit cards will no longer be available to Health Care Spending Account participants.  The debit cards caused more claims than contributions early in the year, resulting in significant cash-flow problems for this plan.

Look for more information regarding these changes in your Annual Enrollment materials, which will be available next month.

Electronic EOBs available to A&M Care participants

If you are enrolled in an A&M Care health plan, you can view your Explanations of Benefits (EOBs) online rather than having them mailed to you. If you would like BlueCross BlueShield of Texas (BCBSTX) to stop mailing you paper EOBs, go to www.bcbstx.com and log into Blue Access for Members. Once you are logged in, click on your User Profile and check the appropriate box.

Not only does Blue Access give you instant access to your EOBs, but it also lets you check the status of a claim, confirm your coverage and dependent coverage, locate a doctor or hospital in the network, take a health risk assessment, and begin a program to stop smoking or lose weight.

Any Questions?

When I turned 65, I did not enroll in Medicare Part B. Should I enroll even though I’m still working for the A&M System?

Regardless of your age, your A&M System health coverage is primary for you and your spouse as long as you are working for the System, so there’s no need to enroll in Medicare Part B right now. Once you stop working, though, Medicare becomes your primary health coverage, whether you’re enrolled or not. This means your System health plan will pay benefits as if Medicare benefits have already been applied. For this reason, before you retire you’ll want to contact your local Social Security office and enroll in Part B (you’re automatically enrolled in Part A as soon as you become eligible). To avoid paying a penalty for late enrollment, you must enroll in Part B within 90 days after retiring.

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