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Summary of Fringe Benefits Related Links
Updated January, 2008
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| Basic: | The University provides each employee with a $25,000 life insurance policy. This is a double indemnity policy. |
| Supplemental: | Employees have the option to elect supplemental life insurance based on 1, 2, or 3 times your benefits base (annual salary) rounded to the next higher thousand. The premiums are based on your age. The supplemental life insurance is also a double indemnity policy. |
| Dependent: | Employees may elect dependent life insurance which covers all eligible dependents for $10,000 at a cost of $4.70 per month. Children age two weeks but less than six months in age are insured for $2,000. |
Application for enrollment in supplemental and dependent life insurance after the first 31 days of employment requires evidence of insurability. The life insurance plan booklet may be accessed at www.usg.edu/employment/benefits/life/index.phtml
Currently, there are four health plan choices offered to benefits eligible employees and their legal dependents. Blue Cross/Blue Shield of Georgia administers claims for the plans. Employees have the option of enrolling in the Indemnity Health Plan, the Preferred Provider Plan (PPO), the High Deductible Plan (HDHP/HSA), or the Blue Choice Plan (HMO). Highlights of the plans are illustrated below. For more detailed information refer to plan booklets, available from the Human Resources Office.
The healthcare premium contribution for active, eligible employees will be paid with pre-tax dollars. Employees must enroll during the first 31 days of employment or during the annual open enrollment period. Open enrollment is generally held in the fall of each calendar year. A University System of Georgia open enrollment period covers a 30 calendar year time frame. Healthcare plan elections made during an open enrollment period will become effective at the beginning of the new plan year. The plan year is currently a calendar year (January 1 – December 31). During an open enrollment period, an active and eligible employee may elect to: (1) enroll in a healthcare plan; (2) drop healthcare coverage; (3) participate in a different healthcare plan option; and/or (4) change his/her level of coverage (i.e., single, employee + child, employee + spouse, or family).
Because your share of the cost for healthcare plan premiums is paid with pre-tax dollars, the Internal Revenue Service rules state that the choices made by a covered member during an annual open enrollment period must remain in effect for the entire plan year. The only exception permitted is when a covered member has a qualifying event. If you have a qualifying event, you may add, change, or discontinue healthcare coverage within 31 days of the qualifying event. Appropriate documentation must be presented to the Human Resources Office before a change in healthcare coverage can be granted. Some examples of qualifying events include: the birth or adoption of a child, death of a dependent, change in employment status of a covered member, his/her spouse, or his/her covered dependent, the loss of eligibility status by a covered dependent, member or spouse being called to full-time active military duty, losing or gaining healthcare coverage eligibility under Medicare or Medicaid, or a change in residence to a location outside of a healthcare plan’s service area. A failure to complete a change form within 31 days of a qualifying event will prohibit you from making such changes until the next University System open enrollment period.
ELIGIBLE DEPENDENT: Spouse and unmarried children up to age 19, or up to age 26, if they are full time students. Full time students are defined as those enrolled three out of four quarters, or 2 out of 3 semesters. Students enrolled in a co-op program are considered full time for that term.
RELATED HEALTHCARE WEBSITES:
Health Insurance University System of GA www.usg.edu/employment/benefits/health/index.phtml.
This BOR site includes the Health Benefits Comparison Charts, a link to Blue Cross/Blue Shield provider directory info, BC/BS claim forms, and resource links such as Express Scripts.PPO Provider Directories www.healthygeorgia.com/
Provides on-line information regarding networks of Georgia PPO providers (1st Medical Network) and the National PPO providers (Beech Street).
Express Scripts www.express-scripts.com/ga/regents/
The pharmacy benefit program provider has established a web site for University
System of Georgia plan participants. Helpful information regarding pharmacy benefits under the Indemnity and PPO plans is available at this site.
INDEMNITY HEALTH PLAN
(Self Insured Plan through the Board of Regents, University System of Georgia; claims administered by Blue Cross/Blue Shield of Georgia.)
FEATURE
INDEMNITY PLAN
Pre-Existing Condition None Maximum Lifetime Benefit
$2 million
Maximum Annual Deductible
$300 individual
$900 familyMaximum Annual Out-of-Pocket
$2,000 individual
$4,000 familyPhysician Office Visit 80% of UCR charges for non-surgical svcs Wellness Care/Preventive Health Care
$750 per person per plan year; not subject to deductible
Laboratory Services provided in Physicians office (exclusive of Wellness Care/Preventive Health Care)
80% of UCR charges
Maternity Care-Physician Svcs/In-Office (Prenatal, Delivery and Post Natal)
90% of UCR charges
Outpatient Surgery
90% of UCR charges
Second Surgical Opinions
100% of UCR charges; not subject to deductible
Treatment of TMJ 80% of UCR charges; maximum $1,000 lifetime Allergy testing 80% of UCR charges Allergy Shots & Serum 80% of UCR charges In-Patient Hospital Services for Physician Care/Surgery 90% of UCR charges for surgeon;80% of UCR charges for anesthesiologist, pathologuist, or radiologist services/consulatations. Hospital Services Other than Emergency Room Care
90% of contracted DRG rate for In-State Hospitals;90% of UCR charges for service area in Out-of-State hospitals
Maternity Care-Inpatient Hospital (Delivery) 90% of contracted DRG rate Inpatient-Hospital Lab Services 90% of UCR charges Inpatient Hospice Care 90% of UCR charges Inpatient Treatment of TMJ 90% of UCR charges Outpatient Hospital Svcs for Physician Care/Surgery
90% of UCR charges for surgeon;80% of UCR charges for anesthesiologist, pathologist, or radiologist svcs/consultations.
Outpatient Facility Selected by Treating Physician 90% of UCR charges in a Plan approved facility Outpatient Hospital/Facility Laboratory Services 80% of UCR changes Care in a Hospital Emergency Room
( treatment of an emergency medical condition or injury)Surgical Services: 90% of UCR charges if referred by Medcall; 80% of UCR charges if not referred by Medcall.
Non-Surgical Services: 80% of UCR charges if referred by Medcall; 70% if not referred by Medcall
Urgent Care Services
80% of UCR changes Home Nursing Care 90% of UCR charges Extended Care Facility 90% of UCR charges Home Hyperalimentation 90% of UCR charges Ambulance Services 80% of UCR charges Outpatient Hospice Care 90% of UCR charges Cochlear Implants 90% of UCR charges Durable Medical Equipment 80% of UCR changes Outpatient Short Term Rehabilitation Svcs 80% of UCR charges;physical, speech, cardiac, & occupational therapies are limited to 40 visits per incident type per plan year. Chiropractic Care Not covered Surgical Extraction of Impacted Teeth
(medical benefits are not available for partially erupted teeth)
90% of UCR surgeon charges Disease State Management Training & Edu. Svcs.
(Diabetes, Oncology, Congestive Heath Failure, Asthma, and Cardiovascular Disease with Stroke Overlay Program)
100% of vendor negotiated rate; no deductible; pre-certification by UNICARE required. To receive plan benefits coverage, participation in the appropriate DSM program is required.
Mental Health/Substance Abuse Facility Charges for Inpatient: 90% of UCR charges; maximum benefit coverage of 60 days per person per plan year; 90 days per person lifetime.
Provider Charges for Inpatient: 90% of UCR charges.
Provider Charges for Outpatient: 80% of UCR charges; maximum of 20 visits per person per plan year; UNICARE may approve up to 50 visits per year under the following conditions: 1) in lieu of inpatient treatment; or 2) immediately following hospital confinement for the same condition.
Dental/Oral Care Not covered; other than accidental injury to natural teeth which is covered at 80% of UCR charges. Organ & Transplant Program(Prior approval required by UNICARE)
90% of vendor network rate at a UNICARE contracted transplant center. Lifetime benefit limit for expenses related to the donor search using a UNICARE contracted transplant center is $10,000. Pharmacy Program
Prescription DrugsPrescription Drugs
3-Tier Co-payment Structure
(Vendor: Express Scripts)(1) Generic: $10 co-payment per 30-day supply
(2) Preferred Brand Name: $25 co-payment per 30-day supply
(3) Non-Preferred Brand Name: 20% co-payment of drug cost, with minimum co-payment of $40 &maximum member co-payment of $100, for up to a 30-day supply.Quarterly Out-of-Pocket Maximum for generic and preferred brand name prescriptions:
Employee $ 450/quarter
Employee + Child $ 900/quarter
Employee + Spouse $ 900/quarter
Family $1,350/quarter
If the usual and customary charge for a generic or preferred brand name drug is less that the co-payment amount, the member will pay the lesser of the two. If a physician indicates “Brand Necessary” on a prescription, then only a preferred or non-preferred brand name medication can be dispensed. The member will be responsible for the preferred/non-preferred brand name medication co-payment . If a physician does not indicate “Brand Necessary” and the member chooses a preferred/non-preferred brand name medication over its available generic equivalent, the member will be required to pay the generic co-payment. In addition to paying the generic co-payment, the member will also be responsible for paying the difference in the cost between the generic and the preferred/non-preferred brand name drug. This difference in member cost is sometimes referred to as an ancillary charge.
Days Supply
A member will be charged one co-payment per 30 day retail supply of a prescription drug. Maintenance medications are those prescription drugs that a member may obtain for a period of up to 90 days. The member will be charged one co-payment per 30-day supply.
Other Coverage Rules
For specific prescribed drugs, the plan may impose certain requirements. Those requirements may include prior medical authorization, limits on the day supply amount of the prescribed medication, and/or limits on the number of approved units/labels of medication per prescription.
Progressive Drug Management Program (PDMP)
In partnership with physicians and pharmacists, Express Scripts has developed a Progressive Drug Management Program. The PDMP is a prescriptions drug protocol management resource that promotes the appropriate utilization of first line medications and/or therapeutic categories. PDMP is a clinically justified program that assists your physician in prescribing the most appropriate and cost-efficient therapeutic treatment strategy for you and/or your family. Under this program, your physician will usually prescribe a proven, less expensive medication that is known to be safe and effective, as an initial treatment strategy.
PREFERRED PROVIDER OPTION HEALTH PLAN (PPO)
On-line provider directories for the PPO plan can be accessed at www.healthygeorgia.com, or by calling 1-800-675-6492 for providers within the state of Georgia, or by calling 1-800-424-8950 for national providers.
FEATURE
PPO PLAN, Georgia In-Network
PPO PLAN, National In-Network PPO PLAN, Out-of-Network
Pre-Existing Conditions None None None Maximum Lifetime Benefit
$2 million
$2 million $2 million
Maximum Annual Deductible
$300 individual
$900 family$ 400 individual
$1200 family
$400 individual
$1,200 familyMaximum Annual Out-of-Pocket
(Stop Loss)$1,000 individual
$2,000 family
$2000 individual
$4000 family
$2,000 individual
$4,000 family
Physician Ofc Visit $100% of network rate after $20 co-payment per visit-applies to ofc visit only(non-surgical svcs) 100% of network rate after $20 co-payment per visit-applies to ofc visit only(non-surgical svcs) 60% of network rate for non-surgical svcs. Wellness Care/Preventive Care $750/ person per plan year paid at 100%; not subject to deductible; $20 co-payment per ofc visit. $750/ person per plan year paid at 100%; not subject to deductible; $20 co-payment per ofc visit. Not covered. Charges do not apply to annual deductible or annual-out of pocket maximum. Lab Svcs provided in Physician's Ofc (exclusive of wellness/preventive care 90% of network rate; subject to deductible. 80% of network rate; subject to deductible. 60% of network rate; subject to deductible and balance billing. Maternity Care (prenatal, delivery, postnatal) 90% of network rate after an initial visit co-payment of $20. 80% of network rate after an initial visit co-payment of $20. 60% of network rate; subject to deductible and balance billing. Outpatient Surgery 90% of network rate 80% of network rate 60% of network rate; subject to deductible and balance billing. Second Surgical Opinions 100% of network rate after a $20 co-payment per visit; not subject to deductible. 100% of network rate after a $20 co-payment per visit, not subject to deductible 60% of network rate; subject to deductible and balance billing. Treatment of TMJ 90% of network rate.
Lifetime benefit limit of $1,100.
80% of network rate. Lifetime benefit limit of $1,100. 60% of network rate; subject to deductible and balance billing. Lifetime benefit limit of $1,100. Allergy Testing 90% of network rate 80% of network rate 60% of network rate; subject to deductible and balance billing. Allergy Shots & Serum 100% for allergy shots & serum; not subject to deductible. 100% for allergy shots & serum; not subject to deductible. 60% of network rate; subject to deductible and balance billing. In-Patient Hospital Physician Care/Surgery 90% of network rate subject to deductible and balance billing 80% of network rate subject to deductible and balance billing 60% of network rate; subject to deductible and balance billing. In-patient Hospital Svcs Other than for Emergency Room Care 90% of network rate 80% of network rate 60% of contracted State Georgia DRG rate; subject to deductible and balance billing. Maternity Care In-Hospital (Delivery) 90% of contracted DRG rate 80% of network rate 60% of contracted State of Georgia rate; subject to deductible and balance billing. In-patient Hospital Lab Svcs 90% of network rate 80% of network rate 60% of contracted State of Georgia DRG rate; subject to deductible and balance billing. Inpatient Hospice Care 100% of network rate 100% of network rate 60% of network rate; subject to deductible and balance billing. Outpatient Physician Care/Surgery Physician Svcs 90% of network rate 80% of network rate 60% of network rate; subject to deductible and balance billing Care in Hospital Emergency Room 90% of network rate after a $75 co-payment per visit; co-payment is reduced to $50 if referred by MedCall. Co-payment is waived, if admitted within 24 hrs. 90% of network rate after a $75 co-payment per visit;co-payment is reduced to $50 if referred by MedCall. Co-payment is waived if admitted within 24 hrs. 90% of network rate after a $75 co-payment per visit; co-payment is reduced to $50 is referred by MedCall. Co-payment is waived if admitted within 24 hrs. Outpatient Lab Svcs 90% of network rate 80% of network rate 60% of network rate; subject to deductible and balance billing. Urgent Care Svcs 90% of network rate after $20 co-payment per visit. 80% of network rate after $20 co-payment per visit. 60% of network rate; subject to deductible and balance billing Home Nursing Care 90% of network rate; limited to 2 hours of care in a 24-hour day. 80% of network rate; limited to 2 hours of care in a 24-hour day 60% of network rate; limited to 2 hours of care in a 24-hour day; subject to deductible and balance billing Outpatient Hospice Care 100% of network rate 100% of network rate 60% of network rate; subject to deductible and balance billing. Extended Care Facility Not available Not available Not available Home Hyperalimentation 90% of network rate; lifetime limit of $500,000 80% of network ratelifetime limit of $500,000 60% of network rate; subject to deductible and balance billing. Ambulance Svcs 90% of network rate 90% of network rate 90% of network rate; subject to the MRN/GA First in-network deductible; subject to balance billing. Cochlear Implants 90% of network rate 80% of network rate 60% of network rate; subject to deductible and balance billing. Durable Medical Equipment 90% of network rate 80% of network rate 60% of network rate; subject to deductible and balance billing. Outpatient Short Term Rehabilitation Svcs 90% of network rate; Physical, speech, cardiac and occupational therapies are limited to 40 visits per incident type per plan year 80% of network rate; Physical, speech, cardiac and occupational therapies are limited to 40 visits per incident type per plan year. 60% of network rate; subject to deductible and balance billing; Physical, speech, cardiac, and occupational therapies are limited to 40 visits per incident type per plan year. Chiropractic Care
90% of network rate;limited to 40 visits per member per plan year.
80% of network rate; limited to 40 visits per member per plan year. 60% of network rate; subject to deductible and balance billing; limited to 40 visits per member per plan year.
Surgical Extraction of Impacted Teeth
(Medical benefits are not available for partially erupted teeth)
90% of network rate 80% of network rate 60% of network rate Dental/Oral Care
(Not covered other than accidental injury to natural teeth)
90% of network rate 80% of network rate 60% of network rate Disease State Management Program
(Diabetes, Oncology, Congestive Heart Failure, Asthma, and Cardiovascular Disease with Stroke Overlay Program)
100% of vendor negotiated rates; not subject to deductible. (To receive plan benefits coverage, participation in the appropriate DSM program is required)
80% of vendor negotiated rates; not subject to deductible. (To receive plan benefits coverage, participation in the appropriate DSM program is required)
Not applicable Mental Health/Substance Abuse Facility Charges for Inpatient In-network: 90% of network rate; subject to deductible and to a separate $100 hospital deductible; maximum benefit of 60 combined mental health and substance abuse days per person per plan year; substance abuse coverage limited to 3 episodes per lifetime. Provider Charges for Inpatient In-Network: 80% of network rate; maximum of 60 visits per person per plan year. For outpatient: 80% of network rate with authorization from Magellan.
Facility Charges for Inpatient In-Network: 90% of network rate; subject to deductible and to a separate $100 hospital deductible; maximum benefits of 60 combined mental health and substance abuse days per person per plan year; substance abuse coverage limited to 3 episodes per lifetime. Provider Charges for Inpatient In-Network: 80% of network rate; maximum of 60 visits per person per plan year. For outpatient: 80% of network rate with authorization from Magellan.
Not applicable Prescription Drugs
Prescription Drugs
3-Tier Co-payment Structure (Vendor: Express Scripts)
Pharmacy Program
Cont'd1) Generic: $10 co-payment for up to a 30-day supply
2) Preferred Brand Name: $25 co-payment for up to a 30-day supply
3) Non-Preferred Brand Name: 20% co-payment of drug cost, with a minimum co-payment of $40/maximum co-payment of $100, for up to a 30-day supply.
Quarterly Out-of-Pocket Maximum for generic and preferred brand name prescriptions:
Employee:$450/quarter
Employee + Child: $900/quarter
Employee + Spouse: $900/quarter
Family: $1,350/quarter
1) Generic: $10 co-payment for up to a 30-day supply
2) Preferred Brand Name: $25 co-payment for up to a 30-day supply
3) Non-Preferred Brand Name: 20% co-payment of drug cost, with a minimum co-payment of $40/maximum co-payment of $100, for up to a 30-day supply.
Quarterly Out-of-Pocket Maximum for generic and preferred brand name prescriptions:
Employee: $450/quarter
Employee + Child: $900/quarter
Employee + Spouse: $900/quarter
Family: $1,350/quarter
1) Generic: $10 co-payment for up to a 30-day supply
2) Preferred Brand Name: $25 co-payment for up to a 30-day supply
3) Non-Preferred Brand Name: 20% co-payment of drug cost, with a minimum co-payment of $40/maximum co-payment of $100, for up to a 30-day supply.
Quarterly Out-of-Pocket Maximum for generic and preferred brand name prescriptions: Employee: $450/quarter
Employee + Child: $900/quarter
Employee + Spouse: $900/quarter
Family: $1,350/quarter
If the usual and customary charge for a generic or preferred brand name drug is less that the co-payment amount, the member will pay the lesser of the two. If a physician indicates "Brand Necessary" on a prescription, then only a preferred or non-preferred brand name medication can be dispensed. The member will be responsible for the preferred/non-preferred brand name medication co-payment . If a physician does not indicate "Brand Necessary" and the member chooses a preferred/non-preferred brand name medication over its available generic equivalent, the member will be required to pay the generic co-payment. In addition to paying the generic co-payment, the member will also be responsible for paying the difference in the cost between the generic and the preferred/non-preferred brand name drug. This difference in member cost is sometimes referred to as an ancillary charge.Days Supply
A member will be charged one co-payment per 30 day retail supply of a prescription drug. Maintenance medications are those prescription drugs that a member may obtain for a period of up to 90 days. The member will be charged one co-payment per 30-day supply.Other Coverage Rules
For specific prescribed drugs, the plan may impose certain requirements. Those requirements may include prior medical authorization, limits on the day supply amount of the prescribed medication, and/or limits on the number of approved units/labels of medication per prescription.Progressive Drug Management Program (PDMP)
In partnership with physicians and pharmacists, Express Scripts has developed a Progressive Drug Management Program. The PDMP is a prescriptions drug protocol management resource that promotes the appropriate utilization of first line medications and/or therapeutic categories. PDMP is a clinically justified program that assists your physician in prescribing the most appropriate and cost-efficient therapeutic treatment strategy for you and/or your family. Under this program, your physician will usually prescribe a proven, less expensive medication that is known to be safe and effective, as an initial treatment strategy.HIGH DEDUCTIBLE HEALTH PLAN (HDHP/HSA)
This plan is administered by Blue Cross/Blue of Georgia, and provides major medical coverage including diagnosis and/or treatment of illness, injury or medical conditions. Benefits include physician, hospital, surgical, disease state management, mental health/substance abuse and transplant services.
The High Deductible Health Plan is Health Savings Account (HSA) qualified. The University System nor Blue Cross/Blue Shield of Georgia administrate the HSA. If you enroll in the High Deductible Health Plan and wish to establish a Health Savings Account (HSA), you may do so at a bank or financial institution that offers the HSA. IRS guidelines do not allow both a Health Savings Account (HSA) and a Flexible Health Spending Account. If you are considering opening an HSA, you are advised to consult with a qualified tax advisor.
FEATURE HIGH DEDUCTIBLE PLAN /HSA Pre-Existing Conditions
None
Max. Lifetime Benefit
$2 million
Max. Annual Deductible
$1500 Individual (In-Network)
$3000Family (In-Network)(entire family deductible must be met for those enrolled in options other than employee only, before plan starts to pay its percentage)
Max. Annual Out-of-Pocket
$3000 Individual (In-Network)
$6000 Family (In-Network)$6000 (Out-of-Network)
$12,000 (Out-of-Network)Physician Office Visit
90% of UCR, in-network
70% of UCR, out-of-networkWellness Care/Preventive Care
$750 per person, paid at 100% in network; paid at 70% out of network; not subject to deductible.
Laboratory Services
(exclusive of wellness/preventative care)90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkMaternity Care
(Prenatal, Delivery and Postnatal)90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkOutpatient Surgery
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkSecond Surgical Opinions
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkAllergy Testing
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkAllergy Shots & Serum
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkTreatment of TMJ
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkInpatient Hospital Services for Physician Care/Surgery
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkHospital Services Other than those for Emergency Room Care
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkMaternity Care-Inpatient Hospital (Delivery)
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkInpatient-Hospital Lab Services
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkInpatient Hospice Care
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkInpatient Treatment of TMJ
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkOutpatient Hospital Svcs for Physician Care/Surgery
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkOutpatient Facility Selected by Treating Physician
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkCare in a Hospital Emergency Room
(treatment of an emergency medical condition or injury)90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkOutpatient Hospital/ Facility Laboratory Services
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkUrgent Care Services
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkHome Nursing Care
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkExtended Care Facility
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkHome Hyperalimentation
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkOutpatient Hospice Care
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkCochlear Implants
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkAmbulance Services
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkDurable Medical Equipment
90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkOutpatient Short Term Rehabilitation Svcs
90% of UCR charges, In-Network
70% of UCR charges, Out-of-Network
Limited to 20 visitsChiropractic Care
90% of UCR charges, In-Network
70% of UCR charges, Out-of-Network; limited to 20 visits per plan year.Surgical Extraction of Impacted Teeth
(medical benefits are not available for partially erupted teeth)90% of UCR charges, In-Network
70% of UCR charges, Out-of-NetworkDisease State Management Training & Edu. Svcs.
(Diabetes, Oncology, Congestive Heath Failure, Asthma, and Cardiovascular Disease with Stroke Overlay Program and Obesity/Eating Disorder Program)100% of vendor negotiated rates; not subject to deductible.
Dental/Oral Care
Not covered; other than accidental injury to natural teeth which is covered at 90% of UCR charges, In-Network; 70% of UCR charges, Out-of-Network
Mental Health/Substance Abuse
Inpatient:
90% of UCR charges, maximum benefit coverage of 30 days per plan year; 90 days per person per lifetime.
Outpatient:
90% of UCR charges, maximum of 20 visits per person per plan year.Organ & Transplant Program
(Prior approval required by UNICARE)90% of vendor network rate at a UNICARE contracted transplant center. Lifetime benefit limit for expenses related to the donor search using a UNICARE contracted transplant center is $10,000. Lifetime benefit limit of $500,000.
Pharmacy Benefits
90%; subject to deductible
BLUE CHOICE HEALTH PLAN
HEALTH MAINTENANCE ORGANIZATION (HMO)
This is a healthcare program that offers employees an alternative healthcare plan. Members in this plan must use the Blue Choice HMO network providers. The closest participating physicians to Carrollton currently are in Villa Rica. This is an in-network benefit level plan; there is no coverage for out-of-network in the Blue Choice HMO Plan. Participants must declare a primary care physician from the HMO network at the time of enrollment. On-line provider directory information can be obtained at www.bcbsga.com, or by calling their customer service line at 1-800-424-8950.
BLUE CHOICE (HMO)
PLAN DESIGN FEATURES Max. Lifetime Benefit $2 million Annual Medical Deductible None Annual Pharmacy Deductible None Maximum Annual Out-of-Pocket (Stop Loss) Individual-No annual maximum ; Family-No annual maximum Pre-Existing Conditions None
PHYSICIAN SERVICES IN OFFICE SETTING COPAYS Office visits: Preventive Care Well-child care, immunization $15 Co-payment per visit Physical Examinations $15 Copayment per visit Annual gynecology examination (No PCP referral
Required-Must use network provider)
$15 Copayment per visit Routine Eye Exams Not Covered Routine Hearing Exams Not Covered Illness or Injury Primary Care Physician (PSP) office visit includes
Lab, radiology and office surger)
$15 Copayment Specialty care physician office visit (PCP referral
Required)
$15 Copayment per visit Maternity Services (prenatal, delivery and post-
partum
All related physician care services are covered by $15 copayment at first office visit Allergy care (primary care physician office visit,
Specialty care, allergy shots, serum and testing)
$15 Copayment per visit Vision care services provided by network
Ophthalmologist or optometrist for the treatment
Of acute conditions (No PCP referral required)
$15 Copayment Covered Services provided by a network dermatologist
(No PCP referral required)
$15 Copayment Dental Care Not covered except for accidental injury to natural teeth or extraction of impacted teeth100% covered for x-ray services EMERGENCY ROOM SERVICES Life Threatening illness, serious accidental
Injury or with a PCP referral
$75 Copayment; waived if admitted Non-emergency use of the emergency room Not covered INPATIENT HOSPITAL SERVICES COPAYS Daily room, board and general nursing care at
Semi-private room rate, ICU/CCU charges;
Other medically necessary hospital charges such
Diagnostic x-ray and lab services; newborn
Nursery care.
Plan pays 100% after a $200 copay Physician Services (surgery, anesthesia, radiology,
pathology, etc.)
Plan pays 100% after a $200 copay OUTPATIENT SERVICES In-Network Benefits Level (no coverage for out-of network) Facility/hospital charges (including diagnostic
x-ray and lab services)
Play pays 100% Physician Services (surgery, anesthesia, radiology,
Pathology, etc)
Plan pays 100%, after a $50 copay Therapy Services
-Speech Therapy
-Physical, Occupational Therapy
-Respiratory Therapy
-Radiation Therapy, Chemotherapy
-Chiropractic Care (No referral required)
$15 Copayment
$15 Copayment; 40 visit calendar year maximum
Plan pays 100%; 40 visit calendar year maximum
Plan pays 100%
$15 Copayment; 20 visit calendar year maximum
Behavioral Health/Substance Abuse Services
Provided through Magellan Behavioral Health)
No PCP referral required. Services must be authorized by Magellan Health at 1-800-292-2879 Inpatient (facility and physician fee) Plan pays 100% after a $200 copay; 30-day calendar year maximum Outpatient $25 copayment; 20-visit calendar year maximum Inpatient alcohol substance abuse detoxification Plan pays 100%; 6-day calendar year maximum (combined with other inpatient behavioral health and substance abuse benefits) OTHER SERVICES Skilled Nursing Facility Plan pays 100%; 30-day calendar year maximum Home Health Care Plan pays 100%; 120-visit calendar year maximum Hospice Care Plan pays 100%; $10,000 lifetime maximum Ambulance Plan pays 100% when medically necessary PRESCRIPTION DRUGS Prescription must be written by a network physician or an emergency room physician Blue Choice participating pharmacies include: CVS,Eckerd, Kmart, Kroger, Publix, Walgreens, Wal-Mart, and many independent pharmacies $10 Co-payment for Generic (up to 30 day supply)
$25 Co-payment for Name Brand (up to 30 day
Supply)
CONSUMER CHOICE OPTION:
If you select the Consumer Choice Option for the PPO or HMO plans, and your personal physician or hospital is not a member of the respective PPO or HMO networks, the Georgia Consumer Choice statute permits you to nominate a provider to render medical care at in-network levels of benefit coverage. A physician or hospital must have the appropriate licensing; must agree to the PPO's or HMO's contractual terms and conditions for network providers; and must accept the plan's reimbursement rates. However, a physician or a hospital that has been nominated by a member may decline to participate in the PPO or HMO network. If you select a Consumer Choice option, you will be required to continue under that healthcare plan choice for the remainder of the plan year. While the premium for Consumer Choice is higher, the benefit will be identical to the in-network coverage.
MONTHLY PREMIUM RATES FOR HEALTH PLAN YEAR 2008
PLAN EMPLOYEE ONLY EMPLOYEE+CHILD EMPLOYEE+SPOUSE SELF+FAMILY BOR Traditional Indemnity Plan BOR Preferred Provider Organization(PPO) BOR Preferred Provider Organization(PPO) Consumer Choice* Blue Choice HMO
Blue Choice HMO
Consumer Choice*
High Deductible Health Plan/HSA (HDHP/HSA) $ 22.70
*Consumer Choice Option: This coverage allows you to nominate an out-of-network provider to function as an in-network provider for you, subject to plan and provider approval. This election is irrevocable during the plan year.
SUMMARY OF DENTAL COVERAGEThe dental plan is a self-insured indemnity plan through the Board of Regents of the University System of Georgia. Blue Cross/Blue Shield of Georgia administers the plan and payment of claims. Enrollment in the dental plan is only offered to employees during their first 31 days of employment. There are no open enrollment periods for the dental plan.
According to the indemnity dental plan design, a member may elect dental coverage only at the time of initial eligibility (within first 31 days of employment). A qualifying event is the only reason that a member may elect to make a change in his/her dental plan coverage; request must be made within 31 days of qualifying event with presentation of appropriate documentation of qualifying event.
Monthly Dental Premiums:
Employee Only $27.24 Employee + Child $51.74 Employee+Spouse $54.46 Family $87.14
Pays Usual, Customary and Reasonable (UCR) Charges
Deductible: $50 per year per person Plan Pays: 100% of UCR for preventive dental services (no deductible)
80% of UCR for routine and major restorative dental services
80% of UCR for orthodontic dental servicesLifetime Maximum Orthodontic Benefit: $1,000 per person Effective January 1, 2004, there is a six-month waiting period for orthodontic benefits Annual Maximum Plan Benefit: $1,000 per person The dental insurance plan booklet and dental network information (participating providers) can be accessed from the University System of GA web site at: www.usg.edu/employment/benefits/dental/index.phtml
AFLAC
Several supplemental and optional insurance plans are available through AFLAC using payroll deduction. Employees can obtain information about these plans and enrollment forms from the local AFLAC representative. The name and phone number of the AFLAC representative is available by contacting the Human Resources Office. Most AFLAC programs are subject to Section 125 and employees must enroll within the first 31 days of employment or during the annual open enrollment period.
(IRS SECTION 125)
Employees have the option to participate in a Cafeteria Plan in which contributions to the healthcare and/or dependent care flexible spending account plan(s) are paid with pre-tax dollars and therefore exempt from FICA (Social Security), Federal and State taxes.
INSURANCE PLANS: Premiums paid by an employee for participation in the health and dental benefit plans are automatically deducted before taxes.
HEALTH CARE SPENDING ACCOUNT PLAN: Eligible expenses include costs that are not covered by health benefits plans such as deductibles, co-pays, co-insurance payments, dental expenses, vision care, charges in excess of reasonable and customary allowances, charges in excess of insurance plan limits, and over the counter medications used for medical care. The current maximum contribution is $5,000 per year.DEPENDENT CARE SPENDING ACCOUNT PLAN: Eligible expenses include costs for care of qualifying dependent children and/or parents who meet the requirements to be claimed as a dependent for federal income tax purposes. You may contribute up to a maximum of $5,000 per year to this plan as a single or married individual but only $2,500 per year if you are married and file a separate return.
Eligible employees may enroll in the flexible spending plans during their first 31 days of employment. Employees may also enroll during the annual open enrollment period for the upcoming calendar year (effective January 01). Employees who wish to continue this benefit from one plan year to the next must re-enroll during each annual open enrollment period.
AFLAC administers the processing of claims for the Flexible Spending Account plans.
To learn more about the Flexible Spending Accounts, click here.
This is an optional plan offered to employees via payroll deduction. This plan offers coverage for up to 60% of income replacement in the event of long term disability that is certified by a physician. The rates and elimination periods (waiting periods) are as follows:
Members of Teachers Retirement System 150 day elimination period $ .35 per $100 of coverage 90 day elimination period $ .43 per $100 of coverage
Members of Optional Retirement Plan 150 day elimination period $ .45 per $100 of coverage 90 day elimination period $ .54 per $100 of coverage
Employees may participate in the Georgia Peach Credit Union via payroll deduction. Further information about Credit Union programs can be obtained by contacting Georgia Peach Credit Union at 404-656-2508. Membership application forms and payroll deduction authorization forms are available in the Human Resources Office.
Payroll checks are directly deposited using the National Automated Clearing House (ACH). ACH is operated through the Federal Reserve and will allow employees the ability to deposit payroll checks in any bank within the Continental United States. Direct deposits are made on the regularly scheduled payroll dates for biweekly and monthly paid employees. Employees must provide their routing and account numbers on the Direct Deposit Authorization Form.
Employees may choose to enroll in optional supplemental plans. Payroll deduction for a 403b or 457b is available for a number of authorized companies. Employee contributions to a Tax Sheltered Annuity are not subject to Federal and State taxes, but are limited to $15,500 per year, or $20,500 if over age 50 (for 2007). Employees may contribute to both a 403b and a 457b. To participate in one of these plans via payroll deduction, an employee must enroll with the representative of his/her chosen company, and then complete a salary reduction/ payroll authorization form in the Human Resources Office.
Employees have 31 days from their initial date of employment to elect benefits in which they wish to participate. (If you are a member of the corps of instruction and are under contract on at least a regular half-time basis, you are eligible on the first day of the month in which you are required to be at work.) If employees do not elect to enroll in the benefits program within the first 31 days, they are not allowed entrance in the following programs until open enrollment:
- group health
- cafeteria plan - (IRS Section 125)
a. insurance plans
b. health care spending account plan
c. dependant care spending account plan- applicable AFLAC programs
¨ Special Note: DENTAL coverage is offered only within the first 31 days of employment. No open enrollment periods are offered for the dental plan.
If employees do not elect to enroll in the benefits programs listed below within the first 31 days of employment, they can enroll at any time during the year by completing an “Evidence of Insurability Application” and being approved by the insurance carrier:
1) Group supplemental life insurance
2) Group dependent life insurance
3) Additional life insurance -- RELISTAR Life Insurance Co
4) Long term disability -- ITT Hartford Life Insurance Co
5) Long-term care insurance -TIAA-CREF Life
¨ Special Note: Open enrollment is normally in the Fall of each year (mid-October through mid-November), with the changes taking effect the following January 1st. The open enrollment dates are set by the USG Board of Regents each year.
The University of West Georgia offers an Employee Assistance program through Tanner EAP for UWG benefits-eligible employees and their dependents. The Employee Assistance Program is a service that provides short-term confidential counseling and assistance associated with resolving life problems such as family issues, job stress, substance abuse issues, traumatic events, and other personal concerns. For more information, contact the Human Resources Office or Tanner EAP at 770-834-8327.
Full-time benefits-eligible employees of UWG (employed full-time for at least six months by TAP application deadline) may be eligible to participate in the Tuition Assistance Program for approved courses for academic credit. Tuition is waived for approved courses. Participants are allowed to register for courses on a space available basis only. Request forms must be approved by Human Resources by established deadlines prior to employee registration for each term. Copies of the Tuition Assistance Policy and TAP application forms may be obtained from the Human Resources Office or from the following web address: www.bf.westga.edu/HRPay/tuition_remission.asp
RETIRED EMPLOYEES INSURANCE
Career employees of the University System who retire by meeting the criteria for the definition of a University System of Georgia employee eligible for retirement, shall remain eligible to continue as members of the basic and dependent group life insurance and health benefits plans. The University System shall continue to pay its portion of the cost of group insurance for retired career employees. Nothing in this statement of policy shall be interpreted to reduce the benefit committed to existing career employees. A state employee who is employed by the University System of Georgia, a previous University System of Georgia employee who is rehired by the System, or a new hire of the University System of Georgia after October 31, 2002, shall not be entitled to career employee status and must otherwise meet the definition of a retiree as set forth to be eligible for benefits continuation into retirement. An individual who has retired from another State of Georgia sponsored retirement plan may not count such retirement service toward meeting the criteria for being a career employee.
DISABLED EMPLOYEES INSURANCE
Employees who become permanently and totally disabled under the criteria established by the Teachers Retirement System of Georgia and who also have at least ten years of service with the University System of Georgia, even though they may not be members of the Teachers Retirement System, shall remain eligible for employee and dependent group health and life insurance benefits. The University System shall continue to pay its portion of the cost of group insurance for disabled career employees.
Other employees who are disabled based on the same criteria may remain
in the group health and life insurance program for a period of twelve months with full University System participation in the cost. The inclusion
in the group may continue after the twenty-four month period, but University
System participation in the cost shall cease.
DEPENDENTS OF DECEASED EMPLOYEES, RETIREES, OR DISABLED EMPLOYEES
The dependents of an employee who dies while in active service or the dependents of a retired employee (either of whom was eligible for retirement under the criteria established by the Teachers Retirement System and who has at least ten years of service with the University System, even though he or she may not be a member of the Teachers Retirement System) may remain in the group for life and health insurance purposes with the University System participation in the cost.
Under the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), you or your covered dependents may have the option of continuing coverage under the benefits plan(s) for a period of time, paying the required premiums, after termination of employment.
Note: The Benefits Summary is designed solely for the purpose of providing information regarding current benefits available at the University of West Georgia to eligible employees. The policies addressed are subject to change at any time. This Benefits Summary is not intended as a legal or binding document, and does not imply or guarantee employment or entitlement to benefits. The University of West Georgia is a unit of the University System of Georgia (USG). The benefits statement is not intended to be a substitute for the official University System Policy. USG benefits information can be found at the USG web site www.usg.edu/employment/benefits/index.phtml.
