2013 Benefit Enrollment Guide - Troy University

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Healthcare Benefits Medical (Blue Cross Blue Shield of AL) Medical Summary of Benefits PPO Plan Benefits In-Network Out-of-Network Out-of-Area Office Visits $25 PCP / $40 Specialist 70% after deductible 80% after deductible Hospital Services Inpatient Outpatient Surgery & Emergency Service Preventive Care Services Routine Well Child Care Routine Immunizations Physicians Services In-Hospital Visits, Surgery, Anesthesia, Diagnostic X-rays & Lab Services for treatment in the Emergency Room Other Covered Services Durable Medical Equipment, Physical Therapy, Ambulance Service $300 deductible per admission, 100% after deductible $950 deductible per admission, $50 copay per day, 80% after deductible 80% after deductible $125 copay, 100% after copay $300 copay, 100% after copay 80% after deductible $25 copay; 100% after copay 100% of allowed amount; no deductible or copay No deductible; 100% of allowed amount Covered only when provided by Primary Care Physician Covered only when provided by Primary Care Physician Covered only when provided by Primary Care Physician Covered only when provided by Primary Care Physician 70% after deductible 80% after deductible $40 copay, then 100% 70% after deductible 80% after deductible 80% after deductible 70% after deductible 80% after deductible Chiropractic Services 80% after Ded, limit 12 visits per year or $400 a year Not Covered 80% after Ded, limit 12 visits per year or $400 a year Deductibles $500 Individual / $1,500 Family $500 Individual / $1,500 Family $500 Individual / $1,500 Family Out-of-Pocket Maximum $400 Individual / No family max $400 Individual / No family max $400 Individual / No family max Mental Health and Substance Abuse Behavioral Health Systems (BHS) specializes in managing mental health and substance abuse benefits. BHS has a preferred provider network of credentialed mental health care providers. Benefits are available to all persons enrolled and eligible under a Troy University-sponsored medical plan. To qualify for coverage, you must be pre-certified and referred through Behavioral Health Systems. It is your responsibility to make sure that approval is received from BHS before you are treated. If you do not receive approval, no benefits will be paid. To Access Benefits: Call 1-800-245-1150 or visit their website at www.behavioralhealthsystems.com. Member login is Troysu. Prescription Drugs Prescription Drugs (Blue Cross Blue Shield of AL) Deductible Individual No deductible Family No deductible Retail Co-payments Generic $10.00 Preferred $35.00 Non Preferred $50.00 Mail Order Co-payments (90 day supply) Generic $20.00 Preferred $70.00 Non Preferred $100.00 Please call 1-866-688-9727. Troy University 2013 Benefits Enrollment Guide 4
Healthcare Benefits Pre-Tax Cafeteria Plan (Section 125) Troy University provides its employees with the option of having certain benefit premiums payroll deducted on a pre-tax basis. You may choose to have your health, dental, flexible spending, and some voluntary coverage deducted from your check on a pre-tax basis (section 125). A Cafeteria Plan is an employee benefits program designed to take advantage of Section 125 of the Internal Revenue Code. A Cafeteria Plan allows employees to pay certain qualified expenses (such as health insurance premiums) on a pre-tax basis, thereby reducing their total taxable income and increasing their spendable/ take-home income. Funds set aside in Flexible Spending Accounts (FSAs) are not subject to federal, state, or Social Security taxes. It is important to know that under the pre-tax option once you make your benefit election you cannot change that election unless you have a qualified life event, such as marriage, birth, divorce, or loss of other coverage. The reduction also lowers the salary on which Social Security benefits are calculated. While the actual impact on the benefit calculation is typically very minor, if you are concerned and you are close to beginning a Social Security benefit, you may wish to consider waiving the Section 125 Plan. About Qualifying Events Changes to benefits for which you elect to have your premiums deducted on a pre-tax basis are NOT allowed during the plan year, except for a “qualifying life event.” Qualifying life events that could result in changes to your coverage include: • marriage or divorce • birth or adoption of a child • death of a dependent • Medicare entitlement • loss of coverage If you have a qualifying life event, you must notify The Enrollment Center and provide the necessary documentation within 30 days of the event. If you do not do so, you must wait until the next Annual Enrollment. Example of Employee Savings Cafeteria Plan Waived (premiums deducted post-tax) Cafeteria Plan Elected (premiums deducted pre-tax) Employee Gross Pay $2,000 $2,000 Medical Premiums $0 $142.88 Taxable Income $2,000 $1,857.12 Tax Rate 25% 25% Taxes Withheld $500 $464.28 Employee Net Pay $1,500 $1,392.84 Medical Premiums $148.88 0 Take Home Pay $1,351.12 $1,392.84 An employee who elected pre-tax cafeteria plan option paid less tax and took home more pay. Please call 1-866-688-9727. Troy University 2013 Benefits Enrollment Guide 5
Page 1 and 2: 2013 Benefit Enrollment Guide an ov
Page 3 and 4: introduction Enrollment Current Emp
Page 5: Healthcare Benefits Medical (Blue C
Page 9 and 10: Healthcare Benefits BlueCard Worldw
Page 11 and 12: Voluntary Life Insurance Voluntary
Page 13 and 14: travel assistance MEDEX ® Travel A
Page 15 and 16: flexible spending Flexible Spending
Page 17 and 18: etirement Mandatory Retirement Plan
Page 19 and 20: important notices Summary Plan Desc
Page 21 and 22: Troy University-54395/000 Coverage
Page 23 and 24: Common Medical Event If you need dr
Page 25 and 26: Excluded Services & Other Covered S
Page 27 and 28: Questions and answers about the Cov
Page 29 and 30: BlueCard PPO: Troy University Cover

2013 Benefit Enrollment Guide - Troy University

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