Retiree Guide - Michigan State University Human Resources · entrance for the Fair will be Gate C, ... For long-distance, call toll-free 800-353-4434. Retiree Guide ... Balance Billing

2017

The next MSU Benefits Open Enrollment will be held from Saturday, October 1 through Monday, October 31, 2016. This is the time of year when eligible MSU retirees can re-evaluate their benefits needs and make changes to benefits selections. The Benefits Fair will be held for three days at the Breslin Center, where retirees can learn about benefits options and ask questions of benefits vendors and Human Resources staff. The entrance for the Fair will be Gate C, directly in front of Lot 63 West. See the dates and times in the left column.

This Open Enrollment guide contains information about the benefits options available for eligible retirees in the 2017 plan year. If you have questions about Open Enrollment that aren’t addressed in this publica-tion, email your questions to [email protected] or call 517-353-

4434. For long-distance, call toll-free 800-353-4434.

Retiree Guide

If you are an MSU retiree and ANY of the following statements are true, then you DO need to participate in Open Enrollment between Octo-ber 1 and October 31, 2016:

• You currently cover a spouse or Other Eligible Individual (OEI) underyour health benefits (who is NOT an MSU employee or retiree) andyou want to continue to cover your spouse or OEI in 2017.

• You want to add an eligible dependent to your health or dentalbenefits (or you want to remove someone from your benefits).

• You want to switch health or dental plans for yourself and/or youreligible dependents.

Should You Participate?

To enroll using the enclosed forms:

• Complete the affidavit (the yellow form) if you are covering a spouse orOEI.

• Fill out the enrollment change form only if you are making benefit changes.

• Return them to MSU HR by October 31 in the enclosed return envelope.

To enroll on the web:

• See the instructions on the Open Enrollment website,www.hr.msu.edu/openenrollment.

Open Enrollment Steps

MSU Benefits Open

Enrollment is October 1

through October 31,

2016

Benefits Fair Dates

October 11, 2016Breslin CenterNoon to 6 p.m.

October 12, 2016Breslin Center

9 a.m. to 4 p.m.

October 13, 2016Breslin Center

7 a.m. to 3 p.m.

mailto:SolutionsCenter%40hr.msu.edu?subject=Retiree%20Open%20Enrollment%20Inquiry

http://www.hr.msu.edu/openenrollment

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www.hr.msu.edu/openenrollment

At a Glance: What’s New, Changing or Especially Important to Remember This YearHere are a few important things to note:

1. The health care affidavit MUST be completed during Open Enrollment. Ifyou plan to cover a spouse or Other Eligible Individual (OEI) on your healthbenefits in 2017, you must complete the health care affidavit by October 31,2016. If you do not, your spouse or OEI will not have health care benefitsthrough MSU in 2017.

2. Online Open Enrollment has changed for those who complete it online.The benefits enrollment application has been updated with the refreshedEBS Portal. Updated instructions are available on the website at www.hr.msu.edu/openenrollment

3. Rates have nominally increased for Community Blue. Other rates remainthe same. Please review the health plan contribution rates on page 6 to seeyour plan options and associated costs.

4. Spinal manipulation benefits expanded to BCN. Spinal and osteopathicmanipulations are covered with a $20 co-pay for a combined 24 visits percalendar year through BCN. BCN requires prior authorization from your pri-mary physician.

5. Reminder: All benefits are offered on a calendar-year basis. Open enroll-ment is held annually in October, and plan selections are effective fromJanuary 1 through December 31. (Note: retirement plans and some voluntarybenefits are offered without an open enrollment period).

6. The ARAG® Legal Insurance Plan excludes most pre-existing legal issuesand business-related matters. A pre-existing condition, which ARAG definesas any legal matter which is initiated prior to the effective date of coverage,will be considered excluded and no benefits will apply. Learn more on page 3.

7. Optional Vision Insurance is available through VSP® Vision Care. Retireesand their benefits-eligible dependents may purchase optional, retiree-paidvision coverage through VSP. Learn more on page 4.

Retiree

Why is an Affidavit Necessary Each Year?People often forget to notify Human Resources when circumstances in

their lives change that impact their benefits coverage. In the unfortunate event of a death or divorce, we need to know about it to make the appropriate benefits changes. The affidavit helps people remember to notify us of changes we need to know about in order to reserve all our health care resources for those who are eligible for coverage. The affidavit is also required for continued coverage of spouses.




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2017 Benefits Open EnrollmentRetiree

Lowest Cost Health Plans for 2017The lowest cost health plans for MSU retirees for the 2017 plan year are as follows:

• For retirees over age 65 with Medicare, the Blue Cross Blue Shield (BCBS) Traditional planwill remain the lowest cost plan.

• For retirees in mixed Medicare and non-Medicare households, BCBS Transition will remainthe lowest cost plan.

• Blue Care Network (BCN) will again be the lowest cost plan for retirees under age 65 with-out Medicare.

As in the past, retirees under the age of 65 without Medicare also will have the option of se-lecting the Community Blue PPO. See this year’s rates on page 6 of the guide.

Optional Legal Coverage Offered by ARAGMSU is pleased to provide you with the opportunity to enroll in an optional, retiree-paid ARAG® legal plan during the October 1 – October 31, 2016, enrollment period for 2017.

For as low as $18.30 per month, this voluntary benefit offers you and your family added protection from many of today’s legal matters. When you choose to work with an ARAG network attorney, most covered legal matters are 100 percent paid-in-full. Some of the covered services include:

• Consumer Protection, such as warranty issues, telemarketing scams, auto purchase/repairand contractor problems

• Financial Protection for debt collection matters, Medicare/Medicaid, Social Security andveterans benefits

• Wills and Estate Planning, including durable/financial power of attorney, inheritance rights,health care power of attorney and living wills

You also have the option to choose UltimateAdvisor Plus™ plan ($22.50 per month), which includes additional benefits such as:

• Identity Theft Protection. From credit monitoring to lost wallet and identity restoration,your personal information and financial standing are protected.

• Caregiving Services. Work with an Eldercare Specialist who can help you assess eldercareneeds, answer your legal questions and much more.

• Coverage for Trusts. Protect the assets that you have worked hard for.

To enroll or learn more, you may call ARAG Customer Care at 800-247-4184, Monday through Friday, 8 a.m. to 8 p.m. Eastern Time.

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www.hr.msu.edu/openenrollment Retiree

Optional Vision Insurance through VSPRetirees and their benefits-eligible dependents may purchase optional,

retiree-paid vision coverage through VSP® Vision Care. VSP offers savings on your eye exam and eyewear, and discounts on laser vision correction.

Some highlights of the VSP plan include personalized care, a large variety of available eyecare, ease of use and a satisfaction guarantee. You may enroll at any time, and your coverage will become effective the first of the month following enrollment.

To enroll in this optional vision insurance, you enroll and work directly with VSP Vision Care. Monthly contributions are $8.35 for Member Only, $16.70 for Member + One, and $17.11 for Member + Family coverage.

You may enroll with VSP using either of these options:

• Complete the online enrollment form at vsp.com/go/msuretirees.

• Call 800-400-4569 to speak with VSP (Monday – Friday, 8 a.m. to 11p.m., Eastern Time or Saturday, 9 a.m. to 8 p.m., Eastern Time)

Current enrollees do not need to do anything to re-enroll. Enrollment isautomatic.

Facing a Difficult Medical Decision? Best Doctors Can Help!

If you are facing a serious diagnosis or recommendations for medical care like surgery, chemotherapy, radiation or any number of other complex treatment options, Best Doctors can help.

You can call the Best Doctors service at 866-904-0910 for help getting expert second opinions or help locating doctors and specialists. It is completely confidential and could provide you with vital information and options you might otherwise miss. There are no out-of-pocket costs to you related to using Best Doctors. However, please be aware that your medical providers may charge you for copying and forwarding your medical records to Best Doctors and you will be responsible for those charges.

In a survey of MSU users, over 90 percent of respondents gave the highest rating for the service’s overall ability to meet their needs and would recommend Best Doctors to their co-workers. The next time you and your family face a difficult medical decision, please consider giving Best Doctors a call.

About MSU NetIDs

If you do not have an MSU NetID,

please visit https://netid.msu.edu on the Web or call

MSU IT at 517-432-6200. You

also can accesshelpful information at https://tech.msu.

edu./support


http://vsp.com/go/msuretirees

https://netid.msu.edu

https://netid.msu.edu

https://tech.msu.edu./support

https://tech.msu.edu./support

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Retiree 2017 Benefits Open Enrollment

Glossary of TermsAllowed Amount Maximum amount on which payment is based for covered health care services. If your provider charges more than the allowed amount, you may have to pay the difference.

Balance Billing When a provider bills you for the difference between the provider’s charge and the allowed amount.

Co-insurance Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. You pay co-insurance plus any deductibles you owe.

Coordination of Benefits (COB) A provision to help avoid claims payment delays and duplication of benefits when a person is covered by two or more plans providing benefits or services for medical, dental or other care or treatment. One plan becomes the “primary” plan and the other becomes the “secondary” plan. This establishes an order in which the plans pay their benefits.

Co-payment (Co-pay) A fixed amount you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

Deductible A deductible is a set dollar amount that enrollees must pay out-of-pocket toward certain health care services before insurance starts to pay. Deductibles run on a calendar-year basis.

Durable Medical Equipment (DME) Equipment and supplies ordered by the health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.

In-network Refers to the use of health care professionals who participate in the health plan’s provider and hospital network.

Out-of-network Refers to the use of health care professionals who are not contracted with the health insurance plan.

Out-of-pocket maximums The highest amount a health plan member is required to pay for covered services outside of his/her benefits plan. Once the member reaches the out-of-pocket maximum(s), the plan pays 100% of expenses for covered services.

Prior Authorization A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called preauthorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

Premium The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

Referral Specific directions or instructions from a member’s PCP that direct a member to a participating health care professional for medically necessary care. A referral may be written or electronic.

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www.hr.msu.edu/openenrollmentwww.hr.msu.edu/openenrollment

Monthly Retiree Contributions for 2017*

Coverage Tier BCBSTraditional

BCBS Transition

Blue Care Network (BCN)

Community Blue PPO

Faculty Staff Faculty StaffNo Medicare (Part B)Retiree only (not on Medicare)2 Person (with no Medicare)Family (with no Medicare)

Not availableNot availableNot available


$0$0$0

$0$0$0

$231.28$485.65$566.55

$253.48$532.28$620.93

With Medicare (Part B)Retiree (with Medicare)2 Person (both with Medicare)Family (all with Medicare)

$0$0$0


$62.03$124.57$985.74

$62.03$124.57$985.74


Mixed - some with Medicare (Part B)2 Person Mixed (1 with Medicare)Family (1 with Medicare)Family (2 with Medicare)


$0$0$0

$193.55$452.77$717.53

$193.55$452.77$717.53


If allcovered

have Medicare(Part B)

If Mixed

Medicare(Part B)& non-

Medicare

If none have Medicare

Is available

to all

* Assumes full University contribution -prorated for part-time (see note below)

The chart below will help you determine which health plan options are available to you and the monthly rates that are associated with each plan. After determining which plans are available to you, the tables on the following pages can help you compare some basic information about the coverage offered by each plan.

The health plan summary provided on the following pages is not a contract. The information is intended to be an easy-to-read summary to help you compare the various MSU health plan offerings. The summary describes plan features in general terms and does not provide a full description of coverages or conditions of coverage. From time to time we may need to update the information in this guide to ensure the clearest and most accurate information is always available. If updates occur, updated versions will be maintained on the HR website at www.hr.msu.edu/openenrollment.

An Important Note About Health Plans Coverage Summary

Note: If you need additional information about part-time retiree contribution requirements or rates for health plan riders for sponsored dependents, email [email protected] or call 517-353-4434 (toll-free at 800-353-4434).

Retiree



mailto:SolutionsCenter%40hr.msu.edu?subject=Contribution%20Rates%20Inquiry

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Benefit BCBSTraditional Plan

BCBSTransition Plan

Blue Care Network In-Network

BCBSCommunity Blue

In-NetworkPREVENTIVE SERVICESHealth Maintenance Exam 1 per calendar year

Covered - 100% Covered - 100% Covered - 100% Covered - 100%

Annual Gynecological Exam1 per calendar year


Pap Smear Screening(lab services only)1 per calendar year


Contraceptive Devices (IUD, Diaphragm, Norplant)


Contraceptive Injections Covered - 100% Covered - 100% Covered - 100% Covered - 100%

Mammography Screening1 per calendar year


Well-Baby and Child Care Exams Covered - 100% Covered - 100% Covered - 100% Covered - 100%

Immunizations(as recommended by the Advisory Committee on Immunization Practices or mandated by the Affordable Care Act)


Flu Shots Covered - 100% Covered - 100% Covered - 100% Covered - 100%

Prostate Exam1 per calendar year(1)


Fecal Occult Blood Screening1 per calendar year


Colonoscopy1 per calendar year(1)


Flexible Sigmoidoscopy Exam1 per calendar year


Prostate Specific Antigen (PSA) Test1 per calendar year(1)


PHYSICIAN OFFICE SERVICES (Medically Necessary)Office Visits/Consultations Covered - 80% after

deductibleCovered - 80% after deductible Co-pay: $20 Co-pay: $20

Health Plans Coverage Summary


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Retireewww.hr.msu.edu/openenrollment


BCBSTransition Plan


BCBSCommunity Blue

In-NetworkEMERGENCY MEDICAL CAREHospital Emergency Room Co-pay: $250

(waived based on signs and symptoms, accident or if admitted)

Co-pay: $250 (waived based on signs and symptoms, accident or if admitted)



Emergency Room Physician’s Services

Covered - 100% Covered - 100% Covered - 100% Co-pay: $20 (when medical emergency criteria not met)

Urgent Care Center Covered - 80% after deductible

Covered - 80% after deductible Co-pay: $20 Co-pay: $20

Ambulance Service Covered - 80% after deductible

Covered - 80% after deductible Covered - 80% after deductible, ground and air

Covered - 100% of the approved amount Subject to faculty deductible

DIAGNOSTIC SERVICESLaboratory and Pathology Tests Covered - 100% Covered - 100% Covered - 100% Covered - 100%

Subject to faculty deductible

Diagnostic Tests and X-Rays

Covered - 100% Covered - 100% Covered - 100% after deductible

Prior authorization may be required

Covered - 100%


Radiation Therapy Covered - 100% Covered - 100% Covered - 100% after deductible

Covered - 100%Subject to faculty deductible

MATERNITY SERVICES PROVIDED BY A PHYSICIAN Pre-Natal and Post-Natal Care Pre-Natal Covered - 100%

Post-Natal Covered - 80% after deductible

Pre-Natal Covered - 100%Post-Natal Covered - 80% after deductible

Covered - 100% Covered - 100%

Delivery and Nursery Care Covered - 100% Covered - 100% Covered - 100% after deductible Prior authorization may be required

Covered - 100%


HOSPITAL CARE Semi-Private Room, General Nursing Care, Hospital Services and Supplies

Covered - 100% (unlimited days)




Covered - 100% after deductible (unlimited days)

Prior authorization required



Subject to faculty deductibleInpatient Consultation Covered - 100%


Covered - 100%Prior authorization may be required

Covered - 100% after deductible

Covered - 100%

Subject to faculty deductibleChemotherapy Covered - 100% Covered - 100% Covered - 100% after

deductibleCovered - 100%Subject to faculty deductible

Health Plans Coverage Summary (continued)

The Health Plans Coverage Summary provided in this document is not a contract. It is intended as an easy-to-read summary to help you compare the various MSU health plan offerings. It describes plan features in general terms and is not a full description of coverages.



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Retiree


BCBSTransition Plan


BCBSCommunity Blue

In-NetworkALTERNATIVES TO HOSPITAL CARESkilled Nursing Care (must meet medical criteria)

Covered - 100% in approved facilities (unlimited days)


Covered - 100% in approved facilities (unlimited days)


Covered - 100% after deductible (combined in-network and out-of-network benefits limited to 100 days per calendar year)


Covered - 100% in approved facilities(up to 120 days per calendar year)

Prior authorization may be requiredSubject to faculty deductible

Hospice Care Covered - 100% With approved providers

Covered - 100%With approved providers



Covered - 100% With approved providers

Home Health Care (medically necessary)



Covered - 100% after deductible (combined in-network and out-of-network benefits limited to 60 days per calendar year)

Covered - 100% With approved providers(unlimited visits)

Subject to faculty deductibleSURGICAL SERVICESSurgery and Related Surgical Services

Covered 100%Prior authorization may be required


Covered 100% after deductiblePrior authorization may be required


MENTAL HEALTH CARE AND SUBSTANCE ABUSE TREATMENT (In approved facilities)Inpatient Mental Health/ Substance Abuse Care

Covered - 100% Subject to Blue Cross reviewPrior authorization may be required

Covered - 100%Subject to Blue Cross review


Covered 100% after deductible


Covered 100%

Prior authorization may be requiredSubject to faculty deductible

Outpatient Mental Health Care Covered - 80% after deductible

Covered - 100% Covered 100%


Covered - 100%

Outpatient Substance Abuse Care


Covered - 100% Covered 100%


Covered - 100%

OTHER SERVICESAllergy Testing and Therapy (includes allergy injections)


Covered - 80% after deductible Covered 100%

Office visit co-pay may apply to consultations

Covered - 100%

Spinal and Osteopathic Manipulation

Covered - 80% after deductible, limited to a combined 38-visit maximum per member per calendar year

Covered - 80% after deductible, limited to a combined 38-visit maximum per member per calendar year

Co-pay: $20 (In-network only. Annual maximum of 24 visits)


Co-pay: $20(in-network and out-of-network services have an annual combined maximum of 24 visits)

Outpatient Diabetes Management Program(certified providers)

Covered - 100% Diabetic training

Covered - 100%Diabetic training



2017 Benefits Open Enrollment


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Retireewww.hr.msu.edu/openenrollment


BCBSTransition Plan


BCBSCommunity Blue

In-NetworkOutpatient Physical, Speech, and Occupational Therapy

Covered - 100% (60 visits);Subsequent visits covered 80% after deductible

Subject to Blue Cross review

Covered - 100% (unlimited days)Subject to Blue Cross review

Co-pay: $20 (in- and out-of-network services have an annual combined maximum of 60 visits)


Covered - 100%(in- and out-of-network services have an annual combined maximum of 60 visits)

Durable Medical Equipment (DME) and Medical Supplies (including breastfeeding equipment)


Covered - 80% after deductible Covered - 80%


Covered - 100%

Private Duty Nursing Covered - 80% after deductible

Covered - 50% after deductible Not covered Covered - 50%

Autism Spectrum Disorder (applied behavioral analysis (ABA) treatment – when rendered by an approved board-certified behavioral analyst – is limited through age 19) (2)



Co-pay: $20 per visit for applied behavioral analysis.

Co-pay: $20 per visit for outpatient physical, speech, and occupational therapy Prior authorization required


FOREIGN TRAVELHospital Services Covered - 100% Covered - 100% Only covered for emergency

servicesCovered - up to the group’s level of benefits, subject to applicable co-pays

Physician Services Basic services covered at 100%.

Covered - 100% Not covered Covered - up to the group’s level of benefits, subject to applicable co-pays

DEDUCTIBLES, CO-PAYS, AND DOLLAR MAXIMUMSDeductibles Basic coverage - none

$200 per member/$400 family per calendar year

Basic coverage - none

$200 per member/$400 family per calendar year

$100 per member/$200 per family per calendar year

None for support staff retirees

$100 per member/$200 per family per calendar year for pre-65 faculty and academic staff retirees

Fixed Dollar Co-pays As noted in chart As noted in chart As noted in chart As noted in chart

Percent Co-pays General services: none

20% as noted

General services: none

20% as noted, 50% on private duty nursing, except where otherwise indicated

As noted in chart As noted in chart

50% for private duty nursing

Out-of-Pocket Maximum

This amount includes deductible, coinsurance and co-pays, where applicable.

Basic coverage: none

$1,200 per member/$1,400 per family per calendar year

Basic coverage: none

$1,200 per member/$1,400 per family per calendar year

$3,000 per member/ $6,000 per family per calendar year for medical services only. (3)

$2,000 per member/ $4,000 per family per calendar year for out-of-network services (3)

Transplant Maximum No maximum No maximum No maximum No maximum

1. Age limits may apply.2. Diagnosis of an autism spectrum disorder and a treatment recommendation for ABA services must be obtained by an MSU-approved autism evaluation center (AAEC) prior to seeking ABA treatment. ABA and AAEC services are not available outside ofMichigan.3. Two separate limits apply to In-Network and Out-of-Network services.


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DENTAL SERVICE AETNA PREMIUM DMO DELTA DENTALDIAGNOSTIC AND PREVENTIVE

Exams No co-pay 50% co-payCleanings No co-pay 50% co-payX-rays No co-pay 50% co-payFluoride No co-pay (1 per year

under age 16)50% co-pay

Sealants (to prevent decay of permanent molars for dependents)

$10 co-pay per tooth Not covered

Space maintainers $80 co-pay (fixed and removable)

50% co-pay (less than age 19)

MINOR RESTORATIVEAmalgam (silver) fillings No co-pay 50% co-payComposite (resin) fillings (anterior teeth)

No co-pay 50% co-pay

PROSTHETICSCrowns (semi-precious) $315 co-pay 50% co-payBridges (per unit) $315 co-pay 50% co-payDenture (each) $320 co-pay 50% co-payPartial (each) $320 co-pay 50% co-pay

ORAL SURGERYSimple extraction No co-pay 50% co-payExtraction - erupted tooth No co-pay 50% co-payExtraction - soft tissue impaction $60 co-pay 50% co-payExtraction - partial bony impaction $80 co-pay 50% co-payExtraction - complete bony impaction $120 co-pay 50% co-pay

ENDODONTICSRoot canal - anterior $120 co-pay 50% co-payRoot canal - bicuspid $180 co-pay 50% co-payRoot canal - molar $300 co-pay 50% co-payApicoectomy $170 co-pay 50% co-pay

PERIODONTICSGingivectomy (per quadrant) $125 co-pay 50% co-payOsseous surgery (per quadrant) $375 co-pay 50% co-payRoot scaling (per quadrant) $60 co-pay 50% co-pay

ORTHODONTICSChild (under age 19) $1,500 co-pay * 50% co-pay

Adult (age 19 or older) $1,500 co-pay * Not covered

* includes screening exam, diagnostic records, orthodontictreatment and orthodontic retention.

DENTAL PLAN MAXIMUMSAnnual No maximum $600 maximumLifetime Orthodontics No maximum $600 maximum

The plan summary on this page is intended to help you compare your options. It is not intended to be a full description of coverages.

Dental Plan Summary of BenefitsDMO or Traditional?

In a Dental Maintenance Organization (DMO) like Aetna Premium DMO, enrollees select a participating primary care dentist. Their primary dental care is provided by that dentist and only at locations and by dentists that participate in the plan. Though choice of providers is more limited, a DMO tends to cover a greater range of services at lower co-

pays than traditional dental plans. If you plan to enroll in the Aetna DMO, please verify that the dentist you want to use accepts “Aetna DMO” rather than just “Aetna” to avoid rejected claims. You also can contact Aetna toll-free at 877-238-6200.

Traditional plans, like the Delta Dental plan, typically allow enrollees greater freedom in selecting service providers but tend to have higher co-pays and a more restricted range of coverage than DMO plans. Delta offers hundreds of participating providers and allows enrollees to seek care from both participating and non-participating providers. (If you select a non-

participating provider, the dentist will bill you the full amount, and you will be responsible for submitting a claim form to Delta Dental for reimbursement for covered services.) You can contact Delta Dental toll-free at 800-524-0149.

PLAN FULL-TIME(90% - 100%)

3/4 TIME (65%-89.9%)

1/2 TIME (50% - 64.9%)

Delta DentalSingle2 PersonFamily

Paid by MSUPaid by MSUPaid by MSU

Paid by MSUPaid by MSU

$16.25

Paid by MSU$6.68

$32.49Aetna DMOSingle2 PersonFamily

$3.15$6.23$10.68

$8.35 $16.02$26.93

$13.56$25.82$43.17

Retiree MonthlyDental Plan Contributions

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www.hr.msu.edu/openenrollmentwww.hr.msu.edu/openenrollment Retiree

MAC User?It is recommended

that MAC users access Benefits Open Enroll-ment in the EBS Portal using the Safari Web browser for Mac OS.

Users who need to add dependents to

their coverage can now contin to use Safari for Mac to complete the

Add a Family Member or Dependent Form online. Visit www.

hr.msu.edu/openenroll-ment for Benefits Fair and browser compat-

ibility information.

Prescription Coverage InformationThe prescription drug plan is still administered through CVS/Caremark.

Retirees continue to be automatically enrolled for prescription drug cover-age in CVS/Caremark when they enroll in one of the health plans (Community Blue PPO, Blue Care Network (BCN), BCBS Transition Plan and BCBS Tradi-tional Plan).

The table below shows co-pay rates for various types of prescription drugs effective January 1, 2017. Complete information detailing prescription drug cov-erage under CVS/Caremark is available in the Benefits section of the MSU HR website at www.hr.msu.edu. You also can call CVS/Caremark at 800-565-7105 or visit Caremark.com and become an engaged member by creating a profile.

CVS/Caremark Prescription Plan Co-Pays - 2017# Drug Tier 34-Day Supply

Co-Pays90-Day Supply

Co-Pays**1. Generic Medications $10 $202. Preferred Brand-Name Medications* $20 $403. Non-Preferred Brand-Name Medications $40 $804. Bio-Tech Drugs/Specialty Drugs*** $50 **90-day supplies of bio-tech/

specialty drugs are not offered*Some formulary medications may require a Prior Authorization.

**90-day supply medications (except for Bio-Tech/Specialty Drugs) may be filled at MSU Pharmacies or through CVS/Caremark mail order. 90-day supplies of Bio-Tech/Specialty Drugs are not allowed.

***Some specialty drugs will require step therapy. Step therapy is a type of prior authorization that begins medication for a medical condition with the most cost-effective drug therapy and progresses to other more costly or risky therapies only if necessary. Specialty injectable medications (medications for conditions such as Hepatitis B & C, RSV, Hemophilia, Immune Deficiency, and Osteo & Rheumatoid Arthritis) are only covered through CVS/Caremark Specialty Pharmacy. Please call 1-800-237-2767 for more information on this benefit.

A preferred brand-name medication is one that is listed on the plan’s formulatory or preferred list of prescription drugs.

A non-preferred brand-name medication is one not included on the plan’s formulary or list of preferred prescriptions. Non-preferred brand-name drugs have a higher coinsurance than preferred brand-name drugs. You pay more if you use non-preferred drugs than if you opt for generics and preferred brand-name drugs.

If Preferred Brand-Name Medications or Non-Preferred Brand-Name Medications are selected, you may have a pricing penalty. This means you will need to pay the difference in cost between the brand drug and generic drug.

Please note: Compound medications over $300 will require a Prior Authorization.





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13


If you are already enrolled in optional retiree-paid life insurance, you can cancel your coverage during Open Enrollment, but you cannot re-enroll, increase or decrease your cov-erage or add new dependents.

If you are not already enrolled, you cannot enroll.

As in the past, retirees will be billed for their life insurance premiums. You can estimate your rates using the below table. If you need help determining what your current coverage level is, contact MSU Human Resources at 517-353-4434 or toll-free at 800-353-4434.

Life Insurance Information

Optional Retiree-Paid Life Insurance Monthly RatesRETIREE RATES PER $1,000 OF

COVERAGE BY AGE

SPOUSE RATES PER $1,000 OF

COVERAGE BY AGE

RATES FOR CHILDREN PER $1,000 OF

COVERAGE45-49: $0.07750-54: $0.11855-59: $0.22060-64: $0.33865-69: $0.648

45-49: $0.12750-54: $0.19055-59: $0.35360-64: $0.54365-69: $1.050

$0.086 per $1,000 of coverage — age is not a factor in rates for children.

Notes:

1. Spouse rates are based on the age of the retiree, NOT the age of the spouse.

2. The benefit amount will decrease to 65% at age 65 and coverage will be discontinued atage 70.

3. For those that retired prior to July 1, 2008, there are no age-related reductions to yourbenefit amount, but coverage will be discontinued at age 70.

4. You may convert your policy to individual coverage within 31 days of turning 70. Formore information, call Prudential at 877-232-3555.

5. Coverage for the Child(ren) Retiree-Paid Life Insurance begins at live birth andcontinues to age 19 for children. If the child is unmarried, dependent on you and afull-time student, or meets the IRS dependent gross income test, coverage continues toage 23.

Children who become incapacitated before the age limit can continue coverage afterthe age limit if the following criteria are met:

• The child is mentally and physically incapable of earning a living

• Prudential has received proof of the incapacity within 31 days

If the child becomes incapacitated after the age limit then they will not be able to continue coverage.

Dependent Age Limits

Dependent children who turn age 23 by December 31 will automatically be removed from dental coverage at the end of the calendar year, and COBRA information will be issued.

Also at age 23, the dependent child is no longer eligible for child retiree-paid life insurance. It is the enrollee’s responsibility to cancel coverage in order to stop premium deductions.

Enrolled children who turn age 26 by December 31 will automatically be removed from health coverage at the end of the calendar year, and COBRA information will be issued.

14

www.hr.msu.edu/openenrollmentwww.hr.msu.edu/openenrollment

Summary of Health Plan Provisions for RetireesEffective January 1, 2017

Blue Cross Blue Shield of Michigan (BCBSM) TRADITIONAL Plan

This plan is only available to retirees when the retiree and all other family members are enrolled in Medicare (Part B).

The plan consists of Comprehensive Major Medical (CMM), which combines existing traditional catastrophic benefits with the added benefits of Major Medical. In addition, the providers submit claims on the members’ behalf. Members no longer have to file claims unless they decide to use a non-participating provider.

The CMM plan covers all preventive services at 100 percent. Most other services are covered at 80 percent after the required deductible.

Annual deductibles consist of $200 per member ($400 per family) per year. The annual out-of-pocket maximum, which consists of applicable deductible and coinsurance, is $1,200 per member ($1,400 per family) per year.

For questions about specific coverage details, please call Blue Cross Blue Shield at 877-354-2583.

Blue Cross Blue Shield of Michigan(BCBSM) TRANSITION Plan

This plan is only available to retirees when there is a mix of Medicare (Part B) and non Medicare enrolled family members on the plan or when there is a sponsored dependent rider with Medicare (Part B).

The plan consists of Comprehensive Major Medical (CMM), which combines existing traditional catastrophic benefits with the added benefits of Major Medical. In addition, the providers submit claims on the members’ behalf. Members no longer have to file claims unless they decide to use a non-participating provider.

The CMM plan covers all preventive services at 100 percent. Most other services are covered at 80 percent after the required deductible.

Annual deductibles consist of $200 per member ($400 per family) per year. The annual out-of-pocket maximum which consists of applicable deductible and coinsurance is $1,200 per member ($1,400 per family) per year.

For questions about specific coverage details, please call Blue Cross Blue Shield at 877-354-2583.

Retiree


15

Blue Care Network (BCN)This plan is available to retirees with and

without Medicare (Part B). This is a Health Maintenance Organization

(HMO) offering services through statewide primary care physicians and referral specialists practicing from their own community offices.

Reimbursement begins after a covered individual has met the calendar-year deductible of $100 ($200 per family) for retirees.

BCN is available to retirees in most counties in lower Michigan.

A complete listing of participating providers for each area is available at MSU Human Resources, or by phoning BCN’s Customer Service Department at 800-662-6667 or visiting www.bcbsm.com/find-a-doctor.

Community Blue — PPOCommunity Blue PPO will continue as

a health plan option for all retirees without Medicare (Part B).

This is a Preferred Provider Organization (PPO) and allows you to choose whether you receive health care services from a Blue Preferred PPO physician (in-network) or to choose any physician (out-of-network).

There is a nationwide network of participating PPO physicians and hospitals which allows you to choose any physician in the network without requiring a referral from a primary care physician.

Faculty, academic staff and executive management retirees will have to meet the calendar-year deductible of $100 ($200 per family) for retirees.

For questions about specific coverage details, please call Blue Cross Blue Shield at 877-354-2583. If you’re already enrolled, youcan log in as a member at www.bcbsm.com.

Spousal Coverage NoteTo be eligible to enroll in MSU health plan

coverage, spouses of MSU retirees who have access to coverage elsewhere must purchase single coverage through their own employer if his/her annual premium cost for that coverage is $850 or less.

Medicare Part D NoteMedicare Part D open enrollment for the

2017 plan year runs from Oct. 15, 2016 through Dec. 7, 2016. Medicare Part D plans offer outpatient prescription drug coverage that may be helpful to populations that lack other forms of prescription drug coverage with equal or better benefits. MSU has compared Medicare Part D coverage to the current CVS/Caremark Prescription Drug Plan offered by MSU and has determined that the MSU Caremark Plan offers more comprehensive coverage than Medicare Part D for most MSU people. For this reason MSU strongly urges you (and any of your dependents enrolled in the MSU CVS/Caremark Plan) NOT to enroll in the Medicare Part D plan for 2017.

Look for Legal NoticesPublications that include some important

legal notices regarding health care privacy and other laws, along with other health care reform-related information, will be sent to you in a separate mailing in October.

MSURA Annual Meeting — Save the Date!Don’t miss the MSU Retirees Associa-

tion annual meeting and awards luncheon on Monday, May 1, 2017. More information will be sent this winter by the MSURA or you can visit https://www.msu.edu/~msura/.


http://www.bcbsm.com/find-a-doctor

http://www.bcbsm.com

https://www.msu.edu/~msura/

Open Enrollment Steps

To enroll using the enclosed forms:

□ Complete the affidavit (yellow form) if you are covering aspouse or other eligible individual (OEI).

□ Fill out the enrollment change form only if you are makingany benefit changes.

□ Return the forms you are required to complete to MSUHuman Resources by October 31 in the enclosed returnenvelope. Don’t forget to put on a stamp!

To enroll on the web:To participate in Open Enrollment online, see the instructions on the Open Enrollment website, www.hr.msu.edu/openenrollment.

Questions?Contact MSU Human Resources at 517-353-4434, toll-free at 800-353-4434 or by email at [email protected].

www.hr.msu.edu

2012Open

EnrollmentGuide

MSU Human Resources1407 S. Harrison RoadNisbet Building, Suite 110East Lansing, MI 48823-5239

RetireeEdition


mailto:SolutionsCenter%40hr.msu.edu?subject=Retiree%20Open%20Enrollment%20Inquiry

http://www.hr.msu.edu

Human Resources Benefits Retiree Health Plan Affidavit for 2017 Benefits Year

(Page 1 of 2)

1. Is the person that was covered by your benefits between January 1, 2016 andDecember 31, 2016 still living? If you check no, please provide his or her name anddate of death:

Name____________________________ Date of Death ________________

2. Is the person that was covered by your benefits between January 1, 2016 andDecember 31, 2016 still your spouse? If you check no, please provide his or hername and the date you divorced your spouse:

Name____________________________ Date _______________________

3. Is your spouse eligible for single coverage from another employer at a premium costthat is $850 or less per year? If you check yes, please provide the name of his or heremployer and the name of the health plan of the other employer below. (*Seeimportant eligibility information on the back of this form.)

Name of other employer _________________________________________

Name of other health plan ________________________________________

PLEASE COMPLETE THIS AFFIDAVIT IF YOU COVERED A SPOUSE UNDER YOUR BENEFITS IN 2016 OR IF YOU ARE ADDING A SPOUSE UNDER YOUR BENEFITS IN 2017

Yes No

Yes No

Yes No

PLEASE RETURN THIS FORM BY OCTOBER 31, 2016 TO: MSU Human Resources1407 S. Harrison Road, Ste. 110 East Lansing, MI 48823-5287

Contact us at 1-800-353-4434, 517-353-4434 or [email protected],or visit us on the web at www.hr.msu.edu.

By signing this form I verify the eligibility or ineligibility of my current or former spouse for coverage under my ben-efits plan for the 2017 benefits year. I understand that this is a legal document and that the information I have provided is accurate. I also understand that I will be held responsible for the cost of any benefits paid for on behalf of my spouse if he or she receives benefits that he or she was not eligible to receive through my MSU health plan.

Retiree Name (Please Print Neatly) Retiree Signature

Last 4 Digits of Retiree Social Security Number (SSN) Date of Signature

YOUR SIGNATURE AND WHAT IT MEANS

WHY MSU NEEDS YOU TO COMPLETE AND SIGN THIS FORM EVERY YEAR

Often, people don’t notify us when circumstances in their lives change that impact their health benefits coverage. If your spouse dies or the relationship ends, MSU needs to know to take that person off your cov-erage. Likewise, if other coverage becomes available to him or her through another employer at a premium cost of less than $850 per year, we need to know about that too.

Health care coverage for employees, retirees and their dependents is one of the fastest growing segments of the Michigan State University budget. We want to be able to offer a good quality and scope of coverage to our employees and retirees and their eligible dependents. When we lose money by continuing to cover individuals who are no longer eligible, it decreases the resources we have to offer good benefits coverage for all the employees, retirees and their families who are genuinely eligible for coverage. Please help us use the resources MSU has available for benefits as effectively as possible by filling out and returning this form right away.

IMPORTANT ELIGIBILITY INFORMATION

*If you answered “NO” to question number 3 on the other side of this form, you may cover your eligiblespouse on your MSU health plan in 2017 since he/she is not eligible for health plan coverage through his orher employer at an annual premium cost of $850 or less.

If you answered “YES” to question number 3 on the other side of this form or if your spouse becomes eligi-ble for health plan coverage through his or her employer at an annual premium cost of $850 or less, he or she must enroll in the other employer’s health plan coverage in order to maintain coverage under an MSU health plan. The other employer’s health plan will be primary for your spouse.

(Page 2 of 2)

POTENTIAL CONSEQUENCES OF NOT RETURNING THIS AFFIDAVIT EVERY YEAR

MSU Human Resources uses this affidavit to determine if spouses that are currently covered under the MSU Retiree Benefits Plan are still eligible to be covered in the upcoming benefits year. We need to receive a com-pleted and signed affidavit prior to the end of Open Enrollment each year or we cannot determine benefits eligibility for the next plan year. Failure to return a completed affidavit by the deadline can result in cancella-tion or interruption of health plan benefits for spouses.

PLEASE RETURN THIS FORM BY OCTOBER 31, 2016 TO:

MSU Human Resources1407 S. Harrison Road, Ste. 110 East Lansing, MI 48823-5287

Contact us at 1-800-353-4434, 517-353-4434 or [email protected], or visit us on the web at www.hr.msu.edu.

2017 OPEN ENROLLMENT

Retiree Enrollment/Change Form - Side One

Complete this form to enroll, change, or delete benefits for you and/or your eligible spouse or dependent(s).

1. To add or delete a new dependent to or from your health and/or dental plan, completely fill out the dependentinformation below. When adding new dependents due to marriage, birth or adoption, provide a copy of themarriage certificate, birth certificate or adoption information and attach it to this Enrollment/Change Form.

2. Sign, date and return this form to MSU Human Resources no later than October 31, 2016.

Personal Information – Please print clearly

Name (Last, First, Middle Initial) Social Security Number Phone

Home Street Address City State Zip Code

Enrolled in any other health plan? Yes No

Enrolled in any other dental plan? Yes No

If your spouse is an MSU employee/retiree, indicate his/her full name:

Health Plan Employee Only Employee +

One Family Cancel Coverage

Blue Cross/Blue Shield Traditional/Caremark Cancel

Blue Cross/Blue Shield Transition1/Caremark N/A

Community Blue PPO/Caremark Effective Date

1/1/2017 Blue Care Network/Caremark

1The Blue Cross/Blue Shield Transition Plan is available when there is a mix of Medicare and non-Medicare enrolled family

members.

Dental Plan Employee Only Employee +

One Family Cancel Coverage

Aetna Dental

Delta Dental Effective Date

1/1/2017

Enrolling Eligible Dependents

To add a dependent to your plan, provide all the requested information for each dependent in the spacesprovided below.

If you wish to change information about an enrolled dependent, list that person’s correct information in thespaces provided below.

Dependent Name (Last, First, Middle Initial)

SSN Date of Birth (MM/DD/YY)

Gender (M/F)

Relationship

Enroll(ed) in MSU

coverage?

Enrolled in other

coverage?

Medicare A & B?

Full-time Student?

Health Dental Health Dental

Continued on the reverse side.

MSU is an affirmative-action, equal-opportunity employer.

Retiree Enrollment/Change Form – Side Two

Remove Dependents To remove an existing dependent from your plan, list the person(s) and provide COBRA information in the spaces provided below.

Dependent Name (Last, First, Middle Initial)

Social Security Number

Delete MSU Coverage?

Other Coverage?

For COBRA notification, provide the person’s address if he/she is not living with

the subscriber. Health Dental Health Dental

Employee-Paid Life2

For any questions or concerns about your Employee-Paid Life please contact

The Human Resources Office at 800-353-4434.

Effective Date:

1/1/2017

Cancel All Employee-Paid Life:

Cancel Spouse Coverage Only:

Cancel Child(ren) Coverage Only:

2If you wish to change your beneficiary for Employee-Paid Life, please obtain a Beneficiary Designation Form online at

https://www.hr.msu.edu/benefits/documents/BeneficiaryDesignation.pdf

Authorization – Please read, sign and date this section.

I am applying for and/or changing coverage as specified in the Group Agreements between MSU and my selected benefit plan(s). I understand that only those dependents listed on this form who meet the definition of “Dependent” or “Sponsored Dependent” will be covered by the benefits I have elected (refer to the plan brochure for the definition of “Dependent” and “Sponsored Dependent”).

I authorize my selected health plan to obtain, from providers of services and hospitals, the medical records relating to me and my enrolled spouse and/or dependent(s), which are necessary to the administration of my contract.

I have read and agree to the terms and conditions above and outlined in the plan brochures. I verify all above information is true, correct and complete.

If you have questions or need plan brochures describing your benefits, please contact MSU Human Resources at:

Mailing address: 1407 S Harrison Rd, Suite 110, East Lansing MI 48823-5287

Phone number: 517-353-4434 or 800-353-4434 Fax number: 517-353-1869

Email: [email protected] Website: www.hr.msu.edu

Signature Date

https://www.hr.msu.edu/benefits/documents/BeneficiaryDesignation.pdf

Documents

Retiree Guide - Michigan State University Human Resources · entrance for the Fair will be Gate C, ... For long-distance, call toll-free 800-353-4434. Retiree Guide ... Balance Billing