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Annual Open Enrollment

2011 Benefits Open Enrollment

Health Coverage
Instructions and Information for
Completing Your Personal Enrollment

These instructions will assist you in completing your Personal Enrollment for The University of Iowa Benefits Program.

Health Coverage

The University contributes towards the cost of health and dental insurance for permanent University faculty, professional and scientific staff, and supervisory exempt merit staff holding a 50% time or greater appointment.

Health Coverage. Description and comparison of plans.  Enrollment is optional. If you do not want coverage, select option number “90.” If you want medical coverage, you must select from the medical programs shown. Once the type of coverage is selected, enter that number on the line labeled “Option Code.”

Comparison sheet (pdf) and Usage Guide 

 

Changes and cost for 2011

There are no major changes to coverage or plan structure for 2011.

COSTS

Employee Only
Employee and Spouse
Employee and Children
Employee and Family
UIChoice
$447.00
$963.00
$798.00
$1116.00
UI contribution
$447.00
$771.00
$639.00
$893.00
Employee Cost
$0.00
$192.00
$159.00
$223.00
 
CHIP II
$ 593.00
$ 1326.00
$ 613.00
$ 1337.00
UI contribution
$593.00
$771.00
$613.00
$893.00
Employee Cost
$0.00
$555.00
$0.00
$444.00

 

 

UICHOICE

Health care under the UICHOICE PLAN may be obtained from any provider you wish.  This plan includes three benefit levels; the provider you choose automatically determines the plan benefit level within UICHOICE.

YOU DO NOT HAVE TO PICK A PLAN LEVEL – THE PROVIDER YOU CHOOSE AUTOMATICALLY DETERMINES AT WHICH LEVEL THAT PARTICULAR CLAIM IS PROCESSED AND HOW MUCH YOU PAY.

You can use any provider.  Plan levels 1 and 2 will result in lower out-of-pocket costs for you.  While you can use any provider you want, there are advantages to using providers who have contracts with Blue Cross and Blue Shield.

Co-payments, Coinsurance, and Deductibles

Office visits with level 1 providers have a $5.00 co-payment.  Level 2 providers have a $20 co-payment.  Level 3 providers have 40% coinsurance.

There is no physician charge or co-payment for a routine annual physical examination. There is a charge for Labs, tests, and imaging on all levels.

There is no co-payment or coinsurance for immunizations on any of the levels or well-child care (children up to seven years of age).

Insureds will pay 20% for durable medical equipment.

When an individual is admitted to a hospital, the individual will pay a deductible.  The deductible for Tier 1 is $400, the deductible for Tier 2 is $600, and the deductible for Tier 3 providers is $800.   After the first $400, $600, or $800 of the hospital charges are paid(depending on the provider tier), the individual will pay 10% of the charges for level 1 and 2 providers and 40% of the charges for level 3 providers, subject to the out-of-pocket maximum(OPM) limits. 

Out-of-Pocket Maximum (OPM) Expenses for Individuals and Families

The UIChoice Plan provides an annual maximum limit for the out-of-pocket expenses for both individuals and families.   When the amount paid in coinsurance & deductibles equals the applicable OPM, the plan pays 100% of the covered charges for most additional medically necessary expenses incurred during the remainder of the calendar year.

The OPM for the individual's expenses for levels 1 and 2 combined is $1,700. The OPM for all other contracts (family, employee & children, employee & spouse, etc.) is $3,400 for levels 1 and 2 combined.

The OPM for level 3 services is separate from the Level 1 and 2 OPM.  The OPM for level 3 services is $2,000 for individuals and $4,000 for all other contracts.

The OPM for prescription drugs is $1,100 for individuals (a single contract) and $2,200 for all other contracts.

The amount paid by an individual for co-payments, for the treatment or care of infertility, or due to contract limitations are not included in computing the annual out-of-pocket amount.

When a plan member in a contract other than “Individual” meets their OPM, the additional plan member/s continue to pay co-insurance & deductibles until the overall OPM for their contract is met.

Coverage for Prescription Drugs

This plan has a tiered prescription benefit. This means for each prescription you will pay coinsurance, which will vary depending on the tier (or category) of the drug.

The coinsurance amounts are:

The OPM expense provision for prescription drugs is separate from the medical OPM. The insured is responsible for paying coinsurance on prescriptions (as described above) up to $1,100 for individuals or $2,200 for family in prescription drug cost. Once the OPM has been met, the plan pays 100% of covered expenses incurred during the rest of the calendar year for drugs.

CHIP II

Care under the CHIP II program can be through any provider you choose.

While you can use any provider you want, there are advantages to using providers who have contracts with Blue Cross and Blue Shield.

Insureds pay a deductible and coinsurance on this plan.

Deductible

This coverage is subject to a Benefit Period Deductible (calendar year). This is the fixed amount you pay in a benefit period before benefits become available. This Benefit Period Deductible applies to all services except well child care (children up to seven years of age) and facility and practitioner services for a newborn's initial hospitalization.

The Benefit Period Deductible is $1,200 per person or $3,600 (maximum) per family.

The family deductible is reached from deductible amounts accumulated on behalf of any combination of members.

Coinsurance

This is the amount, using a fixed percentage, you pay each time you receive covered services, except for immunizations and/or physician charges for annual physicals.

After you meet the $1,200 deductible, 10% coinsurance applies.

For durable medical equipment, 20% coinsurance applies after the $1,200 deductible.

Out-of-Pocket Maximum (OPM) Expenses for Individuals

The CHIP II Plan provides an annual maximum limit for the OPM expense for both individuals and families.

The annual OPM is $4,200 per person and $8,400 for any other contract (total accumulated amounts paid on any combination of family members).

Once the OPM is reached the plan pays 100% of covered expenses incurred during the calendar year.

The amount paid by an individual for co-payments, for the treatment or care of infertility, or due to contract limitations are not included in computing the annual out-of-pocket amount.

When a plan member in a contract other than “Individual” meets their OPM, the additional plan member/s continue to pay co-insurance & deductibles until the overall OPM for their contract is met.

Coverage for Prescription Drugs

You have coverage for most prescription drugs and medicines. 

There is 10% coinsurance after the $1,200 deductible. 

Generic medication will be provided at no cost to the insured; you will be fully reimbursed for generic medication (0% coinsurance) and the plan deductible will not apply.

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Questions? Need Help?

If you have questions or concerns regarding the enrollment process, please contact:

University Benefits
120-40 USB

Email: benefits@uiowa.edu

Web Site: www.uiowa.edu/hr/benefits

Phone: 319-335-2676 or
877-830-4001 (toll free)

Fax: 319-335-2776