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Human Resources

Open Enrollment 2016

OPEN ENROLLMENT is closed for the
July 1, 2016 – June 30, 2017 plan year.

 


This is your annual opportunity to review your current benefit elections, make changes to your medical, dental and life insurance coverage, as well as enroll (or re-enroll) in a health care or dependent child care Flexible Spending Account (FSA) for the new plan year.

As was true last year, Open Enrollment for Plan Year 2016-2017 will be completed online via an Electronic Open Enrollment Form. The form allows you to login, enroll and change your benefits online – at work, home or from any computer with Internet access – anytime during the Open Enrollment period. Note: VPN access is NOT required.  

You will have to complete enrollment via the Electronic Open Enrollment Form if you wish to make changes to your benefit elections and/or if you wish to re-enroll in the health care or dependent child care Flexible Spending Accounts for the new plan year. Upon successful completion of the form, you will receive an e-mail confirmation.

PLEASE NOTE: If you have no changes to make and do not wish to participate in the Flexible Spending Accounts, it is not necessary to complete the Electronic Open Enrollment Form – your benefits will continue as they are. However, please review the “What Has Changed for 2016-2017” section below (including the General Reminders), as there are some plan modifications that take effect on July 1, 2016.

All changes made during this Open Enrollment period will become effective on July 1, 2016* and will remain in effect through June 30, 2017. You cannot change your benefit selections until the next Open Enrollment period, unless you experience a qualifying change in family status during the plan year.

*With the exception of voluntary life insurance changes for those currently on short-term disability, FMLA leave or unpaid personal leave. Such changes will become effective on the first of the month following the employee’s return to work.


Important!

You will need your Pace Portal username and password as well as all dependent data (Social Security Number, date of birth, etc.) in order to complete the Electronic Open Enrollment Form.

This is a SINGLE TRANSACTION system. **Once you make your elections and select FINALIZE, you will not be able to re-enter the system to make additional changes.**

If you exit the system without completing the process, your elections will be lost and you will have to begin again.


What Has Changed For 2016-2017?

DENTAL PLANS

No changes to the dental plan designs. 

Dental PPO Plan – we are pleased to announce that the PPO rate for 2016-2017 will remain unchanged.  The rate for the Dental DHMO Plan will increase by 3%.

Reminder: Deductibles and annual limits are calculated on a calendar year basis, even though our plan is year is July-June. Please plan accordingly.


MEDICAL PLANS

Increase in Copayments for All Plans and Pharmacy

A $5 increase in copayment for medical and prescription benefits for all plans will go into effect on July 1, 2016 with some exceptions. Please refer to the table below for actual increases by plan and service type. As a result of the increase in copayments, CIGNA participants (except for those enrolled in the Consumer Core HDHP plan) will receive new ID cards for the July 1, 2016 – June 30, 2017 plan year.

 

Current Copayments and Deductibles

Plan

Copayment

for PCP / Specialist

Urgent Care

Emergency Room

Prescription

Generic / Brand / Formulary

Prescription Deductible (waived for

Generic Use)

Consumer Core HDHP

No Impact. Plan does not have any copayments.

In Net $50*

$50 / $50

$55

$155

$20 / $40 / $80

$125 / $375

Network Core

$25 / $25

$25

$80

$15 / $30 / $55

Network Choice 90/70

$25 / $25

100/70**

$15 / $20

 

 

Copayments and Deductibles Effective July 1, 2016

Plan

Copayment

for PCP / Specialist

Urgent Care

Emergency Room

Prescription

Generic / Brand / Formulary

Prescription Deductible (waived for

Generic Use)

Consumer Core HDHP

No Impact. Plan does not have any copayments.

In Net $50*

$50 / $50

(no change)

$60

$160

$25 / $45 / $85

$125 / $375

Network Core

$30 / $30

$30

$85

$20 / $35 / $60

Network Choice 90/70

$30 / $30

100/70**

$20 / $25

 

* The In Net $50 Plan is closed to new enrollees (new hires and current employees). Only those enrolled in the plan at the time of closure are allowed to remain enrolled in the plan.

** The 100/70 Plan is closed to new enrollees (new hires and current employees). Only those enrolled in the plan at the time of closure are allowed to remain enrolled in the plan. In addition, employees currently enrolled in the 100/70 plan are encouraged to consider the Network Choice 90/70 as an alternative plan option. Both plans offer the same out-of-network benefit, so the difference in plans is the in-network benefit. The Network Choice 90/70, while having higher point-of-service costs, which include a deductible and coinsurance to the out-of -pocket maximum, has lower per paycheck premiums when compared to the 100/70 plan.

 

See the chart below:

 

In-Network Employee Only Coverage

In-Network Family Coverage

Expense Type

Network Choice 90/70 Plan

100/70 Plan

Network Choice 90/70 Plan

100/70 Plan

Annual Premium

$2,200

$4,633

$12,810

$19,891

Medical Deductible

$250

n/a

$500

n/a

Medical Copayments

$30 each

$20 or $25 each

$30 each

$20 or $25 each

Maximum Out of Pocket (Medical)

$1,200

$1,750

$2,400

$3,500

Total Minimum Cost

$2,200

$4,633

$12,810

$19,891

Total Maximum Cost

$3,400

$6,383

$15,210

$23,391

Note that the Total Maximum Cost under the 90/70 is less than the Total Minimum Cost of the 100/70.


IRS Change in Health Savings Accounts (HSA):  The IRS has updated the following limit, effective January 1st of each respective year:

Plan

Coverage Type

2015

2016

2017

HSA Contribution Limit

Individual

$3,350

$3,350

$3,400

Family

$6,650

$6,750

$6,750

Please note: The Family deductible and out-of-pocket maximums are cumulative. There is no individual limit for employee plus one or family coverage.


CIGNA Pharmacy

In an effort to keep pharmacy costs down, CIGNA is making some changes to the formulary effective July 1, 2016.  Please click here for details on this change. Those impacted by this change were notified in late 2015 to provide advance notice.  Please note that the document indicates a January 1, 2016 effective date however, Pace was able to delay the enactment of this change until July 1st.


HEALTH CARE FLEXIBLE SPENDING ACCOUNT

2016-2017 Health Care Flexible Spending Account Plan Year Maximum – No Change

Flexible Spending Accounts (FSAs) allow you to set aside pre-tax dollars on a per-paycheck basis to save for expenses not covered under your medical plan.

  • The annual limit has not changed (remains $2,550) for the July 1, 2016 through June 30, 2017 plan year.
  • You must enroll, during each Open Enrollment period, in order to participate for the new plan year.
     
  • Click here to access a list of Eligible Expense Items.

Reminder: Deductibles and annual limits are calculated on a calendar year basis, even though our plan is year is July-June. Please plan accordingly.


Per Paycheck Premiums

 


General Reminders:

Cigna’s Pre-Enrollment Hotline

If you are considering changing plans during Open Enrollment and have coverage-related questions, CIGNA’s pre-enrollment hotline number is 1-800-401-4041 (available 24/7 during the Open Enrollment period).


Mail Order Pharmacy Co-Payments – For Certain Maintenance Medications

One (1) copayment for a three (3) month supply of certain maintenance medications via CIGNA Home Delivery pharmacy. This benefit pertains to the maintenance medications on this list only.


CIGNA Lab Services

In most instances you should not experience any issues, as your physician automatically sends your lab work to the correct CIGNA-participating lab. However, if the in-network provider sends your lab work to a non-participating vendor, the claim will be processed at the out-of-network level or not covered at all (if you are enrolled in an in-network only plan). As such, we strongly recommend that you inform your provider of the participating labs whenever you utilize these services. The following provides some guidance on how to best handle these services.

What you need to do when lab work is needed:

  • Find network labs by going to mycigna.com or calling the number on your CIGNA ID card.
  • Tell your doctor you want to use a CIGNA network lab.
  • If your doctor takes a sample in the office, tell your doctor to send it to a CIGNA network lab.
  • Bring a print-out of participating labs to your appointment.
  • Make sure the lab is an in-network lab. Just because a lab accepts your CIGNA ID card, it doesn’t necessarily mean that the lab is contracted within the CIGNA Open Access Plus network.

If an in-network doctor does not send your lab work to a participating provider and your claim is processed at the out-of-network level (or not covered if you are in the In-Net $50 or Network Core Plan), you do have the right to appeal the decision. This can be done by contacting CIGNA’s customer service department at the number listed on your ID card.


Annual Deductibles, Out-Of-Pocket Maximums, Etc.

Annual deductibles, out-of-pocket maximums, etc. are based upon a calendar year.


High Deductible Health Plan (Hdhp) With Health Savings Account (Hsa) In-Network Coverage Only

The University continues to offer an innovative plan – a High Deductible Health Plan (HDHP) with a corresponding Health Savings Account (HSA). An HDHP with an HSA is an example of a consumer-driven health plan that is designed to empower you to take control of your health and the dollars you spend on your care.

With the HDHP, there is an annual deductible, which is not a feature in some of our other medical plans; however, that is only part of the cost you should consider when making your enrollment decision. Another cost to think about is the amount you pay for medical coverage through your payroll contributions. With the HDHP/HSA, the deduction from your paycheck is lower than other medical plan options. The lower premium gives you the perfect opportunity to start saving in an HSA account.

You have the freedom to see any in-network health care providers, including specialists, without a referral. This is especially important since instead of a copay, you will be paying the full cost of a doctor’s visit or service until you satisfy your deductible. Once you meet the annual deductible, you will pay 10% (coinsurance) or 20%, 30% or 40% for prescriptions (up to the plan out-of-pocket maximum - then you pay 0% and the plan pays 100%).

To encourage a healthy lifestyle and active management of your health, eligible preventive care services, such as routine physicals and well-woman exams, are covered at 100%. All other services (including prescription drugs) are subject to the deductible before the Plan pays a portion of the cost. Once you meet the deductible, you and the Plan share the costs of your care (coinsurance).

Here’s how the HDHP deductible works:

Let’s say Jill has a family of five and elects the HDHP/HSA Plan for herself only.  She has $1,400 in medical expenses for the year.  Since the individual deductible is $1,300, she would be responsible for that amount, with the remaining $100 being eligible for 90% coverage from Cigna. She is responsible for 10% coinsurance on the $100 amount over the deductible and any expenses incurred for the remainder of the year (until the Out-of-Pocket Maximum is satisfied).

Let’s say Jill has a family of five and elects the HDHP/HSA Plan for herself and her family. She has $1,400 in medical expenses, her husband has $1,000 and two of her children have a total of $200 in covered expenses. As a family, they have cumulatively incurred $2,600 in expenses.  Any expense incurred by any family member (including Jill) for the remainder of the year is eligible for 90% coverage from Cigna. Jill or any of her covered family members are responsible for 10% coinsurance on the amount over the $2,600 family deductible for the remainder of the year (until the Out-of-Pocket Maximum is satisfied).

Another example of the family deductible:

Let’s say Jill has a family of five and elects the HDHP/HSA Plan for herself and her family. She has $2,400 in medical expenses. Since she has not met the $2,600 family deductible, Jill is responsible for the full $2,400 expense.  Her husband later incurs an expense of $400.  The first $200 is paid by her husband toward the cumulate family deductible of $2,600 and the remaining $200 is covered by CIGNA at 90% (her husband pays 10% coinsurance).  Any expense incurred by any family member (including Jill) for the remainder of the year is eligible for 90% coverage from Cigna. Jill or any of her covered family members are responsible for 10% coinsurance the amount over the $2,600 family deductible for the remainder of the year (until the Out-of-Pocket Maximum is satisfied).

Here’s how the family Out-of-Pocket Maximum works:

Let’s say Jill has a family of five and elects the HDHP/HSA Plan for herself only. She incurs $13,300 in expenses. The first $1,300 is paid by Jill toward the deductible leaving a balance of $12,000. Jill then pays 10% of the remaining balance, not to exceed a total of $2,500, including the deductible amount of $1,300 already paid.  As such, after $13,300 of expenses, Jill has paid $1,300 towards the deductible and an additional $1,200 in coinsurance and thus has met the Out-of-Pocket Maximum of $2,500 for the calendar year. The plan will now pay 100% of covered charges for the remainder of the calendar year.

Let’s say Jill has a family of five and elects the HDHP/HSA Plan for herself and her family. She incurs $13,300 in expenses. The first $2,500 is paid by Jill toward the family (cumulative) deductible leaving a balance of $10,800. Jill then pays 10% of the remaining balance but not to exceed a total of $5,000 including the deductible amount of $2,500 already paid. As such, she will have to pay $1,080 (10% of the $10,800). Jill and her family’s year to date Out-of-Pocket amount is $3,580 ($2,500 deductible plus $1,080 coinsurance).  Her husband then incurs an expense of $2,200. Her husband will pay 10% coinsurance of $220 bringing Jill and her family’s year to date Out-of-Pocket amount to $3,800. ($2,500 deductible plus $1,300 coinsurance). Jill and all her family members will continue to pay the 10% coinsurance on the remaining $12,000 of expenses since they are response for the 10% coinsurance until they cumulatively reach the family Out-of-Pocket Maximum of $5,000. Once the $5,000 Out-of-Pocket Maximum is reached, the plan will pay 100% of eligible expenses.
 

Benefits to Consider During this Open Enrollment period:

Benefits to Consider Throughout the Plan Year (Can be Changed During the Year):

Need Help?

For assistance with your enrollment selections, please contact the University Benefits office, at 914-923-2828 (X22828), or via e-mail at openenrollment@pace.edu or at benefits@pace.edu.