Open Enrollment

THE ANNUAL BENEFITS OPEN ENROLLMENT IS CURRENTLY CLOSED.

THE NEXT ANNUAL BENEFITS OPEN ENROLLMENT WILL TAKE PLACE MAY 7-28, 2015 FOR AN EFFECTIVE DATE OF JULY 1, 2015.

 

 

**THIS SITE IS UNDER CONSTRUCTION**

The information contained on these pages may not be accurate

 

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 2015-2016 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 2015-2016” section below (including the General Reminders), as there are some plan modifications that take effect on July 1, 2015.


All changes made during this Open Enrollment period will become effective on July 1, 2015* and will remain in effect through June 30, 2016. 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.

 

WHAT HAS CHANGED FOR 2015-2016?
 

   MEDICAL PLANS

 

Plan Renaming (Rebranding)

Effective July 1, 2015 the plans will be renamed:

Current Plan Name

New Rebranded Plan Name

HDHP

Consumer Core HDHP

In Net $20

Network Core $25

90/70

Network Choice 90/70

In Net $50

No change; plan has been frozen since July 1, 2013

100/70

No change; plan will be frozen as of July 1, 2015 (see below)


Although Pace will continue to maintain all five health plans, after July 1st only three will be available to new hires for initial enrollment and to current employees to elect during Open Enrollment (or following a qualified life event). Those enrolled in the In-Net $50 or 100/70 plans as of July 1, 2015 will continue to be enrolled. Current employees may enroll in the 100/70 plan, for the last time, during the current Open Enrollment period for an effective date of July 1, 2015. The three remaining plans each have distinct features, which will meet the different needs of our employees.

The three plans and their basic features:

Plan

Feature

Consumer Core HDHP

In-Network only plan that allows employees, willing to be active consumers, to directly benefit from utilizing lower cost health services.  The plan has a high deductible, offers the lowest per paycheck premium and allows the participant to enroll in a Health Savings Account (HSA).

Network Core $25

In-Network only plan that has no deductibles or coinsurance, only copayments (with the exception of non-generic prescriptions).  This plan allows employees to easily estimate their annual costs; best for employees who have recurring or known annual costs.

Network Choice 90/70

This plan provides both in- and out-of-network coverage with deductibles and coinsurance (on both the in-network and out-of-network sides) for employees who need or want the option of going outside the CIGNA network and are willing to pay a higher per paycheck premium for the flexibility to access more expensive out-of-network services.

 

 

No New Enrollments - 100/70 Plan (after July 1, 2015)

Effective July 1, 2015, employees will no longer be able to enroll in the 100/70 plan.  Those currently enrolled may continue to remain in the plan.  During this Open Enrollment period, if an employee is not currently enrolled in the 100/70 plan, he/she may elect to enroll for an effective date of July 1, 2015. However, following Open Enrollment, an employee who is not enrolled in the 100/70 plan will not be able to enroll in the plan at any subsequent date. The plan will only remain active for enrollees as of July 1, 2015.

Employees currently enrolled in the 100/70 plan are encouraged to consider the 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 90/70 Plan, 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:
 

                             Employee Only Coverage

Family Coverage

Expense Type

Network Choice 90/70 Plan

100/70 Plan

Network Choice 90/70 Plan

100/70 Plan

Annual Premium

$2,077

$4,375

$11,748

$18,241

Medical Deductible

$250

n/a

$500

n/a

Medical Copayments

$25 each

$15 or $20

$25 each

$15 or $20

Maximum Out of Pocket (Medical)

$1,200

$1,750

$2,400

$3,500

Total Minimum Cost

$2,077

$4,375

$11,748

$18,241

Total Maximum Cost

$3,277

$6,125

$14,148

$21,741

 

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

 

Increase in Copayments for All Plans and Pharmacy Deductible

A $5 increase in copayment for medical and prescription benefits, as well as an increased prescription annual deductible for all plans will go into effect on July 1, 2015 with some exceptions. Please refer to the table below for actual increases by plan and service type.

 

Current Copayments and Deductibles

Plan

Copayment

for PCP / Specialist

Urgent Care

Emergency Room

Prescription

Generic / Brand / Formulary

Prescription Deductible (waived for

Generic Use)

HDHP

No Impact. Plan does not have any copayments.

In Net $50**

$50 / $50

$50

$150

$15 / $35 / $75

$100 / $300

In Net $20

$20 / $20

$20

$75

$10 / $25 / $50

90/70

$20 / $20

100/70

$10 / $15

 

Copayments and Deductibles Effective July 1, 2015

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)

$55

$155

$20 / $40 / $80

$125 / $375

Network Core $25

$25 / $25

$25

$80

$15 / $30 / $55

Network Choice 90/70

$25 / $25

100/70

$15 / $20

 

 

Change to Network Choice 90/70 and 100/70 Plans Out-of -Network Benefit

Effective July 1, 2015, the out-of -network deductible for the Network Choice 90/700 and 100/70 plans will increase from:

$1,000 individual / $2,000 family

To:

$1,200 individual / $2,400 family

In addition, the out-of-network reimbursement, for both plans, will no longer be based on 80% of the Usual, Customary and Reasonable (UCR) rate.  UCR is the amount paid by insurance companies for a medical service in a geographic area based on what the healthcare providers in the geographic area usually charge for the same or similar medical service.  UCR rates are typically unpublished, propriety insurance company calculated values; as such, employees typically have no option of calculating their out of network health service costs until after the service has been provided.

Effective July 1, 2015, the 80% of UCR will be replaced with 300% of Medicare.  By switching to 300% of Medicare, employees will have the ability to estimate their out-of-pocket costs, before services are rendered, based on procedure codes (CPT) and will no longer rely on unknown insurance provider UCR rates.

 

Out-of-Pocket Maximum*:

Effective July 1, 2015, as a condition of the Affordable Care Act (ACA), all medical plans will be required to include an in-network out-of-pocket maximum for out-of-pocket medical and prescription costs.  All medical co-payments will count toward the medical out-of-pocket maximum and all prescription costs will count towards the prescription out-of-pocket maximum.  After the out-of-pocket maximum is satisfied, the plan pays 100% of remaining eligible charges for the rest of the plan year. The out-of-pocket maximum is not the same as a deductible.

There is no change to the In-Network Medical Out-of-Pocket Maximum. This is the first year for the In-Network Prescription Out-of-Pocket maximum.
 

Plan

In-Network Medical

Out- of-Pocket Maximum 

(Single / Family)

In-Network Prescription

Out- of-Pocket Maximum 

(Single / Family)

In Net $50**

$5,000 / $10,000

$1,600 / $3,200

Network Core $25

$2,000 / $4,000

$4,000 / $8,000

Network Choice 90/70

$1,200 / $2,400

$4,000 / $8,000

100/70

$1,750 / $3,500

$4,000 / $8,000

*Out of Pocket Maximum: The most you will pay for covered services during the plan year before the medical or prescription plan begins to pay at 100% of covered charges. The out-of-pocket maximum for medical does not include premiums, balance-billed charges, prescriptions and health care charges that the plan does not cover.  The out-of-pocket maximum for prescription coverage does not include any medical costs or charges that the plan does not cover.

The HDHP plan out-of-pocket maximums are listed in the next section with other HDHP plan changes.

**Plan only available to employees enrolled prior to July 1, 2013.
 

IRS Change in High Deductible Health Plan (HDHP) & Health Savings Accounts (HSA):

The IRS has updated the following limits, effective January 1st of each respective year:
 

Plan

Coverage Type

2015

2016

HSA Contribution Limit

Individual

$3,350

$3,350

 

Family

$6,650

$6,750

HDHP Deductible

Individual

$1,300

$1,300

 

Family*

$2,600

$2,600

HDHP Out of Pocket Maximum

Individual

$2,500

$2,500

 

Family*

$5,000

$5,000

Please note: Per the IRS, the HDHP/HSA option’s in-network deductible will increase effective July 1, 2015.

 

   DENTAL PLANS

 

 

   HEALTH CARE FLEXIBLE SPENDING ACCOUNT

2015-2016 Increased Health Care Flexible Spending Account Plan Year Maximum to $2,550

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 increased to $2,550 for the July 1, 2015 through June 30, 2016 plan year (it was $2,500 for the July 1, 2014 to June 30, 2015 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 Expenses Items.

 

 

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.
  

   PER PAYCHECK PREMIUMS

 

  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 CIGNA In-Net 50 or CIGNA In-Net 20 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).

 

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.