Open Enrollment

THE ANNUAL BENEFITS OPEN ENROLLMENT IS CLOSED FOR THIS 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 2014-2015 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 2014-2015” section below (including the General Reminders), as there are some plan modifications that take effect on July 1, 2014.


All changes made during this Open Enrollment period will become effective on July 1, 2014* and will remain in effect through June 30, 2015. 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 2014-2015?
 

  MEDICAL PLANS

Out-of-Pocket Maximum*: Effective July 1, 2014, as a condition of the Affordable Care Act (ACA), all medical plans will be required to include an in-network out-of-pocket maximum and all medical co-pays will count toward that 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.

 

Plan

New In-Network Out- of-Pocket Maximum  (Single / Family)

In Net $50**

$5,000 / $10,000

In Net $20

$2,000 / $4,000

90/70

$2,500 / $5,000

100/70

$1,750 / $3,500

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

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

 

Brand Cost on Pharmacy (does not apply to HDHP/HSA Plan):  Effective July 1, 2014, CIGNA mandates that employees pay the actual full cost of brand medications less the actual full cost of the equivalent generic plus the generic co-payment. 

Example:

  • Brand Medication Actual Cost: $150
     
  • Generic Actual Cost: $25
     
  • Generic Copayment: $10
     
  • Your Cost:$150 (Brand Cost) - $25 (Generic Cost) + $10 (Generic Copay) = $135.


This will not impact:

  • Brand prescriptions for which the healthcare provider has indicated “Dispense As Written”
  • Brand prescriptions where there is no generic alternative
  • Generic prescriptions


Note:  Pharmacies in New York and New Jersey are required to automatically dispense medication as generic, unless the prescribing healthcare provider checks the “Dispense As Written” box.

 

IRS Change in High Deductible Health Plan (HDHP) & Health Savings Accounts (HSA) Limits:  The IRS has updated the following limits, effective January 1st of each respective year:

Plan

Coverage Type

2013

2014

2015

HSA Contribution Limit

Individual

$3,250

$3,300

$3,350

 

Family

$6,450

$6,550

$6,650

HDHP Minimum Deductible

Individual

$1,250

$1,250

$1,300

 

Family

$2,500

$2,500

$2,600

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

 

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.


 

  2014-2015 HEALTH CARE FLEXIBLE SPENDING ACCOUNT

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.

  • Heath Care Reform reduced the maximum Health Care FSA annual contribution from $8,000 to $2,500 last year. The $2,500 annual limit continues for the July 1, 2014 through 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.

 

  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. You may also submit a Help Desk request at https://help.pace.edu.