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Open Enrollment 2013
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  1. Open Enrollment 2013 Human Resources, Benefit Services

  2. Open Enrollment October 22 – November 2 Benefit changes effective: January 1, 2013 through December 31, 2013

  3. Open Enrollment Options Enroll or Make Changes Online: hr.osu.edu/oe • eBenefits—online self-service tool • Enroll in or change your medical, dental, vision plans • Add or drop dependents based on eligibility • Re-enroll in Flexible Spending Accounts • Update Group Term Life Insurance Beneficiaries • Elect or cancel short-term disability coverage • Elect or increase Dependent Group Life Insurance coverage • Elect or increase Voluntary Group Life Insurance for your dependent children • Medical, Dental, Vision – no changes? Your current elections will carry over Forms Available: (614) 292-1050 or (800) 678-6010

  4. Getting Started with Open Enrollment eBenefits To view, update, and change your Benefit election for Open Enrollment: • Go to hr.osu.edu/oe and click “Enroll Online” • You will be prompted to enter Ohio State Username and password (name.#) • For help, contact 614-688-HELP

  5. Who May be Eligible? • Legal spouse • Dependent Children up to age 26 • Adult Dependent Children 26 to 28 • Disabled dependent (over the age of 26) • Same-sex domestic partner* • Includes children of same-sex domestic partner • Sponsored dependent * • Includes opposite-sex domestic partner • Eligibility requirements, rates and affidavits are available online at hr.osu.edu *Affidavit required

  6. Statewide Network • Ohio PPO Connect will be the new statewide network (replacing MMO SuperMed PPO) for services outside Franklin County • No network change for Franklin County • Check the Medical Plan Provider Search link to see if your provider is in the Ohio PPO Connect network. • Provider search: osuhealthplan.com/Search • All members will receive new medical/prescription drug cards

  7. Changes at a Glance • Primary Care Physician (PCP) Office Visits: • $0 Out-of-Pocket for the office visit: family medicine, general internal medicine, geriatric medicine, general pediatrics and a PCP’s primary care nurse practitioner • Mental Health and Substance Abuse Parity: • Federal regulations require that member costs are aligned across all medical plans • Women’s Preventative Health: • Provides access to certain FDA approved contraceptives with no out-of-pocket cost

  8. Prime Care AdvantageNetwork Plan • PCP Office Visit : $0 out-of-pocket • Family medicine, general internal medicine, geriatric medicine, general pediatrics and a PCP’s primary care nurse practitioner • Other Practitioner Office Visits: $20 copay • Specialist Office Visit & Urgent Care: $35 copay • Emergency Room: $150 copay • Lab and X-Ray: 10% coinsurance, no deductible • Behavioral Health Office Visit: 10% coinsurance, no deductible • Deductible: $100 (does not apply to copays) • Other Services: Deductible and 10% coinsurance • Annual Out-of-Pocket: $2,000 per person/$4,000 family

  9. Prime Advantage PlusNetwork Coverage • Deductible: None for most services • PCP Office Visit : $0 out-of-pocket • Family medicine, general internal medicine, geriatric medicine, general pediatrics, a PCP’s primary care nurse practitioner and behavioral health services • Other Practitioner Office Visit: $20 copay • Specialist Office Visit & Urgent Care: $35 copay • Emergency Room: $150 copay • Outpatient Surgery: $300 copay • Inpatient Admission: $350 copay • Annual Out-of-Pocket : $2,000 per person/$4,000 family

  10. Prime Advantage PlusNon-Network Coverage • All services subject to deductible and coinsurance • Deductible: $500 individual/$1,500 family • Coinsurance: 30% (most services) • Annual Out-of-Pocket Maximum: $3,000 per person/$6,000 family

  11. Prime Advantage ValueNetwork Plan • PCP Office Visit: $0 out-of-pocket • Family medicine, general internal medicine, geriatric medicine, general pediatrics and a PCP’s primary care nurse practitioner • All other services subject to deductible and coinsurance • Deductible: $300 individual/$900 family • Coinsurance: 20% (most services) • Annual Out-of-Pocket: $3,000 per person/$6,000 family

  12. Independent Choice PlanNon-Network Plan • PCP Office Visit: $0 out-of-pocket • Family medicine, general internal medicine, geriatric medicine, general pediatrics and a PCP’s primary care nurse practitioner • All other services subject to deductible and coinsurance • Deductible: $600 individual/$1,800 family • Coinsurance: 20% (most services) • Annual Out-of-Pocket: $3,000 per person/$6,000 family

  13. Out-of-Area PlanNo Network Access • Available only when network is not accessible • Office Visit to Primary Care Physician: $0 copayment • Family medicine, general internal medicine, geriatric medicine, general pediatrics and a PCP’s primary care nurse practitioner • No deductible • Coinsurance: 20% (most services) • Emergency Room: $150 copayment • Annual Out-of-Pocket: $2,000 per person/$4,000 family

  14. Prime Care ConnectNetwork Plan • Premium contribution same as Prime Care Advantage but with out-of-pocket savings due to low dollar copays for most services • Eligibility criteria: • Employee (75%-100% FTE) eligible for the full-time medical contribution rate • At least one year of continuous Ohio State faculty or staff employment • Household income cannot exceed 175% of the federal poverty level

  15. Prime Care ConnectNetwork Plan • Deductible: None • PCP Office Visit: $0 out-of-pocket • Family medicine, general internal medicine, geriatric medicine, general pediatrics, a PCP’s primary care nurse practitioner and behavioral health services • Other Practitioners and Specialist Visits: $10 copay • Urgent Care: $10 copay • Emergency Room: $50 copay(waived if admitted) • Outpatient Procedures: $35 copay • Outpatient Surgery: $100 copay • Inpatient Hospitalization: $100 copay • Annual Out-of-Pocket: $1,000 per person

  16. Prescription Drug StructurePrime Care Connect Prescription Benefit Annual Out-of-Pocket is $1,250 per person

  17. Prime Care ConnectNetwork Plan • If you meet all the requirements and are interested in applying, contact OSU Health Plan at (614) 292-4700 or 1-800-678-6269 • An application and documentation will be required to confirm family income • Once the application has been reviewed, an approval or denial letter will be sent to your home address • To ensure medical plan coverage, be sure you enroll in one of Ohio State’s medical plans while waiting to hear if you have been approved for this plan Must re-apply annually

  18. Prescription Drug Plan • Annual out-of-pocket maximum increasing to $2,500 per person • Retail • Up to 30-day supply at a network pharmacy • Home Delivery • 90-day supply of maintenance medication • New prescription necessary Pricing Tool: https://member.express-scripts.com/preview/osu2013/

  19. Prescription Drug StructurePrime Care Advantage, Prime Advantage Value, Independent Choice, Out-of-Area Plan

  20. Prime Advantage Plus Prescription Drug Structure

  21. Dental Coverage (No benefit changes) Delta Dental of Ohio • Preventative Care • Oral exams and bitewing X-rays are covered at 100% (no deductible) • Maximum annual benefit remains at $1,200 per person • Orthodontia • $1,200 lifetime maximum • Limited to age 18 or younger

  22. Vision Coverage (No benefit changes) Vision Service Plan (VSP) • Eye Exam • Once per plan year • Frames • Once every other plan year up to $155 • Lenses* • Once per plan year • Contact Lenses* • Once per plan year up to $130 *Only one lens benefit per plan year

  23. Flexible Spending Accounts (FSA) • Lower gross pay = lower taxes • Two types of accounts • Health Care Account • Expenses not covered by insurance plans • Full listing of eligible and ineligible expenses: hr.osu.edu/benefits/healthflex.htm • Dependent Care Account (not to be used for your dependent’s health care expenses) • Care for dependent children under age 13 so employee can work or your adult dependents who are incapable of self-care Mustre-enroll each plan year!

  24. Flexible Spending Accounts (FSA) • Plan Year--to incur expenses • Jan. 1, 2013 through Feb. 28, 2014 • Reimbursement Requests • Must be submitted by March 31, 2014 • Minimum Contribution • $100 per plan year for Health Care FSA • $250 per plan year for Dependent Care FSA • Maximum Contribution • $2,500 per plan year for Health Care FSA • $5,000 per plan year for Dependent Care FSA • Health Care FSA and Dependent Care FSA funds maintained in separate accounts

  25. Flexible Spending Accounts (FSA) • Proof of expenses must be itemized and include the date of service • All reimbursements are paid directly to you • Contribution levels cannot be changed unless a qualifying event occurs • Unused funds are forfeited per IRS guidelines • Extended plan year to incur eligible expenses

  26. Short Term Disability • Special opportunity to elect Short Term Disability during Open Enrollment • STD benefit provides 60% of base salary up to a maximum of $5,000 a month, begins on 31st day of disability • Subject to pre-existing conditions clause • STD benefits are payable upon an approved claim even if you still have a sick leave balance • Elections made during Open Enrollment will be effective January 1, 2013

  27. Short Term Disability

  28. Life Insurance • Dependent Group Term Life Insurance (DGTLI) • You may enroll in or increase current DGTLI coverage • Purchase Life Insurance for your spouse, same-sex domestic partner and dependent children up to age 26

  29. Life Insurance • Voluntary Group Term Life Insurance (VGTLI) • You may enroll in or increase coverage for eligible dependent children up to age 26 • Maximum amount of coverage per eligible child is $10,000

  30. Next Generation Member Portal • Design • Simpler, cleaner, easy to navigate • Functionality • Login with university credentials • Integration with physician community • Set personalized goals • Have access to community forums • Participate in individual/group challenges • Set up your own challenges • Benefit from mobile device integration

  31. Questions • Visit our website at hr.osu.edu • Call Office of Human Resources Customer Service Center • (614) 292-1050 or 1-800-678-6010 • TDD (614) 688-3730 • Email: • service@hr.osu.edu