2016 Open Enrollment Frequently Asked Questions

This section applies employees that utilize Akron General only

Q. How will the changes in provider network affect my medical benefits in 2016?

A. If you utilize Akron General facilities or physicians who are exclusively affiliated with Akron General, you will be paying for services on an-out of- network basis.  This means that you will pay for all services (including office visits) up to the out-of-network deductible before the plan will pay.  Once you have reached your out-of-network deductible, the services will be paid at the out-of-network coinsurance level, which means, the amount you pay will be higher than if you used an in-network provider. 

Out-of-network providers may choose to balance bill you for any portion over the allowed amount.  For example, an out-of-network provider charges $1,000 for a service and the allowed amount is $500, you may have to pay the $500 difference. 

To determine if your physician will continue to be in the network, you should search the Apex website. 

• Go to http://www.apex-healthsolutions.com/networks/ and select the SC Premier network.
• Enter the search criteria and click the continue button.
• Select the a specific network radio button.
• Choose the SC Premier (Self-Funded) network and click the search button.

Q. What will happen if I am currently being treated by a physician at Akron General?

A. UA employees and dependents in an active course of treatment may be able to continue accessing their current providers in an effort to avoid disruption in their treatment. Continued access will be allowed for a period of time up to 90 days during which time Apex Health Solutions will work with the employee or dependent to identify and transition to an in-network provider.

 If you believe this may apply to you or your dependent, you should call Apex Health Solutions at 1-800-753-8429 and request a Continuation of Care Evaluation.  Apex customer service will send the information to their Health Services Management (HSM) department to be reviewed.  The clinical designee and Medical Director will evaluate the facts of the case and make a determination for continued care as appropriate.  If approved, Apex Health Services Management will notify the member and the provider that the service has been approved and for number of visits and/or the period of time that the approval covers.   Apex HSM will enter an authorization for approved services to pay at the in- network benefit level.

Q. What facilities are affected?

A. The facilities associated with Akron General Health System that will be out-of-network January 1, 2016 are below

          Akron General Health System Major Locations ¹

           Out-of-Network effective January 1, 2016

¹ As listed on AGHS’ website plus Express Care & Urgent Care

² Limited services will be available via a direct contract between Apex and Edwin Shaw after the AGMC contract expires 12/31/15

Q. What physicians are affected?

A. Refer to the provider directory to determine if a physician is in the SC Premier network.  Please remember, services provided by an in-network physician at an out-of-network facility will be subject to out-of-network benefits for facility charges. 

This section applies to all benefit eligible employees

Q. When is Open Enrollment?

A. Open Enrollment will be November 16, 2015 – November 30, 2015.

Q. Where do I go to enroll for my benefits?
A.  1.Login to myAkron

     2.  Click the Faculty/Staff tab

     3. Click on Benefits Enrollment

Q. If I don’t want to make any changes, do I need to complete the online enrollment? *

A.   Completion is not required unless you

1.   Want a Flexible Spending Account (FSA for health and/or dependent care)
2.   Need to update your life insurance beneficiaries.  It’s good to validate each year that your records are up to date.

*Don’t forget, if you are covering a spouse or same-sex domestic partner, you are required to complete a Working Spouse – Primary Coverage Certification every year during open enrollment.

Q. How do I know who I can cover on my benefit plans for 2016?

A. The Eligibility Rules are listed online at http://www.uakron.edu/hr/benefits/general-plan-provisions-and-eligibility/

Q. When are the working spouse forms and eligibility documentation due?

A. Forms are due no later then November 30, 2015.

Q. When do my elections go into effect?

A. Any changes in employee contributions, plan selection, or enrollments are effective January 1, 2016.

Q. Will I receive new Apex medical ID cards for 2016?

A.  Yes, you will receive medical ID cards for 2016 even if you do not make any changes.

Q.  Will I receive new CVS Caremark prescription ID cards for 2016?

A.  You will only receive new prescription drug cards if you make changes to your enrollment.  Otherwise, you should continue to use the ID card you have.

Q. Does any money I have left in my FSA rollover to 2016?

A. The dollars do not roll forward, but the account remains active for the additional 2 ½ month period. You will forfeit any money remaining in your FSA for 2015 if you have not incurred claims by March 15^th and submitted for reimbursement by May 31, 2016.

Q. If I have more questions, who do I contact?

A.      You can contact anyone in the Benefits Administration at 330-972-7090, email us at UnivOfAkron_Benefits@uakron.edu or  stop by the Administrative Services Building between 8 a.m. and 4:30 p.m. so that someone can assist you.