Changes to benefits for 2017
As reported last fall, we have been reviewing health care plan offerings and options for 2017 and beyond, including seeking proposals from qualified vendors. I am pleased to announce, as a result of this effort, today the Board of Trustees awarded a multi-year contract to Anthem Inc. for medical plan administration services beginning January 1, 2017. Anthem provided The University with the most financially competitive proposal covering the broadest network access. Under Anthem, employees and their dependents will see little disruption to in-network providers and services, as the network provides a 99% match to our current network Apex Community Choice. More details will be sent out as Talent Development & Human Resources begins the implementation process with Anthem and prepares for open enrollment.
In the meantime, there are other important changes coming to our health plan for 2017 that I would like to make you aware of. We want to provide people with information early, before open enrollment even begins, so they have plenty of time prepare and consider their options. More detailed information will be provided prior to November’s open enrollment period.
Medical and Prescription Plan Design Changes
New medical insurance plans will be offered in 2017 through Anthem. Caremark will remain our pharmacy benefits manager. The plan names of Gold and Blue remain the same, but benefits will change slightly. The changes in plan design and contribution rates are being instituted in response to current health trends and compliance with the Affordable Care Act. You’ll find these plans still offer a high level of affordable coverage that adds to your overall compensation package.
In 2017, point of service costs such as co-pays, coinsurance, and deductibles will increase slightly for both the Gold and Blue plans. To provide better benefits to our employees, the medical and prescription out-of-pocket maximums will be combined into one out-of-pocket maximum. This change will provide better protection to our employees who may experience catastrophic health events during the year.
Please see the brief summary below. More details will be provided during Open Enrollment.
| 2016 | 2017 | 2016 | 2017 | ||
| Plan Type | Gold 90/70% | Gold 85/65% | Blue 80/60% | Blue 75/55% | |
| Employee Coinsurance | |||||
| In-Network | 10% | 15% | 20% | 25% | |
| Out-of-network | 30% | 35% | 40% | 45% | |
| Deductible | |||||
| In-Network (Single/Family) | $200/400 | $400/800 | $400/800 | $600/1,200 | |
| Out-of-Network (Single/Family) | $400/800 | $800/1,600 | $800/1,600 | $1,200/2,400 | |
| Medical/RX Out-Of-Pocket Max | Single Combined OOP | Single Combined OOP | |||
| In-Network (Single/Family) | $1,500/3,000 | $2,500/5,000 | $3,000/6,000 | $4,500/9,000 | |
| Out-of-Network (Single/Family) | $3,000/6,000 | $5,000/10,000 | $6,000/12,000 | $9,000/18,000 | |
| Employee Copays (In-Network) | |||||
| PCP/Outpatient BH & SA | $20 | $25 | $25 | $30 | |
| Specialist | $25 | $35 | $35 | $45 | |
| Urgent Care | $35 | $50 | $50 | $70 | |
| Emergency Room | $75 | $100 | $100 | $140 | |
| Prescription Drug | |||||
| Retail (30 day supply) | |||||
| Generic-Copay | $10 | $10 | $12 | $12 | |
| Formulary Coinsurance / Maximum | 20% up to $50 | 25% up to $70 | 25% up to $60 | 30% up to $85 | |
| Non-Formulary Coinsurance / Maximum | 25% up to $70 | 35% up to $85 | 35% up to $100 | 40% up to $125 | |
| Specialty Coinsurance / Maximum | 25% up to $125 | 30% up to $125 | 35% up to $150 | 35% up to $150 | |
| Mail Order (90 day supply) | |||||
| Generic-Copay | $25 | $25 | $30 | $30 | |
| Formulary Coinsurance / Maximum | 20% up to $125 | 25% up to $175 | 25% up to $150 | 30% up to $225 | |
| Non-Formulary Coinsurance / Maximum | 25% up to $175 | 35% up to $175 | 35% up to $250 | 40% up to $250 |
Employee Contribution Changes
Employee contributions to premiums for the medical and prescription drug plans will increase by 1%, per year, for the next four years. The current average employee contribution for the gold and blue plans are 15% and 5% respectively. In 2017, the average gold plan contribution will be 16%, while the blue plan contribution will be equal to the total cost of the blue plan minus the university contribution to the gold plan. The actual contribution structure will continue to be tiered based on 7 salary ranges.
The Dental plan will require a 15% employee contribution beginning January 1, 2017.
Eligibility Changes
Adult Children: In 2016, Ohio law changed regarding the coverage of dependents over the age of 26 to match ACA guidelines of a maximum age limit of 26 years old. Effective January 1, 2017, adult children over age 26 of UA employees will not be eligible for health insurance through the University. Those who are affected will receive COBRA information mailed to their homes. Those affected may also want to research additional options through the Marketplace at https://www.healthcare.gov/ .
Domestic Partners: In 2015, the Supreme Court declared same-sex marriages legal in all 50 states. Now that marriage is an option for same sex couples, the University will cease to cover same sex domestic partners as of the end of the year. For January 1, 2017, all currently covered domestic partners will be required to be married in order to enroll in University benefits. At that time you’ll be required to provide a copy of a marriage certificate and copy of the front page of your most recently filed federal tax return confirming this dependent as a spouse OR documentation dated within the last 6 months establishing current relationship status such as a joint bank/credit account, joint mortgage or lease, listing your name and your spouse’s name.
Details regarding the change to Anthem and other 2017 plan details will be sent out as we get closer to open enrollment.