Choose the right plan for you during open enrollment

Make benefit selections, changes online April 4-22

Rice’s annual open enrollment for health and welfare benefits will begin April 4. Some changes have been made to the plans Rice has been offering benefits-eligible employees since 2014, and employees are encouraged to reacquaint themselves with each plan to determine if their current choice is still a good fit.

“We want employees to really take a deep dive into the four plans that are being offered and select the best one for themselves and their family,” said Mary Cronin, associate vice president for human resources. “Just because an employee has had the same plan for many years doesn’t mean that it still works for them. There are new alternatives that may work better. It’s worth a look.”

Cronin added that because the primary cost of Rice’s health plans is driven by the medical claims expenses by every employee and dependent who is covered by the university’s benefit plan, making strategic decisions about benefits choices helps maintain the overall cost of the health plans.

Benefits-eligible employees must go online via Esther at http://esther.rice.edu by 11:59 p.m. April 22 to make selections and changes. Benefit selections and changes made during open enrollment will be effective July 1.

The benefits team will be available to answer questions and discuss plan options at Rice Fest, which will be from 11 a.m. to 3 p.m. April 5 in Rice Memorial Center’s Grand Hall. Employees can also contact the team at benefits@rice.edu or 713-348-2363.

All open-enrollment and detailed benefits information can be found online at http://openenrollment.rice.edu.

Health plan options

Rice will continue to offer four options for health plans through Aetna:

• Accountable Care Organization (ACO). This is a plan with a specific network of doctors and hospitals affiliated with Memorial Hermann, with a primary care physician, or PCP, guiding each patient’s care with assistance from a specified team of professionals dedicated to that patient’s overall care.
• Health Maintenance Organization (HMO). This is a traditional HMO where the employee selects a PCP who serves as a “gatekeeper” for all medical services. Under this plan, patients must consult with their PCP before receiving services from most specialist physicians and other service providers, who are all within the HMO network.
• Point-of-Service (POS). This is a plan that builds in and additional choice of physicians beyond the HMO network. Patients pay a set amount for in-network care; however, this plan does not require a patient to get a referral from a PCP before seeing a specialist and has an out-of-network option.
• Consumer-Driven Health Plan (CDHP). This plan was previously called “the high-deductible plan.” It has high deductibles and coinsurance rather than copayments for medical services. Participants pay the full cost for services and prescriptions up to the deductible and then the plan kicks in, paying coinsurance for medical services until the out-of-pocket maximum is met. This plan allows for the benefits of a health savings account because it is a qualifying high-deductible health plan. Employees can get the triple tax benefit of pre-tax deductions, tax-free growth and tax-free use of the savings if used for qualified medical, dental and vision expenses.

Medical plan premiums

For an employee only, the monthly premium for 2016-17 will be $79 for the ACO, $95 for the HMO, $120 for the CDHP and $162 for the POS.

Premiums for two of Rice’s plans are not increasing in 2016-17: the ACO Memorial Hermann will be unchanged and the CDHP decrease considerably. The POS premium will increase more than the HMO premium, reflecting participants’ use of the plan during the past fiscal year. In reviewing all plans, employees might find that their doctors are in-network in more than one plan and can choose the plan that best meets their needs based on premiums, deductibles and other distinguishing features.

Copayments

Copayments for the ACO, HMO and POS will increase by $5 for primary care and specialist office visits. For a primary care office visit, the copayments will be $25 for the ACO, $30 for the HMO and $35 for the POS.

The CDHP does not have copayments but instead has coinsurance for medical services; participants in this plan pay a percentage of the allowed amounts rather than a set dollar amount. For a primary care office visit, the coinsurance is 20 percent of the service charge after the deductible is met.

Under all four plans, all preventive services — such as annual physicals, mammograms, well-woman exams and well-child visits — are covered at 100 percent in-network.

Emergency room and urgent care

Emergency room visits will have a $200 copayment (up from $175) for the ACO, HMO and POS; for the CDHP, ER visits will be covered at 80 percent after the deductible is met. In-network urgent-care clinic visits will continue to be $50 for the ACO, HMO and POS.

Urgent-care clinics are a valuable option for when you need treatment but can’t get in to see your doctor. They are not meant for life-threatening emergencies, such as a heart attack or major trauma, but are designed to treat problems like a severe sore throat or a cut that requires stitches.

“Smart use of urgent-care clinics instead of an ER can save hundreds of dollars and keep plan costs down, as well as save time and travel,” Cronin said.

Employees can search the Aetna website, www.aetna.com, for in-network urgent-care clinics. This information can also be accessed via Aetna’s smartphone app, which can be downloaded at www.aetna.com/individuals-families/using-your-aetna-benefits/aetna-mobile.html.

Prescription benefits

For all plan options except the CDHP, copayments for 30-day retail prescriptions will be $10 for generic drugs, $40 for brand-name drugs and $60 for nonformulary drugs. For specialty drugs, plan participants will pay 25 percent of the cost of the prescription, up to $150. All prescription drugs on the CDHP are subject to deductible before the copayment begins.

Copays for 90-day prescriptions will be $25 for generic, $100 for brand-name and $150 for nonformulary drugs, and can be obtained at both retail outlets and through mail-order.

New this year is a “dispense as written” provision. If a plan participant has a prescription for a drug for which a generic equivalent is available but a brand-name drug is still requested, the participant will pay the difference between the generic price and the brand-name prescription’s face value as well as the brand-name copayment. For example, if a brand-name drug is $100 and a $20 generic drug is available, a plan participant who still requests the brand-name drug will pay the $40 copayment plus the $80 difference between the cost of the two drugs — or $120 in total.

Cost savings for maintenance medication

To save money for plan participants as well as the university, the 2016-17 plan year will require that prescriptions for maintenance medications be filled for a 90-day supply via retail or mail-order service. Maintenance medications are those filled each month and taken daily for such things as blood-pressure control, birth control, thyroid conditions and high cholesterol.

Prescriptions for the 90-day supplies, traditionally filled through Orchard Pharmacy, Rice’s mail-order service, can also be filled at local retail pharmacies, with the same copay savings. Plan participants can fill a prescription for a 30-day supply of a maintenance medication at a retail pharmacy two times, but thereafter they must use Rice’s mail-order service or retail 90-day program for the medication to be covered by insurance.

Dental plans

Rice will continue to offer the same two dental plan options as last year, both administered by Aetna: the PPO and the DMO.

Under the PPO plan, participants may use any dentist they choose; however, using an in-network dentist is generally less expensive. When a plan participant uses an out-of-network provider, they are subject to paying the amount in excess of the negotiated fees for the specific services. The PPO monthly premium for an employee only is $48.75.

The DMO plan requires participants to select a dentist from those on the DMO panel. The plan covers the most frequently performed procedures either in full or with a specified copayment. The DMO monthly premium for an employee only is $13.68.

Flexible medical spending and health savings accounts

Flexible medical spending accounts, or FSAs, allow participants to set aside pretax dollars to pay for eligible out-of-pocket medical and dependent-care expenses. FSAs are “use it or lose it” accounts; any money left in the account at the end of the plan year is forfeited. FSA elections made for the 2015-16 plan year must be used by Sept. 15 and filed for by Nov. 30 or the money will be forfeited. Medical FSAs can stand alone or accompany the ACO, HMO and POS plans only.

Health savings accounts (HSAs) are similar to the FSAs but are part of the CDHP plan only. The CDHP is a qualifying high-deductible health plan that allows the use of an HSA. HSAs do not have the “use it or lose it” provision. HSAs also allow for higher pretax contributions. The contribution limits have increased for the 2016-17 plan year to $3,350 for an individual and $6,650 for a family. A catch-up provision for those 55 and older allows for an additional $1,000 contribution.

Open enrollment ends April 22

Employees who miss the April 22 deadline for open enrollment will automatically be re-enrolled in their current plan; however, renewing contributions to a flexible spending or a health savings account is not automatic. Employees must re-enroll each year to set their medical, dependent-care and health savings account contributions.

Employees who are not making changes to their current medical plan do not have to do anything unless they want to contribute to a medical, dependent-care or health savings account.

Rice Fest is April 5

Rice Fest, the annual showcase of benefit providers during the open-enrollment period to educate staff and faculty about benefits, will be from 11 a.m. to 3 p.m. April 5 in Rice Memorial Center’s Grand Hall. Representatives from Aetna, Envision Rx, TIAA-CREF and Fidelity will be among those at the event.

The benefits team will be at Rice Fest to answer questions about open enrollment and plan options. Employees can also contact the team at benefits@rice.edu or 713-348-2363.