Smart benefits, smart choices

Benefit plans unchanged for 2015-16, premiums increase 3 percent

Rice’s annual open enrollment for health and welfare benefits will be held April 6 through April 24. Benefits-eligible employees will have the opportunity to go online via Esther (http://esther.rice.edu) to make selections and changes.

Plan options for the 2015-16 fiscal year, which begins July 1, will remain unchanged; however, plan premiums will increase by 3 percent. Rice will continue to pay between 64 and 84 percent of the cost of the premiums, depending on the plan.

“When the members enrolled on our health care plans make smart choices on how they use the plan, it helps with the overall cost, and Rice had a good year in terms of claims experience,” said Janel Edson, benefits manager. “Members are making smart choices in how they use the benefit plans — using generic prescriptions when possible, using mail order for maintenance medications, staying up-to-date on preventive exams, participating in the wellness program and using urgent care instead of the emergency room, when possible.”

Edson said such strategic decisions by faculty and staff and their dependents can help maintain the overall cost of Rice’s health plans because the primary cost is driven by the medical claims expenses by every employee and dependent who is covered by the university’s benefit plan.

“We are trying to encourage employees to make a smart benefit choice in terms of which plan works best for them and then make smart choices in terms of how they use their health care.”

Four medical plan options

The health insurance options for the 2015-16 plan year are the same choices as last year:

Memorial Hermann Accountable Care Organization (ACO)

The ACO is a limited network of doctors and hospitals, with a primary care physician, or PCP, guiding each patient’s care. The Memorial Hermann ACO is limited to the Memorial Hermann network of doctors and facilities, and care outside of the network is for emergency only.

Aetna HMO

This plan 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 Aetna PCP before receiving services from most Aetna specialist physicians or other service providers.

Aetna Choice POS II (Open Access)

The POS, or point of service, plan is built on the HMO model, which means patients under this plan pay only a nominal amount for network care. This plan, however, does not require a PCP or referrals to see specialists — that is, it is “open access.”

High-Deductible Health Plan (HDHP)

The HDHP has high deductibles — $1,750 for individuals and $5,250 for families for in-network care for the 2015-16 plan year. It also has coinsurance, rather than copayments; participants in this plan pay a percentage of the cost for physician services rather than a fixed amount for the service. The HDHP also allows participants to elect a health savings account, which is similar to a flexible medical savings account but does not have the “use it or lose it” provision and allows for more pretax contributions.

Emergency room and urgent care

Emergency room visits have a $175 copay for the ACO, HMO and POS II; for the HDHP, they are covered at 80 percent after the deductible is met. Urgent care visits have a $50 copay for ACO, HMO and POS II and are covered at 80 percent after the deductible for HDHP.

“Smart use of urgent care clinics in lieu of emergency rooms has saved Rice hundreds of thousands of dollars,” Edson said. “Continued smart use of the health plan saves us all money since our plan premiums are directly related to our plan spending.”

Prescription benefits, copays remain unchanged

The pharmacy benefit program and copays and coinsurance remain unchanged from last year. For a 30-day prescription from a retail pharmacy, the copays are $10 for generic drugs, $35 for formulary brands and $55 for nonformulary brands. Specialty prescriptions are 25 percent of the drug cost up to $125. The HDHP covers prescription drugs at these copay levels after participants have met the plan deductible.

“Employees can save money on prescription drugs by using the 90-day mail order option, which offers considerable savings for both you and the plan,” Edson said. “You receive a 90-day supply for the price of a 60-day supply: generic drugs are $20 copay, formulary brand are $70 and nonformulary are $110 copay.”

Dental coverage

Rice will continue to offer the same two dental plan options as last year, both administered by Aetna: the PPO and the DMO. The monthly premium for the PPO is increasing by 4.5 percent, but the DMO premium will remain unchanged.

In the PPO plan, participants may use any dentist of their choosing and the plan pays a percentage of the services. The monthly premium for an employee only will cost $42.76, up from $40.92 last year. The DMO, the plan that requires participants to select a dentist from a list of providers and covers frequently performed procedures either in full or the a specified copay, will remain unchanged: $13.28 per month for employee only, $24.18 for employee plus one and $33.86 for employee plus two or more.

As in previous years, employees earning less than $40,000 annualized salary may be eligible for a 50 percent premium subsidy.

Flexible spending accounts

Flexible spending accounts allow participants to set aside pretax dollars for qualifying medical and/or dependent care expenses. Claims for reimbursement must be submitted no later than Nov. 30 following the end of the plan year grace period (Sept. 15). The flexible spending accounts are “use-it or lose-it.” For this reason, accounts should be funded wisely. Careful planning is essential because the amount allocated cannot be changed during a plan year unless the employee has a qualifying event. Flexible spending accounts at Rice are administered by WageWorks (www.wageworks.com).

The IRS announced a slight increase in the amount an individual can contribute to their medical spending account:

• Medical spending account: $2,550, up $50 from last year.
• Dependent care account: $5,000.
• Health savings accounts (these are only available to participants in the HDHP):
• Individual: $3,350, a $50 increase from last year.
• Family: $6,650, a $100 increase.

People over age 55 can contribute an additional $1,000 per the “catch-up” provision.

As always, employees must re-enroll in the medical spending, dependent care and health savings accounts each year. Last year’s elections will not automatically carry over. The account is reset to zero each year unless employees actively re-enroll through Esther during open enrollment.

Enroll from anywhere

This year, Administrative Systems has formatted the open-enrollment application to be mobile-friendly so enrollment can be completed on a smartphone.

Admin. Systems also enhanced the application via Esther to include an audio option that will provide a description of the various plans and other hints about navigating the system.

RiceFest is April 7

RiceFest, 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 7 in Rice Memorial Center’s Grand Hall. Representatives from Aetna, Envision Rx, TIAA-CREF and Fidelity will be among those at the event.

All open-enrollment and detailed benefits information can be found online at http://benefits.rice.edu. A brief comparison of the four medical plans is available at http://tinyurl.com/p7lafv9.

Employees who miss the April 24 deadline for open enrollment will automatically be re-enrolled in their current plan; however, renewing contributions to a flexible spending or health savings account is not automatic. Employees must re-enroll each year to set their medical, dependent-care and health savings account contribution, even if they are currently enrolled in the plan.

“There are no deadline extensions and no exceptions, so don’t procrastinate,” Edson said.

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

The benefits team will be at RiceFest to answer questions about open enrollment. Employees can also contact benefits at benefits@rice.edu or 713-348-2363.