Make smart choices for benefit plans during open enrollment, April 10-28

Rice’s annual open enrollment for health and welfare benefits will be April 10-28. Benefits-eligible employees will have the opportunity to go online via Esther (http://esther.rice.edu) to make selections and changes.

The deadline to complete the benefits annual enrollment is 5 p.m. April 28. There are no extensions or grace periods. Employees who miss the April 28 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.

What’s new for fiscal year 2018?

Plan options for the 2017-18 fiscal year, which begins July 1, will remain unchanged. Plan premiums will increase by 4.3 percent for both Rice and for employees.

Among the benefit plans, the only change is to the POS II Plan, which will see an increase in the in-network deductibles. The in-network individual deductible will be $500, up from $250, and the in-network family deductible will be $1,000, up from $500. The non-network deductibles for both individual and family will remain unchanged.

Rice will have a new pharmacy benefit provider — Express Scripts — which will offer a larger network of pharmacies but still include all the major ones, including CVS, Walgreens, Kroger, HEB, Wal-Mart, Target and many more.

The prescription plan design will remain unchanged and there will be no change in copays.

“Express Scripts offers lots of new tools and resources for employees to manage their pharmacy benefit,” said Susan Prochazka, director of benefits in Human Resources. “There may be a little disruption associated with this move, such as a new formulary, new customer service phone number, new ID cards and a new address for mail order, but overall, we are looking forward to a positive change.”

Express Scripts is the second-largest pharmacy benefit manager (PBM) in the country and services over 75 million Americans.

“We are excited to have access to new programs and features that simply were not available with our previous PBM,” Prochazka said. “We are in the process of implementing this service, so there are still a lot of details to work out. We will be sharing more about this exciting change between now and July 1 (the beginning of the new benefit plan year).”

Something that has not changed, Prochazka noted, is the importance of plan participants continuing to make smart choices when they use their health plan. “It helps to save us all money. Remember that our plan premiums are directly related to our plan spending,” she said. “Plan participants can make smart choices by being aware of such things as the difference between an emergency room and urgent care. ER copayments are $175 whereas copayments for urgent care centers are $50. Money can also be saved on prescription drugs by using the mail-order pharmacy service and using generic alternatives to your brand-name drugs.”

Four medical plan options

The medical insurance options for the 2017-18 plan year are the same as last year’s:

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 II)

This is a plan that builds in an 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 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 for qualified medical, dental and vision expenses.

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 10.7 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 will be $54.61 for an employee only, $108.87 for an employee plus one and $159.33 for an employee plus two or more. 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 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 per year may be eligible for a 50 percent premium subsidy.

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 2017-18 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.

Rice Fest is April 11

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 11 in Rice Memorial Center’s Grand Hall. Representatives from Aetna, Express Scripts, TIAA-CREF and Fidelity will be there.

The benefits team also 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.