Medical Insurance

The university’s self-funded medical plan is available to eligible employees. Claims are processed by a third-party administrator, Med-Pay Inc. The university pays over 90% of the employee’s monthly premium. In addition, a portion (up to $360 annually) can be waived with participation in the designated wellness activities, making this benefit even more valuable to you. Refer to the tables below for details.


Cost and coverage

Base Plan 

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium

Employee only

$470.45

$40.00

$0.00

$510.45

Employee + spouse

$711.84

$40.00

$340.00

$1091.84

Employee + child(ren)

$658.41

$40.00

$240.00

$938.41

Employee + family

$1084.79

$40.00

$395.00

$1519.79

*Monthly premium will be reduced up to $30 for employee who qualify by participating in the designated wellness activities.

Buy Up Plan

Coverage University pays for employees Employee pays for self* Employee pays for dependents Total premium

Employee only

$465.26

$76.00

$0.00

$541.26

Employee + spouse

$742.06

$76.00

$340.00

$1158.06

Employee + child(ren)

$679.10

$76.00

$240.00

$995.10

Employee + family

$1140.90

$76.00

$395.00

$1611.90

*Monthly premium will be reduced up to $30 for employee who qualify by participating in the designated wellness activities.

Services covered

 Refer to the summary plan document for complete covered services information.  Covered services include comprehensive medical and prescription services including Mental health.

Covered Preventive Services received at Magers Health and Wellness Center and/or In-Network Providers will be paid 100% by the plan.

Prescription coverage

  • Elixir is our Pharmacy Benefit Manager (PBM).
  • The Base Plan maximum out of pocket for prescriptions is $2000 individual/$4000 family. 
  • The Buy-Up plan maximum out of pocket for prescriptions will be $1500 individual/$3000 family.

Both base and buy-up plans participate in the following RX programs:

Generic Incentive Covered expenses are limited to the cost of a generic drug if an equivalent generic drug is available when a multi-source brand name drug is dispensed. In addition to the coinsurance, the covered person must pay the difference between the cost of the generic drug and the multi-source brand name drug.  This is a significant increase in the incentive to use generic drugs when available and has been necessary to reduce unnecessary pharmaceutical costs to the health plan.

Step Therapy - This program requires you to try a particular drug that is cheaper before you can move to a more expensive choice.  However, if you have already tried the cheaper drug without benefit, you will not have to try it again if you obtain documentation from your doctor.

Members may save an additional 10% when receiving prescriptions at Magers pharmacy. Members may also save by utilizing the mail order service as well.

 

Forms and publications

Forms

Publications

If you are hired after Sept. 1, you will initially be given the wellness premium discount until the next available opportunity to participate in the qualifying wellness activities.

Enrolling and making changes

You must enroll, and select dependent coverage options, within 30 days of your start date. **Premiums are paid ahead monthly. Your coverage will start the first of the month following date of hire. (example: coverage starts 7/1 premium is due from June payroll)

Once enrolled, changes may only be made yearly during Open enrollment, or within 30 days of a qualifying event. Qualifying events include loss or gain of coverage (add/drop of like coverage) Marriage (add newly eligible dependents), divorce (drop non qualifying dependents), birth/adoption (add new dependent).  For more information, contact human resources.

Declining Coverage

You have the option to decline the medical insurance coverage. If you decline the university’s medical coverage for yourself, you are also declining coverage for your family members. Declining the coverage does not result in a payment or increase in your salary in lieu of coverage.

Access Your Information

Through My Mercy, you have direct access to your medical records, including test results and immunizations. This resource also gives you a direct line to your physician’s office to schedule appointments, request medication refills or ask medical questions from Mercy providers.

Through Med-pay you will be able to view and reprint your explanation of benefits (EOBs), view your claim history, see detailed information related to your claims, view deductible and coinsurance accumulators, and contact Med-Pay Customer Service. There is also a claims summary CSV file download available. Additional features will be added over the coming months, including the ability to request and view your ID card.

How to File a Claim

If you’re enrolled in the university’s cafeteria plan, follow the instructions on this form to submit a medical claim or to submit a pharmacy claim form.

Policy

Contact information

Deidre A. Mings

Deidre A. Mings

Assistant Director, Human Resources - Benefits

Provides full range of HR Benefits management services. Specific responsibilities include health insurance, dental, vision, long term disability, life insurance, FSA, leave and FMLA benefits, and retirement.

Denise Lofton

Responsibilities: Benefits Administration; Wellness Fair; Workers’ Compensation; FMLA Administration; Emergency Paid Leave; Open Enrollment