2019-2020 Benefits Spring Presentation – RETIREES Slide 1 - Welcome MUS Retiree Benefits FY2020 (July 1, 2019 – June 30, 2020) Mon ontan tana a Un Univ iver ersi sity ty Sys System tem 1 Retir etiree ee Ben enef efits its Plan Plan Good afternoon from the Office of the Commissioner of Higher Education. Thank you so much for joining us for our presentation of the Montana University system retiree benefits for fiscal year 2020. If you have questions during the presentation, please feel free to type them in. We do have staff available to answer the questions throughout the presentation, or we will also spend a little bit of time at the end answering your questions.
Slide 2 - Agenda Agend Agenda ❖ Impo Importan tant t Benefi fit t Inf Informa mati tion for r FY2020 1. Medical Benefits 2. Pharmacy Benefits 3. Dental Benefits 4. Vision Benefits Plan Rates tes for r FY2020 1. Medical 2. Dental 3. Vision ❖ Enrollme ment t Remin minders 2 Today's agenda will include discussion of your important benefit information for the upcoming fiscal year, including medical, pharmacy, dental and vision benefits. The premiums are plan rates for your medical, dental, and vision, and then of course a few important enrollment reminders.
Slide 3 – MUS Self-Funded Plan MUS is is a S a Self elf-Funded Funded Plan lan – Wha hat t does does this this mean? mean? ❖ All MUS benefit plans (medical, prescription drug, dental, and vision hardware) are self-insured (self-funded). ❖ Premium contributions go directly into a fund, which is used to pay the cost of benefits for Plan participants who experience illness or injury. 3 We always start off with a small discussion about what it means to be a self-funded plan. As you are all probably aware, the Montana University system is a self-funded health plan that includes medical, prescription drug, dental and vision hardware, and self-funding simply means that we all contribute our premiums into a fund which is used to pay the cost of benefits for plan participants who experience illness or injury. So anyone who has a claim, all of our premium contributions are pooled in order to pay those claims.
Slide 4 – Annual Enrollment Dates MUS Choices Annual Enrollment Dates for FY2020 April 22 – May 15, 2019 4 The annual enrollment dates for fiscal year 2020 began on April 22nd, and will end on May 15th of 2019.
Slide 5 – Eligibility Information Eli Eligibili gibility ty In Infor orma mation tion for or FY202 FY2020 ❑ Dependent children, up to age 26, may be enrolled in medical, dental, and/or vision hardware benefits during annual enrollment. (MUS has a closed enrollment for spouses) ❑ Proof of eligibility will be required for all new dependent children being added to the MUS Plan for a July 1, 2019 effective date. ❑ Mid- year enrollment or disenrollment may only occur with a “Qualifying Event” or during a “Special Enrollment Period” . 5 A few reminders about eligibility. During this annual enrollment period, you may add dependent children up to the age of 26 in medical, dental, or vision hardware benefits. Remember we do have closed enrollment for a spouse. Proof of eligibility will be required for all new dependent children who are added to the Montana University system plan with, the July 1, 2019 effective date. And then just a reminder that any mid-year enrollment or dis-enrollment may only occur with a qualifying event or during a special enrollment period.
Slide 6 – Medical Plan Options Me Medical dical Bene enefit fit Pl Plans ans for or FY FY2020 ** Choices WILL CONTINUE OFFERING THREE MEDICAL PLAN OPTIONS FOR FY2020 ➢ Allegiance ➢ BlueCross BlueShield ➢ PacificSource 6 For fiscal year 2020 the Montana University system continues to partner with three third party administrators for processing of claims. They include Allegiance, Blue Cross Blue Shield, and Pacific Source.
Slide 7 – Retiree Medical Benefits Choices Choices Retiree Medical edical Benefi Benefits ts for or FY2020 FY2020 BENEFIT DESCRIPTION IN-NETWORK BENEFITS PCP Office Visit $30 copay Specialty Office Visit $50 copay Coinsurance 30% Emergency Room Facility Visit $250 copay (room charge only) Urgent Care Visit $75 copay In-Network Deductible $1,250 (individual) / $2,500 (family) In-Network Out-of-Pocket (OOP) $4,350 (individual) / $8,700 (family) Maximum Eye Exam Benefit (routine or medical) $0 copay/1 per plan year (with an In-Network provider) ➢ No In-Network Medical Plan benefit changes for FY2020!!! ➢ Take the time to research and select the Medical Plan that best fits your needs. ➢ The plans provide the same medical benefits but have differences in monthly 7 premiums and provider networks. The medical benefits for the upcoming fiscal year, there are no plan changes for the in-network benefit. However, we do have a change to the out-of-network benefit, and that is only because last year when the plan design change was made, it was not made to the out-of-network benefit. It's just being lined up so that we are in alignment with the in- and out-of-network benefits. Please be sure that you take the time to do your research, and make a selection of medical plan that best fits the needs of yourself and your family. All three of the third party administrators are administering the same medical benefits, but there are differences in the monthly premiums and in the provider networks. One other quick reminder is that your eye exam benefit, regardless of whether it has a routine or a medical diagnosis, is processed on the medical benefit. There is a $0 copay for the first one each plan year with an in-network provider.
Slide 8 – Retiree Medical Benefits Continued Choices Choices Retiree Medica Medical l Benefi Benefits ts for or FY2020 FY2020 cont. Benefits thru 6/3 Be /30/1 /19 – Be Benefits as of 7/1 /1/1 /19 – BE BENEFIT NEFIT DE DESCR CRIP IPTION ION OUT OUT-OF OF-NET NETWORK ORK OUT-OF OUT OF-NET NETWORK ORK BE BENEFIT NEFITS BE BENEFIT NEFITS Out-of Ou of-Ne Network Ded Deductible $750 $750 (individual) / / $2,500 (individual) / $1,750 (fami $5,000 (fami mily) mily) Coins Coinsurance 35% 35% 40% 40% Out-of Ou of-Ne Network Ou Out-of of-Pocket $6,000 (individual) / / $6,000 (individual) / / (OOP (OOP) ) Max aximum mum $1 $12,000 2,000 (family) $1 $12,000 2,000 (family) ➢ Changes to Out-of-Network Medical Plan benefit accumulations for FY2020 ➢ Out-of-Network deductible/Out-of-Pocket maximums are separate from the In- Network deductible/Out-of-Pocket maximums and do not cross-accumulate. 8 This is just a breakdown of what the out-of-network benefits will look like as of July 1 of 2019. You will see the changes in the out-of-network deductible for both the individual and the family, and the coinsurance changes from 35% to 40%. The out of pocket maximums will remain the same. And then a final reminder here is that the out-of-network deductible and out of pocket maximums are separate from the in network deductible, and out of pocket maximum. They do not cross accumulate so they are completely separate, and then of course if you do utilize services from an out of network provider you may be balance billed the difference between the allowance and the charge in addition to the separate and the higher out-of-network deductible and coinsurance amount.
Slide 9 – Prescription Drug Plan Pres escription cription Dr Drug ug Plan lan for or FY2020 FY2020 ➢ Navitus Health Solutions will continue as the Pharmacy Benefit Manager for the MUS Plan. ➢ Lumicera Health Services will continue as the Specialty Pharmacy for the MUS Plan. ➢ CVS/Target and Western Drug pharmacies are not participating in the pharmacy network. If you choose to use these pharmacies, you will be responsible for all charges. ***This is not applicable to MedicareRx members. ➢ Prescriptions can be filled at a participating retail pharmacy for either a 34-day or 90-day supply. ➢ Mail Order prescriptions for a 90-day supply can be filled at Ridgeway, Costco, or miRx (only delivers to Montana, Idaho, Washington, Wyoming, S. Dakota, and N. Dakota). 9 The prescription drug plan for the new fiscal year is not changing. Navitus Health Solutions will continue as our pharmacy benefit manager, and Lumicera Health Services will continue as our specialty plan. There is a reminder that CVS, Target, and Western drug pharmacies are not participating in the pharmacy network and that is for those on the commercial plan only, which means pre-Medicare retirees. This is not applicable to Medicare retirees as Medicare does have an open network. You may fill your prescriptions at a participating retail pharmacy for either a 34 or a 90 day supply, and you can also fill your 90 day supplies via a mail order pharmacy, either Ridgeway, Costco or miRX, and of course miRX only delivers in Montana, Idaho, Washington, Wyoming, South Dakota, and North Dakota. If you're outside that limited delivery area and you'd like to utilize mail order, then you would want to contact Ridgeway or Costco.
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