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  • Open Enrollment Dates:May 2 - June 3, 2016

    2016-2017 EmplOyEE BEnEfits &Open enrOllMent InfOrMatIOn

    Please visit hr.usu.edu for more information

  • 2

    Enrollment schedulesEnroll Between

    May 2 - June 3, 2016Pages 6 - 16

    Medical & Dental Insurances

    Flexible Spending Accounts

    Supplemental Life Insurance

    Short-term Disability Insurance

    Supplemental Accidental Death & Dismemberment Insurance

    MetLaw Hyatt Legal Services

    EyeMed Supplemental Vision Insurance

    Enroll AnytimePages 17 - 22

    HealthSparq

    Supplemental Retirement Plans

    Employee Wellness at USU

    MetLife Home & Auto Insurance

    Retirement Healthcare Savings Plan

    Health Savings Account

    1

  • Dear Employee,Open Enrollment begins May 2, 2016 at 8:00 a.m. and ends June 3, 2016 at 5:00 p.m. (MDT). Open Enrollment is your opportunity to enroll or make changes to the following benefits:

    Medical and dental plans Short-term disability insurance Supplemental life insurance Flexible spending accounts Hyatt Legal Zurich AD&D EyeMed Supplemental Vision Insurance

    The Hartford will mail details to your home address relating to your current life and disability insurance coverage and provide instructions on how to make any necessary changes.

    REMEMBER if you wish to participate in ASI Flex Spending, you must re-enroll EVERY YEAR during open enrollment. This benefit does not automatically roll over into the new fiscal year.

    OpEn EnROllmEnt AnD BEnEfits OpEn HOUsEsThe Office of Human Resources is offering multiple Benefits Open Houses on May 23-26, 2016, from 9:00 a.m. - 4:00 p.m. in the Center Colony and West Colony rooms of the Taggart Student Center. USU Human Resources representatives and benefits vendors will be available to assist you and answer questions relating to benefits and open enrollment.

    The Office of Human Resources encourages you to carefully review this booklet describing the benefits available to you as an employee of Utah State University.

    To make an appointment to meet with a Human Resources representative during the Open Houses, please visit: conference.usu.edu/OpenHouse.

    32

  • COntEntsEvery year during open enrollment, USU employees have the opportunity to change medical and dental coverage options, add or change life insurance, add short-term disability insurance, and sign up for medical or dependent care flex spending. In addition to open enrollment information, this booklet provides information on other important employee benefits. Please keep this booklet as a reference.

    HealthSparq - A Tool to Compare Health Care CostsMetLife Home & Auto InsuranceEmployee Wellness at USU - Be WellNeed Help with Medicare?Retirement Savings Providers & Plans Where Can I Get More Information?

    171819202023

    Open Enrollment information

    Other Employee Benefits information

    Senior Editor Marla Boyer, Senior Associate Director

    Design & LayoutDanielle Hurst, Graphic Designer

    publication team

    Which Family Members Are Eligible for USU Benefits?New for FY 2016-2017Medical & Dental Insurance Premiums VRx USUs Pharmacy Benefit ManagerHeard of HDHP and HSA?Flexible Spending Account The Hartford - Life & Disability InsurancesZurich Supplemental Accidental Death & Dismemberment InsuranceMetLaw Hyatt Legal Services

    4591213141516

    16

    Photographs provided by:Derek Toone and USU Archives

    Open enrollment: May 2 - June 3, 20163

  • Open enrollment: May 2 - June 3, 2016 5

    Which family members Are Eligible for UsU Benefits?Eligible family members are: Spouse Domestic partner Children under age 26 Natural children Step children Legally adopted children Children for whom you have legal guardianship Foster children Children placed with you for adoption Children of your domestic partner who depend on you for support and live with you in a parent/child relationship Unmarried children to whom you are legally responsible to provide health coverage under the terms of a Qualified Medical Child Support Order Unmarried children over the age limit who depend on you for primary financial support and maintenance due to physical or mental disability

    Does your spouse or partner Work at UsU?If your spouse works at USU, you may elect Dual Coverage (see page 11 for details). Both employees will pay premiums for the same plan, one at family or couple rates, the other at single rate.

    Waiving medical CoverageIf you have medical coverage elsewhere, you may choose to waive coverage through USU by filling out the Medical Opt-out form. Please contact the Office of Human Resources at (435) 797-0122 to obtain this form.

    Open enrollment: May 2 - June 3, 2016 4

    HealthSparq - A Tool to Compare Health Care CostsMetLife Home & Auto InsuranceEmployee Wellness at USU - Be WellNeed Help with Medicare?Retirement Savings Providers & Plans Where Can I Get More Information?

  • Open enrollment: May 2 - June 3, 20165

    new for fy 2016-2017introducing Eyemed supplemental Vision Benefits plan EyeMed is a new supplemental vision plan for USU benefit eligible employees. EyeMed offers five of the top six most admired national retail chains as in-network options including: LensCrafters, Sears Optical, Target Optical, JCPenney Optical and most Pearle Vision locations. In addition, EyeMed offers more independent vision care providers than anyone. Above all else, EyeMed makes vision care easy. They have member tools that save time, save hassle and provide you with piece of mind. EyeMeds award-winning Customer Care Center is open day and night, 7 days a week. EyeMed vision plans start at $5.86 per month and are available through USU beginning July 1, 2016. For more information about EyeMed, please visit www.eyemed.com. An EyeMed representative will be available for questions during the USU Benefits Open Enrollment Open Houses scheduled for May 23-26, 2016, from 9:00 a.m. to 4:00 p.m. in the Center Colony and West Colony rooms of the Taggart Student Center. For more information about the USU Benefits Open Enrollment Open Houses, please visit hr.usu.edu.

  • Open enrollment: May 2 - June 3, 2016 6

    Steps for Medical and Dental Enrollment/Changes: 1. Between May 2 - June 3, 2016, go to ServiceNow.usu.edu and log in with your A number and password.

    2. Click on the Service Catalogs link and select the Human Resources tile.

    3. Click on Medical and Dental Enrollment.

    4. Select the appropriate form.

    5. Select your desired medical and dental insurance plans and coverage levels.

    6. Verify your family members. (This is a list of all your family members on Banner Access.) If someone needs to be updated or added click Update Family Members, this will direct you to Banner Access.

    Note: If adding a family member for the purpose of insurance you are required to attach proof of the relationship via ServiceNow. (e.g marriage certificate, birth certificate, or adoption document).

    7. Verify that all eligible dependents are to be added to the insurances. When selecting No, please include the details in the coverage comments box.

    8. Select yes to the agreement and click Submit Now.

  • 7

    2016-2017 plan Benefits

    Open enrollment: May 2 - June 3, 2016

    For a full explanation of all plan coverages, please consult the plan documents at hr.usu.edu and click on benefits, then Regence Summary Plan Description, or contact the Office of Human Resources at (435) 797-0122.

    *See page 13 for more information.

    OVERVIEW PLAN COMPARISONWELLNESS

    (White)70/30 Coverage

    HIGH PREMIUM(Blue)

    80/20 Coverage

    CHOICEHIGH DEDUCTIBLE

    80/20 Coverage

    BENEFITS PER PLAN YEAR YOU PAY YOU PAY YOU PAY

    Preventative Care Cost Preventative Care is not subject to deductibles!

    $0 $0 $0

    Deductible (Ded) Per Person Per Family

    $750$1,500

    $500$1,000

    $1,500 $3,000*

    Co-pays Doctor visits (regular office hours) Hospitalization

    $35 co-pay, after Ded$250 co-pay, after Ded

    $30 co-pay, after Ded$200 co-pay, after Ded

    20% after Ded20% after Ded

    Co-insurance Percentage 30% after Ded 20% after Ded 20% after Ded

    Maximum Out-of-Pocket Per Person Per Family

    $3,750$7,500

    $3,000$6,000

    $5,000$10,000

    Diagnostic X-ray and LabAfter Ded, you pay $0 up to $1,000. Thereafter you

    pay 30%

    After Ded, you pay $0 up to $1,000. Thereafter you

    pay 20%

    After Ded, you pay $0 up to $1,000. Thereafter

    you pay 20%

    Prescription Drugs Generic Formulary Non-Formulary

    $535%50%

    $535%50%

    20% after Ded

    Premiums See page 9 See page 10 See page 9

    Rx Co-insurance Maximum Per Person Per Family

    $1,500$3,000

    $1,250$2,500

    N/A

  • 8

    Hospital Preferred ValueCare (PVC)Participating

    (PAR)Alta View Hospital XAmerican Fork Hospital XAshley Regional Medical Center X XBear River Valley Hospital X XBeaver Valley Hospital X XBlue Mountain Hospital X XBrigham City Hospital X XCache Valley Hospital X XCastleview Hospital X XCentral Valley Medical Center X XDavis Hospital and Medical Center X XDelta Community Medical Center X XDixie Regional Medical Centers X XFillmore Hospital X XGarfield Memorial Hospital X XGunnison Valley Hospital X XHeber Valley Medical Center X XHuntsman Cancer Hospital X XIntermountain Medical Center XJordan Valley Medical Center West Jordan X XJordan Valley Medical Center West Valley X XKane County Hospital X XLakeview Hospital X XLDS Hospital XLogan Regional Hospital X XLone Peak Hospital Inc X XMcKay Dee Hospital XMilford Memorial Hospital X XMoab Regional Hospital X XMountain Point Medical Center X XMountain View Hospital X XMountain West Medical Center X XOgden Regional Medical Center X XOrem Community Hospital XPark City Medical Center X XPrimary Childrens Hospital X XRiverton Hospital XRiverton Childrens Unit X XSalt Lake Regional Medical Center X XSan Juan County Hospital X XSanpete Valley Hospital X XSevier Valley Medical Center X XSt. Marks Hospital X XThe Orthopedic Specialty Hospital (TOSH) Murray XTimpanogos Regional Hospital X XUintah Basin Medical Center X XUniversity Hospital X XUniversity of Utah Orthopedic Center X XUtah Valley Regional Medical Center XValley View Medical Center X X

    Participating Physicians (MD and OD) 5823 5904Other Professional Providers 5126 5194

    Hospitals 41 50

    REGENCE BLUECROSS BLUESHIELD OF UTAH HOSPITAL NETWORK COMPARISON

  • 10

    Employee monthly medical and Dental insurance premiums: 2016-2017

    CHOICE HIGH DEDUCTIBLE HEALTH PLAN (HDHP)

    NETWORK: Preferred ValueCare Network (PVC)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Family Coverage

    ALL SALARY RANGES $0 $0

    NETWORK: Participating Network (PAR)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Family Coverage

    ALL SALARY RANGES $27 $87

    WELLNESS PLAN (White Plan)

    NETWORK: Preferred ValueCare Network (PVC)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Two-Party Coverage Family Coverage

    $24,508 or less $13.67 $30.76 $44.44

    $24,509 - $37,295 $17.23 $38.76 $55.99

    $37,296 - $57,540 $21.70 $48.83 $70.53

    $57,541 or more $27.35 $61.53 $88.87

    NETWORK: Participating Network (PAR)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Two-Party Coverage Family Coverage

    $24,508 or less $37.67 $84.76 $122.44

    $24,509 - $37,295 $41.23 $92.76 $133.99

    $37,296 - $57,540 $45.70 $102.83 $148.53

    $57,541 or more $51.35 $115.53 $166.879

  • 10

    CHOICE HIGH DEDUCTIBLE HEALTH PLAN (HDHP)

    NETWORK: Preferred ValueCare Network (PVC)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Family Coverage

    ALL SALARY RANGES $0 $0

    NETWORK: Participating Network (PAR)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Family Coverage

    ALL SALARY RANGES $27 $87

    WELLNESS PLAN (White Plan)

    NETWORK: Preferred ValueCare Network (PVC)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Two-Party Coverage Family Coverage

    $24,508 or less $13.67 $30.76 $44.44

    $24,509 - $37,295 $17.23 $38.76 $55.99

    $37,296 - $57,540 $21.70 $48.83 $70.53

    $57,541 or more $27.35 $61.53 $88.87

    NETWORK: Participating Network (PAR)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Two-Party Coverage Family Coverage

    $24,508 or less $37.67 $84.76 $122.44

    $24,509 - $37,295 $41.23 $92.76 $133.99

    $37,296 - $57,540 $45.70 $102.83 $148.53

    $57,541 or more $51.35 $115.53 $166.87

    Employee monthly medical and Dental insurance premiums: 2016-2017 (continued)

    DENTAL COVERAGE LEVELS PREMIUMS

    Employee Only $10.42

    Employee Plus One Dependent $18.18

    Employee Plus Two+ Dependents $32.96

    DENTAL BENEFITS PLAN PAYS

    Dental Co-insurance Preventative & Basic paid at 80%, Major paid at 50%

    Dental Maximum $1,500 per claimant

    Ortho Lifetime Maximum $1,500 per claimant

    HIGH PREMIUM PLAN (Blue Plan)

    NETWORK: Preferred ValueCare Network (PVC)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Two-Party Coverage Family Coverage

    $24,508 or less $47.66 $107.24 $154.90

    $24,509 - $37,295 $60.05 $135.11 $195.16

    $37,296 - $57,540 $75.66 $170.23 $245.89

    $57,541 or more $95.32 $214.47 $309.80

    NETWORK: Participating Network (PAR)

    COVERAGE LEVELS

    Salary Ranges Single Coverage Two-Party Coverage Family Coverage

    $24,508 or less $74.66 $167.24 $241.90

    $24,509 - $37,295 $87.05 $195.11 $282.16

    $37,296 - $57,540 $102.66 $230.23 $332.89

    $57,541 or more $122.32 $274.47 $396.80

  • Open enrollment: May 2 - June 3, 201611

    DUAL OPTION PLANWELLNESS PLAN

    (White Plan)HIGH PREMIUM PLAN

    (Blue Plan)

    BENEFITS FOR PLAN YEAR YOU PAY YOU PAY

    Preventative Care CostDeductible (Ded) Per Employee Per Family

    $375$750

    $250$500

    Co-pays Doctor visits (regular office hours) $15 $15

    Prescription Drugs Generic Formulary Non-Formulary

    $2.50 15% 25%

    $2.50 15% 25%

    DENTAL BENEFITS PLAN PAYS PLAN PAYS

    Dental Co-insurance Preventative & Basic Paid at 100%; Major Paid at 80%Preventative & Basic Paid at

    100%; Major Paid at 80%

    Dental Maximum $2,000 per claimant $2,000 per claimant

    Ortho Co-insurance Paid at 80% Paid at 80%

    Ortho Lifetime Maximum $2,000 per claimant $2,000 per claimant

    Dual Employed Benefit plan (2016-2017)

  • Open enrollment: May 2 - June 3, 2016 12

    VRx UsUs pharmacy Benefit managerUSING YOUR ID CARD

    To use your prescription benefit the pharmacy must have the information on your ID card with the VRx logo. Be sure to show them the card the first time you fill a prescription (for each member of the family). Also, its a good idea to have the card available each time you fill a prescription. The RxBIN (610245) and RxPCN (05780000) provided on your ID card is required from the pharmacy in order for claims to process.

    USE A PARTICIPATING PHARMACY

    RETAIL PHARMACY

    The retail pharmacies you used last year are still available. Most retail pharmacies, including, Walgreens, Smiths, Target and Walmart are contracted to allow you to fill a 30-day supply and up to a 90-day supply of maintenance medications.

    MAIL ORDER PHARMACY

    VRx offers the convenience of home delivery through our partnership with WelldyneRx. You will be able to enroll online through the VRx website as soon as your coverage begins. You may also contact a VRx Benefit Advocate for additional details at (855) 586-2569.

    SPECIALTY PHARMACY

    VRx has contracted with specialty pharmacies to meet the needs of members using specialty medications. If you are u...

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