Cooperative Extension (CES) Benefits Open Enrollment ... · *You are required to provide documentation proving dependent eligibility (e.g. marriage license, birth certificate) in

Office of Human Resources October 31, 2018 Little Rock, AR 72204 501-671-2219 www.uaex.edu

Cooperative Extension (CES) Benefits Open Enrollment

November 1-30, 2018 All changes must be received in Human Resources by November 30, 2018

All changes must be received by November 19, 2018 to receive any new ID cards by January 1, 2019 Changes are effective January 1, 2019

Throughout this letter you’ll be referred to our website, www.uaex.edu/OpenEnrollment, for information and open enrollment materials. If you do not have access to a computer, phone or smart device with an internet browser, contact our office for assistance, 501-671-2219. If you are enrolled in the UA UMR medical plan, you should have received two booklets from the University of Arkansas System (The Benefits Bulletin & the Benefits Decision Guide) which describe plan options and other voluntary benefits in detail. If you are not currently enrolled in the UA UMR medical plan, a copy of the booklets are enclosed. These booklets are also posted on our open enrollment website, www.uaex.edu/OpenEnrollment. You may also view these booklets on the new University of Arkansas System website effective November 1 at www.uasys.edu/benefits . A copy of this CES packet, the Benefits Bulletin and the Benefits Decision Guide will be available under the CES Open Enrollment website. This mailing includes all rate sheets that correspond to the benefit information provided in the CES packet, the Benefits Bulletin and the Benefits Decision Guide.

Not sure what benefits you have now? Included in this packet is a summary of your current 2018 plan year benefit elections. Any enrollments and changes you make during Open Enrollment will not be reflected in Banner until January 15, 2019. You can view your voluntary benefits enrollment at any time in Banner at http://uaex.edu/links. A complete list of your payroll deductions can be found on each pay stub, which can also be found in Banner. You can view your designated life insurance beneficiaries at any time in CEDAR. Go to the CEDAR Link and log in: http://cedar.uaex.edu and then click on HR: Your Personnel Records and then Display Matches by Name. Review form(s) Group Benefits Enrollment Form or Group Benefits Change Form for the most recently named beneficiary. Your retirement plan beneficiaries are maintained by your plan sponsor. If you are enrolled in the UA Retirement Plan, simply log into your TIAA and/or Fidelity account to update your beneficiary online, or call TIAA, www.tiaa.org 1-800-842-2776 / Fidelity, www.fidelity.com 1-800-343-0860. If you participate in the state retirement plan, APERS, beneficiary forms are available at www.apers.org or call 501-682-7800.

http://www.uaex.edu/

http://www.uaex.edu/OpenEnrollment


http://www.uasys.edu/benefits

http://uaex.edu/links

http://cedar.uaex.edu/

http://www.tiaa.org/

http://www.fidelity.com/

http://www.apers.org/

What changes can I make during Open Enrollment?

1. *Enroll in or cancel Medical, Dental, Vision 2. *Add or remove dependents on your Medical, Dental, Vision coverage 3. Change your medical plan between 3 options: Classic, the Health Savings Plan (includes a Health Savings Account or

“HSA” feature), or the Premier Plan 4. Change the status of Medical, Dental and Vision premiums between after-tax and pre-tax 5. **Enroll in Flexible Spending Accounts - Healthcare and/or Dependent Day Care 6. Enroll in Optional Long Term Disability 7. Enroll in Voluntary Benefits

*You are required to provide documentation proving dependent eligibility (e.g. marriage license, birth certificate) in order to add a spouse or child. **Flexible Spending Account enrollments are required each plan year in order to participate

How do I enroll or make changes?

Medical, Dental, Vision, Flexible Spending Account (FSA), Optional Long Term Disability: Use the appropriate enrollment Form(s). Go to www.uaex.edu/OpenEnrollment, click the Open Enrollment Forms tab and select the appropriate form. You must re-enroll in an FSA every year in which you wish to continue this benefit. The form(s) must be sent to the Human Resource office – by fax, email or in person. The fax number is 501-671-2251. All forms must be received by the deadline of 4:30 p.m. on Friday, November 30, 2018.

Life and Disability Insurance Coverage Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Documents and Rates tab and review materials

listed under the UA Life and Disability Plan section for details. These are group plans fully insured by Standard Insurance Company. To apply for additional life insurance, you must complete the appropriate Group Benefit Change form and the Standard Application via the online application.

Catastrophic Leave Bank Program Go to www.uaex.edu/OpenEnrollment, and click the Open Enrollment Forms tab and review materials listed under the Catastrophic Leave Bank Program section for details. Donations to the Catastrophic Leave Bank Program may be made throughout the year, upon resignation or upon retirement. A donation cannot be accepted if it would reduce the combined sick and annual leave balance of the donor to less than 80 hours. The minimum donation is one hour.

Check Your Dependents Only lawful spouses and children under age 26 can be covered. A child can be your biological child, a child for which

you have legal custody or have adopted (court document required), and stepchildren if you are married to the child’s parent.

You are required to provide documentation proving dependent eligibility (e.g. marriage license, birth certificate) in order to add a spouse or child.

You CANNOT cover ex-spouses, domestic partners, boyfriends or girlfriends, fiancé(e)s, grandchildren, nieces and nephews, parents, or anyone already covered under a UA insurance plan (can’t have double coverage).

If claims or University premiums are paid for an ineligible dependent, the employee will be liable for costs and be subject to disciplinary action, including termination of employment.




Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP)

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. See the CHIP Notice located at: http://www.uaex.edu/OpenEnrollment

Future Changes

The required UA Retirement Plan contribution will continue to increase by 1% each July until it reaches 5% in 2020. Currently the required contribution is 3%. It will increase to 4% in July 2019 (automatically, no action on your part needed). If that percent, combined with your additional voluntary percent contribution, is 10% or higher, you benefit from the 10% match.

The Cooperative Extension Service three tier salary structure will change to a four tier salary structure, the employer contribution (subsidy) will decrease and the employee premium rate will increase. The University’s Base Total Premium cost has not been determined for the July 1, 2019 – December, 31, 2019 plan period.

Be thoughtful in your open enrollment choices. After the November 30, 2018 deadline, you are locked into your choices for 2019 unless you experience a “qualifying event” such as marriage, divorce, birth, or change in spouse’s employment status.

Need Help? Have Questions? Your Human Resources office is just a short walk, phone call, or email away.

Your Benefits Team -Human Resources Phone: (501) 671-2219 Fax: (501) 671-2251

Email: [email protected] Web address: http://www.uaex.edu/OpenEnrollment

http://www.healthcare.gov/


mailto:[email protected]


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Federal

Benefits

Notice:

Federally

benefited

employees

electing to

participate

in a Dental

and/or

Flexible

Spending

Account

are

required to

do so

under the

UA System

Plans.

Federal Employees’ Health Benefits (FEHB) Program Open Season runs from November 12, 2018 through December

10, 2018.

During open season, you may enroll in, change, or cancel an existing enrollment in a health plan. Changes will be effective

January 1, 2019. Please note that the 2018 Federal Open Season information will be posted on the OPM website,

www.opm.gov/insure.

As a federally benefitted employee, should you elect to enroll in the flexible spending account, dental or vision

insurance plan(s), you are required to enroll in the University of Arkansas Plans. Details for these programs are

included within this packet.

To change your enrollment, download and complete SF 2809 (link located below) and return it to Human Resources by fax

1-501-671-2251, email, mail, or in person no later than December 10, 2018. Be sure to make copies of any enrollment

forms before sending them to Human Resources. Human Resources will return a date-stamped copy of all completed

enrollment change forms received.

As a result of the Affordable Care Act, FEHB plans have been providing a summary document on their websites which

details information about health plan benefits and coverage. The Summary of Benefits and Coverage (SBC) document

includes information on the following and will continue to have a disclaimer indicating that the plan brochure remains the

official statement of benefits:

Cost – deductibles, copayments, coinsurance, and out-of-pocket limits

Coverage – covered services, examples of covered services, and excluded services

Rights – rights to continue coverage as well as grievance and appeal rights

A statement that coverage under the plan qualifies as “minimum essential coverage”

A statement that the health coverage of the plan meets the minimum value standard for the benefits the plan

provides

Copies of all FEHB plan brochures can be viewed at www.opm.gov/FEHBbrochures. You are encouraged to visit the OPM

website for FEHB notifications and rate sheets. Your FEHB health plan will contact you to offer the option of obtaining

your 2019 benefit brochure online or obtaining a paper copy of the benefit brochure. If you did not previously request a

paper copy of your health plan brochure, you will not automatically receive one.

Insurance Fast Facts

Federal Healthcare Plan Comparison

2019 Federal Health Benefits (FEHB) Premium Rates

Federal Health Benefits Election Form SF 2809 – enroll/change/cancel FEHB coverage

FEHB 2019 Rates

Employer Employee Total

*New Health Plan Options for 2019 Plan Semi-Monthly 2019 Semi-Monthly

2019 Semi-Monthly

Rates reflect 24 month pay cycle Code

s Contribution Amount Premium Amount Amount

BCBS Standard Self 104 $249.36 $121.59 $370.95

BCBS Standard Family 105 $569.10 $290.57 $859.66

BCBS Standard Self Plus One 106 $533.30 $277.92 $811.21

BCBS Basic Self 111 $239.61 $79.87 $319.48

BCBS Basic Family 112 $569.10 $192.01 $761.11

BCBS Basic Self Plus One 113 $533.30 $184.78 $718.08

GEHA High Family 312 $569.10 $339.03 $908.13

GEHA High Self Plus One 313 $533.30 $267.87 $801.16

MHBP - Standard Self 454 $216.40 $72.08 $288.48

MHBP - Standard Family 455 $502.52 $167.51 $670.02

MHBP - Standard Self Plus One 456 $497.73 $165.91 $663.64

*BCBS Blue Focus Self (New) 131 $172.72 $57.58 $230.30

*BCBS Blue Focus Self & Family (New) 132 $408.45 $136.15 $544.59

*BCBS Blue Focus Self Plus One (New) 133 $371.33 $123.78 $495.11

Rates listed on OPM site are biweekly and not semimonthly.

http://www.opm.gov/insure

http://www.opm.gov/FEHBbrochures

http://www.opm.gov/healthcare-insurance/fastfacts

http://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/

http://www.opm.gov/healthcare-insurance/healthcare/plan-information/premiums/

http://www.opm.gov/forms/pdf_fill/sf2809.pdf

Effective: January 1, 2019

UNIVERSITY OF ARKANSAS Medical Plans Comparison

UMR

This is not a legal document. Complete benefits descriptions and exclusions are contained in the Summary Plan Description which is available through your campus HR Office.

CLASSIC PREMIER HEALTH

SAVINGS PLAN

INDIVIDUAL MEDICAL DEDUCTIBLE (a) $1,250 $650 $2,700

FAMILY MEDICAL DEDUCTIBLE (a) $2,500 $1,300 $5,400

COINSURANCE (b) 25% 20% 10%

MEDICAL OUT OF POCKET MAXIMUM Individual (c) $4,000+Deductible = $5,250 $2,350+Deductible = $3,000 $6,650 Family (c)

$8,000+Deductible=$10,500

$1,400/$2,800 wellness OOP credit

$4,700+Deductible=$6,000

$500/$1,000 wellness OOP credit

$13,300

PREVENTIVE CARE SERVICES (l) Well Baby/Child Visit (f) Immunizations Mammograms(first yearly mammogram) Colorectal Cancer Screening Nutritional Counseling* Physical Exams PCP or OB/GYN Specialist

Paid in Full Paid in Full Paid in Full Paid in Full Paid in Full

Paid in Full Paid in Full





PHYSICIAN SERVICES IN OFFICE (d) PCP or OB/GYN Office Visit Specialist Office Visit Diagnostic Lab Testing Surgical Services Advanced Imaging Services (CT, PET, MRI, & Nuclear Medicine)Prior Authorization Required

$35 Co-pay $55 Co-pay Coinsurance

Deductible + Coinsurance $100 Copayment

Deductible + Coinsurance

$25 Co-pay $45 Co-pay

Covered at 100% Deductible + Coinsurance


All services other than ACA-Preventive apply to

deductible and coinsurance.



PHYSICIAN SERVICES NOT IN OFFICE Inpatient Medical Care Diagnostic Testing Surgical Services

Deductible + Coinsurance Deductible + Coinsurance Deductible + Coinsurance


Covered at 100% Deductible + Coinsurance

PHYSICIAN MATERNITY SERVICES (g)(h) Maternity/Obstetrical Care OB/GYN

No deductible or coinsurance for pre-natal and physician services

No deductible or coinsurance for pre-natal and physician services

OUTPATIENT FACILTY SERVICES Diagnostic Testing Surgical Services

ER Copay(waived if admitted) Urgent Care Center


$150 Co-pay + Deductible + Coinsurance $250 per visit $55 Co-pay

Deductible + Coinsurance Deductible + Coinsurance

$250 per visit $50 Co-pay

INPATIENT SERVICES (g) (h) Semi-Private Room & Board, Intensive Care

Room & Board, Ancillary Charges, & Maternity Inpatient Charges

$300 Co-pay + Deductible + Coinsurance (h)

$300 Co-pay

OTHER SERVICES Ambulance (Co-pay waived if admitted) Home Health (40 visits per year max)

Speech Therapy , PT, OT, Chiropractic ( 30 visits Combined / approval required for additional visits)

Durable Medical Hospice TMJ

$100 Co-pay

Deductible + Coinsurance $35 Office Visit Co-pay,

Deductible + Coinsurance on All Therapy and Chiropractic


$200 copay + $1,000 Deduct + Coinsurance

$100 Co-pay

Deductible + Coinsurance $25 Office Visit Co-pay,

Deductible + Coinsurance on All therapy and Chiropractic


$200 copay + $1,000 Deduct + Coinsurance

MENTAL HEALTH/SUBSTANCE ABUSE Inpatient Services (h) Outpatient Intensive Day Treatment

Outpatient Services in office

$300 Co-pay + Ded + Coins $150 Copayment +

Ded + Coins $35 Co-pay


$25 Co-pay

ROUTINE VISION EXAMS (j) One exam per calendar year $35 Co-pay $25 Co-pay

PRESCRIPTION DRUGS (k) $1600 OOP Max individual $3200 OOP Max family Separate from Medical OOP Max

$15 Tier 1; $55 Tier 2; $90 Tier 3 (k)

$10 Tier 1; $50 Tier 2; $80 Tier 3 (k)

FOOTNOTES:

(a) Deductible means a fixed dollar amount that you must incur each calendar year before the health plan begins to pay for covered

medical services. The calendar year deductible applies to all Covered Services except for those that a Co-payment applies, unless otherwise noted. In-network deductibles and out-of-network deductibles do not cross-apply. Two individual deductible = family deductible.

(b) Coinsurance means a fixed percentage of charges you must pay toward the cost of covered medical services. Coinsurance applies to

all Covered Services except those for which a Co-payment applies unless otherwise noted.

(c) Medical Out of Pocket Maximum is the maximum combined deductible, coinsurance and copayments you will pay in any calendar

year. It does not include costs for services not covered by the plan such as exclusions, limitations and pharmacy copayments. The maximum OOP for prescription drugs is a separate OOP from medical expenses. Family OOP max requires two individual family members meet the individual OOP max.

(d) Co-Payment means a fixed dollar amount that you must pay each time you receive a particular medical service. You pay a co-payment

when you obtain health care directly from your Network Primary Care Physician or a Network Specialist. Certain services rendered in the Network Primary Care Physician or Network Specialist’s office are not subject to the deductible. Services rendered in the Network Primary Care Physician or Network Specialist’s office that are subject to deductible, coinsurance and additional copayments include

advanced imaging such as MRI, CT Scans, PET Scans and Nuclear Medicine (imaging studies using medical radioisotopes), Temporomandibular Joint Disorder (TMJ) treatment and all therapy including chiropractic.

(e) When you obtain health care through a Non-UMR Provider, your benefit payments for covered services will be based on the Maximum Allowable Payment for out-of-network services, as determined by UMR. Charges in excess of the Maximum Allowable Payments do not count toward meeting the deductible or meeting the limitation on your Out of Pocket maximum. Non-UMR Providers may bill the patient for amounts in excess of the Maximum Allowable Payment.

(f) Well baby/child visits from an In-Network provider are covered in full from birth until the day the child attains age 19.

(g) Maternity inpatient charges are subject to co-payment and coinsurance. It is your responsibility to notify Human Resources within 31 days of the birth or adoption of your child in order to obtain coverage for your newborn.

(h) Maximum combined Inpatient co-payment per calendar year is $1,200 per person (no more than one co-payment per 30 calendar days).

(i) The TMJ deductible is separate from the other In-Network or Out-of-Network deductibles. The TMJ deductible is in addition to any In-Network or Out-of-Network deductible and requires pre-authorization.

(j) Vision Exams: Ophthalmologist or Optometrist in-network and out-of-network benefits are the same.

(k) Under the Premier and the Classic Plan, Co-payments at non-participating pharmacies will be $18.50 for Tier 1, $53.50 for Tier 2, and $83.50 for Tier 3. If a new enrollee has to get a prescription prior to receiving his/her pharmacy card, he/she will have to pay for the prescription in full, apply for reimbursement, and will be reimbursed less the $18.50, $53.50, or $83.50 Co-payments. Alternatively, if the enrollment process has been completed and benefits are in effect, a temporary prescription drug ID card can be printed by going to www.medimpact.com, registering and clicking on ‘member ID card’. A complete summary of prescription drug benefits is also on the above web-address. Prescription drug OOP max $1600 individuals and $3200 family. Excluded or non-covered medication or devices do not apply to the RX OOP maximum.

(l) Preventive care services and cancer screenings will follow the U.S. Preventive Task Force Recommendations. See the health plan

Summary Plan Description for details on coverage. The following procedures for both the Premier and the Classic Plan will require pre-authorization before the services are rendered:

1. Any admission to Inpatient Facilities or Partial Hospitalization Units 2. Any referral by your PCP to an Out-of-Network Provider 3. Pre-Natal/Maternity Care. Authorization includes physician care and one ultra sound. Additional ultrasounds require pre-

authorization. UAMS offers a $500 waiver of out-of-pocket expenses for deliveries at its hospital.

4. Home Health Care and Home Infusion Services 5. Transplant Services (including the evaluation to determine if you are a candidate for transplant by a transplant program) 6. All Advanced Imaging (CT, MRI, Thallium Stress Test, PET. Go to www.UMR.com for a complete listing) regardless of place of

service. 7. MRI of the Breast

Note: Certain other services have special Pre-authorization including surgical treatment of Temporomandibular Joint Dysfunction (TMJ), Accidental Injury to Teeth.

Procedures for testing and treatment of a diagnosed condition will be subject to deductible and coinsurance.

The Smoking Cessation Program: smoking cessation program provides free PCP visits and $0 copay for certain nicotine addiction drugs.

The Diabetes Management Initiative and the Healthy Heart Program provide the opportunity for $0 copayments on certain medications.

For more information on all programs call UMR 888-438-6105

*Nutritional Counseling and Weight Management Services: One annual visit with a dietitian and up to three additional visits in

conjunction with health coaching for those who have a BMI of 27 and above. Prior authorization is required and continued approval contingent upon program compliance.

Metabolic weight loss programs are reimbursable up to $1000/ life time for individuals with a BMI of 30 and above who participate in

coaching. Prior authorization is required. For more information call UMR 888-438-6105 modified 04-19-17

http://www.medimpact.com/

http://www.umr.com/

Effective: January 1, 2019

UNIVERSITY OF ARKANSAS Medical Plans Comparison showing UAMS SmartCare

This is not a legal document. Complete benefit descriptions and exclusions are contained in the Summary Plan Description available through your campus HR Office. Please note that all medical services (e.g., durable medical equipment, hospice, ambulance, some therapies, chiropractic) may not be available at UAMS.

For UAMS appointments, call the SmartCare Concierge

(501) 686-8749

CLASSIC under

CLASSIC under

Other In-Network Providers

PREMIER under

PREMIER(j) under

Other In-Network Providers

HEALTH SAVINGS PLAN

under

HEALTH SAVINGS PLAN(j)

under Other In-Network

Providers

INDIVIDUAL DEDUCTIBLE (c)

FAMILY DEDUCTIBLE

$750

$1,500

$1,250

$2,500

$150

$300

$650

$1,300

$2,700

$5,400

COINSURANCE (d) 20% 25% 15% 20% 5% 10%

OUT OF POCKET MAXIMUM (g) Individual (If complete wellness)(h) Family (If complete wellness) (h)

$4,750 ($3,350) $9,500 ($6,700)

$5,250 ($3,850)

$10,500 ($7,700)

$2,500 ($2,000) $5,000 ($4,000)

$3,000 ($2,500) $6,000 ($7,000)

$6,150

$12,300

$6,650

$13,300

PRIMARY CARE OFFICE VISIT(b) $20 copay $35 copay $10 copay $25 copay 5% after

deductible 10% after

deductible

SPECIALIST OFFICE VISIT(b) $40 copay $55 copay $30 copay $45 copay 5% after

deductible 10% after deductible

ROUTINE ANNUAL EYE EXAM $10 copay $35 copay $10 copay $25 copay Paid in full Paid in full

DIAGNOSTIC LAB TESTING (In office)

20% coinsurance 25% coinsurance Paid in full Paid in full 5% after

deductible 10% after

deductible

PREVENTIVE CARE SERVICES(a) Annual Wellness Exams (at PCP or

OB/GYN); Well Baby/Child Visits; Immunizations; Mammograms (first

one each year); Colorectal Cancer Screening

Paid in full Paid in full Paid in full Paid in full Paid in full Paid in full

HOSPITAL INPATIENT SERVICES (e) Semi-private/Intensive care room & board & Maternity inpatient services

$150 copay + deductible +

20% coinsurance

$300 copay + deductible +

25% coinsurance $150 copay $300 copay

5% after deductible

10% after deductible

EMERGENCY ROOM (Copay waived if admitted)

$250 copay $250 copay 10% after deductible

THERAPY Speech , PT, OT, Chiropractic (30 visits combined, pre-approval required for additional visits)

$ 35 copay + deductible + coinsurance

$25 copay + deductible + coinsurance


MATERNITY (f)

Hospital Inpatient costs apply at delivery; no member cost for covered prenatal care and physician delivery

charges

Hospital Inpatient costs apply at delivery; no member cost for

covered prenatal care and physician delivery charges

5% after deductible


ADVANCED IMAGING (CT, PET, MRI, & Nuclear Medicine) Prior authorization required

$50 copay + deductible

+ coinsurance

$100 copay + deductible

+ coinsurance deductible + coinsurance

5% after deductible


URGENT CARE VISIT Not available $55 copay Not available $50 copay Not available 10% after deductible

OUTPATIENT SERVICES a. Diagnostic Lab Services

b. Diagnostic Testing and Surgical

Services

a. 20% coins b. deductible + 20% coins.

a. 25% coins b. $150 copay + ded. + 25% coins.

deductible + coinsurance

5% after

deductible

10% after

deductible

PRESCRIPTION DRUGS (i) $1,600 OOP Max Individual $3,200 OOP Max Family (Separate from Medical OOP Max)

$15 Tier1 $55 Tier 2 $90 Tier 3

$10 Tier1 $50 Tier 2 $80 Tier 3

10% after deductible OOP medical and RX OOP

are combined

FOOTNOTES: (a) Preventive care services from an In-Network provider include:

Well baby/child visits from birth until the day the child attains age 19

Preventive care services and cancer screenings per the U.S. Preventive Task Force Recommendations. See the Summary Plan Description for details on coverage.

Note that mammograms and nutritional counseling/weight management are not covered if you go out-of-network. (b) Co-Payment (“copay”) means a fixed dollar amount that you must pay each time you receive a particular medical service. You pay a copay

when you obtain health care directly from your Network Primary Care Physician (PCP) or Network Specialist. Referrals are NOT required for Network Specialist office visits.

(c) Deductible means a fixed dollar amount that you must incur each calendar year before the health plan begins to pay for covered medical services. In-network deductibles do not apply to out-of-network deductibles and vice versa. Two individual deductibles = family deductible

(d) Co-insurance (“coins”) means a fixed percentage of charges you must pay toward the cost of covered medical services, after satisfying the annual deductible.

(e) Maximum combined inpatient copays per calendar year is $1,200 per person (no more than one hospital admission copay per 30 calendar days).

(f) Maternity inpatient charges are subject to deductible, co-payment and coinsurance. It is your responsibility to notify UAMS Human Resources and submit the required enrollment forms within 31 days of the birth or adoption of your child in order to obtain coverage for your newborn.

(g) Medical Out of Pocket Maximum is the maximum combined deductible, coinsurance and copayments you will pay in any calendar year. It does not include costs for services not covered by the plan such as exclusions, limitations and pharmacy copayments. In the Classic and Premier Plans the maximum OOP for prescriptions drugs is a separate OOP from medical expenses. In the Health Savings Plan the medical OOP and pharmacy OOP are combined. Family OOP max requires two individual family member meet the individual OOP max.

(h) Wellness incentive requirements will be announced to employees the prior year and may include one or more of the following: completion of annual biometric screening, on-line health risk assessment, selection of a Primary Care Physician, preventive care, tobacco free, and participation in disease management programs. Employees who enroll in the health plan after the annual wellness window will be subject to the lower OOP max in their first calendar year of coverage. Wellness incentives, including the reduced OOP max, do not apply to retiree, surviving family or COBRA members.

(i) In the Classic and Premier Plans, co-payments at non-participating pharmacies will be $20.00 for Tier 1, $60.00 for Tier 2, and $95.00 for Tier 3. If a new enrollee has to get a prescription prior to receiving his/her pharmacy card, he/she will have to pay for the prescription in full, apply for reimbursement, and will be reimbursed less the $20.00, $60.00, or $95.00 co-payments. Alternatively, if the enrollment process has been completed and benefits are in effect, a temporary prescription drug ID card can be printed by going to www.medimpact.com, registering and clicking on ‘member ID card’. A complete summary of prescription drug benefits is also on the above web-address. Excluded or non-covered medication or devices do not apply to the OOP maximum.

(j) Out-of- network benefits are available. If services are received out-of-network, a higher out-of-network annual deductible, higher coinsurance percentage and higher out-of-pocket maximums apply. In-network deductibles and out-of-network deductibles do not cross-apply. For more information about out-of-network coverage, or to get a copy of the complete terms of coverage, visit www.UMR.com or contact UMR at 1-888-438-6105. When you obtain health care through a Non-UA-UMR Provider, your benefit payments for covered services will be based on the Maximum Allowable Payment for out-of-network services, as determined by UMR. Charges in excess of the Maximum Allowable Payments do not count toward meeting the deductible or meeting the limitation on your co-insurance maximum. Non-UA-UMR Providers may bill the patient for amounts in excess of the Maximum Allowable Payment.

The following procedures will require pre-authorization before the services are rendered: 1. Any admission to Inpatient Facilities or Partial Hospitalization Units 2. Any referral by your PCP to an Out-of-Network Provider 3. Pre-Natal/Maternity Care 4. Home Health Care, Home Infusion Services, or Hospice (inpatient or outpatient) 5. Transplant Services (including the evaluation to determine if you are a candidate for a transplant by a transplant program) 6. All Advanced Imaging (CT, MRI, Thallium Stress Test, PET; go to www.UMR.com for a complete listing), regardless of place of service. 7. MRI of the breast

NOTE: Certain other services have special Pre-authorization requirements: Surgical treatment of TMJ, Accidental Injury to Teeth. Procedures for testing and treatment of a diagnosed condition are subject to deductible and co-insurance.

University of Arkansas Disease Management Programs:

Smoking cession program provides free PCP visits and zero copay for Chantix, a medication for nicotine addiction.

Diabetes Management Initiative and Healthy Heart Programs provide the opportunity for zero copays on many generic medications. For more information on this and other wellness programs, call UMR at 1-866-575-2540.

Nutritional Counseling and Weight Management Services: One annual visit with a dietitian and up to 3 additional visits in conjunction with health coaching for those who have a BMI of 27 and above. Prior authorization is required and continued approval contingent upon compliance with health coaching engagement. Metabolic weight loss programs are reimbursable up to $1000/life time for individuals with a BMI of 30 and above who participate in health coaching (prior authorization required). Call UMR at 1-888-438-6105 for more information.

http://www.medimpact.com/

http://www.umr.com/

http://www.umr.com/

UMR 75% - 100% Appointment Health Plan Rates

University of Arkansas Cooperative Extension Service

*January 1, 2019 - June 30, 2019 Insurance Premiums - 75% to 100% Appointment Only

CLASSIC PLAN 75% - 100%

Employee Employer Total Employee Employer Total Employee Employer Total

Employee Only $39.50 $171.59 $211.09 $39.50 $171.59 $211.09 $39.50 $171.59 $211.09

Employee and Spouse $95.50 $384.25 $479.75 $95.00 $384.75 $479.75 $94.00 $385.75 $479.75

Employee and Children $74.00 $320.91 $394.91 $72.50 $322.41 $394.91 $71.50 $323.41 $394.91

Employee and Family $127.00 $541.62 $668.62 $125.00 $543.62 $668.62 $123.50 $545.12 $668.62

HEALTH SAVINGS PLAN 75% - 100%


Employee Only $24.38 $171.44 $195.82 $24.38 $171.44 $195.82 $24.38 $171.44 $195.82




PREMIER PLAN 75% - 100%

Employee Employer Total

Employee Only $73.74 $171.92 $245.66

Employee and Spouse $175.97 $385.05 $561.02

Employee and Children $138.47 $321.55 $460.02

Employee and Family $235.34 $542.70 $778.04

*The Cooperative Extension Service three salary tiers, the employer contribution (subsidy) will remain the same and the employee premium rate will remain the same.

The University's Base Total Premium cost will remain the same.

**July 1, 2019 - December 31, 2019 Insurance Premiums - 75% to 100% Appointment Only

Employee Employer Total Employee Employer Total Employee Employer Total Employee Employer Total

Employee Only 39.50$ 171.59$ 211.09$ 39.50$ 171.59$ 211.09$ 40.50$ 170.59$ 211.09$ 41.50$ 169.59$ 211.09$

Employee and Spouse 105.00$ 374.75$ 479.75$ 116.00$ 363.75$ 479.75$ 125.00$ 354.75$ 479.75$ 138.50$ 341.25$ 479.75$

Employee and Children 80.00$ 314.91$ 394.91$ 86.50$ 308.41$ 394.91$ 95.00$ 299.91$ 394.91$ 107.00$ 287.91$ 394.91$

Employee and Family 140.50$ 528.12$ 668.62$ 151.50$ 517.12$ 668.62$ 165.00$ 503.62$ 668.62$ 183.00$ 485.62$ 668.62$


Employee Only 24.22$ 171.60$ 195.82$ 24.22$ 171.60$ 195.82$ 25.22$ 170.60$ 195.82$ 26.22$ 169.60$ 195.82$





Employee Only 76.06$ 169.60$ 245.66$

Employee and Spouse 219.76$ 341.26$ 561.02$

Employee and Children 172.10$ 287.92$ 460.02$

Employee and Family 292.42$ 485.62$ 778.04$

** The Cooperative Extension Service three salary tiers will change to four salary tiers, the employer contribution (subsidy) will decrease and the employee premium rate will increase.

The University's Base Total Premium cost has not been determined.

PREMIER PLAN - 75% - 100%

Coverage All Employees

SEMI-MONTHLY

SEMI-MONTHLY

SEMI-MONTHLY

HEALTH SAVINGS PLAN - 75% - 100%

Coverage Employees with annual salary less

than $39,000

Employees with annual salary

$39,000 - $59,999


$60,000 - $100,000


greater than $100,000


than $39,000


$39,000 - $59,999


$60,000 - $100,000



SEMI-MONTHLY

July 1, 2018 - June 30, 2019


less than $28,000

July 1, 2018 - June 30, 2019 July 1, 2018 - June 30, 2019 July 1, 2018 - June 30, 2019

Employees with annual salary greater

than $55,000


$28,000 - $55,000

CLASSIC PLAN - 75% - 100%

SEMI-MONTHLY


SEMI-MONTHLY

Employees with annual salary greater

than $55,000


$28,000 - $55,000


less than $28,000

UMR 50% - 74% Appointment Health Plan Rates

University of Arkansas Cooperative Extension Service

*January 1, 2019 - June 30, 2019 Insurance Premiums - 50% to 74% Appointment Only

CLASSIC PLAN 50% - 74%


Employee Only $66.62 $144.47 $211.09 $66.62 $144.47 $211.09 $66.62 $144.47 $211.09




HEALTH SAVINGS PLAN 50% - 74%


Employee Only $51.50 $144.32 $195.82 $51.50 $144.32 $195.82 $51.50 $144.32 $195.82




PREMIER PLAN 50% - 74%


Employee Only $100.86 $144.81 $245.67

Employee and Spouse $236.69 $324.33 $561.02

Employee and Children $189.19 $270.83 $460.02

Employee and Family $320.94 $457.10 $778.04

*The Cooperative Extension Service three salary tiers, the employer contribution (subsidy) will remain the same and the employee premium rate will remain the same.

The University's Base Total Premium cost will remain the same.

**July 1, 2019 - December 31, 2019 Insurance Premiums - 50% to 74% Appointment Only


Employee Only 66.36$ 144.73$ 211.09$ 66.36$ 144.73$ 211.09$ 68.04$ 143.05$ 211.09$ 69.72$ 141.37$ 211.09$





Employee Only 51.08$ 144.74$ 195.82$ 51.08$ 144.74$ 195.82$ 52.76$ 143.06$ 195.82$ 54.44$ 141.38$ 195.82$





Employee Only 104.28$ 141.38$ 245.66$

Employee and Spouse 313.94$ 247.08$ 561.02$

Employee and Children 244.86$ 215.16$ 460.02$

Employee and Family 416.86$ 361.18$ 778.04$

** The Cooperative Extension Service three salary tiers will change to four salary tiers, the employer contribution (subsidy) will decrease and the employee premium rate will increase.

The University's Base Total Premium Cost has not been determined.

PREMIER PLAN - 50% - 74%

Coverage All Employees

SEMI-MONTHLY

SEMI-MONTHLY

SEMI-MONTHLY

HEALTH SAVINGS PLAN - 50% - 74%


than $39,000


$39,000 - $59,999


$60,000 - $100,000




than $39,000


$39,000 - $59,999


$60,000 - $100,000



SEMI-MONTHLY

July 1, 2018 - June 30, 2019




$28,000 - $55,000


less than $28,000


CLASSIC PLAN - 50% - 74%

SEMI-MONTHLY

SEMI-MONTHLY




$28,000 - $55,000


less than $28,000


AR BCBS Dental Insurance Rate Sheet

Arkansas Blue Cross Blue Shield (AR BCBS) Insurance Premiums

Semi-Monthly Rates Effective January 1, 2018

75% - 100% Appointment Employee Employer Total

Employee only $8.00 $8.00 $16.00

Employee & Spouse $16.53 $16.47 $33.00

Employee & Child(ren) $13.93 $13.92 $27.85

Employee, Spouse, & Child(ren) $22.45 $22.40 $44.85

50%-74% Appointment

Employee only $10.57 $5.43 $16.00

Employee & Spouse $21.85 $11.18 $33.00

Employee & Child(ren) $18.39 $9.46 $27.85

Employee, Spouse, & Child(ren) $29.63 $15.22 $44.85

No Rate Change 2019

Superior Vision Rate Sheet

You may choose from two plans: Basic Plan and Enhanced Plan – No Rate Change 2019

Basic Plan Enhanced Plan Co-payments Co-payments

Exam $10 Exam $10

Materials¹ $20 Materials¹ $20

Contact Lens Fitting $25 Contact Lens Fitting $25

Monthly Premiums

Monthly Premiums

Emp. Only $5.76 Emp. Only $11.62

Emp. & spouse $11.43 Emp. & spouse $22.97

Emp. & child(ren) $11.19 Emp. & child(ren) $22.52

Emp. & family $17.01 Emp. & family $34.22

Services/Frequency Services/Frequency

Exam 1 per calendar year Exam 1 per calendar year

Frames 1 per 2 calendar years Frames 1 per calendar year

Contact Lens Fitting 1 per calendar year Contact Lens Fitting 1 per calendar year

Contact Lens 1 allowance per calendar year Contact Lens 1 allowance per calendar year

Optional Long Term Disability Calculation Formula

To determine the cost for employees with an annual salary above $20,000: 1. Take your annual salary (up to $500,000 max) and subtract $20,000. 2. Multiply that figure by .00512 for your annual cost. 3. Divide by # of pay periods in the year: 24 semi-monthly.

Optional Life, Dependent Life and Accidental Death and Dismemberment Insurance Rate Sheet

Optional Life Insurance

You have the option of buying additional term life insurance as a new hire or upon proof of insurability. You may choose additional

coverage of one, two, three, or four times your annual salary rounded up to the next thousand. Maximum coverage is $500,000. You

pay the cost of this coverage. The cost is based on your age:

Present Age Rate per $1,000 Present Age Rate per $1,000

Under age 25 .042 50 through 54 .193

25 through 29 .042 55 through 59 .361

30 through 34 .059 60 through 64 .554

35 through 39 .067 65 through 69 1.067

40 through 44 .084 70 and older 1.722

45 through 49 .126 Updated as of 1/1/2018

To figure your cost, do the following:

1. Multiply your annual salary by 1, 2, 3, or 4 (depending on the level of coverage you choose)

2. Round that amount up to the nearest $1,000.00 and divide by $1,000.00

3. Multiply by the rate in the chart above based on your age

4. The result is your monthly cost

Optional Dependent Life Insurance You may choose from the following provisions: Updated as of 1/1/18

Level of Coverage Spouse Each Eligible Child Monthly Rate

I $10,000 $5,000 $2.85

II $15,000 $7,500 $4.27

III $20,000 $10,000 $5.69

Optional Accidental Death and Dismemberment Insurance

You have the option of enrolling yourself and your family. *You are limited to 15 times your annual salary (rounded up to the next

level) for all coverage amounts in excess of $150,000. Maximum coverage is $300,000. You pay the cost of coverage according to

the following schedule: Updated as of 1/1/15

Amount of Employee's

Coverage

Monthly Cost

Employee Only

Amount of Spouse's

Coverage

Amount of Child's

Coverage

Monthly Cost Employee

& Family

$25,000 $.38 $15,000 $ 5,000 $.75

50,000 .75 30,000 10,000 1.50

75,000 1.13 45,000 15,000 2.25

100,000 1.50 60,000 20,000 3.00

125,000 1.88 75,000 25,000 3.75

150,000 2.25 90,000 30,000 4.50

*175,000 2.63 105,000 35,000 5.25

*200,000 3.00 120,000 40,000 6.00

*225,000 3.38 135,000 45,000 6.75

*250,000 3.75 150,000 50,000 7.50

*275,000 4.13 165,000 55,000 8.25

*300,000 4.50 180,000 60,000 9.00

No Rate Change 2019

Notes: