Health Insurance

 

Printable Version

 

2013 Health Insurance Information (pdf)

 

If you do not want to make changes to your health insurance, no action is necessary.

 

It's Your Choice period: October 8-November 2, 2012

 

It's Your Choice Books

• The It’s Your Choice books are being distributed electronically again this year.
• The 2013 Decision Guide provides key information that will assist you in choosing a health plan.
• The 2013 Reference Guide contains technical information such as the full certificate of coverage and required federal notifications.

If you would like hard copies of the books, please pick them up in Human Resources, stop by one of the Focus on Your Benefits sessions or e-mail uwhchrsc@uwhealth.org.

 

Topics:

• To Enroll or Make Changes to Your Health Insurance
• Important 2013 Uniform Benefit Changes and Enhancements
• Premiums

 

To Enroll or Make Changes to Your Health Insurance 

 

The annual It’s Your Choice period allows employees the opportunity to enroll in or make changes to their health insurance without having a qualifying event. All enrollments and changes will be effective January 1, 2013 provided a Health Insurance Application/Change form is completed and submitted to Human Resources between October 8 and November 2, 2012. 

 

Please note the 2013 Decision Guide instructs employees to make their It’s Your Choice enrollments and changes online via the Department of Employee Trust Funds (ETF) MyETF website. Please disregard these instructions as UW Hospital and Clinics has not gone live with this functionality. All changes and enrollments must be supplied to Human Resources on a paper Health Insurance Application/Change form.

 

Open Enrollment

 

You can enroll in health insurance with no restrictions during the It’s Your Choice period, even if you do not currently have coverage.

 

Add/Remove your Adult Child(ren)

 

You can add or remove your adult child(ren), ages 19-26, with no restrictions. Please refer to Adult Children Benefit Information Sheet for more information.

 

Add/Remove your Domestic Partner

 

You can add or remove your domestic partner and his/her eligible children with no restrictions. Please refer to the Domestic Partner Benefit Information Sheet for details and possible tax implications.

 

Change Your Coverage Level

 

You can change from single to family or family to single coverage with no restrictions.

 

Change Your Health Plans

 

You can change your health plan with no restrictions.

 

Not Currently a Unity Member?

 

Here are just a few reasons to Choose Unity:

• You work hard every day to deliver world-class care to our patients. Don’t you deserve the same world-class care?
• Guaranteed access to UW Health’s 1,200 physicians and health care providers and 45 clinic locations without referrals
• Access to UW Hospital which was ranked the number one hospital in Wisconsin by U.S. News and World Report
• Access to the world-class pediatricians and health care providers at American Family Children’s Hospital
• Access to care in your community
• Market-leading wellness programs. Earn up to $150 per adult member in addition to $200 per household for participating in wellness activities.
• High overall member satisfaction over the past five years
• Four consecutive, three-year Excellent Accreditations from the National Committee for Quality Assurance

The Choice is Easy. Choose Unity. Learn more at chooseunityhealth.com.

 

Important 2013 Uniform Benefit Changes and Enhancements

 

For a complete listing of important changes to your health plan, please refer to your 2013 Decision Guide.

 

Health Risk Assessments (HRA) and Biometric Screenings

 

In an effort to help you understand and potentially improve your health, every health plan will be offering HRAs and Biometric screenings to their members. To encourage you and your family members to participate, all of the health plans will be offering incentives upon completion of one or both of these tools.

• HRAs: A questionnaire about your present and past health status. The HRAs may be offered online, via telephone or at your doctor’s office.
• Biometric Screening: Four (4) screening tests to help assess and identify potential health risks. The tests include blood pressure, body mass index (BMI), cholesterol level and glucose level. 

Please review your health plan’s wellness information on their individual page in the 2013 It's Your Choice Decision Guide to learn about how your plan will administer these initiatives and what incentives are provided for participation.

 

Pharmacy Benefits (HMO/PPO Plans)

 

A new $50 Level 4 copayment is being added effective January 1, 2013 for formulary and covered non-formulary drugs classified as specialty medications. In general, specialty medications require special storage and handling and, as a result, are more costly and typically not available from all participating pharmacies. Examples of specialty medications include self-injectable medications and medications to treat cancer and multiple sclerosis. Please review the listing of Level 4 Formulary Specialty Medications.

 

A reduced Level 4 copayment of $15 will apply if the Level 4 Formulary Specialty Medications are obtained by using Diplomat Specialty Mail-Order Pharmacy through the Navitus SpecialtyRx program. The use of any other pharmacy will result in the standard $50 copay.

 

Navitus will be mailing personalized letters to each member that is currently taking a medication that will be included in the new Level 4 copay. If you have specific questions regarding your medications, please contact Navitus directly at 1-866-333-2757.

 

Effective January 1, 2013, the following pharmacy copays will apply:

 

Level	Prescription Type	Copay	Annual Out of Pocket Limit (OOPL)
Level 1	Formulary generic and low cost brand name drugs	$5.00	Individual -  $410     Family - $820
Level 2	Formulary brand name and certain high cost generic drugs	$15.00
Level 3	Covered non-formulary drugs	$35.00	No OOPL
NEW Level 4	Formulary drugs classified as Specialty drugs	$50.00 or $15.00*	Individual -  $1,000** Family - $2,000**
	Covered, non-formulary drugs classified as Specialty drugs	$50	No OOPL

 

*$15 Level 4 copay only applies to Level 4 Formulary Specialty Medications that are obtained via the preferred participating Diplomat Specialty Mail-Order Pharmacy.

 

**The copay for Level 4 does not accumulate toward the Level 1-3 OOPL. 

 

Please note that pharmacy benefits through Navitus are not changing for Level 1- 3 prescription drugs in 2013.

 

Please review pages 74 and 75 in the 2013 It's Your Choice Decision Guide or visit Navitus online for additional pharmacy benefit details.

 

Hospice Benefit

 

In an effort to facilitate improvements in end-of-life care, a new Hospice benefit will be added. The plan will cover a one-time in-home palliative consult after the member receives a terminal diagnosis and also covers up to a total lifetime maximum of 30 days of confinement in a Health Plan-approved or Medicare-certified Hospice Care facility. Please see page 89 of the 2013 It's Your Choice Reference Guide for additional information.

 

Prior Authorization for Low-back and High-tech Radiology

 

In 2013, health plan prior authorization will be required for:

• Low back surgery for members with a history of low-back pain who have not completed a regimen of conservative care.
• High-tech radiology tests such as MRI, PET scan, CT scan and nuclear stress tests.

Members requiring immediate or expedited care may not have to obtain prior authorization. It is the member’s responsibility to learn and follow the prior authorization process for their health plan. 

 

Updated Preventive Services Covered at 100 Percent

 

The federal list of preventive services that are covered at 100% has been updated. The updates include the addition of eight (8) Women’s Care screenings and services that will be covered at 100% (no 10% coinsurance). The newly covered items include contraceptives, breastfeeding counseling and supplies (includes breast pumps), domestic abuse counseling, gestational diabetes screening, HIV counseling, HPV screening, STD counseling and well woman visits.

 

Smoking Cessation

 

The smoking cessation benefit will be expanded to include four (4) telephonic counseling sessions and will require prior authorization for any limited extension of related pharmacological products. 

 

Premiums

• Tiers: In 2013, all health plans will be assigned to Tier 1 with the exception of the Standard Plan, Anthem Blue Northwest and WPS Metro Choice Southeast which will be assigned to Tier 3. There will be no Tier 2 plans.
• Premiums: The monthly employee health insurance premiums below will be effective in December of 2012 for January 2013 coverage.

Eligible Full and Part-Time (50%+) Regular Employees

 

Employee Group	Tier 1: HMO/PPO		Tier 3: Standard Plan   WPS Metro Choice SE
	Single	Family	Single	Family
Non-Represented	$85.00	$211.00	$230.00	$575.00
WSP, SEIU and WSEU Represented	$47.61	$117.70	$230.00	$575.00

 

Employees in Training (EIT) - Residents/Interns

 

Employee Group	Tier 1: HMO/PPO		Tier 3: Standard Plan   WPS Metro Choice SE
	Single	Family	Single	Family
Residents/Interns	$42.50	$105.50	$115.00	$287.50

 

 

Eligible Per Diem, LTE, Temporary and Regular Employees working less than 50% will continue to pay 50% of the total monthly premium.