Benefits Bulletin Benefits Open Enrollment Begins November 1

Benefits
Bulletin
35 State Street | Albany, New York | 12207-2826
Benefits Open Enrollment Begins November 1
Open Enrollment will occur from November 1 to November 30. This is your annual opportunity to review the Health Care
coverage you have through the Research Foundation, and to make any necessary changes. If you have questions about
your RF benefits, visit the RF Benefits Website at www.rfsuny.org/benefits or contact RF Benefits Services at 518-434-7101.
PPO Prescription Drug Formulary
Changes for 2015
To help control upward-spiraling prescription drug costs, your
RF health care plans maintain a list of preferred drugs called
a formulary. Drugs on the list are often generic versions of
their pricier brand-name equivalents and they provide effective
treatment at a fraction of the cost.
Mark Your Calendar
November 1, 2014: Open Enrollment begins.
November 30, 2014: Enrollment ends. If you want to make
changes, return completed enrollment forms to:
The Research Foundation for SUNY
Benefits Services
P.O. Box 9
Albany, NY 12201-0009
The formulary list is updated regularly. Sometimes a patient’s
prescribed drug is removed from the formulary list if a better
option becomes available for a certain condition. This year, the
changes affect very few participants – fewer than one quarter of
one percent.
January 1, 2015: Your coverages take effect. New premiums
will appear on your monthly billing coupons.
If you are one of the small number of patients whose medications
will no longer be covered in 2015, you will be contacted directly by
Express Scripts. You will be given alternative options that you can
discuss with your prescribing physician. Standard notifications for
formulary list changes are also made to participating doctors and
pharmacists, so your doctor will be aware when you call.
Visit the RF Benefits Website at www.rfsuny.org/benefits
to get details about the plans you are eligible for. If you do
not have Internet access, contact RF Benefits Services
(518-434-7101, [email protected]) for plan options.
HIP and Vytra Premium Network
Plans Discontinued; Excellus
Rochester Closed to New Members
Due to high costs and very low enrollment, HIP and HIP-Vytra
Premium Network will be eliminated from the RF’s health plan
options for 2015. These plans are the most costly options and
fewer than 20 members are enrolled in them. In addition, the plans
were projecting increases of 12 to16 percent for 2015. Members
in downstate New York and Long Island will be able to choose
between the Deductible and Traditional PPO plans offered by
Empire Blue Cross. Those not choosing a new plan will be
enrolled in the Traditional PPO.
Excellus Rochester remains closed to new enrollees.
Review Your Options
Make Informed Decisions
Health, Dental and Vision Care coverage. If you take no
action during Open Enrollment, your current elections will roll
over to next year.
Where to Find the Forms You Need
The following forms are available on the RF Benefits
Website (www.rfsuny.org/benefits) and from your campus
Benefits Office:
••
RF Benefits Enrollment Form
••
HMO Enrollment Form (if enrolling in an HMO
other than IHA)
BENEFITS BULLETIN | OCTOBER 2014
1
2015 Health Care Plan Comparison and Monthly Rates
EMPIRE
BLUE CROSS
TRADITIONAL PPO
EMPIRE
BLUE CROSS
DEDUCTIBLE PPO 1
BLUE CHOICE
(ROCHESTER/
EXCELLUS) 2,3
CAPITAL DISTRICT
PHYSICIANS’
HEALTH PLAN
(CDPHP)
INDEPENDENT
HEALTH
ASSOCIATION
(IHA)
MVP
$697.37
$643.46
$594.33
$672.89
$617.70
$724.82
Individual + Spouse/
Domestic Partner
$1,466.47
$1,358.63
$1,366.53
$1,345.81
$1,482.71
$1,446.08
Individual + Child(ren)
$1,231.10
$1,134.04
$1,497.06
$1,278.50
$1,112.03
$1,386.84
Family
$2,086.22
$1,924.46
$1,575.40
$1,884.13
$1,729.84
$2,071.98
Individual
WHAT YOU PAY
Preventive Care
(gym reimbursement
up to $300)
(gym reimbursement
up to $300)
$0
$0
$0
$0
$0
Office Visit
$20
$30
$25-$40
$20
$20
$20
Lab
$20
deductible and
coinsurance
$25
$20
$0-$20
$20
X-ray
$20
deductible and
coinsurance
$40
$20
$20
$20
Emergency Room
$50
$50
$100
$50
$125
$50
Outpatient Surgery
$0
deductible and
coinsurance
$50+$40
$75
$15
$75
$0
covered in full
deductible and
coinsurance
50%
20%
50%
20%
Generic Rx
$10
$10
$10
$10
$10
$10
Preferred Rx
$25
$25
$25
$25
$30
$25
Nonpreferred Rx
$45
$45
$40
$45
$50
$40
$10/$50/$90
$10/$50/$90
3 copays
2.5 copays
2.5 copays
2.5 copays
$100
$100
$240
Durable Medical
Equipment
Mail Order Rx
$0
DEDUCTIBLES
Inpatient Hospital
1
$100
deductible and
coinsurance
This plan has a $500 in-network deductible and 10 percent
coinsurance for services other than an office, urgent care or
emergency room visit.
2
This plan is no longer accepting new enrollments.
3
Blue Choice has an inpatient surgery copayment of the
lesser of 20 percent or $200.
About This
Benefits Bulletin
2
$100
2015 Dental Plan and Vision Care Monthly Rates
DENTAL PLAN
VISION CARE
Individual
$35.22
$3.83
Family
$83.27
$9.08
This document is intended to provide a brief overview of changes taking effect. It is not meant to be all-inclusive. If there are any
conflicts between the information presented in this document and the legal plan documents, the legal plan documents will govern.
The Research Foundation reserves the right to change or terminate the plans at its discretion.
BENEFITS BULLETIN | OCTOBER 2014
Annual Notices
Annual Notice of Women’s
Health and Cancer Rights Act
Date Did you know that the Women’s Health and Cancer Rights Act
of 1998 requires that all RF health plans provide benefits for
mastectomy-related services?
Contact Benefits Administration
Address 35 State Street, Albany, NY 12207
Email [email protected]
Services include all stages of reconstruction and surgery to
achieve symmetry between the breasts, fashion prostheses
and correct complications resulting from a mastectomy,
including lymphedemas.
For more information, refer to the Benefits Handbook, available
from the RF Benefits Website (www.rfsuny.org/benefits) under
“Quick Links” or from your campus Benefits Office.
Reminder of Health Plan
Privacy Practices
There is a “Notice of Privacy Practices” that describes how
protected health information (PHI) may be used or disclosed
by your group health plan to carry out payment, for health care
operations and for purposes that are permitted or required by law.
This notice also sets out legal obligations of the RF concerning
your PHI and describes your rights to access and control it.
You can access this notice on the RF Benefits Website
(www.rfsuny.org/benefits – see “Legal Notices” under “Health
Insurance”) or you may request a paper copy of the notice from
your campus Benefits Office.
Important Notice About Your
Prescription Drug Coverage
and Medicare
File This! This is a notice of creditable coverage. If you decide
to join one of the Medicare drug plans when you become
eligible, you may be required to provide this notice to show
whether or not you have maintained creditable coverage,
and whether or not you are required to pay a higher premium
(a penalty). This notice is distributed each year and at other
times, such as before the next Medicare prescription drug
coverage enrollment period and if the RF coverage changes.
You may request a copy at any time, but you should keep a
copy on file.
October 15, 2014
Name of
Entity /Sender The Research Foundation for SUNY
Because your existing RF coverage is on average at least as
good as the standard Medicare prescription drug coverage,
Medicare considers the RF coverage “creditable.”
You can keep this coverage and not pay a higher premium
(a penalty) if you later decide to join a Medicare plan.
However, even though your RF coverage is creditable, you
could still be subject to penalties (in the form of higher
premiums) if you lose or decide to leave RF coverage and
wait longer than 60 days to enroll for Medicare Part D.
For More Information
Detailed information about Medicare plans that offer
prescription drug coverage is available in the “Medicare &
You” handbook. You’ll get a copy of this handbook in the mail
every year when you become eligible for Medicare. You may
also be contacted directly by Medicare prescription drug plans.
For more information:
••
Visit www.medicare.gov
••
Call your State Health Insurance Assistance Program (see
the inside back cover of the “Medicare & You” handbook
for the number)
••
Call 800-MEDICARE (800-633-4227) or
TTY: 877-486-2048
If you have limited income and resources, extra help paying
for Medicare prescription drug coverage is available from the
Social Security Administration at www.socialsecurity.gov; or
call 800-772-1213 (TTY users should call 800-325-0778).
BENEFITS BULLETIN | OCTOBER 2014
3
INDICIA
35 State Street
Albany, New York 12207-2826
Find the Benefits
Bulletin Online!
Go to www.rfsuny.org/
benefits and select
“Benefits Publications”
under “Quick Links.”
Benefits Open Enrollment Is
November 1 – November 30
Look inside for important information!
••
••
Find out what’s changing for 2015
See your 2015 monthly rates
BENEFITS BULLETIN | OCTOBER 2014