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