|
Human Resources
» Benefits
Information Center » Health
Insurance
General
Information
Regular full time and regular
part time employees (budgeted for 20 or more hours a week)
are eligible to participate in the health insurance plan,
subjected to the waiting period and other eligibility qualifications.
In general, this is the first of the month following one (1)
month of employment in a benefit eligible position. Medical
insurance premiums may be deducted pre-tax.
Employees
will be provided detailed information about this benefit
as they become eligible. The specific eligibility requirements
and provisions of coverage are detailed in the summary plan
documents prepared by the insurance provider. These and other
plan documents will be the final determinant of eligibility
and coverage.
Overview
of Your Cafeteria Plan
The Northwestern
Health Sciences University Cafeteria Plan provides a means
for you to use pre-tax dollars to pay for:
- your
employee premiums for the Northwestern Health Sciences University
Health Plans
- uncovered
medical and dental expenses for yourself and your eligible
dependents
- dependent
day care expenses for eligible dependents
This voluntary
program enables you to save taxes and increase your spendable
income through your pre-tax contributions. Your election to
the Plan is made on a Plan Year basis. The Plan Year is a
calendar year (January 1 through December 31).
The IRS
allows election changes during the Plan Year if, and only
if, you incur a change in family status during the Plan Year.
Please note, election changes must be consistent with the
change in status. Examples of a status change include:
- Marriage
- Divorce
- Birth
or adoption of a child
- Death
of a spouse or dependent child
- Change
in your employment status from full time to part time or
part time to full time
- Change
in your spouse's employment status from full time to part
time or vice versa
- Your
spouse commences or terminated employment
- A significant
change in health coverage due to your spouse's employment
- Unpaid
leaves of absence
There
are many benefits to participating in the cafeteria plan.
As with any formal employee benefit plan, however, certain
rules and requirements must be followed. IRS rules regarding
cafeteria plans include the following:
An employee must be an active participant in the Plan when
expenses are incurred in order for the expenses to
be eligible for reimbursement. Expenses incurred before
participation in the plan becomes effective are ineligible.
Expenses are considered incurred on the date the service
is provided. Most out-of-pocket medical and dental
expenses incurred by the participant, the participant's
spouse, and his or her dependents are reimbursable.
Examples
of qualifying expenses include:
- Co-pays
and deductibles from your medical plan
- Dental
expenses
- Prescription
drugs
- Over-the-counter
drugs
- Chiropractic
services
- Prescription
eyeglasses and contact lenses
- Hearing
aids
- Orthodontia
Some
expenses which do not qualify for reimbursement under the
regulations include: cosmetic surgery, spousal or personal
insurance premiums, and weight reduction programs for general
well being.
In order
for dependent care expenses to qualify under the Plan, the
expenses must qualify for dependent care credit, they are
necessary to permit you and your spouse to be employed,
and there is an annual limit for reimbursement (generally
$5,000, but see your summary plan description for more details).
Generally children under age 13 qualify as a dependent for
reimbursement under this Plan. In certain circumstances,
dependents that are physically or mentally incapable of
self-care may also qualify.
When
you terminate employment, pre-tax contributions stop. You
may choose to continue your medical expense reimbursement
account contributions on an after-tax basis through that
Plan Year. You can submit for reimbursement your medical
expenses incurred up to the date of your termination. If
you continue contributions on an after-tax basis, you can
submit requests for reimbursement on medical expenses incurred
during the period for which you have continued to make contributions.
Following termination of employment, you can continue to
submit claims for dependent care expenses for the rest of
the Plan Year.
Plan your
contribution elections carefully to minimize your risk of
forfeiture (forfeiture is required by IRS rules if you have
money left in your account at year end). A budget form is
included for estimating expenses. To qualify for reimbursement
under the cafeteria plan, expenses cannot be eligible for
coverage or reimbursement through any other plan or deducted
on your or your spouse's income tax return.
To be
reimbursed through the cafeteria plan, simply complete the
claim for reimbursement form and submit your completed form
to America's VEBA Solution with a copy of expense documentation.
| |
Health
Care
Reimbursement Account |
Dependent
Care
Reimbursement Account |
Annual
Election
|
|
|
Minimum Amount
|
None |
None |
Maximum Amount
|
$5,000 |
$5,000 |
| Plan
Year |
Jan.
1 - Dec. 31 |
Jan.
1 - Dec. 31 |
| Reimbursement
Frequency |
Semi-monthly |
Semi-monthly |
"Run
Out" Period
(for submitting claims from prior
year)* |
60
Days |
60
Days |
* This
is NOT a "postmarked by" deadline. Claim forms must be received
by Administration Resources Corporation (ARC) no later than this date.
Reimbursement requests should be mailed to ARC using the available return business
envelopes or faxed to ARC at 1-763-772-1370.
Faxed claims must be received by 1:00 PM Central Time
on the claim deadline date.
To access your account information, log on to vebaclaims@arcadministration.com and click on "Participant Login".
This is
only a summary of the plan highlights. Please see Summary
Plan Description (SPD) for a more detailed summary. If
there is a discrepancy between this summary and the SPD, the
provisions in the SPD will be controlling.
FAQs
General
Q: Why is
January 1st the beginning of the insurance year when the
academic year is September 1st - August 31st ?
A: It is
the most common plan year for health insurance. The plan
runs January - December to correlate with the payroll
as well as the Section 125 cafeteria plan.
Q: Can I
change options during the year?
A: A qualifying
event must have taken place in order for you to change
benefit options. Examples of qualifying events are marriage,
divorce, birth, or adoption of a child. It is your responsibility
to notify the Plan Administrator about the benefit change
within thirty (30) days of the event.
Q: How does
coordination of benefits work if I'm covered under the University's
plan as well as my spouse's plan?
A: The primary
plan pays its benefits without regard to any other plan.
The secondary plan adjusts its benefits so that the total
benefits paid by both plans will not exceed 100% of the
allowable expenses. Our plan would be considered the primary
plan, because it is covering you directly as an active
employee. Your spouse's plan would be considered the secondary
plan.
Q: Does Blue
Cross Blue Shield have an on-line service available?
A: Yes! Blue Cross Blue Shield is on-line. Follow
these steps to log on and gain access to items such
as PPO Directory, order additional insurance cards,
check the drug formulary, check the status of claims
and explore additional features.
- Log on to www.bluecrossmn.com
- Click on "Member"
- Register for online access. A PIN will be mailed
to your home address
Medical
Q: Are pre-existing
medical conditions covered by our insurance plan?
A: Yes,
pre-existing conditions are covered as a new employee.
If you are a special enrollee, you will need to provide
proof of creditable insurance,
in order to avoid the pre-existing conditions clause.
Q: How much
is the annual deductible?
A: $1,000
per person, $2,000 per family.
Q: How much
do I pay for an annual physical?
A: Preventative
care (routine physical) is covered at 100%.
Q: Is there
a co-pay for physician office visits?
A: No,
you are responsible for the annual deductible. After the
deductible you will pay 20% of the allowed amount.
Q: What
happens if my doctor is not listed in the BCBS directory
or web site?
A: You may still see your doctor, however,
you will be charged the out-of-network provider
charges. To avoid being charged out-of-network costs,
you must select a doctor within the network. Our
group network is Blue Cross Blue Shield of MN-AWARE.
Vision
Q: What
type of vision program does NWHSU offer?
A: Routine
eye exams are covered under the preventative care benefit.
Preventative care is covered at 100%.
Prescriptions
Q: How do
I get my prescriptions filled at a retail pharmacy?
A: Present
your insurance card when you drop-off your prescription
at a participating Blue
Cross Blue Shield
pharmacy. Your co-insurance will be 20% of the
cost of the drug with a maximum of $50. If the drug costs
are less than $15, you will pay the cost of the drug.
Q: How do
I use the mail order service for prescriptions?
A: Obtain
the mail order materials from Lisa
Franczak @ Human Resources. Ask your doctor
for two prescriptions: one for the maximum ninety (90)
days supply allowed by the plan, plus refills; one to
be filled at a retail pharmacy for use until you receive
your prescription order through the mail.
Q:
What if my healthcare professional prescribes a brand-named
drug instead of the generic?
A:
Your pharmacist may automatically fill the prescription
with the generic. If not, you wil be billed the difference
of what you would have paid for the generic.
Q:
What if my healthcare
professional feels the generic will not be as effective
as its brand-named counterpart?
A:
Your docotr may certify a medical necessity for the brand-named
drug in writing . In this case, you would pay 20% of the
cost of the drug.
Section
125
Q: How do
I find out how much money I have left in my Cafeteria Plan?
A: Log in to: vebaclaims@arcadministration.com.
B: Contact Lisa
Franczak.
Lab
Tests & X-Rays
Q: How do
I order a lab test at NWHSU?
A: Lab tests need to be ordered by a healthcare
practitioner and an appointment needs to be scheduled
with Rita
Russella at extension 434. You may obtain the
Lab Order form from the lab.
Q: How does
my doctor get my results?
A: Your
lab tests will be sent (either by mail or by fax) to your
doctor within 24 - 48 hours after your tests are completed.
Q: Do I
need an appointment to have lab work done? If so, who do
I call and where do I go?
A: Yes, you do need an appointment for
lab work. Please call Rita
Russella at extension 434 to set up an appointment.
The lab is located
in suite 108A (near the library). All work done
in the lab is treated as confidential.
Q: What
type of lab work is the University able to perform?
A: Any lab work that is handled by Quest
Diagnostics, which is the organization that
handles lab work for many doctor's offices. For
specific test information, contact Rita
Russella at extension 434.
Q: How do
I order an x-ray at NWHSU?
A: Call
the University
Health Services front desk at extension 415 to schedule
an appointment. Remember to bring along the completed
and signed employee
x-ray referral form
to your appointment. The referral form lists what
type of x-ray is to be done.
Q: How will
I receive the results?
A: Completed
x-rays, along with a radiology report, will be sent to
your physician within 24 to 48 hours.
Please Note:
Lab tests and x-rays are at no cost to NWHSU employees and
applicable dependents that are covered under the University's
insurance. Those not covered will receive a 20% discount.
|
