Changes include online option, PPO plans

Updated 10:00 AM August 16, 2004

Changes include online option, PPO plans

By Jean Dolega
HR Communications

Open Enrollment—the time for faculty, staff and retirees to enroll in benefits plans or make changes to their benefits packages—is Oct. 18-29. The Benefits Office suggests all benefits-eligible faculty, staff and retirees carefully review the options because this is a year of transition with new plans and rates.

With the addition of two new preferred provider organization (PPO) plans for 2005, active employees will have several options for choosing a comprehensive medical insurance plan. Enrollment patterns experienced this year will help the University determine the number and types of plans that make the best long-term mix of options for the future.

The schedule

Late September: Open Enrollment books will be distributed via campus mail to faculty and staff. Books for retirees, survivors and long-term disability participants will be mailed to home addresses.

Early October: Personal Enrollment Worksheets (PEW) will be sent to the home addresses of faculty and staff. Enrollment applications for retirees and for employees on long-term disability will be included in their Open Enrollment books.

Oct. 18-29: Faculty and staff should submit any desired changes in their benefits.

Mid-November: HR will mail confirmation statements to home addresses.

Dec. 1: Deadline for faculty, staff and retirees to submit corrections to confirmation statements.

Jan. 1: New benefits elections and rates take effect.

What's New for 2005

New medical insurance options

The two new medical insurance choices available to faculty, staff and retirees during this year's Open Enrollment period are PPOs. M-CARE PPO PLUS and the Blue Cross Blue Shield of Michigan's Community Blue PPO will be available, with coverage effective Jan. 1. Members are not required to reside in a specific area to participate.

PPOs offer limited out-of-pocket expenses, flexibility to visit any doctor or hospital without a referral, and access to health care providers throughout the United States.

Enrollees may use a network provider or out-of-network doctor or hospital, but co-pays are higher for out-of-network services. The addition of the new plans is a result of recommendations made by the Committee on Health Insurance Premium Design (CHIPD) and responds to the University community's desire for greater choice of plans that offer nationwide provider networks.

New rates and coverage levels

A new premium rate structure will be in effect in 2005 and the number of coverage level choices has increased. The new rate structure provides lower premium costs for many employees through the new Employee + Child(ren) coverage level. This new option provides a lower premium for coverage of one adult with any number of dependent children, reflecting the fact that it generally is less expensive to provide health care to children than to adults.

Previously, there were three coverage levels (employee only, employee + one dependent, and employee + two or more dependents). For 2005, there are five coverage levels (employee only, employee + adult, employee + adult + child(ren), employee + child, and employee + children.)

"Adult" refers to a spouse or registered same-sex domestic partner (SSDP). "Child" refers to dependent children.

M-CARE HMO and POS Out-of-Area Dependent Coverage

M-CARE will provide new coverage for dependents of members of M-CARE HMO and M-CARE Point-of-Service plans who reside outside the network service area and qualify under existing eligibility guidelines. The coverage is similar to that of the M-CARE HMO. Pre-certification is required for certain services but physician referrals are not needed. The member must register with M-CARE customer service to receive out-of-area dependent coverage.

Opt-Out Credit dollars for U-M dual career couples eliminated

Beginning Jan. 1, employees no longer will be eligible to receive opt-out credit dollars for waiving coverage for themselves if they enroll under the University medical coverage of a spouse or SSDP who also works for U-M.

The opt-out credit dollars option remains available for U-M employees who waive coverage because they have other insurance outside the University, through the employer of a spouse or SSDP.

Certification of non-U-M coverage is required to receive opt-out credit dollars by using forms accessible online through the eBenefits enrollment system (see related story, this page) or using the PEW.

Dual-career couples generally will have lower premium costs by insuring each person separately through "employee only" coverage rather than "employee plus adult." Similarly, dual career couples with dependent children should consider assigning children separately to each spouse or SSDP's coverage for potential savings in premium by using "employee plus child(ren)" coverage, since coverage for an employee plus one child is less expensive than coverage for two adults plus children. The premium costs for all plans and coverage levels can be viewed on the Benefits Office Web site at http://www.umich.edu/~benefits/.

For more information

Web: To view information on the new PPO plans and the 2005 rate charts for all benefits plans, visit the Benefits Office Web site at http://www.umich.edu/~benefits/newplans/. Watch the Web for more information on eBenefits and Open Enrollment.

E-mail: Reach a benefits representative at benefits.office@umich.edu.

Phone: Consult with HR/Payroll Service Center staff at (734) 615-2000 or (866) 647-7657 (toll-free for off-campus long-distance calling).

University Record: Watch for further details as Open Enrollment nears.

Changes include online option, PPO plans

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