Insurance and Benefits Enrollment FAQs
Q. When is Open Enrollment?
A. Open enrollment will begin on May 1, 2021, and end on May 31, 2021. Your Benefit Information Enrollment Form is due to the Human Resources Department by May 31, 2021.
Flexible Spending Account enrollment forms are also due by May 31, 2021. A Flex enrollment form is required for enrollment each year. If you do not submit a Flex enrollment form by May 31, you will not be enrolled for the new plan year.
Q. What’s new for the plan year?
- Medical Plan: 5% premium decrease with no plan design change
- Dental Plan: No premium change and no plan design change
- Vision Plan: No premium change and no plan design change
- New FSA/HSA/COBRA/Retiree Billing Vendor: WEX will be our new 3rd party administrator
- Flexible Spending Account (FSA for those on a traditional health plan) medical account limitations have remained unchanged at $2,750 for the 2021 – 2022 plan year.
- Health Savings Account: (HSA for those on the High Deductible plan) limitation has increased to $3,600.
- Those with an existing HSA prior to 7/1/2021 may remain with their current bank
- Those new to an HSA will need to set up an account through WEX for payroll contributions.
Q. Will new medical cards be sent to me?
A. You will not be receiving a new medical card unless you change coverage between plans. You will not be receiving a new dental card unless you are newly signed up this year. VSP, our vision insurance carrier does not send out cards. If you would like to print one, you will need to create an account at www.vsp.com.
Q. What is a co-pay?
A. Health insurance co-pays are the fixed amounts ($10, $25, $40, or $50) you pay at the time you receive care for doctor visits, specialists, and chiropractic care under the Value $1,500 plan. Higher co-pays also apply for emergency room visits and some urgent care. When you go to the doctor, you pay a small portion of the cost and your insurer pays the balance. You may be billed for additional charges that are subject to your deductible.
Q. What is a deductible?
A. A deductible is an amount that you owe for health care services before your health insurance begins to pay. For example, if your deductible is $1,500, your health insurance will start paying their portion after you have met your $1,500 deductible for covered health care services. The deductible may not apply to all services, such as those covered by your co-pay.
Q. What is co-insurance?
A. Co-insurance is a type of co-pay, but rather than paying a specified dollar amount, you pay a percentage of the covered costs after meeting your deductible. For example, if you have a hospital stay, you will have to pay the deductible and the remaining cost of the claim will be shared by you and the insurance company. The insurance company will pay 80% of the cost, and you will pay 20% up to your out-of-pocket maximum.
Q. What is an out-of-pocket maximum?
A. An out-of-pocket maximum (OPM) is the most you pay during the calendar year before your health insurance plan starts to pay 100% for covered essential health benefits. OPMs will include all deductibles, co-pays (for prescription drugs and office visits), and co-insurance amounts for your health plan. The OPM does not include your payroll contributions or charges for health care the plan does not cover.
Q. What is a high deductible health plan (HDHP)?
A. A high-deductible health plan (HDHP) is a health insurance plan with a high minimum deductible for medical expenses in lieu of a lower monthly premium payment. A deductible is an amount the member pays prior. Once an individual has paid that portion of a claim, the insurance company will cover the remaining portion.
Q. When do premiums and out-of-pocket maximums restart?
A. Although the new benefit plan year will begin on July 1, 2021, the deductibles and out-of-pocket maximums for UnitedHealthcare are accumulated on a calendar year basis from January 1 – December 31. Deductibles and out-of-pocket maximums accumulated from January 1 – June 30 will transfer to your plan election for July 1 – December 31. If you change plans on July 1st, you may owe the difference between the two plan deductibles and out-of-pocket maximums.
Q. How do I find in-network providers/doctors?
A. To locate a provider or to find out if your provider is contracted with UHC, follow the directions below.
- Go to www.myuhc.com
- Under Links and Tools (right-hand side) select: Find Medical, and Mental Health Providers and Facilities
- Choose what type of provider you are looking for.
- Under choose a type of plan, select: All UnitedHealthcare Plans
- Select: Choice Plus (8th down on the list of plans)
- Enter the zip code for your care provider
- Click on the People or Places boxes to locate providers, or enter the doctor’s name in the search
field for a particular doctor
Q. What is my prescription benefit?
A. The VALUE PLAN drug benefit has three tier levels. The co-pay amounts are listed below.
|Retail 30-Day Supply||Retail 60-Day Supply||Mail Order 90-Day Supply|
|Specialty||Processes at Tier 2 or Tier 3 co-pay level||Processes at Tier 2 or Tier 3 co-pay level||Processes at Tier 2 or Tier 3 co-pay level|
Under the High Deductible Health Plan prescriptions, drugs will be subject to the member’s deductible prior to UHC payment coverage. Prescriptions covered under the ACA will continue to be paid at 100% with both medical plans.
Prescription Drug List
To determine which tier your medication is listed under you can go to the www.myuhc.com website. Click on Pharmacy information on the right-hand side of the webpage. In the new window that pops up, click on the 2021 Tier 3 Prescription Drug List with the most recent effective date. You can use the index at the back of the booklet to quickly locate the page for your particular medication.
Programs and Limits
The letters next to the medications refer to the pharmacy benefit programs. If you ever have questions on your prescription drug coverage please call Member Services listed on the back of your ID card.
|DSP||Designated Specialty Program – Specialty medications need to be filled at a designated specialty pharmacy for network coverage. Call the number on your ID card or call 1-888-793-5820 for more information.|
|E||May be excluded from coverage or subject to prior authorization and/or trial/ failure of another medication(s) – Lower-cost options are available and covered.|
|H||Health Care Reform Preventive – This medication is part of a Health Care Reform preventative benefit and may be available at no cost to you.|
|MC||Multiple Copay – More than one month’s worth of medication included in the package so additional copay applies.|
|PA||Prior Authorization Required* – Your doctor is required to provide additional information to us to determine coverage.|
|RS||Refill and Save Program – Save money on your copayment when you refill your prescription on time as prescribed. Program eligibility may vary.|
|SL||Supply Limit – Amount of medication covered per copayment or in a specific time period.|
|ST||Step Therapy – Trial of a lower-cost medication is required before a higher-cost medication is covered.|
*Depending on your benefit you may have notification or medical necessity requirements for select medications.
90 Day Supply / Mail Order Pharmacy / CVS Pharmacy Discount
You may save money by having your doctor prescribe a 3-month supply of eligible medication. Through OptumRx, your medications are mailed to you with standard shipping at no additional cost. You can also take advantage of this savings by using the Walgreens or CVS pharmacy located in Target.
How to setup Optum Rx Mail Service Pharmacy
- By Phone:
- Just call the member phone number on the back of your health plan ID card to talk with a customer service representative. It’s helpful to have your health plan ID card and medication bottle available. For your convenience, the representative can also contact your doctor directly if you need a new prescription.
- By Mail:
- Ask your doctor for a new prescription for up to a three-month supply, plus refills for up to one year. Next go to www.myuhc.com and download the new Prescription Order Form. Then mail it to the address provided on the bottom of the form.
- By Fax/ePrescribe:
- Ask your doctor to call 1-800-788-4863 for instructions on how to fax your prescription directly to OptumRx Mail Service Pharmacy. Or your doctor can send an electronic prescription to OptumRx Mail Service Pharmacy.
Once OptumRx receives your complete order for a new prescription, your medication should arrive within 10 business days. Completed refill orders should arrive in about seven business days.
Q. What are Virtual Visits?
A. A virtual visit lets you see and talk to a doctor 24/7 from your mobile device or computer without an appointment. Most visits take about 10-15 minutes and doctors can write a prescription if needed, that you can pick up at your local pharmacy. And, it’s part of your health benefits.
Doctors can diagnose and treat a wide range of non-emergency medical conditions, including:
- Bladder infection
- Sore throat
- Pink Eye
- Stomach ache
- Sinus problems
Log in to www.myuhc.com and choose from provider sites where you can register for a virtual visit. After registering and requesting a visit you will pay your portion of the co-pay, and then you will enter a virtual waiting room. During your visit, you will be able to talk to a doctor about your health concerns, symptoms, and treatment options.
Q. Who and what are premium providers?
A. Premium designations are given to providers who meet higher quality standards while still providing cost-efficient care. Make sure to look for the Premium Care Physician designation when choosing your next provider.
Q. How do I appeal a decision that UnitedHealthCare has made?
A. If you disagree with either a pre-service request for Benefits determination, post-service claim determination or a recession of coverage determination, you can contact UnitedHealthcare in writing to formally request an appeal, or you can fax to 801-938-2109. Your request for an appeal should include:
- The patient’s name and the identification number from the ID card.
- The date(s) of medical service(s).
- The provider’s/doctor’s name.
- The reason you believe the claim should be paid.
- Any documentation or other written information to support your request for claim payment.
Your first appeal request must be submitted to UnitedHealthcare within 180 days after you receive the denial of a pre-service request for Benefits or the claim denial. For further information on the appeal process, please view the Summary Plan Description on the District website under the Human Resources Department.
Q. Can I get a mobile app for UnitedHealthCare?
A. UnitedHealthcare has a Health4Me app that can search for a physician near you, check the status of a claim, view your health plan ID card, or allow you to speak directly with a health care professional.
Instructions to download the free health4Me app:
- Click on the store icon (App Store for iPhones; Google Play for Android)
- Type Health4Me option
- Click on the Health4Me option
- Click Download or Install
Q. I am retiring this year, what do I need to do to get retirement benefits?
A. If you are retiring this year, you will be receiving a letter at your home address in early June with information on how to sign up for retiree benefits. We offer medical and dental benefits to our early retirees, who have not reached Medicare eligibility. You and/or your dependents will be required to pay full premium amounts to remain on the District’s plan.
Q. What is the difference between a health savings account and a flexible spending account?
A. A Health Savings Account (HSA) is only for those who have a high deductible health plan. HSA can be sent up through a vendor of the employee’s choice. The HSA contribution maximum for 2021 is $3,600. You can elect pre-tax contributions be made through payroll to your HSA. WEX will administer new payroll contributions effective July 1, 2021 (HSA contributions made through payroll prior to 7/1/2021 may continue with the HSA banking arrangement in place).
Medical, dental and vision expenses that are eligible for reimbursement through an FSA can also be reimbursed under an HSA. Although FSA dollars must be spent during the plan year elected, HSA money can be rolled from year to year, and may also be treated as a pre-tax retirement account.
Q. What is a flexible spending account?
A. A Flexible Spending Account (FSA) allows an employee to set aside pre-tax dollars to pay for eligible medical, dental, vision and daycare expenses incurred during the plan year. You can include out-of-pocket expenses incurred by you, your spouse and your qualified dependents. Maximum annual contributions for a Health Care FSA is $2,750, and the maximum annual contribution for a Dependent Care FSA is $5,000 if single or married filing jointly, and it is $2,500 if married and file separate tax returns.
The amount you contribute to a FSA reduces your taxable income. Lower taxable income means lower Federal, Social Security and state taxes.
Although the tax advantage of your FSA will vary depending on your salary level, tax filing status and contributions amounts, the following examples show the potential tax savings (Federal and Social Security taxes only) available through the reimbursement account program.
|Single Person||Working Couple||Family Person
|Without FSA or HSA||With FSA or HSA||Without FSA or HSA||With FSA or HSA||Without FSA or HSA||With FSA or HSA|
|Total Monthly Payment||$2,500||$2,500||$4,100||$4,100||$3,250||$3,250|
|Less Non-Taxable Benefits|
|Medical / Dental Expenses||$0||$50||$0||$150||$0||$250|
|Child Care Expenses||$0||$0||$0||$400||$0||$0|
|Total Pay Subject to Tax||$2,500||$2,450||$4,100||$3,550||$3,250||$3,000|
|Federal & State Taxes||$700||$686||$1,148||$994||$910||$840|
|Social Security Tax||$191||$187||$88||$76||$70||$64|
|After Tax Income||$1,609||$1,577||$2,864||$2,480||$2,270||$2,096|
|After Tax Expenses|
|Medical / Dental Expenses||$50||$0||$150||$0||$250||$0|
|Child Care Expenses||$0||$0||$400||$0||$0||$0|
|Annual Increase in Take Home Pay||$216||$1,992||$912|