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Health Insurance

The College offers the Educator's Health Alliance (EHA) Blue Cross/Blue Shield PPO health plan to full-time Faculty, Counselors and Academic Advisors. Under the BCBS PPO, eligible employees receive comprehensive health benefits and may choose in-network or out-of-network providers with each health care situation. Employees share in the cost of medical services by paying “out-of-pocket” costs (office visit and prescription co-pays, deductibles, and co-insurance.) The amount of cost share varies depending on the health care services and whether in-network or out-of-network providers are utilized.

Choice of Providers: While the BCBS network of PPO providers is extensive, not all local providers are included in the network. (Refer to BCBS PPO Directory of Providers at www.nebraskablue.com and go to "Find a Doctor".) When preferred in-network providers are utilized, members receive the highest level of benefits possible under the plan. If out-of-network providers are utilized, members are still eligible to receive benefits, but a reduced benefit level.

Effective Date: New employees must enroll within 31 days of employment, and coverage becomes effective the first of the month following the beginning date of employment.

Pre-Existing Health Conditions: New employees and “special enrollees” have up to a 12-month waiting period before pre-existing health conditions are covered. When applicable, the waiting period may be reduced by previous creditable health coverage under the Health Insurance Portability and Accountability Act (HIPAA).

Dependent Children: Children are covered until age 26.

EHA HEALTH PLAN OPTION 1
 
IN-NETWORK
OUT-OF-NETWORK

Calendar year deductible

  • Individual
  • Family

 

$500
$1000

 

$1000
$2000

Calendar year coinsurance maximum

  • Individual
  • Family

 

$2,250
$4,500

 

$4,500
$9,000

Coinsurance you pay for most covered services after satisfaction of the calendar year deductible
20% of allowable charges
40% of allowable charges
Office visit exam
$30 copay per visit-primary physician
$50 copay per visit --specialist
Subject to deductible and 40% coinsurance
Emergency services
$30 copay per visit--Urgent Care
$50 copay per visit--Emergency Room
Subject to deductible and 40% coinsurance
Preventive services
Benefits for covered services paid at 100%, subject to age, gender and frequency limits. Refer to Benefits for Preventive Services chart
Subject to deductible and 40% coinsurance
Inpatient and outpatient mental illness and/or substance abuse treatment
Subject to deductible and 20% coinsurance
Subject to deductible and 40% coinsurance
PRESCRIPTION, DRUG BENEFITS
TIER
CLASSIFICATION
COPAY/COINSURANCE
PER 30-DAY SUPPLY
OUT-OF-POCKET MINIMUMS AND MAXIMUMS PER PRESCRIPTION
   
In-Network
Out-of-Network
 
1
Generic Drugs
25%
25% + 25% penalty
$5 minimum /$25 maximum*
2
Formulary brand name drugs
25%
25% + 25% penalty
$30 minimum / $60 maximum*
3
Nonformulary brand name drugs
50%
50% + 25% penalty
$60 minimum /$90 maximum*
4
Speciality drugs
25%
50%
In-Network
Out-of Network
$50 minimum/ $100 maximum $150 minimum/ $300 maximum
INSULIN, DIABETIC AND OSTOMY SUPPLY BENEFITS
Member Coinsurance per 30-day supply
 
In-Network
Out-of-Network

Insulin and diabetic supplies

  • Generic and formulary
  • Nonformulary

 

20%
30%

 

20% + 25% penalty
30% + 25% penalty

Ostomy supplies
20%
20% + 25% penalty
CALENDAR YEAR PRESCRIPTION DRUG OUT-OF-POCKET MAXIMUMS
Per individual $2,500
Family maximum $5,000
Once the applicable out-of-pocket maximum is reached, you pay nothing for covered prescription drugs for the remainder of the calendar year.
* Does not include 25% out-of-network penalty, if applicable.
BENEFITS FOR PREVENTIVE SERVICES
Preventive Service Recommended US Preventive Services Task Force
Gender
Age
Frequency
Men Women Pregnant Women Children    
Abdominal Aortic Aneurysm, Screening
*       65 and older Once per lifetime
Alcohol Misuse Screening and Behavioral Counseling Intervention
* *       One per calendar year
Alcohol and Drug Assessment, Developmental /Behavioral Assessment
      *    
Aspirin for the Prevention of Cardiovascular Disease
*
*
   
Men:45 to 79
Women:55 to 79
Subject to plan's retail day supply limit
Asymptomatic Bacteriuria in Adults, Screening
   
*
     
Autism Screening, Developmental/Behavioral Assessment
      * up to age 3  
Breast Cancer, Screening (mammogram)
 
*
*
 
40 and older
One per calendar year
Breast Cancer, Discuss Chemoprevention When at High Risk
  *        
Breast and Ovarian Cancer Susceptibility, Genetic Risk Assessment and discussion of BRCA Mutation Testing (based on family risk factors)
 
*
*
     
Breastfeeding, Primary Care Interventions to Promote Breastfeeding
 
*
*
     
Breastfeeding Support, Supplies, and Counseling
  * *     Pumps: One pump per pregnancy; Lactation support and counseling: No frequency restrictions
Cervical Cancer, Screening (Pap smear)
  * * *   One per calendar year
Chlamydial Infection, Screening
  * *      
Colorectal Cancer, Screening (Screenings include: colonoscopy, signoidoscopy, proctosigmoidoscopy, barium enema, fecal occult blood testing, laboratory tests, and realted services)
  * *   50 and older

One every 5 calendar years

One per calendar year for fecal occult blood test

Congenital Hypothyroidism Screening (newborns)
      * Up to age 1  
Contraceptive Methods and Counseling (female contraceptive methods)
  *        
Contraceptive Methods (Pharmacy) (excluding over-the-counter)
  *       Subject to plan's retail day supply limit
Dental Caries in Preschool Children, Prevention (prescribe oral fluoride if deficient in water)
     
*
6 months up to age 6
Subject to plan's retail day supply limit
Depression (Adults) Screening
* *        
Development Screening, Development/Behavioral Assessment
      * Up to age 3  
Developmental Surveillance, Development/Behavioral Assessment
      *    
Diabetes Mellitus (Type 2) in Adults, Screening
* *   *    
Diabetes, Screening for Gestational Diabetes
    *      
Diet, Behavioral Counseling in Primary Care to Promote Healthy Diet (adults with hyperlipidemia and other risk factors)
* *       Up to 9 visits per calendar year
Evaluation and Management Services (E/M)(periodic preventive examination/office visit)
*
*
*
*
 
Newborn up to age 6 unlimited; annually thereafter
Folic Acid, Daily Suppliement of
 
*
*
   
Subject to plan's retail day supply limit
Gonorrhea, Screening
  * *      
Gonorrhea, Prophylactic Eye Medication (newborns)
      *    
Hearing Loss in Newborns, Screening
      * Up to age 1 month  
Hearing, Sensory Screening (beyond newborn screening)
      * Up to age 22 One per calendar year
Hepatitis B Virus Infection, Screening
    *      
High Blood Pressure, Screening
* *   *    
HIV Screening and Counseling (at risk and all pregnant women)
* * * *
*
*
Human papillomarlus (HPV), Screening
*
*
*
*
*
*
*
Interpersonal and Domestic Violence, Screening and Counseling   *    
*
*
*
Immunizations * * * *    
Iron Deficiency Anemia, Prevention-Hemocrit or Hermoglobin Screening (at risk older babies)
*
*
*
*
Up to age 2
Lab tests are not limited. Drugs are subject to plan's retail day supply limit
Iron Deficiency Anemia, Screening
    *      
Lipid Disorders in Adults, Screening (cholesterol)
* *       One every 5 calendar years
Lipid Dyslipidemia Screening for Children (cholesterol)
      *   One every 5 calendar years
Major Depressive Disorders in Children and Adolescents, Screening
      *    
Obesity in Adults, Screening
* *        
Obesity in Children, Screening
      *    
Oral Health Screening
      *    
Osteoporosis in Women, Screening (bone density testing)
  *    
60 and older
One every 2 calendar years
Phenylketonuria (PKU), Screening (newborns)
      * Up to age 1 One per lifetime
RH (D) Incompatibility, Screening
    *      
Sexually Transmitted Infections, Counseling
* *   *    
Sickle Cell Disease, Screeing (newborns)
      * Up to age 1  
Syphilis Infection, Screening
* * * *    
Tobacco Use and Tobacco-Caused Disease, Counseling (including tobacco/nicotine cessation drugs and deterrents)
* *   *   Medical: Up to 8 visits per calendar year. Drugs and deterrents are subject to plan's retail day supply limit
Tubercluine Test, Screening
* *   * Up to age 22  
Vision, Sensory Screening
      *
Up to age 22
One per calendar year
Visual Impairment in Children Younger than 5 years, Screening
      *
Up to age 5
One per calendar year

Prescription Drug Mail Order Service: BCBS members can save money when filling prescriptions for “maintenance” medication used to treat chronic or long-term conditions; for example, blood pressure and diabetes. When you use PrimeMail, the most you will pay for a 180-day supply of a covered drug is five times maximum for a 30-day supply, subject to the applicable coinsurance maximum.

*IMPORTANT: The mail order service program benefits are subject to a specific list of covered maintenance medications. For more information on the prescription mail service program, go to www.nebraskablue.com and go to "Member Services".

MyRxHealth.com: MyRxHealth.com is the powerful and secure pharmacy benefit website for Blue Cross/Blue Shield members. Features include: on-line refills for existing PrimeMail (mail order) prescriptions, review your drug history, perform drug list/formulary search, compare estimated retail costs to mail service costs, learn about generic alternative, and access detailed information on health and disease topics.

Discount Program: BCBS members are eligible to receive discounts on vision care and hearing care services. Members also enjoy exclusive discount offers on fitness, travel, weight management, and more, through Blue365! For more information, go to www.nebraskablue.com and click on "Member Services".

To obtain the above discounts, you must show the participating vision or hearing care provider your BCBS ID card and pay for the services at the time care is received. This is a discount program only. No BCBS claims are filed. For more information, go to www.nebraskablue.com and click on "Member Services".

HEALTH & DENTAL COVERAGE



EMPLOYEE COSTS
EFFECTIVE 9/1/13
(Per pay period)

EE Health/EE EE Dental $0.00
EE Health/EE & Child(ren) Dental $0.00
EE Health/EE & Spouse Dental

$0.00

EE Helth/EE & Family Dental $0.00
   
EE & Child(ren) Health/EE Dental $0.00
EE & Child(ren) Health/EE & Child(ren) Dental

$0.00

EE & Child(ren) Health/EE + Spouse Dental $0.00
EE &Child(ren) Health/EE + Fanily Dental $0.00
   
EE & Spouse Health/EE Dental

$0.00

EE & Spouse Health/EE & Child(ren) Dental $0.00
EE & Spouse Health/EE & Spouse Dental $0.00
EE & Spouse Health/EE & Family Dental $0.00
   
EE & Family Health/EE Dental $0.00
EE & Family Health/EE & Child(ren) Dental $21.27
EE & Family Health/EE & Spouse Dental $27.53
EE & Family Health/EE & Family Dental $45.54
 

 

EE Dental Only $0.00
EE & Child(ren) Dental Only

$0.00

EE & Spouse Dental Only $0.00
EE & Family Dental Only $0.00

IMPORTANT: Employees may pay their share of the health and dental costs on a "before-tax" basis through a Section 125 Compensation Reduction Agreement. In accordance with IRS regulations, an employee may change his/her pre-tax election mid-year only if the employee (or eligible dependent) experiences an IRS-qualifying “change-in-status” event and the change is consistent with the event.

Employees must contact the Human Resources Office immediately due to a “change of status” event such as: involuntary loss of other health insurance coverage; marriage, divorce, birth, adoption; spouse changes employers or spouse’s employer offers an open enrollment; dependent reaches limiting age of 26 or dependent becomes eligible to enroll in his/her own employer's health plan. There is a limited 30-day (60 day for loss of Medicaid) special enrollment period from the date of the qualifying event to apply for a change in health insurance coverage.

CASH-IN-LIEU-OF: Eligible employees may receive “cash-in-lieu-of” (CILO) health insurance if the employee provides evidence of other creditable health insurance for themselves and/or their dependents. Payments are spread over a 12-month (or 9 month) period and are taxable as income. Cash-in-lieu-of health insurance is not part of the employee’s regular earnings and is subject to change.

No Health or Dental
Employee Only Health OR Dental Only
$2200/year Cash-in-lieu of
$1850/year Cash-in-lieu of

BCBS Customer Service: 1-877-721-2583.

Website:www.nebraskablue.com

HR Contact: Julie Nohrenberg, 402-457-2232 or Karla Stoltenberg, 402-457-2235

 
 
 
 
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