Benefits briefing: More about medical coverage

The UNMC Benefits Office has composed a list of the most frequently asked questions concerning benefits. This week, UNMC Today will have articles addressing those questions. If you have a specific question, please email the benefits office.

Annual NUFlex Enrollment for employee benefits begins at 8 a.m. CST, Monday, Oct. 31, and runs through Friday, Nov. 18, 5 p.m. CST.

Today’s question and answers is Part 2 about the medical coverage offered by the University of Nebraska.

Q: What are the wellness benefits provided under each plan?

A: All three PPO plans offer 100% coverage for preventative services for dependents under the age of 2 years old. For the employee and covered dependents age 2+, you are allocated $250 toward preventative services. Any preventative services costing more than the $250 will be billed to your deductible and co-insurance. The plan also provides a free annual screening for a routine mammogram that is processed separately from the $250 preventative allowance.

For the High Deductible Health Plan, preventative services provided by a preferred tier or in-network provider will be paid at 100%.

 Q: What is the Health Risk Assessment and what are the benefits of taking it?

A: The Health Risk Assessment is a brief survey that employees are encouraged to take each year during Annual NuFlex Enrollment. The link for this survey can be found at the top of the medical section under the NuFlex Enrollment tile.

Employees who are enrolled in one of the PPO Plans and complete the assessment will receive the following enhanced benefits:

  • An increased preventative allowance for all covered dependents ages 2+. The allowance will go from $250 to $400 for that calendar year.
  • $0 generic drug co-pay through CVS Caremark’s mail order program. To sign up, visit CVS Caremark online or call 1-866-239-4704.
  • A routine colonoscopy through an in-network provider after age 45 (one every 10 years)
  • $0 copay for flu shots administered at an in-network pharmacy and submitted to the prescription drug program.

Q: What are the co-pays for prescription drugs?

A: Here is the pricing for a 30-day supply under the PPO plans:

  • Generic: $9
  • Brand Name (Formulary): $31
  • Brand Name (Non-Formulary): $52

Please note: There is a $57 annual deductible on the prescription drug plan. This deductible is waived for generic prescriptions.

For employees that elect the HDHP, prescription drug costs are applied to the deductible and co-insurance. This means that you will be charged the full price of each prescription until you have met your deductible.

Q: What happens when an employee or covered spouse turn age 65 while on a medical plan with the university:

A: If the employee and/or spouse are covered under one of the PPO plans, you are able to stay on these plans. We do not require you to enroll in a Medicare supplement; however, we do encourage you to apply for Part A of Medicare. Once an employee or dependent are no longer covered by an employer plan, they are encouraged to sign up for a Medicare supplement, as penalties can be incurred for not enrolling after employer coverage is terminated.

If an employee and/or spouse are enrolled in the HDHP, they are able to stay on this coverage after attaining the age of 65; however, if they sign up for any part of Medicare, including Part A, they will no longer be allowed to participate in the Health Savings Account.

Also, if the employee or spouse delays enrolling in Medicare, they will need to stop contributing to their Health Savings Account at least six months prior to their enrollment date. This is due to Medicare Part A enrollments becoming effective with up to six months of retroactive coverage. If the Health Savings Account is not stopped at least six months prior to the Medicare enrollment, there may be a tax penalty incurred.

Q: Are employees able to keep their medical coverage through the university upon retirement?

A: Yes. We would encourage any employee looking at retirement to contact the benefits office and set up a meeting to go over all retiree benefits.

If you have questions or concerns pertaining to benefits enrollment, please contact the benefits office to schedule a one-on-one meeting. Meetings can be scheduled via email or by calling 402-559-4340.

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