Your ICUBA Health Benefits

1
Your ICUBA Health Benefits
FEBRUARY 2006

• Open Enrollment 2006
• NOVA SOUTHEASTERN UNIVERSITY

2
ICUBA BenefitsIndependent Colleges and
Universities Benefit Association

• Medical
• Dental
• Vision
• Flexible Spending Account
• Health Reimbursement
• Account

The Plans you enroll in or re-enroll in will
cover you April 1, 2006 through March 31, 2007.
If you are not making any changes to your
current plans, no further action is required.
3
The ICUBA program now has 6,200 employees
participating from 10 ICUF schools
4
What's New with ICUBA

• 3,500 Employees participate in Consumer
  Directed Health Plans with Health Debit Cards
• ICUBA has been able to keep premiums stable with
  single digit rate increases on Consumer Directed
  Health Plans.
• ICUBA continues to spend less than 12 of premium
  dollars on administrative expenses, including
  monies paid to BCBS. That means 88 cents of each
  dollar is spent directly on benefits.

5
What's New with ICUBA

• Wellness Benefits have been enhanced
• No Age Limit on Fecal Occult Blood Test
• Additional Tests available and Six Nutrition
  counseling sessions for Members Diagnosed with
  Obesity
• Extension of Health Risk Appraisal Incentive.
  During two periods each Plan Year, from 2/1- 4/30
  and 9/1- 11/30, ICUBA will give Employees an
  opportunity to receive a 25 incentive by taking
  the Health Risk Appraisal by logging onto
  www.mybenefitshome.com
• ICUBA also gives a 25 incentive to any
  participant of the plan who is pregnant and takes
  a Maternity Health Risk Appraisal

6
What's New with ICUBA

• Enhanced Shared Decision Making and Member
  Outreach
• Preadmission planning tools with Blues on Call
• Outreach from a RN when in the hospital
• Discharge Planning and support
• RX Quantity Level Limits to ensure that each
  member is being prescribed an appropriate dosage
  of specific drugs per FDA guidelines.
• At the Pharmacy, the approved dosage of these
  specific drugs will be approved and your doctor
  will be engaged to see if an exception should be
  made
• Specialty Drugs will no longer be available via
  Mail Order

7
What's New with ICUBA

• ICUBA will cover dependents up through the end of
  the calendar year in which they turn 25 years of
  age providing they meet IRS Eligibility criteria,
  even if they are not a student
• OTC Drugs Expenses allowed under HRA
• Domestic Partner Coverage offered
• ICUBA and NSU will offer a Health Reimbursement
  Account for employees electing Risk/Reward Plan
  and PPO 70 Plan

8
What's New with ICUBA

• ICUBA invests in their members by providing
  enhanced benefits by paying 100 of total costs
  of the following services

• Mammogram
• PAP Smears
• PSAs
• Urinalyses
• General Health Blood Panels
• Venipuncture and Services
• ECGs
• Fecal Occult Blood

• 1st reported Bone Mineral Density test each
  Benefit Plan Year
• 1st reported Colonoscopy each Benefit Plan
  Year
• All recognized Immunizations, including all
  recommended Wellness Screenings and Immunizations
  for plan participants age 19 and under.

9
Online Enrollment Deadline

• MARCH 10, 2006

Make your benefit plan changes online at
www.webstar.nova.edu New benefit elections are
effective April 1, 2006, you must enroll or
make changes online by the deadline.
10
Special Note
New hires are eligible for health coverage
effective their first day of employment.
Therefore, anyone hired through March 31, 2006
wishing to enroll in the current health plans
must do so via www.webstar.nova.edu. New
hires not wishing to make any further changes
after their initial enrollment are required to
take no further action. New Hires who wish to
make changes must do so during open enrollment in
www.webstar.nova.edu
11
Tools to Facilitate Your Enrollment

• NSU Benefits web site new and improved for easy
  use,
• available 24/7 www.nova.edu/cwis/hrd/benefits
• Email your questions to ohrbenefits_at_nsu.nova
• HR Representatives are available in OHR/Benefits,
  
• Monday Friday, 9am to 4pm

12
ICUBA and Blue Cross Blue Shield of Florida

• Medical insurance plans will continue to be
  administered by Blue Cross Blue Shield of
  Florida/Highmark
• BCBS/ Highmark will process claims and administer
  the health plan, provide PPO network of providers
  and provide prescription coverage.
• BCBS offers worldwide coverage to members
  traveling outside of the U.S.
• BCBS provides an EAP plan for all NSU employees
  through Magellan

13
Blue Cross Blue Shield Medical Plan Options
PPO 80 PPO 70 PPO Risk/Reward
14
PPO PLAN Similarities and Differences

• Similarities
• Prescription Drug Benefit
• Annual Wellness Benefit
• Plan Rules
• Network of Providers
• 24/7 Health Info Hotline
• ER Urgent Care (in network)

• Differences
• Premiums
• Deductibles
• Coinsurance
• Copays
• Annual Out-of-Pocket Maximums
• HRA contributions for PPO Risk/Reward Plan and
  PPO 70

15
Blue Cross Blue Shield ID Card
First Name Last Name ID
ABC123456789001 COPAY OV SP ER
GR
ICUBA
BC PLAN 363 BS PLAN 865
Card uses unique identifier not your social
security number
16
Blue Cross Blue Shield BlueCard PPO Program
Broadest National Network your benefits travel
with you Greatest Access of Physicians and
Hospitals in Florida and across the US No
Primary Care Physician requirements or
referrals Deepest Network Discounts Savings for
Employees Savings for ICUBA
17
Blue Cross Blue Shield BlueCard PPO Program
Using In-Network Providers Saves
money Providers agree to reduced fees Higher
level of benefits Less hassle Provider
handles claim forms
18
Blue Cross Blue Shield BlueCard PPO Program
Using Out-of-Network Providers Your
Responsibility Pay for your care at the time
of service File claim forms Reimbursement
after your cost sharing requirement May be
balance billed
19
Medical Definitions Review

• Copay A flat fee charged to an insured
  employee as specified by the plan. A copay DOES
  NOT accumulate towards the deductible or
  out-of-pocket maximum.
• Deductible A dollar amount that must be paid by
  the insured for health or dental services before
  the claim becomes payable by the carrier. The
  deductible DOES accumulate toward out-of-pocket
  maximum.
• Coinsurance The employee portion of the health
  expense for services such as, but not limited to,
  facility/hospital charges, laboratory charges,
  physician services (surgery, anesthesia,
  radiology, pathology, etc.). Coinsurance DOES
  accumulate toward out-of-pocket maximum.

20
Medical Definitions Review

• Preauthorization An authorization that must be
  obtained from carrier prior to inpatient medical
  procedures only. (This is not the same as a
  referral PPO plans do not require referrals).
• Out-of-Pocket The maximum risk threshold, or
  maximum dollar amount that the insured will pay
  for covered health care services in addition to
  premium payments.
• Certificate of Prior Creditable Coverage A
  document detailing the period of prior coverage
  for a new employee. It is used for the purpose
  of determining creditable coverage under HIPAA
  regulations.

21
In-Network Plan Comparison
22
In-Network Plan Comparison
23
Annual Plan Cost Comparisonworst case scenario
24
BCBS Telephonic Member
Customer
Service

• Toll Free Number
• Staffed Monday Friday
• From 800 am 500 pm EST
• Website www.mybenefitshome.com
• Voice Mail
• After hours calls returned within 24 48 hours

1-800-470-2963
25
Blue Cross Blue Shield
Online Capabilities

• Effective April 1, 2006
• Access to Blues on Call Health Coach 24/7
• Wellness Programs including Health Risk Appraisal
• Email Questions to Member Services
• Rx Information
• Review formulary
• Renew Mail Order Prescriptions
• Locate a Pharmacy Near You

www.mybenefitshome.com
26
My Benefits Home
27
Blues On Call sm

• Registered Nurse Assistance
• 24 hours a day, 7 days a week
• Available for
• Case management support
• Health care decision making support
• General health information
• Audio Library
• 1-888-BLUE-428

28
Blue Cross Blue ShieldPharmacy Program

• Formulary list provider information is
  available online
• www.mybenefitshome.com

29
Blue Cross Blue ShieldPharmacy Program

• Pharmacy Benefit Manager Medco
• 60,000 participating pharmacies
• Retail Co-Payments
• Generic 10.00
• Brand formulary 25.00
• Brand non-formulary 50.00
• Mail Order Drug Program
• Home delivery
• 90-day supply
• Co-payments Two times retail

30
HRA and FSA Differences

• Flexible Spending Account
• Funded by employee pre-tax dollars
• Available for Medical and Dependent Care expenses
• No carry-over of funds from year to year (by law)
  
• Use-it-or-lose-it
• FSA funds expended before tapping into HRA funds
• Can have FSA and no HRA

• Health Reimbursement Account
• Funded by NSU
• Available for PPO Risk/Reward Plan and PPO 70
  Plan
• Funds rollover at the end of each plan year
  indefinitely
• Portable after 36 months of continuous
  participation
• Can have HRA alone with no FSA

31
Health Reimbursement Account

• Funded by NSU to help employees pay for
  deductibles, other eligible medical out-of-pocket
  costs
• Funds are deposited on a monthly basis at the end
  of the month and earn interest each quarter
• Balances available at end of plan year rollover
  to next plan year in secure trust fund separate
  from ICUBA funds
• Funds available via the ICUBA MasterCard debit
  card issued by MBI Bank and administered by
  Outsource One, or by filing a paper claim
• Portable after 36 months of participation
• Can be used in conjunction with FSA

32
Health Reimbursement Account

• Eligible Expenses
• Out-of-pocket medical expenses for persons
  covered under the PPO Risk/Reward and PPO 70
  Plans
• COBRA, long-term care, employee retiree health
  premiums
• Non-Eligible Expenses
• Life, long-term disability, and other pre-tax
  premiums
• Non-medical expenses, cosmetic or other
  non-medically necessary expenses
• Non-dependent expenses, individuals not covered
  under the PPO Risk/Reward Plan or PPO 70 and
  domestic partners who are not tax dependents

33
Medical Flexible Spending Account

• Funded by employee with pre-tax contributions and
  used to pay for qualified medical expenses
• For convenience, NSU will pre-fund the employees
  annual on the first day of the plan year
• Bi-weekly pre-tax deductions will be made from
  the employees paycheck
• Funds available by using the ICUBA health debit
  card issued by MBI Bank and administered by
  Outsource One, or by filing a paper claim

34
Medical Flexible Spending Account

• Substantiation of expenses required need to
  submit itemized receipts for non-ICUBA health
  plan expenses i.e., cold medication or vitamins,
  or charges above set co-payments.
• Transaction denied
• If account suspended pending substantiation
• If no funds available in account
• Subject to use-it-or-lose-it rule
• Reimbursement requests may be submitted until
  June 30,
• (3 months after plan year ends expense must
  occur within plan year)

35
Dependent Care
Flexible Spending Account

• Funded by employee with pre-tax contributions and
  used to pay for qualified dependent care expenses
• Maximum annual limit of 5,000
• Dependents dependent under age 13, physically or
  mentally challenged adults who are unable to care
  for themselves can not earn more than 3,200 a
  year
• Funds available by using the ICUBA MasterCard
  debit card issued by MBI Bank and administered by
  Outsource One, or by filing a paper claim
• Subject to use-it-or-lose-it rule

36
Health Reimbursement Account PPO Risk/Reward
Plan PPO 70 Plan

• HRA available to employees who choose the PPO
  Risk/Reward Plan with monthly contributions from
  NSU as follows PPO RR PPO 70
• Employee 110.00 20.00
• Employee and Spouse 140.00 32.00
• Employee and Child/ren 145.00 45.00
• Family 155.00 60.00
• Married EEs with Family 265.00 80.00

37
ICUBA MasterCard Debit Card

• Can be used for eligible medical and dependent
  care expenses with flexible spending accounts and
  health reimbursement accounts
• Funds available through ICUBA MasterCard Debit
  Card issued by MBI Bank and administered by
  Outsource One
• Electronic debit at point of service/sale or
  submit hard copy reimbursement request to
  Outsource One
• Participants will be required to provide
  substantiation (itemized receipt) for non-ICUBA
  health plan and dependent care expenses
• If no funds available in account, transaction
  denied
• If account is suspended pending substantiation,
  transaction denied
• SmartCard technology-card will use flex spending
  account funds first, and then health
  reimbursement account funds

38
MAGELLANEmployee Assistance Program

• Employee Assistance Program (EAP) available to
  help employees balance work and life matters
• Completely Confidential
• Available to all NSU employees, whether or not
  they elect to participate in ICUBA medical
  insurance coverage
• FREE!

39
EAP Benefits
1-800-416-0835 MagellanHealth.com

• 24-hour online and toll-free number access
• Licensed counselors with masters degree in
  social work or other human services, minimum of 5
  years practical experience
• Provides prepaid, confidential assessment,
  counseling, and referral services (no charge to
  employee or household members)
• 6 visits per issue, seamless referral to BCBS
  provider, as needed

40
Bi-weekly Medical PremiumsMonthly HRA
Contributions
41
ICUBA Dental from CompBenefits
Sealants and space maintainers require a
copay. Out of Network Services in the PPO are
paid at the discounted PPO provider fee and
balanced billed. There is no balance billing in
network.
42
ICUBA Vision from VisionCarePart of CompBenefits
43
ENROLL TODAY!

• Enrollment information
• can be found online at www.nova.edu/cwis/hrd/bene
  fits.html
• Sign on to WebSTAR from NSUs homepage at
  www.nova.edu
• This requires
• NSU ID
• WebSTAR Pin (refer to your Pin Mailer or contact
  the Office of Information Systems and Technology
  at extension 4850)

44
WebSTAR Notes

• Click the Complete button once you have
  finished with your elections and before you try
  to attach your dependents.
• Attach your dependents to your selected plans.
• If you wish to remove a dependent from a plan,
  enter 03/31/2006 as the benefit plan termination
  date. This date will not be visible when you
  finish because is a future effective date.
• If you select Restart, all of your previous
  selections will be deleted and you must begin the
  process again.

45
Adding/Removing A Dependent due to a Life
Status Change
If your new dependent is not enrolled within 31
days of status change they will not have benefit
coverage. If this occurs, you can enroll
dependent during next open enrollment period. In
this situation, your dependent may be subject to
pre-existing condition limitations of the plan.

• Life status changes include change in marital
  status, birth, adoption, death of a dependent,
  and change in employment status of spouse or
  dependent
• Covered for benefits on the day of status change
  provided plan change made within 31 days of the
  life status change
• Email OHRbenefits_at_nova.edu to add/remove a
  dependent

46
THANK YOU!

• Thank you for viewing the Nova Southeastern
  University 2006 Open Enrollment Benefits Plan
  Presentation.
• If you have any questions, please email the
• Office of Human Resources Benefits Department at
  www.nova.edu/cwis/hrd/benefits
• or call [phone]