Your Insurance

1
Your Insurance Flex Benefits
2
You are eligible to enroll in UAMS benefits if

• You are in a regular staff or faculty position
  (not temp, not student), and
  
• Your appointment is 50 or greater (you work 20
  hours or more per week), and
  
• You are hired to work for at least 6 months.

3
What benefits are offered?

• Medical insurance
• Dental insurance
• Life insurance
• Basic Life
• Optional Life
• Dependent Life
• ADD

• Long-Term Disability insurance
• Basic and Optional LTD
• Section 125 Flex Plan
• Premium Conversion
• Flexible Spending Accounts

4
Enrollment Window

• One month, 31 days max from your date of hire
  into a benefits-eligible position.
  
• During this time you can enroll in any of the
  group benefit plans, no health screenings.
  
• Mark the one month date on your calendar so you
  dont miss the deadline.

5
Is there a waiting period for coverage to take
effect?

• Yes !
• Based on the date you sign up (within 31 day
  window), your coverage will start on the first
  day of the NEXT calendar month.
  
• If you turn in insurance forms today, your
  coverage will take effect on _____________.
  

6
Examples of Effective Dates
7
More on effective dates

• Make sure your benefits are in effect before you
  see a doctor or fill a prescription.
  
• The deduction from your paycheck will be for past
  coverage. For example, the deduction from your
  Jan 31 monthly paycheck is to pay for your
  January 1-31 coverage.
• If youre paid monthly, your first deduction will
  be a full deduction.
  
• If youre paid biweekly and the pay period does
  not begin exactly on the 1st day of the month,
  your first premium will be prorated.
  

8
Who can you cover?

• You can cover these persons on your Medical and
  Dental plans
  
• Your lawful spouse
• Your unmarried child through age 18, or through
  age 24 if a full-time student. Includes
  
• Natural child
• Adopted or foster child (court documentation
  required)
  
• Your step-child if they live with you in a
  parent-child relationship at least half of the
  year. (Even if your spouse is court-ordered to
  cover a child, you cannot cover the child unless
  they live with you.)
• Grandchildren, nieces and nephews are NOT
  eligible for coverage unless you have full
  custody and have legally adopted them (court
  documentation is always required), and a parent
  of the child does not live with you.
• Be sure to visit Human Resources within 31 days
  regarding the eligibility status of a dependent
  (i.e., marriage, new baby, divorce).
  

9
Children over age 18

• You must provide documentation twice a year to
  our plan administrators (QualChoice and Delta
  Dental) to verify your student is still taking
  classes full time.
• When your child is no longer eligible, you must
  always notify Human Resources. It may affect
  your premium costs.

10
Medical Insurance
11
Medical Insurance

• UA plan (self-funded and self-insured)
• Third Party Administrators who processes the
  claims?
  
• Medical benefits QualChoice of Arkansas
• Prescription benefits PharmaCare
• Refer to rate sheet for premiums
• 2 plans to choose from POS Classic

12
You choose your Medical plan

• CLASSIC (Classic Managed Care Plan)
• All services must be rendered by your Primary
  Care Physician or other UA QualChoice network
  provider. Similar to an HMO.
  
• POS (Point of Service Plan)
• In-network benefits similar to Classic, but also
  provides reduced benefits for out-of-network
  care.
  
• Refer to Medical Plans Benefit Comparison
• If you live in another state without access to
  QualChoice network providers, ask about the
  Alternative POS plan.
  

13
Definitions

• Copay the flat dollar rate you pay per office
  visit, hospital stay or prescription.
  
• Deductible the annual fixed dollar amount you
  pay before insurance pays. Excludes copays.
  
• Coinsurance the of the bill you pay after
  youve satisfied your deductible and/or copay
  (you pay a , insurance covers a )
  
• Out-of-Pocket Max annual maximum coinsurance
  you would pay per calendar year (excludes copay
  and deductible) then insurance pays 100.
  
• Network provider Physician or other health
  care specialist who is listed in the UA
  QualChoice directory. Little Rock hospitals in
  the network are UAMS, ACH and St.
  Vincent's/Doctors, not Baptist or Heart
  Hospital.

14
In-network benefits that are the same for Classic
and POS

• 200 copay per inpatient admission deductible
  1,000 maximum out of pocket individual (2,000
  family)
  
• Preventive care covered
• Routine vision exam covered once every 12 months.
  You pay 20 copay to see any optometrist or
  in-network ophthalmologist.

• You pay 20 copay to see your PCP or Ob/Gyn doc.
  Covers services performed in physicians office.
  
• 35 copay to see other network physician
• You pay 500 deductible (1,000 family) and 20
  coinsurance on other services outside doctors
  office
  

15
In-network benefits that are different

• POS 30 mental health visits max per year
• POS a portion of TMJ covered

• Classic 10 mental health visits max per year
• Classic TMJ not covered

16
Out of network benefits

• Classic None !
• POS
• You first pay 1,000 (2,000 family) as
  deductible.
  
• Then insurance covers 60 based on Maximum
  Allowable Charges. Your out-of-network doctor
  may balance bill you the amount over
  QualChoices fee schedule. Your actual cost may
  be 40 difference between actual and allowable
  expenses. Your coinsurance out-of-pocket max
  is 5,000 (10,000 family).
• Separate 200 copay for hospital admission
• No benefits for preventative care

17
Maternity Benefits Classic and POS In-Network

• 20 copay for initial visit to Ob/Gyn PCP
• 500 annual deductible
• 200 Copay for inpatient hospital stay 20
  coinsurance (same as any other hospital stay)
  until 1,000 coinsurance max is reached.
  
• Must add newborn through your Human Resources
  Office within 31 days of birth in order for the
  baby to be covered.

18
Emergency Benefit (same for Classic POS)

• 100 Emergency Room Copay - waived if admitted
• 100 Ambulance Copay - waived if admitted
• Covered anywhere in the world for sudden onset of
  any unforeseen illness or accident.
  
• If out of state without access to network
  providers, you may lower your costs by going to a
  provider in the national Private Health Care
  Systems (PHCS) network (www.phcs.com).
• You must notify QualChoice if you are admitted to
  any nonparticipating hospital.
  
• If possible, use network hospitals for emergency
  services.

19
Regardless of the plan you choose...

• Select a PCP (primary care physician) to receive
  maximum benefit. Not necessary for female to
  select an Ob/Gyn you can see any Ob/Gyn doctor
  in the network.
• Each family member may have a different PCP.
• You may change your PCP at any time. Notify
  QualChoice by the 25th of a month and it to be
  effective the 1st of next month.
  
• If your PCP refers you to another doctor in the
  network, no QualChoice referral approval is
  necessary.
  
• When in doubt as to your coverage or plan
  benefits, contact QualChoice at 219-5133 (special
  number for UA employees) or log in at
  www.qcark.com.

20
Classic vs. Point of Service

• Once you select a plan, youre not locked into it
  forever.
  
• End of every year (mid November through mid
  December) you may change to the other plan
  effective January 1. This only applies to
  employees who are already enrolled in Medical.
  
• We do NOT have open enrollment every year !!!

21
Prescription Drugs
30-day supply covered same under
Classic and POS plans Maintenance drugs may b
e obtained in a 90-day supply, 3 copays.

• 10 Generic copay
• 30 Preferred brand name copay
• 50 Non-preferred brand name copay
• Please refer to the UA Drug Formulary.
• Show it to your physician when drugs are
  prescribed to see if a less expensive generic
  drug is available.

22
Insurance Card

• QualChoice will send you medical cards for each
  family member. They will not use your Social
  Security number for ID purposes. You will be
  assigned a unique member number.
• If you have medical expenses after your coverage
  begins but before you get your cards, you may
  have to pay from your own pocket. But you can
  file a QualChoice claim and be reimbursed.

23
Prescription Card

• PharmaCare will send you a prescription benefit
  card. Present this to your pharmacist when
  filling a prescription.
  
• If you need to fill a prescription before you get
  your card, ask your pharmacist if they can wait
  and file the claim later, once youre in
  PharmaCares computer. Or you might have to
  pay the full cost of the drug from your pocket
  then file the claim to a paper claim to be
  reimbursed.
• Visit www.pharmacare.com for a list of
  participating pharmacies. Also find out what
  your cost will be for your prescription ahead of
  time.

24

• Check out QualChoices website, www.qcark.com.
• After registering as a Member you can
• Check status of claims
• Order new ID cards print temporary cards
• Change PCP
• View a description of your benefit plan drug
  formulary
  
• Read current and past issues of newsletters

25
2 more benefits when you log into www.qcark.com

• Edocamerica Convenience of getting medical
  advice from physicians via the Internet, possibly
  saving an office visit.
  
• QCare Disease management and wellness
  counseling for asthma, diabetes, high blood
  pressure, high cholesterol, etc.
  
• Links to both websites are on Human Resources
  website, www.uams.edu/ohr.
  

26
Dental Insurance
27
Dental Insurance

• UA Plan (self funded self insured)
• Third Party Administrator Delta Dental of
  Arkansas
  
• Preventative plan. No orthodontia benefits.
• Annual Deductible 50 per individual
• See rate sheet for premium cost

28
Dental Insurance

• Covers 2 routine visits per year. Includes
  periodic exams, x-rays, cleanings, sealants for
  children.
  
• Then 50 deductible must be satisfied before
  other, non-routine benefits are paid.
  
• 80 coverage on restorative services such as
  fillings and extractions.
  
• 50 coverage on major services such as dentures,
  bridges, crowns, etc.
  
• 1,500 maximum annual benefit

29
Dental Insurance

• You dont have to pick a dentist. See any
  dentist you want. Insurance pays based on what
  your network your dentist is in.
  
• You get your best benefit by seeing a dentist in
  the Preferred network.
  
• Preferred (best benefit for restorative or major
  services)
  
• Premier (no difference between Preferred and
  Premier for routine services)
  
• Non-participating dentist (benefit is 90 UCR)

30
Adding Children to Your Dental Plan

• Our plan lets you add children at any time up
  through age 3 years.
  
• But if you pre-tax your dental premiums, IRS
  regulations take over. You can only add your
  child at the end of year before they reach age 3
  (coverage would take effect Jan 1 of new calendar
  year).
• Easy rule of thumb check with HR when your
  child has 2nd birthday.

31
Dental Card

• Delta Dental will send you a welcome letter but
  not a card. You actually dont need a card.
  But you may use the one in your packet to write
  in your name and use as a handy reference for
  Deltas phone number.
• This card is not proof of insurance. Your
  dentist will verify your coverage and file a
  claim electronically through Deltas website.
  
• Once your coverage begins, register as a
  Subscriber at www.deltadental.com to view
  benefits and claim status.

32
Campus Dental Services

• CHRP Dental Hygiene Clinic
• 15 cleanings (10 for children 6 and under)
• 1st floor, Ward Bed Tower

33
Premium Conversion through Section 125 Flex Plan
34
Premium Conversion

• Applies to your share of Medical and Dental
  insurance premiums
  
• You may elect to pay these premiums on a pre-tax
  basis.
  
• Decreases your taxable income reported on your
  W-2
  
• Increases your take-home pay because less taxes
  are deducted
  
• Most employees elect this benefit to maximize
  their take-home pay.

35
Premium Conversion

• Your risk You cant make a mid-year change to
  your coverage, such as dropping coverage on
  yourself or family members. You would have to
  wait until the end of the calendar year, or be
  within 31 days of a qualified change of status
  event.
• Consider enrolling on an after-tax basis if you
  think you might drop coverage before end of the
  year.
  
• You may change your Premium Conversion election
  at the end of each year (by mid-December), to
  take effect January 1.
  

36
Qualifying Changes in Status include
(as defined by IRS complete list in HR)

• Gain or loss of dependent
• Marriage, divorce, legal separation or annulment
• Death of spouse or dependent
• Birth or adoption
• Spouse loses coverage due to loss or change of
  employment
  
• Your benefit change must be on account of and
  consistent with the qualifying change in
  status.
  
• Be sure to notify HR within 31 days!

37
This may be your only chance to enroll in Medica
l or Dental!

• The University does NOT have annual open
  enrollment nor evidence of insurability (EOI)
  application process
  
• If you are declining coverage because you have
  other coverage, make absolutely sure you are
  covered under the other planget written
  verification (especially from Medicaid,
  ARKids1st).
• Refer to Life Events/Benefits Matrix for changes
  you may make in the future.

38
Life Insurance
39
Basic Life Insurance

• FREE! UAMS provides this coverage for you.
• Indicate your beneficiary(ies) on the UA Group
  Benefits Enrollment Form.
  
• Coverage is 1 times your base annual salary, up
  to 50,000. Reduced benefits at age 70 and 75.
  
• Benefits are payable to your designated
  beneficiary(ies) in the event of your death.
  We do not recommend that you list minor children
  as your beneficiaries.
• Insurance carrier is UNUM Provident.

40
Optional Life Insurance

• You may increase your life insurance benefit by
  enrolling in Optional Life. See rate sheet for
  your age-based premium.
  
• Coverage is available up to four (4) times your
  base annual salary, up to 500,000 max.
  
• Combined with Basic Life, you could possibly have
  5 times your salary in life insurance.
  
• Indicate your beneficiary(ies) on the UA Group
  Benefits Enrollment Form.
  
• Your premium, as well as amount of your insurance
  benefit, will automatically update as your salary
  changes. Your rate will also automatically
  increase when you reach a new age bracket.

41
Calculating Optional Life Premium

• Example 41 year old employee earns 34,350
  per year, is paid biweekly
  
• Round up to 35,000
• Multiply by 2 for 2 x coverage
• 35,000 x 2 70,000 Opt Life coverage
• 70,000/1000 70
• 70 x .05 (age 40-45) 3.50 biweekly cost

42
Dependent Life Insurance

• Benefits would be payable to you in the event of
  your spouse or eligible childs death.
  
• See rate sheet for your premium.
• Coverage available 10,000, 15,000 or 20,000
• 100 benefit payable on spouse, 50 on each
  eligible child
  
• Insurance carrier is UNUM Provident.

43
Optional ADD

• Benefits are payable in the event of accidental
  death or dismemberment.
  
• Coverage is available for Employee Only or
  Employee Family. See rate sheet for your
  premium.
  
• Coverage is available in increments of 25,000 up
  to 15 times base annual salary, or a maximum of
  300,000.If you make less than 20,000 you are
  not eligible to elect the maximum 300,000.
• In event of accidental death, 100 benefit is
  payable on employee, 60 on spouse, 20 on each
  eligible child.
  
• Different levels of coverage payable for
  different types of dismemberment.
  
• Insurance carrier is The Hartford.

44
Your Life Insurance Coverage

• Optional Life, Dependent Life and ADD take
  effect the first day of the NEXT calendar month
  after you enroll, same as Medical and Dental.
  
• If you miss your 31-day window, you may apply for
  coverage through the carrier. Must pass
  evidence of insurability health screening.
  
• However, you may sign up for or increase your
  ADD coverage at any time, even beyond your
  31-day enrollment window. (Accidents are not
  predictable.)

45
Long Term Disability Insurance
46
Basic LTD

• FREE! UAMS provides this coverage for you. No
  forms to sign.
  
• Benefit is 60 replacement of your base salary in
  event of disability and you can no longer able to
  perform the duties of your position.
  
• Maximum monthly benefit is 1,000 a month (in
  other words, covers first 20,000 of salary).
  
• Benefits start 6 months following your last day
  to work.
  
• Payments continue to be paid until the first of
  the date you are no longer disabled, the date you
  retire, or the date you reach age 65.

47
Optional LTD

• Applies to employees with salaries above
  20,000. Exception College of Medicine
  Faculty Group Practice members and Medical
  Residents/Housestaff have a carve-out LTD plan
  that is different.
• Provides same 60 protection of your salary, but
  raises your maximum benefit up to 5,000/month
  (raises maximum by covering salary from 20,000
  to 100,000).
• See rate sheet for premiums.
• Example if your annual salary is 34,350,
  Optional LTD raises your maximum monthly benefit
  from 1,000 to 1,717.50 at your cost of 6.57
  per month.

48
Your Long Term Disability Coverage

• If you enroll in Optional LTD, coverage takes
  effect the first day of the NEXT calendar month
  after you enroll, same as Medical and Dental.
  
• If your salary goes over 20,000 in the future,
  you may enroll in Optional LTD at that time,
  within 31 days.
  
• If you miss your 31-day window, you may apply for
  Optional LTD coverage through the carrier. Must
  pass evidence of insurability health
  screening.

49
Flexible Spending Accounts through Section 125
Flex Plan
50
Flexible Spending Accounts

• Also known as Reimbursement Accounts or
  Cafeteria plan.
  
• 2 separate accounts. Can enroll in one or
  both
  
• Dependent Care Account
• Health Care Account

51
FSAshow do they work?

• You estimate how much youre going to spend for
  healthcare and daycare the rest of this calendar
  year. Be conservative and include only
  PREDICTABLE expenses!
• We will deduct that amount from your paycheck
  throughout the calendar year. Your elected
  annual amount divided by number of paychecks
  deduction amount.
• Deduction is pre-tax. Deducted before federal,
  state and FICA taxes are calculated, so it
  reduces your wages that will be reported on your
  W-2.
• You then file a claim to our administrator,
  Conexis, to reimburse yourself for eligible
  expenses.
  
• If youre in a 30 tax bracket, its like saving
  30 on eligible healthcare and daycare expenses.

52
Dependent Care FSA

• Eligible expenses are for day care (child or
  adult dependent)
  
• Dependent care expenses must be work-related.
  Expenses must relate to care that enables you and
  your spouse to work. Both spouses must be
  employed.
• If you make more than 30,000, an FSA is
  generally better than taking the tax credit when
  you file your returns.
  
• Maximum contribution is the lesser of
• 5,000,
• your salary,
• your spouses salary, or
• your expenses

53
Health Care FSA

• Eligible expenses are health care expenses
  (incurred during the period of coverage) of the
  employee and eligible dependents which are not
  reimbursed by an insurance plan.
• Includes eye glasses, braces, contact lenses, OTC
  drugs
  
• Includes your insurance deductible, copays and
  coinsurance amounts. See plan booklet for more
  details.
  
• Maximum contribution 4,000/year. Minimum
  contribution 120/year.
  
• Always contact Conexis before setting up a Health
  Care FSA for orthodontia.

54
Health Care FSA Benefit Card

• If you enroll in a health care FSA, you
  automatically will receive a Conexis benefit
  card. Looks like a credit card but its really
  a debit card with no PIN.
• Its use is strictly voluntary.
• Whats nice about the benefit card? Better cash
  flow! You dont have to pay your copay or other
  eligible expense up front and then wait to be
  reimbursed. Payment comes directly from your
  FSA.
• Using the benefit card DOES NOT mean you can
  throw away your receipts. Keep all receipts, but
  do not file a claim. Wait and see if Conexis
  asks you for documentation.
• You may only use the benefit card to pay for
  eligible medical expenses as allowed by the IRS.

55
Flexible Spending Accounts

• Your election to participate is only good for the
  current calendar year. The plan automatically
  ends Dec 31.
  
• Open enrollment held each year. Sign up before
  mid-December to participate for the following
  year. Mid-year changes and enrollments are
  allowed only for qualified events.
• Cant claim FSA expenses as a deduction on your
  income tax return, except for 1000 in related
  child care towards tax credit (ask your tax
  advisor).
• Your risk Contributions not used are forfeited
  to the University. Estimate your FSA amount
  carefully. Read the plan book thoroughly before
  signing up.

56
More on FSAs

• Once you enroll, FSAs take effect the first day
  of the NEXT month, same as Medical and Dental
  insurance.
  
• You can only use your FSA for expenses you incur
  on or after that date.
  
• Check out www.conexis.org for forms, your account
  balance, status of a claim, list of eligible
  expenses, tips on using the benefit card for
  health care expenses, etc.

57
Voluntary Insurances
58
Voluntary Insurances

• You can also enroll in
• Long term care insurance
• Home/auto insurance
• Cancer/critical illness insurance
• Discounted group rates
• Convenience of payroll deduction
• Please refer to information in your packet.
• Contact carrier to enroll or get a rate quote.

59
Voluntary Insurances

• Long Term Care Insurance
• Enroll in Long Term Care through the carrier,
  CNA, within 60 days of hire and your policy is
  guaranteed issue, no medical questions.
  
• Home/Auto Insurance
• You can apply for Home/Auto coverage through
  Liberty Mutual at any time.
  
• Cancer/Critical Illness
• Enrollment is only offered once a year.
  Look for announcement from Human Resources.

60
Benefits Quiz

• When is my deadline to enroll?
• 31 days from my hire into a benefits-eligible
  position
  
• When do my benefits take effect?
• 1st of next month (if I sign up this month)
• T or F UA offers an annual open enrollment for
  the Medical and Dental plans.
  
• False. UA doesnt offer open enrollment. But
  I can make changes within 31 days of a qualifying
  family event such as marriage, birth or divorce.

61
Forms to Turn In Today

• UA Group Benefits Enrollment Form
• Everyone must turn in this form.
• Qualchoice Enrollment Form
• Only if you are enrolling in Medical insurance
• Delta Enrollment Form
• Only if you are enrolling in Dental insurance
• If you wish to enroll in a Flexible Spending
  Account, ask for that form (not in your packet).
  
• Remember, you may change your mind during your
  31-day enrollment window.
  

62
Required for ALL benefits-eligible employees
Does your Spouse work for the U of A? If so,
each family member can only be covered under one
Medical, Dental, Life or ADD plan.
63
Required for all employees enrolling in the
Medical plan. Dont forget... children ages 19-
24 must be full-time students to be eligible.

64
Required for all employees enrolling in the
Dental plan. Dont forget... children ages 19
-24 must be full-time students to be eligible.

65
Benefit Questions Later?

• Call HR/Employee Servicesat 686-5650.
• Visit the Office of Human Resources in the Annex
  Building, Mon-Fri, 730 - 430.
  
• Visit our web site at www.uams.edu/ohr