Overview - Healthcare Modification

Healthcare Modification Overview

Bargaining Unit Faculty Members (BUFMs)

Plan Offerings

There will be two medical plan offerings, PPO 80/20 and HDHP. Dental and Vision plan offering offerings remain unchanged.

Your healthcare plan offerings will be unbundled. You will be required to elect or waive among two medical plan offerings (PPO 80/20 or HDHP), a dental plan and a vision plan. For example, you could elect a medical and dental plan, but waive vision.

 You also will be able to vary your coverage level as to whether the same or different eligible dependents are enrolled on each of the three offerings. For example, you could elect Employee + Spouse for medical, but select Employee for dental.

The four coverage levels are available for the three healthcare plans:

  • Employee                                             
  • Employee + Child(ren)                  
  • Employee + Spouse                       
  • Employee + Family                     

Eliminating Domestic Partner Benefits

Since federal law changed to allow same sex couples to marry, Wright State University will no longer offer benefits related to domestic partners and his/her dependent child(ren).  This change is effective April 1, 2019 for BUFMs.

Any current domestic partner and/or domestic partner child(ren) will be offered COBRA continuation effective April 1, 2019.

Eliminating of Older Adult Child Benefits

As a result of the state regulation changes and consistent with federal regulations, the age limit for covered dependents on Wright State plans is 26.  Thus, the coverage of Older Adult Child aged 27 to 28 will cease March 31, 2019. 

Any current Older Adult Child will be offered COBRA continuation effective April 1, 2019.

PPO 80/20 – Plan Design

The deductibles and out-of-pocket maximums effective April 1, 2019 are as follows:

The deductible is the amount of money you pay before co-insurance is applied.

PPO (80/20) In-Network Non-Network
Single $800 $1,600
Family $1,600 $3,200

The out-of-pocket max (OOPM) is the most you will pay for covered services in a plan year. It is the total you spend on deductibles, copays, and co-insurance for medical and pharmacy services.

PPO 80/20 In-Network Non-Network
Single $4,000 $8,000
Family $8,000 $16,000

 

NOTE:  The PPO 80 plan design is considered non-embedded with regards to deductibles and OOPM.

  1. The Single amounts in charts above are for those employees who select Employee coverage. 
  2. The Family amounts in charts above are for those employees who select Employee + Child(ren), Employee + Spouse, or Employee + Family coverages. Per Affordable Care Act (ACA) regulation:  the maximum OOPM for an individual within a Family plan will not exceed $7,900.

For more details on the PPO plans, you can reference the Summary Benefits and Coverage (SBC), Anthem Plan Summary, the Plan Comparison, and How it Works: PPO 80/20.  (Refer to pages 4, 6, 8 and 9 listed in the Table of Content).

Pharmacy Formulary (PPO 80/20 and HDHP)

Effective April 1, 2019, you will transition to a formulary titled Essential Drug List.

This formulary is a list of brand-name and generic prescription medications that have been selected and are reviewed regularly by Anthem’s physicians. It includes FDA approved drugs that are proven effective and ensures no gaps in care.    

Changes you might encounter:

  • Drugs with an over-the counter equivalent will no longer be offered
  • Drugs shift tiers
  • If alternatives, drugs may no longer be available
  • Select drugs might now require precertification
  • Drugs with no over-the counter or a lower-cost alternative will remain on the plan

90% of current utilized prescriptions remain unchanged. Anthem will mail letters to impacted members early February 2019. 

HDHP – Addition of Co-Insurance

Effective April 1, 2019, the HDHP plan will include a co-insurance component and higher out-of-pocket maximums.

The deductible is the amount of money you pay before co-insurance is applied.

HDHP In-Network Non-Network
Single $2,000 $4,000
Family $4,000 $8,000

Co-insurance of 10% is being introduced.

  • How it works: Once the deductible is met, participants will pay 10% of the expenses until the out-of-pocket maximum is reached.

The out-of-pocket max (OOPM) is the most you will pay for covered services in a plan year. It is the total you spend on deductibles and co-insurance.

Effective April 1, 2019, the out-of-pocket maximum (OOPM) amounts are the following:

HDHP In-Network Non-Network
Single $3,000 $6,000
Family $6,000 $12,000

For more details on the HDHP plan, you can reference the Summary Benefits and Coverage (SBC), Anthem Plan Summary, and the Plan Comparison. (Refer to pages 5, 7, and 8 listed in the Table of Content).

Spousal Added Fee

Wright State will implement a spousal added fee for anyone including a spouse on your medical plan effective April 1, 2019. This is applicable to Employee + Spouse and Employee + Family coverages. The spousal added fee will be tiered as indicated in the chart below and is in addition to the monthly medical plan premium. 

Salary Tier < $47,000 $47,000 - $75,000 > $75,000
Medical Spousal Added Fee* $32 $50 $68

* Does not apply to dental and vision premiums.

IRS Health Savings Account (HSA) Contribution Limits

The following are the IRS HSA annual contribution limits for 2019:

  • $3,500 for Single coverage
  • $7,000 for Family coverage
  • $1,000 additional for HSA catch-up contributions (age 55 or older)

According to the IRS, it is your personal responsibility to ensure that you do not exceed these HSA contribution limits. You can determine your total HSA contributions by adding the following:

  • Wright State’s contributions, and
  • Your personal paycheck contributions

The Wright State’s contribution to the HSA for 2019 with two semi-annual deposits is as follows:

Wright State University's HSA Contribution
For HDHP Participants
Coverage January 4 July 5 Total
Employee $250 $250 $500
Employee + Child(ren) $500 $500 $1,000
Employee + Spouse $500 $500 $1,000
Employee + Family $500 $500 $1,000
  • The January deposit was completed for those enrolled in HDHP as of January 1, 2019.
  • The July deposit will be completed for those enrolled in HDHP as of March 1, 2019.
  • Those new to HDHP as of April 1, will receive a pro-rated employer contribution for April                  through June 2019.

NOTE:  If you are currently participating in FSA Healthcare for 2019, and if by chance you elect to move to the HDHP effective April 1, 2019, per IRS regulations you will not be allowed to participate in the Health Savings Account (HSA).  This restriction applies to both the employer and employee contributions.

Flexible Spending Accounts (FSA)

Per IRS regulations, FSA for Healthcare and Dependent Care cannot be changed during the calendar year unless you experience a qualifying event.  This Modification election is not a FSA qualifying event, any election during last year’s open enrollment will be retained and new enrollments or changes to enrollments are not allowed.

Medical Premiums

The premium structure is a 4-step process:

1. Horan Associates, our benefit consultant, provided the following total cost plan projections: 

Coverage Ratio PPO 80/20 HDHP
Employee 1.0x $606 $534
Employee + Child(ren) 1.8x $1,098 $962
Employee + Spouse 2.2x $1,342 $1,170
Employee + Family 3.0x $1,828 $1,598


2. These total costs were multiplied by 19.5% to obtain the employee cost share. Previously, the cost  share was 20% for premiums.  The slight reduction for 2019 was intended to hold down the premium increases.  The university’s goal remains to be as close as possible to the 20% employee cost share.

 

Coverage Ratio PPO 80/20 HDHP
Employee 1.0x $118 $104
Employee + Child(ren) 1.8x $214 $188
Employee + Spouse 2.2x $262 $228
Employee + Family 3.0x $356 $312


3. The three tier structure is based on annualized salary levels providing an almost equal distribution of employees among the tiers. 

Tier 1 Tier 2 Tier 3
< $47,000 $47,000 - $75,000 > $75,000
1/3 employees 1/3 employees 1/3 employees


4. The premiums for Tier 2 represents the 19.5% cost share noted in Step 2 above.  The discount value for Tier 1 equals the additional percentage assigned to Tier 3. Consistent with the 1/3 guidance in Step 3, we established Tier 1 to represents 67% of Tier 2 premiums (a 33% decrease) and Tier 3 to represent 133% of Tier 2 (33% increase).

Tier 1 Tier 2 Tier 3
< $47,000 $47,000 - $75,000 > $75,000
67% 100% 133%

The resulting monthly medical premiums for 2019 are as follows:

 

Plan Coverage < $47,000 $47,000 - $75,000 > $75,000
PPO 80/20 Employee $80 $118 $158
Employee + Child(ren) $144 $214 $286
Employee + Spouse $176 $262 $348
Employee + Family $240 $356 $472
         
HDHP Employee $70 $104 $138
Employee + Child(ren) $126 $188 $250
Employee + Spouse $154 $228 $302
Employee + Family $210 $312 $416

The spousal added fee mentioned above will be in addition to the premiums listed in this chart.
 

Dental and Vision Premiums

The dental and vision premiums were developed similar to the medical premiums with the total cost spread over the four coverage levels utilizing the same relationship ratio as medical. The 20% employee cost share was applied to the total costs. These premiums will remain one tier.

 

Coverage Ratio Delta Dental of Ohio Vision Service Plan (VSP)
Employee 1.0x $7.40 $1.60
Employee + Child(ren) 1.8x $13.32 $2.88
Employee + Spouse 2.2x $16.28 $3.52
Employee + Family 3.0x $22.20 $4.80

 

Engage (previously Castlight)

Anthem launched a new comprehensive digital health platform for members nationwide. The platform, called Engage is a partnership with Castlight Health. The digital tool creates a personalized member experience by connecting health plan and benefits data with individual clinical and claims data. Engage helps members with better cost and quality decisions when accessing care. Wright State transitioned to Engage on January 1, 2019. 

Previous Castlight enrollees were automatically added to Engage on January 1, 2019. 

You can use Engage to:

  • Save on the care you need. Find doctors, hospitals, medical services, and prescriptions. Compare them by cost and quality.
  • Understand your plan. See simple descriptions of your medical plan and what’s covered.
  • Review past expenses. Learn where you are in your deductible phase and how much you paid and why, so you can plan for the year ahead.
  • Make smart choices. Receive personalized recommendations based on your past care and in-network options.

To start using Engage CLICK HERE or download the “Engage Wellbeing” app and sign in with your Castlight login credentials or access Engage through WINGS under Employee Services.

Engage is provided free of charge for adults enrolled in a Wright State medical plan.

Reminder: $50 Late Enrollment Fee

Wright State utilizes a positive enrollment so that each employee understands their healthcare options so they can select the coverage that best suits their needs and their budget. Regardless of current coverage, you must take action to elect or waive your healthcare coverage during this Modification effective April 1, 2019.

Enroll timely and submit your election during the Modification period, February 14th through February 25th.  Those who do not take action will have a $50 late fee deducted from their April 2019 paycheck.

New Anthem Medical Cards

Your new Anthem insurance cards will be mailed to your home address. 

  • In addition, you can access a copy of your new card at www.anthem.com or on Anthem’s or on Engage’s mobile app after April 1.
  • Remember to provide your new card to your medical and pharmacy providers.