Medical and Pharmacy

NEW: The Families First Coronavirus Response Act (HR 6201) was passed containing important employee information related to COVID-19.

Medical Coverage for COVID-19 Testing

Retroactive to January 1, 2020, all self-insured medical plans, including Wright State University, will cover at 100% testing for COVID-19. This means that for all Wright State employees participating in our medical plans:

  • Testing in medical offices, emergency rooms, and urgent care facilities is all covered
  • No deductibles, copayments, or coinsurance apply for visit
  • No prior authorization or medical management is needed
  • Telehealth visits for testing are included

Please note that this does not apply for COVID-19 treatment presently so all normal co-pays and deductibles will apply should you need treatment.

In addition to covering telehealth visits for COVID-19, the university is expanding “free” telehealth coverage March 18 through June 14, 2020.

This means that your co-pay of $20.00 for PPO plan members and $59.00 for HDHP plan members are waived during this time. Encouraging utilization of Live Health Online supports Governor DeWine’s stay at home order and allows individuals to see a physician from their own home if needed. Employees are encouraged to preregister for Live Health Online so that if and when a visit is needed, you are not hassling with registration.


Employees who are appointed to work on more than a 75% Full-time Equivalency basis are eligible to enroll for medical benefits with an employer contribution from Wright State University. The university provides medical and pharmacy coverage through Anthem Blue Cross and Blue Shield.

New Hires

Benefits are effective the first day of the month following the date of hire.  Employees have 31 days from their hire date to enroll in benefits.

Eligible employees can choose between two medical plans, the Anthem Blue Access PPO 80/20 or the Anthem High Deductible Health Plan (HDHP).  They may choose to enroll for medical, dental, and/or vision coverage for themselves and eligible dependents. These coverages are not linked and can be elected on an individual basis. There are employee premiums for each coverage and coverage level selected. 

Further information about the services provided by Anthem Blue Cross and Blue Shield, including an on-line directory of member physicians and hospitals, can be found at the Anthem website. Information can also be obtained by calling 844-422-7714.

Qualifying Life Events

Within 31 days of experiencing a qualifying life event, you may be eligible to make consistent changes to your benefits.  Please see our Life Events section for more information.

 

Definitions

The following are a few definitions which may be helpful when making your health plan choices. More definitions can be found in the Summary of Benefits and Coverage.
Covered Services. A medically necessary service or supply for which the benefit plan will reimburse expenses according to the plan’s limits.

Co-Payment. The fixed dollar amount you pay each time you receive specific services, supplies or prescriptions.

Deductible. The specified amount of covered medical expenses you pay for yourself and/or covered dependents each calendar year before any additional covered medical expenses are paid by the Plan. Applies to covered services noted as percentages.

Co-Insurance. After the annual calendar-year deductible met, co-insurance will apply. Co-insurance is your share of the cost of a covered service. The cost is calculated as a percent of the allowed amount for the service.

Out-of-Pocket Maximum. The maximum amount you pay in co-insurance for covered expenses in a calendar year before the Plan pays 100%.

Usual, Customary & Reasonable (UCR). A fee usually established by health insurance or government agency that is considered to be the “usual” cost of a specific medical service. The fee is commonly based on the amount the company or agency will pay for that service and may vary with geographic area.

Generic Prescription Drug. A prescription drug that is produced by more than one manufacturer. It is chemically the same as brand and usually costs less than the brand name prescription drug for which it is being substituted and will produce comparable effective clinical results.

Brand Name Prescription Drug. A prescription drug that has been patented with the brand name and is produced by the original manufacturer under that brand name.

 

Disclaimer: The benefits information contained in this site provides a summary for employees of Wright State. This information does not list all the provisions and does not supersede the individual provisions of our group insurance contracts, benefit plans and university policies that it describes. Similarly, the information presented does not guarantee that the university, the state of Ohio, and/or others responsible for these contracts, plans, programs, and policies will not make future changes in the provisions applicable to each.