Open Enrollment 2010: New rates and new services

Benefits U logoSMU’s 2010 Open Enrollment takes place Oct. 14-30, 2009. The Open Enrollment period is the only opportunity for SMU employees to make changes to benefits elections for the coming year, except for life event changes.

Some important information for 2010:

  • The Aetna HMO plan will no longer be offered as of 2010. Those who are currently enrolled in the HMO and wish to continue medical coverage under an SMU plan must select another option for the coming year.
  • The Employee + One category has been replaced with two new options: Employee + Spouse and Employee + Child(ren).
  • Medical premium costs will rise this year. However, many can avoid premium increases by selecting a higher deductible level or offset out-of-pocket expenses by participating in the Healthcare Savings Account (HSA) or the Flexible Spending Account (FSA).
  • Health Savings Account (HSA) contribution limits will increase for 2010.
  • Section 125 of the Internal Revenue Code enables SMU to deduct premiums for your health coverage on a pre-tax basis. As a result, SMU will undergo a dependent eligibility audit of University health plans during the first quarter of 2010. All individuals claiming a dependent for insurance purposes will be required to provide supporting documentation of the relationship to the covered dependent. Faculty and staff members will have the opportunity to drop non-eligible dependents from coverage during open enrollment, prior to the audit.
  • Under the SMU Health and Wellness Plan, mental health and substance abuse services will be covered at the same benefit level as physical health and illness.

This year, Human Resources is offering an enhanced and updated version of the Access.SMU Benefits Open Enrollment application introduced during 2009 open enrollment. The application gives faculty and staff members easy access to useful information to help make decisions on benefit options and plans.

Training in the Access.SMU open enrollment application will be available during Health and Wellness Day Oct. 22. In addition, Director of Total Compensation and Associate Director of Human Resources Sheri Starkey will offer an information session on choosing the right plan for your needs. Read more on 2009 Health and Wellness Day.

Who needs to make changes?

This year’s benefits changes will require many faculty and staff members to make an active election during open enrollment. For 2010 open enrollment, you must take action for the following conditions:

  • You want to make changes to your current coverage.
  • You want to add or drop dependents from coverage.
  • You are currently enrolled in the Aetna HMO, which will not be offered for 2010.
  • You are currently enrolled for Employee + One medical coverage.
  • You want to adjust your premium payments.
  • You want to participate in one or both of the Flexible Spending Accounts in 2010.
  • You want to make a contribution to the Health Savings Account (HSA) in 2010.

To take advantage of Online Open Enrollment at Access.SMU:

  • Enter your Access.SMU user ID and password as you normally would to review your pay statement.
  • Click Benefits Open Enrollment under Benefits on the right to access your personalized Open Enrollment record.
  • Be sure to read all instructions carefully before making elections for 2010.

Learn more under the link.


A summary of changes to benefits programs for 2010:

Medical premium changes

SMU’s primary health benefit plan is self-funded – that is, not insured by an insurance carrier – so the bulk of increasing costs are borne by the University. SMU pays $78 of each $100 in care provided to faculty and staff. In addition to medical and pharmaceutical cost inflation, catastrophic claims and legislative mandates have further added to the significant costs shared by you and SMU.

As a result, premium costs will rise this year. However, many can avoid premium increases by selecting a higher deductible level or offset out-of-pocket expenses by participating in the Healthcare Savings Account (HSA) or the Flexible Spending Account (FSA). Based on changes described below, your premium actually could decrease if you are covering yourself and a child in 2010. Premiums for the $2,500 deductible with an HSA option are not changing.

Review the new medical premiums for 2010 in the 2010 Benefits Guide.

Premium structure changes for families

The Employee + One category has been replaced with two new options:

  1. Employee + Spouse
  2. Employee + Child(ren)

This change will ensure that those who cover dependents pay premium amounts that reflect the claims experience of the type of dependent(s) covered. For example, under this plan, if you choose to cover yourself and a child, expenses are typically less than if you cover yourself and a spouse. This is due to the differences in the types of services received and their associated costs.

If you are currently enrolled in Employee + One, to retain coverage you must actively elect either Employee + Child(ren) or Employee + Spouse coverage during open enrollment for 2010. If you elect the Employee + Child(ren) category for 2010, your medical premiums will be less than what you paid in 2009.

Dental and vision premiums remain stable

For the third consecutive year, premiums remain the same for dental coverage. Vision premiums will decrease for the coming year. The 2010 Benefits Guide provides the new premium amounts for all plans.

Emeriti Health Account contribution changes

For those eligible, effective Jan. 1, 2010, the monthly pre-tax contribution to the Emeriti Health Account will increase by $2.08 per month to $54.08. SMU’s matching contribution to your Emeriti account will also increase to $54.08 per month. These increases help your contributions and savings keep pace with inflation so enough money is set aside to help cover premiums and other out-of-pocket medical expenses in retirement.

Health Savings Account (HSA) contribution limits increase

Effective Jan. 1, 2010, if you elect coverage for yourself, the maximum amount you can contribute for 2010 is $3,050. The maximum contribution for family coverage is $6,150. If you will be age 55 or older in 2010, you may contribute an additional $1,000 in “catch-up” contributions to an HSA in 2010.

Health plan eligibility rules

Section 125 of the Internal Revenue Code enables SMU to deduct premiums for your health coverage on a pre-tax basis. Withholding your deductions pre-tax reduces your taxable income at the end of the year.

Section 125 Plans require that certain rules and restrictions regarding eligible dependents be observed. Covering dependents that are not eligible is a violation of the Section 125 IRS Code as well as University policy; it also drives up costs across all SMU health plans. SMU has hired an outside firm, HR Advance, to conduct a dependent eligibility audit of our plans during the first quarter of 2010.

If you are currently covering dependents under SMU’s benefit plans who do not meet our plan eligibility requirements, you will have the opportunity to drop them from coverage during open enrollment prior to the audit. All individuals claiming a dependent for insurance purposes will be required to provide supporting documentation of the relationship to the covered dependent (examples include marriage license, birth certificate and tax return documentation).

Additional details on plan eligibility rules including required documentation are provided in the 2010 Benefits Guide, which will be available on-line during open enrollment Oct. 14-30, 2009.

Aetna HMO option no longer available

Given an average of 35 percent increase in HMO premiums for the past two years and declining enrollment in the plan, the Aetna HMO option will not be offered in 2010. Currently, all other SMU Health and Wellness Plan options have premiums that are significantly less than those of the Aetna HMO. If you are currently enrolled in the HMO, you will save money by moving to one of the PPO options.

About 91 percent of the doctors in the Aetna HMO network also participate in the Blue Cross/Blue Shield of Texas (BCBSTX) PPO network, making it highly likely that you will be able to continue using your current doctor(s).

If you are currently enrolled in the HMO and wish to continue medical coverage, you must select another option for the coming year from the SMU Health and Wellness Plan, or your coverage will be discontinued.

New administrator for specialty drugs

Beginning Jan. 1, 2010, Blue Cross/Blue Shield of Texas (BCBSTX) has partnered with Triessent and Prime Therapeutics to administer the specialty prescription drug component of the SMU Health and Wellness Plan. Specialty drugs are typically higher-cost medications used to treat chronic medical conditions, such as diabetes and cancer. All other types of medications will continue to be covered and administered by Prime Therapeutics through BCBSTX.

Also effective Jan. 1, 2010, the amount the SMU Health and Wellness Plan pays for specialty drugs will change. These changes help provide more financial protection for those who need specialty drugs. If you fill a prescription for a specialty drug through Triessent, you will pay 30 percent of the cost, up to a maximum of $225 per prescription. For example, if the total cost of a prescription is $150, you would pay 30 percent, or $45. However, if you have a medication that costs $750, you would pay $225 – a savings of $525.

If you take specialty medications, more detailed information will be sent to your home mailing address.

New vision provider

For 2010, SMU has chosen a new provider, Vision Service Plan (VSP), to administer the University’s vision plan. Moving to VSP offers SMU faculty and staff numerous advantages, including lower premiums and a broader network of eye care providers. The coverage for vision expenses will be the same as the current SMU plan if you use a VSP provider, and the plan will actually pay a higher benefit for out-of-network vision care than the current plan.

Details on the VSP plan will be provided in the 2010 Benefits Guide.

Mental health parity

Effective Jan. 1, 2010, changes are being made to comply with the Mental Health Parity and Addiction Equity Act, a federal law requiring health plans to cover mental health and substance abuse expenses in the same manner as physical health and illness.

Under the SMU Health and Wellness Plan, mental health and substance abuse services will be covered at the same benefit level as physical health and illness. Find details on available benefits in the 2010 Benefits Guide.

Human Resources urges all faculty and staff members to follow the steps below to ensure that you and your family get the most out of the SMU benefits plans for 2010:

  • Carefully review the electronic version of the 2010 Benefits Guide. It contains detailed information about the options available to you and your family.
  • Make sure you understand the changes to the benefits plans so that you can make informed decisions that will best meet your needs.
  • Elections for 2009 must be made no later than 5 p.m. on Friday, Oct. 30, 2009.
  • If you wish to enroll in the Flexible Spending Accounts (FSAs) for the first time or “re-enroll,” you must make a new election for 2010 – even if you wish to elect the same amount you elected for 2009. The same rule applies for Health Savings Account (HSA) enrollments.

If you need specific benefits guidance, schedule a face-to-face meeting with a representative of the Benefits Department. Scheduling an appointment will ensure that you are able to receive assistance in a timely manner. The Human Resources offices are located on East Campus in Expressway Tower, 6116 N. Central Expressway, Suite 200.

Detailed information about all of the Benefits plans can be found in the 2010 Benefits Guide. Contact the Department of Human Resources, 8-3311, for more information or to schedule an appointment.

About Kathleen Tibbetts

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