SMU’s 2011 Open Enrollment takes place Oct. 18-29, 2010. 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.
The University will make certain health plan changes for 2011 to comply with the federal healthcare reform legislation passed in spring 2010, according to the Open Enrollment guide distributed by SMU Human Resources. Most of these required changes are enhancements to the plans. The other changes for 2011 are designed to help SMU and its faculty and staff members to better manage plan costs.
Effective Jan. 1, 2012, SMU will no longer offer the $500 Deductible option to faculty and staff members. If you enroll in this option for 2011, you will need to choose a new option during Open Enrollment 2012.
The 2011 Benefits Guide is available at HR’s Benefits U page.
For 2011 open enrollment, you must take action for the following conditions:
- You want to make changes to your current coverage, including adding or dropping dependents.
- You want to participate in one or both of the Flexible Spending Accounts (FSAs) in 2011.
- You want to participate in the Health Savings Account (HSA) in 2011.
SMU uses a secure online open-enrollment application available through Access.SMU. To use the application:
- Enter your Access.SMU user ID and password as you normally would to review your pay statement.
- Click Benefits in the Employee Self-Service navigation on the right, then choose Benefits Enrollment to access your personalized Open Enrollment record.
- Be sure to read all instructions carefully before making elections for 2011.
More information on vendors and plan changes will be available at SMU’s 2010 Health and Wellness Fair, 9 a.m.-2:30 p.m. Oct. 21 in the Hughes-Trigg Student Center lower level.
Human Resources also offers guidance through face-to-face meetings with Benefits Department representatives. For more information or to schedule an appointment, contact the Department of Human Resources, 214-768-3311.
2011 KEY BENEFIT CHANGES
2011 Plan Premiums
Medical, Dental & Vision Plans
SMU pays more than $70 of each $100 in premiums for faculty and staff and their enrolled dependents. In addition to medical and pharmaceutical cost inflation (estimated at 14 percent for 2011), catastrophic claims and the healthcare reform law have added to the significant cost increases shared by you and SMU.
As a result, medical premiums will rise this year at an average of 14 percent. The most significant premium increases will apply to the $500 and $1,000 deductible options. There will be modest increases to the $2,000 option and no increases to the $2,500 option. Wise healthcare decisions, such as using generics to fill prescriptions, participating in wellness initiatives, and only using the emergency room for true emergencies, help lower costs for you and the University.
Premiums will remain the same for dental and vision coverage.
The 2011 premiums for full-time and part-time employees are available at Benefits U 2011 Open Enrollment homepage.
Emeriti Health Account
Full-time benefits-eligible faculty and staff are automatically enrolled in the Emeriti Health Account on the first of the month following their 40th birthday. Your Emeriti Health Account enables you to set aside funds on a pre-tax basis to help cover premiums and out-of-pocket medical expenses incurred during your retirement years. Employee contributions and SMU matching contributions automatically increase 4 percent each year.
Effective Jan. 1, 2011, the monthly contribution amount will increase by $2.16 per month to $56.24. SMU’s matching contribution will also increase to $56.24 per month.
SMU PLAN CHANGES
Changes to Specialist Office Visit Copays
Effective Jan. 1, 2011, the copay for in-network office visits for specialty physicians under all of the SMU Health and Wellness medical options is increasing from $35 per visit to $40 per visit. The copay for office visits to primary care physicians will remain the same.
Medco is the New Prescription Drug Provider
SMU has chosen Medco to replace Prime Therapeutics as our new prescription drug provider, effective Jan. 1, 2011. Medco will offer faculty and staff better discounts on medications and help us manage prescription drug costs more effectively.
Things to know about the change to Medco:
- Medco generally has the same network of pharmacies that Prime Therapeutics does – for example, most of the major retail chains, like CVS and Walgreens, will remain part of the network.
- If you have open refills on medications, your prescription will be transferred from Prime Therapeutics to Medco on Jan. 1, so you do not have to obtain a new prescription from your prescribing physician.
- There will be some changes to the list of medications that are covered under the plan, or formulary. For a complete list of Medco’s generic, preferred brand and non-preferred brand medications, visit the Benefits U homepage.
If you have questions about how the plan covers specific medications, call Medco toll-free at 1-866-662-0294.
Generic Substitution for Brand Medications
If a generic alternative is available for a brand medication, your pharmacy will automatically fill a prescription with the generic (unless your doctor writes “Dispense As Written” on the prescription). If you choose to get the brand rather than the generic, you will have to pay the full cost of the brand drug.
Accredo is the New Specialty Drug Provider
Medco’s specialty drug provider is Accredo. If you need specialty drugs, such as injectables, you can continue to fill these prescriptions at a retail pharmacy or through Accredo. A transition letter with contact information will be sent to all members who use specialty drugs prior to Jan. 1.
Increases to Mail-Order Maximums
Effective Jan. 1, 2011, when you fill a 90-day supply of mail order medications, the maximum cost you will pay per prescription for generic and preferred brand drugs is increasing. The maximum cost you will pay for non-preferred brand drugs will be unlimited, meaning you will pay the remainder of the cost after the 50% coinsurance paid by the plan.
The new mail-order maximums are as follows:
- Generics: You pay 30% coinsurance up to $20.
- Preferred Brands: You pay 30% coinsurance up to $98.
- Non-Preferred Brands: You pay 50% coinsurance.
To get a list of generic and preferred brand medications to share with your doctor, visit http://smu.edu/hr/benefits.
Coverage for Dental Implants
Effective Jan. 1, 2011, the Aetna Freedom-of-Choice PPO dental plan will cover the cost of implants as an alternative to bridges, subject to the $1,500 annual benefit maximum and review of medical necessity.
Flexible Spending Accounts
New Administrator and FSA Debit Card
In an effort to improve customer service and processing of claims, SMU has chosen Discovery Benefits to replace Ceridian as our new Flexible Spending Account (FSA) administrator, effective Jan. 1, 2011.
As part of the move to Discovery Benefits, anyone participating in the Healthcare or Dependent Care FSA will receive an FSA debit card. Some highlights of how the new FSA debit card works:
- You can use the FSA debit card to pay for eligible expenses at the point of sale (rather than submitting a claim). The debit card will replace the automatic reimbursement arrangement currently in place with BCBSTX and Ceridian.
- You may still choose how to submit your claims. You can pay using your new FSA debit card at the point of sale or submit a paper or online claim form to Discovery Benefits. The only exception is for over-the-counter (OTC) medications. Due to changes in the law that require you to submit a doctor’s prescription with OTC medications, you must file a paper claim for these expenses. You cannot use your FSA debit card to pay for OTC medications.
- Even if you use your FSA debit card to pay for eligible expenses, there are some transactions that still require you to submit your receipts. More details on how to use the FSA debit card will be provided to you when the debit card is mailed to your home. Information can also be found online at www.discoverybenefits.com.
HEALTHCARE REFORM CHANGES
Effective Jan. 1, 2011, the following changes will be made to the SMU Health and Wellness medical options, in accordance with the healthcare reform law, also known as the Patient Protection and Affordable Care Act (PPACA).
Lifetime Benefit Maximums No Longer Apply
The SMU Health and Wellness medical options will no longer have a $1 million lifetime maximum on benefits.
Annual Benefit Limits No Longer Apply
There will no longer be any annual dollar limits or maximums on certain services covered by the SMU Health and Wellness medical options. Examples of services that will no longer have dollar limits include: chiropractic, skilled nursing facility care, home health care, and hospice.
Enhanced Coverage for Preventive Services
There will no longer be a $500-per-person annual limit on basic preventive care expenses covered under the SMU Health and Wellness medical options. The medical options will cover 100% of in-network preventive care services, including physical exams and age-recommended screenings.
Eligibility for Dependent Children Extends to Age 26
Effective Jan. 1, 2011, you can cover your eligible dependent children under SMU’s Health and Wellness medical options until they reach age 26, regardless of marital or student status.
If you had to remove a child from coverage because he or she no longer met eligibility requirements, you can re-enroll your child during this Open Enrollment, with a Jan. 1, 2011 effective date.
New Rules for Reimbursement of OTC Expenses
If you contribute to the Healthcare Flexible Spending Account (FSA) or the Health Savings Account (HSA), the rules for reimbursement of over-the-counter (OTC) medications are changing. If you purchase OTC medications on or after Jan. 1, 2011, you will not be able to use your FSA or HSA to reimburse yourself for these expenses unless you submit a doctor’s prescription with your claim.
Examples of these expenses include: allergy medications, aspirin and pain relievers, cold medicines, antacids, and contact lens cleaning supplies. The main exception to these new guidelines is diabetic insulin and supplies, which do not require a doctor’s prescription.
For a complete list of eligible expenses, visit the Discovery Benefits website.