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Annual Enrollment. 2011-2012 Plan Summaries. A&M System Health Plans (Employees). A&M Care Plan Scott & White Health Plan (in some areas) Graduate Plan. A&M System Health Plans (Retirees). A&M Care Plans A&M Care 65 PLUS Scott & White Health Plan (in some areas). A&M Care. - PowerPoint PPT Presentation
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Annual Enrollment
2011-2012 Plan Summaries
A&M Care Plan
Scott & White Health Plan (in some areas)
Graduate Plan
A&M System Health Plans(Employees)
A&M Care PlansA&M Care65 PLUS
Scott & White Health Plan (in some areas)
A&M System Health Plans (Retirees)
A&M Care Plan: $700 deductible Coinsurance: Plan pays 70%,
Member Pays 30%Office Visit Copayments: $30 PCP;
$45 Specialist
A&M Care
A&M Care Plan: $700 deductible
65 PLUS: $500 deductible
A&M Care (Retirees)
Network benefits—Live in a network area and use a network provider
Out-of-Network benefits—Live in a network area and use an out-of-network provider
Non-Network benefits—Live outside a network area or have Medicare
A&M Care
NetworkOffice visit: $30 for PCP; $45 for
specialist, PCP referral not required
Hospital services: A&M Care: 30% after plan-year
deductible
A&M Care: What You Pay
Out-of-NetworkOffice visit: 50% after plan-year
deductible
Hospitalization: 50% after plan-year and hospital deductibles
A&M Care: What You Pay
Non-Network
Most services: 30% after plan-year
deductible
A&M Care: What You Pay
Must live or work in an eligible ZIP code to enroll
Office visit copayment $30 PCP$45 Specialist
$350 Deductible80/20 Coinsurance
Health Maintenance Organizations (HMOs)
Scott & White Health Plan
Some vision and hearing coverage available with
Requires selection of a primary care physician
Must use HMO doctors/hospitals except in emergency
Health Maintenance Organizations (HMOs)
The Scott & White Health Plan
A&M DentalDeltaCare USA
Dental HMOVisionBasic Life/Basic
AD&DAlternate Basic
LifeOptional LifeDependent
Life
Other A&M System Benefits
Optional AD&DLong-Term DisabilityLong-Term CareFlexible Spending
AccountsAmerican Hearing Aid
AssociatesMarsh Optional BenefitsGMS Relocation
Services
Preventive: 100%; no deductible
Basic: 80% after deductible
Major: 50% after deductible
Orthodontia: 50% after deductible
Delta PPO and Premier Network dentists’ charges lower than non-network dentists
Maximum allowable limits apply
A&M Dental
Deductible: $75/person, $225/family per plan year
Maximum benefits: $1,500/person per plan year
Maximum orthodontic benefits: $1,500/person per lifetime
A&M Dental
Must use DeltaCare USA general dentist
General dentist must refer to specialist
No deductible or maximum benefit
Orthodontia: Max 24 mos of treatmentYou pay set fee for other services
$ 5 copay for cleanings and $8 copay for amalgam fillings through a network dentist
DeltaCare USA Dental HMO
Eye exam: Network: You pay $10
Non-Network: Plan pays up to $50Eyeglasses:
Network: You pay $15 for lenses every plan year and frames every other plan year, plus any frames cost over the frames allowance
Non-Network: Limited benefits
Vision
Contact lenses:Network: Up to $150 every plan year
Non-Network: Up to $150 every plan yearSurgery:
Network: 15% discount off retail cost and 5% off promotional cost
Non-Network: No benefit
Additional Material Discount Program
40% Discount on an additional pair of glasses
1-855-862-4300 for participating providers
Vision
Basic Life/Basic AD&D
Alternate Basic Life
Optional Life
Dependent Life
Optional Accidental Death and Dismemberment (AD&D)
Beneficiaries
Living Access benefit
Life Insurance
$7,500 life coverage on you
$5,000 life coverage on your eligible dependent children
$5,000 AD&D coverage on you
Included with all A&M System health plans
Basic Life/Basic AD&D
Alternate Basic Life Can purchase only if no A&M
System health coverage, but certify other coverage
Can use the employer contribution
Cannot elect if you buy Optional Life
Alternate Basic Life
Employees: $50,000 or 7 times your pay, whichever is less, in coverage on you
Retirees: $50,000 or your Optional Life amount, whichever is less, in coverage on you – reduces to $30,000 at age 80
$5,000 life coverage on your eligible dependent children
$5,000 AD&D coverage on you
Employees:Coverage of ½, 1, 2, 3, 4, 5 or 6 times
annual salary on you
Maximum is $1 million
RetireesWhen you retire your Optional Life
amount is reduced to $100,000
Reduction at age 70 to $60,000 and to $30,000 at age 80.
Optional Life
Cost is based on age and tobacco use
Evidence of good health required to increase coverage or enroll in coverage
Cannot elect if have Alternate Basic Life
Optional Life
Three plans: Plan A, Plan B or Plan CPlan A covers:
Spouse amounts of: $25,000, $50,000, $75,000, $100,000, $150,000, or $200,000
Each child: $10,000
Plan B covers spouse and each child:$5,000/life; $5,000 AD&D
Plan C covers:Spouse: 50% of your Alternate Basic LifeEach child: 10% of your Alternate Basic Life
Dependent Life
Life Enhancements
Travel Assistance
Legal Services
Beneficiary Financial Counseling
Coverage for yourself/yourself & family
Employees: Multiples of $10,000Up to $250,000, regardless of pay
Up to 10 times pay or $800,000 maximum
Retirees: Multiples of $10,000Up to $200,000 if younger than 70
Up to $60,000 if 70 or older
Optional AD&D
Dependents: Percentage of your coverage amount
Spouse: 50% and Children: 10%
Spouse only: 60%
Children only: 15%
Optional AD&D
Pays benefits for death or certain injuries resulting from an accident.
Pays full coverage amount or a percentage depending on the extent of loss.
Optional AD&D
Loss of: Percent of Benefit Paid
Life 100% Both hands or feet 100% Sight (both eyes) 100% Quadriplegia 100% Paraplegia 75% Sight (one eye) 50% Speech 50% Hearing (both ears) 50% Thumb and index finger of same hand
25%
Optional AD&D
Education benefit
Felonious assault benefit
Child care benefit
Medical continuation
Coma benefit
Pays a benefit of 65% of your pay, reduced by other benefits you receive
Reduced by Social Security, workers’ compensation, Federal Civil Service and most other group disability benefits
Reduced by TRS or ORP benefits if you receive payment
Long-Term Disability
Maximum monthly benefit is $8,000
Minimum monthly benefit is $100 or 10% of your benefit before deductions
Benefits for partial disability
Benefits begin after 90 days of disability
Benefits continue until the greater of the Benefit Duration or Social Security Normal retirement Age
Mental health limited to 24 months
No Evidence of Good Health Required
Long-Term Disability
Workplace accommodation benefit
Cost based on pay, tobacco use
Pre-existing condition definition: A sickness/ injury for which you have received treatment, care, services, or taken medication during the 90 days before LTD coverage begins.
To receive coverage for a pre-existing condition, you must be in the plan 12 months or go 90 days after coverage begins without receiving care/medication.
Long-Term Disability
Long-Term CareYou choose from five maximum benefit levels
$100/day
$150/day
$200/day
$250/day
$300/dayWaiting period: 90 days/nursing facility;15
days/other care
Long-Term Care
To receive benefits, you must be:unable to perform at least 2 activities of
daily living without assistance
require supervision due to a severe cognitive impairment
Six activities of daily living: bathing, continence, dressing, eating, using a toilet and transferring
Eligible persons:Employees and retireesSpouses
Parents and parents-in-law
Grandparents
Children 18 and older
Portability
Cost depends on age
Long-Term Care
Must re-enroll each year
Can set aside before-tax dollars to pay health and dependent day care costs
Separate health/day care accounts—no transfers
Can change elections only if you have a Change in Status
Must use it or lose it
No monthly administrative fee
Flexible Spending Accounts
Can be used for health care expenses not paid by health, dental or vision plan
Can pay medical, dental, vision and hearing expenses even if you don’t have insurance.
Can pay deductibles, coinsurance and copayments
Annual maximum: $4,800
Monthly minimum: $20
Money available at start of plan year
Health Care Account
If you elect to use the debit card, it costs $9/year
Money comes right out of the Health Care Flexible Spending Account
No paper claims
Keep receipts
Debit Card
Can be used to pay for:Care of a child 12 or youngerCare of an older person with physical or
mental disabilityOnly care that allows you to work
Annual maximum: $5,000
Monthly minimum: $40
Money available as you contribute to plan from paychecks
Dependent Day Care Account
File health claims with your health and dental plans first if you have health/dental insurance
Cannot use for over-the-counter medications, unless prescribed by a doctor.
Cannot take both tax credit/deduction and use Spending Accounts
Flexible Spending Accounts
American Hearing Aid Associates
30% hearing aid discounts or $250 discount at AHAA providers
Hearing aid price includes:Testing, fitting and routine maintenanceQuarterly cleanings and adjustmentsYearly audiometric screeningsYearly hearing aid evaluationsFirst-year warrantyRepair/loss and damage replacementBatteries for life of instrument
American Hearing Aid Associates
Show A&M System identification
No premiums or forms
Spouse, children, parents and grandparents are eligible
www.AHAAnet.com or (800) 984-3272
Global Mobility Solutions
Home sale assistance
Van line assistance
Home finding assistance
Special mortgage program
Temporary housing assistance
GMS Relocation Network
Web site relocation tools: www.gmsmobility.com
Relocation coach – Lori Herbert Call (800) 617-1904 Ext. 8850
Marsh PersonalPlans
Besides the core benefits available to you, Marsh’s PersonalPlans offers additional services that may be of interest.Auto InsuranceHomeowner’s/renters’ insuranceIdentity TheftPet InsuranceHealth Insurance Mart
Marsh PersonalPlans
Marsh PersonalPlans provides: A broad selection of products and services from
highly rated providers
Personalized help from licensed insurance professionals
Free, no obligation quotes by phone or on-line
An information rich web-site
Strict security standard
Visit the website:www.tamuspersonalplans.com or call 1-866-814-7516 for more information
