Important Information

To:  Faculty and Staff

Benefits Open Enrollment 2014


Open Enrollment Q&A

Following are answers to questions you may have as you begin to read the benefits guide and open enrollment materials

How does the Furman Healthcare Plan (the Plan) work?

The Plan is self-insured.  This means that Furman is responsible for the larger share of the payment of the health plan including claims, and admin fees for a third party administrator to process payments, negotiate discounts, etc.  Employee premiums are designed to cover a smaller portion (approximately 20%) of the overall cost. 

This is in contrast to a fully-insured plan where employer and employee premiums are paid to the insurance company and the payment of claims is their responsibility.

If the Furman Plan was fully insured the total costs including employee premiums would be significantly higher.

What is CIGNA’s role relative to the Plan?

CIGNA’s is the third party administrator for the Plan.  In this role they do the following:

o   Process claims in accordance with the terms of the Plan

o   Manage the provider network

o   Negotiate discounts with providers

o   Provide other resources

CIGNA does not define benefits.  These are defined in the Plan description.

What are the key terms I need to know and understand as I consider my Plan options?


·         A per visit fixed amount paid for visits to the doctor, specialist, ER or urgent care

·         Only applicable to the Core plan


·         An amount that must be paid by the plan participant before any claims are paid

·         Claims are paid by the patient at 100% until the deductible limit is met

·         Once  the deductible amount  is met, the patient pays a set % of billed charges

·         In the Core plan, deductibles are applicable to healthcare that is outside of an office visit

·         In the Basic plan, deductibles are applicable to all healthcare charges, except pharmacy


Out of Pocket Maximum (OOPM)

·         The maximum an employee will pay out of pocket in a year. 

·         Historically

o   Only the % payment made after the deductible was met was included in arriving at this total.  Any out of pocket costs prior to meeting the deductible did not go toward the OOPM

o   Co-pay payments did not go toward meeting OOPM

·         Affordable Care Act 2014 and beyond

o   Every medical dollar spent goes towards OOPM


What are the most significant changes in the Plan for 2014?

There has been a significant plan change due to the Affordable Care Act (ACA) requirements of how the OOPM is met as described above.  Unlike in the past, now all co-pays and deductibles will go towards meeting the OOPM. Additionally, there is no longer a separate OOPM for pharmacy.  Now both healthcare and pharmacy payments will accumulate to one combined OOPM.  As a result, the total OOPM has changed as follows (the change is calculated by comparing the total healthcare and pharmacy OOPM for 2013 to the total OOPM for 2014):


·         OOPM individual is $1,000 lower in total

·         OOPM family is unchanged in total


·         OOPM individual is $2,000 lower in total

·         OOPM family is $2,000 lower in total

Furman has historically paid a portion of the calculated total premium, what % of the premium is Furman paying for 2014?

·         Core Furman share is unchanged

o   Furman 80%

o   Employee 20%

·         Basic Furman share has increased

o   Furman moved from 85% to 90%

o   Employee from 15% to 10%.

How do the 2014 premiums compare to 2013 for both Basic and Core

For both plans there is a decrease in the premium for Employee only, and Employee plus Spouse. 

For both plans there is an increase in the premium for Employees + Child(ren), and Family.

Why did the premiums for Employees + Child(ren), and Family increase while others decreased?

·         Premiums are determined for each tier/group based on their expected use of benefits.  Expected use is tied to the number of people covered by the tier level as well as participant type (employee, spouse, or child)


·         2013 was the Plan’s first year with 4 tiers/groups

o   The estimate of usage was based on non-industry and non-actuarially supportable data 

o   Since this was the first year with this structure, it was not known who would move to which groups or what the cost impact would be 

·         Actual experience for 2013 revealed usage estimates for Employee + Children, and Family were too low and thus related premiums were artificially low


·         For 2014, premium calculations for all groups are based on industry standard market data, and based on actual 2013 experience, resulting in higher premiums for these two groups and lower premiums for the other two groups

Are there any new benefits for 2014?

Furman now offers a convenience feature called Teladoc  

With this feature, employees can pay a $15 consultation fee for a phone or video consultation with a doctor.  This service may help employees avoid expensive urgent care or emergency room visits.  The doctor will be able to help a patient decide if they need to visit a doctor and, if appropriate, the doctor may be able to prescribe needed medicine.  Narcotic type medicines cannot be prescribed through this service.


Furman Onsite Medical Clinic

As part of Furman’s Wellness Program the onsite clinic will be available at NO COST to employees who participate in CIGNA health plan.  Office hours are Tuesday & Thursday from 1:00 p.m. until 4:30 p.m. in the Earl Infirmary.  No appointment necessary. 


We hope this document helps you as you read the enrollment materials and consider your Plan options.  Please feel free to call Human Resources with any additional questions. 


For additional information or assistance, please contact the Office of Human Resources at ext 2217 or 3106.

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