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
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.
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:
Process claims in accordance with the terms
of the Plan
Manage the provider network
Negotiate discounts with providers
Provide other resources
CIGNA does not define benefits. These are defined in the Plan description.
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
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
of Pocket Maximum (OOPM)
The maximum an employee will pay out of
pocket in a year.
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
Co-pay payments did not go toward meeting OOPM
Affordable Care Act 2014 and beyond
Every medical dollar spent goes towards OOPM
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
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
has historically paid a portion of the calculated total premium, what % of the
premium is Furman paying for 2014?
Core Furman share is unchanged
Basic Furman share has increased
Furman moved from 85% to 90%
Employee from 15% to 10%.
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.
did the premiums for Employees + Child(ren), and Family increase while others
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
The estimate of usage was based on
non-industry and non-actuarially supportable data
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
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.