|
Insurance
1.
Eligibility
2. Enrollment
3. Waiting Periods
4. Medical Insurance
5. Prescription Drug
Benefits
6. Dental Insurance
7. Vision Insurance
8. Monthly Insurance Premiums
9. Mental Health, Substance Abuse & Employee
Assistance Program
10. When Insurance Coverage Ends
11. COBRA Information & Rates
12. Retiree Insurance
13. Basic & Supplemental Life Insurance
14. Short & Long Term Disability
15. Important Contact Information
16.
Weight Management Program Continuous Enrollment
1.
Eligibility
Eligible
Employees
You are
eligible for benefits if you are working an average of 20 hours or more per week, or 84
hours per month, and are expected to work at least 5 months during any
consecutive 12 month period.
Eligible
Dependents
-
Your legal
spouse;
-
Your
unmarried children up to their 19th birthday. The term "children"
includes natural children, stepchildren, adopted children, or children
in the process of adoption from the time placed with you. The term
"children" also includes children legally dependent upon you or your
spouse for support where a normal parent-child relationship exists with
the expectation that you will continue to rear that child to adulthood.
However, if one or both of that child's natural parents live in the same
household with you, a parent-child relationship shall not be deemed to
exist, even though you or your spouse provides support.
-
Children
may be covered beyond their 19th birthday, but not beyond the end of the
calendar month in which they attain the age of 23, so long as they
remain unmarried and are eligible to be claimed as dependents on your
most recent U.S. Individual Tax return.
2.
Enrollment
To enroll in
insurance, employees should complete the online medical enrollment form within 30 days of their hire date.
Medical Enrollment
Power Point Presentation
If you enroll
within 30 days of your hire date, health insurance, vision and dental will
be effective the first day of the month following date of hire.
Changing Elections
After your initial
enrollment period, you may add or drop coverage for family members
at any time. You have 60 days to enroll new family members acquired
through marriage, birth or adoption. Coverage will begin the first
of the month after they become part of your family (or, in the case
of newborns and newborn adoptive children, on the date of birth or
placement). If you wait longer than 60 days to enroll them, coverage
will be effective the first day of the month following the date you
complete the enrollment form.
Open enrollment
occurs annually during the month of May. At this time, you may
change your health insurance plan elections. Changes are effective
July 1st. Typically, we have medical insurance open enrollment every
year. Dental and vision insurance do not always have an open
enrollment period every year. Information will be distributed via
our website, Intranet and direct mailings to employees.
Handbook
The State of Idaho
insurance handbook is available on-line at:
http://adm.idaho.gov/insurance/contracts.htm
3. Waiting
Periods
The State employee
medical plans have a 12 month waiting period before they will begin
to pay benefits for pre-existing conditions. If you were
covered by another medical plan within 63 days of your date of hire
and you enroll for coverage within 60 days of employment, the time
enrolled under the prior plan may count toward fulfilling this 12
month waiting period.
For all new dental
plan enrollees, there is a 12 month waiting period for major care
(covered crowns, bridges, dentures, etc) and orthodontia services.
Your time enrolled in a prior dental plan cannot be credited against
the waiting period.
4. Medical
Insurance
Traditional Plan
After you pay an
annual deductible, the plan generally pays 80% of most Allowable
Charges. You can use any provider you want - but you may save
money when you use providers who belong to the Blue Cross of Idaho
network of participating providers. For a complete listing of Blue Cross preferred providers, please access
www.bcidaho.com.
Plan Features
|
Traditional Plan
|
|
Deductibles |
|
|
|
- Insured pays
first $350 of eligible expenses per Benefit Period
|
|
|
- Insureds pay a
combination of $1,050 of eligible expenses for all Insureds
under same Family Coverage per Benefit Period
|
Out-Of-Pocket Limit
(Deductible plus Coinsurance) |
|
|
|
- Insured pays
$4,300 of eligible expenses per Benefit Period
- When an
Insured has met the Out-of-Pocket Limit, the benefits payable on
behalf of the Insured for Covered Services will increase to 100%
of the Maximum Allowance during the remainder of the Benefit
Period, except for vision care, dental covered services, and
Prescription Drug Covered Services.
|
|
|
- Insured pays a
combination of $8.600 of eligible expenses per Benefit Period
- When Insureds
have met the Out-of-Pocket Limit, the benefits payable on behalf
of all the Insureds for Covered Services will increase to 100%
of the Maximum Allowance during the remainder of the Benefit
Period, except for vision care, dental covered services, and
Prescription Drug Covered Services.
|
Comprehensive Lifetime Benefit
Limit
|
BCI pays up to $1,000,000 on behalf
of an Insured for all combined Covered Services. Payments
applied toward specific Lifetime Benefit Limits also apply toward
the all-inclusive Comprehensive Lifetime Benefit Limit.
|
|
Services BCI Covers |
Amount Blue
Cross Pays |
|
Ambulance Transportation Service |
80% of Maximum Allowance after
Deductible |
|
Cardiac Rehabilitation Services |
80% of Maximum Allowance after
Deductible |
|
Chiropractic Care Services |
|
- Contracting Chiropractic
Physician
|
80% of Maximum Allowance after
Deductible
|
- Non-contracting Chiropractic
Physician
|
50% of Maximum Allowance after
Deductible |
|
Dental Services Related to
Accidental Injury (for covered services received within 12
months of the injury) |
80% of Maximum Allowance after
Deductible |
|
Diagnostic Services |
80% of Maximum Allowance after
Deductible |
|
Durable Medical Equipment/Orthotic
Devices/Prosthetic Appliances |
80% of Maximum Allowance after
Deductible |
|
Employee Assistance Program (EAP)
(1-5 visits per person per Benefit Period) |
Administered by Business
Psychology Associates (BPA) 1-877-427-2327 |
|
Home Health Skilled Nursing Care
Services |
80% of Maximum Allowance after
Deductible (up to $5,000 per Insured, per Benefit Period) |
|
Hospice Services (only for
providers contracting w/ BCI) |
100% of Maximum Allowance (deductible
does not apply) (Lifetime benefit limit is $10,000 per Insured) |
|
Hospital Services (includes
coverage for newborn nursery charges) |
80% of Maximum Allowance after
Deductible |
|
Human Growth Hormone Therapy |
80% of Maximum Allowance after
Deductible |
|
Inpatient Physical Rehabilitation
Care (only for providers contracting w/ BCI) |
80% of Maximum Allowance after
Deductible (up to $15,000 per insured, per Benefit Period) |
|
Mammography Services
(preventive screening services and diagnostic services) |
See Wellness/Preventive Care
Services
80% of Maximum Allowance after Deductible |
|
Maternity Services |
80% of Maximum Allowance after
Deductible |
|
Mental Health & Substance Abuse
Inpatient Services (facility and professional services) |
80% of Maximum Allowance after
Deductible (up to 8 days per Insured, per Benefit Period)
(Benefits will be extended with no annual maximum if an insured's
diagnosis falls within the Mental Health Parity guidelines) |
|
Mental Health & Substance Abuse
Outpatient Services (facility and professional services) |
80% of Maximum Allowance after
Deductible (up to 30 visits per Insured, per Benefit Period)
(Benefits will be extended with no annual maximum if an insured's
diagnosis falls within the Mental Health Parity guidelines) |
|
Outpatient Diabetes Education
(only for providers approved by BCI) |
80% of Maximum Allowance after
Deductible (up to $500 per Insured, per Benefit Period) |
|
Outpatient Physical Therapy
Services |
80% of Maximum Allowance after
Deductible (up to $800 per Insured, per Benefit Period) |
|
Outpatient Rehabilitation Therapy
Services |
80% of Maximum Allowance after
Deductible (up to a combined total of $1,000 per Insured, per
Benefit Period) |
|
Post-Mastectomy/Lumpectomy
Reconstructive Surgery |
80% of Maximum Allowance after
Deductible |
|
Professional Services
(Surgical/Medical) |
80% of Maximum Allowance after
Deductible |
|
Selected Other Therapy Services
(includes but is not limited to radiation therapy, chemotherapy,
renal dialysis) |
80% of Maximum Allowance after
Deductible |
|
Skilled Nursing Facility |
80% of Maximum Allowance after
Deductible (limited to 30 days per Insured, per Benefit Period) |
|
Temporamandibular Joint (TMJ)
Syndrome |
80% of Maximum Allowance after
Deductible (Lifetime Benefit Limit is $2,000 per Insured) |
|
Transplant Services |
80% of Maximum Allowance after
Deductible (Lifetime Benefit Limit is $350,000 per Insured)
(Includes separate Lifetime Benefit
Limit of $5,000 for related BCI approved transportation, lodging,
meals, and other living expenses. Benefits for meals and
other living expenses are limited to a maximum of $50 per day) |
Wellness/Preventive Care Services
- For specifically listed
Covered Services
- For services not specifically
listed
Specific benefits are for:
- Well Baby care and Well Child
care - routine or scheduled examinations, including Rubella and
PKU tests
- Adult examinations - annual
physical examinations, including pap tests, preventive screening
mammogram services, fecal occult blood test, PSA tests,
cholesterol panel, and CBC and SMAC blood tests
- Immunizations - Accellular
Pertussis, Diphtheria, Hemophilus Influenza B, Hepatitis A,
Hepatitis B, Influenza, Measles, Mumps, Pneumococcal
(pneumonia), Poliomyelitis (polio), Rubella, Tetanus, Varicella
(Chicken Pox) and routine immunizations included in the State of
Idaho Vaccine for Children Program, as amended or revised).
(Other immunizations may be covered at the discretion of BCI
when Medically Necessary. No benefits are provided for
travel vaccines.)
|
100% of Maximum Allowance (up to $250
per Insured, per Benefit Period) (For services in excess of
the above limit, BCI pays 80% of the Maximum Allowance after
Deductible) 80% of Maximum
Allowance after Deductible
|
PPO Plan
After you pay an annual
deductible, the plan generally pays 85% of most Allowable Charges
provided by an In-Network provider. In-Network Physician
office visits (office exam only) require a $20 co-payment and are
not subject to the annual deductible. Eligible Out-of-Network
services are subject to a separate deductible, and are generally
reimbursed at 70% of most Allowable Charges. For a complete listing of Blue Cross preferred providers, please access
www.bcidaho.com.
Plan Features
|
PPO Plan In-Network
|
PPO Plan Out-of-Network |
|
Deductibles |
|
|
|
- Insured pays
first $250 of eligible expenses per Benefit Period
|
- Insured pays
first $500 of eligible expenses per Benefit Period
|
|
|
- Insureds pay a
combination of $750 of eligible expenses for all Insureds under
same Family Coverage per Benefit Period
|
- Insureds pay a
combination of $1,500 of eligible expenses for all Insureds
under same Family Coverage per Benefit Period
|
Out-Of-Pocket Limit
(Deductible plus Coinsurance) |
|
|
|
- Insured pays
$3,250 of eligible expenses per Benefit Period
- When an
Insured has met the Out-of-Pocket Limit, the benefits payable on
behalf of the Insured for Covered Services will increase to 100%
of the Maximum Allowance during the remainder of the Benefit
Period, except for vision care, dental covered services, and
Prescription Drug Covered Services.
|
- Insured pays
$6,500 of eligible expenses per Benefit Period
- When an
Insured has met the Out-of-Pocket Limit, the benefits payable on
behalf of the Insured for Covered Services will increase to 100%
of the Maximum Allowance during the remainder of the Benefit
Period, except for vision care, dental covered services, and
Prescription Drug Covered Services.
|
|
|
- Insured pays a
combination of $6,750 of eligible expenses per Benefit Period
- When Insureds
have met the Out-of-Pocket Limit, the benefits payable on behalf
of all the Insureds for Covered Services will increase to 100%
of the Maximum Allowance during the remainder of the Benefit
Period, except for vision care, dental covered services, and
Prescription Drug Covered Services.
|
- Insured pays a
combination of $13,500 of eligible expenses per Benefit Period
- When Insureds
have met the Out-of-Pocket Limit, the benefits payable on behalf
of all the Insureds for Covered Services will increase to 100%
of the Maximum Allowance during the remainder of the Benefit
Period, except for vision care, dental covered services, and
Prescription Drug Covered Services.
|
Comprehensive Lifetime Benefit
Limit
|
BCI pays up to $1,000,000 on behalf
of an Insured for all combined Covered Services. Payments
applied toward specific Lifetime Benefit Limits also apply toward
the all-inclusive Comprehensive Lifetime Benefit Limit.
|
|
Services BCI Covers |
Amount Blue
Cross In-Network Pays |
Amount Blue
Cross Out-of-Network Pays |
|
Ambulance Transportation Service |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Cardiac Rehabilitation Services |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Chiropractic Care Services |
85% of Maximum Allowance after
Deductible |
50% of Maximum Allowance after
Deductible |
|
(up to a combined total of $500 per Insured, per Benefit Period)
|
|
Dental Services Related to
Accidental Injury (for covered services received within 12
months of the injury) |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Diagnostic Services |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Durable Medical Equipment/Orthotic
Devices/Prosthetic Appliances |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Emergency Services |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Employee Assistance Program (EAP)
(1-5 visits per person per Benefit Period) |
Administered by Business
Psychology Associates (BPA) 1-877-427-2327 |
|
Home Health Skilled Nursing Care
Services |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
(up to a combined
total of $5,000 per Insured, per Benefit Period) |
|
Hospice Services |
100% of Maximum Allowance (deductible
does not apply) (Lifetime benefit limit is $10,000 per Insured) |
No benefits |
|
Hospital Services (includes
coverage for newborn nursery charges) |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Human Growth Hormone Therapy |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Inpatient Physical Rehabilitation
Care |
85% of Maximum Allowance after
Deductible (Lifetime Benefit Limit is $150,000 per Insured) |
No benefits |
|
Mammography Services
(preventive screening services and diagnostic services) |
Insured pays $20 Copayment
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Maternity Services |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Mental Health & Substance Abuse
Inpatient Services (facility and professional services) |
85% of Maximum Allowance after
Deductible (up to 8 days per Insured, per Benefit Period)
(Benefits will be extended with no annual maximum if an insured's
diagnosis falls within the Mental Health Parity guidelines) |
70% of Maximum Allowance after
Deductible (up to 8 days per Insured, per Benefit Period)
(Benefits will be extended with no annual maximum if an insured's
diagnosis falls within the Mental Health Parity guidelines) |
|
Mental Health & Substance Abuse
Outpatient Services (facility and professional services) |
85% of Maximum Allowance after
Deductible (up to 30 visits per Insured, per Benefit Period)
(Benefits will be extended with no annual maximum if an insured's
diagnosis falls within the Mental Health Parity guidelines) |
70% of Maximum Allowance after
Deductible (up to 30 visits per Insured, per Benefit Period)
(Benefits will be extended with no annual maximum if an insured's
diagnosis falls within the Mental Health Parity guidelines) |
|
Outpatient Diabetes Education
(only for providers approved by BCI) |
85% of Maximum Allowance after
Deductible (up to $500 per Insured, per Benefit Period) |
No benefits |
|
Outpatient Rehabilitation Therapy
Services |
50% of Maximum Allowance after
Deductible (up to a combined total of $2,000 per Insured, per
Benefit Period) |
No benefits |
|
Physician Office Visits |
Insured pays $20 Copayment per visit
(Any additional services, such as
lab, x-ray, and other Diagnostic Services are subject to Deductible
and Coinsurance) |
70% of Maximum Allowance after
Deductible |
|
Post-Mastectomy/Lumpectomy
Reconstructive Surgery |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Professional Services
(Surgical/Medical) |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Selected Other Therapy Services
(includes but is not limited to radiation therapy, chemotherapy,
renal dialysis) |
85% of Maximum Allowance after
Deductible |
70% of Maximum Allowance after
Deductible |
|
Skilled Nursing Facility |
85% of Maximum Allowance after
Deductible (limited to 30 days per Insured, per Benefit Period) |
70% of Maximum Allowance after
Deductible (limited to 30 days per Insured, per Benefit Period) |
|
Transplant Services |
85% of Maximum Allowance after
Deductible (Lifetime Benefit Limit is $350,000 per Insured) |
70% of Maximum Allowance after
Deductible (Lifetime Benefit Limit is $350,000 per Insured) |
Wellness/Preventive Care Services
(For specifically listed Covered Services)
- Well Baby care and Well Child
care - routine or scheduled examinations, including Rubella and
PKU tests
- Adult examinations - annual
physical examinations, including pap tests, preventive screening
mammogram services, fecal occult blood test, PSA tests,
cholesterol panel, and CBC and SMAC blood tests
- Immunizations - Accellular
Pertussis, Diphtheria, Hemophilus Influenza B, Hepatitis A,
Hepatitis B, Influenza, Measles, Mumps, Pneumococcal
(pneumonia), Poliomyelitis (polio), Rubella, Tetanus, Varicella
(Chicken Pox) and routine immunizations included in the State of
Idaho Vaccine for Children Program, as amended or revised).
(Other immunizations may be covered at the discretion of BCI
when Medically Necessary. No benefits are provided for
travel vaccines.)
For services not specifically
listed |
Insured pays $20 Co-payment per visit
Immunizations require no Copayment
85% of Maximum Allowance after Deductible
|
No benefits
|
5. Prescription Drug Benefits
|
Network
Pharmacy Co-Payments
|
| *Generic - $10 co-payment
*Brand
name drugs w/ no generic equivalent - $18 co-payment
*Brand name drug w/ a generic equivalent - $40
co-payment plus cost differential
*Zero Co-payment for generic statins
*A 90-day supply of certain maintenance
medications can be obtained for two co-payments |
6. Dental
Insurance
Declining
Dependent Dental
As you an
employee, if you elect medical coverage, you're required to take dental.
But you can decline dental coverage for your dependents anytime you want.
Once you've declined dependent dental coverage, you may only obtain it again
if the State holds a special dental open enrollment period. Currently,
there is not annual dental plan open enrollment.
Participating Providers
You can use
any dentist for covered expenses, but it is to your advantage to use a
participating Delta Dental Premium or PPO dentist. Participating
dentists will accept plan benefits plus your share of costs (deductible and
coinsurance) as payment in full.
To locate
participating providers, refer to
http://www.deltadental.com/ Go to
“Searching for a Dentist?” then select Delta Premier and follow the screen
prompts.
Summary of Dental Benefits
(Delta Dental)
|
Features & Covered
Costs |
Delta Premier |
Delta PPO
|
| Annual Deductible |
$25 per
person |
$25* per
person |
| Annual Maximum
Benefit |
$1,000 per
person, not including orthodontic benefits |
$1,000 per
person, not including orthodontic benefits |
Preventive &
Diagnostic,
Exams, Cleanings, X-Rays |
Plan pays
70% of Allowable Benefits, after the deductible |
Plan pays
85% of Allowable Benefits |
| Basic
Restorative Services, Fillings |
Plan pays 70% of Allowable Benefits,
after the deductible |
Plan pays 80% of Allowable Benefits,
after the deductible |
Oral Surgery,
Root Canals, Extractions, Periodontics |
Plan pays
50% of Allowable Benefits, after the deductible |
Plan pays
80% of Allowable Benefits, after the deductible |
| Major Restorative
Services, Crowns, Crown Build-Ups, Dentures, Bridges, after
12-month waiting period |
Plan pays
50% of Allowable Benefits, after the deductible |
Plan pays
50% of Allowable Benefits, after the deductible |
| Dependent
Orthodontic Services, Only available for eligible dependent
children up to age 17, after 12-month waiting period |
Plan pays
50% of Allowable Benefits; $1,000 Lifetime Maximum Benefit |
Plan pays
50% of Allowable Benefits; $1,000 Lifetime Maximum Benefit |
* Deductible does not
apply to PPO diagnostic and preventive services
7. Vision Insurance
Declination of Vision Insurance
Dependent vision coverage is
available only if the dependents are also covered by the State
medical plan. You may decline vision coverage for your family. To
decline vision coverage for your family, employees must complete a
Dependent Vision Declination form. The effective date is the first
of the month following the declination. After declining, you may
only add your family to vision coverage when there is an open
enrollment for vision. There may be several years between open
enrollment periods for vision.
Participating Providers
You can use any provider you want,
but you may save money when you use providers who belong to the
State plan network. Most benefits are paid based on Allowable
Charges, which means they’ll accept plan benefits plus your
share (any deductible, coinsurance or co-payments) of the costs as
payment in full.
Non-participating Providers may
charge more than the plan’s Allowable Charges, which means you are
responsible for any amounts that exceed the Allowable charges plus
any deductible and coinsurance amounts. An exception may be made
when you have to use a non-participating provider for an emergency
or because a non-participating provider is the only source of
services.
To find Participating Vision
Providers, please contact Vision Service Plan, 1-800-877-7195 or go
on-line
http://www.vsp.com Go to
"Members & Consumers", then select "Find a VSP Network Doctor".
When logging onto their website
for the first time you'll need to register by clicking on the light
purple box labeled "Members & Consumers". Then in the login box use
the "Register now" link to create your username and password. First
you will be asked for your Social or Member ID number. DO NOT use
your Social instead put in your full Member/Enrollee ID Number
(Minus the 3 letter Prefix), full name and birthday then click
continue. On the next screen you'll be asked to enter a username,
password, security question, etc. for your account. After filling
out the rest of your personal information your registration will be
complete. If you encounter any problems or need customer service
call VSP at the number listed above.
Filing Claims
Participating providers will
bill the plan on your behalf. When you use a non-participating
provider, you will have to make a claim for reimbursement. Submit a
detailed invoice from your provider. Be sure to include your name,
subscriber identification number
(Your VSP subscriber
identification number is your Blue Cross Identification number less
the 3-letter prefix.) and the name of
your employer to the following address:
VSP
PO Box 997105
Sacramento, CA 95899-7105
For faster reimbursement from
VSP, complete their on-line reimbursement form,
http://www.vsp.com/
and submit it to the above address with the appropriate invoice.
You can also complete the
Out-of-Network Reimbursement Form and fax it to VSP at
916-851-5152.
Summary of
VSP Plan
|
Plan Features |
Vision Care Benefits (VSP) |
| Professional Fees |
VSP pays up to
the amounts listed:
|
Materials - Lenses
Per Pair
|
- Single Vision, up to $32
- Bifocal, up to $60
- Trifocal, up to $72
- Lenticular, up to $100
- Frame, up to $30
|
Contact Lenses - Per
Pair
(evaluation, materials, and fittings only)
|
- Effective, up to $47
- Medically Necessary, up to
$100
|
Service Frequency
Limitations
|
- Insured may receive 1 eye
exam every 12 months.
- Insured may receive 1 pair
spectacle lenses or contact lenses every 12 months.
- Insured may receive 1 frame
every 24 months.
|
8. Monthly Insurance Premiums
The State group insurance
plans each have a monthly premium - that's the amount it costs per month for
coverage under the plan. For some benefits, the State pays a
substantial portion of the premium and you pay the balance.
Premium costs can vary from
one year to the next.
Medical, Dental, and
Vision
You and the State share in
the monthly cost of these coverages. How much you'll pay depends on
which plan you choose and how many family members, including yourself, are
enrolled. If you've elected to participate in the Premium Only Plan,
your share of the monthly premium will be deducted from your paycheck on a
pre-tax basis.
2008/2009 Monthly Premium Rates
Plan Type
|
Employee
Only
|
Employee Plus
Spouse |
Employee Plus
Child |
Employee Plus
Children |
Employee
Plus
Spouse &
Child |
Employee Plus Spouse &
Children |
Blue Cross Traditional Plan
|
$35.00 |
$89.00 |
$61.00 |
$81.00 |
$110.00 |
$124.00 |
|
Blue Cross PPO
Plan |
$28.00 |
$73.00 |
$49.00 |
$67.00 |
$91.00 |
$103.00 |
| Blue Cross
High-Deductible Plan |
$23.00 |
$61.00 |
$41.00 |
$56.00 |
$76.00 |
$86.00 |
Vision Service Plan (VSP)
|
$0.00
|
$2.00
|
$3.00 |
$3.00 |
$4.00 |
$6.00 |
|
Delta Dental |
$7.75 |
$36.25 |
$30.50 |
$46.50 |
$51.75 |
$59.75 |
9. Mental Health, Substance Abuse & Employee Assistance
Program
Eligibility
All benefit
eligible employees and their dependents, not enrolled in one of the
State’s medical plans, are only eligible for the EAP benefits.
Employees and dependents enrolled in the State’s medical plan are
eligible for the EAP and Mental Health & Substance Abuse Program.
Summary of Benefits - EAP
Employees and their
dependents are allowed 5 visits per plan year. Pre-authorization is
required. Services are designed to help the employee cope with any
mental health, chemical dependency, marital, family, legal or
financial problems. To utilize the EAP, employees must contact
Business Psychology Associates, 343-4180 or 1-877-427-2327.
Summary of Benefits – Mental Health & Substance Abuse
Eligible employees
and dependents have up to 200 Behavioral Health Benefit Hours
available per contract year as detailed below.
|
Plan Design |
| Benefit |
PPO In-Network |
PPO Out-of-Network |
Traditional |
| |
|
|
|
| EAP |
5 Visits per year |
No Benefit |
5 Visits per year |
| |
|
|
|
| Mental Health Deductible |
$250 Individual/
$750 Family |
$500 Individual/
$1,500 Family |
$350 Individual/
$1,050 Family |
| Inpatient Care |
Plan pays 85% of
allowable charges after deductible |
Plan pays 70% of
allowable charges after deductible |
Plan pays 80% of
allowable charges after deductible |
| Outpatient Care |
Plan pays 85% of
allowable charges after deductible |
Plan pays 70% of
allowable charges after deductible |
Plan pays 80% of
allowable charges after deductible |
| Annual Maximum Benefit
Serious Mental Illness (SMI)
Non SMI
In Patient Care
Out Patient |
no annual maximum
8 Days
30 Visits
|
no annual maximum
8 Days
30 Visits
|
no annual maximum
8 Days
30 Visits
|
Contact Information
State of Idaho’s
Office of Insurance Management,
http://adm.idaho.gov/insurance
1-800-531-0597,
332-1860,
ogi@adm.idaho.gov
Employee Assistance
Program (EAP) & Integrated Behavioral Health Plan (IBHP):
Business Psychology
Associates, BPA,
http://www.bpahealth.com
or
1-877-427-2327 or 1-208-343-4180
10. When Insurance Coverage Ends
Your coverage under the
various State sponsored benefit plans ends on the earliest of these dates:
-
You cease to be a State
employee. If your active status ends Before the 15th of a month,
coverage will continue through the end of that month or On or after the
15th of a month, coverage will continue through the end of the following
month;
-
You cease to be eligible;
or
-
The plan is terminated.
For your enrolled dependents,
coverage ends when your coverage ends or the end of the month in which they
cease to be eligible for the plans - whichever comes first.
11.
COBRA
After your eligibility for
group health care coverage ends, you may be able to purchase continued
medical and dental, on an individual basis, for a period of time under a
federal law known as the Consolidated Omnibus Budget Reconciliation Act of
1985 (COBRA).
COBRA Qualifying Events
You have the right to
continue coverage under COBRA if you have one of the following qualifying
events. The duration of COBRA coverage available to you depends on the
specific event:
| Qualifying
Event |
Individuals
Eligible for COBRA |
Duration of
COBRA Coverage |
Your termination of employment
Your reduced working hours |
Employee
Spouse
Dependent child |
18 months from the date Active
plan coverage ends |
Your death
Your divorce or legal separation |
Spouse
Dependent child |
36 months from the date Active
plan coverage ends |
| Loss of dependent child status |
Child |
36 months from the date Active
plan coverage ends |
COBRA Extensions
The 18 month COBRA period may
be extended up to 29 months in the event you are disabled according to the
Social Security Administration. Additional information about the 29
month COBRA period is available from your insurance carrier.
If another qualifying event
takes place during the 18 month continuation period that would entitle your
dependents to a longer period of continued coverage, the COBRA period for
your dependents may be extended. At the most, however, coverage cannot
be extended more than 36 months.
COBRA Election
To continue coverage, the
insured person must complete a COBRA continuation enrollment form 60 days
after group coverage terminates. The COBRA participant must pay the
required monthly costs for the continuation of coverage. If you have
any questions or need COBRA enrollment forms, contact the Office of
Insurance Management, 208-332-1860,
ogi@adm.idaho.gov
COBRA Monthly Premium
Rates Effective 7/1/07 - 6/30/08
|
Medical Coverage |
| |
PPO |
Traditional |
| Subscriber |
$403.00 |
$429.00 |
| Subscriber & Spouse,
w/ dependent vision |
$795.00 |
$847.00 |
| Subscriber & Spouse,
w/o dependent vision |
$793.00 |
$845.00 |
| Subscriber & 1 Child,
w/ dependent vision |
$562.00 |
$598.00 |
| Subscriber & 1 Child,
w/o dependent vision |
$559.00 |
$595.00 |
| Subscriber & 2 or
More Children, w/ dependent vision |
$796.00 |
$848.00 |
| Subscriber & 2 or
More Children, w/o dependent vision |
$793.00 |
$845.00 |
| Subscriber, Spouse &
Child, w/ dependent vision |
$953.00 |
$1,015.00 |
| Subscriber, Spouse &
Child, w/o dependent vision |
$949.00 |
$1,011.00 |
| Subscriber, Spouse &
Children, w/ dependent vision |
$1,189.00 |
$1,266.00 |
| Subscriber, Spouse &
Children, w/o dependent vision |
$1,183.00 |
$1,260.00 |
|
Dental Coverage |
| Subscriber |
$24.00 |
| Subscriber & Spouse |
$48.00 |
| Subscriber & 1 Child |
$34.00 |
| Subscriber & 2 or
More Children |
$48.00 |
| Subscriber, Spouse &
Child |
$58.00 |
| Subscriber, Spouse &
Children |
$72.00 |
12. Retiree Insurance
Your unreduced regular
retirement allowance must equal or exceed the Single retiree premium rate in
effect on the date coverage becomes effective, OR you must have 10 or more
years (20,800 or more hours) of credited state service. Retirees and
their covered dependents have Blue Cross of Idaho medical coverage without
vision benefits or dental coverage. For more information on retiree
benefits, visit
http://adm.idaho.gov/insurance/grp/Retirees/handbooks_manuals_retiree.htm
13. Basic & Supplemental Life
Insurance
Basic Life Insurance
Basic Life insurance is
automatic for all benefit eligible employees, their spouses, and their
unmarried dependent children, age 10 days to 23 years. If you die
while enrolled, the plan will pay your full coverage amount to your
beneficiary. (Benefits are reduced for employees age 70 and older)
The plan will pay 100% of your annual salary with a minimum benefit of
$20,000. For the employee's spouse the amount is $2,000 and for the
employees dependent children the amount is $1,000 for each dependent.
Supplemental Life
Insurance
If you elect Supplemental
Life insurance, the plan will pay benefits in addition to any paid by the
Basic Life insurance. Supplemental Life insurance plan will pay 100% of
annual salary.
Premiums
Premiums for the Basic Life
insurance are paid by the State.
Premiums for Supplemental
Life insurance are paid by the employee depending on their age and annual
salary. Example: Annual Salary = $32,750, Age = 37, $.012 x 33 =
$3.96 monthly premium
|
Monthly Premium Rates
|
| Age |
Per $1,000 of
coverage |
| 35 & Under |
$0.08 |
| 36-40 |
$0.11 |
| 41-45 |
$0.16 |
| 46-50 |
$0.26 |
| 51-55 |
$0.41 |
| 56-60 |
$0.73 |
| 61-65 |
$0.99 |
| 66-70 |
$1.52 |
| 71-75 |
$2.17 |
| 76-80 |
$3.27 |
| 81-85 |
$4.88 |
14. Short & Long Term Disability
The State's Disability
Program can help replace a portion of your income if you're ever unable to
work due to disability. The cost of the coverage is provided by the State as a
portion of your Basic Life policy. No special enrollment is required.
To qualify for Short Term
Disability and Long Term Disability benefits, you must meet the plans
definition of Total Disability or Residual Disability:
-
For the first 30 months
of disability, you're unable to perform the essential functions of your
regular occupation and unable to earn more than 70% of your monthly
salary; and
-
After 30 months of
disability, you're unable to perform the essential functions of any
occupation for which you are or may reasonably become qualified based on
your education, training, or experience, and you are unable to earn more
than 60% of your monthly salary.
| Plan |
Waiting Period |
Maximum Benefit
Period |
Short Term
Disability,
benefits equal 60% of monthly pre-disability salary.
|
The longer of:
- 30 continuous days of Total
Disability, or
- 30 continuous days of
Residual Disability, or
- The expiration of all accrued
sick leave earned at the date of Disability
|
26 continuous weeks
following the date of Total Disability or Residual Disability, as
defined by Principal Life Insurance Company, less the Waiting Period
|
Long
Term Disability, benefits equal 60% of your pre-disability
monthly salary. Maximum benefit: $3,000 per month.
|
The longer of:
- 26 continuous weeks of Total
Disability or Residual Disability, or
- The exhaustion of all sick
leave earned as of the date of Total disability or Residual
Disability
|
For each
employee who becomes Totally Disabled or Residually Disabled (as
defined by Principal Life Insurance Company) prior to age 70,
benefits payable until the attainment of age 70:
- For each employee who becomes
Totally Disabled or Residually Disabled between the ages of 70
and 75, benefits are payable until the earlier of:
*Recovery; or
*12 months of benefit payments under this contract.
- For each employee who becomes
Totally Disabled at age 75 or older, benefits are payable until
the earlier of:
*Recovery; or
*6 months of benefit payments under this contract.
|
15.
Important Contact Information
Blue Cross of Idaho
P.O. Box 7408
Boise, ID 83707
www.bcidaho.com
1-866-804-2253
Office of Group Insurance
P.O. Box 83720
Boise, ID 83720
http://adm.idaho.gov/insurance
1-800-531-0597
ogi@adm.idaho.gov
Delta Dental
555 E. Parkcenter Blvd.
Boise, ID 83706
www.deltadentalid.com
1-888-333-3582
Principal Life Insurance Company
Des Moines, IA 50392-0002
1-800-531-0597
Disability Program/Principal Life
Insurance Company
Des Moines, IA 50392-0002
1-800-531-0597
Flexible Spending Accounts
Stanley, Hunt, DuPress, Rhine, & Associates, Inc.
P.O. Box 6400
Greenville, SC 29606
www.shdr.com
1-800-930-2417
16. Weight Management Program Continuous
Enrollment
All State of Idaho employees, retirees,
and dependents covered under one of the State's medical plans with Blue
Cross of Idaho are eligible to participate in the program. The weight
loss programs offered are:
While these programs share the common goal
of helping you lose weight, each offers different techniques to accomplish
this goal. The cost of each of the plans differ and will also vary by
individual. Program costs are not covered. For the best results,
choose the one that can be most easily incorporated into your daily routine.
How does reimbursement work?
Six months after starting the program if you have lost 10% of your initial
weight, you will be eligible for a $100 incentive payment. After 12
months, if you have either maintained that weight loss, or are just now
achieiving the 10% weight loss, you will be eligible for a second $100
incentive payment. This means that each individual has the potential
of receiving up to $200.
How do I get my incentive payment?
To obtain the $100 incentive payment(s) for attaining and maintaining the
10% weight loss goal through the Jenny Craig, LA Weight Loss, or Weight
Watchers programs, fill out the
Reimbursement Form.
Please use the address below for all
forms.
Heather Mykelgard
Blue Cross of Idaho
P.O. Box 7408
Boise, ID 83707
Questions?
Contact Office of Group Insurance at 1-800-531-0597.
Please refer to the
Employee Group Insurance Handbook
or
http://adm.idaho.gov/insurance/contracts.htm for more detailed information.
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