Human Resources - Lewis-Clark State College

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 typically occurs 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

Waiting Periods

Medical Plans

The State employee medical plans have a 12 month waiting period for pre-existing conditions for anyone who is age 19 or older. Please refer to the Blue Cross contracts for specific details.

If you were covered by another medical plan within 63 days of your date of hire and you enroll for coverage within 30 days of employment, the time enrolled under the prior plan may count toward fulfilling this 12 month waiting period.

Benefits While On A Leave of Absence

The State allows employees to take paid and unpaid leaves of absence for a variety of reasons. For more about when and under what circumstances a leave may be approved, contact Human Resource Services.

Leave Without Pay (LWOP)

You may continue the following coverages for up to 6 months (12 months if you are on employer-sponsored leave for professional or education purposes), by self-paying the full monthly premiums, including any amount the State usually pays for active employees:

Medical, Dental, Basic & Supplemental Life

Disability insurance is not available for continuation during your leave - State paid coverage ends after 30 days, counted from the first day after your leave starts.

Family Medical Leave Action (FMLA)

For questions about your eligibility for FMLA, how FMLA works and continuing benefits during FMLA, contact Human Resource Services.

These continued benefits are available while you are on FMLA leave:

Medical and Dental: The State will continue to pay its share of the premiums, the same as for active employees, while you continue to pay your share during approved FMLA leave. If you exhaust your 12 week FMLA leave, you can continue coverage by self-paying the full cost for the balance of 6 months following your initial date of leave.
Basic Life: During the FMLA period, the State will pay the monthly premiums. After that, you can continue coverage by self-paying the full cost for a maximum of 6 months from your initial date of leave.
Supplemental Life: For up to 6 months from the date you go on leave, by self-paying the full premiums.

Medical Insurance

Blue Cross 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
Individual	Insured pays first $350 of eligible expenses per Benefit Period
Family	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)
Individual	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.
Family	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.
Annual Maximum Benefit Limit	BCI pays up to $1,250,000 on behalf of an Insured each Benefit Period. All Covered Services apply towards the Annual Maximum Benefit Limit except for Chiropractic Care Services, Diabetes Self-Management Education Services, Hospice Services, Transplant Travel Benefits and Temporamandibular Joint (TMJ) Syndrome Services.
Services BCI Covers	Amount of Payment
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	80% of Maximum Allowance after Deductible
Diagnostic Services	80% of Maximum Allowance after Deductible
Diabetes Self-Management Education Services (only for Providers approved by BCI)	80% of Maximum Allowance after Deductible (up to $500 per Insured, per Benefit Period)
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)	1-877-427-2327
Home Health Skilled Nursing Care Services	80% of Maximum Allowance after Deductible
Home Intravenous Therapy (only for Providers contracting with BCI)	80% of Maximum Allowable after Deductible
Hospice Services (only from a Contracting Hospice)	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
Inpatient Physical Rehabilitation Care (only for providers contracting with BCI)	80% of Maximum Allowance after Deductible
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
Psychiatric Care Services - Inpatient (facility and professional services)	80% of Maximum Allowance after Deductible
Psychiatric Care Services - Outpatient (facility and professional services)	80% of Maximum Allowance after Deductible
Nutritional Formula Therapy	80% of Maximum Allowance after Deductible
Outpatient Physical Therapy Services	80% of Maximum Allowance after Deductible (up to 20 visits per Benefit Period)
Outpatient Rehabilitation Therapy Services Outpatient Occupational Therapy Outpatient Respiratory Therapy Outpatient Speech Therapy	80% of Maximum Allowance after Deductible (up to a combined total of 10 visits 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 (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 Service 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).	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

Blue Cross of Idaho 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	In-Network	Out-of-Network
Deductibles
Individual	Insured pays first $250 of eligible expenses per Benefit Period	Insured pays first $500 of eligible expenses per Benefit Period
Family	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)
Individual	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.
Family	Insured pays a combination of $6,750 of eligible expenses per Benefit Period When the Out-of-Pocket Limit is met, benefits payable for Covered Services increases 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 the Out-of-Pocket Limit is met, benefits payable for Covered Services increases 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.
Annual Maximum Benefit Limit	BCI pays up to $1,250,000 on behalf of an Insured each Benefit Period. All Covered Services apply towards the Annual Maximum Benefit Limit except for Chiropractic Care Services, Diabetes Self-Management Education Services, and Hospice Services.
Services BCI Covers	Amount of Payment In-Network	Amount of Payment Out-of-Network
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
Chiropractic Care Services	(up to a combined total of $500 per Insured, per Benefit Period)
Dental Services Related to Accidental Injury	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
Diabetes Self-Management Education Services	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
Diabetes Self-Management Education Services	(up to a combined total of $500 per Insured, per Benefit Period)
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)	1-877-427-2327
Home Health Skilled Nursing Care Services	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
Home Intravenous Therapy	85% of Maximum Allowance after Deductible	20% of Maximum Allowance after Deductible
Hospice Services	100% of Maximum Allowance (deductible does not apply)	70% of Maximum Allowance after Deductible
Hospice Services	(Lifetime benefit limit is $10,000 combined per Insured)
Hospital Services (includes coverage for newborn nursery charges)	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
Inpatient Physical Rehabilitation Care	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
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
Psychiatric Inpatient Services (facility and professional services)	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
Psychiatric Outpatient Services Outpatient Psychotherapy Services Facility and other Professional Services	Insured pays $20 Copayment, per visit 85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
Nutritional Formula Therapy	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
Outpatient Rehabilitation Therapy Services Outpatient Occupational Therapy Outpatient Physical Therapy Outpatient Speech Therapy	50% of Maximum Allowance after Deductible	20% of Maximum Allowance after Deductible
	(up to a combined total of 20 visits per Insured, per Benefit Period)
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	70% of Maximum Allowance after Deductible
Skilled Nursing Facility	(up to 30 days per Insured, per Benefit Period)
Transplant Services	85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible
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. For services not specifically listed	Insured pays $20 Co-payment per visit Immunizations require no Copayment 85% of Maximum Allowance after Deductible	70% of Maximum Allowance after Deductible

High Deductible Plan

After you pay an annual deductible, the plan generally pays 70% 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
High Deductible Plan

Deductibles

Individual

Insured pays first $2,000 of eligible expenses per Benefit Period

Family

Insureds pay a combination of $6,000 of eligible expenses for all Insureds under same Family Coverage per Benefit Period

Out-Of-Pocket Limit
(Deductible plus Coinsurance)

Individual

Insured pays $5,000 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.

Family

Insured pays a combination of $10,000 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 70% of Maximum Allowance after Deductible

Cardiac Rehabilitation Services 70% of Maximum Allowance after Deductible

Chiropractic Care Services

Contracting Chiropractic Physician

70% 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) 70% of Maximum Allowance after Deductible

Diagnostic Services 70% of Maximum Allowance after Deductible

Diabetes Self-Management Education Services (only for Providers approved by BCI) 70% of Maximum Allowance after Deductible

Durable Medical Equipment/Orthotic Devices/Prosthetic Appliances 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 70% of Maximum Allowance after Deductible (up to $5,000 per Insured, per Benefit Period)

Home Intravenous Therapy 70% of Maximum Allowance after Deductible

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) 70% of Maximum Allowance after Deductible

Inpatient Physical Rehabilitation Care (only for providers contracting w/ BCI) 70% 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
70% of Maximum Allowance after Deductible

Maternity Services 70% of Maximum Allowance after Deductible

Mental Health & Substance Abuse Inpatient Services (facility and professional services) 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) 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 Physical Therapy Services 70% of Maximum Allowance after Deductible (up to $800 per Insured, per Benefit Period)

Outpatient Rehabilitation Therapy Services

Outpatient Occupational Therapy

Outpatient Respiratory Therapy

Outpatient Speech Therapy

70% of Maximum Allowance after Deductible (up to a combined total of $1,000 per Insured, per Benefit Period)

Post-Mastectomy/Lumpectomy Reconstructive Surgery 70% of Maximum Allowance after Deductible

Professional Services (Surgical/Medical) 70% of Maximum Allowance after Deductible

Selected Other Therapy Services (includes but is not limited to radiation therapy, chemotherapy, renal dialysis) 70% of Maximum Allowance after Deductible

Skilled Nursing Facility 70% of Maximum Allowance after Deductible (limited to 30 days per Insured, per Benefit Period)

Temporomandibular Joint (TMJ) Syndrome 70% of Maximum Allowance after Deductible (Lifetime Benefit Limit is $2,000 per Insured)

Transplant Services 70% 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 70% of the Maximum Allowance after Deductible)
70% of Maximum Allowance after Deductible

Prescription Drug Benefits

Network Pharmacy Co-Payments

Generic Drugs $10 copayment

Formulary Brand Drugs $25 copayment

Non-formulary Brand $50 copayment

Certain prescription drugs have generic equivalents. If the Insured requests a Brand Name Drug, the Insured is responsible for the difference between the price of the Generic Drug and the Brand Name Drug, regardless of the Formulary or Non-Formulary status.