CONNECTING WORK + LIFE
EMPLOYEE | July 2015
NEWS ABOUT INSURANCE, RETIREMENT AND WELLNESS PROGRAMS FOR THE UNIVERSITY OF TEXAS SYSTEM
EMPLOYEE | July 2015
Special Edition
Annual Enrollment &
Resource Guide
This A Matter of Health newsletter is a special Annual
Enrollment (AE) edition providing details on the benefits
enrollment process and the uniform benefits plan for
UT employees and their qualified dependents. It also
contains important information you may wish to refer to
throughout the year.
IN THIS ISSUE
3 Annual Enrollment Timeline
4 Out-of-Pocket Rates for 2015-2016
5 UT SELECT Medical Plan Changes for
2015-2016
5 Optional Coverage Highlights 20152016
6 Short and Long Term Disability
6 Annual Enrollment: Your Opportunity
to Review and Change Vision Benefits
7 Annual Enrollment: Your Opportunity
to Review and Change Dental Benefits
8 Living Well Program
8 Voluntary Group Term Life and AD&D
Insurance
IMPORTANT: AVAILABILITY OF SUMMARY HEALTH INFORMATION
9 Understanding Dependent Eligibility
and Documentation Requirements
9 Other Eligibility
10 UT Retirement
10 UT FLEX Program
12 How to Change your Benefits
12 Evidence of Insurability
12 Evidence of Eligibility
13 New UT SELECT Medical ID Cards
13 Changes During the Year
14 2015-2015 UT Benefits Contacts
15 Contact Information
Choosing a health coverage option is an important decision. To help you make an
informed choice, your plan makes available a Summary of Benefits and Coverage (SBC),
which summarizes important information about any health coverage option in a standard
format, to help you compare across options. The uniform Summary of Benefits and
Coverage (SBC) provision of the Affordable Care Act requires all insurers and group health
plans to provide consumers with an SBC to describe key plan features in a mandated
format, including limitations and exclusions. The provision also requires that consumers
have access to a uniform glossary of terms commonly used in health care coverage.
To review an SBC for UT SELECT PPO or Out-of-Area coverage, visit the website www.
bcbstx.com/ut. You can view the glossary at www.dol.gov/ebsa/pdf/SBCUniformGlossary.
pdf. To request a copy of these documents free of charge, you may call the SBC hotline at
(855) 756-4448.
UT Benefits for one.
Health for UT System.
ANNUAL ENROLLMENT
TIMELINE
PLEASE
REVIEW THIS
ENTIRE NEWSLETTER
Carefully review the 2015-2016 Annual Enrollment Benefits Overview
included in this newsletter for information about insurance plan premium rates,
plan changes and other AE details.
Review what’s changing and consider
your insurance needs for the upcoming
year. Then, if you don’t want to make
any changes, you don’t have to do
anything to continue with your
current plan selections.
MAKE ELECTIONS
ANNUAL ENROLLMENT (AE) PERIOD
JUL 15
JUL 30
AUG 15
REVIEW
FOLLOW UP
AE OPTIONS LETTER + AE WEBSITE
EOI OR EOE, IF REQUIRED
REVIEW
MAKE ELECTIONS
MAKE INFORMED BENEFITS
CHOICES WITH RESOURCES
AVAILABLE TO HELP YOU
Annual Enrollment Website
available by July 15, 2015
Annual Enrollment Meetings
(at your institution)
Insurance vendors available for planspecific questions (see Contacts at the
end of this publication)
IN THE
NEW
(PLAN)
YEAR
ANNUAL ENROLLMENT PERIOD
July 15 – July 31, 2015
UT Benefits Enrollment Options (PIN)
letter or email delivered by July 15
Lists current coverage, options for
coverage for the next plan year beginning
September 1, and instructions for making
changes online.
July 15, 2015 - July 31, 2015. During this
period, you can:
• Make changes to your benefits,
• Add or remove dependents*,
• Enroll in UT FLEX,
• Change coverage options for certain plans.
Outside of this time period you cannot make
any changes unless you have certain life
events such as birth, marriage, divorce,
death, or gaining or losing other coverage
that affect your or your dependents’ need
for benefits.
This is a good time to update other items if
you’ve had changes during the year like:
• Contact information,
• Tobacco user status,
• Beneficiary information.
FOLLOW UP
COMPLETE EOI OR EOE
(IF REQUIRED)
Deadline Saturday, August 15, 2015
Evidence of Insurability (EOI) is required
to enroll in certain insurance coverage,
including: Voluntary Group Term Life and
Long Term Care insurance.
Evidence of Eligibility (EOE) is required when
you enroll your spouse or a dependent in any
UT Benefits plan for the first time.
*Effective July 1, 2015, same sex spouses are eligible for enrollment in the UT Group
Insurance Program. Contact your benefits office for information on adding your spouse
to your insurance coverage.
SEPTEMBER 1, 2015
ONGOING: KEEP IN TOUCH
• Plan changes (including new rates) begin
• New Medical ID cards issued for everyone
• New ID cards for any plans you changed during Annual Enrollment
• Deductibles and limits start over
• YOUR ADDRESS | Your address or employment changes? Notify your institution.
• NEWSLETTER | Read the UT Office of Employee Benefits monthly newsletter. If you
don’t already receive it, subscribe by entering your email address in My UT Benefits.
• CONTACT INFO | Keep the Contact Information section of this newsletter to contact
insurance vendors for plan information or your institution about your coverage.
A Matter of Health | Annual Enrollment Edition for Employees
3
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OUT-OF-POCKET
RATES FOR
2015-2016
PLAN
EMPLOYEE
EMPLOYEE & CHILD(REN)
EMPLOYEE & SPOUSE
EMPLOYEE & FAMILY
UT SELECT
Medical*
FULL-TIME
$0
$244.10 $17.03 increase p
$255.30 $17.81 increase p
$480.71
$283.48 $19.78 increase p
$676.18 $47.17 increase p
$633.86 $44.22 increase p
$1,008.76 $70.38 increase p
$32.40
no change
$61.51
$67.80
$96.40
no change
$55.85
no change
$106.06 no change
$117.03 no change
$166.74
no change
no change
$16.90
no change
$18.68
no change
$26.67
no change
$5.90
$1.10 reduction q
$9.30
$1.70 reduction q
$9.52
$1.72 reduction q
$15.10
$2.74 reduction q
$9.00
$2.00 reduction q
$14.08
$3.10 reduction q $15.08
$3.32 reduction q
$21.30
$4.70 reduction q
$33.54 increase p
UT SELECT
Medical*
PART-TIME
UT SELECT
Dental
no change
no change
UT SELECT
Dental Plus
DeltaCare
Dental HMO $8.89
Superior
Vision
Superior
Vision Plus
*Tobacco
Premium
$0 to $90 per month based upon tobacco user status
Program
Basic Coverage package includes medical, prescription, $20K Basic Life and $20K Basic AD&D for employees.
Premium rates for Voluntary Group Term Life are not changing for the 2015 - 2016 plan year, but your Voluntary
Group Term Life rate may change due to age. See the chart below for the age-banded rates.
EMPLOYEE RATE CHART
4
AGE OF SUBSCRIBER ON 9/01/15
RATE PER $1,000 COVERAGE
< 35
$0.038
35 - 39
$0.048
40 - 44
$0.065
45 - 49
$0.100
50 - 54
$0.155
55 - 59
$0.240
60 - 64
$0.375
65 - 69
$0.670
70 and over
$0.752
A Matter of Health | Annual Enrollment Edition for Employees
REVIEW
UT SELECT MEDICAL
PLAN CHANGES FOR
2015-2016
This year, the UT SELECT Medical plan deductible remains at $350
for individuals and $1,050 for families. The deductible is what you
pay for certain services (outpatient and inpatient procedures and
services, for example) before the medical plan starts to pay. Once
the deductible is met, the plan pays a portion and you pay a portion
called coinsurance. In-network coinsurance is 20% of allowed
charges. For the 2015 - 2016 plan year, the UT SELECT Medical Plan
coinsurance out-of-pocket maximum of $2,150 for individuals
and $6,450 for families. This means that you will not pay above that
amount in coinsurance for allowed charges.
Last year, in accordance with the Affordable Care Act guidelines,
UT SELECT Medical introduced an additional out-of-pocket limit
that included medical copayments in addition to the deductible and
coinsurance. This limit added an extra level of financial protection for
you.
This year, the broader out-of-pocket maximum of $6,600 for
individuals and $13,200 for families includes all member cost share
for allowed medical and prescription services covered under the plan:
• medical deductible,
• medical coinsurance,
• medical copayments,
• $100 prescription drug deductible, and
• prescription drug member responsibility (usually a copayment).
The cost for services not covered under the plan including balance
billing do not apply to any out-of-pocket limits.
Individuals whose primary insurance is Medicare were, in the past,
typically unaffected by the out-of-pocket limits because they only
applied to medical services which are generally paid in full by
OPTIONAL
COVERAGE
HIGHLIGHTS
2015-2016
LONG TERM CARE
This Annual Enrollment is the last opportunity to sign up for the Long
Term Care (LTC) plan offered to UT by CNA. If you wish to enroll
in LTC, you can find a direct link to the CNA website within My UT
Benefits. On that site, you will find instructions describing how to
print and mail a form to the insurer for yourself or if you have other
eligible family members who wish to enroll. The LTC forms are also
available online at www.ltcbenefits.com/uts, or you may request a
paper form directly from CNA by calling (888) 825-0353. If you are
currently enrolled in a CNA Long Term Care plan through UT, that
coverage will continue as usual. There are no changes to rates.
VISION - SAME BENEFITS, EVEN LOWER RATES!
Last fall the UT System Office of Employee Benefits (OEB) posted
Requests for Proposals (RFPs) for the fully insured Vision plans. OEB
is extremely pleased with the results of the competitive bid process
as we had several companies interested in partnering with us. The
contract for Vision Insurance was awarded to Superior Vision. Their
network of providers was unmatched by other vendors, none of
Medicare and UT SELECT Medical. Beginning September 1, 2015,
however, since prescription drug costs are included in the calculations
for the larger whole plan out-of-pocket maximum, some individuals
with high prescription drug costs may meet that limit at which time
all allowed charges will be paid by the plan.
COPAYMENTS FOR THERAPY VISITS
For those in-area, the in-network benefits for physical, occupational,
chiropractic, Airrosti, and speech therapy are changing from
deductible/coinsurance to a specialist copayment of $35.
CHANGE IN EMERGENCY ROOM BENEFIT
Emergency room visit benefit is changing from a flat $150 copayment
to $150 copayment plus coinsurance. This applies to in-network and
out-of network benefits for the in-area plan. On average, an ER visit
costs $1,650, meaning your cost under the new benefit would be
$450 consisting of the $150 copayment plus 20% of the remaining
allowable cost.
ABA THERAPY BENEFIT
Applied Behavioral Analysis will be covered for dependent children
up to age 19. A $35 copayment applies to in-network services, and
out-of-network deductible and coinsurance apply to out-of-network
services. Out-of-network providers may balance bill. No network
exceptions are allowed and the plan year benefit maximum is
$36,000.
PRESCRIPTION DRUG FORMULARY CHANGE
There are occasional updates to the formulary for the UT SELECT
Prescription Drug plan. So, while the plan benefits are not changing,
you could see changes in your medication costs.
which had all five of the top 5 vision service providers in network.
This will enable members to continue to receive uninterrupted
services from their current provider, which is a key component of the
customer service experience. The new 2015-2016 premium rates will
also be significantly lower than current rates; good news for enrollees
in both the Regular Vision plan and the Vision Plus plan.
DENTAL PPO PLAN EXCLUSION CHANGE
UT SELECT Dental PPO plans will no longer exclude the initial
installation of a fixed bridge or partial denture made necessary by
the absence of natural teeth occurring before the Primary Enrollee
was enrolled in dental coverage under The University of Texas System.
Removing this exclusion, commonly referred to as the “missing tooth
clause” should help expedite treatment for many UT SELECT Dental
participants and improve the patient experience.
SHORT AND LONG TERM DISABILITY
No Evidence of Insurability (EOI) required during this year’s Annual
Enrollment.
A Matter of Health | Annual Enrollment Edition for Employees
5
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SHORT TERM
AND LONG TERM
DISABILITY
ANNUAL
ENROLLMENT:
YOUR
OPPORTUNITY
TO REVIEW AND
CHANGE VISION
BENEFITS
As announced in May and promoted in June, enrolling in Disability
Insurance can make a tremendous difference in maintaining an income stream should you suffer an illness, injury or accident that will
keep you out of work. With the new Short and Long Term Disability
contract in place for the upcoming plan year, the new contract not
only offers slightly decreased rates, it also offers a great opportunity
to enroll in disability insurance during Annual Enrollment in July
without having to complete Evidence of Insurability. This opportunity
is generally only allowed for new employees or for employees who
are adding coverage due to a change of status such as marriage
or the birth or adoption of a child. Normally during Annual Enrollment, applicants would need to answer health questions that could
lead them to be turned down for coverage. If you are not currently
enrolled in coverage, this is a prime time to consider adding it.
DISABILITY INSURANCE
MONTHLY PREMIUM RATES
Short Term Disability
$0.28 per $100 of monthly income
$0.022 reduction q
Long Term Disability
$0.38 per $100 of monthly income
$0.017 reduction q
VISION PLAN OPTIONS
For additional information about each of the current UT vision plans briefly described below, please visit the OEB website. Plan limitations
and exclusions do apply for each of these plans. Contact Superior Vision customer service for specific details about plan benefits and
coverage at (800) 507-3800.
SUPERIOR VISION PLAN (STANDARD PLAN)
We are pleased to announce that the contract for Vision Insurance was awarded to Superior Vision. The network of providers will remain the
same, which translates to uninterrupted services. The new 2015-2016 premium rates will also be significantly lower than current rates; good
news for enrollees in both the Regular Vision plan and the Vision Plus plan.
SUPERIOR VISION PLUS PLAN (ENHANCED PLAN)
In addition to the standard Superior Vision plan, there is also the enhanced Superior Vision Plus plan. For a higher premium, you receive
higher benefit allowances than the standard plan. See below for additional details.
VISION PLAN DESIGN FEATURES 2015-2016
PLAN DESIGN
FEATURES
Superior
ANNUAL EXAM
FRAME
PROGRESSIVE LENS
COVERED LENS
NETWORK
CO-PAYMENT
ALLOWANCE
ALLOWANCE
OPTIONS
OF PROVIDERS
$35 COPAY
$140
Vision
Member pays
Options are provided at a 20%
New Contract provides
difference between
discount
uninterrupted service.
lined trifocals and
Best value provided when
progressive retail
visiting a contracted
cost
Superior Vision provider.
Please contact Superior
Superior
Vision Plus
$35 COPAY
$150
$120
Polycarbonates, dependents to
Vision customer service
age 25
before you receive services
(standard plan does not cover)
to confirm if your provider
Scratch coat covered in full
is in-network.
(standard plan does not cover)
Ultraviolet coat covered in full
(standard plan does not cover)
6
A Matter of Health | Annual Enrollment Edition for Employees
REVIEW
ANNUAL
ENROLLMENT:
YOUR
OPPORTUNITY
TO REVIEW AND
CHANGE DENTAL
BENEFITS
DENTAL PLAN OPTIONS
UT System will continue to offer two self-funded UT SELECT Dental PPO plan options: UT SELECT Dental and UT SELECT Dental Plus. There
will be no premium changes to either of the PPO plans and we are happy to announce that the Missing Tooth Exclusion clause will no longer
apply as of September 1, 2015.
The UT SELECT Dental and UT SELECT Dental Plus plans are both administered by Delta Dental Insurance Company. As self-funded plans, all
claims are paid by UT System through premiums collected from participants.
While both PPO plans cover most of the same types of services and provisions, the premiums are different and the benefits are higher in the
UT SELECT Dental Plus plan. Compare the benefits closely in order to select the plan that best meets your or your family’s particular needs.
PLAN DESIGN FEATURES
PLAN
DEDUCTIBLE
ANNUAL PLAN BENEFIT
ORTHODONTICS
ALLOWANCE
NETWORK OPTIONS
UT SELECT
$25
$1,250 ANNUAL
Separate
Freedom to choose any licensed dentist. For maximum
Dental PPO
DEDUCTIBLE
BENEFIT MAXIMUM
$1,250 lifetime
savings, choose from the Dental Preferred Organization
orthodontic
(DPO). If you choose a provider outside of the DPO
maximum
network, you may be subject to balance billing. Contact
Delta Dental customer service to confirm the status of
your dental provider.
UT SELECT
PLAN PAYS
$3,000 ANNUAL
Separate
Freedom to choose any licensed dentist. For maximum
Dental Plus PPO
DEDUCTIBLE
BENEFIT MAXIMUM
$3,000 lifetime
savings, choose from the Dental Preferred Organization
orthodontic benefit
(DPO). If you choose a provider outside of the DPO
maximum
network, you may be subject to balance billing. Contact
Delta Dental customer service to confirm the status of
your dental provider.
BENEFITS AND COVERED SERVICES
PLAN
DIAGNOSTIC &
BASIC
MAJOR
ORTHODONTIC
PREVENTIVE SERVICES
SERVICES
SERVICES
SERVICES
UT SELECT Dental PPO
100%
80%
50%
50%
UT SELECT Dental Plus PPO
100%
100%
80%
80%
DENTAL HMO – DELTACARE USA
The DeltaCare USA dental HMO plan has set copayments and no annual deductibles or maximums for covered benefits. There are no premium
changes and the benefits will remain the same for plan year 2015-2016.
DELTACARE USA PLAN DESIGN FEATURES
• Set copayments.
• No annual deductibles and no maximums for covered benefits.
• Low out-of-pocket costs for many diagnostic and preventive
services (such as professional cleanings and regular dental
exams).
• Upon enrollment into the DeltaCare USA plan, you must select
a new dentist in My UT Benefits during Annual Enrollment
or one will be selected for you based on your address. You
may call Delta Dental at (800) 893-3582 to find out if your
current dentist is in the DeltaCare network. Do not make
any appointments until you are certain that DeltaCare has
confirmed a dentist for you and/or for each of your covered
dependents. If you visit a dentist other than the one listed as
your primary dental provider, your services may not be covered.
Plan limitations and exclusions do apply for each of these plans. Contact Delta Dental customer service for specific details about plan benefits
and coverage at (800) 893-3582. For additional information about the three dental plans briefly described above, please visit the OEB website.
A Matter of Health | Annual Enrollment Edition for Employees
7
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VOLUNTARY
GROUP TERM
LIFE AND AD&D
INSURANCE
Voluntary Group Term Life (VGTL) insurance can help ensure financial
security for your family and loved ones upon your death. UT System,
through the vendor Dearborn National, provides eligible employees
the opportunity to purchase additional life Insurance coverage at
group rates in addition to the $20,000 basic GTL included in the basic
coverage package. During annual enrollment employees can elect
up to a maximum of six times their annual salary with approval of
Evidence of insurability (EOI). Additionally, spouses of employees who
have VGTL are eligible for up to $50,000 in VGTL with EOI.
Benefits-eligible active employees enrolled in UT SELECT Medical are
automatically enrolled in the Accidental Death and Dismemberment
(AD&D) plan with $20,000 as part of the basic coverage package.
Active employees may also enroll themselves and their eligible
dependents in optional Voluntary AD&D insurance in amounts of
coverage up to ten times their annual salary, with spouse coverage of
up to 50% of the employee’s election. All amounts of AD&D coverage
are guaranteed issue. No EOI is required for any increases in AD&D
benefits during annual enrollment or during the plan year following a
qualified change in status event.
YOU MAY ADD OR INCREASE VOLUNTARY
GROUP TERM LIFE INSURANCE DURING
ANNUAL ENROLLMENT
* Evidence of Insurability is required to add or increase
Voluntary Group Term Life Insurance.
LIVING WELL
PROGRAM
WELLNESS. FIND YOUR WAY.
ONSITE FLU SHOTS
The University of Texas System Living Well: Make it a Priority
Worksite Health & Wellness program was established to encourage
all employees, retirees, and dependents to reach their potential and
maintain the productivity necessary to meet the challenges of work
and life. Our Living Well program goal is to enable you to take charge
of your health by developing your own personal wellness program,
using resources available through the Office of Employee Benefits
and your UT institution. For more details please visit our website at
www.livingwell.utsystem.edu or email us at livingwell@utsystem.
edu.
Flu Shots may be available at your institution at no cost to you.
Details will be sent in our “A Matter of Health” newsletter in fall of
2015.
CONDITION MANAGEMENT PROGRAM
Members with chronic conditions, such as diabetes, asthma, high
blood pressure, and many more, can get personalized professional
support in managing the disease. To learn more about this voluntary
health improvement plan by BCBSTX, call 1-800-462-3275.
24/7 NURSELINE
Get answers to your health care questions with the BCBSTX 24/7
Nurseline. Experienced registered nurses are available 24/7 to help
you with questions you have about major medical issues, chronic
illness, and lifestyle changes. Call toll-free: 1-888-315-9473.
ONSITE HEALTH CHECKUPS
The checkup, similar to what you might receive at your doctor’s
office, is designed to identify issues that may affect your health
and help you get them under control before they become serious.
Participating institutions will communicate the dates via email and
posters. Checkups include a quick health evaluation; including finger
stick blood test, blood pressure, and body composition, followed up
by a private health consultation with a licensed Nurse Practitioner.
8
A Matter of Health | Annual Enrollment Edition for Employees
EXPERT PHARMACIST HELP
If you have been diagnosed with high cholesterol, diabetes, or any
other condition, pharmacist specialists from the Express Scripts
Therapeutic Resource Center can provide you with vital information
about your condition and treatment, including potential risks and
side effects of medications. Learn more by calling 1-800-818-0155.
PHYSICAL ACTIVITY CHALLENGE
Each spring, team up with your institution for the UT System Physical
Activity Challenge. You’ll receive a weekly goal and work with
those who are registered towards earning individual rewards and
institution recognition.
The following Institutions were awarded the 2015 Traveling Trophies:
nn2015 UT Activity Challenge Small Institution Champion: UT System
Administration
nn2015 UT Activity Challenge Medium-sized Institution Champion:
UTHealth
nn2015 UT Activity Challenge Large Institution Champion: UTMB
Galveston
REVIEW
UNDERSTANDING
DEPENDENT
ELIGIBILITY AND
DOCUMENTATION
REQUIREMENTS
With Annual Enrollment this month, it’s important to be aware of the dependent eligibility rules for the UT Benefits program and the
requirement to provide documentation verifying that your dependents are eligible to participate. Here is a brief review of the dependent
eligibility requirements as well as information about providing required supporting documentation.
ELIGIBILITY
Eligibility to participate in certain UT Benefits coverage as a
dependent is determined by law. Eligible dependents are:
nnYour spouse*;
nnYour children, including stepchildren and adopted children, who
are:
• under age 26 regardless of marital status for the UT SELECT
Medical plan (due to federal eligibility rules),
• unmarried and under age 25 for other UT Benefits (Dental,
Vision, and Life insurance);
nnChildren for whom you are named a legal guardian or who are the
subject of a medical support order requiring such coverage;
nnYour unmarried grandchildren under age 25, provided they qualify
and you claim them as your dependent for federal tax purposes;
and,
nnCertain children over age 25 (over age 26 for the UT SELECT
Medical plan based on federal eligibility rules) who are determined
by OEB to be medically incapacitated and are unable to provide
their own support.
OTHER ELIGIBILITY
SURVIVING DEPENDENTS
INCAPACITATED DEPENDENTS
IF YOU CURRENTLY COVER
A DEPENDENT who is also
receiving premium sharing for
coverage through a a plan with
Texas A&M or Employees Retirement
System of Texas, please choose to
have that person covered under only
one plan and make the appropriate
enrollment changes at this time.
*Effective July 1, 2015, same sex
spouses are eligible for enrollment
in the UT Group Insurance Program.
Contact your benefits office for
information on adding your spouse to
your insurance coverage.
SURVIVING DEPENDENTS
OVERAGE INCAPACITATED DEPENDENTS
The surviving spouse or other benefits-eligible dependent of an
employee or retired employee who, on the date of the employee’s
death, had at least five (5) years of Teacher Retirement System of
Texas (TRS) or Texas Optional Retirement Program (ORP) creditable
service, including at least three (3) years with UT as a benefitseligible employee at the time of death, is eligible for benefits as a
surviving dependent if the dependent had been participating in UT
Benefits at the time of the employee or retired employee’s
death. A surviving spouse may continue UT Benefits coverage for the
remainder of the surviving spouse’s life. A dependent
child may continue until the child loses his or her status as a
dependent child. The dependent of an individual who has not
met the service requirements at the time of death may elect COBRA
coverage for a period not to exceed 36 months.
Enrolled children may remain eligible for UT Benefits as an
incapacitated dependent if they are determined to be medically
incapacitated at the time they age out of eligibility for coverage
as a child under the program (either at age 25 or 26, depending
on coverage type). An older dependent child who is determined to
be medically incapacitated at the time a subscriber first becomes
benefits eligible may be enrolled in the plan if the child was covered
by the subscriber’s previous health plan with no break in coverage.
Please contact your institution’s Human Resources or Benefits Office
for additional information about covering incapacitated dependent
children.
IMPORTANT
Misrepresentation of dependent eligibility constitutes a policy violation that could result in consequences ranging from a reprimand
to dismissal. Misrepresentation may also require that you reimburse benefits paid on behalf of an ineligible individual. Deliberate
misrepresentation may constitute criminal fraud and could result in a referral to law enforcement.
A Matter of Health | Annual Enrollment Edition for Employees
9
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UT RETIREMENT:
ANNUAL
ENROLLMENT AND
YOUR RETIREMENT
SAVINGS
OPPORTUNITIES
With Annual Enrollment fast approaching and decisions to be made
regarding your health care options, there is no better time to consider
your financial health as well.
UT FLEX:
CONVENIENT,
EASY SAVINGS
AND NO MORE
ADMINISTRATIVE
FEE
Participating in the UT FLEX flexible spending account program is convenient, easy, and best of all, saves you money! Through your UT FLEX
account, you can pay for eligible health care and dependent day care expenses using pre-tax dollars, which means you don’t pay federal
income or Social Security taxes on this money.
In addition to a suite of health insurance options to take care of
you and your family, the University of Texas System also offers
two voluntary retirement savings plans that all you to plan for the
financial future for yourself and your family.
While you can enroll or increase your contribution in the UTSaver
TSA or UTSaver DCP at any time, annual enrollment is a great time to
think about your total future retirement needs. Contributions can be
as little as $15 per month or as much as $18,000.00 a year. In some
cases, you may even be able to contribute more. All contributions
are conveniently deducted from your paycheck before taxes, which
means your taxable income decreases. If you prefer to make your
contributions after taxes have been deducted, that option is there for
you too.
NEED HELP INVESTING YOUR CONTRIBUTIONS?
The UTRetirement Programs partner with our providers to
ensure you have the resources you need. There are dozens of
financial representatives in your area who will be glad to sit
down with you and help you determine your best course of
action.
After making your annual enrollment elections, make sure to
go back and click on the link to the UT System Retirement
Programs website at www.utretirement.utsystem.edu to
learn more about the TSA or DCP plans, or to read about the
services each provide makes available to you at no cost. You
can even schedule an appointment with a financial advisor at
your convenience. Take the opportunity to ensure that your
financial health is just as robust as your physical health!
HOW MUCH MIGHT YOU SAVE?
WITH AN FSA
WITHOUT AN FSA
ANNUAL SALARY
$40,000
$40,000
HEALTH CARE FSA CONTRIBUTION (PRE-TAX)
($1,500)
($0)
DEPENDENT CARE FSA CONTRIBUTION(PRE-TAX)
($4,000)
($0)
TAXABLE INCOME AFTER CONTRIBUTION AMOUNT
$34,500
$40,000
ESTIMATED TAXES WITHHELD (22.65%)*
($7,814)
($9,060)
POST-TAX INCOME
$26,686
$30,940
MONEY SPENT AFTER TAX ON HEALTH CARE AND DEPENDENT DAY CARE EXPENSES
($0)
($5,476)
TAKE HOME PAY
$26,686
$25,464
SAVINGS
$1,222
$0
*Based on 7.65% FICA and 15% tax bracket.
Note: Please be advised that this example is for illustrative purposes only. These projections are only estimates of tax information and
should not be assumed to be tax advice. Be sure to consult a tax advisor to determine the appropriate tax advice for your situation.
10
A Matter of Health | Annual Enrollment Edition for Employees
REVIEW
PHYSICIAN EXERCISE
REFERRAL
Individuals with medical conditions
that can be improved by physical
activity (such as diabetes,
hypertension, depression, and more)
are able to receive reimbursement
from their healthcare flexible
spending account to pay for some
exercise expenses. A Letter of
Medical Necessity is needed from
the physician advising the exercise.
Details can be found at
www.utsystem.edu/offices/employeebenefits/ut-flex-active-employee
UT FLEX HEALTH CARE REIMBURSEMENT ACCOUNT
(HCRA)
Important: In response to the Internal Revenue Service (IRS)
increasing the annual maximum election, effective plan year 20152016 (September 1, 2015) the new annual maximum election per
employee for HCRA accounts is $2,550 (an increase of $50).
With a UT FLEX HCRA, you can set aside up to $2,550 per year in
pre-tax dollars to pay for eligible health care expenses, including
these common expenses:
UT FLEX DEPENDENT DAY CARE REIMBURSEMENT
ACCOUNT (DCRA)
You can set aside pre-tax dollars (up to $5,000 per family per
calendar year) to pay for eligible expenses for dependent day care
that allows you (and, if married, your spouse) to work, look for
work, or go to school full time. Eligible expenses for care of qualified
dependents include costs for:
nnBefore/after school care,
nnDeductibles, copayments, and coinsurance;
nnPreschool or nursery school (for pre-kindergarten aged
dependents), and
nnPrescription drugs, insulin, and syringes;
nnSummer day camp.
nnDental exams, x-rays, fillings, crowns, and orthodontia;
nnEye exams, prescription eyeglasses, and prescription sunglasses;
nnContact lenses and cleaning solutions; and
nnHearing aids.
You can find additional details about eligible HCRA expenses online
at www.utflex.com.
NO ADMINISTRATIVE FEES FOR PARTICIPATION OR
DEBIT CARD
Starting September 1, 2015, participants in the UT FLEX program will
no longer have to pay the $12 annual fee per UT FLEX account. The
PayFlex Debit Card will continue to be free for HCRA participants as
well.
You can find complete details about qualified dependents and
eligible DCRA expenses online at www.utflex.com.
NEED HELP DETERMINING HOW MUCH TO ELECT?
Use the savings calculator online at www.utflex.com to help you
estimate your eligible expenses by itemizing your unreimbursed
health and dependent day care costs. To use the calculator on the
UT FLEX website, click on the Savings Calculator tab and enter your
annual estimated costs in each category. Once complete, you’ll
have an estimate for an annual election and you can also see your
estimated tax savings!
Using the PayFlex Debit Card gives you several advantages,
including:
nnImproving your cash flow throughout the plan year by allowing
you to directly access your account for eligible expenses rather
than paying out of pocket and filing for reimbursement. You have
direct access to your entire annual election amount beginning on
the first day of the plan year (9/1/2015);
nnEliminating the need for you to complete claim forms or any other
paperwork for most expenses;* and,
nnEnsuring that eligible purchases are automatically deducted from
your available UT FLEX HCRA balance so you always know how
much you have remaining in your account.
IMPORTANT
REMINDERS
Don’t forget – to participate in UT
FLEX for 2015-2016, you must make your
election through the My UT Benefits online
enrollment system during this year’s
Annual Enrollment period – even
if you are a current UT FLEX
participant.
nnSave all of your receipts and especially those for dental and vision
services which will likely require documentation to prove the
service was medically necessary.
Important: If you currently have a PayFlex Debit Card, do NOT
discard it. As long as you make a UT FLEX HCRA election for 20152016, your Debit Card will continue to work. Expiring cards will be
replaced as necessary, similar to most credit and debit cards.
A Matter of Health | Annual Enrollment Edition for Employees
11
MAKE ELECTIONS
HOW TO
CHANGE YOUR
BENEFITS
All of your changes can be made using the My UT Benefits online system at www.utsystem.edu/myutbenefits.
LOGIN TO MY UT BENEFITS
Login using one of the options provided. Your PIN will be sent to you
in the email or letter titled “Your UT Benefits Enrollment Options” by
July 15th.
BEFORE MAKING YOUR ELECTIONS, YOU MUST
DECLARE OR UPDATE YOUR TOBACCO USER STATUS
The Tobacco Premium Program (TPP) is an out-of-pocket premium
of $30 per month. It applies to subscribers and dependents aged 16
and over who are enrolled in the UT SELECT Medical plan and use
tobacco products. Before making election changes via My UT Benefits,
you will be prompted to confirm tobacco user status for yourself and
eligible dependents.
EVIDENCE OF INSURABILITY/EVIDENCE OF
ELIGIBILITY
Evidence of Insurability (EOI) application (for adding or increasing
Voluntary Group Term Life or Long Term Care), you must follow
through by providing this information. If you do not, your requested
changes will not be implemented.
REVIEW YOUR CHANGES
Login using one of the options provided. Your PIN will be sent to you
in the letter or email titled “Your UT Benefits Enrollment Options” by
July 15th.
BE AWARE THAT CHANGES MADE DURING AE WILL
TAKE EFFECT ON SEPTEMBER 1
EXCEPTION: If EOI is required and has not been approved by
September 1, changes will take effect on the approval date for Life
Insurance or the first of the month following approval for Long Term
Care.
If you make a coverage election that requires documentation of
relationship (for adding a dependent) or for you to submit an
FOLLOW UP
EVIDENCE OF
INSURABILITY
DEADLINE FOR SUBMISSION
IS AUGUST 15
During this year’s Annual Enrollment (AE) period, Evidence of Insurability (EOI) will be required to enroll in or increase Voluntary Group Term
Life and Long Term Care (LTC) insurance. EOI is not required for UT SELECT Medical. In addition, no EOI is required to enroll in short- or longterm disability during AE period.
Important Notes:
LONG TERM CARE EOI
nnEOI is not required for enrollment in the UT SELECT Medical Plan
Employees and their spouses as well as any other eligible family
members will need to complete and pass EOI in order to enroll in
Long Term Care.
nnThe deadline for submitting electronic EOI or mailing a paper EOI
form is August 15th.
LIFE EOI
The My UT Benefits online system will automatically direct you to
complete EOI electronically if you enroll online. Otherwise, you may
complete a paper form and submit it to the insurer. You can view
and print the life EOI form online at www.dearbornnational.com/ut/
pdf/employees/gtl/ut_eoi.pdf. You can also request a form from your
institution’s HR or Benefits Office.
EVIDENCE OF
ELIGIBILITY
DEADLINE FOR SUBMISSION
IS AUGUST 15
12
If you wish to enroll in LTC, you can find a direct link to the CNA
website within My UT Benefits. On that site, you will find instructions
describing how to print and mail a form to the insurer for yourself
or if you have other eligible family members who wish to enroll. The
LTC forms are also available online at www.ltcbenefits.com/uts, or
you may request a paper form directly from CNA by calling (888)
825-0353.
DOCUMENTATION – EVIDENCE OF ELIGIBILITY
When requesting to add a dependent to your UT Benefits
coverage, you must provide appropriate supporting documentation
demonstrating Evidence of Eligibility (EOE). You should be prepared
to provide copies of relevant documents. Depending on the
relationship and circumstances, appropriate documentation may
include items such as a marriage certificate, a birth certificate,
completed adoption paperwork, or other legal documents.
A Matter of Health | Annual Enrollment Edition for Employees
The My UT Benefits online system offers the convenience of
submitting documents electronically when adding NEW dependents
to your benefits coverage during Annual Enrollment. To do this, you
simply upload clear, legible digital images (scanned documents or
photographs) of required documents directly through My UT Benefits
as evidence of your dependent’s eligibility. Additional information
will be available when you log into My UT Benefits, including FAQs
about the documentation upload process. There is a separate tab for
dependent information to help you more easily find details that you
may need.
NEW UT SELECT
MEDICAL ID CARDS
New UT SELECT Medical ID cards from Blue Cross and Blue Shield
of Texas (BCBSTX) will be issued to all UT SELECT Medical enrollees
before September 1, 2015. The new Medical ID Card will feature the
same information you are accustomed to seeing on your current ID
card plus new language about the Emergency Room benefit and
therapy benefit copayments for physical, occupational and speech
therapy. See the article on UT SELECT Medical Plan Design Changes
elsewhere in this newsletter for more details about these changes.
Please do not discard your current UT SELECT Medical ID card until
you receive your replacement ID cards. You can still access your
benefits with the old ID card. After you receive your new Medical
ID card in the mail, you can contact BCBSTX Customer Service at
(866) 882-2034 to request additional ID cards for your covered
dependents, if needed.
CHANGES DURING
THE YEAR
Because there are no changes to key benefits information for the
Prescription Drug Plan with Express Scripts, UT SELECT Dental plans,
the Delta Dental HMO, or Superior Vision plans for the upcoming
2015-2016 Plan Year, new ID Cards will not be issued this year
to continuing participants in these plans. If you enroll in a new
insurance plan type during Annual Enrollment or you change the
plan you are currently enrolled in (such as from Vision to Vision Plus),
you will receive a new insurance ID card prior to the start of the
2015-2016 plan year.
Outside of Annual Enrollment, you may not make changes to your benefits unless you have certain qualified change of status events
including:
nnmarriage, divorce, annulment, or spouse’s death;
An employee
nnbirth, adoption, medical child-support order, or dependent’s death;
nnwhose dependent loses insurance coverage under the Medicaid
or CHIP program as a result of loss of eligibility of either the
employee or the dependent; or
nnsignificant change in residence if the change affects you or your
dependents’ current plan eligibility;
nnchange of job status affecting eligiblity;
nnchange in dependent’s eligibility (e.g., reaching age 26 for UT
SELECT Medical, marriage or reaching age 25 for all coverage
other than UT SELECT Medical, or gaining or losing eligibility for
any other reason); or
nnsignificant change in coverage or cost of other benefit plans
available to you and your family.
nnwhose dependent becomes eligible for a premium assistance
subsidy under Medicaid or CHIP may enroll this dependent in
the basic coverage under UT Benefits, as long as the dependent
meets all other UT eligibility requirements and is enrolled within
60 days from the date of the applicable event. If enrollment of the
dependent is conditioned on enrollment of the retired employee,
the retired employee will also be eligible to enroll.
You may enroll in or make changes to benefits by contacting your institution HR/Benefits office within 31 days of one of these change of
status events.
ONGOING: KEEP IN TOUCH
If your address or employment changes, it could affect your benefits. Notify your institution if you have one of these changes.
Monthly Newsletter | Read the UT Office of Employee Benefit
montly newsletter. If you don’t already receive it, subscribe by
entering your email address in My UT Benefits.
Contact Us | Keep the “Contacts” section of this newsletter to
contact insurance vendors for plan information or your institution
about your coverage.
WHAT DO WE DO &
HOW CAN YOU FIND HELP?
INSTITUTION
UT BENEFITS
VENDORS
Address Change
Life Events / Change of Status
Eligibility
Rates
Monthly Newsletters
Legal Notices
Plan Guides
Annual Enrollment
Plan Details
ID Cards
Value Added Benefits
Claim Issues
Customer Service
A Matter of Health | Annual Enrollment Edition for Employees
13
2015-2016
UT BENEFITS
CONTACTS |
EMPLOYEES
UT ARLINGTON
Office of Human Resources
(817) 272- 5554
Fax: (817) 272-5798
benefits@uta.edu
(512) 471-4772 or
Toll Free: (800) 687-4178
Fax: (512) 232-3524
HRSC@austin.utexas.edu
UT BROWNSVILLE
Human Resources
(956) 882-8205
Fax: (956) 882-6599
benefits@utb.edu
UT DALLAS
Office of Human Resources
(972) 883-2221
Fax: (972) 883-2156
benefits@utdallas.edu
UT EL PASO
Human Resources
(915) 747-5202
Fax: (915) 747-5815
benefits@utep.edu
UT HEALTH SCIENCE CENTER
HOUSTON
Employee Benefit Services
(713) 500-3935
Fax: (713) 500-0342
benefits@uth.tmc.edu
UT HEALTH SCIENCE CENTER
SAN ANTONIO
Office of Human Resources
(210) 567-2600
Fax: (210) 567-6791
ben-admin@UTHSCSA.EDU
A Matter of Health | Annual Enrollment Edition for Employees
UT RIO GRANDE VALLEY
Office of Human Resources
Brownsville
Human Resources
(903) 877-7784
Fax: (903) 877-5394
benefits@uthct.edu
(956) 882-8205
Fax: (956) 882-6599
hr@utrgv.edu
Edinburg
Human Resources
UT AUSTIN
Human Resource Services
14
UT HEALTH SCIENCE CENTER
TYLER
UT MD ANDERSON
CANCER CENTER
Human Resources Benefits
(956) 665-2451
Fax: (956) 665-3289
hr@utrgv.edu
(713) 745-6947
Fax: (713) 745-7160
hrbenefits@mdanderson.org
UT SAN ANTONIO
Physicians Referral Service (PRS)
(713) 792-7600
Fax: (713) 794-4812
prsfacbensrvs@mdanderson.org
(210) 458-4250
Fax: (210) 458-7890
benefits@utsa.edu
UT MEDICAL BRANCH
AT GALVESTON
Human Resources
UT SOUTHWESTERN
MEDICAL CENTER
Employee Benefits Services
Human Resources/Employee Benefits Division
(409) 772-2630, Option “0”
Toll Free: (866) 996-8862
Fax: (409) 772-2754
benefits.services@utmb.edu
(214) 648-9830
Fax: (214) 648-9881
benefits@utsouthwestern.edu
UT SYSTEM ADMINISTRATION
UT PAN AMERICAN
Office of Employee Services
Human Resources
(512) 499-4660
Fax: (512) 499-4380
esc@utsystem.edu
(956) 665-2451
Fax: (956) 665-3289
hrbenefits@utpa.edu
UT TYLER
UT PERMIAN BASIN
Office of Human Resources
Human Resources
(903) 566-7480
Fax: (903) 565-5690
aclem@uttyler.edu
(432) 552-2751
Fax: (432) 552-3747
CONTACT
INFORMATION
INSURANCE PLAN ADMINISTRATORS
RETIREMENT PROVIDERS
UT SELECT MEDICAL
DELTACARE USA DENTAL HMO
FIDELITY INVESTMENTS
(Blue Cross and Blue Shield of Texas)
Group: 71778
(Delta Dental)
Group: 6690
(866) 882-2034
M-F 8:00 AM-6:00 PM CT
www.bcbstx.com/ut
(800) 893-3582
M-F 7:00 AM-8:00 PM CT
www.deltadentalins.com/
universityoftexas
(800) 343-0860
M-F 7:00 AM-11:00 PM CT
www.netbenefits.com/ut
UT SELECT PRESCRIPTION
(Express Scripts)
Group: UTSYSRX
SUPERIOR VISION
(800) 818-0155
24hrs a day 7 days a week
www.express-scripts.com/ut
(800) 507-3800
M-F 7:00 AM-8:00 PM CT
Sat 10:00 AM-3:30 PM CT
www.superiorvision.com/ut
UT FLEX
(PayFlex)
(866) 887-3539
M-F 7:00 AM-7:00 PM CT
Sat 9:00 AM-2:00 PM CT
www.utflex.com
Group: 26856
GROUP TERM LIFE, AD&D, AND
DISABILITY
(Dearborn National)
Group: GFZ71778
LIVING WELL HEALTH PROGRAM
(866) 628-2606
M-F 7:00 AM-7:00 PM CT
www.dearbornnational.com/ut
livingwell@utsystem.edu.
www.livingwell.utsystem.edu
LONG-TERM CARE
UT SELECT DENTAL and
UT SELECT DENTAL PLUS
(Delta Dental)
Group: 5968
VOYA FINANCIAL (formerly ING)
(866) 506-2199
M-F 7:00 AM-9:00 PM CT
Sat 7:00 AM-3:00 PM CT
https://utexas.prepare4myfuture.com
LINCOLN FINANCIAL GROUP
(800) 454-6265 * 8
M-F 7:00 AM-7:00 PM CT
www.lfg.com/ut
TIAA-CREF
(800) 842-2776
TDD (800) 842-2755
M-F 7:00 AM-9:00 PM
Sat 8:00 AM-5:00 PM CT
www.tiaa-cref.org/utexas
VALIC
(CNA)
Group: 0010025IS
(888) 825-0353
M-F 7:00 AM-5:00 PM CT
www.ltcbenefits.com/uts
(800) 448-2542
M-F 8:00 AM-7:00 PM CT
www.valic.com/utexasorp
(800) 893-3582
M-F 6:15 AM-6:30 PM CT
www.deltadentalins.com/
universityoftexas
A Matter of Health | Annual Enrollment Edition for Employees
15
OFFICE OF EMPLOYEE BENEFITS
210 W. 6TH STREET SUITE B.140E
Presorted
Standard Mail
U.S. Postage Paid
Austin, Texas
Permit No. 391
AUSTIN, TEXAS 78701
Annual Enrollment is July 15 - July 31
Important News About Your UT Benefits and Annual Enrollment is Enclosed.
For detailed plan information, scan the QR code with
your Smartphone or visit our website at
www.utsystem.edu/offices/employee-benefits