FY2017 CHOICES
BENEFITS PRESENTATION
Rita Garland, Benefits Specialist
and
Terri Phillips, Associate V.P.
HUMAN RESOURCE SERVICES
UNIVERSITY OF MONTANA
TM
ANNUAL BENEFIT
ENROLLMENT PERIOD
Online Enrollment
April 18, 2016
thru
May 20, 2016
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AGENDA FOR TODAY
 IMPORTANT CHANGES FOR FY2017
1.
2.
3.
4.
FY 2016 Mid-Year Change Recap
CHOICES workbooks are online
Rehabilitation benefit changes
Medical Flexible spending accounts (FSA),
Tax Advantage Account (TAA) & Wellness
reminders
 Benefit Changes and Your Decisions for FY2017
1. Medical, Dental, and Vision Hardware
2. Rates and Fees
 Time Frame for Making Benefit Election Decisions
April 18, 2016 thru May 20, 2016
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BENEFIT PLAN BASICS
 For FY2017, the employer contribution to health insurance
has increased to $1,054 per month.
 Our self funded plan has two sources of revenue – the
employer contribution as mandated by the State of Montana
and the out of pocket contributions that are charged to
members to cover children, spouses and adult dependents.
 The provisions of the plan are the same regardless of which
insurance administrator you choose – Allegiance, Blue Cross
Blue Shield, or PacificSource. The difference between the three
is with the doctors, hospitals and providers who have
entered into discount arrangements with those
administrators.
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Our Plan is Still Operating Under
“Closed Enrollment”
 You
cannot add any spouses or adult dependents to
the mandatory insurance items.
 You
may add children who qualify up to age 26 to the
mandatory insurance plan items.
 You
can delete a spouse or adult dependent from the
plan but you will not be able to add them back on
until such time that we have another open
enrollment period or you have a qualifying event.
 Will
we ever have “open enrollment” again? With
current, on-going changes to health insurance from
the Affordable Care Act, it is hard to predict – not in
the near future.
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ELIGIBILITY
Dependents up to age 26 may be enrolled
annually in Medical, Dental, and/or Vision
hardware benefits. (Does not include spouses).


Your dependents must be eligible according
to criteria in the Summary Plan document.

Mid-year dis-enrollment may only occur with a
“qualifying event” or during a “Special Enrollment
Period.”
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Qualifying Event Information
 New employees will have 30 days to enroll themselves and eligible
dependents.
 Within 31days of the birth, adoption, or affidavit of intent to adopt, add a
dependent child. Coverage begins on the date of birth of child(ren).
 For the following Qualifying Events, coverage begins on the
1st day of the month following the date HRS receives the
valid mid-year change form with appropriate
documentation:
1. Within 63 days of a family status change (marriage, divorce, legal separation,
attestation of a domestic partnership, death, etc.) plan members may enroll
or drop a dependent.
2. Within 63 days of the loss of eligibility for reasons other than non-payment
of premiums (e.g. loss of job, elimination of other coverage, becoming
ineligible for programs such as Medicaid or Healthy Montana Kids, or other
significant adverse event), add a dependent.
3. With a child support order or change in support which makes an MUS plan
member responsible for the medical coverage of a dependent child.
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Health Plans and Networks
To receive your best benefits,
STAY IN-NETWORK
with your health plan!!
Allegiance: 1-877-778-8600
Website: www.abpmtpa.com/mus
Blue Cross Blue Shield: 1-800-820-1674
Website: www.bcbsmt.com
PacificSource: 1-877-590-1596
Website: www.PacificSource.com/MUS
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HEALTH INSURANCE FACTS
 Managed
Care copays (flat dollar amounts that
you pay for services) remain the same as changes
on December 31, 2015 – for example: $25/office
or $40/specialty visit for “in-network” providers
(these dollars count toward your out of pocket
maximum).
 Managed
Care plans all have networks they work
with for out-of-state (national) coverage.
Allegiance works with Cigna
Blue Cross Blue Shield works with Blue Card
Pacific Source works with First Health & First Choice
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BALANCED BILLING AND INSURANCE
DEDUCTIBLES

When you remain “in-network” you get the best possible use
of your insurance dollars. You could complete the “innetwork” deductible and only have a maximum out of pocket
cost for medical bills of $4,000 (Person) or $8,000 (Family).

When you go “out-of-network” you have a second deductible
and out of pocket maximum that you must meet – the “innetwork” and “out-of-network” costs do NOT add together.

When you go “out-of-network” you could also face the
concept of “balanced billing”. This means the provider has no
agreement with the plan administrator in regard to how much
they can charge for a service. They will charge whatever they
want, the insurance plan will only cover the allowed portion,
and you will pay the rest out of pocket – this can be VERY
EXPENSIVE.
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Important Changes for FY2017
MID-YEAR CHANGE RECAP
BENEFIT THROUGH
DECEMBER 30, 2015
BENEFIT DESCRIPTION
CHANGE AS OF
DECEMBER 31, 2015
Copayments
Office Visits (non-specialty)
Specialty Visits
Emergency Room Facility
Visits
Urgent Care Visits
URx Copays
URx Specialty Copays
Increase In-Network
Deductible
Increase In-Network Medical
OOP
Increase Rx Out-of-Pocket
Infertility Treatment
Vision Hardware Benefit
$15
$15
$125
$25
$40
$250
$50
Tier A (retail/mail) $0/$0
Tier B (retail/mail) $15/$30
Tier C (retail/mail) $40/$80
Tier D (retail/mail) 50 %
Tier F (retail/mail) 100%
Specialty $50/ Specialty $200
Deductible
$500 (individual)/$1,000 (family)
$75
Tier A (retail/mail) $0/$0
Tier B (retail/mail) $25/$50
Tier C (retail/mail) $60/$120
Tier D (retail/mail) 50 %
Tier F (retail/mail) 100%
Specialty $150/ Specialty $300
Out-of-Pocket Maximums
$3,500 (individual)/$7,000 (family)
$1,650 (individual)/$3,300 (family)
Other Benefit Adjustments
Covered – see Summary Plan
Description for details
See full description at
www.choices.mus.edu/Vision.asp
$750 (individual)/ $1,500 (family)
$4,000 (individual)/$8,000 (family)
$2,150 (individual)/$4,300 (family)
Not covered – plan exclusion
$300 frames and lenses maximum
annual allowance, in lieu of contacts
$150 contacts maximum annual
allowance, in lieu of frames and lenses
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IMPORTANT CHANGES for FY2017
REHABILITATION BENEFIT
CHANGES
 Rehabilitative Services will be expanded to
include Acupuncture and Chiropractic Services.
BENEFIT DESCRIPTION
IN-NETWORK
COPAY/COINSURANCE
OUT-OF-NETWORK
COPAY/COINSURANCE
25%
35%
REHABILITATIVE SERVICES
Inpatient Services
(Pre-certification is strongly
recommended)
Outpatient Services
Max: 30 days per year (all therapies combined)
$25 copay /visit
35%
Max: 30 visits per year (all therapies combined)
Covered Rehabilitative Services Include:

Physical Therapy

Occupational Therapy

Speech Therapy

Cardiac Rehabilitation

Respiratory Rehabilitation

Pulmonary Rehabilitation

Acupuncture

Chiropractic
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Montana University System- Choices Benefit Plan
Mid-Year 2015-2016 and 2016-2017 Benefit Plan
Changes
Benefit Description
Primary Care Office Visits
(including naturopathic)
Specialist Office Visits
Urgent Care Visits
Emergency Room Facility Visits
Increase In-Network Deductible
Increase In-Network Medical OOP
URx Copays/Coinsurance
URx Specialty Copays
Increase URx Out-of-Pocket
Infertility Treatment
Vision Hardware Benefit
Outpatient Rehabilitative Services
Benefit through December 30,
2015
Medical Copayments
$15
Change as of December 31, 2015
$25
$15
$40
$50
$75
$125
$250
Medical Deductible
$500 (individual)/$1,000 (family)
$750 (individual)/ $1,500 (family)
Medical Out-of-Pocket Maximum
$3,500 (individual)/$7,000 (family)
$4,000 (individual)/$8,000 (family)
URx Copayments/Coinsurance
Tier A (retail/mail) $0/$0
Tier A (retail/mail) $0/$0
Tier B (retail/mail) $15/$30
Tier B (retail/mail) $25/$50
Tier C (retail/mail) $40/$80
Tier C (retail/mail) $60/$120
Tier D (retail/mail) 50 %
Tier D (retail/mail) 50 %
Tier F (retail/mail) 100%
Tier F (retail/mail) 100%
Specialty $50/ Specialty $200
Specialty $150/ Specialty $300
URx Out-of-Pocket Maximum
$1,650 (individual)/$3,300 (family)
$2,150 (individual)/$4,300 (family)
Other Benefit Adjustments
Covered – see Summary Plan
Not covered – plan exclusion
Description for details
$300 eyeglass frame and lenses maximum annual allowance, in lieu
See full description at
of contact lenses/
www.choices.mus.edu/Vision.asp
(frames, lenses and contacts subject to
$150 contact lenses maximum annual allowance, in lieu of eyeglass
copayments)
frame and lenses
Benefit through June 30, 2016
$25/visit- annual 30 visit combined
maximum for all therapies
(physical, occupational, cardiac,
respiratory, pulmonary, & speech
therapy)
Change as of July 1, 2016
$25/visit- annual 30 visit combined maximum for all therapies will
include acupuncture and chiropractic services
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Montana University System- Choices Benefit Plan
Monthly 2016-2017 Active Premium Rate Changes
MEDICAL
Choices Benefit Plan – Medical Active Rates
Allegiance
BCBS
Pacific Source
Rates July 1, 2015 – June 30, 2016
Allegiance
BCBS
Pacific Source
Rates July 1, 2016 – June 30, 2017
Employee Only
$624
$610
$682
$782
$748
$837
Employee &
Spouse/AD
$929
$909
$1,016
$1,145
$1,075
$1,225
Employee &
Child(ren)
$846
$828
$925
$1,024
$994
$1,096
Employee & Family
$1,178
$1,153
$1,289
$1,387
$1,327
$1,484
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Montana University System- Choices Benefit Plan
Monthly 2016-2017 Active Premium Rate Changes
DENTAL
Choices Benefit Plan – Dental Active Rates
Basic
Select
Rates July 1, 2015 – June 30, 2016
Basic
Select
Rates July 1, 2016 – June 30, 2017
Employee Only
$16
$42
$17
$43
Employee &
Spouse/AD
$31
$80
$31
$82
Employee &
Child(ren)
$31
$80
$31
$82
Employee & Family
$43
$113
$45
$116
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Montana University System- Choices Benefit Plan
Monthly 2016-2017 Active Premium Rate Changes
VISION HARDWARE
Choices Benefit Plan – Vision Active Rates
BCBS
Rates July 1, 2015 – June 30, 2016
BCBS
Rates July 1, 2016 – June 30, 2017
Employee Only
$7.11
$7.48
Employee &
Spouse/AD
$13.42
$14.12
Employee &
Child(ren)
$14.13
$14.86
Employee & Family
$20.73
$21.80
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USE IN-NETWORK PROVIDERS
Be sure to use “In-Network” providers to ensure you
do not incur “balance billing” charges.
 Network participation by providers is changing in
the health care market.

Always check - DO NOT assume
participation - your doctor may have dropped
participation in the network.

Check with your medical plan provider,
the MUS Benefits office, or your campus HRS
office, if you need help finding “In-Network”
providers.
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FLEXIBLE SPENDING ACCOUNT CHANGES

With the limitations on the manner and amount of employer
funds that may be placed in a medical FSA, MUS Choices
will continue to offer two account options for employees:
1.
Medical FSA option funded only with employee
contributions from paycheck (up to $2,550 per year).
2.
Tax Advantaged Account (TAA)
•
Same allowable expenditures as a medical FSA.
•
No “Use-it-or-Lose-it” annual requirement.
•
Account balance is portable upon termination of
employment.
•
Correction to CHOICES workbook (pg. 36). There is NO
TAA election option during the online benefits enrollment
process.
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MEDICAL SPENDING ACCOUNTS for FY2017
Tax Advantaged Account (TAA) Things to Know....

Only Employer funds can be placed in a TAA; employee
funds cannot be contributed (use the FSA instead).

If your spouse has coverage through an HSA or has a highdeductible health plan, you may wish to consult with a tax
advisor about whether you can use the TAA.

Account balances are not “Use-It-Or-Lose-It “and can
continue up to 24 months following the last day of
employment with MUS (for terminating or retiring
employees) and up to 24 months following the date that
MUS Benefits ceases to make employer contributions
(including Wellness Incentive funds).
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MEDICAL SPENDING ACCOUNTS FY2016
MEDICAL SPENDING ACCOUNTS
TAA & FSA
TAX ADVANTAGED ACCOUNT
Wellness Incentive Funds you
earn will be placed in TAA instead
of FSA.
TAA
FLEXIBLE SPENDING ACCOUNT
Up to $2,550 of Employee
contribution $$ from paycheck
(pre-tax).
Medical
FSA
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MEDICAL SPENDING ACCOUNTS FY2017

WELLNESS INCENTIVE PROGRAM

1.
2.
3.
Benefits Eligible Employees Who Completed in 2015:
A WellCheck in 2015 (biometric screening and blood draw),
Completed the online Well-Being Assessment on Wellness
Incentive “Limeade” program
Reached Explorer level = 406 points during 2015.
Will receive the $250 Wellness Incentive funds into their
Tax Advantage Account (TAA) on July 1, 2016.

Employees whose spouses/adult dependents completed a
WellCheck will receive an additional $250 in their employee TAA.
Maximum of $500 per individual household enrolled in the MUS
Plan.
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WELLNESS INCENTIVE PROGRAM

Discover great health with MUS Wellness and blaze a trail to your
best life! Participate in the MUS Wellness Incentive program and
earn points towards rewards.

Sign up at https://muswell.limeade.com/Home

Wellness Incentive “Limeade” program runs the 2016 calendar
year: January 1, 2016 to December 25, 2016.

You must: 1) participate in a WellCheck in 2016; 2) take the online
Wellbeing Assessment; 3) complete the Integrity Pledge. If you
reach 406 points and elect the $80 TAA award, it will be available
to you on July 1, 2017. (You must be a UM employee at the time).

Once you have reached the first level of 406 points and the
Wellcheck points have been added (may be a few weeks), an email
notification will come from Limeade. Shortly thereafter, the
Wellness Team will email asking what award choice you prefer.

Continue to earn points while you wait!
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MEDICAL SPENDING ACCOUNTS FY2017
 $500 Annual Flexible Spending (FSA)
Roll-Over

If you have funds remaining in your FSA account as of
June 30, 2016, the rollover provision is:
1.
These funds will be placed in your FSA sometime in
early October 2016 after FY2016 claims accounting
reconciliation is completed by Allegiance Flex.
2.
You may incur expenses against these funds
beginning July 1, 2016. However, the funds to pay
expenses from the roll-over funds will not be available
until they are deposited in to your FSA in early October
2016.
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LIFE INSURANCE ELECTIONS


Evidence of Insurability Is Required When:
1.
An Active employee wishes to add Optional
Supplemental Life Insurance in an amount above
$300,000 or increase existing coverage more than
one increment of $25,000 annually.
2.
Adding Optional Supplemental Dependent Life
for a spouse if not enrolled during the new hire
election.
Optional Supplemental Life and Optional AD&D
Coverage premiums are paid on an after-tax
basis.
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VISION HARDWARE BENEFIT

Optional Vision Hardware covers ONLY hardware (frames,
lenses, and contacts).

Eye exam is provided as part of your medical plan.

No need to use a network for purchasing hardware – simply
select a place to purchase and then submit claims to Blue
Cross &/Blue Shield. You will be required to pay at time of
service by most providers as there is not a network
agreement.

Claim form copies are available in the HRS office in
Lommasson 252 or on the HRS website at:
www.umt.edu/hrs/benefits/insurance
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Healthy Montana Kids is available for
qualifying MUS employees!
 The State of Montana allows the children of Montana
University System (MUS) and State of Montana employees to
participate in the Healthy Montana Kids program.
 This is a graduated program based on household income and
number of dependents – it could provide savings for your
family.
 You can decide to keep your child(ren) on the MUS insurance
plan.
 For more information, contact your campus HRS office or go to
ww.hmk.mt.gov or call 1-877-543-7669.
 The hardship waiver for coverage for children is still
available – you must apply for HMK and be denied before
applying for the MUS waiver. This must be applied for
every year.
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Why is it important to complete
Annual Benefit Election?





Dependent children are eligible until age 26 – if you have
children you previously had to drop you can now add
them back on until age 26.
The medical plan monthly costs have increased – the plan
you were in last year may no longer be the best plan for
you.
The health care providers that you use may or may not
still be “in network” for the plan you were in last yearproviders do change.
Your goal is to stay “in network” to make the best use of
your money – going “out of network” will cost you more.
Flexible spending accounts for both medical and
dependent care DO NOT ROLL FORWARD – you
must sign up for that option every year.
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CHANGES to CHOICES
 REMINDER - Closed enrollment for spouses in FY2017
(qualifying event required to add spouses – children to age 26 may be
added).
 If you do not submit any changes, then you will be reenrolled in the prior year benefit elections (except for FLEX or
TAA).
 FLEX PLAN ENROLLMENT and TAA ELECTION
1. You must re-enroll in Flex each year and specify the
dollars you wish to go into your account from your
paycheck.
2. Remember that Flex is “USE IT OR LOSE IT”!
Rollover provision permits up to $500 to carry forward
to the following benefit year.
3. WellCheck Incentive awards of up to $500 per
household is available with the funds deposited into
a Tax Advantage Account (TAA).
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Annual Benefits Elections
Online Facts

Online Annual Benefits Election opens on April 18, 2016
and closes on May 20, 2016.

Come to the LA 139 Computer Lab for online election
assistance – check the online schedule. First come, first
served! Don’t wait until May 20th—the lab will be
packed and the wait will be very long.

You must follow the instructions for using online
enrollment that will be available on the HRS website –
this will ensure that your elections are complete
and accurate.

You will log onto CyberBear using your NetID and
password.
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Be sure to do these things 
Online annual benefit election process – click on the
SUBMIT button when you are done.

Be sure to print the “Benefits Summary or Calculate
Cost” page for your records.

REVIEW your elections—if it isn’t what you elected, contact
HRS immediately. Changes cannot be made after May 20, 2016.

If you want to contribute your own paycheck funds to a
Flexible Spending Account, you must ELECT it each year – it is
not automatic.

Check covered dependents and provide correct SSN and
birthdate information for IRS reporting purposes.

This is also a good time to review all of your Beneficiaries on
ALL insurance and life policies, Decedent's Warrant, etc.) to
make sure they are up to date.
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QUESTIONS?
Thank you for your time!
UM HUMAN RESOURCE SERVICES
Office: 406-243-6766
Email: HRSCommunications@mso.umt.edu
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