2015
Your Benefits
Summary
Open Enrollment is
November 3rd–14th
Better choices for a healthier you
The University System of Georgia (USG) continues to update benefit plans
to offer the best combination of features and value. Your needs change,
too — so, it’s a good idea to review your benefit options for 2015.
What’s new? What’s changing?
•While healthcare carriers remain the same, some healthcare options will have new names. The HSA
Open Access POS plan will be known as the Consumer Choice HSA plan, and the Open Access POS
plan will become the Comprehensive Care plan.
–– In 2015, BCBS plans will offer enhanced member support programs, including complex care
management, educational tools, 24/7 Nurseline, Personal Health Consultants and NICU support.
•There will be changes to healthcare deductibles, copays, coinsurance and premiums — see details inside.
•For 2015, CVS Caremark will be USG’s pharmacy benefit provider for all healthcare plans, other than
Kaiser. CVS Caremark helps you manage your prescriptions, saving you time and money.
•Make sure you’re getting the best value with Castlight — a free, online tool that helps you compare
doctors and healthcare services on quality, convenience and cost. Castlight will be available to those
covered by the Consumer Choice HSA or Comprehensive Care plans beginning in January 2015.
Learn more now by visiting MyCastlight.com/USG.
Understanding your needs: A brief survey
Employees enrolling in healthcare coverage will be required to complete a simple, three-question
survey about their spouse’s coverage. The information will help us ensure our plans address
employee needs and manage costs.
USG helps you save money on everyday expenses
Coming in November 2014: Your dollars will go further with USG Perks, a free,
new program. We leverage group buying power to help you save money on things
you already buy, like clothing, electronics, travel, dining, and movie tickets.
New for 2015! LifeStyle Benefits offer you discounts on roadside assistance, identity
theft protection, fitness center memberships, legal counseling, tax help, and pet care.
During Open
Enrollment,
you must…
Certify your Tobacco
Use Status if you choose
healthcare coverage! If you
do not certify, your status
will default to “tobacco
user,” and a $75 monthly
surcharge will be added
to your premium. If you
have covered dependents,
their Tobacco User Status
will default to “no.” You
may make changes to your
tobacco use status at any
time, and the change will
be effective the first of the
following month. However,
there will be no refunds of
the $75 surcharge — so
certify your status correctly
during Open Enrollment.
University System of Georgia Benefits
Visit usg.edu/hr/benefits/oe for Open Enrollment information and to find out how
you can start saving money!
we provide • you decide
Healthcare
When it comes to keeping you and your family healthy, we’ve got you covered.
•Consumer Choice HSA — Provided by Blue Cross Blue Shield
•Comprehensive Care — This BCBS plan was formerly known
of Georgia (BCBS), this plan was formerly known as the Health
as the Open Access POS, and it offers coverage for both in-network
Savings Account (HSA) Open Access POS. This is the only healthcare
and out-of-network providers.
plan that provides you with access to an HSA — see more
•BlueChoice HMO — You receive benefits when your care is
information on page 3.
coordinated by your BCBS primary care physician.
•Moving to the Consumer Choice HSA for 2015? If you have
•Kaiser Permanente (KP) HMO — You receive benefits when
an FSA now, make sure the balance is zero by December 31, 2014 —
your care is coordinated by your KP primary care physician.
otherwise, you won’t be able to open an HSA until April 1, 2015.
What if I don’t enroll? If you have healthcare coverage for 2014 and do not enroll for 2015, your 2015 coverage will default to your 2014 coverage.
Your healthcare options
Consumer Choice HSA
In-network
Comprehensive Care
In-network
BlueChoice HMO
In-network only
Kaiser Permanente HMO
In-network only
Deductible
(Single/Family)
$1,500/$3,000
$500/$1,500
None
None
Out-of-pocket max
(Single/Family)
$3,500/$7,000
$1,250/$2,500
$5,500/$9,900
$6,350/$12,700
No
No
Yes
Yes
100%
100%
100%
100%
Physician office visit/
Specialist visit
80% after deductible
$20 copay/$30 copay
$30 copay/$50 copay
$20 copay/$25 copay
Inpatient hospital services
80% after deductible
90% after deductible
$500 copay
$250 copay
80% after deductible
$150 copay, then
90% after deductible
$250 copay
$250 copay
• Generic
$10 copay
$10 copay
$10 copay
• Preferred brand
$35 copay
$35 copay
Kaiser pharmacies: $35 copay
Contracted non-Kaiser pharmacies:
$45 copay limited to a one-time fill per medication
20% with $45 min
and $125 max
20% with $45 min
and $125 max
Not covered
$25 copay
$25 copay
$20 copay
$87.50 copay
$87.50 copay
$70 copay through Kaiser pharmacies only
20% with $112.50 min
and $250 max
20% with $112.50 min
and $250 max
Not covered
Primary care physician
required
Preventive care
Emergency care
Prescription drugs
Retail
80% after deductible
• Nonpreferred brand
Mail order (90-day supply) Retail
• Generic
• Preferred brand
• Nonpreferred brand
80% after deductible
Bold text indicates change for 2015.
Your dental options
You can choose from these dental options
through Delta Dental.
*Preventive and diagnostic services don’t count toward
the annual maximum.
**Benefit limits on full replacement of existing dentures
or crowns apply.
For 2015, you can choose dental and vision coverage for
eligible dependents without student verification until the end
of the month in which they turn 26. If your dependent has
been dropped from your coverage in the past, you may add
the dependent(s) to your dental and vision coverage during
Open Enrollment.
Delta Dental Base Plan
Delta Dental High Plan
In-network
In-network
$1,000 per person*
$1,500 per person*
$50/$150
$50/$150
Diagnostic/preventive services*
100%
100%
Basic benefit services
80%
80%
Major benefit services**
50%
80%
Orthodontia (child and adult)
No coverage
80%
Lifetime orthodontia maximum
No coverage
$1,000
Annual maximum
Deductible (Single/Family)
Your vision option
Healthcare FSA
You can choose to enroll in vision coverage through EyeMed,
whose provider network includes top national retail chains. Vision
benefits are provided for the following services and supplies once
per 12-month period.
A Healthcare FSA can save you money on healthcare, prescription drug,
dental, or vision expenses. You can contribute up to $2,500 a year.
EyeMed Vision
In-network
Out-of-network
reimbursement
Exam
$10 copay
$40
Single vision lens
$25 copay
$40
Frames contribution
$150 allowance
$58
Contact lenses
$150 allowance
$130
Paid in full
$210
Medically necessary
contact lenses
NEW! CVS Caremark
For 2015, CVS Caremark will be USG’s pharmacy benefit manager
for employees enrolled in BCBS healthcare plans. You will
receive one ID card with your BCBS and CVS Caremark benefit
information. CVS Caremark will provide ways to save you time
and money, whether you fill your prescription at a network retail
pharmacy or choose convenient mail service for your refills.
Dependent Care FSA
A Dependent Care FSA can save you money on dependent care
expenses you pay while you’re at work. These include day care
expenses and summer camps for children under age 13 and care
for an elderly parent. You can contribute up to $5,000 a year, or
$2,500 if you’re married and file separate income tax returns.
Plan carefully! FSAs have a “use it or lose it” policy. Money left in
an FSA cannot be returned to you.
Protect your income
We provide you with coverage to help protect your family’s income
against the unexpected.
Disability coverage
2015 Rates:
•Short-term disability (STD) — After you’ve been disabled
for 14 days, this benefit replaces 60% of weekly salary, up to
$2,500. Benefits may last up to 11 weeks. Evidence of Insurability
is required if you elect this coverage during Open Enrollment.
•Long-term disability (LTD) — After you’ve been disabled
for 90 days, this benefit replaces 60% of monthly salary, up to
$15,000. No evidence of insurability is required.
See premiums for all 2015 benefit options in
the Comparison Guide: http://www.usg.edu/hr/
benefits_docs/BOR_Comparison_Guide_NEW.pdf
Do you already have a condition? You may not be eligible for
LTD benefits for 12 months if you received treatment for a condition
within three months of when your disability coverage begins.
Save money on healthcare
and dependent care
A U.S. Bank Health Savings Account (HSA) and/or Flexible Spending
Account (FSA) can save you money on health and dependent care
expenses. Your contributions to these accounts are tax-free, saving you
money on federal and state income taxes and Social Security taxes.
Health Savings Account (HSA)
If you’re enrolled in the Consumer Choice HSA plan, you’re eligible
to have an HSA. Unlike an FSA, money left in your HSA rolls over
from year to year.
When you contribute to your HSA, USG will match you dollar-fordollar until your contributions reach $375 for an individual or $750
for a family. In 2015, you can personally contribute up to $2,975 for
an individual or $5,900 for a family. And the HSA is always yours,
even if you leave USG!
Limited Purpose Healthcare FSA
A Limited Purpose Healthcare FSA is an additional tax-free account
for those enrolled in the Consumer Choice HSA. You may
contribute up to $2,500 for eligible dental and vision expenses only.
Life insurance
You can protect your family’s income in the event of a death due to
illness or accident.
•Basic life and AD&D — You’ll receive life and Accidental
Death & Dismemberment (AD&D) insurance equal to $25,000
at no cost to you.
•Supplemental life insurance — You can buy additional life
insurance coverage from one to eight times your salary, up to a
maximum of $2.5 million. Each year, you can elect or increase your
coverage by one times your salary without having to provide proof
of good health to the lesser of three times your salary or $500,000.
•Dependent coverage — You can choose life insurance
coverage for your dependents, too:
–– Spouse coverage options of $10,000 to $500,000. Proof of
good health is required for all requests for spouse coverage
during Open Enrollment.
–– Child(ren) coverage options of $5,000, $10,000 or $15,000.
No proof of good health is required.
•Supplemental AD&D insurance — You can buy additional
supplemental AD&D insurance in amounts of $10,000 to $500,000.
Coverage is available for you alone, or you and your family.
Bonus! You’ll also receive these benefits: beneficiary financial
counseling, legacy planning services, legal services, and travel assistance.
Protect those who matter
Your USG benefits can also cover your eligible dependents.
Healthcare benefits: Your legal spouse; your natural, adopted, or
stepchild(ren) through the end of the month of their 26th birthday;
your disabled child(ren) with proof of disability.
Dental, Vision, Life, and AD&D benefits: Your legal spouse or
domestic partner; your natural, adopted or stepchild(ren) who live
with you, through the end of the month of their 26th birthday; your
disabled child(ren) with proof of disability.
If you are adding new dependents to any coverage, you may be
required to show documentation of your relationship or your
child’s age. Examples include a marriage certificate, birth certificate,
adoption certificate, and income tax returns.
If both you and your spouse are eligible University System of
Georgia employees, only one may elect to cover the other
spouse and/or dependent children.
Get help when you need it
Have questions about your benefits? We have answers. Visit usg.edu/hr/benefits/oe or call your institution’s HR/Benefits office. When you
need to contact our benefits partners …
Healthcare
BCBS
1-800-424-8950
bcbsga.com/usg
Kaiser Permanente HMO
1-404-261-2590
1-888-865-5813 (Outside of Atlanta)
kp.org
Pharmacy (BCBS plans)
CVS Caremark
1-800-231-4403
caremark.com (available 1/1/2015)
Healthcare transparency tool
(Comprehensive Care and Consumer
Choice HSA plans only)
Castlight
1-800-424-8950 (first-level service support mycastlight.com/usg
provided by BCBS)
Dental
Delta Dental
1-800-471-4214
deltadentalins.com/usg
Vision
EyeMed
1-866-800-5457
eyemedvisioncare.com/usg
HSA & FSA
U.S. Bank
1-877-470-1771
mycdh.usbank.com
Disability
MetLife
1-866-647-6766
mybenefits.metlife.com
Life and AD&D
Minnesota Life
1-866-293-6047
lifebenefits.com
Discounts on services
LifeStyle Benefits
1-855-647-6766 (available 1/1/2015)
MyMemberPortal.com (available 1/1/2015)
Online purchasing program
USG Perks
Contact the Help Center via the website
usg.affinityperks.com
• Consumer Choice HSA
• Comprehensive Care
• BlueChoice HMO
The University System of Georgia Health Plan meets the Affordability requirement under the Affordable Care Act. Therefore, generally, University System of Georgia employees
will not be eligible for a tax credit in 2015 through the Health Insurance Marketplace created under the Affordable Care Act.
BENEFITS SUMMARY