Congratulations on your decision to retire! We are pleased to provide benefit plan information for retirees for the
2016 calendar year. We encourage you to review this communication and the enclosed information thoroughly
and carefully.
STEPS YOU ARE REQUIRED TO TAKE TO CONTINUE COVERAGE
•
Complete the enclosed enrollment form to elect benefit coverage(s)
o If you or your spouse are age 65 or older, and are choosing to continue medical
coverage through Xavier, you must elect the Medicare Employer Preferred Provider
Plan. In addition to completing and signing the attached election form, you will also
need to complete and return the enrollment packet required by Humana. Please
contact the Office of Human Resources to obtain this packet.
This communication will include:
•
•
•
•
•
2016 Medical Plan Summary/Rates
2016 Dental Plan Summary/Rates
2016 Vision Plan Summary/Rates
Retiree Monthly Premium Payment Process
Required Benefit Election Form
2016 Medical Plan Offering – Retirees and Spouses under age 65
For the 2016 calendar year, Xavier University continues to offer two medical benefit options. For those that are
Medicare-eligible (age 65 or over), there is a different medical benefit plan offered.
•
•
National Point of Service Plan (NPOS) – for 2016, with a deductible change to $750 / $1,500, and coinsurance
change to 80/20%
High Deductible Health plan (HDHP)
Based on national medical plan average increases and Xavier University’s health plan claims experience, plan design
changes and rate increases are required for 2016. For the plan design, the NPOS Plan deductible will increase from
$500 for single coverage and $1,000 for family coverage to $750 for single coverage and $1,500 for family coverage.
Coinsurance share amounts for 2016 also will change from 90/10% to 80/20%.
Enclosed, please find additional information on the plan including rates and coverage by plan.
2016 Medical Plan Offering – Retirees and Spouses under age 65
For the 2016 calendar year, Xavier University offers the Humana Medicare Advantage plan to retirees and
their spouses age 65 and over. The Humana Medicare Employer Preferred Provider Organization (PPO) plan
gives you access to any Medicare provider or facility. If you use Humana’s broad network of primary care
doctors, specialists, and hospitals, your out-of-pocket costs may be less. You never need a referral to see any
provider. You must have both Medicare Part A and Part B.
Enclosed is the rates sheet for this plan, please contact the Office of Humana Resources to obtain more
detailed information from Humana regarding the Medicare Advantage Plan. Once you obtain the packet, if you
have questions about this plan, please call Humana Group Medicare Customer Care at 1-866-396-8810 (TTY:
711). You can call Monday through Friday from 8 a.m. to 9 p.m. Eastern time.
2016 Dental Plan Offering
If you are currently enrolled with Dental Care Plus, you may continue coverage or decline. Plan summary and
rates are enclosed.
2016 Vision Plan Offering
If you are currently enrolled with Humana Vision, you may continue coverage or decline. Plan summary and
rates are enclosed.
Retiree Monthly Premium Payment Process
Xavier University continues to partner with Chard Snyder for purposes of billing and collecting payments
for retiree benefits. Retirees submit payment of retiree benefit premiums to Chard Snyder. Additional
information is enclosed describing the process and the conveniences offered by Chard Snyder.
NEXT STEPS:
Review the enclosed information. Once you have reviewed the information, complete any applicable form(s)
such as the Retiree Benefit Change Form and/or a Humana Medicare Advantage application and return no
later than 30 days following your date of retirement:
•
•
•
Via mail: Xavier University, Office of Human Resources, 3800 Victory Parkway, Cincinnati, OH 452075400
Via email (scan and email): benefits@xavier.edu
Via fax: 513-745-3644
If you have any other questions about the benefits reviewed above, please contact our engagement team at Horan
Associates at 844-694-6726 or the Office of Human Resources at 513-745-3638.
This communication is intended as a material modification to amend benefits offered to retirees for calendar year 2016. Medical, dental
and vision benefits and rates are subject to change at the discretion of Xavier University. I understand that I am required to submit
contribution payments on a monthly basis for the benefits elected. If my payments are not submitted timely, I understand that my
benefits are subject to being terminated and are not eligible for reinstatement.
2016 Retiree Monthly Premium Contributions - Retirees and Spouses Under Age 65
Tier
Single
EE+ Spouse
EE+ Child(ren)
Family
Humana NPOS
Humana HDHP
Total Premium Rates
$589.00
$1,173.00
$1,114.00
$1,833.00
Total Premium Rates
$519.00
$1,034.00
$982.00
$1,615.00
Retiree Premium Monthly Rate Qualification:
1) Retired prior to 1994 your medical premium is paid 100% by Xavier
Tier
Single
EE+ Spouse
EE+ Child(ren)
Family
Humana NPOS
Humana HDHP
Total Premium Rates
$0.00
$0.00
$0.00
$0.00
Total Premium Rates
$0.00
$0.00
$0.00
$0.00
2) If not 50 years old as of 1995, you have access to coverage and pay 100% of the medical premium rate
Tier
Single
EE+ Spouse
EE+ Child(ren)
Family
Humana NPOS
Humana HDHP
Total Premium Rates
$589.00
$1,173.00
$1,114.00
$1,833.00
Total Premium Rates
$519.00
$1,034.00
$982.00
$1,615.00
3) If 50 years old as of 1995, you will receive $135 subsidy per month from Xavier
Tier
Single
EE+ Spouse
EE+ Child(ren)
Family
Humana NPOS
Humana HDHP
Total Premium Rates
$454.00
$1,038.00
$979.00
$1,698.00
Total Premium Rates
$384.00
$899.00
$847.00
$1,480.00
4) Retired before 12/31/94, meet requirements of age 62 with 7 years of service, you will receive a subsidy of $135 a month for
single coverage and $270 a month for double or family coverage
Tier
Single
EE+ Spouse
EE+ Child(ren)
Family
Humana NPOS
Humana HDHP
Total Premium Rates
$454.00
$903.00
$979.00
$1,563.00
Total Premium Rates
$384.00
$764.00
$847.00
$1,345.00
2016 Retiree Monthly Premium Contributions - Medicare Advantage Plan
Offered to Retirees and Spouses age 65 and over
Humana Medicare Advantage
Tier
Total Premium Rates
Single
EE+ Spouse
EE+ Child(ren)
Family
$269.00
Retiree Premium Monthly Rate Qualification:
1) Retired prior to 1994 your medical premium is paid 100% by Xavier
Humana Medicare Advantage
Rate per retiree/Spouse
Tier
Total Premium Rates
Single
EE+ Spouse
EE+ Child(ren)
Family
$0.00
2) If not 50 years old as of 1995, you have access to coverage and pay 100% of the medical premium rate
Humana Medicare Advantage
Rate per retiree/Spouse
Tier
Total Premium Rates
Single
EE+ Spouse
EE+ Child(ren)
Family
$269.00
3) If 50 years old as of 1995, you will receive $135 subsidy per month from Xavier
Humana Medicare Advantage
Rate per retiree/Spouse
Tier
Total Premium Rates
Single
EE+ Spouse
EE+ Child(ren)
Family
Retiree
Spouse
$134.00
$269.00
4) Retired before 12/31/94, meet requirements of age 62 with 7 years of service, you will receive a subsidy of $135 a month for
single coverage and $270 a month for double or family coverage
Humana Medicare Advantage
Rate per retiree/Spouse
Tier
Total Premium Rates
Single
EE+ Spouse
EE+ Child(ren)
Family
$134.00
XAVIER UNIVERSITY VOLUNTARY PLAN
Effective January 1 – December 31, 2016
DESCRIPTION OF BENEFITS
Individual Maximum per
Calendar Year...........................$1,000
$50 Annual Individual Deductible
$150 Annual Family Deductible on Basic and Major Benefits only
Percentage Paid by Dental Care Plus
Preventive Benefits...................100%
Basic Benefits........................…60%
Major Benefits...........................40%
Orthodontic Benefits.................50%
+ $500 Individual Lifetime Maximum
+ Limited to eligible dependent children under age 19
A complete description of benefits, limitations and exclusions are available in the Individual
Certificate. Members must receive services from a Dental Care Plus dentist.
Monthly Employee Rates
Single - $28.18
Double - $54.24
Family - $95.56
Xavier University
Humana Voluntary Vision Outline and Employee Monthly Contributions
January 1, 2016
Renewal
Humana
Rates
Employee Only
$5.80
Double
$10.56
Family
Benefits
Exam with Dilation as Necessary
$16.08
In-Network
Out-of-Network
$20
Up to $35
Standard Plastic Lenses
Single Vision
$20
Up to $25
Bifocal
$20
Up to $40
Trifocal
$20
Up to $60
$50 wholesale
Up to $40 retail
Frames/Frame Allowance
Contact Lenses
Contact Lens Allowance
Up to $150
Up to $150
Conventional
Up to $150
Up to $150
Disposables
Medically Necessary
Laser Vision Correction (Lasik or PRK)
Up to $150
Up to $150
Covered in full
Up to $250
Discount
N/A
Allowed Frequencies
Exams
12 months
Frames
24 months
Lenses
12 months
Contact Lenses
12 months
Rate Guarantee
2 years
Please note: Members receive additional fixed copayments on lens options including: anti-reflective and scratch-resistant coatings