Open Enrollment for Plan Year
April 1, 2014 - March 31, 2015
Open Enrollment Period:
February 17, 2014 to February 28, 2014
Celebrating 12 Years of
“Better Benefits Through Collaboration”
Welcome to the 2014 Open Enrollment Season
for the Plan Year April 1, 2014 – March 31, 2015
2
Brand Partners
Company
Benefit
Health Insurance
Prescription Drug Plan
Mental Health, Substance Abuse/
Employee Assistance Program
Contact
ID Card?
www.floridablue.com
800-664-5295
Yes
www.mycatamaranRx.com
800-207-2568
Yes
www.mhnet.com
877-398-5816
Back of Florida Blue Card
www.humanadental.com
Dental Insurance
Eye Care Plan
Term Life, AD&D and Short and Long
Term Disability Program and Insurance
Flexible Spending Plans:
Health Care Spending Account
Dependent Care Spending Account
Health Reimbursement Account
800-233-4013 (PPO)
800-979-4760 (DHMO)
www.advanticabenefits.com
866-425-2323
Contact Human Resources
http://icubabenefits.org
866-377-5102
Yes
Yes
No
ICUBA Benefits
MasterCard®
Member ID Health Cards can be printed online or stored to your smart phone!
3
Health Care Reform
 Enrollment in an ICUBA Medical Plan satisfies the requirement
for having coverage
 ICUBA Medical Plans are equivalent to Gold Plans offered on
the Public Marketplace Exchanges
 ICUBA has lower out-of-pocket costs, broader networks of
providers, pre-tax benefits, employer contributions into HRA’s,
and more generous FREE wellness benefits.
 No pre-existing condition limitations effective April 1, 2014
 All other requirements of Health Care Reform are in place
4
Same Great ICUBA Benefits in 2014

Florida Blue™ Medical Plans

Catamaran™ Pharmacy Benefits and Network

MHNet™ Behavioral Health, including Employee Assistance Program

ICUBA Benefits MasterCard™

Advantica Eyecare

Humana Dental Plans

Free in-network benefits such as lab tests at Quest Diagnostics, immunizations,
and other preventive/wellness services, including FREE diabetic supplies

No copay or coinsurance for wellness office visit

Prescribed Aspirin (for adults), and folic acid and generic pre-natal vitamins (for
pregnancy) are covered at no cost to you under the prescription drug plan

Florida Blue™ “Know Before You Go” at (888) 476-2227

Blue 365® from Florida Blue™ at www.floridablue.com

Summary of Benefits and Coverage (SBC)
5
What’s New?
Enhancements effective 4/1/14
 NEW NAME for the PPO Risk/Reward Plan - Preferred PPO Plan
 FREE tobacco cessation benefit
 FREE office visits at Blue Physician Recognition™ providers
 FREE coverage of ESSURE for women
 NEW LOW COPAY for 90-day retail prescription fill (same 90-day mail order)
 NEW AND IMPROVED wellness program
 ADDITIONAL ADVANTICA VISION PLAN - with a 12 month frame option
 PRENATAL OFFICE VISIT - $20 co-pay added to the Preferred PPO for initial
prenatal office visit - just like the PPO 70. All remaining prenatal office visits in
the same plan year are FREE. Delivery fees are based upon plan design and
subject to applicable deductible, coinsurance, and co-pays.
6
FREE ICUBA Cares™ In-Network Benefits
ICUBA medical plans provide generous wellness benefits beyond those required by law. Each plan
year you may receive a FREE Annual Physical and/or FREE Annual Gynecological Exam. All of the
following benefits are always FREE to Members regardless of your health condition, age, gender
or number of times you receive the medically necessary service:





Lab Tests
Pap Tests
Urinalysis
Colorectal
Screenings
Prostate
Cancer
Screenings







Electrocardiograms
Echocardiograms
Mammograms
Colonoscopies and
Sigmoidoscopies
Immunizations
Allergy Injections
Bone Mineral Density Tests
Employee Assistance Program
for available to all benefiteligible employees and
household members.
Call the EAP 24-hours a day at
1.877.398.5816
Receive up to six free face-toface counseling sessions per
presenting issue per plan year.



Prescribed diabetic supplies
including meters, lancing
devices, lancets, test strips,
control solution, needles,
and syringes
Aspirin for adults with a
physician prescription
Prescribed generic folic acid
and generic pre-natal
vitamins for pregnancy
NEW
$0 copay for all office visits to Blue Physician Recognition™ provider
$0 copay for two courses of treatment per plan year for tobacco cessation
7
PPO Plan Comparison
Plan Similarities
Plan Differences
 Catamaran Prescription Drug
Benefit (Same low co-pays for 90day fill by mail or retail)
 Premiums
 All Free ICUBA Cares™ Wellness
Benefits
 Coinsurance
 24/7 Health Information Hotline
 ER & Urgent Care Benefits
 Plan Rules
 Deductibles
 Co-pays (except maternity visits)
 Annual Out-of-Pocket Maximums
 HRA Contributions
 Free office visits to Blue Physician
Recognition™ providers
 Free Tobacco Cessation Benefit
 Same $20 copay for initial
Maternity Visit
8
Definitions:
 Blue Physician Recognition™ (BPR): Personal physician (Family Practice, General Medicine,
Internal Medicine, and Pediatrics) who coordinates all aspects of patient care and who meets
NCQA quality measures and is designated as a participating Blue Physician Recognition™
provider by Florida Blue.
 Deductibles: The cumulative amount that you must pay in the Plan Year before benefits will be
paid by the Plan. No Deductibles for Physician office visits, Therapy office visits, Urgent
Care visits, Emergency Room visits and Prescription Drugs.
 Coinsurance: The percentage of a covered expense that you pay after the satisfaction of any
applicable deductible. For example, the plan may pay for 70% of covered services and you pay
30%.
 Copays (Co-payments): The fixed dollar amount you are required to pay each time a particular
service is used. The copay does apply to out-of-pocket but does not reduce amounts applied to
the deductible or co-insurance.
 Plan Year: The plan year runs from April 1, 2014 through March 31, 2015.
 Annual Out-of-Pocket Maximum: The maximum amount of deductible, co-insurance and copayments during any Plan Year that you pay before the Plan begins to pay 100% of Covered
Expenses for the balance of the Plan Year.
 Flexible Spending Account: A Health Care or Dependent Care Spending account in which you
put aside pre-tax dollars to pay for eligible expenses.
9
Side by Side Plan Comparison
2014-2015 Plan Year
PPO 70 Blue Options
Preferred PPO Blue Options
Network
Non Network
Network
Non Network
$1,000/$2,500
$1,500/$4,000
$2,000/$4,000
$3,500/$9,750
30% after
deductible
50% after
deductible
20% after
deductible
40% after
deductible
$3,000/$6,000
$6,000/$12,000
$3,500/$7,000
$7,000/$14,000
$0
N/A
$0
N/A
$20 co-pay;
no deductible
50% after
deductible
20%
no deductible
40% after
deductible
$20 co-pay per plan
year; not subject to
deductible
50% after
deductible
$20 co-pay per plan
year; not subject to
deductible
40% after
deductible
Deductible Individual/Family
Coinsurance
Out of Pocket Maximum (includes all
medical co-pays, deductibles, and
coinsurance)
Blue Recognition Office Visits
(includes General Practice, Family
Practice, Internal Medicine, and
Pediatrics)
Physicians Office Visit
(includes General Practice, Internal
Medicine, Family Practice, Pediatrics,
and OB/GYN)
Maternity Office Visits
10
Side by Side Plan Comparison
2014-2015 Plan Year
PPO 70 Blue Options
Preferred PPO Blue Options
Network
Non Network
Network
Non Network
$30 co-pay;
no deductible
50% after deductible
20%; no deductible
40% after deductible
$0
Not Covered
$0
Not Covered
$100 co-pay and
30% after deductible
50% after deductible
20% after deductible
40% after deductible
$30 co-pay;
no deductible
$30 co-pay;
no deductible
20%; no deductible
20%; no deductible
Emergency Room Services
$100 co-pay
(waived if admitted)
no deductible
$100 co-pay
(waived if admitted)
no deductible
$100 co-pay
(waived if admitted)
no deductible
$100 co-pay
(waived if admitted)
no deductible
Hospital Inpatient
$250 co-pay, and
30% after deductible
$500 co-pay and 50%
after deductible
20% after deductible
40% after deductible
Specialist Office Visit, including
Chiropractors and Therapists
Wellness Exam
Outpatient Diagnostic Imaging
Urgent Care
11
The ICUBA premium increases are 3.6% + 1.2% in new taxes = a total of 4.8%.
Rate increases in the Florida market are averaging 9% this year.
Preferred PPO and PPO 70 Plan Premiums
Coverage Tier
Total
Monthly
Premium
NSU Contribution
Monthly
Monthly
Premium
HRA
Employee Contribution
Monthly
Bi-weekly
Premium
Premium
Preferred PPO Blue Options
Employee
$
511.00
$
429.50
$
50.00
$
81.50
$
40.75
Employee & Spouse
$ 1,022.00
$
511.00
$
100.00
$
511.00
$
255.50
Employee & Child(ren)
$
920.00
$
555.50
$
100.00
$
364.50
$
182.25
Employee & Family
$ 1,431.00
$
715.50
$
100.00
$
715.50
$
357.75
Dual Enroll (Husband & Wife
Employed by NSU) Family
$ 1,431.00
$
985.50
$
150.00
$
445.50
$
222.75
PPO 70-Blue Options
Employee
$
656.00
$
419.00
$
25.00
$
237.00
$
118.50
Employee & Spouse
$
1,312.00
$
445.50
$
50.00
$
866.50
$
433.25
Employee & Child(ren)
$
1,182.00
$
503.00
$
50.00
$
679.00
$
339.50
Employee & Family
$
1,838.00
$
660.00
$
50.00
$
1,178.00
$
589.00
Dual Enroll (Husband & Wife $
Employed by NSU) Family
1,838.00
$
922.00
$
75.00
$
916.00
$
458.00
12
Making a Choice
Estimating Your Financial Risk
ANNUAL
PREMIUM
OUT OF POCKET
MAXIMUM (OOP)
MEDICAL
OUT OF POCKET
MAXIMUM
PHARMACY
PREMIUM +
OOP
NSU HRA
CONTRIBUTION
ESTIMATED
IN-NETWORK
FINANCIAL
RISK
PPO 70 Blue Options
$2,844.00
$3,000.00
$2,000.00
$7,844.00
$300.00
$7,544.00
Preferred PPO Blue
Options
$ 978.00
$3,500.00
$2,000.00
$6,478.00
$600.00
$5,878.00
PPO 70 Blue Options
$10,398.00
$6,000.00
$4,000.00
$20,398.00
$ 600.00
$19,798.00
Preferred PPO Blue
Options
$6,132.00
$7,000.00
$4,000.00
$17,132.00
$1,200.00
$15,932.00
PPO 70 Blue Options
$8,148.00
$6,000.00
$4,000.00
$18,148.00
$ 600.00
$17,548.00
Preferred PPO Blue
Options
$4,374.00
$7,000.00
$4,000.00
$15,374.00
$1,200.00
$14,174.00
PPO 70 Blue Options
$14,136.00
$6,000.00
$4,000.00
$24,136.00
$ 600.00
$23,536.00
Preferred PPO Blue
Options
$8,586.00
$7,000.00
$4,000.00
$19,586.00
$1,200.00
$18,386.00
Coverage/Tier
EMPLOYEE ONLY
EMPLOYEE & SPOUSE
EMPLOYEE & CHILD(REN)
EMPLOYEE & FAMILY
Pay Only the Proper Amount of Your Out-of-Pocket Expenses
• If you are going in for your wellness visit, make sure you have a discussion
with your doctor/office staff to have the visit filed as a wellness claim.
• If you are using a Blue Physician Recognition™ provider, All office visits are
FREE and your doctor should not collect a co-payment.
• All In-Network Maternity office visits are free after the initial office visit copayment per plan year. Care Consultants will advocate on your behalf.
Remember to enroll with Healthy Additions.
• If you are billed for a facility fee for an office visit or are billed for an annual
physical or annual gynecological exam, please advocate on your behalf and
contact Florida Blue™ Customer Service at 1 (800) 664-5295 and have the
claims properly adjusted.
• Always pay your provider based on the Member Health Statements available
to you at www.floridablue.com as a registered member.
14
FREE OFFICE VISITS FOR ALL CARE
When you are using a Blue Physician
Recognition™ provider, all office visits are FREE.
Your doctor should not collect a co-payment.
How to locate a Blue Physician Recognition
Provider™:




Go to Florida Blue at www.floridablue.com
Click the Find a Doctor tab
Select a Primary/Family Care Doctor
Check the box for Blue Physician
Recognition™ providers in order to narrow
down your search to National Committee on
Quality Assurance (NCQA) Primary Care
Physicians (PCP).
 NSU Primary/Family Care Physicians
participate in this program
3
15
A convenient way to verify the cost of
an office visit or procedure.
Members have a choice when accessing the tool:
CALL: The Care Consultant Team at 1 (888) 476-2227
CLICK: Visit www.floridablue.com and click on Members,
login with your user name and password, then select
compare medical costs
VISIT: A Florida Blue Center
Call 1 (877) 352-5830 for a location
near you
16
Mobile Apps
App Features
• Find a doctor, hospital and Map
of location (GPS based)
• Get your plan details on the go
• Access and view an image of
your Member ID card.
• Fax or email ID Card
• Claims Accessibility
• Health Coach
• 24-hour Nurse Line/Care
Consultants
• Health News & Views
• Health Check Guidelines
.
17
Pharmacy Benefit: Understanding
Your Tiered Copays
 Your Catamaran™ pharmacy benefit plan offers three categories or tiers of drugs that determine your
cost share or copay.
 Whenever possible, have your doctor consult your Preferred Medication List for the lowest cost generic
or brand medications available for your therapy.
 You may visit www.mycatamaranRx.com or call member services at 1-800-207-2568.
Tier
Co-pay
30 day Retail/90 day
Retail or Mail Order
Definition
1st Tier:
Generics
$5/10
Generics contain the same active ingredient as their brand-name equivalents
and offer the same effectiveness and safety. Some generics use a brand name
instead of a chemical name. Both have the lowest co-pay.
2nd Tier:
Preferred
$27/50
Medications in this tier have been selected by your pharmacy benefit plan as
preferred brand drugs. These drugs have higher co-pays than generics but are
less costly than non-preferred medications on the third tier.
$60/120
Because a generic version or a second-tier alternative is available, nonpreferred medications have the highest co-pays and are not listed on the
Preferred Medication List.
3rd Tier:
Nonpreferred
Maximum annual plan year out-of-pocket for prescription drug co-pay is $2,000 per
individual; $4,000 for family. 90-day prescriptions are available at the same co-pay at retail
and mail order.
Remember 90 day prescriptions save you money!
18
™
Catamaran Member Portal
Catamaran Mobile
App:
 Free of charge
 Find the lowest cost drug and pharmacy options
 View prescription history
 Key Features:
• Fill-My-Scripts is a reminder to fill prescriptions.
• Take-My-Meds is a reminder to take
medications.
• Mobile Advocate is designed to mimic behavior
of provider to elicit action and participation.
Web-enabled access: www.mycatamaranRx.com
 Refill Rxs from Catamaran Home Delivery
 Obtain a list of preferred medications to
maximize savings
 Perform test co-pays for Rxs
 View prior authorization history
19
Catamaran Mobile App
Good health is in your hands.
The Catamaran™ Mobile App provides easy, on-the-go
access to your personalized health information. Once
you receive your pharmacy ID card, download the app
to take advantage of the benefits your pharmacy plan
offers.
With the Mobile App in your pocket:
 Never miss a dose! Set reminders to take
your
prescription
or
over-the-counter
medications.
 Stay on top of medication refills. See when
refills are due, get refill reminders and
quickly contact your pharmacy.
 Show your doctor exactly what medications
you are taking.
 Pull up your medication history anytime.
 Learn about medication side effects and
interactions.
 Find network pharmacies by zip code or
location, then check and compare current
prescription prices.
 Keep your mind sharp with a Brain Quiz and
brain games.
 Have one-touch access to your electronic
pharmacy ID card.
 Order refills from Catamaran Home Delivery.
Get the app by searching for Catamaran at the
Apple App Store or the Google Play Store or
scanning the QR code.
20
Catamaran™ Pharmacy Benefits
Free Generic Drugs at NSU Pharmacy
• Full service pharmacy
• Accepts NSU/ICUBA
prescription plan
• FREE generic drugs for
NSU/ICUBA healthcare
subscribers
• Open:
Monday – Friday
9:00 AM – 6:00 PM
Saturday
9:00 AM – 1:00 PM
For questions and appointments please call: 954.262.4550
Web address: http://pharmacy.nova.edu/clinic/index.html
21
Behavioral Health, Substance Abuse and EAP Benefits
 Free Employee Assistance Program (EAP) services (up to six counseling sessions per issue per
plan year) are available to ALL benefit-eligible employees and members of your household. You
do not need to be enrolled in any ICUBA benefit plan in order for you or a household member to
access EAP services.
 Client Connect® Provider Matching Service assists members in locating an appropriate provider
for their current situation.
 The MHNet website has many helpful resources including informative articles; interactive health
and wellness instruments; health assessments and videos; family, personal, and mental health
information; on-line seminars; discounts to vendors and community resources.
 To contact MHNet, call 1-877-398-5816.
 To access the website, go to www.mhnet.com
Username: ICUBA - Password: 8773985816
 MHNet contact information can be located on the
back of the Florida Blue ID card.
22
Tobacco Cessation Program
Free Prescription Medications
Member chooses to
participate in the Tobacco
Cessation program
Member calls to enroll with
“Next Steps” program with
Florida Blue
Florida Blue notifies
Catamaran of Member
participation
Member obtains Tobacco
Cessation medications at
$0 co-pay, 2 cycles per
Plan Year
Member calls “Next Steps”
Health Coach and obtains an
Rx from physician
23
THE IQUIT TOBACCO PROGRAM PROVIDED BY
FLORIDA AHEC NETWORK
Free over-the-counter nicotine replacement therapy (NRT)
and face-to-face support
To locate/register for an IQuit Tobacco Program
in your area call 877-848-6696 (1-87-Quit Now-6) or
visit www.ahectobacco.com/calendar
24
Introducing
Wellness program
Beginning April 1, 2014, you will have the opportunity to earn points redeemable for
a host of wellness, entertainment, food, apparel, jewelry, and other consumer
goods by meeting a variety of self-selected health goals.
You may earn points if you:
•
•
•
•
Complete the Florida Blue biometric screening at your employer health fair
Complete your annual physical with your personal physician
Utilize a Florida Blue online health tool
Attend an employer sponsored wellness event
The choice is yours on how you earn points and select prizes.
Watch for more information coming from your
Wellness Committee soon!
25
HRA and HCSA Differences
Health Reimbursement Account
Health Care Spending Account
• Funded by NSU
• Funded by employee pre-tax dollars
• Available for PPO 70 and Preferred
PPO Plan
• Can be used for employee and eligible
dependent medical expenses
• Funds rollover at the end of each plan
year indefinitely
• No carry-over of funds from year
to year (by law)
• Use-it-or-lose-it
• Portable after 36 months of continuous
participation
• HCSA funds expended before tapping
into HRA funds
• Can have HRA alone with no FSA
• Can have HCSA and no HRA
• HCSA allowable amounts limited to
$2,500 under Health Care Reform
26
Dependent Care Spending Account
• Funded by employee with pre-tax contributions and used to pay
for qualified dependent care expenses.
• Maximum annual limit of $5,000.
• Dependents: dependent under age 13, physically or mentally
challenged adults who are unable to care for themselves.
• Funds available by using the ICUBA Benefits MasterCard®.
• File your claims online at http://icubabenefits.org.
• Subject to use-it-or-lose-it rule.
• Funds are available as they are deducted from payroll.
27
Dental & Vision
Humana Dental Plans are exactly the same and the prices are
not changing from last year.
Advantica Vision Plans the current plan benefits and costs
remain the same as last year. A second plan with an enhanced
frame benefit has been added.
28
High Option PPO Dental Plan
High Option PPO Plan
 Two additional
preventive
cleanings for a total
of four cleanings
per year.
 Two periodontal
cleanings per year
to be covered at
preventive levels of
benefits.
 Coverage for
composite fillings
on all teeth.
 Addition of an
Extended Annual
Maximum Benefit
paying 30%
coinsurance after
the annual
maximum benefit is
met.
In-Network
Out-of-Network
$50 / $150
$50 / $150
Yes
Yes
$2,000
$2,000
Preventive Services
0%
20%
Basic Services
20%
50%
Major Services
50%
70%
Orthodontia – Adult & Child
50%
50%
$2,000
$2,000
Plan Year Deductible – Single / Family
Deductible Waived for Preventive
Plan Year Maximum (excludes orthodontia
services)
Orthodontia Lifetime Maximum
High Option PPO Dental Plan
2013-2014 Monthly Dental Rates
Employee
$ 36.68
Employee + 1
$ 73.04
Family
$122.84
Refer to your Dental Summary Plan Description (SPD) for full benefit description.
The NSU Faculty Dental Practice participates in this plan.
29
Low Option “Preventive Plus” Plan
Low Option “Preventive Plus” Plan
Low Option PPO Plan
In-Network
Out-of-Network
$50 / $150
$50 / $150
Yes
Yes
$1,000
$1,000
Preventive Services
0%
0%
*Basic Services
20%
20%
Discount
Not Covered
Plan Year Deductible – Single / Family
Deductible Waived for Preventive
* Services include
amalgam/resin
restorations and
simple extractions.
** Receive a discount
on these services if
you see participating
dentists.
Plan Year Maximum (excludes orthodontia
services)
**Major Services
Low Option “Preventive Plus” Plan
2014-2015 Monthly Dental Rates
Employee
$19.48
Employee + 1
$45.28
Family
$74.96
**Major Services are not covered under this plan, however you can receive a discount
for services if you see participating dentists.
Refer to your Dental Summary Plan Description (SPD) for full benefit description.
The NSU Faculty Dental Practice participates in this plan.
30
DMO CS250 Plan
DMO CS250 Dental Plan
DMO CS250 Plan
In-Network Only
Calendar Year Deductible
No deductible
Out of Pocket Maximum
No maximum
Office Visit Copays
(during normal business hours)
$5 copay per visit
Preventive Services
Please refer to dental schedule for copay amounts
Basic Services
Please refer to dental schedule for copay amounts
Major Services
Please refer to dental schedule for copay amounts
Orthodontics – Adult & Child
$2,000 Adult; $1,800 Child fixed copay
DMO CS250 Dental Plan
2014-2015 Monthly Dental Rates
Employee
$10.98
Employee + 1
$22.02
Family
$34.20
Refer to your Dental
Summary
Plan
Description
forbenefit
full benefit
description.
Refer
to your
dental
SPD (SPD)
for full
description
The NSU Faculty Dental Practice DOES NOT participate in this plan.
31
Advantica Base Vision Plan
In-Network
The NSU Eye Care Institute participates in this plan
Out-of-Network
Vision Exam
$5 Co-Pay
Up to $40 Reimbursement (less applicable Co-Pay)
Standard Frames
$15 Co-Pay; $100 allowance
Reimbursed up to $40 (no Co-pay if included with
eyeglass lenses)
Single Vision, Bifocal, Trifocal, and
Lenticular Lenses
Covered After $15 Co-Pay
Up to $20 for Single Vision, $40 for Bifocal, $60 for
Trifocal, $100 for Lenticular Reimbursement less Co-Pay
Standard Progressive Lens
$50 Co-Pay
Up to $45 reimbursement less Co-pay
Single Vision (SV) Polycarbonate
Included with Lens Co-Pay up to age
19; over age 19, $30 Co-Pay
Up to $10 reimbursement less Co-pay under age 19
UV Coating Lens
$12 Co-Pay
Up to $5 reimbursement less Co-pay
Contact Lenses - Medically Necessary (in
lieu of eyeglasses and elective contact
lenses)
$15 Co-pay; $250 materials
allowance; $30 fitting fee allowance
Up to $250 reimbursement (less applicable Co-pay)
Contact Lenses – Elective (in lieu of
eyeglasses)
$15 Co-pay; $100 materials
allowance; $30 fitting fee allowance
Up to $60 reimbursement (less applicable Co-pay)
Frequency Limitations - Vision Exams
Once every 12 months
Frequency Limitations - Eyeglass Lenses
Once every 12 months
Frequency Limitations - Frames
Once every 24 months
Frequency Limitations - Contact Lenses
Once every 12 months
April 1, 2014 – March 31, 2015 Monthly Base Vision Plan Premiums
Employee
$ 3.98
Family
$10.18
32
Advantica Buy-Up Vision Plan
In-Network
Out-of-Network
Vision Exam
$5 Co-Pay
Up to $40 Reimbursement (less applicable Co-Pay)
Standard Frames
$15 Co-Pay; $100 allowance
Reimbursed up to $40 (no Co-pay if included with
eyeglass lenses)
Single Vision, Bifocal, Trifocal, and
Lenticular Lenses
Covered After $15 Co-Pay
Up to $20 for Single Vision, $40 for Bifocal, $60 for
Trifocal, $100 for Lenticular Reimbursement less Co-Pay
Standard Progressive Lens
$50 Co-Pay
Up to $45 reimbursement less Co-pay
Single Vision (SV) Polycarbonate
Included with Lens Co-Pay up to age 19;
over age 19, $30 Co-Pay
Up to $10 reimbursement less Co-pay under age 19
UV Coating Lens
$12 Co-Pay
Up to $5 reimbursement less Co-pay
Contact Lenses - Medically Necessary
(in lieu of eyeglasses and elective
contact lenses)
$15 Co-pay; $250 materials allowance;
$30 fitting fee allowance
Up to $250 reimbursement (less applicable Co-pay)
Contact Lenses – Elective (in lieu of
eyeglasses)
$15 Co-pay; $100 materials allowance;
$30 fitting fee allowance
Up to $60 reimbursement (less applicable Co-pay)
Frequency Limitations - Vision Exams
Once every 12 months
Frequency Limitations - Eyeglass Lenses
Once every 12 months
Frequency Limitations - Frames
Once every 12 months
Frequency Limitations - Contact Lenses
Once every 12 months
April 1, 2014 – March 31, 2015 Monthly Buy Up Vision Plan Premiums
Employee
Family
$ 4.78 ($9.60 in additional annual premium for frames once every 12 months)
$12.22 ($24.48 in additional annual premium for frames every 12 months)
The NSU Eye Care Institute participates in this plan
33
Member Action Plan
To enroll, logon to http://icubabenefits.org and select
 Your elections are effective 4/1/2014 and will remain in effect until 3/31/2015 unless you
experience a qualified status change.
 You do not have to make changes to any plan other than your Flexible Spending Account(s).
 You are allowed to enroll any eligible dependent during this open enrollment.
 To assist you with your Plan Year elections, you can access the Predictive Modeling Tool by
clicking on the link labeled “View Detailed Plan Comparison” on the Medical Election Page.
Then, select the tab
“Personalized Cost Estimator”
You must complete your enrollment by midnight on February 28, 2014
34
Access Links to Individual Benefit Providers on the ICUBA
Benefits Portal
ICUBA Benefits MasterCard™
For information or claims
associated with your
Blue Cross Blue Shield
account, please click on
the image.
To access your Humana
Dental account online,
please click the image.
For information associated
with your Advantica Eye
care Vision account,
please click on the image.
For information on
your FSA or HRA
please click on the
image.
To view your Catamaran
account online click on the
image.
To access your MHNet
Behavioral Health account
online, click the image.
35
Sun Life Optional Term Life Insurance
• Enroll now or increase your coverage level
• Elect coverage amount between $10,000 and $200,000 in $10,000
increments
• Your application will be subject to Evidence of Insurability (EOI),
access this form through www.sunlife-usa.net/eoi
• Sun Life will notify you when your application is approved, denied
or pending additional information
• First monthly premium deduction will occur in the first pay of the
month following the approval of your coverage
• If you do not send an EOI to Sun Life by 4/30/2014 your enrollment
request will expire
• The value of the policy reduces to 65% at age 65, and 50% at age 70
36
Aflac
formerly PrePaid Legal

Offers various insurance plans,
accident insurance, hospital
indemnity, short-term disability
and cancer indemnity

Legal Shield premium deductions once
a month. Deductions will be taken in the
second pay period of each month
Voluntary employee benefit - no
employer contribution

View PowerPoint presentation on
benefits webpage

Voluntary employee benefit - no
employer contribution


Contact Kelley Kaupas-Rheault at (954)214-0327 or John Broadbent at (954)881-1296 or visit
www.LegalShield.com/info/novaseuniv
Contact AFLAC representative
Joe Evans at (954) 560-6000 for
more information.

View additional information on benefits
webpage www.LegalForNova.com

“Safeguard for Minors” identity theft
protection for dependents for an extra
$1.00 a month

Real Estate, Family Law, Estate
Planning, Traffic Issues

37
We are available to discuss plan details and problem
solve with members after the presentation.
38