Transcription
MSU Faculty and Academic StaffOPEN ENROLLMENT GUIDETime toChoose YourBenefits for2022HIGHLIGHTS:Page 1Page 4Page 5Page 23See contact info for allbenefit providers.Determine if you needto participate this year.Find instructions tocomplete enrollment.Learn about vision, criticalillness & legal insurance.hr.msu.edu/open-enrollment
DEAR MSU EMPLOYEE,Table of ContentsMSU Open Enrollment will be held from October 1-31, 2021.During this time, you can re-evaluate your benefit needsand make changes to benefit selections, which are effectiveJanuary 1 – December 31, 2022. This guide contains informationabout the benefits options available for eligible faculty andacademic staff employees. Find all the open enrollmentguides – including those for retirees or individuals on a leave ofabsence – at hr.msu.edu/open-enrollment.1Benefits Provider Contact Info2Steps to Complete OpenEnrollment3New or Notable for 20224Determine if You Need to TakeActionQuestions?5Open Enrollment InstructionsPlease contact MSU Human Resources or our benefitsproviders using the contact information below. We encourageyou to ask HR questions via phone or email. Limited in-personhelp is available by appointment only. To get in touch or makean appointment, call the Solutions Center using the detailsbelow:6Making Critical Decisions7Summary of Health Plan Provisions9Faculty Monthly Health PlanPremiumsMSU HUMAN RESOURCES:10Academic Year Faculty MonthlyHealth Plan Premiums11Health Plan Coverage SummaryMSU BENEFIT PROVIDERS:15Glossary of TermsAetna Dental 877-238-620016Prescription Drug Information17Dental Plan Information19Life Insurance Information20Accidental Death &Dismemberment InsurancePrudential 877-232-355521Flexible Spending Accounts 23Voluntary Benefits25Teladoc for Online Medical Care25Teladoc Medical Experts26Livongo26Retirement Programs at MSU SolutionsCenter@hr.msu.edu 517-353-4434 (toll-free: 800-353-4434) hr.msu.edu/open-enrollmentaetna.comBCN 800-662-6667 bcbsm.comCommunity Blue 888-288-1726 bcbsm.comCDHP (by BCBSM) 888-288-1726 bcbsm.comCVS/Caremark 800-565-7105 caremark.comDelta Dental 800-524-0149 deltadentalmi.comHealthEquityHSA: 877-219-4506 my.healthequity.comFSA: 877-924-3967 participant.wageworks.comPrudential.comMSU Benefits Plus 888-758-7575 MSUBenefitsPlus.comVISIThr.msu.edufor brochures about MSUbenefits plans and options.AppendixLegal Notices
Steps to Complete Open EnrollmentPlease use the following steps to help you complete Open Enrollment by October 31. Check the boxes asyou complete each step.1. Review Open Enrollment MaterialsReview this Open Enrollment guide completely.2. Ask Questions or Learn MoreAsk questions or learn more about your benefit options. Page 1 provides contact information for MSU Human Resources and benefit vendors. MSU Benefits Fair and HR Site Lab Options: We’re dedicated to helping you learnmore and ask questions about your benefit options. Please visit the HR websiteat hr.msu.edu/open-enrollment to find the most updated details about the MSUBenefits Fair and HR Site Lab options in October.3. Make DecisionsRead page 4 to determine if you need to take any action by October 31. If you do need to take action, continue to step 4. If you don't need to take any action, then you don't need to complete step 4.Continue to step 5.4. Take ActionFind instructions for how to complete necessary actions by October 31: Page 5 provides instructions to complete the spouse/other eligible individual (OEI)affidavit and enroll in, change or cancel health, dental, life insurance and/or flexiblespending accounts. Page 23 provides instructions to enroll in, change or cancel voluntary benefts.IMPORTANT: You may only enroll in, change or cancel voluntary vision, legal or criticalillness insurance during the Open Enrollment period.5. Other Items to ConsiderYou many want to check if your life insurance beneficiaries are correct (if applicable).Find instructions at hr.msu.edu/benefits/beneficiaries.htmlQuestions? Visit hr.msu.edu/open-enrollment 2
New or Notable for 2022Read the following important changes, updates, and/or reminders regarding this year’s Open Enrollment and the2022 plan year. Visit the HR website (hr.msu.edu) for the most up-to-date information.NEW INFORMATIONMSU Benefits Fair and Site Lab OptionsDue to the changing nature of the pandemic, pleasevisit the HR website at hr.msu.edu/open-enrollmentto find the most updated details about the MSUBenefits Fair and HR Site Lab options in October.Increase to Maximum Benefit for AccidentalDeath and Dismemberment (AD&D) InsuranceYou can enroll in AD&D coverage at 1 to 10 times yourannual salary, up to a maximum of 1,500,000 for theemployee (increased from 1,000,000), 750,000 fora spouse/OEI (increased from 600,000), or 100,000per child (no change). Learn more on page 20.Upgrades to Critical Illness Insurance CoverageEffective January 1, 2022The upgraded plan offers more benefits withcoverage for different, distinct medical conditions.Contact MSUBenefitsPlus at 888-758-7575 or visitMSUBenefitsPlus.com for details. If you’re currentlyenrolled and you do not change your coverageelection during open enrollment, your plan will beupgraded automatically as of January 1, 2022. Learnhow to enroll on page 23.NOTABLE INFORMATIONPremium Threshold for Spousal AffidavitIf your spouse/other eligible individual (OEI) hasaccess to health care coverage through their owncurrent or former employer, they must purchase thecoverage their own employer offers if the annualemployee premium cost for single-person coverage is 1,500 or less. You may still cover your spouse/OEI onyour MSU health coverage as a secondary plan.Federal Regulations Allowing Benefit ChangesDuring Emergency SituationEffective March 1, 2020, the Department of Labor(DOL) and Internal Revenue Services (IRS) providedprovisions to extend deadlines for birth, marriage andloss of coverage and relax rules for adding, cancelingand changing health, dental and flexible spendingaccount (FSA) plans. Learn more on page 6.Flexible Spending Accounts (FSA): DifferenceBetween Dependent Care and Health Care FSAMSU’s FSA vendor offers eligible employees twodifferent FSAs: Dependent Care FSA and/or HealthCare FSA. Before you enroll, make sure you know thedifference between the two options. Learn more onpage 21.Review Your Voluntary Benefit Options, Such asVision, Legal and Critical Illness InsuranceSome voluntary benefits – like vision, legal, and criticalillness insurance – require you to enroll, make changesor cancel during the Open Enrollment period. Learnmore on page 23.MSU Health Care ServicesMSU Health Care provides pharmacy, radiology,primary care provider, and specialty care providerservices. Save time by taking advantage of these oncampus services! Learn more at pharmacy.msu.edu,radiology.msu.edu, and healthcare.msu.edu.3 Faculty and Academic Staff Open Enrollment Guide – 2022 Edition
Determine if You Need to Take ActionDo you need to take any action during the Open Enrollment period? Answer the following question:As an MSU benefits-eligible employee, which of the following statements is true regarding yourbenefits? Check all boxes that apply to you.I currently cover a spouse/other eligibleindividual (OEI) under my health benefits(who is NOT an MSU benefits-eligibleemployee or retiree), and I want to continuetheir coverage in 2022. You must completea Spouse/OEI Affidavit every plan year tocontinue coverage. See page 5 for instructions.I want to enroll in, change or cancel health ordental insurance coverage for myself and/ormy eligible dependent(s).I want to enroll in, change or cancel life oraccidental death & dismemberment insurancefor myself and/or my eligible dependent(s).I want to enroll in, change or cancel myvoluntary benefits (e.g. vision, legal, criticalillness insurance, etc.) options for myself and/or my eligible dependent(s). See page 23 formore information about voluntary benefits.I do not cover a spouse/OEI under my healthbenefits.I do not want to make any changes to myhealth or dental insurance and want to keepthe exact same coverage in 2022.I do not want to enroll in, change or cancelmy life or accidental death & dismembermentinsurance.I do not want to enroll in, change or cancel myvoluntary vision insurance, legal and/or criticalillness insurance.I do not want to enroll in a Flexible SpendingAccount (FSA) for 2022.I currently elect to waive my health carecoverage through MSU, and I want to continueto waive my health care coverage throughMSU. See page 8 for more details.I want to enroll or re-enroll in a FlexibleSpending Account (FSA). You must re-enroll inan FSA every plan year.I elect to waive my health care coveragethrough MSU. See page 8 for how to enroll inthe waiver.RESULT:If you selected any of the above options, you mustparticipate in Open Enrollment between Oct. 1–31.See page 5 for instructions.RESULT:If you only selected the above option(s), and did notselect any options in the left column, you do not needto take any action during Open Enrollment.However, we encourage you to review your benefitsoptions to ensure you’re getting the best coverage.Questions? Visit hr.msu.edu/open-enrollment 4
Open Enrollment InstructionsUse the Enterprise Business System (EBS) to complete Open Enrollment for health, dental, life andflexible spending accounts between October 1–31. Follow these steps:12345678Visit ebs.msu.edu. Log in with your MSUNetID. No NetID? Visit netid.msu.edu or callMSU IT at 517-432-6200.9The next screens display the different plansavailable (health plans, flexible spendingaccounts, life/accident plans, etc.). You canAdd, Edit or Delete enrollment in these plans.To exit, click Cancel – all changes will be lost.10When you reach the Review and Save screenyou can Add, Change or Remove coverage byusing the top navigation to navigate back toprevious screens. Click Save.11On the final screen, review info on the BenefitElections Summary. You have the option toclick additional links such as MSU BenefitsPlus or Retirement/Health Savings Accounts.12You have completed the enrollment steps forthe MSU administered benefit programs. Youshould receive a confirmation email shortly.Click the My Benefits top navigation tab.Click the Benefit/Retirement Enrollmentand Changes tile. Select the Open Enrollmentoption from the dropdown menu, then clickNext.A CDHP/HSA plan disclaimer will appear(regardless of your eligibility for CDHP/HSA).Read and click OK.If the Health Plan Affidavit for Spouse/OEIappears, answer Yes or No and click Next.The following statement will confirm youranswer. If the info is correct, click Next.On the Personal Profile screen, verify nameand address info and click Next. To makecorrections, find instructions at On the Dependents screen, verify all familymembers/dependents and click Next. If infois missing, exit Open Enrollment and submitthe Add a Family Member or Dependentform. If it is inaccurate, contact MSU HR.The Benefits Summary screen displayscurrent coverage. When finished reviewing,click Next.Enrollment Instructions VideoThe visually inclined can watch a How-ToEnroll Video on the HR website at hr.msu.edu/open-enrollment/instructions.html.Other Enrollment InstructionsPage 23: Voluntary Benefits (vision, legal,critical illness insurance, among others)Page 26: Retirement Programs5 Faculty and Academic Staff Open Enrollment Guide – 2022 Edition
Making Critical DecisionsDuring the Open Enrollment period (Oct. 1–31) youmake important decisions that impact your benefitsfor the upcoming plan period. However, due tothe changing nature of the pandemic, the federalgovernment has provided provisions to extenddeadlines and relax rules related to your benefits.Since these provisions are currently expectedto end on December 31, 2021, we stronglyencourage you to carefully review and makeany necessary changes to your benefits optionsduring the Open Enrollment period for the 2022 planyear.COVID-19 Provisions from the FederalGovernment that Impact Your BenefitsEffective March 1, 2020, the Department of Labor(DOL) and Internal Revenue Services (IRS) providedprovisions to extend deadlines for birth, marriage andloss of coverage and relax rules for adding, cancelingand changing health, dental and flexible spendingaccount (FSA) plans.These provisions are currently expected to end onDecember 31, 2021, and subject to change by the DOLand IRS at any time due to the changing nature of thepandemic. We strongly encourage you to carefullyreview and make any necessary changes to yourbenefits options for the 2022 plan year during theOpen Enrollment period in October.What Happens When the COVID-19Emergency Period Ends? Cancel or change life or accidental death anddismemberment insurance. Enroll or re-enroll in a flexible spending accountplan. Add, cancel or change voluntary vision, legalservices and critical illness insurance.Your choices are permanent until the next OpenEnrollment period, with changes effective January 1.Carefully review Open Enrollment materials to helpyou select the plans that best meet your coverageand financial needs.Note on Vision, Legal and CriticalIllness Insurance:This temporary change from the DOL and IRS doesNOT extend to voluntary vision, legal, and criticalillness insurance. If you need to cancel, add or changeany of these voluntary benefits options you must doso during Open Enrollment in October.Qualifying Life EventsOutside of Open Enrollment and after the federalgovernment determines the COVID-19 emergencyperiod has officially ended, changes can be made toyour benefits for certain qualifying life events. Theselife events include marriage, childbirth/adoption, lossof existing coverage for you and your family membersor retirement. Changes must be made within 30 daysof the qualifying event. Learn more at hr.msu.edu/benefits/life-change.After December 31, 2021, the provisions provided bythe DOL and IRS will no longer be in effect and youWILL NOT be able to reverse or change your benefits,which includes the following: Switch from one health or dental plan to another. Add yourself or additional dependents to healthor dental coverage. Cancel or change health or dental coverage foryou or your dependent(s).Questions? Visit hr.msu.edu/open-enrollment 6
Summary of Health Plan ProvisionsBlue Care Network (BCN)BCN is a Health Maintenance Organization (HMO),which means you select and work closely witha primary care physician to manage your care.Deductibles, co-insurance and prior authorizationrequirements apply in some circumstances.The in-network deductible is 100 per individual and 200 per family. After meeting the deductible, a 20%co-insurance may apply, up to a maximum of 3,000/single or 6,000/family, per calendar year.For questions about specific coverage details or toaccess a listing of BCN participating providers, visitBCBSM.com or call 1-800-662-6667.Highlights of the BCN Plan: Lower premium cost. Only eligible to employees who live in Michigan. Access coverage with BlueCard when traveling outof-state and Blue Cross Blue Shield Global Core fortraveling outside of the USA. Plan does not require a referral, but some servicesare subject to prior authorization. You must choose a primary care physician.For more information, see the Health Plan CoverageSummary on page 11.Community Blue PPOCommunity Blue is a Preferred Provider Organization(PPO), which gives you the flexibility to manageyour own care. Deductibles, co-insurance andprior authorization requirements apply in somecircumstances. There is a worldwide network ofparticipating PPO physicians and hospitals.The deductible for in-network services is 100/singleor 200/family and 250/single or 500/family forout-of-network services. After meeting the out-ofnetwork deductible, a 20% co-insurance may apply, upto a maximum of 2,000/single or 4,000/family, percalendar year.For questions about specific coverage details or toaccess a listing of PPO participating providers, visitBCBSM.com or call 888-288-1726.Highlights of the Community Blue PPO Plan: An in-network deductible of 100/single or 200/family. Higher premium cost. More flexibility in managing care. Does not require you to choose a primary carephysician.For more information, see the Health Plan CoverageSummary on page 11.Consumer Driven Health Plan (CDHP)with Health Savings Account (HSA)If you do not anticipate having high health care needs andare looking for a sound strategy to save for your retirementhealth expenses, this plan may be the most cost-effectiveoption for you.Consumer Driven Health Plan (CDHP)While you pay a deductible ( 2,000/single and 4,000/family) first before the plan pays medical and prescriptionbenefits, preventive care and certain generic medicationsfor chronic conditions (asthma, cholesterol, diabetes, andanti-hypertensives) are 100% covered with no deductibleor co-pays when using an in-network provider. Review theHealth Plan Coverage Summary on page 11 to anticipateyour annual costs under this plan – you may find that mostof your annual medical costs are 100% covered.The provider network for this plan is the same as theCommunity Blue PPO plan, which means you can choosefrom a larger provider network.This plan limits the maximum amount you pay for anycovered services in a year to 3,000/single and 6,000/family using in-network providers. After expenses reach thisamount, you do not have to pay for any other health carecosts, including prescription drugs.7 Faculty and Academic Staff Open Enrollment Guide – 2022 Edition
Health Savings Account (HSA)Along with the CDHP, you should enroll for the HSA atthe same time. MSU contributes up to 750 to the HSAeach year and you may add funds to the HSA tax-free. Ifyou do not enroll during Open Enrollment, you will loseMSU’s contribution. You can use these HSA funds to payfor any eligible medical expenses or doctor visits youdo incur. Employer and employee combined annual HSAcontributions are limited to the 2022 IRS limits of 3,650/single and 7,300/family. These contributions are tripletax-free! You make contributions pre-tax, your accountbalance earns interest tax-free, and your distributions aretax-free if they are used for eligible medical expenses.Summaries of Benefits and Coverage(SBC)The Affordable Care Act requires health plans andemployers who provide self-insured plans to providecomparative information to consumers on healthplan options. Find SBC documents for the health planoptions at hr.msu.edu/benefits/summaries.Legal NoticesOur legal notice publication is attached to the end of thisPDF (if viewing online at hr.msu.edu/open-enrollment).It includes important legal notices regarding health careprivacy and other laws.Please Note: due to IRS regulations, Health Care FSAsare not compatible with Health Savings Accounts(HSA). You are unable to participate in a Health CareFSA if you enroll in the HSA offered with the CDHP.Do you have an existing HSA from a previous employer?You can add those funds into your new HSA. The moneyin the HSA is yours to take with you – even if you leaveMSU for a different employer or retire. In fact, investingin your HSA now to use in your retirement is a soundstrategy to fund your medical expenses in retirement.For questions about the CDHP, contact Blue Cross BlueShield of Michigan at 888-288-1726. For questions aboutthe HSA, contact Health Equity at 877-219-4506.Health Plan WaiversIf you are covered by another health plan thatadequately meets your health care needs, you maywant to consider waiving your MSU health coverage.Individuals who waive coverage will receive a paymentof up to 600 per year. Payments occur in Februaryfor the previous plan year. This means if you enroll inthe waiver for the 2022 plan year, you will receive yourpayment in February 2023.Enrollment is not automatic, you must enroll online forthe waiver during Open Enrollment.Note: Employees and spouses who are both employedat MSU are not eligible for the waiver option. Finddetailed waiver info ions? Visit hr.msu.edu/open-enrollment 8
Faculty Monthly Health Plan PremiumsContributions are made pre-tax throughpayroll deduction on a monthly basis.Dependent Age CriteriaChildren (biological, step or adopted) areeligible through the end of the calendaryear in which they turn age 26.Non-adopted grandchildren, nieces,nephews or wards are eligible throughlegal guardianship through the end of thecalendar year in which they turn age 23.You will receive an email from HR withoptions to continue coverage for childrenonce they have aged out of coverage.PLANCOVERAGE FULL-TIME 3/4 TIME1/2 TIMETIERFACULTY (65%–89.9%) (50%–64.9%)FACULTYFACULTYBlue CareNetwork (BCN)with CVS/CaremarkSingle2 personFamily 64.79 136.06 161.98 213.61 448.58 534.03 362.43 761.11 906.08CDHP withHSA with CVS/CaremarkSingle2 personFamily 26.92 51.59 60.22 82.50 109.22 107.24 216.25 386.87 435.99 301.58 633.32 753.96 450.40 945.84 1,126.01 599.22 1,258.37 1,498.06Community Blue SinglePPO with CVS/2 personCaremarkFamily1. Dependents who become incapacitated before age 19 can continue coverage after age23 or 26 by completing the MSU Dependent Disability Certification Form at ertForm.pdf.Health Plan Premiums for Sponsored DependentsThis is the monthly premium rate if you wish toadd a sponsored dependent to your health andprescription coverage. A sponsored dependent issomeone who is related to you by blood, marriageor legal adoption, is a member of your householdand is dependent on you for more than half oftheir support. The dependent must meet the IRSdependency test. More details can be found on theHR website at hr.msu.edu.Health Plan Premiums forFamily ContinuationThis is the premium rate if you wish to add a nonadopted grandchild, niece, nephew or ward throughlegal guardianship (age 23 to 25) to your health andprescription coverage. More details can be found onthe HR website at hr.msu.edu.PLANSPONSORED DEPENDENTBlue Care Network (BCN) withCVS/Caremark 714.35CDHP with HSA with CVS/Caremark 402.70Community Blue PPO with CVS/Caremark 998.50The sponsored dependent premium is in addition to the faculty monthly premiumrates listed above.PLANFAMILY CONTINUATIONBlue Care Network (BCN) withCVS/Caremark 297.63CDHP with HSA with CVS/Caremark 167.78Community Blue PPO with CVS/Caremark 416.04The family continuation premium is in addition to the faculty monthly premiumrates listed above.9 Faculty and Academic Staff Open Enrollment Guide – 2022 Edition
Academic Year (AY) Faculty Monthly Health PlanPremiumsThese charts are for faculty and academic staff on nine-month academic year (AY) appointments. Instead ofreceiving 12 monthly paychecks throughout the year, faculty and academic staff who have nine-month AYappointments receive 10 monthly checks over the duty period (August 16 through May 15).Health plan contributions are madepre-tax through payroll deduction,and taken out of eight of the tenpaychecks (September through tmlto learn more.PLANCOVERAGE FULL-TIMETIERFACULTY3/4 TIME1/2 TIME(65%–89.9%) (50%–64.9%)FACULTYFACULTYBlue Care Network Single(BCN) with CVS/2 personCaremarkFamily 97.19 204.09 242.97 320.42 672.87 801.05 543.65 1,141.66 1,359.13CDHP withHSA with CVS/CaremarkSingle2 personFamily 40.38 77.38 90.33 123.76 163.84 160.86 324.37 580.30 654.00Community BluePPO with CVS/CaremarkSingle2 personFamily 452.38 949.98 1,130.94 675.61 1,418.76 1,689.02 898.83 1,887.55 2,247.10Health Plan Premiums for Sponsored DependentsNote: The health plan contributions listed for AYfaculty will be taken out of 8 of 10 paychecks (Sep.–April). Deductions taken from Jan. through April coverthe time period Jan. through June, and deductionstaken from Sept. through Dec. cover the time periodJuly through Dec.A termination or retirement that is effective after July1 will result in you being billed for your health and/ordental premiums. A termination or retirement beforeJuly 1 will result in a refund.Health Plan Premiums for FamilyContinuationThis is the AY faculty premium rate if you wish to adda non-adopted grandchild, niece, nephew or wardthrough legal guardianship (age 23 to 25) to your healthand prescription coverage. Find more details on the HRwebsite at hr.msu.edu.PLANSPONSORED DEPENDENTBlue Care Network (BCN)with CVS/Caremark 1,071.53CDHP with HSA with CVS/Caremark 616.13Community Blue PPO withCVS/Caremark 1,497.75A sponsored dependent is someone who is related to you by blood, marriage orlegal adoption; a member of your household; dependent on you for more thanhalf of their support; meeting the IRS dependency test. The sponsored dependentpremium is in addition to the faculty monthly premium rates listed above.PLANFAMILY CONTINUATIONBlue Care Network (BCN)with CVS/Caremark 446.45CDHP with HSA with CVS/Caremark 256.70Community Blue PPO withCVS/Caremark 624.06The family continuation premium is in addition to the faculty monthly premiumrates listed above.Questions? Visit hr.msu.edu/open-enrollment 10
Health Plan Coverage SummaryCommunity BlueBenefitIn-NetworkOut-of-NetworkBlue Care NetworkIn-NetworkOut-of-NetworkCDHP w/HSAIn-NetworkOut-of-NetworkPREVENTIVE SERVICESHealth Maintenance Exam1 per calendar yearCovered 100%(1)Not coveredCovered 100%(1)Not coveredCovered 100%(1)Not coveredAnnual Gynecological Exam1 per calendar yearCovered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredPap Smear Screening (lab servicesonly) 1 per calendar yearCovered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredMammography Screening1 per calendar yearCovered 100%Covered 80% afterdeductibleCovered 100%Covered 80% ofeligible expensesafter deductible(2)Prior authorizationmay be required(3)Covered 100%Covered 60%after deductibleContraceptive Devices (IUD,Diaphragm, Norplant)Covered 100%Covered 100% afterdeductibleCovered 100%Not coveredCovered 100%Covered 60%after deductibleContraceptive InjectionsCovered 100%Covered 80% afterdeductibleCovered 100%Not coveredCovered 100%Covered 60%after deductibleWell-Baby and Child Care ExamsCovered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredImmunizations (as recommendedby the Advisory Committee onImmunization Practices or mandatedby the Affordable Care Act)Covered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredFlu ShotsCovered 100%Not coveredCovered 100%Covered 100%Covered 100%Not coveredFecal Occult Blood Screening1 per calendar yearCovered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredPreventive Colonoscopy(4)1 per calendar yearCovered 100%Covered 80% afterdeductibleCovered 100%Covered 80% ofeligible expensesafter deductible(2)Prior authorizationmay be required(3)Covered 100%Covered 60%after deductibleFlexible Sigmoidoscopy Exam1 per calendar yearCovered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredProstate Exam1 per calendar year(4)Covered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredProstate Specific Antigen Screen1 per calendar year(4)Covered 100%Not coveredCovered 100%Not coveredCovered 100%Not coveredCovered 80%after deductibleNot coveredPHYSICIAN OFFICE SERVICES (MEDICALLY NECESSARY)Office Visits/ConsultationsCo-pay: 20Covered 80% afterdeductibleCo-pay: 20Covered 80% afterdeductibleHospital Emergency RoomCo-pay: 250(waived basedon signs andsymptoms, accidentor if admitted)Co-pay: 250(waived basedon signs andsymptoms, accidentor if admitted)Co-pay: 250(waived basedon signs andsymptoms, accidentor if admitted)Co-pay: 250Covered 80%(waived basedafter deductibleon signs andsymptoms, accidentor if admitted)Covered 80%after deductibleEmergency Room Physician’sServicesCo-pay: 20 (whenmedical emergencycriteria not met)Covered 80% afterdeductibleCovered 100%Covered 100%Covered 80%after deductibleCovered 80%after deductibleUrgent Care CenterCo-pay: 25Covered 80% afterdeductibleCo-pay: 25Co-pay: 25Covered 80%after deductibleNot coveredAmbulance ServiceMust be medically necessaryCovered 100%of the approvedamount. Subject tofaculty deductibleCovered 100%of the approvedamount. Subject todeductible.Covered 80% afterdeductible, groundand airCovered 80% afterdeductible, groundand airCovered 80%after deductibleCovered 80%after deductibleEMERGENCY MEDICAL CARE11 Faculty and Academic Staff Open Enrollment Guide – 2022 Edition
Community BlueBenefitIn-NetworkOut-of-NetworkBlue Care NetworkIn-NetworkOut-of-NetworkCDHP w/HSAIn-NetworkOut-of-NetworkDIAGNOSTIC SERVICESLaboratory andPathology TestsCovered 100%Subject to facultydeductibleCovered 80% afterdeductibleCovered 100%Covered 100%Covered 80% afterdeductibleCovered 80% afterdeductibleDiagnostic Tests andX-RaysCovered 100%Subject to facultydeductibleCovered 80% afterdeductibleCovered 100% afterdeductible. Priorauthorization may berequired(3)Covered 80% afterdeductible. Priorauthorization maybe required(3)Covered 80% afterdeductibleCovered 60% afterdeductibleRadiation TherapyCovered 100%Subject to facultydeductibleCovered 80% afterdeductibleCovered 100% afterdeductibleCovered 80% afterdeductibleCovered 80% afterdeductibleCovered 60% afterdeductibleMATERNITY SERVICES PROVIDED BY A PHYSICIANPre-Natal and Post-NatalCareCovered 100%Covered 80% afterdeductibleCovered 100%Covered 80% afterdeductible(2)Prior authorizationmay be requiredPre-Natal: CoveredCovered 60% after100%deductiblePost-Natal: Covered80% after deductibleDelivery and NurseryCareCovered 100%Subject to facultydeductibleCovered 80% afterdeductibleCovered 100% afterdeductiblePrior authorizationmay be required(3)Covered 80% afterdeductible(2)Prior authorizationmay be required(3)Covered 80% afterdeductibleCovered 60% afterdeductibleSemi-Private Room,General Nursing Care,Hospital Services andSuppliesCovered 100%(unlimited days)Prior authorization maybe required(3) Subjectto faculty deductibleCovered 80% afterdeductibl
about the benefits options available for eligible faculty and academic staff employees. Find all the open enrollment guides - including those for retirees or individuals on a leave of absence - at hr.msu.edu/open-enrollment. Table of Contents 1 Benefits Provider Contact Info 2 Steps to Complete Open Enrollment 3 New or Notable for 2022
