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2016 Benefits EnrollmentNEWSLETTERHuman ResourcesADJUNCT EDITION2015 Key DatesOctober 23Open Enrollment BeginsOctober 27 & 28You can cover yourself, your spouse or domestic partner,* and your eligible childrenunder your healthcare coverage. An eligible child is: (both days) Fireside Lounge,Student Alumni Union Open Enrollment EndsOctober 2015Effective January 1, 2016, all Adjuncts will be eligible for RIT medical,vision, and dental coverage when they are working.This coverage is not automatic; you must enroll to have coverage.Benefits Fair9:00 a.m. – 3:00 p.m.November 18Finance & AdministrationThe natural or adopted child of the employee or the employee’s spouse who isunder age 26.The natural or adopted child of the employee’s domestic partner who is underage 26.Any other child who is under age 26 who iso a foster child, defined as an individual who is placed with the employeeby an authorized placement agency or by judgment decree, or othercourt order;o any other child for whom the employee is the legal guardian orcustodian, and who resides in the employee’s home, and who isclaimed as a tax dependent on the employee’s federal income taxreturn.*For specific eligibility requirements for domestic partners, refer to the Additional Benefits sectionof the RIT website at www.rit.edu/benefits.RIT has a family member verification (FMV) process to ensure that only those peoplewho are eligible are covered. You will need to provide proof of eligibility for coveredfamily members (e.g., copy of marriage certificate for a spouse and copy of a birthcertificate for a child).You can elect one, two or all three benefits and you can have a different coverage levelfor each. You will find more detail in this newsletter and on the Medical and Prescriptiondrug section of the benefits website at www.rit.edu/benefits in the Keeping Healthysection.We encourage you to read this newsletter and refer to information on the benefitswebsite at www.rit.edu/benefits for more details about your 2016 benefits.Your benefit elections are made for a calendar year. If you return later in the year,your earlier benefit elections will be automatically reinstated. You can only make achange if you have an IRS qualifying event that allows it.Rochester Institute of TechnologyDepartment of Human ResourcesGeorge Eastman Hall8 Lomb Memorial Drive Rochester,New York 14623-5604 2015 Rochester Institute of Technology.
2016 Open Enrollment NewsWHO MUST ENROLL?In order to have coverage in 2016, you MUST enroll.Other than as described below, this is your only chance to enroll in benefits for 2016.YOUR ONLY OPPORTUNITYTO MAKE A CHANGE IS NOWPlease remember that the BenefitsOpen Enrollment period is youronly opportunity to enroll, change,or cancel most of your benefitselections, unless you have a qualifiedfamily or employment status changeduring the year. A qualified family oremployment status change includes: MarriageBirth or adoption of a childDivorceDeath of a spouse or dependentA change in employment (e.g.,spouse or child gaining or losingemployment)If you experience one of theseevents and want to elect, change,or cancel your coverage, under IRSrules, you must notify the HumanResources Department within 31days of the event. Otherwise, youmust wait until the next OpenEnrollment for a January 1 effectivedate. In addition, please note thatthe event must be consistent withthe change you want to make (e.g.,changing from two-person to familycoverage after the birth of a child).Refer to the chart called Mid-YearBenefits Enrollment Change Summaryat www.rit.edu/benefits under “OtherResources” for more details onmaking mid-year changes. If you areadding a family member, proof ofeligibility is required. See the FamilyMember Verification link on thebenefits page of the HR website atwww.rit.edu/benefits.2October 2015Human ResourcesThe following is a brief summary of RIT’s medical, vision, and dental coverage. Youwill find more details on the benefits website.MEDICAL COVERAGERIT offers several medical plans, administered by Excellus BlueCross BlueShield(BCBS). In addition, RIT offers prescription drug coverage administered by OptumRx(effective January 1, 2016); enrollment in the prescription drug coverage is automaticbased on the medical plan elected. Prescription drug coverage cannot be electedseparately. Refer to the Medical Benefits Comparison Book on the benefits websitefor details about each plan.VISION COVERAGERIT’s Vision Care Plan covers much of the cost of prescription eyeglasses andcontact lenses. There is also coverage for routine eye exams. This plan isadministered by VSP. If you go to a participating provider, the coverage is as follows:· Eye Exam: An eye exam is covered once per calendar year with a 15 copayment.· Lenses: VSP’s standard lenses are covered in full, every calendar year, after a 20copayment, including glass or plastic single vision, bifocal, trifocal, progressive,or other more complex lenses necessary for the patient’s visual welfare.· Frames: 130 allowance toward frames, every calendar year. If you select a framethat costs more than 130, VSP offers a 20% discount off the amount over theretail allowance.· Contact Lenses: You may choose contacts instead of glasses (lenses and frame).There is a 130 allowance applied to the contact lens exam (fitting & evaluation)and the contact lenses. You also receive a 15% discount off the contact lensexam before the allowance is applied.You can find VSP providers on their website (www.vsp.com) or by calling (800) 8777195/V and (800) 428-4833/TTY Monday – Friday, 8 a.m. – 10 p.m., Eastern Time.Finance & AdministrationAdjuncts
DENTAL COVERAGEExcellus BlueCross BlueShield administers the RIT Dental Plan. It includesthree service categories. Please note you will receive the maximum benefit ifyou go to a BlueShield participating dentist because he/she has agreed toaccept the BlueShield allowances (Usual and Customary Charge).There are three service categories as follows: Preventive: The Plan pays 100% of covered services up to the Usualand Customary Charge. Preventive services include an oral exam andcleanings once every six months as well as bitewing x-rays every 12months. Restorative: After paying a 25 per person deductible ( 75 family), thePlan pays 80% for covered minor restorative services (e.g., fillings)and 50% for covered major restorative services (e.g., crown) up to theUsual and Customary Charge. The Plan will pay up to 1,250 perperson per calendar year for all restorative services (minor and majorcombined). Orthodontia: The Plan pays 50% of covered services for dependentchildren to the age of 19. The Lifetime Maximum is 1,250 per child.HOW TO ENROLLComplete the form found on theBenefits Open Enrollment web page. Youwill find this page atwww.rit.edu/benefits.AdjunctsOctober 2015Human ResourcesFinance & Administration3
Prescription Drug UpdatesANNOUNCING OUR NEW PHARMACY BENEFIT MANAGER—OptumRxThe following was written for those whohave coverage from RIT today.Since 2005, RIT has been part of thePreferred University Rx PurchasingCoalition (PURPC), a university grouppurchasing coalition for prescriptiondrug products and pharmacy benefitmanagement (PBM) services. PURPCdelivers value to its member universitiesby combining the covered membership(approximately 100,000 people) toachieve better pricing, enhancedservices, and account managementbeyond what would be achievable byany institution individually.As you may know, RIT (throughPURPC) has contracted with ExpressScripts (formerly Medco before it mergedwith Express Scripts) for pharmacybenefit management services. PURPChas conducted Requests for Proposal(RFPs) when the contracts have been upfor renewal and each time, the result hasbeen that PURPC has renegotiated a new,and less costly, contractual arrangementwith Express Scripts.When PURPC conducted an RFPprocess this past spring, the results weredifferent. As a result, RIT and otherPURPC institutions will be switchingto a new pharmacy benefit manager,OptumRx, as of January 1, 2016.We have been working with OptumRxto implement our program and havebeen very impressed by its attentionto detail and willingness and ability toaccommodate the needs of the variousuniversities it serves. We are optimisticthat this will extend to the experienceour prescription drug plan participantswill have with OptumRx.What do I need to know?Much will remain the same. RIT’s plandesigns will not change. Yourcopaysfor Tier 1 (generics), tier 2 (formularydrugs), and tier 3 (non-formularydrugs) will remain the same (although4October 2015Human Resourcessome medications may switch tiers; see“Changes in the formulary” on page 5).In addition, you will still have access to anetwork of participating retail pharmacies,including Wegmans. The reduced copaysfor Wegmans Pharmacy will still apply.While OptumRx has a few differencesin its network of participating retailpharmacies, we have been advised thatmost RIT plan participants should notfeel any impact from this change, asOptumRx’s network includes all the largenational chain pharmacies as well asmany local and community pharmacies.To search for a participating pharmacy,check OptumRx’s member website or callits member services telephone number.Wegmans Pharmacy, RIT’s PreferredPharmacy, has become very popular withRIT plan participants. Wegmans hasbeen used by RIT plan participants tofill 73% of their retail prescriptions andmore than 62% of all prescriptions filledunder the plan at both retail and mailorder pharmacies. See the separate articleabout Wegmans Pharmacy and why youshould consider filling your prescriptionsthere if you are not already doing so.You will receive a new prescriptiondrug ID card in December, so you willneed to let your retail pharmacy knowabout your new coverage. To protectyour privacy, you should destroy yourold Express Scripts/Medco ID card afterthe new PBM arrangement takes effecton January 1, 2016.2016 PURPC MEMBER INSTITUTIONSBoston UniversityBrown UniversityColgate UniversityCornell UniversityFinance & AdministrationHamilton CollegeHobart & WilliamSmith CollegesPrinceton UniversityRochester Instituteof TechnologySkidmore CollegeStevens Instituteof TechnologySt. LawrenceUniversitySyracuse UniversityUniversity ofNotre DameAdjuncts
vvvThere will be some changes, andsome may require you and/or yourdoctor to take action. As with mosttransitions to new vendors, there willbe some changes that will impact someplan participants. RIT has authorizedExpress Scripts to provide information toOptumRx in order to make the transitionfor participants as smooth as possible(of course, detailed information was notshared with RIT). With this information,OptumRx will send letters in Novemberto the home address of those who willbe impacted by changes. The letters willinclude information about the drug(s)that are impacted as well as informationfor you and your physician aboutactions that need to be taken or availablemedication alternatives.Some of the common types of changesthat will occur and that will impact someindividuals are described below.Changes in the formulary—Aformulary is a list of drugs that havepreferred pricing; in RIT’s plan, theformulary medications are “Tier 2”drugs, also referred to as preferred brandname drugs. Each PBM has its ownformulary that is created by a committeeof independent medical practitioners. Ifyou currently take a medication that ison Express Scripts’ formulary (and forwhich you are paying a Tier 2 copay), itis possible that that drug is now a Tier 3drug if it is not on OptumRx’s formulary.Any medication that is Tier 3 will have atherapeutic alternative available on Tier 2.Youwill be notified if this applies to anyof your medications, and you and yourdoctor can determine whether it makessense to switch to the Tier 2 alternative.A link to OptumRx’s formulary is on theOpen Enrollment page of the HR website.Changes in the excluded drugs list—In 2014, Express Scripts adopted a listof excluded drugs. Since that time, thishas become a standard practiceamong PBMs, including OptumRx. Thispractice is designed to address largeprice increases from pharmaceuticalmanufacturers. For any drugs that areexcluded from coverage, there are otherless costly and at least equally effectivealternative products available. Youwill be notified if any of your currentmedications are on OptumRx’s excludeddrug list, which you can find on theOpen Enrollment page of the HR website.Mail-order pharmacy—OptumRxhas its own mail-order pharmacy. If youare currently using Express Scripts’ mailorder pharmacy to fill prescriptions, youwill need to move those by the end ofthe year since you will not be able to useExpress Scripts’ mail-order pharmacyafter December 31, 2015. If you prefer tocontinue the convenience of having yourmedications delivered by mail, you havetwo options. You can switch to OptumRx’smail-order pharmacy. Activeprescriptions with one or more refillsremaining with Express Scripts’ mailorder pharmacy will automatically betransferred to OptumRx. However,you must do the following before therefills will be sent to you: On or after January 1, 2016,register and update your profileAdjunctsOctober 2015on OptumRx’s website, AND Place your refill order whileyou have at least three weeks ofmedication left.There are some circumstanceswhere prescriptions will not transferto OptumRx and will require youto contact your doctor for a new90-day prescription: No refills remain on your currentprescriptionYourmedication is classified as a “controlled substance” Your prescription is expired Your prescription is a compoundmedication Your prescription at the ExpressScripts mail-order pharmacy isbeing held for a future fill date(on or after January 1, 2016). Or, you can choose to use theWegmans new “free homeshipping” option—see the articleon page 7 for more details. Ifyou are already using Wegmansfree home shipping, then you donot need to take any action. Toswitch a prescription from thecurrent Express Scripts mail-orderpharmacy to Wegmans, simply askyour physician to provide a newprescription to Wegmans pharmacy,or ask your Wegmans pharmacyto contact your physician. You canmake this change at any time; youdo not have to wait until the newPBM is in place.Changes in utilization managementprograms—Examples of this includeprior authorizations, step therapies,and quantity limits. If you have alreadycompleted the requirements for one of theutilization management programs that iscontinuing from Express Scripts, then noHuman ResourcesFinance & Administration5
Prescription Drug Updates continuedaction is required at this time. If this hasnot occurred, then you and your physicianwill need to take action. Informationwill be provided to you in the letter fromOptumRx if this applies to you.New specialty pharmacy—If youcurrently fill any of your prescriptionsthrough Accredo, which is ExpressScripts’ specialty pharmacy, then yourmedications will now be filled throughBriovaRx, which is OptumRx’s specialtypharmacy. The specialty pharmacyprovides counseling, patient carecoordination, special shipping, andother resources for patients who takevery costly and complex medications.If you receive a letter from OptumRxabout BriovaRx, then you need to followthe instructions in the letter, includingcalling the toll-free number in the letterto enroll immediately. Accredo will betransferring information about yourspecialty medications to BriovaRx,so you may receive a phone call fromIf you have questions about how you may be individually impacted and do notwish to wait until you receive your written notification, you may contact OptumRxat 855-209-1300/V; for deaf and hard-of-hearing people, use a relay service (VRS,Captioned telephones or dial 711) and then provide the OptumRx phone number.During open enrollment, OptumRx’s Member Service hours are Monday throughFriday 9 a.m.–7 p.m. Eastern time and weekends 9 a.m.–4 p.m. Eastern time.OptumRx has set up a special website that is available during RIT’s openenrollment period, at http://bit.ly/RITOptumRx.IMPORTANT NOTE: This is not the website to use beginning January 1, 2016.On this special site, you will be able to do things such as find participatingpharmacies, review the list of excluded drugs, and review covered medications.BriovaRx. You will not be able to obtainyour medications from Accredo throughRIT’s plan beginning January 1, 2016.Note: Two PBMs recently merged—Catamaran and OptumRx. You maysee some references to Catamaran incommunications from OptumRx whilethey are still in transition. You may ignorethese references; the PBM for RIT’s planis OptumRx.If you are thinking about enrolling inthe POS B No Drug plan for 2016,please see the article on page 8,Important Information Regarding thePOS B No Drug Plan.WHAT IS A PHARMACY BENEFIT MANAGER (PBM)?OptumRx is our new pharmacy benefitmanager (PBM) beginning January 1,2016. What does this mean? The PBMplays two distinct roles: Administration of the plan Ownership and running of themail-order pharmacy and thespecialty pharmacySometimes we hear from people who areconfused by these two roles and what thedifference is between them. We hope thisinformation helps clarify the differences.Administration of the Plan Network of ParticipatingPharmacies—OptumRx contractswith a network of participating6October 2015Human Resourcesretail pharmacies across thecountry. This includes Wegmans(the preferred pharmacy underthe RIT Rx plan) as well as othermajor national chains such as CVSand Rite Aid. It also includes someindependent pharmacies. You cancheck the participating pharmacieslist on OptumRx’s website todetermine whether your pharmacyis participating—chances are, it is.For more detailed information aboutWegmans Pharmacy’s relationshipwith the RIT Rx plan, see the articleon page 7. Establishment of the Formulary—A formulary is a list of preferredbrand name drugs. One importantFinance & Administrationrole of a PBM is to decide whichdrugs are on its formulary. Likemany of the major PBMs, OptumRxdoes this by having an independentPharmacy and Therapeutics(P&T) Committee composed ofindependent practicing cliniciansfrom a variety of specialties from allacross the country. These medicalprofessionals are not employed byOptumRx. The role of the P&TCommittee is to review medicationsfor inclusion in the formulary. Thisreview of each medication is based onthe FDA labeling, clinical outcomes,and national treatment guidelines. Claims Processing and Payment—When you fill your prescription atAdjuncts
vvva participating pharmacy like RiteAid, for example, or at Wegmans, thepharmacy technician or pharmacistenters your participant identificationnumber into the OptumRx onlinesystem. This brings up the RIT Rxplan design that applies to you. Ittells the pharmacy how much youneed to pay, and how much the planwill pay to the pharmacy. It alsoalerts the pharmacy if there are anyissues needing to be resolved—anexpired prescription, a potentialdrug-to-drug interaction due toanother medication you have filled, arequirement that prior authorizationis needed before the plan will pay forthe medication, etc. The pharmacycollects your payment and then thePBM bills RIT’s self-funded Rx planfor the difference. The PBM pays thepharmacy the amount that is dueover what you already paid.If you fill your prescription at anon-participating pharmacy, youwill need to send the receipt with acompleted claim form (available onthe HR website) to the PBM.Mail-order pharmacy andspecialty pharmacySimilar to our current PBM, OptumRxowns and manages its own mail-orderpharmacy. If you fill your 90-daymaintenance prescriptions at theirmail-order pharmacy, the PBM is reallyperforming both roles at the same time.They are both the claims processor/payer and the owner of the pharmacy.OptumRx’s mail-order pharmacy workssimilarly to the current PBM’s mailorder pharmacy.See page 5 for instructions on orderingfrom the OptumRx mail-order pharmacy.OptumRx a
2016 Benefits Enrollment Human Resources Finance & Administration . administered by Excellus BlueCross BlueShield (BCBS). In addition, RIT offers prescription drug coverage administered by OptumRx . drugs), and tier 3 (non-formulary drugs) will remain
