New Medical Plan Effective 7/1/2022
Beginning on July 1, 2022, the University’s previous Preferred Provider Medical Plans, the PPO1 (90/10 in-network coverage, 70/30 out-of-network coverage) and the PPO2 (80/20 in-network coverage, 50/50 out- of-network), will be replaced by one new PPO plan. The new PPO Plan is an 85/15 in-network and 60/40 out-of-network coverage plan. Just like the previous PPO plans, there is a network of healthcare providers for your medical care and a generous prescription plan.
The Office of Human Resources has scheduled meetings throughout March with the University’s Medical Mutual of Ohio representative, Stephanie Mueller. Ms. Mueller will review the new plan design, when to expect new benefit cards, and provide information about deductibles and coinsurance roll overs. Representatives from the Office of Human Resources will provide additional information regarding employee responsibilities and to answer general questions about the plan.
Two virtual meetings are also scheduled for employees unable to attend an in-person meeting. Employees are encouraged to attend one (1) of the meetings for a better understanding of the plan changes, the effects of the plan changes, and the new plan implementation process.
MEETING TIMES AND DATES:
IN PERSON
Tuesday March 1, 2022, at 10am President’s Suite Kilcawley Center
Monday March 7, 2022, at 2pm President’s Suite Kilcawley Center
Wednesday March 9,2022, at 3pm Wednesday President’s Suite Kilcawley Center
Thursday March 17, 2022, at 12pm President’s Suite Kilcawley Center
VIRTUAL
Friday March 25, 2022, at 11am LINK TO ATTEND THE MEETING
Thursday March 31, 2022, at 1pm LINK TO ATTEND THE MEETING
Medical Mutual of Ohio Presentation is available for review before the meeting or for an employee to make their own copy.
RECORDED PRESENTATION OF NEW MEDICAL PLAN*
PASSWORD: Penguin2022!
- New Plan Design
The medical plan effective 7/1/2022 is a PPO plan with Medical Mutual of Ohio. PPO, which stands for Preferred Provider Organization, is defined as a type of managed care health insurance plan that provides maximum benefits if an employee or enrolled family member visits an in-network physician or provider, but still provides some coverage for out-of-network providers. Additionally, enrolled members can usually visit any provider without a referral from your primary physician.
The plan design includes in network benefits:
- Deductible - $350 individual/ $700 family deductible
- Coinsurance - 85% in network
- Coinsurance out of pocket - $1000 individual/$2000 family
- Office Visits - $20
- Specialist Office Visits - $35
- Emergency Room Copay - $200
- Prescription Drug Coverage
- Retail - Generic - copay 20% up to max of $5/ Preferred Brand - copay 25% to a max of $35/ Non-Preferred Brand - copay 25%to a max of $75.
- Mail In through Express Scripts - Generic - copay 20% up to max of $15/ Preferred Brand- copay 25% to a max of $70/ Non-Preferred Brand - copay 25% to a max of $75.
Plan comparison of the traditional/PPO1, alternative/PPO2 and new plan*
- Consumer Driven Health Plan and Health Savings Account
The University will continue to offer the Consumer Driven Health Plan (CDHP) along with employer contributed Health Savings Account. CDHP is also a PPO plan through Medical Mutual of Ohio. PPO, which stands for Preferred Provider Organization, is defined as a type of managed care health insurance plan that provides maximum benefits if an employees or enrolled family member visits an in-network physician or provider, but still provides some coverage for out-of-network providers. Additionally, enrolled members can usually visit any provider without a referral from your primary physician.
Employees and their dependents will be eligible to enroll in this plan during the University's annual open enrollment period.
Consumer Health Driven Health Plan*
Health Savings Account
Employees are ONLY eligible to enroll in the Health Savings Account (HSA) if enrolled in the Consumer Driven Health Plan (CDHP)
A healthcare savings account (HSA) provides employees enrolled in a Consumer Driven Health Plan an opportunity to set aside money on a pre-tax basis for qualified medical expenses such as co-pays, deductibles, and other non-covered medical expenses. Additionally, you have the option to invest in a variety of mutual funds and grow your dollars tax-free upon reaching certain minimum balance requirements and withdraw your dollars tax-free as long as you use them for qualified medical expenses. The funds in the HSA roll over from year to year and will remain with the employees after separation of employment from the University.
Employees who are eligible may elect to participate in the HSA upon their date of hire and an election form must be completed within thirty (30) days of the employee’s date of hire. Once enrolled, the elections are calculated for the remainder of the plan year. A qualifying event allows employees to make midyear changes in coverage consistent with the qualifying event. Please contact the Human Resources department to determine if a family status changes qualifies under the Plan document and IRS regulations.
Elections for the healthcare and dependent care programs must be made annually during the annual open enrollment period. Elections do not roll over into subsequent years. Funds deposited into your HSA remain in your account and automatically roll over from one year to the next.
To be eligible and qualify for the tax benefits of a HSA:
An employee must be covered under a qualified Consumer Driven Health Plan (CDHP) as their only health coverage (except as other wise permitted under IRS guidelines), NOT ENROLLED in MEDICARE and NOT claimed as a dependent on someone's else tax return.
**As an account holder of an Health Savings Accounts, the employee is responsible for understanding and knowing the IRS rules and regulations of a HSA account.**
Annual Enrollment is required to participate in the employee contribution of the health savings account.
YSU contributes $500 to the Health Savings Account for an employee enrolled in single coverage and $1000 for an employee enrolled in family coverage into the Health Savings Account for 2022.
- Employee Premium Share
The University’s premiums are determined using various factors such as the previous two-years claims data, plan design changes and inflation.
The final rates will be announced in April 2022 for the July 1, 2022 new plan implementation.
Employee Premiums Share:
Effective July 1, 2022 employees premium share will increase from fifteen percent (15%) to eighteen percent (18%).
Employees contribute to the premiums through payroll deduction on a pre-tax basis and if preferred, can elect to have the deduction taken post-tax. Premiums may be adjusted annually based on the renewal rates and bargaining unit language. Employees may elect:
- Single coverage
- Employee and One Dependent Coverage (spouse or a child)
- Family Coverage (employee with two or more dependents)
- Pay Date
A premium increase for both medical plans will reflect on enrolled employees’ paychecks as follows:
• Bi-weekly pay periods - effective with the July 29, 2022 paycheck
• Semi-monthly pay - effective with the July 15, 2022 paycheck
• Faculty 18 pay periods - effective with the August 31, 2022 paycheck - Employee Enrollment Into the New Medical Mutual Plan
Employees and/or their dependents enrolled in the traditional and alternative medical plans offered by the University will be transferred to the new medical plan effective July 1, 2022. Employees enrolled in the Consumer Driven Health Plan (CDHP) will remain enrolled in this plan.
- Frequently Asked Questions
What is the employee's responsibility to enroll in the new plan?
All benefit eligible employees who are enrolled in the traditional and alternative plan on June 30, 2022 will be transferred to the new medical plan (PPO1) effective July 1, 2022. Employees enrolled in the Consumer Driven Health Plan (CDHP) will remain enrolled in this plan.
When will the plan change go into effect?
The new plan will be effective at midnight on July 1, 2022. The final rates will be announced in April 2022 for the July 1, 2022 new plan implementation.
Will their be an increase in my premium share?
Employee premiums share will increase from fifteen percent (15%) to eighteen percent (18%) effective on the employee's pay date listed below:
• Bi-weekly pay period-effective with the July 29, 2022 pay check
• Semi-monthly pay - effective with the period July 15, 2022 paycheck
• Faculty 18 pay periods - effective with the August 31, 2022 paycheckHow will the plan change affect any monies the employee and their family have paid towards a deductible and co-insurance?
Any claims that were applied to an employees and/or the enrolled family members deductible, co-insurance, or out of pocket through the traditional, alternative, or Consumer Driven Health Plan will be applied to the new plan the employee elects.
When will new insurance cards be sent out?
Each member who is eighteen (18) or older enrolled in a Medical Mutual of Ohio medical plan will receive an individual card sent to their address on or around July 1, 2022. New cards will be mailed out from Medical Mutual of Ohio in plan white envelopes. Watch your mail carefully to not discard this envelope. Allow up to July 14, 2022 for new cards to be mailed to the address on file with YSU however if cards are not received after July 14, 2022 email benefits@ysu.edu to receive a temporary card.
What about an employee's Flexible Spending Account?
The plan change will have no effect on the current flexible spending accounts for 2022. Employees who are enrolled in a 2022 flexible spending account will not be permitted to make election changes to their account and employees who are not enrolled in a flexible spending account are not eligible to enroll at this time. Flexible spending account elections are made during annual open enrollment or due to a qualifying event. Medical plan design changes are not considered qualifying events.
Is there an in-network provider list available to employees?
Medical Mutual of Ohio no longer provides printed provider lists. Employees can research providers on the Medical Mutual of Ohio website.
When is open enrollment?
YSU's annual open enrollment is in October of each year with the January 1 being the effective date of elected changes.
Where can employees access lists for in network providers for Urgent Care, Emergency Rooms, or labs etc.?
Employee can access provider information on the Medical Mutual Website through My Health Plan. Paper copies of in or out of network provider lists are no longer available.
What is a deductible?
A deductible is the amount, usually stated in dollars, for which an employee is responsible each benefit period before the plan will start to provide benefits.
What is co-insurance?
Co-insurance is the percentage of the Allowed Amount or Non-Contracting Amount for which the employee is responsible after the employee has met the deductible.
What is Maximum Out of Pocket (MOOP)?
The maximum of out pocket is the total amount an employee pays for covered services in a plan year. All deductible, copayment, and coinsurance for in-network care services are combined together. Once the maximum out of pocket dollar amount is met, the employee will have all services paid at one hundred percent (100%) for the remaining portion of the plan year.
How can the medical insurance be used if an employee is traveling out of the country?
An employee will pay for the services and request an itemized statement from the provider in English. Upon the return to the United States, a claim for should be submitted to Medical Mutual of Ohio for the employee's reimbursement.
Can flexible spending account money be used for medical expenses?
Flexible spending account money may be used for deductible, co-payment and co-insurance but cannot be used for employee premiums.
Can money be added to an employees current Flexible Spending Account due to the plan change or must employee's wait until open enrollment to make changes or addition to the flexible spending account?
Plan changes are not considered a qualifying event therefore changes to employees flexible spending account can not be made until open enrollment.
If the deductibles, co-insurance, and maximum out of pocket amounts calculated based on a calendar year, why is YSU changing plans mid-year?
Premiums for medical insurance are calculated on a fiscal year and are applied July 1 each year. The plan changes implementation was negotiated using the effective date of July 1.
How does Medicare apply to an employee who is still employed and enrolled in a YSU sponsored medical plan and reaches the age of 65?
if the employee remains is enrolled in a YSU sponsored medical plan when they reach the age of 65, YSU's sponsored medical plan will remain primary until the employees leaves the University.
Why did I receive two benefit booklets in the mail?
All Medical Mutual of Ohio members received or will receive two new benefit booklets in the mail, one booklet is for the new PPO plan effective 7/1/2022 and the second booklet is for the Consumer Driven Health Plan. Due to the medical plan changes in the PPO plan, the change in group numbers and the Transparency Act, Medical Mutual of Ohio is required to mail out new benefit booklet for both plans to all enrolled Medical Mutual of Ohio members.
Where can an employee submit questions?
Employees can submit questions to benefits@ysu.edu or contact Stacey Luce, Manager; Employees Benefits and Training, at 330-941-1322 or Linda Mazzocco, Benefits Analyst, at 330-941-3748.