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April 19, 2012

Benefits open enrollment ends May 9

Open enrollment for Pitt’s employee benefits runs through May 9. Information packets with details of benefits plans, including vision and dental plan options, as well as long-term care and life insurance options, were being mailed to employees’ homes this week.

Employees who do not receive their packets should contact Benefits at 412/624-8160.

Highlights of the 2012-13 plans:

• Pitt  premiums will be going up next year, but at a rate lower than the national average, officials here say.

• Co-pays on certain office visits and some prescription drugs also will increase.

• Federal regulations are placing new limits on the flexible spending accounts.

• Additional options will be available for obtaining dependent life insurance.

The overall cost increase of Pitt’s medical plans, which are administered by UPMC Health Plan, is 5.1 percent for the health plan year that begins July 1, according to Pitt Benefits director John Kozar. That compares to a projected national average increase of 6-8 percent, he noted.

“We don’t have any major changes in the open enrollment package for the forthcoming plan year,” Kozar said. “As always, there are cost increases because of medical inflation and increased utilization that drive up your costs. We work with the medical advisory committee to try to come up with a balance of holding down the premium increases but balancing that against the increase in co-pays. That has been our strategy for years.”

Kozar added that by examining other health care plans Pitt sees certain trends emerging. “Those trends are indicating there is more and more cost-shifting and changes in plan design. We’ve kept the same plan design we’ve had since July 2003.”

The main goal of the University, he said, is to offer a health care benefits program affordable for everybody.

“These are certainly difficult decisions because of the budget considerations of the University, but the University is very sensitive to what employees pay for their share of the premium,” Kozar added.

Panther Gold enrollees, who make up about 90 percent of the approximately 25,000 plan members (about 13,500 of whom are employees, with the balance being spouses/domestic partners and children), will see their monthly premiums rise $4 for individuals, from $59 to $63; $11 for parent/child(ren), from $145 to $156; $14 for two adults, from $215 to $229, and $17 for family coverage, from $300 to $317.

Pitt’s overall health care costs for the coming plan year are projected to be roughly $112 million, up from about $106.5 million for the current plan year. As has been customary for several years, the University will continue to absorb 80 percent of the annual rate increase to the medical programs, Kozar said.

All UPMC Health Plan participants electing to make any changes in their benefits must do so by May 9.

Employees who elect to maintain their current medical, dental, vision and life insurance benefits need not take any action.

However, those wishing to continue with a flexible spending account must re-enroll in the program. This is a change from previous years.

Changes in benefits must be made electronically by following the online enrollment procedure, accessible at www.hr.pitt.edu by clicking on the “open enrollment” link. An instruction sheet for online enrollment is provided in the printed enrollment materials.

A confirmation letter will be sent to the employee’s home address within a few days of changes being made, according to Human Resources.

Open enrollment is the only time that the Internal Revenue Service permits benefit changes to be made. Otherwise, changes are permitted only if there is a qualified life event such as birth of a child, marriage, divorce or loss of a spouse’s coverage.

To help keep the increases in health plan premium rates relatively low, Kozar said, the University is increasing some co-payments:

• Co-pays are increasing on preferred brand drugs from $34 to $36; on non-preferred brand drugs from $68 to $72, and on specialty medications from $73 to $80 — all on 30-day supplies.

Plan members can save on prescription drug co-pays by purchasing a 90-day supply at the Student Health Service pharmacy or Falk Pharmacy at a discount. The savings is equal to one co-pay.

Co-payments for generic drugs will stay at $12 for a 30-day supply during the coming plan year. Generic drugs represent about 75 percent of all prescription drugs used by Pitt health plan participants, Kozar noted.

• For most enrollees — the 90 percent who are enrolled in the Panther Gold (HMO) — doctor’s office visit co-pays will stay at $20. Specialist visit co-pays will increase from $30 to $35; urgent care facility visits will increase from $30 to $40; behavioral health visits will increase from $15 to $20, and emergency room visits will increase from $30 to $40 for a child and from $50 to $80 for an adult.

Plan options continue to be Panther Gold (HMO), Panther Premium (PPO), Panther Plus (PPO) and Panther Basic (PPO). Details on premium rate increases are included in the packets.

All plans will continue to waive co-pays and deductibles for age-related wellness and preventive services completed in-network, such as pediatric immunizations, mammography, colonoscopy, Pap tests and prostate exams.

The University will continue to offer optional dental and vision coverage. For dental coverage, Pitt is in the second year of a two-year contract with United Concordia.

For the dental plan, rates will remain the same for the Flex I and Flex II program options. The monthly rates for the Concordia Plus DHMO option will increase by 4 percent, ranging from 65 cents for individual coverage to $2.14 for family coverage.

The University has entered into a new two-year contract with Davis Vision. Vision plan participants will see a monthly contribution increase ranging from $1.21 for single coverage to $2.95 for the Fashion Plan. The increase is a result of high utilization of the program, Kozar said.

Details on both plans are contained in the packets.

Under the provisions of the federal Health Care Reform Act, there is now a $208.33 per month cap ($2,500 annually) on the deferral limit for health care flexible spending accounts. This 50 percent reduction from the maximum allowable in the current year takes effect July 1. Participants who wish to continue electing flexible spending accounts must complete the online enrollment form by May 9.

Kozar explained, “The major change is that the federal government under health care reform has reduced the amount you can defer on a pre-tax basis into a health care spending account. They essentially cut it in half. This isn’t a University decision; it’s a decision by the federal government. However, it should be noted there isn’t any change in the dependent daycare account; that remains at a $5,000 maximum.”

Also under federal provisions, adult children up to age 26 may continue to be covered under their parent’s medical insurance.

UPMC Health Plan also has added two options for dependent life insurance coverage, bringing the total options to six. New option 5 offers $75,000 in coverage for a spouse/domestic partner and $10,000 coverage for a dependent child; new option 6 offers $100,000 in coverage for a spouse/ domestic partner and $10,000 for a dependent child.

Enrolling in either of the new options requires evidence of insurability (EOI); an EOI is not required for the other four options, including option 4, which previously did require an EOI.

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Faculty representatives on Pitt’s medical advisory committee were pleased that health insurance cost increases will be relatively low for employees.

Medical advisory committee member Irene Kane, who also chairs the University Senate benefits and welfare committee, told the University Times: “We had multiple meetings to diligently work together to carefully review preserving and even improving benefits while continuing to hold down cost increases. The overall 5.1 percent rate increase is evidence of the success of the continued dedication of the Benefits office to preserve an excellent package while being cognizant of financial concerns of the people it serves.”

Michael Pinsky, president of the University Senate who sits on the medical advisory committee, said: “I am pleased with the limited cost increases considering the tough budget realities faced both in terms of rising costs and reduced state support. [The committee] was able to secure these minimal increases by creative cost-sharing. The University faculty and staff have an excellent health care insurance plan that is the envy of all other employers and employees in southwest Pennsylvania.”

More information on employee benefits can be found at www.hr.pitt.edu/benefits/.

—Peter Hart


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