Active Benefits 2021 - 2022 Montana University System

FINALIZEWhen your enrollment is complete, you willreceive a confirmation number and you canalso Print Benefit Summary.Your To Do list will notify you if you haveany additional actions needed to completeyour enrollment.REVIEW YOUR BENEFITSYou have 24/7 access to your benefit summarythat shows your benefit elections. Click BenefitSummary on the Home page to review yourcurrent benefits at any time.CHANGE YOUR BENEFITSOnce approved, your benefit elections will remain in effectuntil the end of the benefit plan year, unless you have aqualifying life event, such as marriage, divorce or birth of achild. Find detailed qualifying event information atwww.choices.mus.edu.1. Click on Change My Benefits.2. Select Life Event and the event type.3. Review your options and follow the election stepspreviously outlined to complete your changes.**IMPORTANT: You must make changes within 63 daysof the qualifying event and provide the requireddocumentation for verification.FIND BENEFIT INFORMATIONCHANGE YOUR BENEFICIARY(IES)View your MUS Choices benefit plan informationat www.choices.mus.edu.Beneficiary changes can be made at any time of the year.If you have questions about your enrollment,contact your campus Human Resources/BenefitsOffice directly.1. Click on Change My Benefits2. Select Basic Info and Change of Beneficiary.3. Follow the prompts to complete your change.Download the MyChoiceSMMobile App1. Visit your device’s app store anddownload the MyChoice byBusinessolver Mobile App.2. Visit your Benefitsolver Home page toGet Access Code.3. Activate the app with your accesscode.(If you don’t use the code within 20minutes, you’ll need to generate a newone.)4. Follow the instructions within theMobile App to have easy access to yourbenefits on the go.-5-

How the Choices Medical Plan WorksOut-of-Network Providers – Providers whodo not have a contract with the Plan claim’sadministrator. You pay 35% of the allowedamount (after a separate deductible) for servicesreceived Out-of-Network.Out-of-Network providers can also balance billyou for any difference between their billed chargeand the allowed amount.Plan members receive medical services from ahealth care provider. If the provider is In-Network,the provider will submit a claim for the member.The Medical Plan claim’s administrator processesthe claim and sends an Explanation of Benefits(EOB) to the member and the provider, showingthe member’s payment responsibilities (deductible,copayments, and/or coinsurance costs). The Planthen pays the remaining allowed amount. Theprovider will not bill the member the difference between the billed charge and the allowed amount.Emergency Services – Emergency services arecovered everywhere. However, Out-of-Networkproviders may balance bill the difference betweenthe allowed amount and the billed charge.If the provider is Out-of-Network, the membermust verify if the provider will submit the claim or ifthe member must submit the claim. The MedicalPlan claim’s administrator processes the claim andsends an EOB to the member showing the member’s payment responsibilities (deductible, coinsurance, and any difference between the billed chargeand the allowed amount (balance billing)).Deductible – The amount you pay each benefitplan year before the Plan begins to pay.Copayment - A fixed dollar amount you pay fora covered service that a member is responsiblefor paying. The Medical Plan pays the remainingallowed amount.Coinsurance – A percentage of the allowedamount for covered charges you pay, afterpaying any applicable deductible.Definition of TermsIn-Network Providers – Providers who havecontracted with the Plan claim’s administrator tomanage and deliver care at agreed upon prices.Members may self-refer to In-Network providersand specialists. There is a cost savings for servicesreceived In-Network. You pay a 25 copayment forPrimary Care Physician (PCP) visits and a 40 copayment for Specialty provider visits to In-Networkproviders (no deductible) and 25% coinsurance (after deductible) for most In-Network hospital/ facilityservices.Out-of-Pocket Maximum - The maximumamount of money you pay toward the cost ofcovered health care services. Out-of-Pocketexpenses include deductibles, copayments,and coinsurance.ImportantVerify the networkstatus of your providers. Thisis an integral cost savingscomponent of each of your planchoices.-6-

Medical Plan (mandatory)FY2022Administered by BlueCross BlueShield of Montana 1-800-820-1674 or 447-8747, www.bcbsmt.comChoices offers a Medical Plan for Employees and their eligible dependents.Medical Plan MonthlyEmployee/Survivor Only 748Employee & SpouseEmployee & Child(ren)/Survivor & Childr(ren 1,075Employee & Family 1,327Sample Medical card 994The employer contribution for FY2022 is 1,054 per month foreligible active employees (applies to pre-tax benefits only).Medical Plan CostsFY2022Medical Plan CostsAnnual DeductibleApplies to all covered services, unless otherwise noted orcopayment is indicated.Copayment (outpatient office visits)Primary Care Physician Visit (PCP)Specialty Provider VisitMedical PlanIn-NetworkMedical PlanOut-of-Network * 750/Person 1,500/FamilySeparate 750/PersonSeparate 1,750/Family 25 copay 40 copayN/AN/A25%35% 4,000/Person 8,000/FamilySeparate 6,000/PersonSeparate 12,000/FamilyCoinsurance Percentages(% of allowed charges member pays)Annual Out-of-Pocket Maximum(Maximum paid by member in a benefit plan year for coveredservices; includes deductibles, copays and coinsurance)from an Out-of-Network provider have separate deductibles, % coinsurance, and Out-of-Pocket maximums. An Out-of* ServicesNetwork provider can balance bill the difference between the allowed amount and the billed charge.-7-

Examples of Medical costs to Plan and Member - Primary Care Physician Visit(In-Network) Jack’s Plan deductible is 750, his coinsurance is 25%, and his out-of-pocket max is 4,000.July 1Beginning plan yearJack pays 25 officevisit copay and100% of allowedamount for lab chargesmore costsPlan paysremainder ofoffice visitJack hasn’t reached his deductible yetand he visits the doctor and has labwork. He pays 25 for the office visitand 100% of the allowed amount forcovered lab charges. For example,Jack’s doctor visit totals 1,000. Theoffice visit is 150 and labwork is 850.The Plan allows 100 for the office visitand 400 for the labwork. Jack pays 25 for the office visit and 400 for thelabwork. The Plan pays 75 for theoffice visit and 0 for the labwork. TheIn-Network provider writes off 500.June 30End of plan yearmore costsPlan paysremainder of officevisit and 75% ofallowed amountJack pays 25office visit copayand 25% of allowedamount for labchargesJack has seen the doctor several times andreaches his 750 in-network deductible. Hisplan pays some of the costs of his next visit.He pays 25 for the office visit and 25% of theallowed amount for labwork and the Plan paysthe remainder of the office visit 75% of theallowed amount. For example, Jack’s doctorvisit totals 1,000. The office visit is 150 andlabwork is 850. The Plan allows 100 forthe office visit and 400 for the labwork. Jackpays 25 for the office visit and 100 for thelabwork. The Plan pays 75 for the office visitand 300 for the labwork. The In-Networkprovider writes off 500.Jack pays0%Plan pays100% allowedamountJack reaches his 4,000 out-of-pocketmaximum. Jack has seen his doctoroften and paid 4,000 total (deductible coinsurance copays). The Plan pays100% of the allowed amount for coveredcharges for the remainder of the benefityear. For example, Jack’s doctor visittotals 1,000. The office visit is 150and labwork is 850. The Plan allows 100 for the office visit and 400 for thelabwork. Jack pays 0 and the Plan pays 500. The In-Network provider writes off 500.(Out-of-Network) Jack’s Plan deductible is 750, his coinsurance is 35%, and his out-of-pocket max is 6,000.July 1Beginning plan yearJack pays100%Plan pays0%Jack hasn’t reached his deductibleyet and he visits the doctor. He pays100% of the provider charge. Onlyallowed amounts apply to hisdeductible. For example, theprovider charges 1,000. The Planallowed amount is 500. 500 appliesto Jack’s Out-of-Network deductible.Jack must pay the provider the full 1,000.more costsmore costsJack pays 35% anydifference betweenprovider charge andplan allowed amount.Plan pays65% of allowableJack has seen the doctor several times andreaches his 750 Out-of-Network deductible.His plan pays some of the costs of his next visit.He pays 35% of the allowed amount and anydifference between the provider charge and thePlan allowed amount. The Plan pays 65% ofthe allowed amount. For example, the providercharges 1,000. The Plan allowed amount is 500. Jack pays 35% of the allowed amount( 175) the difference between the providercharge and the Plan allowed amount ( 500).Jack’s total responsibility is 675. The Planpays 65% of the allowed amount ( 325).-8-June 30End of plan yearJack pays anydifference betweenprovider charge andplan allowed amount(balance bill)Plan pays100% ofallowedamountJack reaches his 6,000 out-of-pocketmaximum. Jack has seen his doctor oftenand paid 6,000 total (deductible coinsurance). The Plan pays 100% of theallowed amount for covered charges forthe remainder of the benefit year. Jackpays the difference between the providercharge and the allowed amount. For example, the provider charges 1,000. ThePlan allowed amount is 500. Jack pays 500 and the Plan pays 500.

Medical Plan oinsuranceHospital Inpatient Services Pre-Certification of non-emergency inpatient hospitalization is strongly recommendedRoom and Board Charges25%35%Ancillary Services25%35%Surgical Services(See Summary Plan Description forsurgeries requiring prior authorization)25%35%25%25%35%35%Hospital Outpatient ServicesOutpatient ServicesOutpatient Surgi-Center ServicesPhysician/Professional Provider Services (not listed elsewhere)Primary Care Physician (PCP) Office Visit- Includes Telemedicine and Naturopathic visitsSpecialty Provider Office Visit- Includes Telemedicine visits 25 copay/visitfor office visit only - lab, x-ray &other procedures are subject todeductible/coinsurance35%Note: There is no network forNaturopaths, so they are treated asIn-Network, however, the membermay be balance billed thedifference between the allowedamount and the provider billedcharge. 40 copay/visitfor office visit only - lab, x-ray &other procedures are subject utpatient Physician ServicesLab/Ancillary/Misc. ChargesEye Exam(preventive or medical)0%one/yr35%one/yr0%/visitSecond Surgical Opinionfor office visit only - lab, x-ray &other procedures are subject todeductible/coinsurance35% 200 copay/transport 200 copay/transportEmergency ServicesAmbulance Services forMedical Emergency 250 copay/visitEmergency Room Charges 250 copay/visitfor room charges only - lab, x-ray& other procedures are subject todeductible/coinsurance (waived ifimmediately admitted to hospital)for room charges only - lab, x-ray& other procedures are subject todeductible/coinsurance (waived ifimmediately admitted to hospital)25%25%Professional Provider ServicesUrgent Care Services 75 copay/visitFacility/Professional Servicesfor room charges only - lab, x-ray& other procedures are subject todeductible/coinsurance25%25%Lab & Diagnostic ServicesReminder: 75 copay/visitfor room charges only - lab, x-ray& other procedures are subject todeductible/coinsuranceDeductible applies to all covered services unless otherwise indicated or a copay applies. Out-of-Network providerscan balance bill the difference between their billed charge and the allowed amount.-9-

Schedule of Medical BenefitsMedical Plan tworkCoinsurance25%35%Maternity ServicesHospital Services25%Physician Services(delivery & inpatient)(waived if enrolled in WellBabyProgram within first trimester) 25 copay/visitPrenatal Office Visit(waived if enrolled in WellBabyProgram within first trimester)35%35%Preventive ServicesPreventive screenings/immunizations(adult & Well-Child care)Refer to pgs 13 & 14 for listing of PreventiveServices covered at 100% of the allowedamount and for age recommendations0%(limited to services listed onpgs 13 & 14. Other preventiveservices subject to deductible andcoinsurance)35%25%35%First 4 visits 0 copay, then 25 copay/visit35% 40 copay/visit35%Mental Health/Chemical Dependency ServicesInpatient Services(Pre-Certification is recommended)Outpatient Visit(this is a combined max of 4 visits at 0 copay formental health and chemical dependency services)-Includes Telemedicine VisitsPsychiatrist Visit-Includes Telemedicine visitsRehabilitative ServicesChiropracticPhysical, Occupational, Speech, Cardiac, Respiratory, Pulmonary, and Massage Therapy, Acupuncture andInpatient Services25%Max: 30 days/yr(Pre-Certification is recommended)35%Max: 30 days/yr35%Max: 60 visits/yrOutpatient Services 25 copay/visit(this is a combined max of 60 visits for all outpatientrehabilitative services)- Includes Telemedicine visitsReminder:Max: 60 visits/yrNote: There is no network forAcupuncture & Massage Therapy,so they are treated as In-Network,however, the member may bebalance billed the differencebetween the allowed amount andthe provider billed charge.Deductible applies to all covered services unless otherwise indicated or a copay applies. Out-of-Network providerscan balance bill the difference between their billed charge and the allowed amount.- 10 -

Medical Plan oinsurance 25 copay/visitMax: 30 visits/yr35%Max: 30 visits/yr25%Max: 6 months35%Max: 6 months25%Max: 30 days/yr35%Max: 30 days/yrExtended Care ServicesHome Health Care Visit(Prior Authorization is recommended)Hospice ServicesSkilled Nursing Facility Services(Prior Authorization is recommended)Miscellaneous Services 40 copay/visitOffice visit only.If no office visit,deductible & coinsurancewaivedAllergy ShotsDurable Medical Equipment,Prosthetic Appliances & Orthotics(Prior Authorization is required foramounts greater than 2,500)Reminder:25%Max: 200 for foot orthotics35%35%Max: 200 for foot orthoticsDeductible applies to all covered services unless otherwise indicated or a copay applies. Out-of-Network providerscan balance bill the difference between their billed charge and the allowed amount.- 11 -

Schedule of Medical BenefitsMedical Plan tworkCoinsurance0% (no deductible)35%First 8 visits 0 copay, then 25 copay/visit35%Miscellaneous Services cont.PKU Supplies(Includes treatment & medical foods)Dietary/Nutritional Counseling Visit- Includes Telemedicine VisitsObesity Management(Prior Authorization required)TMJ Services(Prior Authorization recommended)25%Must be enrolled in TakeControl for non-surgicaltreatment35%25%Surgical treatment only35%25%35%Organ TransplantsTransplant Services(Prior Authorization required)Travel ReimbursementTravel reimbursement for patient only- If services are not available in local area(Prior Authorization required)0%up to 1,500/yr.-up to 5,000/transplant0%up to 1,500/yr.-up to 5,000/transplantMUS Wellness ProgramPreventive Health ScreeningsHealthy Lifestyle Education & SupportWellBaby ProgramTake Control Lifestyle Management ProgramDiabetes, Weight Loss,High Cholesterol, Tobacco Use, High BloodPressureIncentive ProgramReminder:see pg 25see pg 26Deductible applies to all covered services unless otherwise indicated or a copay applies. Out-of-Network providerscan balance bill the difference between their billed charge and the allowed amount.- 12 -

Preventive Services1. What Services are PreventiveThe MUS Medical Plan provides preventive care coverage thatcomplies with the federal health care reform law, the Patient Protectionand Affordable Care Act (PPACA). Services designated as preventivecare include: periodic wellness visits,certain designated screenings for symptom free or disease-freeindividuals, anddesignated routine immunizations.Lake McDonald, MTWhen preventive care is provided by In-Network providers, services are reimbursed at 100% of the allowedamount, without application of deductible, coinsurance, or copay. Services from an Out-of-Network providerhave a 35% coinsurance and a separate deductible and Out-of-Pocket maximum. An Out-of-Network providercan balance bill the difference between the allowed amount and the billed charge.The PPACA has used specific resources to identify the preventive services that require coverage: U.S.Preventive Services Task Force (USPSTF) A and B recommendations and the Advisory Committee onImmunization Practices (ACIP) recommendations adopted by the Center for Disease Control (CDC).Guidelines for preventive care for infants, children, and adolescents, supported by the Health Resources andServices Administration (HRSA), come from two sources: Bright Futures Recommendations for PediatricHealth Care and the Uniform Panel of the Secretary’s Advisory Committee on Heritable Disorders in Newbornsand Children.U.S. Preventive Services Task Force: www.uspreventiveservicestaskforce.orgAdvisory Committee on Immunization Practices (ACIP): www.cdc.gov/vaccines/acip/CDC: www.cdc.govBright Futures: www.brightfutures.orgSecretary Advisory Committee: www.hrsa.gov/about/organization/committees.html2. Important Tips1. Accurate coding for preventive services byyour health care provider is the key to accuratereimbursement by your health care plan. All standardcorrect medical coding practices should be observed.2. Also of importance is the difference between a“screening” test and a diagnostic, monitoring, orsurveillance test. A “screening” test done on anasymptomatic person is a preventive service andis considered preventive even if the test resultsare positive for disease, but future tests would beconsidered diagnostic, for monitoring the disease orthe risk factors for the disease. A test done becausesymptoms of disease are present is not a preventivescreening and is considered diagnostic.3. Ancillary services directly associated with a“screening” colonoscopy are also consideredpreventive services. Therefore, the evaluati

A, Bozeman, MT 59717 406-994-3651 MSU - Billings 1500 University Dr., Billings, MT 59101 406-657-2278 MSU - Northern 300 West 11th Street, Havre, MT 59501 406-265-3568 Great Falls College - MSU 2100 16th Ave. S., Great Falls, MT 59405 406-268-3701 UM - Missoula 32 Campus Drive, LO 252, Missoula, MT 59812 406-243-6766