Active Benefits 2019 - 2020 - Montana

Complete your Montana University Systembenefits enrollment today!LOG INVisit the MUS Choices website Home pageat www.choices.mus.edu from anycomputer or smart device, click on the StartEnrollment button on the Home page andLogin with your User Name andPassword.New users must Register and answersecurity questions. The case-sensitiveCompany Key is musbenefits.Need to reset your user name or password?1. Click Forgot your user name or password?2. Enter your Social Security Number, birth date and theCompany Key: musbenefits.3. Answer your security phrase.4. Enter and confirm your new password, then clickContinue and Login with your new credentials.GET STARTEDClick Start Here and follow the instructionsto make your benefit elections by thedeadline on the calendar. If you miss thedeadline, you will not be able to make anychanges to your benefit elections until thenext annual enrollment period.MAKE YOUR ELECTIONSUsing Previous and Next to navigate,review your options as you move throughthe enrollment process.Select plan(s) and what dependent(s) youwould like to cover.Track your benefit elections and costs alongthe left side of the page.REVIEW AND CONFIRMMake sure your personal information,benefit elections, dependent(s), andbeneficiary(ies) are accurate andApprove your enrollment.To finalize your enrollment, click I Agree.-4-

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 year-round access to a benefitssummary that shows your personal benefitselections. Click Benefit Summary on theHome page to review your current benefits atany time.CHANGE YOUR BENEFITSOnce approved, your benefit elections will remain in effectuntil the end of the plan year, unless you have a qualifyinglife event, such as marriage, divorce or birth of a child.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 stepsoutlined above to complete your changes.**IMPORTANT: You must make changes within 63 daysof the qualifying event and provide requireddocumentation.FIND BENEFIT INFORMATIONCHANGE YOUR BENEFICIARY(IES)View your MUS Choices benefit plan informationBeneficiary changes can be made at any time of the year.at www.choices.mus.edu.1. Click on Change My Benefits2. Select Basic Info and Change of Beneficiary.3. Follow the prompts to complete your change.If you have questions about your enrollment,contact your campus Human Resources/BenefitsOffice directly.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-

Medical Plan Choices (mandatory)Choices gives you the opportunity to choose from three medical plan options. The next two pages will helpexplain the medical plans and the corresponding monthly medical rates for each plan.Medical Plan ChoicesDefinition of TermsAllegiance, Blue Cross Blue Shield, andPacificSource are the medical plan options. Theplans provide the same benefits but havedifferences in provider networks. To see if yourprovider is an In-Network provider, check themedical plan claims administrator’s website.(See back cover for website addresses).In-Network Providers – Providers who havecontracted with the medical plan claim’sadministrators to manage and deliver care atagreed upon prices. Members may self-refer toIn-Network providers and specialists. There is acost savings for services received In-Network.You pay a 25 copayment for Primary CarePhysician (PCP) visits and a 40 copayment forspecialty provider visits to In-Networkproviders (no deductible) and 25% coinsurance(after deductible) for most In-Network hospital/facility services.How The Plan WorksPlan members receive medical services from ahealth care provider. If the provider isIn-Network, the provider will submit a claim forthe member. The medical plan claim’sadministrator processes the claim and sends anExplanation of Benefits (EOB) to the member,showing the member’s payment responsibilities(deductible, copayments, and/or coinsurancecosts) to the provider. The Plan then pays theremaining allowed amount. The provider willnot bill the member the difference between thecharge and the allowed amount.Out-of-Network Providers – You pay 35% of theallowed amount (after a separate deductible) forservices received Out-of-Network.Out-of-Network providers can also balance billyou for any difference between their charge andthe allowed amount.Emergency Services are covered everywhere.However, Out-of-Network providers may balancebill the difference between the allowed amountand the charge.If the provider is Out-of-Network, the membermust verify if the provider will submit the claim orif the member must submit the claim. Themedical plan claim’s administrator processes theclaim and sends an EOB to the member showingthe member’s payment responsibilities (deductible, coinsurance, and any difference between thecharge and the allowed amount (balance billing)).Deductible – The amount you pay each benefityear 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.ImportantOut-of-Pocket Maximum - The maximumamount of money you pay toward the cost ofcovered health care services. Out-of-Pocketexpenses include deductibles, copayments,ancoinsurance.Verify the networkstatus of your providers. Thisis an integral cost savingscomponent of each of your planchoices.-6-

Medical Plan Monthly Rates for FY2020Monthly PremiumsAllegianceBlue Cross Blue ShieldPacificSourceEmployee/Survivor Only 798 748 837Employee & Spouse 1,169 1,075 1,225Employee & Child(ren)/Survivor & Childr(ren 1,045 994 1096Employee & Family 1,415 1,327 1,484The employer contribution for FY2020 is 1,054 per month for eligible active employees(applies to pre-tax benefits only).Medical Plan CostsFY2020Medical 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 year; includesdeductibles, copay and coinsurance)from an Out-of-Network provider have a separate deductible and a 35% coinsurance and a separate Out-of-Pocket* Servicesmaximum. An Out-of-Network provider can balance bill the difference between the allowed amount and the 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 Charges25%35%Ancillary Services25%35%Surgical Services(See Summary Plan Description forsurgeries requiring prior authorization)25%35%25%25%35%35%Hospital Services (Outpatient facility charges)Outpatient ServicesOutpatient Surgi-CenterPhysician/Professional Provider Services (not listed elsewhere)Primary Care Physician (PCP) Office Visit- Includes Naturopathic 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 charge. 40 copay/visitSpecialty Provider Office 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 FacilityCharges 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 ChargesUrgent Care Services 75 copay/visitFacility/Professional Chargesfor room charges only - lab, x-ray& other procedures are subject todeductible/coinsurance25%25%Lab & Diagnostic ChargesReminder: 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 charge and the allowed amount.-9-

Schedule of Medical BenefitsMedical Plan tworkCoinsurance25%35%25% (waived if enrolled inWellBaby Program within firsttrimester)35%Maternity ServicesHospital ChargesPhysician Charges(delivery & inpatient) 25 copay/visit (waived ifenrolled in WellBabyProgram within firsttrimester)Prenatal Office Visits35%Preventive ServicesPreventive screenings/immunizations/flu shots(adult & Well-Child care)Refer to pages 13 & 14 for listing ofPreventive Services covered at 100% of allowedamount and for age recommendations0%Limited to services listed on pg13 & 14. Other preventiveservices subject to deductible andcoinsurance35%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 Services(this is a combined max of 4 visits at 0 copay formental health and chemical dependency services)PsychiatristRehabilitative 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: 30 visits/yr 25 copay/visitOutpatient ServicesReminder:Max: 30 visits/yr(This is a combined max of 30 visitsfor all rehab services)(this is a combined max of 30 visitsfor all rehab services)Note: 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 charge.Deductible applies to all covered services unless otherwise indicated or a copay applies. Out-of-Network providerscan balance bill the difference between their 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(Prior Authorization is recommended)HospiceSkilled Nursing Facility(Prior Authorization is recommended)Miscellaneous Services 40 copay/visitOffice visit only.If no office visit,deductible & coinsurancewaivedAllergy ShotsDurable Medical Equipment,Prosthetic Appliances &Orthotics25%Max: 200 for footorthotics(Prior Authorization is required foramounts greater than 2,500)Reminder:35%35%Max: 200 for footorthoticsDeductible applies to all covered services unless otherwise indicated or a copay applies. Out-of-Network providerscan balance bill the difference between their 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 CounselingObesity Management(Prior Authorization required for surgical treatment)25%Must be enrolled in TakeControl for non-surgicaltreatmentTMJ(Prior Authorization recommended)35%25%Surgicaltreatment only35%25%35%0%0%Organ TransplantsTransplant Services(Prior Authorization required)TravelTravel for patient only- If services are not available in local area(Prior Authorization required)up to 1,500/yr.-up to 5,000/transplantup to 1,500/yr.-up to 5,000/transplantMUS Wellness ProgramPreventive Health ScreeningsHealthy Lifestyle Ed. & Supportsee pg 25WellBabyTake ControlDiabetes, Weight Loss,High Cholesterol, High BloodPressure, Tobacco Usersee pg 26Incentive ProgramReminder:Deductible applies to all covered services unless otherwise indicated or a copay applies. Out-of-Network providerscan balance bill the difference between their charge and the allowed amount.- 12 -

Preventive Services1. What Services are PreventiveAll MUS medical plan options provide preventive care coverage thatcomplies with the federal health care reform law, the PatientProtection and Affordable Care Act (PPACA). Services designatedas preventive care include: Lake McDonald - Glacier Park, Mtperiodic wellness visits,certain designated screenings for symptom free or disease-free individuals, anddesignated routine immunizations.When 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 charge.The PPACA has used specific resources to identify the preventive services that require coverage: U.S.Prev

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