Human Resources - Benefits
The following is a summary of benefits for employees that occupy the University Assistant job category. For more details please contact Maureen Jeans in the Human Resources Department at 203-837-8631.
Table of Contents
I. Health Benefits
II. Dental Benefits
III. Direct Deposit
I. Health Benefits
- Enrollment & Dependent Information
- Making Changes to Insurance
- Medical Insurance Benefits
- Health Insurance Summaries
- Telephone numbers and Websites of Health Insurance Carriers
- Claim Forms for Anthem Preferred or BlueCare Plans
- Monthly Insurance Rates
- Prescription Drug Benefits
Enrollment & Dependent Information
University Assistant employees have thirty (30) days from their employment date to enroll themselves and their eligible dependents onto the health and/or dental insurance coverage. The insurance coverage will be effective the 1st of the month, following one full month of employment. An enrollment application may be obtained from the Human Resources Department. University Assistant employees enrolling onto the insurance plans will be required to submit their first payment at the time they complete the enrollment application. Payments should be made to the State of Connecticut. Thereafter, adjunct employees will receive a monthly bill from the WCSU Payroll Department. Failure to make a scheduled monthly payment for two months will result in the insurance coverage being terminated for non-payment. Termination of coverage for non-payment voids the employee’s right to COBRA insurance.
Dependent children are allowed on the medical and dental insurance through the age of 19. (An allowance may be made for disabled dependents to remain on the medical and dental insurance beyond the age of 19. This allowance must be coordinated between the employee, the insurance company and the Human Resources Department.)
A dependent child’s medical coverage may continue between the ages of 19 – 23 if the child is attending an accredited college full-time and submits the proper documentation to the Human Resources Department. At the age of 23, dependent childrens’ medical coverage will terminate and the child will be offered the option of purchasing medical coverage through COBRA regulations.
Dependent childrens’ dental coverage must terminate at the age of 19. At the age of 19, dependent childrens’ dental coverage will terminate and the child will be offered the option of purchasing dental coverage through COBRA regulations.
Making Changes to Insurance
Changes to insurance such as adding dependents, changing insurance company or changing plan level may only be made during the Open Enrollment period or through a Qualifying Event, according to the Office of State Comptroller’s rules.
· Open Enrollment: The Office of State Comptroller annually conducts an Insurance Open Enrollment period, which allows employees to make changes to their insurance plans. This is a time for employees to make changes such as; changing insurance company, plan level or adding dependents. Open Enrollment normally takes place during the month of May, with an effective date of change on July 1st.
· Qualifying Event: During the year an employee may experience a Qualifying Event, which allows them a thirty (30) day open window to enroll a dependent and/or spouse onto their health and/or dental insurance. Employees must complete the required paperwork within thirty (30) days from the date of the event. Failure to do so will result in having to wait until an annual Open Enrollment period to make a change.
Qualifying Events & Required Paperwork
Marriage: Copy of marriage certificate required.
Birth/Adoption of Child: Copy of adoption papers required.
Loss of Coverage: Documentation required stating employment termination date and insurance end date.)
Other: Court Orders: Documentation required.
An employee, who has an enrolled dependent on the state-sponsored insurance plan, has the responsibility to inform the State of Connecticut of a change in the dependents status such as divorce, legal separation, or a child losing dependent status under the state sponsored group health plan.
Employees may cancel insurance coverage anytime during the year. Employees must contact the Human Resources Department to cancel their coverage.
Medical Insurance Benefits
Currently the State of Connecticut has three (3) medical insurance companies offering coverage to state employees; Anthem Insurance, Health Net Insurance, and Oxford Insurance. Employees select a company to provide benefits, and also select a Plan Level of care. The different Plan Levels are noted below, and refer to requirements such as in-network benefits only, out-of network services, or requirements such as gatekeeper coordination.
For employees who reside outside of Connecticut the State of Connecticut offers two (2) out-of-area plans. Employees may choose from Anthem Insurance or Oxford USA.
Health Insurance
Summaries
Point of Service: Under the Point of Service (POS) option, health care services are available both within and outside a defined network of physicians and other health care providers. POS members who obtain health care services from network providers pay a small co-payment, and are eligible for all benefits provided by the plan according to the schedule of benefits. Services may be obtained from participating providers without a referral. Covered services obtained from non-participating providers are reimbursed at the rate of 80% of the plan allowance for in-network services, after the annual deductible has been met. Pre-authorizations may be required for non-network services, unless the care is necessitated by a bona fide emergency. Four POS options are offered.
Point of Enrollment (No Gatekeeper): Under the Point of Enrollment (POE) option, health care services are available only from a defined network of physicians and other health care providers. Each covered member must choose a Primary Care Physician (PCP); however, no referral from the PCP is necessary to receive care from participating providers. POE members who obtain health care services from providers outside the network must pay the full cost of these services, unless the care is necessitated by a bona fide emergency. Three POE options are offered.
Point of Enrollment (Gatekeeper): Under the Point of Enrollment with Gatekeeper (POE-G) option, health care services are available only from a defined network of physicians and other health care providers. Each covered member must choose a Primary Care Physician (PCP) who coordinates all care. A referral from the PCP is required for all specialist services. POE members who obtain health care services from providers outside the network, or without a referral from their PCP, must pay the full cost of these services, unless the care is necessitated by a bona fide emergency. Three POE-G options are offered.
Out of State Residents: State employees who reside outside of Connecticut have the option of enrolling in the State Preferred Point of Service plan. Under the State Preferred plan, if you use a health care provider who is a member of the Blue Cross Participating Provider Organization, all service are considered in-network. If you use a provider who is not in this network in your area, you will be required to pay a deductible and co-payment for services. The employee cost is the same as the State Blue Care Point of Service plan. Employees also have the option of selecting Oxford USA.
Telephone Numbers and Websites of Health Insurance Carriers and Prescription Drug Carrier
|
Anthem Blue Cross Oxford Medical Health Net Pharmacare |
800-922-2232 800-385-9055 800-255-5019 800-318-2572 |
Claim Forms for Anthem Preferred or BlueCare POS Plan
For Out-of-Network Claim Forms for Anthem Preferred or BlueCare POS Plans only: To secure an online claim form go to www.anthem.com/statect select FAQ, then select Claims, then select How do I file a claim?, then select Secure Online Form. Employees will be instructed to provide information so a claim form can be mailed to them.
Monthly Insurance Rates - Effective July 1, 2007 through June 30, 2008
*New rates apply annually on July 1st
Adjunct faculty are required to send their insurance payment(s) monthly
into the Payroll Department at Western Connecticut State University.
Payment(s) must reach the Payroll Department by the 10th of each month
for coverage the following month. Failure to have your check received
by the 10th of each month could possibly result in removal from the insurance
plan. Checks should be made out to the insurance carrier chosen and are
to be mailed into Western Connecticut State University, 181 White Street,
Danbury, CT 06810, Attention: Payroll Department, University Hall.
Initial Enrollment into an insurance plan must be done by coming into the
Human Resource Department. The first payment is due at initial enrollment.
Types of Plans |
Subscriber |
Subscriber Plus One |
Family |
Family Less Employed Spouse * |
| Point of Service Plans (POS) $15.00 office visit co-pay. In-network & out-of-network benefits | ||||
| Anthem State Preferred POS | $662.79 | $1458.14 | $1789.53 | $1126.74 |
| Anthem State BlueCare POS | $507.14 | $1115.71 | $1369.28 | $862.14 |
| Health Net Charter POS | $497.19 | $1093.82 | $1342.41 | $845.22 |
| Oxford Freedom Select POS | $449.56 | $989.03 | $1213.81 | $764.25 |
| Point of Enrollment Plans (POE) $10.00 office visit co-pay. In-network benefits only | ||||
| Anthem State BlueCare POE | $487.44 | $1072.37 | $1316.09 | $828.65 |
| Health Net Charter POE | $469.42 | $1032.72 | $1267.43 | $798.01 |
| Oxford HMO Select POE | $428.78 | $943.32 | $1157.71 | $728.93 |
| Point of Enrollment - Gatekeeper Plans (POE-G) $10.00 office visit co-pay. In-network benefits only. Referrals required. | ||||
| Anthem State BlueCare POE Plus | $480.05 | $1056.11 | $1296.14 | $816.09 |
| Health Net Passport HMO | $474.66 | $1044.25 | $1281.58 | $806.92 |
| Oxford HMO | $396.13 | $871.49 | $1069.55 | $673.42 |
| Out of State - Out of Area Plans (OOA) $15.00 office visit co-pay. | ||||
| Anthem State Preferred | $611.66 | $1345.65 | $1651.48 | $1039.82 |
| Oxford USA | $475.50 | $1046.10 | $1283.85 | $808.35 |
* The Family Less Employed Spouse rate is available only when both spouse are employed by the State of Connecticut, eligible for health insurance, and enrolled in the same plan, along with at least one child.
Prescription Drug Benefits
The prescription benefits are included as part of the medical benefits.
PharmaCare is the State of Connecticut pharmacy benefits provider for all covered employees, retirees, and their eligible dependents.
Co-pays: $3.00 generic/$6.00 brand name prescription: up to 34 day supply.
*If you request a brand-name drug substitute, you pay the $6.00 co-pay plus the difference between the cost of the generic and the brand name. If your physician feels that the brand-name drug is necessary and writes "dispense-as-written" of "no substitutes" on the prescription, you only pay the $6.00 co-pay.
PharmaCare's prescription drug plan will enable you to:
- Obtain prescriptions through PharmaCare's network of over 52,000 chain and independent retail pharmacies.
- Obtain maintenance prescriptions through PharmaCare's mail service pharmacy - PharmaCare Direct. Your medications will be delivered directly to your home within seven to ten days. Co-pays will apply.
- PharmaCare's HealthLine, a telephone information and education center you can call for answers to common health and medication related questions.
- Utilize www.pharmacare.com to easily view your plan design and co-pay information, search for details on prescription medications, locate a pharmacy near you, review your claim history, and order your refills through PharmaCare Direct.
- Employees are only allowed to use an Out-of-Network pharmacy in an emergency situation or when overseas. Contact PharmaCare for further details.
Telephone Number and Website
Pharmacare: 800-318-2572 www.pharmacare.com
Claim Form: In the event a prescription is filled at a non-participating pharmacy (emergency situations or overseas travel only) employees will need to submit a claim form to request reimbursement.
Claim forms are available on-line at www.pharmacare.com. Select Members, select Services, under My Benefits select Forms, select Direct Membership Reimbursement. To submit a claim follow the instructions on the claim form. Reimbursement will take approximately 6 to 8 weeks to process.
II. Dental Benefits
- Dental Benefits Description
- Dental Plan Comparison
- Telephone Numbers and Websites of Dental Carriers
- Monthly Rates
- Claim Forms for United Healthcare Basic & Enhanced PPO Plans
Dental Insurance Benefits Summaries
Currently the State of Connecticut offers three (3) different dental plans to provide dental benefits to employees.
United HealthCare Basic Dental Plan: A plan which has no defined network and allows employees the freedom to select a dentist of their choice. Because there is no defined network, the percentage of benefits covered is based on usual and customary rates prevailing in the geographic area in which the expenses are incurred.
United HealthCare Enhanced PPO: This is an expanded dental plan that covers a broader array of procedures, from either a defined network or out of network dentists. If services are provided from an out of network dentist the benefit percentage applies to the schedule of maximum allowable charges. Maximum allowable charges are limitations on billed charges in the geographic area in which the expenses are incurred. Some orthodontia coverage is available with this plan.
Aetna DMO: Aetna Dental Maintenance Organization covers employees for some procedures at one hundred percent (100%). Employees must remain in-network at all times. No out of network benefits are allowed. Upon hire, employees will be required to select a dental office from the network, and will be required to receive treatment from their dentist location selected. Employees wishing to change dental locations must call Aetna first to register with another dental office. Employees using another dental location without contacting Aetna will result in no benefit coverage. Some orthodontia coverage is available with this plan.
Dental Plan Comparison
| UHC Basic | UNC Enhanced PPO | Aetna | |
| Service Areas | Any Licensed Dentist |
Check with United HealthCare for participating PPO dentists in your area | Check with Aetna for Aetna DMO® network dentists in your area. |
| Annual Deductible | None |
$25 individual/$75 family | None |
| Annual Maximum | None |
$3,000 per individual (not including Ortho) |
None |
| Diagnostic & Preventive Care | |||
| Exam | Covered at 80% | Covered at 100% | Covered at 100% |
| X-Rays | Covered at 80% | Covered at 100% | Covered at 100% |
| Simple Restoration | |||
| Fillings | Covered at 80%1 | Covered at 80%1 | Covered at 100%2 |
| Oral Surgery | Covered at 67% | Covered at 67% | Covered at 100%2 |
| Orthodontia | |||
| Children (under 19) | Not Covered | Plan pays $1,500 per individual per lifetime | Patient pays $1,500 fixed co-pay |
| Adults 19 and older | Not Covered | Plan pays $1,500 per individual per lifetime | Patient pays $1,500 fixed co-pay |
1 For fillings and crowns on molars, the least expensive equally effective procedure will be reimbursed.
2 Additional charges may apply for other than simple restoration.
Telephone Numbers and Websites of Dental Carriers
| UnitedHealthCare Dental | 800-896-4834 | www.myuhcdental.com/statect |
| Aetna Dental DMO | 877-238-6200 | www.Aetna.com |
Dental Monthly Rates - Effective July 1, 2007 through June 30, 2008
Subscriber only |
Subscriber Plus One |
Family |
Family Less Employed Spouse* |
|
| United HealthCare Indemnity | $32.15 | $98.05 | $98.05 | $65.90 |
| United HealthCare PPO Plan | $29.57 | $90.19 | $90.19 | $60.62 |
| Aetna DMO Dental | $22.16 | $48.75 | $59.83 | $37.67 |
* The Family Less Employed Spouse rate is available only when both spouse are employed by the State of Connecticut, eligible for health insurance, and enrolled in the same plan, along with at least one child.
Claim Forms for United Healthcare Basic & Enhanced PPO Plans only
To secure an online claim form go to www.myuhcdental.com/statect, select Claims Information, then select Claim Form, then select Claim Form again. At this point you may print the online claim form. Claim forms should be mailed to the address on the back of the employees United Healthcare identification card.
III. Direct Deposit
Employees of Western Connecticut State University may elect to have their paychecks automatically deposited into a personal checking or statement savings account.
Employees may choose any bank or credit union for Direct Deposit. Some banks offer free checking to depositors who enroll in Direct Deposit; you should check with your bank for details.
Funds from checks directly deposited will be available at 9:00 a.m. on the Thursday preceding the check dates.
Direct Deposit is not available to student workers.
For more information, please access our Direct Deposit link: ../procedures/direct_deposit.asp
WCSU is an AA/EEO Educator/Employer.
