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Open Enrollment for the UUA Health Plan
Open Enrollment for the Unitarian Universalist Association (UUA) Heath Plan for all eligible staff takes place during the month of November. Eligible staff may join the plan effective January 1, even if they have not taken advantage of past enrollment opportunities.
Through December 1, 2015, eligible employees of UUA congregations and UUA-related employers may enroll in the UUA Health Plan and/or make changes to their existing health insurance coverage. For currently participating employees of Subscribing Employers or for Subscribing Individuals, there is nothing to do to continue coverage for 2016. The coverage for current participants will be carried over and billed at the 2016 rates. All Plan Participants are free to change plans (from High Deductible to Standard PPO, or to switch out of the Standard PPO to any of our High deductible plans) by notifying the UUA Health Plan office at healthinsurance [at] uua [dot] org.
Eligibility: For our congregations and related organizations, Open Enrollment is an opportunity for all eligible staff to join the plan effective January 1, 2016, even if they have not taken advantage of past enrollment opportunities. Eligible individuals are employees (those receiving a W2, and not independent contractors) scheduled to work 750 hours or more per year.
Plan Background: The UUA Health Plan is a self-insured ERISA/Church plan, owned and managed by the UUA through the UUA Employee Benefits Trust. We contract with Highmark Blue Cross Blue Shield to provide enrollment and claims services, and access to the extensive network of Blue Cross Blue Shield providers in all fifty states and the District of Columbia.
Summaries of Benefits and Coverage: This is a requirement under the Affordable Care Act, first introduced in 2013. We have created a revised SBC for each of the four PPO plans we offer. The descriptions are designed to help employees understand their plan choices for 2016. Currently, 80% of all subscribers are in the Standard PPO plan. The SBC’s are posted on the UUA Health Plan website, at www.uua.org/healthplan. A paper copy is available to anyone who requests it by emailing healthinsurance [at] uua [dot] org.
New Two-Page Summaries: These are the same summaries found on the UUA website and included in the PPO coverage booklets. They are designed to be a helpful reference whenever a member needs to see their benefits at a glance. Because these two-page summaries are not restricted by the rules governing a Summary of Benefits and Coverage (SBC), they are more readable than the SBCs.
What's New For 2016?
WHAT’S NEW FOR 2016: Changes for 2016 were determined by the Employee Benefits Trust Board of Directors. Nearly all of the changes were made to keep the plans as affordable as possible and to position our plans to minimize the risk of substantial “Cadillac Tax” penalties, still scheduled to take effect in 2018. Benefits in our Medicare Supplement Plan are fixed by law and will not change in 2016.
For 2016, all base rates for our plans will increase 9.4%, the lowest possible increase consistent with maintaining the financial strength of the Plan, and nearly identical to last year’s rate change. Our age-rating structure will add another 1% to 2% for employees currently in the plan, consistent with past years.
There are two important benefit changes to all of our PPO plans.
- The individual and family deductibles and the out-of-pocket maximums are increasing in all of our plans. These changes need to be done periodically to keep pace with medical cost inflation. As you review the 2-page summaries that show the new deductible and out-of-pocket levels, keep in mind that few people will reach the maximums in any one year. For the vast majority of our members, the new benefit levels will have no impact at all.
- Our prescription drug benefits are being revised to reflect the realities in the Rx marketplace. First, specialty drug costs are accelerating at a rate never before seen, and the development pipeline is filled with new drugs that will come online over the next few years. Second, pharmaceutical companies are raising the prices of some generic drugs, often without warning, and frequently by a large multiple. In response, insurance plans, including plans like ours, are changing the structure of the “tiers” of Rx coverage. We are adding three new tiers:
- In the Standard PPO plan, we will have a new tier for “preferred generics”, similar to what you might see with some large retailers, and we are lowering the co-pay for those to zero. Many members will see their monthly costs go down as a result. BCBS Free Generic Drug List (pdf)
- At the same time, we are adding a “non-preferred generics” tier, which will have a $20 co-pay.
- We are adding a “specialty drug” tier, which will have 20% coinsurance, with a per-prescription maximum of $250 for up to a 31-day supply. There will also be small adjustments to the co-pays for brand-name drugs.
For members who are currently using a drug that falls in the new “non-preferred generic” tier or the “specialty” tier, we still have the voluntary option of mail-order, which provides for a 90-day supply for only two co-pay amounts. Members who move to mail-order for the first time will have lower costs in 2016 than they did this year.
In all of our High-Deductible plans, we are adding a new tier for “specialty drugs” which will have the same 20% coinsurance and $250 per-prescription maximum for up to a 31- day supply as the Standard PPO.
The change in Rx tier structure is also an opportunity for members to have a conversation with their doctors about specific drugs; physician offices are well aware of how plans are changing, and they will be able to help members consider alternatives.
WHAT WILL NOT CHANGE IN 2016
- We are not increasing any other co-pays.
- In the Standard PPO, office visits will continue to cost $15 for primary care and $35 for specialists.
- Co-pays remain unchanged at $20 for mental health office visits, with no limit on the number of visits.
- Preventive services continue to be free.
- Women’s Preventive Health Services under the Rx benefit continue to be free.
- We continue to have a highly trained and responsive health plan staff in the Office of Church Staff Finances. Time and again over the course of the year, we hear – from you – that having someone at the UUA to call when there is a problem is perhaps the most valuable service we offer. Your calls are answered by UUA staff, not a distant call center whose employees have no personal connection to the Plan.
UUA HEALTH PLAN: THINKING BEYOND THE NUMBERS
The underlying philosophy of the UUA Health Plan has been consistent from the beginning: offering health insurance to employees is a justice, fairness, and equity issue. We want to emphasize this basic UU value, because we continue to hear from “experts” how an employer’s approach to the ACA and their other health insurance options is strictly a business decision, with a narrow focus on the financial implications. We all know that’s not the whole story – employee benefits are inextricably tied to employees’ sense of wellbeing, to their trust in their employer, and to their understanding of the social justice contract that underlies working within our denomination. In considering alternative plans, there are issues beyond price. Compare expected out-of-pocket expenditures, provider networks, plan comprehensiveness, customer service, and the effect on your individual employees and their families.
THINGS YOU NEED TO DO NOW - Congregations:
- Review all of the plans, from the “Gold” level Standard PPO, to the “Silver” level high-deductible plans that we have offered from Plan inception, to the “Bronze” level high-deductible plan that we first offered in 2014. In conversation with your staff, decide how you want to provide health insurance next year.
- Take a careful look at how you fund health insurance for your staff and how that translates into affordability for your employees. UUA Fair Compensation guidelines continue to recommend that congregations contribute 80% of the cost of individual coverage and 50% of the incremental cost of family coverage. Consider how your congregation will structure contributions and whether it would make sense to base contributions on a “Silver” plan. At the same time, consider what effect that could have on your existing staff and what effect it might have on recruiting future staff.
- If your congregation participates in the UUA Health Plan, review your personnel files, and make sure you have a record of a health plan election or rejection for every eligible employee (everyone projected to work at least 750 hours.)
- Tell your employees to carefully review the 2016 UUA Health Plans, and decide whether to keep their current plan, change plans, or enroll for the first time. If they think that their family income may qualify them for a subsidized plan through the Affordable Care Act (either state-sponsored or the Federal Exchange on www.healthcare.gov), they should follow-up on the Exchange website.
THINGS YOU NEED TO DO NOW - Employees
- Review all of the plans, from the “Gold” level Standard PPO, to the “Silver” level high-deductible plans that we have offered from Plan inception, to the “Bronze” level high-deductible plan that we first offered in 2014.
- Remember that you also have the option to add dependents who were not previously covered.
- If you decide to change plans, notify www.healthinsurance [at] uua [dot] org (healthinsurance [at] uua [dot] org) by December 1. To enroll for the first time, use the online application below:
- Enrollment Application
- Dependent Enrollment Application
- Rate Calculator