University of CaliforniaPostdoctoral

ScholarBenefits Plan

Agenda Open Enrollment

Postdoc Titles and Title Codes

Review of Benefits & Plan Design Changes

Review of the Open Enrollment Process

Postdoctoral Scholars (PDS) Contributions for the HMO and PPO Medical Plans Effective 1-1-2013

Q & A

Introduction The Postdoctoral Scholar Benefits Plan

(PSBP)

The University of California has partnered with Garnett-Powers & Associates to administer the PSBP on a system wide basis.

As of January 1, 2005 the system wide University of California Postdoctoral Scholar Benefits Plan was made available to Postdoctoral Scholars (PDS) at UC.

The PSBP is a comprehensive package of benefits designed to closely match the benefits offered to the UC Faculty and Staff .

What is Open Enrollment? Open Enrollment is the period of time the University sets up

each year to allow eligible postdocs to choose from the plans available to them.

What changes can be made during Open Enrollment?

Change from the medical HMO to the PPO plan or vice versa.

Change from the dental HMO to the POS plan or vice versa. Add eligible family members. Enroll in or terminate coverage for the medical, dental

and/or vision plans.

Postdoc Title Codes

Title Code 3252 - Postdocs paid through the UC payroll system have been appointed in the title “Postdoctoral Scholar-Employee”.

Title Code 3253 - Postdocs paid a stipend have been appointed in the title “Postdoctoral Scholar-Fellow”.

Title Code 3254 - Postdocs paid directly from an extramural agency have been appointed in the title “Postdoctoral Scholar-Paid Direct”.

Note: The title of a Postdoctoral Scholar appointment is determined by the requirements of the funding agencies.

Benefits Offered Through PSBP Medical Insurance – Health Net HMO and PPO Dental Insurance – Health Net HMO and Principal

POS Vision Insurance – Health Net/EyeMed PPO Life and AD&D Insurance – Standard Insurance Short Term Disability Insurance – Standard

Insurance Voluntary Long Term Disability Insurance –

Standard Insurance SelectPlus/Sittercity

Plan Design Changes and Updates If a plan was in place on March 23, 2010 and the plan does not make any major

changes at their annual renewal then the plan is considered “grandfathered”.  The PSBP medical plans are grandfathered plans. This means that many of the provisions of the new healthcare law, do not apply to grandfathered plans, including the access to most birth control items at no cost to the covered individual.

All birth control prescriptions will still be covered the same as they are currently with the exception of implantable contraceptive devices. (For example, an IUD) on the HMO plan.

The dental HMO plan has lowered the cost of crowns. The dental PPO plan has now changed to a Point-of-Service (POS) plan. The percentage contribution amount required by a postdoc to pay for the HMO

medical plan remained the same for plan year 2013. The amount required for a postdoc to pay for the medical contribution for the

PPO plan was lowered for plan year 2013. Effective April 1, 2013, the PSBP will terminate the last day of the month that a

postdoc was active.

MEDICAL

INSURANCE

What is an HMO Plan? Under the HMO model, the member chooses a Primary Care Physician (PCP)

contracted with the HMO plan at the time of enrollment (provider directory links are available on the GPA website). A PCP will automatically be assigned to you at the time of your enrollment. You can choose a PCP for each family member by calling the insurance company to request a PCP change. Your PCP becomes your healthcare “gatekeeper”.

If the member is in need of treatment from a Specialist or is in need of an In-Patient or Out-Patient procedure, he/she must obtain a referral from their PCP prior to any type of consultation or treatment (except in the case of an emergency). If the referral is not obtained, no benefits will be paid.

There is no Out-of-Network benefit (except in the case of an emergency).

HMO premiums as well as the out of pocket expenses (i.e. deductible, co-payments, etc.) tend to be lower than their PPO counterpart due to the contractual element of “capitation”.*

* Capitation: The PCP is compensated by the HMO plan in the form of a monthly capitation fee for each member that signs up with him/her at the time of enrollment. The PCP has agreed to provide all primary care, as well as the cost for most Labs & X-rays for that capitated fee.

What is a PPO Plan? When covered under a PPO plan, the member will not be assigned to a

Primary Care Physician (PCP) at the time of enrollment.

The PPO plan offers more flexibility than the HMO plan. As a result, the out-of-pocket costs tend to be higher.

There is an In-Network and Out-of-Network component.

The In-Network benefits (deductible, coinsurance, etc.) will be greater than the Out-of-Network benefits.

At the time of service, the member has the ability to seek care from a Specialist, without having to obtain a referral from a PCP.

The contractual agreement between the PPO Plan and the Provider is on a “discounted fee for service” basis. This means that the provider who participates in the network has agreed to provide their service on an agreed upon discounted fee. The Provider who is not in the network will not agree to that discounted fee and will typically charge a “Reasonable and Customary” fee. There is no “capitation” in a PPO contract.

PSBP Medical HMO Plan  Health Net of California

Medical Benefits Health Net HMOPostdoctoral Scholar Pays

Physician Office Visit: $10 CopayHospitalization:

Inpatient No ChargeOutpatient No ChargePregnancy No Charge

Prescription Drugs:Generic $10 CopayBrand Name $20 CopayNon-Formulary $35 Copay

Emergency Room Visits: $35 Copay (waived if admitted)Health Evaluation: $10 CopayMental Health :

Inpatient No ChargeOutpatient $10 Copay

Annual Maximum Out of Pocket:Individual $1,500Family $4,500

Annual Deductible:Individual NoneFamily None

Lifetime Maximum: Unlimited

PSBP Medical PPO Plan Health Net of California   Medical Benefits Health Net PPO (In-Network) Health Net PPO (Out of Network)*

Postdoctoral Scholar Pays Postdoctoral Scholar Pays Physician Office Visit: $20 Copay 40%Hospitalization: Inpatient $250 Copay then 20% $250 Copay then 40% Outpatient $0 Copay 40% Pregnancy $250 Copay then 20% $250 Copay then 40%Prescription Drugs: Generic $10 Copay 50% + $10 Copay Brand Name $25 Copay 50% + $25 Copay Non-Formulary $35 Copay 50% + $35 CopayEmergency Room Visits: 20% 40%Routine Physical Exam: $20 Copay 40%Mental Health (Severe): Inpatient $250 Copay then 20% $250 Copay then 40% Outpatient $0 Copay 40%Annual Maximum Out of Pocket: $1,500 Individual $1,500 Individual(Does not include deductible) $4,500 Family $4,500 FamilyAnnual Deductible: Individual None $200 Family None $600Lifetime Maximum: Unlimited

*Out of Network reimbursement based on limited fee schedule.

Wellness Programs

The following benefits are included in your Health Net Medical plan:

Health Net offers Text4Baby, a free service that provides free text messages up to 3 times a week with information to assist you through your pregnancy and your baby’s first year. In order to register, text BABY to 511411.

If you are pregnant, or thinking of starting a family, the Decision Power Healthy Baby Take 5 Maternity Program offered through Health Net provides you valuable information to assist you in having a healthy pregnancy and delivering a healthy baby. Many subjects are covered through a series of videos, offering information on exercise, nutrition, weight management, breastfeeding and other important aspects of pregnancy.

Wellness Programs, cont.

Decision Power is a program through Health Net that offers a variety of methods to track possible health risks and identify potential problems. The goal of this program is to assist through online coaching with a guide to pregnancy, tobacco use, weight management, nutrition and stress reduction.

If you wish to make the healthy decision to quit smoking, Smoking Cessation offers a plan to help you kick the habit with the assistance of either online or telephone support.

Lose Weight is another health-wise program offered through Decision Power that keeps you motivated to lose weight, offers healthy eating choices and counseling from a health coach.

To access detailed information about these valuable programs, go to www.garnett-powers.com/postdoc/wellness .

DENTAL

INSURANCE

PSBP Dental DHMO Plan Health Net of California

Dental Benefits Health Net DHMOPostdoctoral Scholar Pays

Deductible: NoneDiagnostic and Preventative Care:Routine Oral Exams No chargeRoutine Teeth Cleanings No chargeRoutine X-Rays No charge Basic Procedures:Fillings Varies up to $80 copayOral Surgery Varies up to $130 copay Endodontics Varies up to $150 copay Periodontics Varies up to $300 copay Major Procedures: Crowns Varies up to $200 copay  Orthodontics:Comprehensive Treatment- Child $1,950 copay plus start-up fees and retentionComprehensive Treatment- Adult $2,250 copay plus start-up fees and retention Annual Maximum: Unlimited

What is a POS Plan? When covered under a Point-of-Service (POS) plan, the member will not be assigned

to a Primary Care Dentist at the time of enrollment.

The POS plan offers more flexibility than the HMO plan. As a result, the out-of-pocket costs tend to be higher.

There are two In-Network options. An Exclusive Provider Organization (EPO) and a Preferred Provider Organization (PPO). There is also an Out-of-Network option. The In-Network benefits (deductible, coinsurance, etc.) will be greater than the Out-of-Network benefits.

The contractual agreement between the POS Plan and the Provider is on a “discounted fee for service” basis. This means that the provider who participates in the network has agreed to provide their service on an agreed upon discounted fee. The Provider who is not in the network sets their own fees and these fees are often higher than what is considered “Reasonable and Customary” fees.

The EPO discounts up to 50% and the PPO discounts up to 30% for procedures performed by participating providers, greatly reducing your out-of-pocket costs. The calendar year maximums are combined for the EPO and PPO at $1,700.00 per person. The calendar year maximum for out-of-network is $1,500.00 per person.

PSBP Dental POS Plan Principal Financial Group Principal EPO/PPO (In-Network) Principal PPO (Out-of-Network)

Postdoctoral Scholar Pays Postdoctoral Scholar PaysCalendar Year Deductible: None $50 per person, waived for

Diagnostic and Preventative CareDiagnostic and Preventative Care:Routine Exams No charge No Charge, except for the amount of Routine Teeth Cleanings No charge the dentist’s fee that exceeds Routine X-Rays No charge Principal’s scheduled allowance

Basic Procedures: Fillings 10% 20% of the scheduled allowance,Endodontics 10% after the deductible is met, plus Non-Surgical Periodontics 10% the amount of the dentist’s fee that Simple Oral Surgery 10% exceeds Principal’s scheduled

allowanceMajor Procedures: Crowns 50% 50% of the scheduled allowance,Bridgework 50% after the deductible is met, plus the Dentures 50% amount of the dentist’s fee that Complex Oral Surgery 50% exceeds Principal’s scheduled

allowanceOrthodontia (Adult and Child):$1,000 Lifetime Maximum 50% 50% of the scheduled allowance,

after the deductible is met, plus the amount of the dentist’s fee that exceeds Principal’s scheduled allowance

 

VISION

INSURANCE

PSBP Vision PPO PlanEyeMed through Health Net of California

Vision Benefits Health Net PPO (In-Network) Health Net PPO (Out of Network) Postdoctoral Scholar Pays Postdoctoral Scholar Allowance

 Exam with Dilation (if necessary): $0 Copay Up to $40

Standard Plastic Lenses:Single Vision $10 Copay Up to $40Bifocal $10 Copay Up to $60Trifocal $10 Copay Up to $80Lenticular $10 Copay Up to $80

Frames: $0 Copay, $120 retail allowance Up to $45for any frame, plus 20% offbalance over allowance

Lens Options:UV Coating $15 N/ATint (solid and gradient) $15 N/AStandard Scratch Resistant $15 N/AStandard Progressive $45 N/A

Conventional Contact Lenses: $105 allowance toward contacts, Up to $105plus 15% discount off balance over allowance

Frequency:Examination Once Every 12 MonthsLenses or Contact Lenses Once Every 12 MonthsFrame Once Every 24 Months

LIFE AND AD&DINSURANCE

PSBP Life Insurance and Accidental Death & Dismemberment Plan

The Standard Insurance Company

The plan pays $50,000 in the event of a death.

The plan pays an additional $50,000 in the event of an Accidental Death.

AD&D Seat Belt Benefit – Up to $10,000 is payable for death as a result of a car accident while wearing a seat belt.

Accelerated Benefit Provision – Allows eligible members who are terminally ill to receive an early allocation of up to 75% of their group life insurance benefit.

All Postdoctoral Scholars (Title Code 3252, 3253 and 3254) are automatically enrolled in the Life and AD&D insurance.

SHORT -TERM

DISABILITY INSURANCE

PSBPShort-Term Disability Plan

The Standard Insurance Company

The plan will pay 70% of the first $1,429 weekly pre-disability earnings.

The maximum weekly benefit is $1,000 per week.

The minimum benefit is $25.00.

The benefit waiting period is 0 days for disability caused by an accidental injury and 7 days for disability caused by sickness or pregnancy.

The maximum benefit period is 180 days.

The plan covers non-occupational disability only.

All Postdoctoral Scholars (Title Code 3252, 3253 and 3254) are automatically enrolled in the STD plan. 

 

Repatriation & Medical Evacuation Coverage

International Postdocs and their dependents are not required to purchase supplemental coverage for their J1 and J2 Visa requirements. The PSBP Short-Term Disability plan satisfies these requirements even if the Postdoc waives the medical, dental, or vision coverage.

Voluntary LONG -TERM

DISABILITY INSURANCE

PSBP Voluntary Long-Term Disability PlanThe Standard Insurance Company

This benefit is voluntary and is paid 100% by the Postdoctoral Scholar. This benefit is not an open enrollment choice and is only available during your period of initial eligibility. If you decide to enroll at a later date, you will have to complete a medical questionnaire and you may be declined or approved. This process may take as long as fifteen weeks.

The Benefit Waiting Period is 180 days of disability. This program starts when the Short Term Disability ends.

The plan will pay 60% of the first $7,500 of your monthly pre-disability earnings.

The maximum monthly benefit is $4,500. This benefit is reduced by deductible income such as workers’ compensation.

Once approved, benefits are payable each month while you are disabled up to age 65. The benefit maximum is graded according to the Age Discrimination Employment Act, if you are disabled after age 62.

The Long Term Disability Insurance Monthly Premium is $7.95.

SelectPlus/Sittercity

Search for caregivers using a direct search based on criteria important to you, or post a job and have candidates apply to you

Read profiles and reviews of caregivers Check caregivers’ references View background checks for the candidates you

prefer

The Open Enrollment Process

The Open Enrollment Process The PDS should go to the Garnett-Powers & Associates website at

www.garnett-powers.com/postdoc/ and click on the “Enrollment” link and then the sub link “Open Enrollment”.

You may qualify to make open enrollment changes through At Your Service Online (the university’s online enrollment system) even if you did not enroll through AYSO initially.

The PDS should then click on the “Open Enrollment Instructions” link and print them out for assistance with completing the enrollment form properly. The instructions will guide you through the appropriate parts of the form that need to be completed to reflect your changes for 01/01/13.

Once the instructions are in hand, click on “Open Enrollment Form”. The enrollment form must be completed online.

When the enrollment form is complete, the PDS must confirm that s/he has read and understands the “COBRA Initial Notification” as required by federal regulations.

The Open Enrollment Process, cont.

Please submit your completed enrollment form with your open enrollment changes to your appropriate campus contact no later than 5:00pm November 20, 2012.

If changes are made at open enrollment, ID cards will be mailed to the Postdoctoral Scholar’s home address.

If you are not making any changes, you do not need to take any action. Your current enrollment will remain the same.

If the PDS (Title Code 3252, 3253 and 3254) chooses not to participate in the PSBP, s/he must complete the waiver portion of the enrollment form and turn it into the Departmental Postdoc Administrator.

All PDS (Title Code 3252, 3253 and 3254) will be enrolled for the Short Term Disability and Life Insurance plans.

Postdoc Contributions

PDS Monthly Contributions For The HMO Medical Plan

Effective 1-1-2013 the PDS will make the following monthly contribution if enrolled in the Medical HMO Plan:

Coverage Type Monthly Contribution Postdoc Only $8.50 Postdoc + Spouse or Domestic Partner $30.59 Postdoc + Child(ren) $14.87 Postdoc + Spouse + Child(ren) $38.87

PDS Monthly Contributions For The PPO Medical Plan

Effective 1-1-2013 the PDS will make the following monthly contribution if enrolled in the Medical PPO Plan:

Coverage Type Monthly Contribution Postdoc Only $20.00 Postdoc + Spouse or Domestic Partner $40.00 Postdoc + Child(ren) $40.00 Postdoc + Spouse + Child(ren) $60.00

The Collection Process

Postdoctoral Scholars with sufficient funds, will have their contributions deducted from their checks via the payroll system.

Postdoctoral Scholars with insufficient funds, will have their contributions collected via invoice through GPA.

GPA will collect contributions for the HMO and PPO Medical plans and the Voluntary Long Term Disability plan.

Family Member Eligibility

Family member eligibility requirements are the same as the family member eligibility requirements for the UC Faculty and Staff plans. The major family member categories are the following:

Spouse

Natural or adopted child or children to age 26 for medical plans (unless eligible to continue coverage because of disability). Adult age children are not eligible to enroll if they are eligible for their own employer-sponsored plan.

Same-sex domestic partner

Opposite-sex domestic partner (per AB205)

Note: When two family members are employed through the UC, duplicate coverage is not allowed.

Enrollment, Change, Cancellation or Waiver Forms for Postdocs:

Please send to:

Nelson Hall nhall@berkeley.edu 643-7546

Garnett-Powers & Associates (PSBP) Forms Processing

UCB Information Sources

UCB Postdoctoral Benefits Coordinator:

Nelson Hall2199 Addison St., Room 192, Berkeley, CA 94720-3540510-643-7546nhall@berkeley.edu

Information Sources

Website: Garnett-Powers’ PSBP website

www.garnett-powers.com/postdoc

Toll Free Phone: Garnett-Powers’ PSBP customer service

800-254-1758

Email Address: Garnett-Powers’ email address

PSBP@garnett-powers.com