Wright State University Health Care Enrollment

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Wright State UniversityHealth Care Enrollment

• For the Period
• July 1, 2005 to December 31, 2005

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Why Are We Here?

• Anthem Blue Cross and Blue Shield and Premier
  Health Partners failed to reach an ongoing
  agreement for Premier Health Partners providers
  to remain Anthem network providers.
• This caused difficulties for many WSU employees
  and their family members.
• Employees told university leadership of their
  desire to receive network benefits for care from
  as many preferred hospitals and physicians as
  possible at a cost we all could afford.

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Options Considered

• University staff and consultants considered a
  variety of options
• Remaining with Anthem as a sole carrier
• Replacing Anthem with another carrier
• Seeking two or more carriers for coverage
• It was determined that the best option for all
  employees, and the university, was to offer plans
  from more than one medical plan carrier.

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Two Medical Carriers as of July 1, 2005

• This is the first time that WSU has offered
  medical plans from multiple carriers.
• Using two carriers enables employees to choose a
  medical plan based not only on benefit levels and
  employee contributions, but also on the
  employees preferred physicians and hospitals.

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Two Medical Plan Carriers

• Anthem Blue Cross and Blue Shield
• our medical carrier since July 1, 2002
• UnitedHealthcare
• our medical carrier for the 10 years before July
  1, 2002
• These have been the two dominant players in the
  Dayton area health care market for a number of
  years.

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Medical Plans Available to You

• Anthem Blue Preferred Primary HMO
• Anthem Blue Access PPO
• UnitedHealthcare Choice Plus PPO
• Anthem Blue Traditional - (for those employees at
  the WSU Lake Campus and those living outside the
  state of Ohio)

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Anthem Blue Preferred Primary HMO

• Provides benefits for care only from Anthem
  network providers (except in the case of an
  emergency, when care by any provider is covered
  care)
• Provides the highest benefit levels with the
  lowest out-of-pocket costs of any of the medical
  plans being offered

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Anthem Blue Preferred Primary HMO
BenefitsEmployees Share of Covered Costs

• Network Benefits
• Hospitalization - 250
• Office Visit - 15
• Surgery/Maternity - 0
• Emergency Care - 75
• Urgent Care - 35
• No Deductible
• Out-of-pocket Maximum -
• 500/1,000 Per Year
• Lifetime Maximum Benefit -Unlimited

• Non-Network Benefits
• Hospitalization - no benefit
• Office visit - no benefit
• Surgery/Maternity - no benefit
• Emergency Care - 75
• Urgent Care - no benefit
• No Deductible
• No Out-of-pocket Maximum Per Year

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Anthem Blue Access PPO Plan andUnitedHealthcare
Choice Plus PPO Plan

• Both Preferred Provider Organization (PPO) plans
  provide benefits for care from any licensed
  physician or hospital.
• Both provide a higher benefit and lower out-
  of-pocket cost for care from a network provider
  than for care from a non-network provider.

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Anthem Blue Access PPO BenefitsEmployees Share
of Covered Costs

• Network Benefits
• Hospitalization - 10
• Office Visit - 20
• Surgery/Maternity - 10
• Emergency Care - 75
• Urgent Care - 35
• No Deductible
• Out-of-pocket Maximum - 1,250/2,500 Per Year
• Lifetime Maximum Benefit 5 million
  including Non-Network

• Non-Network Benefits
• Hospitalization - 30
• Office visit - 30
• Surgery/Maternity - 30
• Emergency Care - 75
• Urgent Care - 35
• After 250/500 Deductible
• The benefit is a percentage of the Covered Cost
  which may be much less than the billed charge.
• Out-of-pocket Maximum for covered expenses -
  2,250/4,500 (including Deductible) Per Year
• Lifetime Maximum Benefit - 5 million including
  Network

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UnitedHealthcare Choice Plus PPO
BenefitsEmployees Share of Covered Costs

• Network Benefits
• Hospitalization - 10
• Office Visit - 20
• Surgery/Maternity - 10
• Emergency Care - 75
• Urgent Care - 35
• No Deductible
• Out-of-pocket Maximum - 1,250/2,500 Per Year
• Lifetime Maximum Benefit - Unlimited for Network
  Benefits

• Non-Network Benefits
• Hospitalization - 30
• Office visit - 30
• Surgery/Maternity - 30
• Emergency Care - 75
• Urgent Care - 30
• After 250/500 Deductible
• Benefit is Percentage of Covered Cost which may
  be much less than the billed charge
• Out-of-pocket Maximum for covered expenses -
  2,250/4,500 (including Deductible) Per Year
• Lifetime Maximum Benefit - 1 million

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Lifetime Maximum Benefit
• Anthem - 5 million per person combined total for
  network and non-network care
• UHC - unlimited maximum for network care and 1
  million per person for non-network care

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Human Organ and Tissue Transplant Benefits
• Anthem - 1 million combined maximum for network
  care (covered in full) and non-network care
  (subject to deductible and 50 copayment).
  Maximum benefit is separate from lifetime maximum
  benefit.
• UHC - covered with no maximum network benefit and
  with 30,000 maximum non-network benefit.
  Benefit is paid subject to 10 network and 30
  non-network copayments. Benefit applies to
  annual out-of-pocket maximum for copayments.

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Non-network Urgent Care Benefits
• Anthem - 35 copayment
• UHC - subject to deductible and 30 copayment
• Skilled Nursing Facility Care Benefits
• Anthem - no maximum for this benefit
• UHC - 180 days per year maximum combined with
  Inpatient Rehabilitation

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Chiropractic Care Benefits
• Anthem - 12 visits maximum per year
• UHC - 24 visits maximum per year
• Non-Network Pharmacy Benefits
• Anthem - 50 copayment
• UHC - 8/25/40 copayment plus the difference
  between the non-network charge and what UHC would
  have paid to a network pharmacy

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Home Health Care Benefits
• Anthem - Network - unlimited visits - covered in
  full Non-Network - maximum of 30 visits
• UHC - Maximum of 60 visits combined network and
  non-network
• Hospice Benefits
• Anthem - covered in full
• UHC - 10 network/30 non-network copayments

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Mental Health/Chemical Dependency Benefits
• Anthem - 50 non-network inpatient mental health
  copayment non-network limits - 10 visits for
  outpatient mental health and 550 for
  inpatient/outpatient chemical dependency care
• UHC30 non-network inpatient mental health
  copayment non-network limits60 days/60 visits

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Medical Equipment Benefits
• Anthem - 20 network/40 non-network copayments
  no annual maximum benefit
• UHC - 10 network/30 non-network copayments
  10,000 maximum benefit
• Temporomandibular Joint Treatment Benefits
• Anthem - covered network and non-network
• UHC - not covered

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Specific Benefit Differences Between the Anthem
and UnitedHealthcare PPO Plans

• Christian Science Practitioners Care Benefits
• Anthem - not covered
• UHC - covered as non-network expense subject to
  deductible and 30 copayment
• Surgical Treatment of Morbid Obesity Benefits
• Anthem - no maximum benefit
• UHC - 75,000 maximum benefit

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Dayton Area Hospital Networks Effective July 1,
2005

• Anthem Network
• Childrens Medical Center
• Community Hospital
• Dayton Heart Hospital
• Grandview Hospital
• Greene Memorial Hospital
• Kettering Medical Center
• Mercy Medical Center
• Middletown Regional Hospital
• Southview Hospital
• Sycamore Hospital
• Upper Valley Medical Center

• UnitedHealthcare Network
• Childrens Medical Center
• Community Hospital
• Good Samaritan Hospital
• Grandview Hospital
• Greene Memorial Hospital
• Kettering Medical Center
• Mercy Medical Center
• Miami Valley Hospital
• Middletown Regional Hospital
• Southview Hospital
• Sycamore Hospital
• Upper Valley Medical Center

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Employee and Employer Health Care Contributions
Effective July 1, 2005
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Employee and Employer Health Care Contributions
Effective July 1, 2005
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Employee and Employer Health Care Contributions
Effective July 1, 2005
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Employee and Employer Health Care Contributions
Effective July 1, 2005
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Employee and Employer Health Care Contributions
Effective July 1, 2005
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Your Choice

• Based on
• Benefit levels
• Employee contributions
• Network of covered physician and hospital
  providers
• Whichever is most important to your family
• Choose a single medical plan for yourself and
  your family members to be covered for the six
  months from July 1 through December 31, 2005

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Wright State UniversityHealth Care
Enrollment/Change Form

• Is available
• In the Department of Human Resources
• 280 University Hall
• On the Human Resources website at
• www.wright.edu/hr
• The form can be completed online,
• printed, signed and submitted.

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Wright State University Health Care
Enrollment/Change Form

• Complete the Enrollment/Change Form whether or
  not you elect to change medical plans or covered
  family members
• To continue the same Anthem coverage with no
  change, check the box titled No Change from
  prior enrollment form in Section 1

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Wright State University Health Care
Enrollment/Change Form

• Return the completed form to
• Department of Human Resources
• 280 University Hall
• as soon as possible.

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Wright State University Health Care
Enrollment/Change Form

• Employees electing UHC coverage who submit the
  Enrollment/Change Form by June 15 can expect
  their enrollment to be processed in the UHC
  enrollment system by July 1.
• UHC enrollments submitted after June 15 will
  likely be processed in early July effective
  retroactive to July 1.

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Questions?

• Questions concerning network providers, benefit
  levels, benefits for ongoing medical care, etc.
  can be directed to
• Anthem Member Services at 800-826-7987
• UHCs Service Transition team at 866-873-3903 or
  to Jessi Obermeyer at 513-603-6768.

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Questions?

• Questions can also be directed to
• Rich Johnson
• Employee Benefits Manager
• 280 University Hall
• Phone [phone]
• E-mail richard.johnson_at_wright.edu