October 23, 2003

Open Enrollment period begins Oct. 27

Look for major benefit plan changes now in effect

Open Enrollment for the 2004 benefit programs begins Monday (Oct. 27) and continues through Nov. 21.

Open Enrollment is the one time each year when the University announces benefit plan changes and monthly premium contribution rates for the next calendar year and benefits-eligible faculty and staff may make changes to plan selections.

It also is the period to re-enroll in the Flexible Spending Account (FSA) Health Care and/or Dependent Care Accounts for continued participation in the next calendar year.

Major benefit plan changes for 2004 include a new health plan provided by Aetna HMO; the discontinuation of the offering of United Healthcare HMO; new physician office, emergency room and prescription drug co-payment amounts; and a new prescription benefit manager — Walgreens Health Initiatives — for the PPO and HMO Illinois plans, replacing AdvancePCS.

Here are the details about the changes that will become effective Jan. 1.

• HMO Illinois members must change physicians or health plan. HMO Illinois and the Northwestern Medical Faculty Foundation (NMFF) are dissolving their relationship in which NMFF has been a provider of physician services to HMO Illinois. During the Open Enrollment period, HMO Illinois members using NMFF or its affiliated physicians are required to change to another health care plan to retain NMFF physician services; to change to another physician or physician group to retain their membership in HMO Illinois: or to change both health plan and physician.

• New health plan, Aetna HMO. Northwestern has negotiated a new HMO agreement with Aetna, one of the nation’s leading providers of health care, serving more than 13 million medical members.

Aetna has an established relationship with NMFF in which NMFF has provided primary care and specialty physician services to Aetna HMO members since 1998.

Aetna HMO offers health plan coverage similar to HMO Illinois at comparable premiums and should provide an easy transition for those needing to make a change of HMO.

• Continuing HMO Illinois membership. To retain HMO Illinois as a current health plan, one must select a physician or physician group that provides primary care physician services through HMO Illinois. Among these groups are Advocate Health Centers, ENH Medical Group, Michael Reese Physicians Group, Physicians Health Association of Illinois, Ravenswood Medical Professional Group, Rush-Presbyterian St. Luke’s Health Associates, St. Francis Health Care (Evanston) and United Physicians Network.

• Other health plans options. Another option is to change both the health plan to a plan other than HMO Illinois and the physician or physician group to a group other than NMFF.

Humana HMO and Unicare HMO, two health plans currently serving the University, will not accept new enrollments by members using NMFF physicians. Current members of Humana and Unicare using NMFF may continue to use NMFF, but these HMOs are not accepting new members transferring from HMO Illinois. These HMOs are available with the option involving both a change of HMO and a change of physician.

• PPO Plan. Another option is to change from HMO Illinois to Plan A, Northwestern’s Preferred Provider Option (PPO) using Blue Cross-Blue Shield of Illinois as the University’s administrator for the plan. The PPO can entail higher out-of-pocket expense by paying more for earlier expenses in the year in the form of deductible amounts and by personally paying a higher proportion of the medical expense. There is a broader choice of physicians and geographic availability of PPO services. Claims are made to Blue Cross.

• Discontinuation of the United Healthcare HMO health plan. Due to declining enrollment and high prices, the University will discontinue the offering of United Healthcare HMO, effective Jan. 1.

Participants in the United plan will need to make decisions about their selection of a health care plan including their selection of physician and hospital providers for themselves and for their family members. This action must be taken during the open enrollment period.

To assist employees to understand their options, health plan materials including monthly premium rates, co-payment amounts, health plan comparison and an Aetna HMO provider directory have been sent to employees affected by the change via campus mail.

• New monthly premium amounts. To moderate the rate of premium increase which impacts all health plan members regardless of the degree of use, co-payments for physician office visits, emergency room visits and prescription drugs will increase. The new co-payment amount for a physician office visit is $20 for all plans (an increase from $15). The new co-payment amount for an emergency room visit is $75 for all plans (an increase from $50). Prescription drug co-payment amounts are increasing by $5 in most plans. These new co-payments are comparable to the amounts charged by other employers and represent a fraction of the total cost.

• New prescription benefit manager. Walgreens Health Initiatives (WHI) will replace AdvancePCS as the administrator of the prescription drug program for PPO and HMO Illinois members and will serve as the prescription benefit manager for Aetna HMO members.

This change is the result of reviewing proposals received from various prescription managers including AdvancePCS and determining that WHI offered the most cost effective program.

Walgreens also will administer the prescription program for Aetna HMO.

• New maximum annual benefit of $2,000 for the Blue Cross dental plan. A new annual maximum benefit of $2,000 for the Blue Cross dental plan, an increase from $1,750, recognizes increasing dental costs and is an attempt to ease the financial burden on employees.

There is no change in First Commonwealth premiums, and Blue Cross dental premiums are decreasing, reflecting lower than anticipated dental cost increases.

• Inclusion of over-the-counter medications as eligible for reimbursement from FSA Health Care Account. Expenses associated with certain over-the-counter non-prescription drugs are eligible for reimbursement. Among the eligible medications are allergy medicines, pain relievers, antacids, cold remedies and flu remedies. All forms of these medications (e.g., tablet, liquid, capsule and drops) are eligible and include generic and store or name brand. Also included are drugs that were recently made available over-the-counter and no longer require a prescription such as Claritin and Prilosec. Expenses must be for treatment of an existing disease or to prevent a disease that is likely to occur if the medication is not taken. They do not include toiletries and cosmetics, vitamins and dietary supplements or herbal remedies.

• New maximum annual pledge amount for FSA Health Care Account of $6,600, an increase of 10 percent. This may help some individuals with larger bills.

• New maximum group term life insurance coverage. The new maximum group term life insurance coverage of $200,000, an increase from $175,000, and the new maximum group term life insurance covered salary of $80,000, an increase from $70,000, recognizes increasing University salaries and escalating prices in general.

• Qualifying years of service for the Portable and Reduced Tuition Plans. Years of part-time University service will be included in the determination of the number of years of service for calculating reduced and portable tuition benefits. At present, the calculation is based on the number of years of continuous, uninterrupted full-time service. Service credit will be prorated to the part time hours worked.

This change is to benefit those individuals who have continuing University service, but, due to personal circumstance or family obligations, need to reduce their status to part time, and return to full time service after their obligations are addressed.

This change benefits women employees who have taken a maternity leave and return to their jobs on a part-time basis, as well as individuals who take a leave from their job to care for an ailing parent or spouse. Employees must have full-time status at the time they request the reduced or portable tuition benefit.

• New Dependent Child and Spouse Life Insurance Plans. The new Dependent Child and Spouse Life Insurance Plans will broaden the scope of life insurance options and will be an enhancement of the program to family members at competitive prices and with the convenience of payroll deduction.

In order for employees to initiate either of these plans, they must be participants themselves in the optional term life insurance plan. If not, they need to apply for such coverage, and if approved, may enroll in the spouse and dependent term life insurance plan.

Coverage for a spouse will be available in $10,000 increments to a maximum of $250,000, and not to exceed 50 percent of the employee’s optional life insurance coverage. Coverage is guaranteed up to $30,000 regardless of health status during open enrollment and within 31 days of benefits eligible employment. Coverage of more than $30,000 requires evidence of good health.

• Short Term Disability Plan Enrollment open to new members. During Open Enrollment, staff not presently enrolled in the Short Term Disability Plan may enroll in the plan without the need to submit evidence of good health. The Short Term Disability Plan provides continued income in the event an individual is unable to work due to extended sickness or injury. The amount of benefit is up to 60 percent of an individual’s last working wage and may extend up to six months.

Decisions made during Open Enrollment are generally binding for the entire year. An individual cannot make any changes until next year’s Open Enroll-ment period unless he or she has an approved change in family or employment status such as marriage, birth, adoption or death, and submits a completed enrollment form to the Benefits Division within 31 days of such a change.

Enrollment forms are included in the 2004 Open Enroll-ment booklet that will be sent to all benefits-eligible faculty and staff. Enrollment forms can also be downloaded from the Benefits Division’s Open Enrollment Web site shown at the end of this story.

To change benefit selections, or to re-enroll in the Flexible Spending Account (FSA) Plan, forms must be received by the Benefits Division or by the Chicago Campus Human Resources Office by 5 p.m.

Nov. 21.

Employees may obtain further information on these and other changes for 2004 through the Open Enrollment Web site at www.northwestern.edu /hr/benefits/news/openenrollment as well as the Benefits Open Enrollment booklet.