Details of Insurance Plans
Beloit College believes the Health Benefit Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator at the Beloit College Human Resources Office, 700 College St., Beloit, WI. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or http://www.dol.gov/ebsa/healthreform/. This website has a table summarizing which protections do and do not apply to grandfathered health plans. You may also contact the U.S. Department of Health and Human Services at http://www.healthcare.gov/.
Humana Preferred Network (HPN) Effective 01/01/2012-12/31/2014
Beloit College offers a health benefit plan to all eligible employees with 3 levels of coverage: single, limited family (employee and spouse or same-sex domestic partner, or employee and child(ren)), and family. The benefit plan is a major medical health plan administered through Humana Inc. of Louisville, Kentucky.
Enrollment - The option for initial enrollment normally occurs at the time of employment, with the option for enrollment, re-enrollment or cancellation effective with the beginning of each calendar year (January 1), though certain life status changes may allow employees to qualify for enrollment during the year.
Effective with our health plan year beginning January 1, 2011, the Department of Labor requires that we provide notice and offer special and open enrollment opportunities for individuals eligible for Medicaid or the Wisconsin Children’s Health Insurance Program (CHIP).
Wisconsin residents who are eligible for or are covered by either of the above programs may be eligible to enroll in the Beloit College health benefit plan and have the state assist them with premium payments.
If you are covered by or think you might be eligible for premium assistance or coverage under Medicaid or CHIP, please read the memo linked here.
If have questions regarding this information, please contact Terri in Human Resources at extension 2630 or firstname.lastname@example.org. Eligible employees and their eligible dependents may submit a health plan enrollment application within 60 days of either of the following new special enrollment events:
- The employee or dependent loses coverage under the state Children's Health Insurance Program (CHIP) or Medicaid, or
- The employee or dependent becomes eligible for state premium assistance for coverage in your medical plan.
Using PPO Providers – The health plan offers a Preferred Provider Organization (PPO) and prescription discount options that can save you money. Our plan has contracted with Humana’s Preferred and ChoiceCare provider networks to discount physician, hospital and other health care costs charged to you and the plan. Using a network provider also reduces your deductible and co-insurance amounts. To encourage use of PPO network providers, in-network deductibles and co-insurance will not reduce the out-of-network deductible or out-of-pocket limits. Out-of-network expenses will reduce in-network deductible and out-of-pocket limits to encourage return to in-network care.
Looking for a network doctor? Start with your address.
If you are a Wisconsin resident of Rock, Walworth, Dodge, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington or Waukesha county, you will be covered under the Humana Preferred (BHCGSW) Network.
The remaining Wisconsin counties are considered out of the 11-county service area, but DO include in-network providers. Wisconsin health care providers outside of the 11-county area are in the BHCGSW Out-of-HP Service Area Network.
Employees who prefer to seek care outside of the state of Wisconsin will have access to ChoiceCare PPO providers. For example, if you live in Beloit and are hospitalized in Rockford or you have a student attending college in another state, you will still have the choice of the non-Wisconsin providers included in the ChoiceCare PPO network.
Humana’s Preferred Network is a high-performance network that includes over 4,000 providers selected for participation based on excellent clinical performance. Preferred Network providers have contracted with the business coalition for larger discounts; this saves you and the health plan money.
If you do not live in one of the 11 Wisconsin counties listed above, you will have PPO coverage through Humana’s ChoiceCare Network.
To find a participating doctor, hospital or other health care provider, log on to www.humana.com. You can get direct access to our PPO provider lists through your personal MyHumana account or you can search from Humana’s main web site to select a provider or hospital. You will be able to search for providers by name, specialty or location.
What if my current provider is not in the PPO? If your physician is not currently in one of our selected PPO networks, call Humana at 1-800-626-2741 to have a provider relations representative contact him/her about joining the network.
Filing a claim - Most providers will automatically file claims. Many providers file claims electronically, and it is very important that all filing information is correct. Remember to show your provider or pharmacy the health plan I.D. card to make sure that claims are charged and filed appropriately with Humana. Claims for purchases of supplies or equipment that cannot be processed by the provider should be submitted to HUMANA, Attn: Claims Office, P.O. Box 14610, Lexington, KY 40512-4610.
Using your I.D. Card - Your Humana I.D. card provides important information about you and your family members to your health care providers. Your social security number is not used as your member I.D. and is not required for provider care or billing. Review the personal information printed on your card to make sure that it is correct and report any errors or changes to Human Resources staff at 608-363-2630. If you have limited family or family coverage, the card will list the names of all family members covered under the plan. Covered adult children will be issued a separate card. If you need additional cards for other covered family members, you can request them on-line at www.humana.com or call Human Resources at 608-363-2630. Make sure that you show the I.D. card to your health care provider at your first visit. The group and personal numbers should be reported to the billing office to ensure that your claims are filed correctly.
Purchasing prescription medications - Your health plan I.D. card is also your prescription drug card. You must show this card to your Humana network pharmacy when purchasing a prescription. The ID card will enable you to purchase prescription drugs at discounted prices and the prescription claim will be processed during the purchase. Most local chain pharmacies are in the Humana network; additional pharmacy information is available on-line at www.humana.com. Prescription drug purchases are considered in-network care. Until you meet the $500 in-network deductible, you will pay 100% of the cost of the prescription. Once the in-network plan deductible has been met, eligible prescription expenses will be covered at 80% and you will pay 20% for the remainder of the calendar year. Using your I.D. card at a Humana pharmacy will also allow you a discount on prescription drugs that are not covered under the plan. The plan also includes a convenient mail order service on prescription medications and direct purchase of some prescription supplies such as diabetic syringes, testing supplies, etc.
Routine and preventive care coverage - You will pay a $25 co-pay for a routine care exam, then the in-network or out-of-network co-insurance will apply to the remaining cost of the exam. For example, when you use a PPO provider, you will pay $25 plus 15% of the remaining cost of the exam with no deductible applied. PPO provider costs for routine lab work, x-rays, immunizations, mammograms, pap smears, and prostate antigen testing procedures will also be covered at the 85/15% co-insurance level, with no co-pay or deductible. To encourage use of PPO network providers, the out-of-network deductible of $1,000 will be applied to non-PPO routine lab work, x-rays, etc.
Monitoring your claims activity with MyHumana - Humana offers you the ability to set up your own secure, personal page at MyHumana at www.humana.com This page allows you to view the payment status of recent medical claims and review your health plan benefits. You may also set up pages for your covered family members. Please note that due to privacy regulations you may have limited access to the health information of covered family members age 18 or older or you may need to obtain a release to access their health information.
Using the Flexible Spending Account - You can save additional money on health care expenses by participating in the Section 125 plan offered to you each year. Pre-tax deduction of the employee share of your health plan contributions saves you money that would have been deducted as tax. You can also set up a pre-tax contribution into an flexible spending account for reimbursement of costs not eligible for health plan coverage, such as your health, dental and vision plan deductibles, co-insurance amounts and certain over-the-counter medications. More about the Section 125 Flexible Spending Plan is available below.
COBRA - Under COBRA, covered employees who leave the College may apply for up to 18 months of continuation coverage under the College health insurance plan; however, the employee pays 100% of the premium. Under certain circumstances, an additional 18 months of coverage may also be available to spouses and dependents. Specific information regarding COBRA coverage is available in the health plan policy booklet or on request from the Human Resources Office.
For more information, check the links to these Health Benefit Plan documents –
Beloit College offers a dental insurance plan to all eligible employees at the current monthly employee contribution rates: $11.00 for single coverage, $23.54 for limited family coverage, and $36.06 for family coverage. Under the plan, preventive services are payable at 100% with no deductible. After a $50 deductible per person, basic services are payable at 80%, and major services are payable at 50%. There is a per person maximum benefit of $1,500 per year. Orthodontic services are payable at 50% up to a lifetime maximum of $1,500.
The option for enrollment in the dental plan normally occurs at the time of employment, though certain life status changes may allow employees to qualify for enrollment or re-enrollment during the year. Under COBRA, covered employees who leave the College may apply for 18 months of continuation coverage.
New in 2013-The vision plan will include a new laser correction benefit. This new benefit allows you to receive an allowance for laser vision correction in lieu of the benefit for glasses or contact lenses, We recommend that if you are interested in the laser correction benefit, you contact the insurance provider for additional information.
Beloit College offers a vision insurance plan to all eligible employees at the current monthly employee contribution rates: $10.35 for single coverage, $20.70 for limited family coverage, and $27.35 for family coverage. Beloit College vision insurance is administered through Vision Insurance Plans of America, Inc. (VIPA) of Milwaukee, Wisconsin.
Under the plan, eye exams are paid in full, frames are covered up to $125, and 100% of the cost of standard, clear glass or plastic, single vision, bifocal, or trifocal lenses will be paid. Contact lenses are covered in full up to $150 each 12 months. Upgrades for tints, coatings, etc., are not covered under the plan, but may be added as an out-of-pocket cost. If you seek the service of a vision provider who is not in the plan network, benefits are more limited. Under COBRA, covered employees who leave the College may apply for 18 months of continuation coverage.
For more information, check out Vision Insurance Plans of America Inc.
These pages are a summary of the benefits you receive from Beloit College. Complete and updated information is available from the Human Resources Department.