Effective January 1, 2009
Medical Insurance
Medical coverage is provided through Optimum Choice, Inc. with Health Maintenance Organization HMO coverage or MAMSI Life and Health Insurance Co. for Preferred Provider Organization (PPO). Information is available on their website at
http://www.mamsiunitedhealthcare.com.
If you elect the Optimum Choice HMO coverage you must choose an OCI-participating PCP who is open for new patients and be sure this PCP is noted on your card. These visits incur a $20 copayment. Failure to select an OCI PCP will result in claims being denied. You must obtain PCP referrals for specialist visits. If properly referred, you will incur a $40 copayment (no referral needed for OB/GYN or eye refraction services). In addition, if your UVa PCP refers you to another UVa provider, no formal referral is necessary. Services provided by non-network providers are not covered except in emergency. There is a 24/7 Member Services Hotline you can contact at 800-331-2102.
If you elect the MAMSI Life and Health Insurance Co. PPO plan, you must use the MAMSI PPO network of participating providers. PCPs and referrals to specialists are not required. Deductibles are waived for services rendered in a Primary, Wellness or Emergency setting and Primary Care Services covered incur a $30 copayment. Covered services rendered by non-network providers are adjudicated under the Non-Preferred Option after deductible. Separate contract year deductibles apply for care rendered under Preferred ($500) and Non-Preferred ($1000) settings. There is a 24/7 Member Service Hotline you can contact at 800-331-2102.
HMO copayments and coinsurances are waived when you utilize healthcare services from the UVA Medical Center and UVA Physicians. This waiver does not include prescription copayments. PPO copayments and coinsurances are waived when you utilize healthcare services from the UVA Medical Center and UVA Physicians. This waiver does not include prescription copayments. You are responsible for paying deductibles no matter what provider is used.
Well Being
Optimum Choice, Inc. and MAMSI Life and Health customers now have access to a no-cost well-being program at the Optimum Choice/MAMSI website
(www.mamsiunitedhealthcare.com). This program, called Health AtoZ offers a number of enhanced capabilities including a health assessment, online health coaching and a live nurse chat. New members can do an easy one time registration to learn more about HealthAtoZ simply by visiting the site.
2009 Premium Costs:
HMO requires no monthly premium payment. The PPO requires payment of a monthly premium as follows:
- $56.16 single coverage
- $117.93 employee + 1 coverage
- $158.93 family coverage
Enrollment:
Enrollment in the housestaff health plan must occur within 31 days of your date of hire. Additions, subtractions, changes to coverage can be undertaken during Open Enrollment or within 31 days of a "Life Status" Change such as Birth, Death, Loss of coverage, Marriage or Divorce.
Enrollment applications must be submitted to the University Human Resources Benefits Division, 914 Emmet St. Charlottesville, VA 22904; fax (434) 924-4486.
Do not submit any Optimum Choice or MAMSI health plan applications directly to Optimum Choice/MAMSI.
MAMSI /Optimum Choice Health Plan COBRA Information for Housestaff
Under a Federal law called the "Consolidated Omnibus Budget Reconciliation Act" (COBRA), you and your eligible covered dependents may continue your group health benefits under the Plan when your coverage is lost due to a "Qualifying Event." You and your spouse and/or dependent children must apply for coverage under COBRA following the Qualifying Event. Then, you must make monthly payments in order to keep your coverage.
Qualifying Event |
Who May Purchase Continuation Coverage |
Duration of Continuation Coverage |
| Your employment terminates |
You, your spouse and your dependent children who were covered under the Plan when coverage was lost |
18 months |
| Your working hours are reduced, i.e., you become a part-time Employee |
You, your spouse and your dependent children who were covered under the Plan when your status changed |
18 months |
| You experience a termination or reduction in hours while you are disabled (as determined by the Social Security Administration) |
You, your spouse and your dependent children |
29 months (18 months plus an additional 11 months) |
| You divorce, or your marriage is annulled |
Your spouse and your dependent children who were covered under the Plan at the time of divorce, marriage or annulment |
36 months |
| Your dependent child no longer qualifies as a dependent |
Your dependent child |
36 months |
| You die |
Your spouse and your dependent children who were covered under the Plan at the time of your death |
36 months |
What You Need to Do
Housestaff Members enrolled in the MAMSI /Optimum Choice Plans must wait for your COBRA Qualifying Event Notification Letter to come to your home address from Chard Snyder before you can enroll in COBRA. If you are moving, Housestaff should notify Medical Center Human Resources Office of your address change to ensure COBRA documents will be sent to the correct address.
Chard Snyder will send a COBRA Qualifying Event Notification, COBRA Enrollment Form, COBRA Family Member Enrollment Form, and COBRA Premium Computation Form to the MAMSI/Optimum Choice subscriber once your termination is entered by your department. You must complete these forms and return them to Chard Snyder. Enrollment in the COBRA program will not occur unless premium payment accompanies the enrollment forms. Housestaff have 60 days from the date of the letter of Notification or the date of the Qualifying Event, whichever is greater, to return the COBRA forms. You must pay all back premiums before any COBRA enrollment will take place.
Cost of Coverage
- 2009 COBRA premiums for Housestaff enrolled in Optimum Choice or MAMSI :
Housestaff Optimum Choice (HMO) monthly rates are:
Single $363.13
Employee+1 $759.25
Family $1032.33
Housestaff MAMSI (PPO) monthly rates are:
Single $420.41
Employee+1 $879.54
Family $1194.44
Housestaff on the HMO are only covered for emergencies when you travel or move outside the HMO provider area. If a housestaff family is moving early in June and wants more than emergency care during that month (for example, if there is a pregnancy involved), the housestaff will need to submit a form BY MAY 31 to move to the PPO plan (moving out of the service area is a mid-year qualifying event) since all applications are effective the 1st of the month following receipt of the form. PPO premiums will be deducted from housestaff paychecks for the month of June.
If you are a Housestaff currently enrolled in the HMO and are moving out of the Mid-Atlantic area where providers participate with the HMO (Virginia, Maryland, Washington D.C.), you will need to move from the HMO to the PPO to receive COBRA coverage from a national network of providers. You should call Chard Snyder (1-800-982-7715) when you receive your Qualifying Event Notice to let them know you must switch to the PPO.
Optical Benefits for Housestaff with MAMSI/ Optimum Choice
Discounts are available on eyewear and related services at participating optical centers. As a MAMSI Life and Health Insurance (MLH) member, simply show your member ID card at a participating center to receive discounts on eyeglasses, including single or multifocal lenses and designer frames, and other optical services. Contact lenses also may be available at a discount.
To find participating optometrist and optical centers, contact Member services by email at mamemberservices@uhc.com or by telephone at 301-360-8115 (toll free 800-709-7604) or TTY at 301-360-8111 (toll free 800-553-7109).
Dental Insurance
Dental coverage is included with the cost of medical insurance. The dental network is provided by United Concordia. You can use non-participating dentists but the non-participating dentist can balance bill for services above the allowable charge. The benefits when using a network provider include a $1,000 annual benefit per covered person. Major restorative services are not provided except for repair. Orthodontia coverage is not provided.
Please see additional information: UCCI Dental Benefit.
Prescription Information
For both the Optimum Choice and MAMSI PPO there is a 3-tier plan drug plan with prescription copayments of $10 generic, $30 formulary brand, and $50 non-formulary brand. In addition, for PPO members who access Non-Preferred Pharmacies, there is a 20% copayment.
Beginning July 1, 2007, Optimum Choice and MAMSI participants were required to obtain specialty medications from select specialty pharmacies to receive in network benefits. Contact the Specialty Pharmacy Referral Line at 866-429-8177 for more information
Disability Insurance and Emergency Travel Assistance
Disability Insurance is provided through UNUM Life Insurance Company of America and enrollment is automatic for all housestaff members. The benefit provides 70% income replacement up to $8,000 per month. Income replacement continues as long as you cannot perform the material duties of your own occupation (your medical specialty) to age 65. The disability benefit is entirely employer paid. Benefits begin on the date full-time active employment begins and coverage ends on the date full-time active employment ends. There is an elimination period of 90 days and an exclusion period of 5 days for pre-existing conditions. There are limited conversion rights so long as application is made within 31 days of termination.
All Housestaff who have UNUM Long Term Disability are also covered in the UNUM sponsored Emergency Travel Assistance Plan at no additional charge. Please see this flyer describing this program.
Life insurance
Life insurance is provided for housestaff through The Guardian Life Insurance Co. in the amount of 1.5 times your salary, rounded to the next thousand, up to $100,000. The life insurance benefit is fully employer paid. Coverage begins on the date full-time active employment begins and ends on the date active full-time employment ends. Coverage will continue for one year if you become totally disabled. Conversion rights are available for up to $10,000 in coverage, or the amount of coverage under this plan less any group coverage you become eligible for within 31 days of this policy terminating. Housestaff are required to complete the Life Insurance application and name a beneficiary.
Tax-Deferred Savings Program
The University of Virginia offers an optional savings program that allow employees to tax-defer income and invest for the future. The plans are available through TIAA/CREF, The Vanguard Group, and Fidelity Investments, and are open to all employees who can contribute the monthly minimum of $20. The maximum amount that can be contributed on a tax-deferred basis in 2009 is $16,500 with an additional age catch-up of $5,500. Employees who have been employed with the University for at least 15 consecutive years may be eligible for an additional catch-up of up to $3,000. The University calculates this maximum amount and the employee signs a Tax Deferred Savings Program Authorization Form (Salaried Employees) or Tax Deferred Savings Program Authorization Form (Wage Employees) which specifies the authorized amount of the salary reduction. These forms were previously referred to as the Salary Reduction Agreement (for salaried employees), and the Wage Reduction Agreement (for wage employees).
Employees may participate in both the 403(b) and Commonwealth 457(b) and can contribute the maximum to both.
For more information contact the Benefits Division at (434) 924-4392 or email benefits@virginia.edu.
| For Plan Details: |
| TIAA-CREF |
(800) 842-2733 |
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| Fidelity |
(800) 343-0860 |
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| Vanguard |
(800) 523-1188 |
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Forms:
Commonwealth Deferred Compensation Plan (457b)
The Commonwealth of Virginia offers for employees an optional savings program that allow employees to tax-defer income and invest for the future. The plan is available through the Commonwealth’s vendor, ING, and is open to all employees who can contribute a monthly minimum of $20 per month. The maximum amount that can be contributed on a tax-deferred basis in 2009 is $16,500 with an additional age catch-up of $5,500. In addition there is a standard catch-up that employees may be eligible for during the three calendar years prior to the designated normal retirement age. ING will determine eligibility for this catch-up.
To enroll in the Commonwealth’s plan employees need to complete the Participant Enrollment Form and Beneficiary Designation Form and submit to the Benefits Division.
For more information contact the Benefits Division at (434) 924-4392 or email benefits@virginia.edu.
Flexible Spending Accounts
The Flexible Spending Account Program allows you to pay for certain expenses on a pre-tax basis. This means that your money goes farther. For example, if you put aside $5,000 for day care expenses in a Dependent Care account, you get to spend the whole $5,000 on day care. If you take the $5,000 in pay, you will only have roughly $3,500 left after taxes to spend on day care! For most individuals whose adjusted gross income is greater than $25,000, this program may be more beneficial than the federal dependent care tax credit – consult a tax professional for an assessment of your personal situation. The FSA Medical Reimbursement account can also help offset the cost of out-of-pocket health care expenses such as copayments, deductibles, coinsurance, and over-the-counter medications.
The University is pleased to announce Chard Snyder as our new administrator for your Flexible Spending Account program. With this change, there are numerous new features available including:
- A pre-paid benefits debit card that will provide you an easy, automatic way to pay for qualified health care/benefit expenses. The pre-paid card lets you electronically access the pre-tax amounts set aside in your accounts.
- Full array of web services including on-line enrollment, claims submission, account balances, and claims history and detail.
- Tri-weekly reimbursement of approved claims.
To learn more about Chard Snyder and your Flexible Spending Account program, you can watch a short 3 minute video at www.chard-snyder.com/video. For reimbursement questions, call toll-free (800) 982-7715 or visit Chard Snyder’s website at www.chard-snyder.com. Request forms from the UHR Benefits Division at (434) 924-4392 or e-mail benefits@virginia.edu.
Medical Reimbursement
Full-time and part-time salaried employees working at least 20 hours per week are eligible to participate in the medical reimbursement program. You must submit an application within 60 days of your hire date or during open enrollment. This account allows the participant to set aside pretax dollars to pay for medical, dental, and vision care, or other eligible expenses that are not covered by the health insurance plan. In addition to claiming out-of-pocket expenses for the participant, expenses for eligible dependents such as spouses, dependent children and other persons considered to be an eligible dependent for Federal income tax purposes may be included. The maximum amount that you may place in this account is $5,000 per plan year. The minimum contribution is $240 per year.
Dependent Care
Full-time and part-time salaried employees are eligible to enroll in the dependent care reimbursement account, as of the first day of the month following the date of hire or during a subsequent open enrollment period. This account allows the participant to set aside pretax dollars to pay for eligible dependent care expenses, such as childcare. In order to participate in a Dependent Care FSA, you must meet at least one of the following qualifications:
- Single parent who works full-time
- You and your spouse both work, and your spouse's annual income is greater than the amount you are claiming for dependent care
- Your spouse is enrolled full-time at an institution of higher learning (If your spouse is a full-time student at least five months a year or is disabled, federal law limits the maximum amount you may contribute on a pretax basis to $3,000 for one dependent and $5,000 for two or more dependents)
- Your spouse is medically disabled and cannot care for your dependents (If your spouse is a full-time student at least five months a year or is disabled, federal law limits the maximum amount you may contribute on a pretax basis to $3,000 for one dependent and $5,000 for two or more dependents)
- If divorced, you must have custody and be claiming the child as a dependent on your tax return
Money must be in the account before you can be reimbursed. The maximum amount you may place in your account is $2,500 during a plan year if you are married and filing tax returns separately from your spouse. If you are single, or married and filing jointly, the maximum is $5,000. The minimum contribution is $240 per year. Forms:
Enrollment Rules
Participation in FSA Accounts must be renewed every year during the annual open enrollment period. Generally, you may not change the amount of money set aside until the next annual enrollment period. However, the IRS will allow you to make changes during the Plan Year due to a qualifying event. Qualifying events (or family status changes) include:
- a marital status change due to marriage, divorce, or death of a spouse
- birth, adoption, or death of a child
- employee obtaining permanent custody of a child
- termination or commencement of employment by the employee, spouse, or dependent
- employee or employee's spouse taking or returning from an unpaid leave of absence
- change in employment status for employee or spouse
- dependent satisfying or ceasing to satisfy the requirements for unmarried dependents
- and significant change in coverage or costs or a change in daycare provider
Applications for change must be accompanied by documentation and received in the UHR Benefits Division within sixty (60) days of the family status change.
The Summary Plan Description for UVA’s Flexible Spending Account Program details the plan benefits and rules.
Miscellaneous Benefits
For additional information on benefits and policies for Housestaff please visit the Housestaff website at
https://www.healthsystem.virginia.edu/internet/housestaff/
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