You can select a category below or scroll through the questions individually.
For the FAQs from the 2008 Open Enrollment meetings click here.
Health
Medical Reimbursement Accounts
Vision
Dependent Care Assistance Plans
Dental
General Questions and Other Benefits
Life Insurance
Q: When can I make insurance changes (change plans, add
or drop dependents)?
A: Changes between plans must be made during annual open enrollment.
Dependents can be added or dropped during open enrollment or within 31 days of
an eligible change in family status. Changes made during open enrollment
will become effective January 1 of the following year. To make changes due
to a change in family status please see the Benefits office.
Q: What is a change in family status?
A: A change in family status is a situation that allows you to change your
health, dental, and vision coverage or spending account participation.
Examples are:
Q: I also have health insurance with my spouse's
employer. Will the University's health plan coordinate benefits with my
other insurance plan? Which insurance will be primary?
A: The University's plan will coordinate benefits with other carriers.
However, you will need to determine whether or not your spouse's plan will
coordinate benefits. Since you are employed by the University, the
University's plan will be the primary insurance for your claims. Likewise,
If your spouse has coverage through his or her employer and is also covered as a
dependent through your health insurance their plan will be primary for their
claims.
Q: Will I be able to mix health plans? For
example, may I elect the Health Plan A while enrolling my dependents in Health
Plan B?
A: No. The employee and all enrolled dependents must participate in
the same plan for health, dental and vision.
Q: If I choose not to participate in the University's
health, dental, vision or spending account plans this year, when will I be able
to participate again?
A: You will be able to return to the University's plans at the next annual
enrollment or if you have an IRS Qualifying Event.
Q: How will declining health insurance affect
pre-existing coverage?
A: When declining health insurance you are stating that you have health
coverage through another source. As long as there is not a 63-day break in
coverage in the last 12 months prior to requesting to elect coverage, no
pre-existing condition will be applied.
Q: What does "Provider's Responsibility" mean on my
Explanation of Benefits (EOB) from Anthem Blue Cross and Blue Shield?
A: The "Provider's Responsibility" is the amount the provider billed over
the amount allowed by the insurance company. If your provider is an Anthem
participating provider he or she cannot bill you for this amount.
Q: How do I find a participating provider or network
pharmacy?
A: You can access the directory online at
www.anthem.com or you can request a printed directory by calling
1-800-392-1104.
Q: How can I get the maximum benefits when I have a
prescription filled?
A: If you use a network pharmacy your cost is less. If you utilize a
non-participating provider your cost will be greater and you may be required to
pay in full for services and file your own claims for reimbursement.
Q: What is prior authorization for prescription drugs?
A: Some prescription drugs will only be covered if your physician requests
prior authorization from the insurance company and the request meets the
criteria for approval. If your physician is an Anthem participating provider,
and he or she prescribes a drug for you that requires prior authorization, they
are required by their contract with Anthem to complete the necessary paperwork to
submit for prior authorization. If the prior authorization is not approved or if
you choose to purchase the medication prior to the prior authorization being
completed you will be required to pay the full purchase price and will not be
eligible to receive any reimbursement from the insurance company. To find out if
your prescription drug requires prior-authorization call 1-800-655-1936.
Q: Do I have a choice between taking a name brand drug
or its generic equivalent?
A: Yes, if your physician allowed a generic substitute on your original
script. If you choose not to take the generic equivalent of a prescribed
medication, or if your physician will not prescribe a generic, you will be
responsible for the co-pay for the generic equivalent plus the
difference in cost between the allowed amount for the generic drug and the
allowed amount for the brand name drug.
Q: What is the mail order service for prescriptions and
how does it work?
A: Anthem utilizes PrecisionRx for the mail order prescription drug program.
You can purchase up to a 90-day supply of most long-term use prescription
medications at one time for the cost of twice your applicable retail co-pay
(after your deductible if you participate in Plan B). To find out if your
prescription is available through the mail order prescription drug program call
1-800-655-1936. The rules for prior authorization also apply to mail order
prescriptions.
Q: I did not enroll in Medicare Part B when I turned 65
because I was still working at the University. Can I enroll once I am no
longer an employee?
A: Yes. You can delay enrolling in Medicare Part B when you turn 65 if you
are working and have group health insurance. Your spouse can also delay
enrollment in Part B if you provided health insurance for him or her. However,
you should contact your Social Security Office to file an application for Part B
shortly before you retire.
Q: I recently terminated, when will I receive my COBRA
information?
A: You should receive COBRA information within 1-2 weeks of your
termination. The COBRA election form will be mailed directly to your home
from the University. If you do not receive the
information during that time contact the Human Resources office at 573-651-2855.
Q: If I do not enroll my spouse or children in the
Health Plan can I still enroll them in the Vision Plan?
A: Yes, the plans are separate from each other.
Q: Is the Lasik discount available through both Vision
Plan A and Vision Plan B?
A: Yes, Lasik surgery is discounted when you utilize a participating
physician.
Q: Where can I find a list of participating physicians
in the Vision Plans?
A: You can access the directory at www.vsp.com.
Q: Where can I get additional information on the Vision
Plans?
A: You can obtain additional information by going to the Benefits Office
website and selecting Vision Insurance:
http://www4.semo.edu/humanresources/Benefits/.
Q: If I do not enroll my spouse or children in the
Health Plan can I still enroll them in the Dental Plan?
A: Yes, the plans are separate from each other.
Q: Who is eligible for the orthodontia coverage in
Dental Plan B?
A: The orthodontia coverage is for dependents up to age 19 who are on the
plan beginning in the third year of coverage.
Q: Where can I get additional information on the Dental
Plans?
A: You can obtain additional information by going to the Benefits Office
website and selecting Dental Insurance:
http://www4.semo.edu/humanresources/Benefits/.
Q: Can I use pre-tax dollars to purchase
supplemental or dependent life?
A: Life insurance premiums are not eligible to be paid
with pre-tax monies.
Q: How do I increase the amount of my life
insurance or my dependent life insurance?
A: You may increase the amount of your life insurance or your dependent life
insurance at any time by contacting the Benefits office at x2083 or coming by and completing the
necessary forms.
Q: How do I change the beneficiary on my
life insurance?
A: You may change the beneficiary of your life insurance by coming by the
Benefits office and completing the necessary forms.
Medical Reimbursement Accounts (MRA)
Q: If I have allocated dollars to my Medical
Reimbursement Account and I do not submit enough receipts to use all of it, what
happens to those funds?
A: Unused funds in your Medical Reimbursement Account will be forfeited.
For the program to work for you, it is necessary that you estimate as accurately
as possible your health care expenses for the plan year.
Q: What is the maximum amount that can be allocated to
an MRA?
A: The current annual maximum is $5,000.
Q: Does EPOCH allow me to access my MRA online?
A: At this time EPOCH does not allow online access.
Q: Do my dependents have to be enrolled in the
University health insurance to receive reimbursement from my MRA for their
eligible expenses?
A: No. Any dependent's expenses, regardless of participation in the
University health plan, are eligible for reimbursement according to plan
guidelines.
Q: How long do I have to submit my receipts?
A: Services have to be rendered during the plan year, which is January 1
through December 31. Your receipts must show services during this time to
access plan dollars set aside during that plan year, but you have until March
31, of the following year, to submit the receipts for reimbursement.
Q: Can you submit a bill for services that flow from
year to year?
A: Orthodontia expenses are the only charges the IRS allows to flow from
year to year. Reimbursement is based on PAID date; therefore, you must pay
the charge before the service can be reimbursed.
Q: How do I submit a request for reimbursement?
A: To request reimbursement for eligible expenses you must complete the
Medical Reimbursement Request,
attach the required information (outlined on the form) and submit it to
Epoch via the address or fax number on the form.
Q: When can I elect to participate in an MRA?
A: You must be an employee with the University on January 1 to be eligible
to participate in an MRA for that year. If you were hired mid-year you
must wait until the next open enrollment to make your election.
Q: How will monies for my MRA be taken out of my check?
A: The annual amount you elect will be divided by the number of paychecks
you receive in a year. (Example: If you choose to put $1,300 in an MRA and are a
bi-weekly paid employee you will have $50 taken out of every check to fund your
MRA.)
Q: Do I have to wait for the money to be deposited in
my MRA account to make a claim for reimbursement?
A: The annual amount you have allocated for your MRA is available to you on
the first day of the plan year.
Q: Where can I get more information on MRAs and the
type of expenses eligible for reimbursement?
A: You can access the Benefits Office website to see a listing of eligible
expenses and to get more information on MRAs. Go to
http://www4.semo.edu/humanresources/Benefits and select Medical
Reimbursement\Dependent Care.
Dependent Care Assistance Plans (DCAP)
Q: If I have allocated dollars to my
Dependent Care Assistance Plan and I do not submit enough expenses to use all of
it, what happens to those funds?
A: Unused funds in your Dependent Care Assistance Plan will be forfeited.
For the program to work for you, it is necessary that you estimate as accurately
as possible your dependent care expenses for the plan year.
Q: What is the maximum amount that can be
allocated to a DCAP?
A: The current annual maximum is $5,000.
Q: Does EPOCH allow me to access my DCAP
account online?
A: At this time EPOCH does not allow online access.
Q: How long do I have to submit my
receipts?
A: Expenses have to be paid during the plan year, which is
January 1 through December 31. Your receipts must show paid dates during
this time to access plan dollars set aside during that plan year, but you have
until March 31, of the following year, to submit the receipts for reimbursement.
Q: When can I elect to participate in a
DCAP?
A: You must be an employee with the University on January 1 to be eligible
to participate in a DCAP for that year. If you were hired mid-year you
must wait until the next open enrollment to make your election.
Q: How do I submit a request for
reimbursement?
A: To request reimbursement for eligible expenses you must complete the
Dependent Care Reimbursement
Request attach the required information (outlined on the form) and submit it
to Epoch via mail or fax.
Q: How will monies for my DCAP be taken out of my
check?
A: The annual amount you elect will be divided by the number of paychecks
you receive in a year. (Example: If you choose to put $1,300 in an DCAP and are
a bi-weekly employee you will have $50 taken out of every check to fund your
DCAP.)
Q: Do I have to wait for the money to be deposited in
my DCAP account to make a claim for reimbursement?
A: Yes. Monies will not be available until after the money is taken
from your check and deposited in your account.
Q: Where can I get more information on DCAPs?
A: You can access the Benefits Office website to get more information on
DCAPs. Go to
http://www4.semo.edu/humanresources/Benefits and select Medical
Reimbursement\Dependent Care.
General Questions and Other Benefits
Q: How do I change my address, my name, or
other personal data?
A: Complete a Personal Data Change Form and
forward it to Human Resources.
Q: What are the eligibility requirements
for dependents to qualify for the Dependent Tuition Reimbursement Program?
A: Please access the information
on the Benefits web-site for a complete description of this benefit.
Q: What are the Employee Educational
Benefit (Employee Fee Waiver) for undergraduate courses and the Cooperative
Graduate Program?
A: Please access the information
on the Benefits web-site for a complete description of this benefit.
Q: I am a new employee, when will my
benefits begin?
A: Benefits elected by a new employee during his or her Benefits
Orientation will be effective on the date of hire.