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2018 Benefits For Retired Employees 
Under Age 65

Click hereFlexOnline Logo to access the Dartmouth benefits enrollment system, review your elections and enroll in your 2018 Dartmouth retiree benefits.
Our annual benefits open enrollment period is officially here, giving you the opportunity to review and make changes to your benefits elections for 2018.
IMPORTANT:   If you are covered on a Dartmouth College retiree medical plan, you need to actively enroll for 2018, even if you do not plan to change your elections

2018 PLAN OPTIONS

Dartmouth offers three different medical plans which also include prescription drug coverage and vision. The Medical Plans are self-insured by Dartmouth College and administered by Cigna Health and Life Insurance Company ("Cigna"). Pharmacy plan benefits are administered by CVS/caremark.

Open Access Plus Plan

Cigna Choice Fund Plan

High Deductible Health Plan


All three plans offer

  • Coverage for medical care, including visits to your doctor's office, hospital stays, mental health and substance abuse services, chiropractic treatment, physical therapy and other services.
  • An option to choose a primary care doctor to help guide your care. It's recommended, but not required.
  • A national network of providers, as well as emergency coverage when traveling abroad for personal travel.
  • No referral is needed to see a specialist, although precertification may be required.
  • In-network preventive care* services covered at no additional cost to you. See your plan materials for a list of covered preventive care services.
  • 24-hour emergency care, in- or out-of-network.
  • The amount you pay out-of-pocket is limited by your plan's out-of-pocket maximum. Once you spend the annual maximum amount, the medical plan pays your covered health care costs at 100%.
  • No-claim paperwork is necessary when you receive care in-network.Access to Dartmouth Health Connect (except when contributing to an HSA).
  • Each family member pays toward their own individual deductible and out-of-pocket maximum. The family limits are in place to help minimize the total amounts of deductible and out-of-pocket maximums that your family would have to pay in a given year.
  • Manage and track claims, order ID cards, find doctors, and track account balances through the myCigna.com website.

*Some preventive services may not be covered. For example, immunizations for travel are generally not covered. Other non-covered services/supplies may include any service or device that is not medically necessary or services/supplies that are unproven (experimental or investigational).

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Open Access Plus Plan (OAP)

Key benefits

  • The deductible, medical copays and prescription copays are the lowest of the three plans.
  • Dartmouth Health Connect is available for your primary care.

Other considerations

  • The OAP has the highest rates of all three plans.
  • Medical and prescription copays DO NOT count toward annual deductibles, but DO count toward annual out-of-pocket maximums.

Plan overview 

  In-network Out-of-network
Medical deductible
 Individual $500 $1,000
 Family $1,000 $2,000
Out-of-pocket maximum
 Individual $2,500 $5,000
 Family $5,000 $10,000
Coinsurance
 Individual 10% 30%
 Family 10% 30%
Copays
 Office visit $20 Deductible/Coinsurance
 Specialist visit $30 Deductible/Coinsurance
 Emergency room $100 $100
 Urgent  care $50 $50
Prescription drugs - Generic/Preferred/Non-preferred
30-Day retail pharmacy $5/$25/$40 N/A
90-Day mail order $10/$50/$80 N/A
90-Day CVS retail $10/$50/$80 N/A

 

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Cigna Choice Fund Plan (CCF)

Key benefits

  • The deductible, co-pays and prescription copays are mid-level, generic prescriptions are $5.
  • Employer contributes to an HRA. (Health Reimbursement Account)
  • Dartmouth Health Connect is available.

Other considerations

  • Medical and prescription copays DO NOT count toward annual deductibles, but DO count toward annual out-of-pocket maximums. 

Plan overview   

  In-network Out-of-network
Employer HRA Contribution $500 individual/$1,000 family
Medical deductible
 Individual $1,500 $3,000
 Family $3,000 $6,000
Out-of-pocket maximum
 Individual $4,000 $6,000
 Family $8,000 $12,000
Coinsurance
 Individual 10% 30%
 Family 10% 30%
Copays
 Office visit $30 Deductible/Coinsurance
 Specialist visit $45 Deductible/Coinsurance
 Emergency room $150 $150
 Urgent  care $50 $50
Prescription drugs - Generic/Preferred/Non-preferred
30-Day retail pharmacy $5/$30/$50 N/A
90-Day mail order $10/$60/$100 N/A
90-Day CVS retail $10/$60/$100 N/A

TO HERE  

 

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High Deductible Health Plan (HDHP)

Key benefits

  • The plan has the lowest rates of all three plans.
  • Employer may contribute to an HRA (Health Reimbursement Account)
  • Dartmouth Health Connect is available for employees with an HRA.  You cannot have a HRA and a Health Savings Account (HSA) at the same time.

Other considerations

  • This plan has the highest deductible of the three plans.
  • You pay 100% of all medical and prescription costs until your annual deductible has been met.

HDHP FROM HERE

Plan overview   

  In-network Out-of-network
Employer HRA contribution $500 individual/$,1000 family
Medical deductible
 Individual $2,700 $4,100
 Family $5,400 $8,200
Out-of-pocket maximum
 Individual $4,000 $6,500
 Family $8,000 $13,000
Coinsurance
 Individual 10% 30%
 Family 10% 30%
 Office visit Deductible/Coinsurance Deductible/Coinsurance
 Specialist visit Deductible/Coinsurance Deductible/Coinsurance
 Emergency room Deductible/Coinsurance In-Network Deductible/Coinsurance
 Urgent care Deductible/Coinsurance In-Network Deductible/Coinsurance
Prescription drugs - Generic/Preferred/Non-preferred
30-Day retail pharmacy Deductible/Coinsurance N/A
90-Day mail order Deductible/Coinsurance N/A
90-Day CVS retail Deductible/Coinsurance N/A

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HEALTH REIMBURSEMENT ACCOUNT (HRA)

Key Benefits of choosing a plan with an HRA

* You can spend the entire account balance on day one (January 1, 2018).

* The full balance will carry over each year as long as you remain in the same plan.

* Deductibles and coinsurance (as applicable) is automatically paid from your HRA account for you.

* There is no paperwork or substantiation required.

* There is no tax reporting required.

Other Considerations

* The account belongs to Dartmouth College, and the balance does not go with you if you leave the plan.

* The full balance will carry over each year until:

   * You change health plans; or

   * The College no longer offers the benefit.

 

RETIREE HEALTH PREMIUM AND BILLING:

If you meet the eligibility requirements for the Retiree Health plan, your Retiree Health premium pays for your participation in the Cigna medical plan you have elected, as well as your CVS Caremark prescription plan. Most Retirees receive a subsidy from Dartmouth College toward the Retiree Health premium, based on age and years of benefit-eligible service. Once enrolled if you owe a premium, you will receive a monthly invoice from Dartmouth College for any unsubsidized portion of your household medical premium costs. If you do not owe a premium, you will not receive an invoice.

COSTS
When services are used, the Retiree and Dartmouth share the costs.  Depending on the type of service received, you may pay a percentage or a set amount of the cost.  Each plan has maximum annual limits, and once these limits are reached, the plan pays at 100% for the remainder of the year.

 

IN-NETWORK vs OUT-OF-NETWORK

An out-of-network provider is one which has not contracted with your insurance company for reimbursement at a negotiated rate. Some out-of-network providers may negotiate lower rates, but are not required to do so. Your insurance may continue to pay what is called an "allowable amount" for the service when out-of-network providers are utilized, however you may be responsible for paying the difference between the "allowed amount" and the full amount charged. This is called balance billing. Out-of-network providers may continue to balance bill, even after the out-of-pocket maximum has been met.
In-network providers are contracted with the insurance company for reimbursement at a negotiated rate, and are not allowed to balance bill.
When utilizing services out-of-network, deductibles and coinsurance paid will count toward your in-network accumulators.  However it does not work in reverse; in-network deductibles and coinsurance paid does NOT count toward your out-of-network accumulators.

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WORDS TO KNOW

Here are some definition of words and phrases that you'll see in this guide.

Deductible: A fixed annual dollar amount that you pay out of pocket during the calendar year, toward health care services before the health plan begins to pay.

Copay: A fixed dollar amount you pay at the time health care services or prescription drugs are received, regardless of the total charge for service. The health plan pays the rest.

Coinsurance: A fixed percentage of covered health care services or prescription drug costs that you pay, after the deductible amount (if any) was paid. The health plan pays the rest.

Out-of-pocketmaximum: The most you pay before the health plan begins to pay 100% of covered charges.

In-network: Health care professionals and facilities that have contracts with Cigna or Medicare to deliver services at a negotiated rate (discount). You pay a lower amount for those services.

Out-of-network: A health care professional or facility that does not participate in your Cigna or Medicare plan's network and does not provide services at a discounted rate. Using an out-of-network health care professional or facility will cost you more.

Generics: Generic medications have the same active ingredients, dosage, and strength as their brand- name counterparts. You will usually pay less for generic medications.

Preferred brands: Preferred brand medications will usually cost more than generics but may cost less than non-preferred brands on your plan.

Non-preferred brands:  Non-preferred brand medications generally have generic alternatives and/or one or more preferred brand options within the same drug class. You will usually pay more for non-preferred brand medications.

Health Reimbursement Account (HRA): An employer funded account that pays up to a pre-determined amount toward certain out-of-pocket medical costs. Your unused HRA funds may be carried over to the next benefit year if you remain in the same health plan. This is a new plan for 2018.

 

CHOOSING A PLAN

When choosing a plan, it is important to first think about how your family utilizes their medical services.  How healthy are you and/or your family members?  Does anyone have a serious illness? Do you use a lot of hospital services or doctor visits? Does anyone in the family unit use a lot of prescription drugs?  To help determine your families' usage, you may want to log in and use the mycigna.com website to review prior claim history.

Next you want to ask yourself about risk.  Are you someone who would rather budget your annual expenses by paying more for your premiums each pay period, and if you have to utilize services, are you someone who would rather not pay as much out of pocket? Or are you on the opposite end of the spectrum, where you'd rather pay as little as possible out of your paycheck, and would rather take a greater risk of paying more out-of-pocketif and when services are needed.  Or do you fall somewhere in between?

Lastly, look at premium costs.  Based on how you and your family utilize services and taking into consideration how much risk you are willing to take, how much premium are you willing to pay each month?  If you are looking at a higher cost plan is the additional amount that you are spending in premiums greater than the additional cost you would pay in deductibles and coinsurance on a lower cost plan?   See the Comparison of the three plans here.

 

VISION COVERAGE

As part of the preventative care services under your Dartmouth College medical insurance plan (OAP, CCF or HDHP), each covered member of your family receives one eye exam per year at no cost. (I.e. no co-pay, deductible, or coinsurance), when using in-network providers.  You pay 30% of provider costs when using out-of-network providers for routine eye exams.

Corrective lenses (ex. glasses or contact lenses) are not covered.  However, a $50 hardware reimbursement toward the cost of frames, lenses and contacts is offered to members of the OAP and CCF plans.

Types of Vision Providers

• Types of Vision Providers - Depending on the type of vision care you need, you may need to utilize a different type of vision provider.  Please use this flyer as a guide to help you determine which type you will need and    how they are covered under your insurance plan.

• Routine Eye Care Providers - Cigna uses VSP as their vision administrator.  For the most up-to-date list of routine eye care providers in your area; select "Find a Cigna Vision Network Eye Care Professional", then click "search as a guest", and enter your location.

•  Medical Eye Care Providers - Medical related eye claims go through Cigna's network of medical eye care professionals.  For the most up-to-date list of medical eye care providers; click on "Eye Doctor" then click on the type of Eye Professional required.

Vision Discounts

•  Healthy Rewards - Cigna's vision network savings program

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MENTAL HEALTH EXCEPTION BENEFIT

Dartmouth College recognizes that there are a limited number of mental health providers in the Upper Valley who participate with health plans. To improve access to mental health care for Dartmouth members and their families, we have worked closely with Cigna to increase the number of participating in-network providers and to develop a mental health benefit program.  Click here for more information on how this program works.

 

DURABLE MEDICAL EQUIPMENT

Cigna uses a National network of contracted vendors as a convenient and cost efficient way of getting you the necessary medical equipment supplies that you need.  Your Doctor provides the appropriate vendor with a prescription and the vendor will make all of the arrangements to deliver the supplies right to your front door.  If supplies are needed immediately, your doctor can indicate overnight delivery on the provided prescription.  Click here for a full list of DME providers and contact numbers.

 

WELLNESS REIMBURSEMENT

Dartmouth offers a $225 fitness reimbursement benefit per family, per calendar year, for expenses limited to fitness facilities and exercise classes, including online/DVD exercise classes.  Reimbursements are subject to applicable tax withholdings.  Please visit the Wellness at Dartmouth website for more details.

 

INFERTILITY REIMBURSEMENT

An Infertility Reimbursement is available for expenses not covered by your medical plan.  Details on the program are available here.  It is recommended that you contact Cigna prior to submitting for reimbursement to find out what benefits are covered by your medical plan.

 

FINDING A DOCTOR

If you need assistance finding a healthcare provider, there are a number of ways that may assist you in doing so:

•  Contact Cigna

•  Visit Cigna's Website and choose "Find A Doctor", or click here for instructions on how to find a doctor in the Cigna Open Access Plus Carelink (OAPC) network.

•  Visit Dartmouth Hitchcock Medical Center's Find A Doctor website or call the Provider Finder line at (603) 653-3211

•  Consult with your friends or family in the area, who may be able to recommend a provider.

In your search for a provider, you should remember to ask the following:

•  Are you a Cigna Participating Provider? (i.e. in the Cigna Network?)

•  Are you accepting new patients?

 

UNDERSTANDING YOUR CLAIMS

EXPLANATION OF BENEFITS

When you seek services, Cigna may send you a document called an Explanation of Benefits (EOBs).  This is not a bill for services.  You should compare the EOB to the providers bill, once it arrives to ensure that your claim was submitted to Cigna, and paid correctly.  For guidance on how to read your Explanation of Benefits (EOB's) please click here.

MYCIGNA.COM

We would also recommend that you set up an account through mycigna.com.  Here you are able to manage and track your claims, order cards, check your paid to date out-of-pocket limits, find a doctor, estimate medical costs, compare hospitals and doctors, take a health assessment, use the interactive medical library, find information on health conditions, and much more.  Mycigna.com is completely personalized, so it's easy to quickly find exactly what you're looking for.  You can also download the app on your smartphone through the app store or google play.  If you have further questions, you should contact Cigna directly.

•  Mycigna.com Instructions
•  Mycigna.com mobile App Instructions

PRE-CERTIFICATION PROCESS

Pre-certification is the process of determining in advance whether a procedure, treatment or service will be covered under your health care plan. It also helps ensure you get the right
care in the right setting – potentially saving you from costly and unnecessary services. Click here to learn more about Cigna's Pre-certification process.

 

MAKING CHANGES TO YOUR PLANS

You may only elect or make changes to your medical insurance as part of the annual Open Enrollment process, or with a qualifying mid-year status change event. You have 30 days from the date of the event to submit a status change form, although you are encouraged to submit the form early to avoid paying past due premiums.  Changing tiers mid-year is not encouraged and may cause a change to your monthly premiums, and arrears or credits may be due.  You may also be required to pay new deductibles and coinsurance.  Click here for more information on making changes to your plan.

OTHER HEALTH PLAN OPTIONS

The Affordable Care Act (ACA) was passed by Congress, and signed into law by President Obama on March 23, 2010. On January 1, 2014, this law required that most Americans have health insurance or pay a penalty.  All of Dartmouth's plans meet or exceed the requirements of the ACA, however eligible Retirees may prefer to elect insurance on one of the State or Federal exchange programs.  More information is available to you here on the ACA requirements and how they relate to Dartmouth College.  You may also get information directly from the Federal and state sites below:

•  HealthCare.gov
•  Vermont Health Connect
•  Service Link (for NH residents)

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CONTACT INFORMATION

CIGNA

Customer Service: 1-855-869-8619
Send Claims To: PO Box 182223, Chattanooga, TN  37422-7223
Website: http://www.cigna.com/
MyCigna Mobile App: Get the App Here

 

BENEFITS OFFICE

For questions on enrolling in medical insurance or making changes to your medical insurance:

Phone: (603) 646-3588
Website: http://www.dartmouth.edu/~hrs/benefits/
E-mail: human.resources.benefits@dartmouth.edu
Fax: (604) 646-1108

Mailing Address:
Office of Human Resources Office 6042,
7 Lebanon Street, Suite 203,
Hanover, NH 03755

For questions on your membership, coverage, or to request new ID cards, you should contact Cigna directly

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Last Updated: 10/26/17