Understanding Your Health Plan
It is important that you understand how your health plans work, so that you know what to expect to pay when you use services.
Cost of Your Benefit Plans
Calculating your monthly benefit costs
The Benefit Plan cost estimator is available for you to use at any time to determine your monthly costs/rates.
Medical Plan Costs
Health care is a shared expense between the College and employees. On average, Dartmouth pays 75% of the cost of the health insurance premium, while employees pay 25%. Our contribution schedule is based on salaries, so some employees will pay more than 25% and some pay less than 25%. Employees also pay out-of-pocket costs in the form of deductibles, coinsurance, and copayments.
If you enroll in a health plan, you will receive a medical credit each pay period toward the cost of your health coverage. The amount you receive is determind by your annual salary, your full time equivalency, your emloyment category and the family members that you are covering. Your share of the plan cost/rate is deducted from your paycheck on a pre-tax basis (Research Fellows pay post-tax).
When monthly benefit costs can change
It is important to understand how a change in your position or in your family coverage could impact the cost of your benefit premiums. If you have one of the following changes during the calendar year, the bi-weekly/monthly cost of your medical, supplemental life, and LTD benefit plans may also change:
- A change in employment category: Exempt, non-exempt, SEIU, Research Associate B or Research Fellow. A change in employment category could impact the benefits that you are eligible for, and in some cases could change the amount you pay each pay period for medical coverage.
- A change in pay frequency: Monthly paid to/from biweekly paid. A change in pay frequency will cause a recalculation of all benefits, which will change the cost of your medical, supplemental life and LTD benefit plans if you also have a change in salary.
- A change in Full Time Equivalency (FTE): Benefit eligible FTE’s can range from 0.5 to 1.0. A reduction in FTE will increase the cost of your medical plan and an increase in FTE will decrease the cost of your medical plan. Don't forget that a change in FTE will in most cases, also change your annual salary. This is important when using the benefit cost estimator to check new monthly costs.
- Qualified Life Event: When adding or removing dependents from your plan(s) outside of open enrollment, or when adding or removing coverage all together, your benefit costs will be recalculated and could change if your salary has changed since January 1st.
If you have one of the above changes in the middle of a calendar year, make sure that you understand how your eligibility and monthly plan costs will be impacted. Use the Benefit Cost Estimator or reach out to the Benefits Office if you have questions.
Copays, Deductibles and Coinsurance
Understanding health care can be confusing. That's why it's helpful to know the meaning of commonly used terms such as copays, deductibles, and coinsurance. Knowing these important terms may help you understand when and how much you need to pay for your health care.
For full definitions of each of these terms and an explanation on how out-of-pocket costs work, please click here.
In-Network vs. Out-of-Network
You can avoid unexpected medical bills by knowing how your plan works. Certain choices you make can affect what you'll pay out-of-pocket. Know the difference between in-network and out-of-network care to help save on health care expenses.
To better understand the difference between in- and out-of network costs, and why out-of-network services cost more, please click here.
Filing Out-of-Network Claims
- In-Network - When using Cigna's in-network providers, these providers are required to file your medical claims directly with Cigna on your behalf. The provider will submit the claim to Cigna, Cigna will process the claim and pay the provider. The provider will then send you a bill for the remaining portion of deductible, coinsurance or copay that is your responsibility.
- Out-of-Network – Your health plan provides coverage for services from doctors and facilities that
are not in your plan’s network. But if you do receive covered out-of-network care,
your share of the costs (i.e. deductibles, copays or coinsurance) will usually be
higher than if you receive those services in-network. There is a limit to the amount
your plan will pay for covered out-of-network services called the maximum reimbursable charge (MRC). An out-of-network doctor or facility can bill you directly for any amount above
your plan’s MRC. This is often referred to as “balance billing.” You will be responsible
for paying that amount and these payments do not apply to your deductible or out-of-pocket
Use the links below to find local medical and behavioral heal care providers within Cigna's national network. Look for the "Open Access Plus/Carelink" network.
Preventive care services are provided when you don't have any symptoms and haven't been diagnosed with a health issue connected with the preventive service.
Using these services at the right time can help you stay healthier by:
- Preventing certain illnesses and health conditions from happening.
- Detecting health problems at early stages, when they may be easier to treat.
Preventive care services are typically covered by your plan at 100% with no cost to you. View more information and a list of covered services.
For time sensitive but non-emergent services, you can often avoid costly and time consuming emergency room visits by seeking treatment at one of the Upper Valley's available urgent care clinics.
All three of Dartmouth's medical plans include prescription drug coverage through
Express Scripts. Your out-of-pocket costs are determined by the medical plan that
For more information about Dartmouth's pharmacy benefits, please click here.
As part of the preventive care services under your Dartmouth College medical plan,
you are eligible for one free eye exam when using a VSP in-network provider. VSP
is Cigna's vision partner.
For more information about how your visition benefit works, please click here.
Behavioral & Mental Health
Traditional Behavioral Health counseling is available through your Cigna health plan at the cost of a PCP copay on the OAP and CCF plans while costs are subject to plan deductibles and coinsurance on the HDHP plans.
Mental Health Exception Benefit: Dartmouth College also recognizes that there are a limited number of mental health providers in the Upper Valley who participate with health insuance carriers. To improve access to behavioral health care for Dartmouth employees and their families, Dartmouth has worked closely with Cigna to increase the number of Cigna participating providers in the Upper Valley, and to develop a behavioral health exception benefit program for those using out-of-network providers.
For additional emotional support tools and resources, like the Faculty/Employee Assistance Program, virtual behavioral care options, free apps, videos and other helpful resources, please visit Wellness at Dartmouth.
EMMA Can Help
Emma is an online assistance tool that is incorporated in the FlexOnline benefits enrollment system, that can help you with the medical plan decision making process. Emma takes the annual cost to have a medical plan and adds the estimated cost of what you might spend to use your health plan (based on how you answer certain questions), and lets you know which plan she believes might be most cost effective for you. Please note: Emma is not the ultimate decision maker, you are. So please feel free to try various scenarios and see if Emma changes her selection, but remember, ultimately, the final decision is yours.
Tax Advantage Plans
Tax advantage plans are special IRS governed accounts that allow you to receive money from Dartmouth or put aside your own money on a pre-tax basis, that will later be used to pay for eligible medical expenses. Your employment category, your FTE, your annual salary and the health plan that you choose, determines which tax advantage plan(s) you are eligible to participate in and how much money you are eligible to receive from Dartmouth and how much you are eligible to contribute of your own funds during the calendar year. Access a helpful chart that demonstrates how the Cigna plans work with the tax advantage plans.
Transparency In Coverage Rule
In response to the federal Transparency in Coverage Rule, the link provided below, leads to the machine readable files that have been made available, and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers.
The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
Access the Machine Readable Files.