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2015 MEDICAL BENEFITS

 Attention
The information found on this page and its attached links is for plan year 2015.  This information is available
FOR REVIEW PURPOSES ONLY
For information on current year benefits, please return to the MAIN BENEFITS WEBPAGE and scroll down to the list of current year benefits.

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CHANGES FOR 2016

NEW -No increase in premiums for active employees in 2016 and no plan changes to OAP1 or OAP2

NEW - HDHP -No more collective/family accumulators on family plan.  Plan returns to individual deductibles and coinsurance

NEW - HDHP - Individual deductible increased to $2,600 per person

NEW - OAP1 and OAP2 glasses and contact lenses

  • Children under the age of 19 always covered at 100%
  • Age 19 and over covered at 100% once out of pocket maximum is met

REMINDER - Premiums are based on salary and FTE, therefore a salary change in 2015 may impact your premiums

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Dartmouth College offers three self insured medical plan options through Cigna Health Care, for all benefits eligible employees. As a self insured employer, Dartmouth utilizes Cigna as a third party adiministrator, to review and manage claims, while the College pays the cost of these claims.  Below is important information regarding all three plans.  It is important that you take the time to review this information carefully, comparing plan structure to your medical premium costs.  Employee's can save money, by learning how to choose and utilize the plan that best suits their families usage.

PLANS

PLAN OPTIONS

Employee's have the option of selecting one of three plans through Cigna Health Care:

•  Open Access Plan 1 (OAP1) - A $250 deductible plan.
•  Open Access Plan 2 (OAP2) - A $500 deductible plan.
•  High Deductible Health Plan (HDHP) - A $2,500 deductible health plan ($2,600 in 2016) with Health Savings Account (HSA) eligibility.

An overview of the three plans can be found on the

2015 Comparison Chart

2016 Comparison Chart

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TIER LEVELS

Employees can pick from four tier levels for their Medical Insurance:

•  Single - The employee only 
•  Employee plus child(ren) - The employee plus one or more children
•  Employee plus spouse - The employee plus their spouse, civil union partner or same sex domestic partner
•  Family coverage - The employee plus their pouse, civil union partner or same sex domestic partner and one or more children of the covered parents.

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HEALTH INSURANCE 101

Many people have trouble understanding how health insurance plans work.  We have created a document explaining co-payments, deductibles, coinsurance and global out-of-pocket maximums with an example of how they all work together.  Please take a few minutes to review the following document called Health Insurance 101

COSTS

Members pay a monthly premium to hold the medical insurance.  Then, when services are used, the employee 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.

PREMIUM COSTS

Dartmouth College contributes to the cost of your medical insurance premiums on a per pay period basis. The amount that Dartmouth contributes is determined by your benefit plan, your full time equivalency (FTE) and your annual base salary. When reviewing premiums in the FlexOnline system and on your paystub, you will notice both the full premium amounts and the Dartmouth Credit displayed. To determine your true out-of-pocket amount, you will need to subtract the Dartmouth credit from the full premium amount. You may also refer to the Employee Medical Plan Cost Estimator to help determine the out-of-pocket cost of your medical premiums. Medical premiums are paid on a pre-tax basis through your paycheck. Research Fellows pay medical premiums on a post-tax basis.

2016 -No increase in premiums for active employees in 2016, however because premiums are based on salary and FTE, a salary change in 2015 may impact your premiums.

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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 global out-of-pocket maximum has been met. 

Out-of-network providers are not required to get pre-authorizations on your behalf, whereas in-network providers are.  You may be responsible for making sure your out of network services have been pre-authorized prior to the service start date.

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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CO-PAYMENTS

Co-payments are a fixed amount of money that the member pays, each time they visit their in-network Primary Care Physician (PCP) or a specialist.  When utilizing a PCP or specialist outside the Cigna network, costs are subject to out-of-network deductibles and coinsurance.  The High Deductible Health Plan does not have co-payments, and you will need to pay the full cost of each visit until the annual deductible has been satisfied. 

TYPE OF VISIT OAP1 OAP2 HDHP
Primary Care Physician $20 $20 N/A
Physical/Occupational/Speech Therapy $20 $20 N/A
Chiropractor $20 $20 N/A
Mental Health Provider $20 $20 N/A
Cardiac Rehab $20 $20 N/A
OBGYN $20 $20 N/A
Specialist $30 $30 N/A
Emergency Room $100 $100 N/A

An overview of the three plans can be found on the

2015 Comparison Chart

2016 Comparison Chart

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DEDUCTIBLES

A Deductible is an annual amount that each member must pay toward certain services before the insurance will begin to pay.  Each plan option has a different deductible level. Whenever these services are utilized, the member must pay 100% of the cost until the annual deductible has been satisfied for the year.

On OAP1 and OAP2 the deductible is accumulated by individual member. As each individual satisfies the individual deductible ($250 or $500), services will then be covered at the coinsurance level. This is true for each family member, until the family unit as a whole, satisfies the annual family limit ($750 or $1,500). When there are only two people on a plan, you will only need to meet two individual deductibles ($500 or $1,000).  When utilizing services out-of-network, claims are subject to the out-of-network deductible.

The annual deductible limits for OAP1 and OAP2 in 2015 will be as follows:

 IN-NETWORK OAP1 OAP2
Individual $250 $500
2 People $500 $1,000
Family (3+) $750 $1,500

The HDHP deductible accumulates as a family unit, not as individuals.  Those on single coverage only need to meet the $2,500 deductible as they did before, after which time, services will be covered at the coinsurance level.  Those with two or more members on the plan must meet the full $5,000 annual deductible prior to coinsurance covering.  This means that one family member could potentially pay the full $5,000 in deductible on this plan.

2016 - The deductible will no longer accumulate as a family unit, and instead will accumulate as an individual.  This means once one individual reaches $2,600 in deductible, all claims for this individual for the remainder of the year will only be subject to coinsurance and out of pocket maximum.

Prescription drugs will continue to count toward the deductible on the HDHP. When utilizing services out-of-network, claims are subject to the out-of-network deductible.


 IN-NETWORK HDHP
Individual $2,500
2 People $5,000
Family (3+) $5,000

An overview of the three plans can be found on the

2015 Comparison Chart

2016 Comparison Chart

2016 - The individual deductible for the High Deductible Health Plan will increase to $2,600 and $5,200 for two people or family plans. This means an individual can potentially reach their out of pocket maximum sooner, resulting in less out of pocket costs to the member.

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COINSURANCE

On OAP1 and OAP2 claims are paid at the coinsurance level, once the individual annual deductible has been met. Coinsurance is a percentage of the "allowed amount", regardless of whether you are using services in or out-of-network.  You will continue to pay coinsurance, until the individual global out-of-pocket limit has been met. When utilizing services out-of-network, claims are subject to the out-of-network coinsurance level.

The coinsurance levels for OAP1 and OAP2 in 2015 will be as follows:

IN-NETWORK OAP1 OAP2
Individual 10% 20%
2 People 10% 20%
Family (3+) 10% 20%

The HDHP will have a coinsurance level.  Once the plan's accumulated deductible has been satisfied, services will be covered at the coinsurance level until the plan's global out-of-pocket limit is reached.  This means that if you have more than one person on your HDHP, the plan will not begin to pay coinsurance until the full $5,000 deductible has been met, after which time it will pay 90% of the "allowed amount" and the member will pay the remaining 10%. 

2016 - The coinsurance will calculate per individual, and no longer as a family accumulator.  This means an individual can potentially reach their out of pocket maximum sooner, resulting in less out of pocket costs to the member.

Prescription drugs are subject to coinsurance on the HDHP and will be covered at 100% once the global out-of-pocket limit has been met.  When utilizing services out-of-network, claims are subject to the out-of-network coinsurance level.

The coinsurance levels for the HDHP in 2015 will be as follows:

IN-NETWORK HDHP
Individual 10%
2 People 10%
Family (3+) 10%

An overview of the three plans can be found on the

2015 Comparison Chart

2016 Comparison Chart

 

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GLOBAL OUT OF POCKET MAXIMUM

The Global out-of-pocket maximum will include prescription drug costs.

On the OAP1 and OAP2 plans, members will pay an accumulation of medical co-pays, prescription co-pays, deductibles and coinsurance until the global out of pocket maximum for an individual has been met. After which time, services for that individual are covered at 100%.  As each family member reaches the individual global out-of-pocket limit ($2,250 or $3,400) their services are also covered at 100%. Once the family unit of three or more members, reach the family global out-of pocket limit ($6,750 or $10,200), all services for the family are then covered at 100%. When there are only two people on a plan, you will only need to meet two individual global out-of-pocket maximums ($4,500 or $6,800).  When utilizing services out-of-network, claims are subject to the out-of-network global out-of-pocket maximum.

The global out-of-pocket limits for OAP1 and OAP2 in 2015 will be as follows:

IN-NETWORK
OAP1 OAP2
Individual $2,250 $3,400
2 People $4,500 $6,800
Family (3+) $6,750 $10,200

On the HDHP, members will pay an accumulation of deductibles and coinsurance for medical and prescription drug costs until the selected plan's accumulated global out-of-pocket limit has been met.  For example, a member on an individual plan will pay out-of pocket until the $4,000 global out-of-pocket maximum is reached, after which time all services will be covered at 100% (same as OAP1 and OAP2). However,an individual utilizing services on a family plan will continue to pay out-of-pocket until the cumulative family costs have reached ($8,000).  NOTE: One individual can potentially pay the full $8,000 if no other family members are utilizing services.

2016 - The family accumulator will go away in 2016, meaning one individual will max their deductible at $2,600 and their global out of pocket maximum at $4,000 when using in-network services. When utilizing out of network services, individual out of network deductibles, coinsurance and out of pocket maximums may apply.

The global out-of-pocket limits for the HDHP in 2015 will be as follows:

IN-NETWORK HDHP
Individual $4,000
2 People $8,000
Family (3+) $8,000

2016 - The Global In-Network, Out of Pocket Maximum for 2016 will be $4,100 for an individual and $8,200 for a HDHP of 2 or more people.

An overview of the three plans can be found on the

2015 Comparison Chart

2016 Comparison Chart

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PREVENTIVE CARE SERVICES

With the implementation of the Health Care Reform Bill, preventive care services are available to you through in-network providers at no cost (i.e. no co-pay, deductible, or coinsurance).  Please note: When utilizing preventive care services out-of-network, these services may be subject to out-of-network deductibles and coinsurance.  The United States government has determined the list of preventive care services and further information is available at the links below:

•  Preventive Services Covered Under the Affordable Care Act
•  U.S. Preventive Services Task Force Recommendations
•  Cigna Preventive Health Care Services
•  Pharmacy Preventive List

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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 are you someone who would rather budget your annual expenses by paying a higher premium each pay period, but less out of pocket if you have to utilize services? Or are you on the opposite end of the spectrum, where you'd rather pay as little as possible in premiums out of your paycheck, and are able to pay more out of pocket when utilizing services.  Or do you fall somewhere in between?  Are you looking for a tax break, by utilizing a Health Savings Account?

Once you get a feel for how much you might spend out of pocket on each plan for services in a year, compare that to the amount of annual premium you would pay per plan. 

Finally, do you have a spouse or same sex domestic partner that also works at Dartmouth? If so you may want to consider reviewing premium costs for multiple tier options, such as couples each looking at single coverage versus automatically taking employee plus spouse coverage, this can often be less expensive. Is employee plus spouse coverage less expensive on one person's plan than the other?  If you have a family, you may want to look at the various options there as well.  Employee plus child(ren) in combination with a single person plan can be less expensive than family coverage.

Below is a diagram showing the basic differences between each of the three plans.*

IN-NETWORK OAP1 OAP2 HDHP
Risk Factor Lowest Risk Mid-Range Risk Highest Risk
Premium Cost Highest Premiums Mid-Range Premiums Lowest Premiums
Co-payments $20 PCP and $30 Specialist $20 PCP and $30 Specialist N/A
Individual Deductible $250 $500 $2,500 ($2,600 in 2016)
Coinsurance 10% 20% 10%
Vision Hardwear $50 Reimbursement $50 Reimbursement N/A
FSA/HSA Eligible FSA FSA FSA/HSA

* See Summary Plan Documents for more detailed information on what is and is not covered on the plans.

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OTHER SERVICES

VISION COVERAGE

As part of the preventative care services under your Dartmouth College medical insurance plan (OAP1, OAP2 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 OAP1 and OAP2 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
•  Delta Dental's Vision Discount Program - If you are enrolled in the dental plan, you may also be eligible for vision discounts through Northeast Delta Dental.

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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 employees 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.

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DURABLE MEDICAL EQUIPMENT

Cigna uses a National network of contracted venders as a convenient and cost efficient way of getting you the necessary medical equipment supplies that you need.  Your Doctor provides the appropriate vender with a prescription and the vender 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.

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INTERNATIONAL COVERAGE

When traveling outside the United States on Dartmouth related business, Cigna offers global health benefits to employees and their family members traveling with them.  Click here for more information on the Cigna Medical Benefits Abroad (MBA) program.

When traveling outside of the United States for non Dartmouth related business, Cigna offers urgent and emergency care services for you and your covered family members traveling with you. Click here for more information on the Cigna international urgent and emergency care program.

WELLNESS REIMBURSEMENT

Dartmouth offers a Wellness Benefit consisting of a $200 reimbursement via Cigna.  Dartmouth has recently expanded the types of wellness-related categories that can be submitted under the benefit, including weight management, stress management, tobacco cessation and others. Watch for more information on the Wellness at Dartmouth website.

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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.

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RETIREE MEDICAL INSURANCE

Retirees under age 65 may elect from the Open Access Plan 1 (OAP1) the Open Access Plan 2 (OAP2) or the High Deductible Health Plan (HDHP) and may be eligible for some of the benefits outlined on this page.

Retirees age 65 and over may elect the Dartmouth College Medicare Supplement (DCMS) Plan. Click here for more information on the DCMS plan.

Fore more information on retiree benefits please visit our retiree webpage.

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FINDING A DOCTOR

If you are new to the area, or new to Cigna, you may need assistance finding a healthcare provider.  There are a number of ways that may assist you in doing this:

•  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, co-workers 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?

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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 global 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

 

 

If you have trouble viewing the above video, please use the video link below.

Video Link: https://youtu.be/KlwysRtTtRk

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.

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MAKING CHANGES TO YOUR PLANS

You may only elect or make changes to your medical insurance as a new hire/benefits eligible employee, 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 make this change through the FlexOnline system.  Changing tiers mid-year will cause a change to your monthly premiums and arrears or credits may be due.  Changing plans mid-year is generally not permitted, as you will be required to pay new deductibles and coinsurance. For more information, please visit our webpage on mid-year qualifying events.

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 employee's 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: www.cigna.com/
MyCigna Mobile App: Get the App Here

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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: 7/24/18