Barnard College Healthcare Plan for Faculty
and Administrators
*may be spouse,
partner or child
PLAN B
|
Salary Band
|
Employee
Contribution
Individual |
Employee
Contribution
* Plus 1 Dependent |
Employee
Contribution
Plus 2 or More Dependents |
|
<$50,000
|
$158.00
|
$391.00 |
$627.50 |
|
$50,000-$74,999
|
$159.50
|
$407.00 |
$656.00 |
|
$75,000-$99,999
|
$168.50
|
$441.50 |
$710.00 |
|
$100,000-$124,999
|
$170.50
|
$451.50 |
$745.00 |
|
≥$125,000
|
$172.50
|
$461.00 |
$780.00 |
*may be spouse,
partner or child
MAKING
CHOICES
Whether you
choose Plan A or Plan B, whenever you elect to use non-network
healthcare providers, you will be responsible for paying a higher
portion of your medical expenses including a deductible and
coinsurance. However, your expenses will be greater than Plan A.
Before electing either plan it is important to review the
following out-of-network plan provisions.
Coverage under these Plans is subject to coinsurance and
deductibles.
Coinsurance:
Coinsurance is the percentage of the cost of covered
services that Oxford will pay towards your submitted claims once
you have met your deductible.
Deductible:
The
deductible is the amount of dollars in claims for covered services
for which you will be responsible before plan coverage is
available. The amount
of the deductible varies by plan design.
Out-of-Pocket
Maximums:
Out-of-Pocket
Maximum limits the amount of coinsurance and deductible you will
pay in any calendar year. Once
the out-of-pocket maximum is reached for a calendar year, the plan
will pay 100% of covered services for the remainder of that year.
For example:
A plan requires a $500 deductible plus your coinsurance of
20%. The
out-of-pocket maximum for the plan is $1,500 for a single
participant. When the
member pays the $500 deductible and 20% of the next $5,000 worth
of covered services, the member will have paid $1,500 out of
pocket. Having
reached the maximum, Oxford would reimburse the remaining covered
services for the calendar year at 100%.
Usual,
Customary and Reasonable (UCR)
A UCR schedule
is a compilation of maximum allowable charges for various medical
services. They vary
according to the type of provider and geographic location.
Fee schedules are calculated using data compiled by the
Health Insurance Association of America (HIAA) and other
recognized sources. What
Oxford reimburses is based on the UCR.
For example: If
the benefit is 80% of the cost of covered services.
Oxford will reimburse you 80% of the UCR for that service.
If the charges exceed the UCR, you must pay the difference
plus 20% coinsurance.
Coordination
of Benefits
Employees may
be covered by two or more plans (theirs and their spouse/partner)
at the time that services are rendered.
In considering double coverage you should review the
Coordination of Benefits clauses of both plans to determine
whether it is cost effective to pay for two coverages.
Oxford provides detailed information about their
Coordination of Benefits provision.
QUESTIONS
TO ASK YOURSELF BEFORE ELECTING COLLEGE COVERAGE FOR DEPENDENTS
Are you or
other family members covered by another plan? Have you compared the coverage?
Is it cost effective to have two plans?
Did you compare the deductible?
How do the benefits coordinate?
How much did
you pay out of your pocket for your health care last year?
Did you meet your individual or family deductible?
How about out-of-pocket limit?
Do you
regularly use in-network providers?
How often do you go out-of-network?
In a medical
emergency, how much could you afford to spend?
Can you
anticipate your medical expenses from the time you enroll through
December. (You may
switch plans during open enrollment in the fall of the following year for
an effective date of January 1.)
ENHANCED
BENEFITS
Chiropractic
Care
The out-of-pocket benefit for chiropractic care has been
expanded from 50% coverage after deductible, with a maximum of
$500, to 50% coverage after deductible, with a maximum of $1,000.
A network chiropractor referred by a network primary
physician will require a $25 copay.
Physical
Therapy
This benefit is expanded
from 60 visits to 90 visits per condition per lifetime.
Psychiatric
Outpatient Treatment
This benefit is expanded from 30 visits per calendar year to
40 visits per calendar year.
Domestic Partners
Oxford insures both the same sex and opposite sex
domestic partners. Employees interested in this coverage
should contact Sollette Baker at (212) 854-7345.
Alternative
Medicine Program
In February 1997, Oxford established this program as an
addition to their healthcare services. You have access to Oxford's
Alternative Medicine providers at any time.
However, expenses from these providers are not reimbursable
by Oxford. Oxford has arranged discounted fees for Acupuncturists,
Massage Therapists, Yoga Instructors, Nutritionists and
Dietitians.
ENROLLMENT
DEADLINE
New employees
have 31 days from their eligibility date to enroll in the Oxford
Medical Plan.
ELECTION
FORM (PINK FORM)
All employees
are required to complete an election form.
FLEXIBLE
SPENDING ACCOUNT
Health Care
Account
This program
allows you to set aside a portion your salary in pre-tax dollars
to help meet your needs for medical care not covered by your
health plan (such as eye glasses, hearing aids, health plan
deductibles and out of pocket dental expenses).
A list of eligible expenses is available in the Human
Resources Office. This
account is governed by the Internal Revenue Code, which has
established certain rules for reimbursement accounts. Reimbursement accounts are "use it or lose it"
accounts; if by December 31 of the plan year you do not use the
funds in this account, you will lose them.
January 2010
