Medical Plan Changes

Physician Services

  • Primary care physician office and ER physician co-pay increases from $30 to $35 per visit.
  • Specialty physician co-pay increases from $35 to $40 per visit.
  • Coverage for physician services rendered by an out-of-network provider in Alabama will increase from 50 percent to 60 percent of the allowance.

Preventative Services

  • Well-childcare office visit co-pay decreases from $15 to $0.
  • Adult routine annual physical co-pay decreases from $30 to $0.
  • Routine bone mineral density screening co-pay decreases from $25 to $0.
  • Specific in-network preventative services as outlined in the federal health care reform legislation will be provided at no cost to employees.

Inpatient/Outpatient Hospital Facility Services

  • Inpatient hospital co-pay increase from $300 to $350 per admission, with a maximum of three inpatient co-pays per person per calendar year.
  • ER facility co-pay increases from $100 to $125 per visit.
  • Outpatient facility co-pays for diagnostic lab, x-ray and tests increase from $75 to $125.

Annual Deductibles

  • The $250 annual deductible for "other covered services" is being replaced with a $125 annual deductible that applies to all hospital, physician and other covered services received each calendar year, with a maximum of three deductibles per family.
  • The $100 annual prescription drug deductible is being increased to $125 per person, with a maximum of three prescription drug deductibles per family.

Plan Eligibility

  • In accordance with the federal health care reform legislation, adult children up to age 26, regardless of marital status, student status, residency or financial dependency, will be eligible for coverage under the University's medical plan effective Jan. 1, 2011.  An adult child is defined as a biological child, adopted child, foster child or stepchild. A foster child is an child placed with you by an authorized placement agency or by judgment , decree or other order of any court of competent jurisdiction.
  • Any other children, such as grandchildren, must meet the same eligibility requirements as foster children and must be placed with you by decree or other order of any court of competent jurisdiction (for examples, legal custody or legal guardianship). The eligibility requirements for permanently incapacitated dependents age 26 and over remain the same.

Other

  • The $2,000,000 lifetime coverage limit per plan member will be eliminated Jan. 1, 2011.
  • The pre-existing condition exclusion for medical plan members under age 19 will be eliminated Jan, 1, 2011.
  • The 72-hour notification requirements for out-of-network ER services will be eliminated Jan. 1, 2011. ER benefits for an accidental injury will be the same whether the services are rendered by an in-network or by an out-of-network provider.

 

Prescription Drug Changes

 

Retail Pharmacy Benefits (In-Network Pharmacy)

From

To

Generic co-pay for 31 day supply

$15

$15

Preferred brand co-pay for 31 day supply

$30

$40

Non-preferred brand co-pay for 31 day supply

$40

$50

Brand with generic alternative co-pay for 31 day supply

$50

$60

Mail-Order Pharmacy Benefits

From

To

Generic co-pay for 90 day supply

$15

$30

Preferred brand co-pay for 90 day supply

$60

$90

Non-preferred brand co-pay for 90 day supply

$75

$105

Brand with generic alternative co-pay for 90 day supply

$100

$150