Vol. 38, No. 18

4-7-2004
By: Susan Wittstock

Open enrollment: Employees can change plans throughout April

No major changes to the university’s
medical plans are being made during this month’s open enrollment period, although co-pay adjustments will occur as a result of medical inflation.

“Our Prime Care plan rates for 2004-05 will be increasing by 9.44 percent, which is well below the national average,” said Susan Marsico, director of benefits. “It is a challenge, but we’re doing our best to provide faculty and staff with affordable, quality benefits.”

Ohio State is working to keep costs down for the benefits plans, but is facing similar increases for health care costs as the rest of the nation, where rates are increasing by 14 to 15 percent for medical care and 17 to 18 percent for prescription drug costs, Marsico said. “I think our faculty and staff are much more aware now that this is a national trend and that this is not just a problem for Ohio State or for the university’s Medical Center,” she said.

Open enrollment packets explaining the changes were mailed to faculty and staff in late March. Faculty and staff are encouraged to enroll online at http://hr.osu.edu/. Those who enroll online will be able to view what plans they are currently enrolled in, view their enrolled dependents to ensure those elections are still valid, and receive a summary of their new choices and immediate confirmation of receipt.

This year, the University Prime Care (UPC) rates will be increasing by 9.44 percent and the Buckeye Health Plan rates will increase by 25 percent. The OSU Health Plan (OSUHP) and the Traditional Health Plan will each increase by roughly 3 percent.

One item of note: The 2004 premium cost is 9.44 percent higher than the 2003 annual premium cost for those enrolled in UPC, for example, but faculty and staff will only see a 7.6 percent monthly increase over what they have paid each month from September 2003 to June 2004. Because salary and premium increases were delayed last year due to uncertainty regarding the state budget process, Ohio State opted to spread the premium increases intended for July and August of 2003 over the remaining 10 months.

PLAN CHANGES

• Due to inflation, home delivery co-pays for the prescription drug plan will increase this year from $15 to $25 for generic drugs; $45 to $55 for preferred brand name; and $65 to $75 for non-preferred brand name. Adjustments to the retail pharmacy drug plan are not needed because payments are made as a percentage of cost, and consequently, increase naturally with inflation.

• Also due to inflation, the co-pay for in-patient hospitalization and outpatient surgery will increase from $200 to $250 and the emergency room co-pay will increase from $75 to $100.

The number of urgent care sites has increased to more than double the previous number of five. Urgent care sites offer after-hours care for serious medical problems that are not life threatening. For a complete listing of locations, visit www.osumhcs.com/ and click on Provider Directory.

• Network plan members will now be limited to 30 visits for chiropractic and occupational therapy. Previously, there was no limit.
“This change brings chiropractic treatment in line with what we offer for physical therapy,” Marsico said. “Also, medical guidelines view 30 visits as the threshold when care switches from treatment to maintenance.”

• Several changes have been made to the benefits offered for weight-loss surgery. The new benefit level will consist of a $25,000 lifetime maximum with a $400 deductible and a 30 percent member co-insurance for all plans, which does not apply to the annual out-of-pocket limit. Individuals enrolled in UPC and Regional University Prime Care (RUPC) must use network providers. These restrictions apply to all related charges, such as the anesthesiologist, diagnostic work-up and room and board, as well as all follow-up services and surgeries.

“Utilization of this benefit at Ohio State has gone up several hundred percent in the past few years. This is a benefit that less than 50 percent of insurers or employers offer and those that do offer a benefit have very strict guidelines,” Marsico said. “We didn’t want to eliminate it, but we felt it was necessary to put a cap on it. This benefit mirrors the plan design for the infertility benefit.”

• The OSU Extension Traditional Health Plan (OSUE-THP) for Extension agents and Ohio State Lima, beginning July 1, has been replaced by an RUPC plan with an extensive statewide provider network.

“Members of OSUE-THP may enroll in any of the university’s other medical plans, but we are encouraging them to consider the RUPC plan. OSUE-THP plan members who select the RUPC plan will experience little adverse effect — a broad provider network, full Prime Care benefits, and premium contributions the same as those offered in the OSUE-THP plan,” Marsico said. “In January, we partnered with Medical Mutual of Ohio to offer the network for our regional faculty and staff.

RUPC members now have a much larger pool of in-network providers from which to choose than they did prior to this network change.”

• A small change was made to the out-of-area plans for UPC and RUPC plans, adding speech therapy coverage at a 20 percent co-insurance, up to a $2,000 benefit.

Open enrollment is available online at http://hr.osu.edu

onCampus Home