Open enrollment, changes in health plans announced

Open enrollment for the various benefit plans will be held Wednesday, Dec. 1, through Tuesday, Dec. 7. During the open-enrollment period, employees may change health and dental plans, add eligible family members to health and dental plans, and set up a Flexible Spending Account for 1994. Changes in health-plan and dental-plan enrollment will take effect on Jan. 1, 1994.

Open Enrollment will be held from 9:30 a.m. to 4 p.m. on weekdays from Wednesday, Dec. 1, through Tuesday, Dec. 7, in the second-floor conference room in Ingleside Hall.

The 1994 monthly health-plan premiums for full-time employees are listed in the table below. These premiums reflect a set of changes that will take effect on Jan. 1, including the merger of the Comprehensive and Maroon plans and the addition of a new salary tier for determining employee health premiums.

The 1994 salary tiers will be as follows: Tier I Under $25,000 Tier II $25,000-$44,999 Tier III $45,000-$65,000 Tier IV Over $65,000

"The University's goal in managing health coverage over the past decade has been to contain the cost of an excellent set of choices," said Henry Webber, Associate Vice President for University Human Resources Management. "The 1994 health-plan premiums and coverage options reflect that ongoing effort."

In order to achieve this goal, the University adopted in 1990 a set of principles to guide the structure and pricing of health options. These principles are as follows:

1. That all employees enrolled in a health plan should contribute toward the cost of that coverage;

2. That employees who select a more expensive plan should pay a greater percentage of the total cost of that coverage than those who select a less-expensive plan;

3. That the University should offer at least one plan that provides comprehensive coverage at low cost. To uphold these principles, the University has implemented price changes over the past three years, including the re-establishment of employee premiums for participation in the HMO-type plans and the introduction of salary-graded employee premiums for all plans. The University also contracted with the EPIQual Preferred Provider Network to negotiate discounts with a set of Chicago-area physicians and hospitals for employees enrolled in the indemnified plans. All of these changes were based upon the recommendations of the University Committee on Health Benefits, chaired by William Pollak, Associate Professor in the School of Social Service Administration.

In 1994, the University expects to contribute an average of 87 percent of the cost of all health plans, according to Webber. "This compares favorably with an average employer contribution of 79 percent at a set of peer research universities and large Chicago-area employers," he said.

In addition, the University will merge the Comprehensive Plan into the Maroon Plan -- offering one indemnified plan instead of two -- and several changes will be made to the Maroon Plan. "These changes will enable the University to continue to offer an indemnified plan at an affordable cost," explained Robert Riesman, Director of the Office of Staff Benefits. "The changes are designed to encourage Maroon Plan subscribers to choose hospitals and physicians that are part of the EPIQual Preferred Provider Network."

The EPIQual network includes 43 hospitals and 3,500 physicians in the Chicago area. Participating providers include the University of Chicago Hospitals and physicians, Rush-Presbyterian-St. Luke's Medical Center, Children's Memorial Hospital and Ingalls Memorial Hospital. Providers recently added include Northwestern Memorial Hospital, the Northwestern Medical Faculty Foundation and Palos Community Hospital.

The changes in the Maroon Plan are as follows:

_ A $200 deductible for each admission to a non-network hospital has been added.

_ Employee co-payments for covered services provided by a non-network physician or hospital will be increased from 20 percent to 25 percent. Co-payments will remain at 10 percent for covered services provided by network providers. Co-payments in all cases are made up to the out-of-pocket maximum.

_ Out-of-pocket limits will be administered on the basis of a maximum of one per family, rather than the current arrangement of two per family. Maximums will be reduced to correspond to the four salary tiers for premiums, and are as follows: Under $25,000 $1,000 $25,000-$44,999 $2,000 $45,000-$65,000 $3,000 Over $65,000 $4,000

Faculty and staff members who are currently enrolled in the Comprehensive Plan will automatically be enrolled in the Maroon Plan. Employees who wish to enroll in a different plan must complete an enrollment form for that plan.

Dental Coverage

In addition to health coverage, employees may also choose dental coverage under the First Commonwealth plan. Such coverage is particularly useful for employees enrolled in the HMO plans, none of which provides dental coverage. This option offers comprehensive coverage through over 700 private-practice dentists for commonly needed dental procedures. The plan requires no annual deductibles and has no annual limitation on coverage, although co-payments are required for most services.

Monthly premiums for calendar year 1994 are as follows: Single $10.40 Single plus one $18.20 Family $24.95

If an employee enrolls in the First Commonwealth dental plan for 1994, the enrollment will remain in effect through Dec. 31, 1994. If an employee is currently enrolled in the First Commonwealth dental plan and wishes to discontinue coverage, he or she must terminate the coverage by completing a termination form during Open Enrollment.

Flexible Spending Accounts

Employees who wish to contribute either to a Health Care Flexible Spending Account or to a Dependent Care Flexible Spending Account during 1994 must complete an enrollment form during Open Enrollment. A Flexible Spending Account enables employees to use pretax dollars to pay for certain medical, dental and dependent-care expenses, in compliance with IRS regulations. Employees with questions about Open Enrollment should call a benefits counselor at 702-9634 or stop by the Benefits Office in Ingleside 103.