State Health Insurance

State Health Insurance
knowyourbenefits.dfa.state.ms.us

Application for Health Insurance Coverage

Please note that you must complete an Application for Health Insurance Coverage even if you are opting to waive coverage and not enrolling in our group plan.

The health insurance coverage offered by the University is provided by the State of Mississippi. The plan is self-funded which means claims are paid from the premiums received from the University, other state agencies, and their employees. Blue Cross Blue Shield of Mississippi is contracted to pay medical claims.

Effective Date
Health insurance coverage for you and your enrolled dependents is effective on the first day of employment. You have thirty-one (31) days from date of hire to elect or waive coverage. However, the coverage is still effective on the first day of employment and premiums will apply.

After the initial enrollment period (the first 31 days), changes are only permitted when you experience a ‘qualifying event’ or during the University’s annual Open Enrollment held each October. Changes elected during Open Enrollment are effective the following January.

Qualifying Events include:

Change in legal marital status
Birth, adoption, placement of a child for adoption or foster care, or death
Change in employment status
Change in work schedule
Change in unmarried dependent status
Change in residence or worksite
*Employees must complete paperwork within 60 days of the qualifying event. A more detailed description of qualifying events is available in the Fringe Benefits Summary Booklet which can be accessed by visiting http://www.olemiss.edu/depts/HR/benefits/booklet.pdf.

Employee Type & Employee Premium

Horizon Employee – any employee hired on or after January 1, 2006 who has never been employed by any State of Mississippi agency on a full-time basis. The University pays 95% of the premium for the employee coverage for the Select Plan and 100% of the premium for the Base Plan (details follow).

Legacy Employee – any full-time employee hired before January 1, 2006 by the University or any State of Mississippi agency (such as a community/junior college, public library, public school, etc). The University pays 100% of the premium for the employee coverage for either the Select Plan or the Base Plan.

Dependent Coverage and Dependent(s) premium
The following family members (dependents) may be enrolled in the health insurance plan. If you enroll a dependent(s), you are responsible for 100% of the premium for the dependent(s) coverage.

Employee’s spouse
Unmarried dependent children under age 19
Unmarried dependent children ages 19 – 25 who are enrolled full-time at an accredited high school, college, or university
Unmarried, handicapped dependent children age 25 and older

Plan Options
There are two (2) options offered with the State Health Insurance: the Select Option and the Base Option (High Deductible Health Plan). Both options provide similar health coverage; however, there are differences in the monthly premium, calendar year deductible for medical benefits, maximum out-of-pocket costs, and pharmacy deductible. A more detailed explanation of each option can be found in the Summary Plan Description (SPD). A copy of the SPD was provided during your initial meeting with Human Resources staff.

Employee Monthly Premiums

Horizon Employee
Monthly Premiums
(hired on or after January 1, 2006)

	Staff & 12 Month Faculty		9 Month Faculty Members
Coverage	Select Plan	Base Plan	Select Plan	Base Plan
Employee	$18.00	$0.00	$24.00	$0.00
Employee & Spouse	$403.00	$339.00	$537.32	$452.00
Employee & 1 Child	$153.00	$89.00	$204.00	$118.68
Employee & Children (2 or more)	$289.00	$225.00	$385.32	$300.00
Employee, Spouse, & Children	$581.00	$517.00	$774.68	$689.32

The University covers and pays 95% ($343.00) of the Employee's premium for the Select Plan
and 100% of the employee's premium for the Base Plan.

Legacy Employee
Monthly Premiums
(hired before January 1, 2006)

	Staff & 12 Month Faculty		9 Month Faculty Members
Coverage	Select Plan	Base Plan	Select Plan	Base Plan
Employee	$0	$0	$0	$0
Employee & Spouse	$385.00	$339.00	$513.32	$452.00
Employee & 1 Child	$135.00	$89.00	$180.00	$118.68
Employee & Children (2 or more)	$271.00	$225.00	$361.32	$300.00
Employee, Spouse, & Children	$563.00	$517.00	$750.68	$689.32

The University covers and pays 100% ($361.00) of the Employee's premium
for either the Select Plan or the Base Plan.

Premiums are collected one month in advance through bi-monthly payroll deductions. For example, in January premiums will be payroll deducted for February coverage. The State mandates that employees hired on or before the 15th of the month must pay a full month’s premium. Those hired after the 15th are only responsible for half-month’s premium for the first month of coverage.

Benefit Plan Summary
A summary of benefits for the Select Option and Base Option (High Deductible Health Plan) is provided in the following tables. For more detailed information please refer to the Summary Plan Document.

Select Coverage Option

	In-Area		Out-of-Area
	In- Network	Out-of- Network	In- Network	Out-of -Network
Calendar Year Deductible (per member)	$500	$1,000	$500	$1,000
Co-insurance *	80/20	60/40	80/20	75/25
Out-of-Pocket (after deductible)	$2,000	$3,000	$2,000	$3,000
Calendar Year Family Deductible	$1,000	$2,000	$1,000	$2,000

Base Coverage Option

	In-Area		Out-of-Area
	In- Network	Out-of- Network	In- Network	Out-of- Network
Calendar Year Deductible (per member)	$1,100	$1,100	$1,100	$1,100
Co-insurance *	80/20	60/40	80/20	75/25
Individual / Family Out-of-Pocket (after deductible)	$2,450/ $4,900	$3,950/ $7,900	$2,450/ $4,900	$3,950/ $7,900
Calendar Year Family Deductible	$2,200	$2,200	$2,200	$2,200

* Co-insurance percentages may vary depending on the type of benefit.
* Some benefits may be paid at a different co-insurance (See SPD).

In-Area: participants whose principal/primary residence is located within the State of Mississippi.
Out-of-Area: participants whose principal/primary residence is located outside the State of Mississippi.
In-Network: physicians, hospitals, and other health care providers who participate in the Advanced Health Systems (AHS) network. These providers agree to accept the allowable charge fees set by AHS. The list of network providers is available at knowyourbenefits.dfa.state.ms.us.
Out-of-Network: medical care providers who are not participants in AHS. Participants who use these providers are responsible for payment of fees over the allowable charge. Participants are also subject to a higher calendar year deductible and higher co-insurance amounts.

Lifetime Maximum
The lifetime maximum amount payable under both coverage options for each covered participants (employee and dependents) is $2,000,000.

Health Savings Account (HSA) and Base Option (High Deductible Health Plan)
University employees participating in the Base Option (High Deductible Health Plan) may be eligible to contribute to a Health Savings Account (HSA). Currently, HSA’s are not offered through the University or the State of Mississippi. Enrollees in this option who wish to have an HSA must make arrangements through their own financial institution to establish an account. HSA participants will be responsible for reporting account contributions on their tax returns to receive any tax benefits.

Provider Network
AHS State Network (Advanced Health Systems) is the provider network for the Plan. Participants are encouraged to utilize Network providers to receive the maximum benefit. However, you have a choice to be treated by any provider and to change providers at any time. Participants utilizing non-participating providers will be responsible for any charges in excess of the allowable charge, in addition to the higher calendar year deductible and coinsurance. A list of network providers (doctors and other health care providers) is available at knowyourbenefits.dfa.state.ms.us

Pre-Existing Condition
A pre-existing condition is any condition for which medical advice, diagnosis, care, treatment, consultation, or a prescription drug was recommended or received within six (6) months prior to your effective date. Pregnancy, genetic information, and prescription drugs are not considered pre-existing conditions. Covered benefits under the plan will not be provided for any pre-existing condition until coverage in this Plan has been in effect for a period of twelve (12) consecutive months (or 18 months for late entrants). Participants may receive a waiver of pre-existing condition if a Certificate of Creditable Coverage from a qualified plan is provided. For more information please refer to the Summary Plan Description.

Student Verification
Dependent children who become nineteen (19) are required to provide student verification letters to The Department of Human Resources to confirm full-time student status at an accredited high school, college, or university to maintain coverage under the Plan.

Maternity
This benefit is available to covered female employees or a covered wife of a male employee. Benefits are payable as defined in the Summary Plan Description.

Well Child Care
This benefit is available to participants with covered dependent children under 18 years of age. Benefits include:

Well-child physician office visits paid at 100% not subject to a calendar year deductible. Covered procedures are determined by age and gender and include tests for hemoglobin, hematocrit, and blood pressure checks. For an all-inclusive list of covered procedures visit the state health plan’s website at http://knowyourbenefits.dfa.state.ms.us/.
Well-newborn nursery care expenses are covered at 100% of the Allowable Charge subject to a calendar year deductible (Select Coverage) and the family calendar year deductible (Base Coverage).
Immunizations are paid at 80% of the Allowable Charge and are subject to the individual calendar year deductible (Select Coverage) and the family calendar year deductible (Base Coverage).

Wellness/Preventive Coverage for Adults
Benefits for wellness and preventive services are available for participants ages 18 and older. Benefits include office visits and certain diagnostic tests based on age and gender as defined by the plan. An all-inclusive list of covered procedures is available by visiting the state health plan’s website at http://knowyourbenefits.dfa.state.ms.us/. Network providers must be used to receive this benefits.

Wellness benefits are payable at 100% up to a maximum of $1000 provided the participant completes the Health Risk Assessment (HRA). This assessment can be accessed at http://knowyourbenefits.dfa.state.ms.us/ or www.healthytogether.net/Mississippi. Participants without internet access can request a copy by calling (877) 289-9109. Complete the HRA prior to scheduling an appointment with a network provider. Remember, you will not receive the full benefit of $1,000 coverage if you do not complete the HRA.

Utilization Review Program
Participants must notify Intracorp at (800) 523-8739 to pre-certify various medical services. A sample list is provided. An all inclusive list is available in the SPD.

Inpatient Hospital Admission
Specified Outpatient Diagnostic Tests
Private Duty and Home Health Nursing Services
Solid Organ and Bone Marrow/Stem Cell Transplants
Home Infusion Therapy Services

Certification determination does not guarantee either payment of benefits or the amount of benefits that will be paid. Penalties may be assessed for failing to adhere to pre-certification guidelines. Plan participants are strongly encouraged to read the Plan’s Utilization Review Program section of the SPD.

Prescription Drugs

Catalyst Rx is the pharmacy benefit manager for the plan's Co-payment Prescription Drug Program.
Each Select Coverage participant must satisfy a $50 calendar year deductible prior to receiving the co-pay rates. Base Coverage participants must satisfy the individual or family annual deductible for all expenses (medical and pharmacy) prior to receiving the co-pay rates.

The co-payment amount for covered drugs is as follows:

Prescription Drug Type	Co-pay (1-30 day supply)
Generic Drug	$13
Preferred Brand Drug (preferred drug list is available at druglist.com)	$33
Other Brand Drug (no generic equivalent)	$55

Prescription Drug List: Contact Catalyst Rx at 1-866-757-7839 or go to http://knowyourbenefits.dfa.state.ms.us

Some prescriptions require prior authorization. The prescribing physician must contact Catalyst Rx at 1-866-757-7839 and provide appropriate documentation.

Mail Order Service for Prescriptions
Participants taking prescription drugs regularly for a chronic health condition may purchase a 90-day supply of the prescription drug at a 60-day rate (a savings!) through mail order service.

The co-payment for mail order prescriptions is as follows:

Prescription Drug Type	Mail Co-payment (90-day supply)
Generic Drug	$26
Preferred Brand Drug (preferred drug list is available at druglist.com)	$66
Non-preferred Brand & Other Brand Drug	$110

To use the mail order service:

Obtain a prescription from the attending physician for a 90-day supply
Complete the Walgreens Healthcare Plus Registration & Prescription Order Form (available online at http://knowyourbenefits.dfa.state.ms.us) and mail it to the address on the form
Remit payment for the deductible and/or co-payment with the Walgreens Healthcare Plus Registration & Prescription Order Form (participants can call Catalyst Rx at 1-866-757-7839 for verification of the appropriate payment)
Order refills 7-10 days before the supply runs out to allow ample time for shipping and delivery of the order. Details for obtaining an early refill can be found in the SPD.

Walgreens Specialty Pharmacy Program
Catalyst Rx has partnered with Walgreens Specialty Pharmacy to provide a dedicated specialty pharmacy program for participants who are receiving specialty medications. Through the Catalyst Rx/Walgreens program, participants will enjoy increased convenience through the availability of specialty prescription pickup at more than 4,000 retail Walgreens stores, at the physician's office, or via home delivery mail service. The participant will pay a $30 co-pay for each 30 day supply subject to the applicable deductible. For additional information, see the SPD or contact 1-888-782-8443.