If you are a Northwestern retiree looking for more information on the transition away from OSEEGIB, welcome.   Thanks for choosing this way to learn more about this exciting project.  HISTORY OF SEARCH FOR BETTER, MORE AFFORDABLE INSURANCE

The OKHEEI human resources directors and insurance coordinators are currently in the Implementation Phase of the transition to new medical, dental, and vision insurance for. . .

1) Active employees (and any eligible dependents) currently covered through OSEEGIB,

2) A person formerly employed at NWOSU (or someone connected to that person by definition of dependency) and currently covered through OSEEGIB.   To be in this category, the person must be under age 65 AND not qualified for Medicare due to disability.

3) A person formerly employed at NWOSU (or someone connected to that person by definition of dependency) and currently covered through OSEEGIB.  To be in this category, the person must be age 65 or older, OR qualified for Medicare due to disability.

These are the 3 categories of insured, referred to as:  "Active," "Pre-Medicare," and "Medicare-Eligible."

Mark your Calendar for Sat. Nov. 21 - presentations - Ranger Room - Student Center.

10:00 - Noon: Medicare-Eligibles.  1:00 - 3:00: Pre-Medicare.

BELOW ARE SOME OF THE QUESTIONS THAT ARE BEING ASKED OF HUMAN RESOURCES DIRECTORS AT THE OKHEEI SCHOOLS.  At NWOSU, we welcome calls from retirees, their family members, their Power of Attorney, or appointed Guardians.

Q.  Do I need to attend both Retiree presentations scheduled at NWOSU for Saturday, November 21, 2009?

A:  You decide which meeting to attend, and whether or not to attend both.  Couples/families who fall into more than one category will want to attend both meetings.  Any currently insured person who will soon qualify for Medicare should attend both meetings.

Q:  What company will provide medical coverage for Medicare-eligible retiree or spouse or child on 1-1-10?

A:  OKHEEI has contracted with UnitedHealthcare (UHC) to provide an excellent medical supplement plan for OKHEEI retirees, spouses, or children who are Medicare-Eligible.  This is the "Senior Supplement" plan customized for our group's retirees to closely resemble what they have had through OSEEGIB.   Senior Supplement features a Part D High Option and Part D Low Option for prescription coverage.

Q:  What company will carry medical for Pre-Medicare persons and dental for persons in any category?

A:  Blue Cross Blue Shield of Oklahoma (BCBSOK) will be the official carrier for medical for Pre-Medicare and dental coverage for all 3 categories of Insureds:  Active, Pre-Medicare, and Medicare-Eligible.

Q:  Will I receive new ID cards?

A:  The new insurance is not effective until January 1, 2010.  Until that day, continue to use your current OSEEGIB ID cards when seeking treatment.  New ID cards will be mailed to home address before 1-1-10 for medical and dental.  However, Vision Service Plan (VSP) does not print ID cards.  When you call a CHOICE Network eye doctor, someone will take your information and verify which coverage you have before  the appointment.    

Q.  Is there a web site where I can learn more about Blue Cross Blue Shield of Oklahoma?

A:  Blue Cross Blue Shield of Oklahoma now has a working website for OKHEEI Pre-Medicare Insureds.  Medicare-Eligibles enrolled in dental will also want to visit that web site.  It is especially useful in helping one locate the nearest Blue Network provider.  Follow the hyperlink labeled Search for Doctors, Dentists, Hospitals & Other Providers in Your Area.  Next, enter a zip code in the Location box.  Be sure to choose the correct Network Type:  Blue Choice (for medical).  To find a Network dentist, drop to bottom of the page and choose Find a Dentist under More Searches.  Be careful!  Only the Blue Care Network (formerly call "Traditional") applies to members of OKHEEI.  Going out-of-network can cost you plenty of extra money that would have been waived by a Network Provider!

Q:  I live in another state.  What Network do I use?

A:  Persons outside the State of Oklahoma should be fully covered through the Blue Card Program, which provides nationwide coverage and in nearly 200 other countries.  Call (580) 327-8530 for a BCBSOK packet for more information.

Q:  What will the pharmacy network be for BCBSOK?

A:  Scroll below, past the gray horizontal line--for a discussion on companies contracted with BCBSOK to handle pharmacy purchases.  Please come to the November 21st meetings to learn more.

Q:  I'm Medicare-Eligible.  What do I need to do in order to have a supplement after 12-31-09?

Only those already enrolled in OSEEGIB's HealthChoice medical supplement will be able to participate in the OKHEEI supplement after 12-31-09, since this is not an open enrollment.  In order to be covered on the OKHEEI medical supplement 1-1-10, you must have Medicare Part B in place, as well as Part A.  This will be a "passive enrollment," so if you do not sign an "opt-out" form, or apply to change from the high Part D to the low, or vice versa, on 1-1-10, your records will transition from the level of coverage you had with OSEEGIB to the same level with the new company(ies).  I.e., if not changing, you do not fill out an enrollment form.  But, don't forget to watch for a mailing from a company called "HealthSmart," since they will handle collecting and remitting monthly premium(s) due to the appropriate companies. 

Q:  Please explain what Medicare Parts A and Part B are.

Part A of Medicare is hospitalization benefits and is free to anyone qualified for Medicare due to age or disability.  Medicare's Part B includes other medical services such as doctors' charges.  The amount due for Part B is normally withheld from one's monthly Social Security benefit.  Part D refers to prescription benefits.  In order to participate in the OKHEEI/UHC plan, one must have both Parts A and B in place. 

Q:  I will reach age 65 next July, so what do I do, since BCBSOK does not provide medical coverage on Medicare-Eligibles?

A:  A few months before one's 65 birthday, the government mails Medicare information to their home address.  Find the  Medicare ID card in that mailing.  Remember UnitedHealthcare will want a copy of the Medicare ID card which shows you have both Parts A and B. 

Q:  What if I have already turned age 65 but am still working full-time at NWOSU?

If you are still working full-time in a benefited position at Northwestern, be sure to reserve Part B for when you retire.  You will stay on BCBSOK after age 65, until you decide to retire/resign.  Until that day, BCBSOK will pay as Primary Carrier, and Medicare will pay as Secondary.  The same is true of any Medicare-Eligible dependent of a regular full-time employee of NW.

Q:  I did not keep OSEEGIB coverage when I retired.  Can I enroll in OKHEEI medical coverage now?  Or dental?

A:  If you retired from Northwestern, but are not currently covered by the Oklahoma State and Education Employees Group Insurance Board (OSEEGIB), this is not an "open enrollment" opportunity.  Also, this is not an "open enrollment" for any dependents who could have had MEDICAL or DENTAL coverage under OSEEGIB, but elected not to do so, or have dropped such coverage.  The only exception is Vision--one can freely drop in or out each January 1.   Call 580-327-8530 for more information.

We have been told that, if a retiree is currently covered by OSEEGIB, but only for certain items, such as Dental, only the items currently in place will passively transfer (or default) to the new carriers 1-1-10.

Q:  I know I can't enroll in medical or dental unless I already have it in place through OSEEGIB, but what about Vision?  Can I now enroll in Vision through the new VSP OKHEEI plan, if I did not carry it before 1-1-10? 

A:  Yes.  This is an Open Enrollment for Vision.  Be sure to ask for paperwork to add Vision if you did not have OSEEGIB's Vision in 2009.  Each October, you will be offered the chance to elect/drop Vision for the next calendar year.

Q:  What are the changes allowed during this transition?

A:  Certain changes will be allowed 1-1-10, such as dropping from OSEEGIB's HealthChoice medical supplement Part D High Option to the new UHC Sr. Supplement Part D Low Option, or vice versa.  Dropping an insured dependent will be allowed.  We will no longer be under the "Insure One Insure All" that governed changes under OSEEGIB.  Adding or dropping Vision will be allowed.   Plan to come to our November 21st 10:00 meeting to learn more.

Q:  Can someone send me something that shows what I'm currently enrolled in [2009]?

A:  November 4th, Northwestern's Human Resources Office staff mailed a "Confirmation of Benefits" to your home address showing what you have in 2009 with OSEEGIB, and what you will have in 2010 with the new company(ies)--unless a change is made. 

Q:  How will I pay my monthly premiums after 1-1-10?  Will Oklahoma Teacher's Retirement System [OTRS] continue to withhold from my monthly benefit?

A:  Watch for an important retiree mailing which will arrive at your home address sometime in November or December.  YOU MUST RESPOND TO THIS MAILING FROM HEALTHSMART, AND CHOOSE BETWEEN AUTO BANK DRAFT OR HOME BILLING.  We have been told that state law prohibits OTRS from withholding any premiums that are not payable to OSEEGIB.  The final withholding from your OTRS benefit will be 1st of January for December 2009 dues.  Remember, failure to pay on time will result in loss of any insurance.

Q:  OTRS was "post-pay."  Will I be required to switch from post-pay to "pre-pay" under the new OKHEEI agreements with UHC, VSP, and BCBSOK?  When will my January 2010 payment be due?

A:  You will be allowed to pay "post-pay" (at the end of the month for that month).  Your January premium(s) will be due February 1.  Please do your part to make sure this new payment arrangement with HealthSmart will work smoothly for you and your family.

Q:  OTRS currently [2009] pays $102 toward the cost of my HealthChoice insurance.  Will that stop 1-1-10?  

A:  Any OTRS subsidy you currently receive will continue after 12-31-09.

Q:  I was told when I retired with OTRS that Northwestern would continue to pay my medical and life until I turn 65.

A:  This 1-1-10 transition to new companies will not change that RUSO (Regional University System of Oklahoma) Employer-Paid Retiree Insurance Benefit.  Anyone who qualified for it when they retired, will qualify to continue receiving it until age 65...even if they qualify for Medicare before age 65, due to disability.

New Payment Process for Northwestern Retirees: 

A company known as HealthSmart will collect retiree/family monthly premiums due to BCBSOK and UHC.  They will offer a choice between home billing or auto bank draft.   Watch for their Kit which will be mailed to your home address. 

New to Northwestern Retirees: 

Some retiree couples/families will experience what is referred to as:  "One Over/One Under."  When a covered retiree or covered family member qualifies for Medicare, BCBSOK will no longer be the assigned medical carrier.  That person will transition from BCBSOK to UHC for MEDICAL coverage, but not for dental or vision.   Only BCBSOK offers dental for the OKHEEI group.  Only VSP offers vision for the group.  Individuals insured for dental and/or vision can remain with BCBSOK and/or VSP after they transition to Medicare and UHC for medical coverage.

I.e., they will transition from BCBSOK medical to OKHEEI's UnitedHealthcare medical supplement.  E.g.:  A spouse who was formerly a retiree's dependent will then become an insured, and charged accordingly.  HealthSmart will coordinate the transition, as well as collect and remit retiree family premiums.

OKHEEI former employees and families should have already received packets mailed by former employers in the OKHEEI group.  Call the Human Resources Director at the former employer if you do not have yours.

Q:  I have heard about NWOSU changing insurance carriers for medical/dental/vision on January 1, 2010. 

But...what should I do TODAY? 

A:  Contact your favorite medical services provider (such as medical doctor, clinic, and hospital) to make sure they are in the Blue Choice Network so you can save money the very first time you need medical services AFTER 12-31-09.  Or go to: 

http://public.hcsc.net/providerfinder/home.do?corpEntCd=OK1

and search by your doctor's/clinic's/hospital's name.

When calling your favorite dentist, tell them Northwestern's dental network will be: Blue Care Dental (formerly LINCS Dental Connection Traditional).  Or go to:

http://c4.go2dental.com/member/dental_search/searchprov.cgi?brand=ok&product=ppo

Q:  I take regular medications.  What company will be in charge of drug purchases?

A:  Prescription drugs will be managed by a company called Prime Therapeutics.  Specialty pharmacy will be managed by Triessent. 

We have been told that, in our new plan, pre-authorization will be required on certain drug purchases.  However, if one of these prescriptions is filled in January-February-March of 2010, the requirement will be waived.  Work with your physician and pharmacist to optimize your prescription benefit.  If a 90-day fill/refill is allowed, the prescription must be written that way.  (Don't forget to take your new ID card with you to the pharmacy after 12-31-09.)

Q:  What is BCBSOK's generic drug policy?

A:  There is a process called, "Step Therapy."  This will not be required on purchases in Jan-Feb-Mar of 2010, but will be April and thereafter.  You may be required to take a generic first in order to save yourself and the OKHEEI plan money.

UPDATE:  Blue Cross Blue Shield of Oklahoma now has a working website for our full-time active employees and our University's retirees/insured dependents still under age 65 and not on Medicare.

 The purpose of the University's insurance program is to:

• Provide important protection from the financial burden of catastrophic illness or injury,
• Provide continued income in the event of total disability,
• Provide financial assistance to designated beneficiaries of deceased employees.

Prospective employees, as well as current, may want to see our Benefits Overview to see "who pays what." 

What is Option Period?  It's that once-a-year chance to enroll in/change plans, or add/drop dependent coverage.  Don't forget the State's insure-one-insure-all eligible dependents rule.  Allowed exceptions:  1) a spouse can opt out of medical and dental, and 2) an eligible dependent can waive coverage if proper proof is provided of other group coverage.

Monthly dependent coverage cost:

Life Highlights (Voluntary Employee Life Coverage Rate Chart on page 5)

FAQs for 010106 conversion to The Standard from HighMark

The Standard's RUSO Portability rate chart

The Standard's Whole Life application form

The Standard's Whole Life conversion rate chart

Evidence of Insurability EOI form for Conversion to Standard.  Do not send to Human Resources--send directly to The Standard at the address on the form--to the attention of E.O.I. Dept.- C4E.  It's a good idea to send this form by certified mail, return receipt requested.

This form is required when:

1)  an employee with HighMark's dependent life already in place 12-31-05 applies for Option 3 dependent life with The Standard to be effective 1/1/06,

The basic benefit, paid for by the University, requires a six-month elimination period (i.e., this is how long you have to wait before drawing the benefit) upon diagnosis and proof of disability. At the employee's option and expense, that elimination period of six months may be "bought down" to three months.  The elimination "time clock" starts on the last day you're able to work.

The monthly cost to the employee for the "buy-down" is calculated: Annual Salary divided by 12 and then multiplied by the factor of  .0016.  

Check eligibility rules in the Medical Insurance section below.

Before enrolling in a vision plan, the member is responsible for making sure a prospective network doctor is accepting new patients.

Features of the VSP vision plan include:

• Basic Coverage with Network Provider:
• $10 exam copay (this means how much you pay before the company pays) every twelve (12) months, plus
• $25 materials copay every twelve (12) months with a $120 allowance, or
• $120 Contact Allowance in lieu of other benefits.  (other plans' coverage similar)
• Reduced cost for laser vision correction.

One question that is frequently asked:  How do you file a claim with VSP if you use an out-of-network provider?

Answer:  To optimize your VSP benefit, always go to a VSP network provider.  However, VSP reimburses for services received from any licensed optometrist, ophthalmologist, or optician.  If you receive services from a non-participating provider, you must pay the provider in full, then submit itemized receipts to VSP for reimbursement.  Here's what you will need to send the company:

*  The covered member's Social Security number, name, phone number and address

*  The patient's name, date of birth, phone number and address

*  The patient's relationship to the covered VSP member

*  A copy of the itemized bill/receipt listing services received

*  The name, address and phone number of the out-of-network provider

*  The name of our group, Oklahoma State and Education Employees Group Insurance

Please keep a copy of the information for your records and send the originals to the following address:

VISION SERVICE PLAN, ATTN:  OUT-OF-NETWORK PROVIDER CLAIMS, PO BOX 997105, SACRAMENTO, CA  95899-7105.

If you enroll in HealthChoice Dental, you will get a better benefit by going to a "network provider" dentist.  Call 1-800-848-8121 to see which dentists are contracted in your area. 

If you enroll in Assurant's Heritage Plus Plan, you are very limited in which dentists you can use.  There is zero benefit when you go to a non-network dentist or someone other than the network provider you pick at enrollment, unless you have prior authorization from the company.   Before enrolling in this "prepaid plan," the member is responsible for making sure a prospective network provider is accepting new patients.  To locate the nearest providers, go to www.assurantemployeebenefits.com and use the provider search options.

Assurant will also offer Freedom Preferred, Preferred Provider (PPO) plan for those who want the freedom to visit any provider they choose.  Assurant Member Services can be reached at 800-443-2995.

Again in 2008, Delta Dental will participate in the State of Oklahoma dental program by offering two different dental plans.  The delta Dental PPO "Point of Service" plan provides access to two of the largest provider networks in Oklahoma and nationwide. 

The Delta's Choice PPO program provides for a low cost dental benefit program with contracted providers nationwide.  Participating members and dependents will be responsible for only the amounts listed in the Delta's Choice PPO table of benefits, deductibles, non-covered services, and all over-maximum services.  They can also access the Delta Dental Premier provider network.  Call 800-522-0188 or go to http://www.DeltaDentalOK.org/state_employees/.

You and your family may choose from one of six plans and expect to pay these premiums:

• HealthChoice State Plan
• Delta's Choice PPO Plan
• Delta PPO Point of Service Plan
• Assurant Heritage Plus Plan w SBA (Prepaid)
• Assurant Freedom Preferred
• Assurant Heritage Secure Plan ("Prepaid")

Be cautious when enrolling in any of these plans.  Make sure you have found a network provider that you want to use.  You will not be allowed to change plans mid-year.  Make sure you know the plan's eligibility rules described in the Medical section below.

At the time of enrollment and once a year thereafter, full-time employees choose either HealthChoice or an HMO associated with the HealthChoice State Plan. Go to this HealthChoice website to read highlights of the State Plan. HMO availability is determined by the employee's zip code of residence or work site.  You cannot enroll in an HMO that is not allowed in the zip code where you work or live.

Eligible dependents include spouse and unmarried children up to age 25, as long as the member is responsible for the child's support.  On July 1, 2008, the age limit increased from 23 to 25.  Here's an important announcement from HealthChoice:

"A new law HB 3112, that became effective July 1, 2008, increased the age dependents can be covered under the plans offered through OSEEGIB.

"The new law allows you to cover dependent children up  to age 25 as long as they are unmarried and dependent on you for support.  Previously, dependent children could only be covered up to age 23.

If you have children age 23 or 24 who are not enrolled because of the previous age limit, OSEEGIB has set a special enrollment period so they may be enrolled.  This special enrollment period will run through July 31, 2008.  Coverage for these dependents will be effective the first of the month following the date OSEEGIB receives your enrollment/change form.

*    Natural, adopted, or stepchildren as long as they are primarily dependent on you for support, or you have been court-ordered to provide insurance coverage

*    Children who live with you in a regular parent-child relationship--a Declaration of Dependency Form must be submitted and approved

*    Children, regardless of age, who are incapable of self-support because of a mental or physical condition that began before age 25--a Disabled Dependent Assessment Form must be submitted and approved."

All of the State's insurance plans (medical, vision, and dental) use the "cover-one-cover-all rule." If you elect dependent coverage, all eligible dependents must be covered unless you provide proof of other group coverage. Contact the Human Resources Office for more details.

Whenever a dependent ceases to be a dependent, they should ask the Human Resources Office about COBRA.  COBRA is a way to continue this valuable medical/dental/vision coverage after losing eligibility status.  Proper and timely application must be made in order to begin COBRA coverage, and payments must be timely made in order to continue it.  Former spouses can continue as long as 36 months or until fully covered on another group plan.  The same is true of former child dependents.

Helpful numbers: 

Call 1-800-782-5218 (EDS) for specific HealthChoice medical or dental coverage/claim questions.

Call 1-800-752-9475 (HealthChoice Member Services) for general enrollment/coverage questions.  Use this same number for network provider directory inquiries.

Call 1-800-903-8113 (Medco) for questions regarding our current HealthChoice drug program.

The 2009 deductible for HealthChoice High Option is $500 per person, maximum of $1500 per family.  Also, if you go out of network, plan to pay more in co-insurance.  Your HealthChoice High medical co-insurance goes to 50% out-of-network.   The member is responsible for the amount over and above what HealthChoice considers "usual/reasonable and customary," if you go OUT-OF-NETWORK.  This could be a small amount, or it could be very high.  This amount must be waived, by law, if the insured person goes IN-NETWORK.

Option Period Guide for cy 2009

Medical Insurance Monthly Cost for Calendar Year 2009:
Name of Plan	Employee	Employee + Spouse	Employee + One Child	Employee + Two or More Children	Employee + Spouse + One Child	Employee + Spouse + Two or More Children
Health Choice (High Option)	0.00	587.92	199.98	343.10	787.90	931.02
Health Choice (Basic Plan)	0.00	503.74	171.56	293.44	675.30	797.18

American Fidelity Assurance Company  currently administers the Section 125 Plan (commonly called the "Cafeteria Plan") for full-time employees. 

NEW!!!!  Current participants, quickly access to a list of URM or DDC expenses the IRS currently considers reimbursement-eligible.

There are two parts to the Plan:

• Conversion of premiums to pre-tax dollars. (Any medical/vision/dental/cancer premium you have withheld "before taxes" from your paycheck can lower your federal, state, and FICA tax liability.)

Employees sign a new Section 125 Election form each October for the following calendar year, stating whether they want the premiums withheld "before-taxes" or "after-taxes."  If premiums are "before-taxes," the coverage cannot be dropped during the calendar year for any reason other than a qualifying change in family status, such as divorce, death, spouse gains coverage through his/her employment, child no longer eligible for coverage, etc.  Likewise, only a bona fide family status change allows a mid-year before-taxes-addition to premiums.

 

• Flexible Spending Account withholdings.

The Expense Reimbursement Accounts allow you to direct a portion of your pay, on a before-taxes basis, into special accounts that can be used throughout the year to reimburse yourself for certain out-of-pocket medical expenses and/or dependent day care expenses. There are two separate accounts:

An Unreimbursed Medical Account ("URM" or "Medical Reimbursement") and a Dependent Day Care Account ("DDC"). Because your money goes into your reimbursement accounts before federal and state income or Social Security taxes are calculated, you pay less in taxes, and ultimately have more disposable income. These accounts are governed by specific federal regulations. For example, after Option Period closes, you cannot change your election during the calendar year, unless you have a change in status that affects your need for the benefit. Federal regulations also require that any money you deposit in a reimbursement account that is not used to cover eligible expenses incurred during that same plan year will be forfeited (called the "Use It or Lose It Rule"). For more information on the Section 125 Flexible Spending Accounts, go to American Fidelity's website , or call their main number: 1-800-654-8489.

Section 125 FSA/Unreimbursed medical vouchers must be completed, signed, and mailed to the company by participating employees claiming reimbursement from their account(s). 

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Affirmative Action Compliance Statement

This institution, in compliance with Title VI and Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, sections 503 and 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act Amendments Act of 2008, and other applicable federal laws and regulations, and to the extent required by law, does not discriminate on the basis of race, color, national origin, sex, age, religion, physical or mental disability, or status as a veteran in any of its policies, practices, or procedures.  This includes, but is not limited to, admissions, employment, financial aid, and educational services.  Inquiries concerning the application of these programs should be made to Brad Franz, Vice President for Student Affairs and Enrollment Management, Northwestern Oklahoma State University, 709 Oklahoma Boulevard, Alva, OK 73717, (580) 327-8415. 

NWOSU Human Resources Office
709 Oklahoma Boulevard
Alva, Oklahoma 73717
Phone: 580-327-8530 or 580-327-8531

Last Updated: 11-06-09

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