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 V.S.P. 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.  VSP will need:

*  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 HealthChoice drug program.

The yearly 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. 

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
Medical Insurance Monthly Cost for Calendar Year 2008:  Option Period Guide for cy 2008
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	496.61	181.44	290.22	678.05	786.83
Health Choice (Basic Plan)	0.00	425.65	155.32	248.88	580.97	674.53

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

NEW!!!!  Current participants:  quick and easy access to a list of URM or DDC expenses eligible for reimbursement.

There are two parts to the Plan:

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

Employees sign a new Election form each October for the following calendar year, stating whether they want the premiums withheld "before-tax" or "after-tax." If premiums are "before-tax," 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.

• Flexible Spending Account withholdings.

The Expense Reimbursement Accounts allow you to direct a part of your pay, on a pre-tax 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: 5-1-09

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