Employee Benefit Option Guide cy 2009

NWOSU Option Period 2009 Rates

Option Period 2009 Enrollment Form

Welcome to the NWOSU
Insurance Program Information Site

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

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.

Group Term Life Insurance

Northwestern Oklahoma State University currently contracts with Standard Life Insurance Company to provide group term life insurance coverage for all full-time employees, at Northwestern's expense.  If proper application is made in time, new employees are covered the first day of the month following the date of hire in a full-time position. 

Monthly dependent coverage cost:

Option 1 Spouse Benefit $10,000 Child Benefit $5,000 $2.40 per month without AD&D

$2.65 per month with AD&D

Option 2 Spouse Benefit $20,000 Child Benefit $10,000 $4.80 per month without AD&D

$5.30 per month with AD&D

Option 3 Spouse Benefit $50,000 Child Benefit $10,000 $12.00 per month without AD&D

$13.00 per month with AD&D

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,

2)  the employee applies for dependent life after the October 26, 2005 deadline for paperwork,

3) an employee applies for dependent life coverage, but did not have it in place with HighMark on 12-31-05.

Eligible Dependent is defined as your spouse, your unmarried child dependent through age 21, your student dependent 21 or older but under 25, who is a registered full-time student, and, in some instances, your handicapped child. Contact the Human Resources Office for an eligibility determination on your child or stepchild.

Long-Term Disability

After working full-time for at least six months at Northwestern, full-time employees are automatically enrolled with The Standard for a benefit equivalent to 60% of regular annual salary in the event of total disability.  This benefit is offset by estimated or real value of disability income from other sources, such as Social Security, worker's compensation, and Oklahoma Teacher's Retirement.

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.  

Vision Coverage

Full-time University employees are covered for vision insurance with their choice of five companies: Vision Service Plan , UnitedHealthcareVision , Primary Vision Care Services , Superior Vision Plan , and Humana/CompBenefits Vision Care Plan.   At the employee's option and expense, eligible dependents may be covered. If one dependent is insured, all eligible dependents must be insured, unless proof is provided of other group coverage.   This is known as the "Cover-One-Cover-All Rule.

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:

Vision Insurance Monthly Cost for Calendar Year 2009:
Company Employee Spouse Only One Child Only Two or More Children Only Spouse + One Child Spouse + Two or More Children

Vision Service Plan (V.S.P.)

0 6.00 5.74 12.92 11.74 18.92

United Health Care Vision (formerly Spectera)

0 5.79 4.59 6.98 10.38 12.77

Primary Vis Care Service (P.V.C.S.)

0 8.00 8.50 10.75 16.50 18.75

Humana/CompBenefits Vision Care Plan

0 5.06 3.57 4.46 8.63 9.52

Superior Vision Services

0 6.90 6.60 6.60 13.50 13.50
Vision Insurance Monthly Cost for Calendar Year 2008:
Company Employee Spouse Only One Child Only Two or More Children Only Spouse + One Child Spouse + Two or More Children
Vision Service Plan (V.S.P.) 0 6.00 5.74 12.92 11.74 18.92
Spectera 0 3.43 2.79 4.49 6.22 7.92

Primary Vis Care Service (P.V.C.S.)

0 5.50 6.00 7.75 11.50 13.25

CompBenefits/Vision Care Plan

0 4.02 2.71 3.61 6.73 7.63

Superior Vision Services

0 4.38 3.98 3.98 8.36 8.36

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.

Dental Insurance

Full-time employees may choose to enroll in and pay for dental coverage for themselves and their families. Employees must be insured if they want dependent coverage. The State of Oklahoma dental plans use the "cover-one-cover-all rule." This means that all eligible dependents must be covered if one dependent is, unless proof is provided of other group coverage.  Spouses are permitted to "waive out" of dental which will allow  only the member and children to be covered.   See eligibility rules in the Medical Insurance section below.

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:

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.

Dental Insurance Monthly Cost for Calendar Year 2009 :
Name of Plan Employee Employee + Spouse Employee + One Child Employee + Two of More Children Employee + Spouse + One Child Employee + Spouse + Two or More Children

State Dental (Health Choice)

28.58 57.16 52.40 90.42 80.98 119.00

Delta's Choice PPO Plan

12.88 42.36 42.14 84.44 71.62 113.92

Delta Dental PPO Plan (POS)

29.88 59.78 56.16 96.76 86.06 126.66

Assurant Freedom Preferred PPO Plan

24.84 49.54 43.36 74.64 68.06 99.34

Assurant Heritage Plus w/SBA (Prepaid)

11.74 20.60 19.34 26.94 28.20 35.80

Assurant Heritage Secure (Prepaid)

7.20 13.18 12.40 17.58 18.38 23.56
Dental Insurance Monthly Cost for Calendar Year 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
State Dental (Health Choice) 26.80 53.60 49.14 84.78 75.94 111.58

Delta's Choice PPO Plan

12.26 40.32 40.12 80.40 68.18 108.46

Delta Dental Point of Service Plan (POS)

28.44 56.90 53.46 92.12 81.92 120.58

Assurant Freedom Preferred

24.84 49.54 43.36 74.64 68.06 99.34

Assurant Heritage Plus (Prepaid)

11.74 20.60 19.34 26.94 28.20 35.80

Assurant Heritage Secure (Prepaid)

7.20 13.18 12.40 17.58 18.38 23.56

Oklahoma Medical EmblemMedical Insurance

Northwestern Oklahoma State University contracts with OSEEGIB (Oklahoma State and Education Employees Group Insurance Board) for group medical coverage.

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

Section 125 Flexible Benefit Plan AFA Emblem

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:

Questions should be directed to:

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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