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." 

NATIONAL HEALTHCARE REFORM, REFERRED TO AS THE RECENTLY PASSED "PPACA LAW."

Required Posting of Amendment to OKHEEI High Option Medical Plan

Required Posting of Amendment to OKHEEI Basic Option Medical Plan

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The best group medical coverage NWOSU has to offer Active Employees and their families, as well as Retirees under 65, Vested Continuees, and COBRA participants, is the BCBSOK-OKHEEI "High Option."  It is also the most expensive. 

A brief medical plan summary is the quickest way to compare our plan with a spouse's plan which may be available with their employer.  Before Option Period week, be sure to check out the medical plan summary for cy 2012.  (Be sure to choose down arrow to go to page 2.)

Another option for medical coverage is referred to as the BCBSOK-OKHEEI "Basic Option."   Please contact the Human Resources Office before changing to this plan.

Mandatory HIPAA Notification of Members' Rights under BCBSOK

The OKHEEI group offers an excellent group dental plan with BCBSOK.  Dental plan summary for 2012.

Before coming to Option Period 2012, be sure to compare our OKHEEI plans with other ones available to you and your family, and to research which "Network Providers" are available for each plan.  The employee is responsible for optimizing their medical, dental, and vision coverage by going to service providers who are contracted with OKHEEI to save members money.

The official money-saving OKHEEI-BCBSOK Network for Medical is called "Blue Choice."  When traveling in the United States and in many foreign countries, in-network savings can be realized through the "Blue Card Program."

The official OKHEEI-BCBSOK Network for Dental is called "Blue Care."  Your doctor's office  may need to know this used to be called the Traditional network.

OKHEEI Board Agenda for August 9, 2011 Meeting

January 1, 2010, 11 colleges and universities in Oklahoma joined together to form group Medical, Dental, and Vision insurance plans. 

There are 3 categories of insureds in the OKHEEI group, referred to as:  "Active," "Pre-Medicare," and "Medicare-Eligible." 

For Active (regular full-time employees) Insureds: 

 Medical and Dental are with BCBSOK (BlueCross BlueShield of Oklahoma), and vision is with VSP (Vision Service Plan.)

For OKHEEI Pre-Medicare Retirees:  Medical and Dental are with BCBSOK, and Vision is with VSP. 

For our OKHEEI Medicare-Eligible Retirees:  Supplement to Medicare ("Sr. Supplement") is with UHC (UnitedHealthCare), Dental is with BCBSOK, and Vision is with VSP.

MORE INFORMATION ABOUT RETIREE INSURANCE IS FOUND AT THE BOTTOM OF THIS WEB PAGE.

Before January 1, 2010, these schools' retirees' monthly premium payments were handled directly by the Oklahoma State and Education Employees Group Insurance Board in coordination with the OTRS (Oklahoma Teachers Retirement System).  Now, a company called HealthSmart assists the OKHEEI schools with billing and collecting premiums for former employees and dependents.  The OTRS continues to pay $100 to $105 per month toward the cost of qualifying retirees' health coverage.   

Monthly dependent coverage cost (AD&D is an accidental death double indemnity):

When leaving Northwestern, be sure to visit with the HR Director about how all, or parts, of this valuable coverage can be extended by submitting required paperwork to the company in a timely manner. 

For example, a retiree may be able to "port" the additional voluntary life coverage they elected and paid for as an Active Employee, without providing proof of medical insurability. 

Existing dependent coverage can often be extended into retirement by providing the NWOSU payroll officer with a supply of post-dated personal checks. 

Resigning employees are sometimes eligible to "port" (take with them) life insurance coverage they enjoyed as an Active Employee at NWOSU.  Call 580-327-8530 for more information.  Exiting employees are encouraged to consider Portability before Conversion, since the Conversion option is more expensive.

Conversion to a whole life policy may be an option for a dependent child losing coverage due to age, student status, or marriage.  However, conversion is much more expensive than portability.  

(See the Whole Life Conversion Rate Chart link below.  Compare to The Standard's RUSO Portability Rate Chart below.)   

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

Standard Life-RUSO Group Term Life Certificate (Policy)

Standard Life Change Form

FAQs for 010106 conversion to The Standard from HighMark

The Standard's RUSO Portability Rate Chart and Application Packet

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 by The Standard when:

1)  an employee wishes to enroll in the RUSO dependent life program after their "Open Period" has expired.  For more information call 327-8530,

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 reduced to just three months.  The Elimination "time clock" starts on the last day you're able to work.  Ask the Human Resources Director about the cost of this "LTD BUY-UP."

LTD Benefits at a Glance.  Certificate for Policy 135140. 

Check dependent eligibility rules in the Medical Insurance section below.  It is the employee's responsibility to make sure the dependents they want to have coverage are actually enrolled.  Be careful and thorough when filling out forms at Option Period.

Before making an appointment for an eye exam, the member is responsible for making sure a prospective network doctor accepts new patients.  Also, realize that some network providers will only accept patients over a certain age.

Features of the VSP vision plan.

One question 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 Signature CHOICE 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 Higher Education Employees Insurance ("OKHEEI")

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

Call 800-877-7195 for more instruction.

If you enroll in BlueCross BlueShield of Oklahoma (BCBSOK) Dental, you will get a better benefit by going to a "network provider" dentist.  Blue Cross Blue Shield of Oklahoma now has a working website for OKHEEI Insureds. 

 It is especially useful in helping 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: 

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 called "Traditional") applies to OKHEEI.  Going out-of-network can cost you plenty of extra money that would have been waived by a Network Provider!

Make sure you have found a network provider that you want to use.  You will not be allowed to drop dental mid-year.  Make sure you know the plan's eligibility rules described in the Medical section below.  It is the employee's responsibility to avoid paying premiums for ineligible children.  Our office must be promptly notified of any change in a family member's status.

At the time of new hire enrollment and once a year thereafter, regular full-time employees are allowed to make certain elections for insurance coverage for themselves and eligible family members.  Option Period is the once-a-year chance to add/drop dependents, add/drop dental, with changes effective the next January 1.

*IMPORTANT UPDATE:  In keeping with the spirit of recent federal health-care reform legislation, BCBSOK has extended the termination age for OKHEEI dependents from 25 to 26 for MEDICAL and DENTAL, regardless of marital status or gainful employment.   This change was effective May 1, 2010, months before the mandated change date written in federal law. 

If this child-dependent is (or becomes) employed in a job which provides employer-sponsored medical coverage, he or she must enroll in that coverage.  Ask Human Resources for an interpretation regarding your child's situation.

We have been informed by American Fidelity Assurance (our Section 125 administrators) that a similar extension will also apply to pre-taxing of premiums and URM (Unreimbursed Medical) reimbursement claims for dependent children's medical/dental/vision out-of-pocket expense claims.  As long as the child is not expected to reach age 27 in a given tax year.

It is the employee's responsibility to promptly notify Northwestern's Human Resources of any and all changes to family status.

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 made in a timely fashion in order to continue it. 

 Former spouses can continue as long as 36 months or until fully covered on another group plan, whichever occurs first.  The same is true of former child dependents.  However, there must be a bona fide qualifying event in order to apply for COBRA coverage. 

HealthSmart is the company contracted to handle collecting and remitting OKHEEI COBRA monthly premiums to BCBSOK and VSP.  Please do not discard any mailings from HealthSmart.

We are no longer under the State's "Insure-one-insure-all rule."  If it is your intent to cover an eligible dependent in medical/dental/vision, make sure that person is listed on your Option Period Confirmation of Benefits when you go through the line at Option Period.  If not, bring it to the attention of Human Resources staff.

Helpful numbers:

BCBSOK Medical:  Customer Service:  800-672-2567, Precertification:  800-672-2378, Network Provider Locator:  800-810-2583, Rx Tech Support:  877-353-0992, Rx Customer Service:  877-546-2779.  Prescriptions (Rx) are serviced by PrimeTherapeutics.  Specialty Drugs serviced by Triessent.

BCBSOK Dental:  Customer Service:  888-381-9727, Network Provider Locator:  888-381-9727.

The 2011 deductible for BCBSOK Medical 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 BCBSOK High medical co-insurance goes to 50% out-of-network.   In addition, the member is responsible for the amount over and above what BCBSOK considers "usual/reasonable and customary," if they go OUT-OF-NETWORK.  This could be a small amount, or it could be very high.  This amount will be waived if the insured person stays IN-NETWORK.

 

Medical Insurance Monthly Cost for Calendar Year 2012:
Name of Plan:  BlueChoice Network	Employee	Employee + Spouse	Employee + One Child	Employee + Two or More Children	Employee + Spouse + One Child	Employee + Spouse + Two or More Children
BCBSOK (High Option)	0.00	496.40	189.10	378.20	874.70	874.70
BCBSOK (Basic Plan)	Please contact Tami Cooper, HR Director, before enrolling in this plan.  580-327-8530

Medical Insurance Monthly Cost for Calendar Year 2011:
Name of Plan: BlueChoice Network	Employee	Employee + Spouse	Employee + One Child	Employee + Two or More Children	Employee + Spouse + One Child	Employee + Spouse + Two or More Children
BCBSOK (High Option)	0.00	496.40	189.10	378.20	874.70	874.70
BCBSOK (Basic Plan)	Please contact Tami Cooper, HR Director, before enrolling in this plan.  580-327-8530

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

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

There are two parts to the Plan:

• Conversion of premiums to before-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 (during Option Period) for the following calendar year, stating whether they want the premiums withheld "before-taxes" or "after-taxes" are computed. 

If premiums are withheld "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 change to before-taxes-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 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/or a Dependent Day Care Account ("DDC") may be something you are interested in participating in. 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 because they represent an exemption from taxes.

After Option Period closes, you cannot change your election mid-calendar year, unless you have a change in family 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). 

NEW:   Effective cy 2011, federal law disallowed certain over-the-counter medical products from being reimbursable expenses under all flexible spending accounts

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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, genetic information, 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. 

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THIS SECTION IS DEVOTED TO NORTHWESTERN'S RETIREES:

New:  Medicare Notice required posting (02232011)

Mandatory HIPAA Notification of Members' Rights under BCBSOK

Update: 

Option Period is a once-per-year chance to add/drop vision for the next calendar year, or adjust the level of Part D prescription coverage (the latter only applies to Medicare-qualifieds). 

OKHEEI Retirees can drop OKHEEI dental and/or medical, but will never be able to return to that coverage in the future.  Also, cancelling Retiree OKHEEI medical coverage requires OTRS to cancel their monthly health premium subsidy, a final decision for the retiree. 

Eligible dependents can only be added mid-calendar-year to OKHEEI medical and dental coverage when there is a bona fide family status change, such as marriage, birth of a child, or spouse loses other group medical/dental.  Call Tami Cooper at 580-327-8530 for more information. 

Retirees should watch their home mail closely for more information from NWOSU or HealthSmart.  And do not forget to stay IN-NETWORK for the most savings.  Read on for more information on Networks.

Answers to Questions I would be asking if I were a retiree/pre-retiree.   --Tami Cooper, Human Resources Director.

(At NWOSU, we welcome calls from each retiree, spouse, Durable Power of Attorney, or appointed Guardian.  Due to privacy laws, POAs and Guardians must fax proof to our office before we can discuss protected health information.  Our fax number is 580-327-8538.)

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

Last Updated: 12-22-11

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