- April 2010 > Insurance Insights
As you know, President Obama has recently signed two important health reform bills: the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act. While this comprehensive legislation has numerous provisions which take time to analyze before the implications for employers, employees, retirees and dependents can be fully understood, there are some areas of certainty. These include:
Once analysis of the numerous provisions is complete, the Office of Employee Benefits will provide clear, thorough and timely communication to each UT Institution regarding the impacts of the reform bills on our plans, including the effective date of the mandatory coverage for adult children up to age 26, possible changes to the Evidence of Insurability processes, and the addition of certain required benefits.
While the Office of Employee Benefits analyzes and clarifies these provisions, please know that the new legislation does not change UT System’s commitment to being a partner in your healthcare and offering a robust health plan.
The UT SELECT Medical plan (administered by Blue Cross and Blue Shield of Texas) includes prescription benefit coverage (administered by Medco Health Solutions) and is self-funded by the UT System. As a self-funded plan, all claims are paid by UT System through premium sharing dollars provided by the State Legislature, UT System, and your monthly out-of-pocket cost.
The UT SELECT Medical plan is unique in that it provides coverage to System employees and retirees at nine different academic institutions and six different health institutions. Full-time benefits eligible employees and retirees of UT System currently receive their UT SELECT Medical insurance with 100% of the premium paid for by the State and UT. Additionally, the State and UT pay 50% of the UT SELECT premiums for the spouses and children of U.T. employees and retirees covered under the plan.
With close to 200,000 individuals eligible for coverage under a UT System insurance plan, one of the Office of Employee Benefits’ (OEB) most important responsibilities is to maximize the benefits and services that employees and retirees receive for every dollar spent on benefits.
As it does every month, OEB works with the contracted vendors to monitor and analyze the claims for benefits and services, while comparing the expenditures to date against the projected costs. For this plan year 2009/2010, the actual claims experience has unexpectedly exceeded the projected costs, as well as the total dollars appropriated (during the 81st Legislative Session) to UT System to administer the UT SELECT Medical insurance plan. OEB is working to analyze the reasons for this unexpected jump in claims costs which has also affected other large government health plans in Texas.
As a result of the higher than anticipated claims experience, it is likely that there will be an increase in the monthly premium cost for all levels of coverage, plus possible changes to the UT SELECT Medical benefit plan design. Because UT and the State of Texas fund 100% of monthly premium cost for full-time employees, employee’s and retired employees without dependent coverage will not feel the impact of a premium increase. Approximately 62% of employees or retired employees have employee only coverage. It is unknown at this time how much the premium increase may be or what the plan design changes could be. Possible changes to the benefit plan design include increasing deductibles, office visit copayments, coinsurance, and prescription copayments.
While determining and implementing premium cost increases and/or benefit plan design changes is always difficult, the Office of Employee Benefits is working with the System Wide Insurance Advisory Committee (SWIAC), which includes representatives from all fifteen institutions plus UT System, in order to ensure that the UT SELECT Medical plan remains financially sound, while maintaining an appropriate balance of robust benefits and affordability for U.T. employees, retirees and their covered dependents.
Over the coming months, continue to watch for information and announcements regarding your UT SELECT Medical plan leading up to Annual Enrollment in July 2010.
Part of handling an emergency is being able to evaluate warning signs and make quick decisions. In an emergency, always call 9-1-1 or other community emergency resources to obtain assistance. If you or a covered family member has an emergency requiring ambulance transport, UT SELECT covers the services when medically necessary. Benefits are paid at the network level which is 80% of the allowed amount after the $250 deductible.
Medical necessity is met when:
The following services are not medically necessary, as they do not require ambulance transportation:
Non-emergency transportation by ambulance is also covered and is deemed medically necessary for a patient who has a medical problem requiring treatment in another location and is so disabled that the use of an ambulance is the only appropriate means of transfer. This includes either of the following:
Transfers by medical vans or commercial transportation (such as physician owned limousines, public transportation, cab, etc.) are not reimbursable.
Long-term care insurance helps pay for the care people need when they are unable to take care of themselves. This need for care could be the result of an injury from an accident or due to a chronic illness such as multiple sclerosis. Services can range from assistance with daily activities such as bathing or dressing at home to skilled care in a nursing home.
What are the estimated costs?
It is easy to confuse long-term care insurance with long-term disability insurance. They’re both great to have, but they have very different uses. Long-term disability insurance is intended to replace your income if you become disabled. No medical or health care expenses are covered.
Your health insurance covers acute medical expenses but typically little or no long-term care expenses.
Another little-known fact is that 40% of the people needing long-term care services today are working age adults.*** The need for long-term care can strike at any age.
The myth of government help
Many people assume that government programs will pay for long-term care. In fact, Medicare only pays for limited care following hospitalization. Medicaid does pay almost half of the nation’s nursing home bills. But to qualify, you must first meet federal poverty guidelines, which means spending virtually all of your savings and assets. And, some nursing homes do not accept Medicaid-only patients.
With long-term care insurance, the quality of your long-term care remains in your control because you select the facilities and caregivers. Features designed to help you remain at home, such as the home medical technology benefit and caregiver training, are not covered under the government programs.
With long-term care insurance, you can protect both your income and your assets. Review your current financial plan and see if a long-term care insurance plan makes sense for you.
Long Term-Care Insurance is available through UT Benefits
Long Term Care Insurance is one of the benefits available through the University of Texas System benefits program. Long Term Care Insurance through UT System is available to: you, your spouse, your adult children (25 years and older), your parents, grandparents, your parents-in-law and your grandparents-in-law. During the Annual Enrollment period this July, you will have the opportunity to enroll in long-term care insurance through the Evidence of Insurability process.
Long Term Care Insurance is provided by CNA, underwritten by the Continental Casualty Company. For more information about this plan visit www.ltcbenefits.com/uts or call CNA LTC Customer Service at 888-825-0353.
*U.S. Department of Health and Human Services website, http://www.longtermcare.gov/LTC/Main_Site/Paying_LTC/Costs_Of_Care/Costs_Of_Care.aspx, accessed March 2010
** Health Insurance Association of American (HIAA), Guide to Long-Term Care Insurance, 1996;
***Public Policy Monograph, Long-Term Care, Academy of Actuaries, January, 1999.
Continental Casualty Company provides the products and/or services described. The information is intended to present a general overview for illustrative purposes only. It is not intended to constitute a binding contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions, and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. CNA is a registered trademark of CNA Financial Corporation. © 2010 CNA. All rights reserved.
Put the brakes on bad oral health
Some personal behaviors are harmful to oral health and can lead to damaged teeth and costly dental work. With hectic schedules and days full of distractions, it is easy to lose track of some of the “little things” that can lead to dental problems. Keep in mind that living without these bad habits will help you develop and maintain a healthier, brighter smile:
*Article provided by Delta Dental
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Your Local Benefits Office: http://www.utsystem.edu/benefits/contacts#1