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Insurance Insights

The Unique Value of UT Benefits

Recently it seems as though there is more and more unwelcome news coming out every single day. Negative storylines seem to easily drown out positive news. Among other issues, the struggling economy, continuing job losses when unemployment is already high, and the seemingly ever increasing costs of healthcare are all topics that show up regularly in the news these days. When such difficult topics dominate the headlines, it can be a challenge to feel confident about being able to take care of even basic healthcare needs for yourself and your family, let alone being able to deal with an unexpected health crisis. Combine the prevailing news with the hectic pace of work and family life, and it’s not surprising that there’s little time to stop and think about all of the UT resources and support that continue to be available for you and your family should you need them.

The extraordinary value of the UT Benefits program is a great example of a positive subject that can easily be overlooked. The UT SELECT medical and prescription plan is the centerpiece for the UT Benefits program and provides significant benefits to eligible employees, retirees, and their families. But much of the true value of the plan becomes crystal clear only during those critical moments when help is most needed by plan participants. The overall value of the UT SELECT plan can suddenly become very apparent if you or a covered dependent is faced with a significant health situation, including such difficult circumstances as a preterm birth with complications; or a serious illness or traumatic injury requiring ongoing treatment, specialty medication, and/or long-term hospitalization; or even an unexpected condition requiring relatively minor outpatient surgery. If you and your family have been fortunate enough to avoid these kinds of situations altogether and have simply needed routine or preventive care, it may not be as obvious just how much the UT SELECT plan protects participants from the potentially devastating financial costs associated with these and many other health situations.

Over the years participants point out that out-of-pocket costs seem to always keep going up. It is true that, due to the ongoing need to adapt as the overall health care market and the specific needs of participants shift, changes have been made throughout the years that require employees and retirees to pay a slightly higher premium for dependent coverage or to pay more out-of-pocket for particular services. Unfortunately, based on national trends and projections, we anticipate that such changes will most likely continue to be necessary in the future. Despite such changes, UT SELECT continues to provide a rich package of benefits while keeping member out-of-pocket costs reasonably low. When considering both the available benefits and overall member costs, UT SELECT still compares very favorably to other large employer plans, both within the state of Texas and around the country.

While a few of the uniquely valuable features of UT SELECT were briefly mentioned in last month’s “A Matter of Health” newsletter, it is difficult to list every valuable feature of the plan. It is also important to keep in mind that the true value is in the overall plan and in having adequate protection available when critical health needs require expensive treatment. However, because most participants thankfully will never have a need to rely on some of the most valuable portions of the plan, the Office of Employee Benefits has developed the expanded list of features below as a way of illustrating just how rich the UT SELECT plan is and how much protection it provides for you and your family. Considering all of the benefits available, we believe it is clear that the security provided far outweighs the out-of-pocket costs associated with participating in the program.

Low Out-of-Pocket Premium Costs

Employees pay no out-of-pocket premiums for their coverage.

Retirees pay no out-of-pocket premiums for their coverage.

Employees and Retirees pay only approximately 50% of premiums for their dependents.

One or multiple children can be covered for the same out-of-pocket premium.

Retirees have the same health benefits available as active employees at the same premium level, subject only to Medicare coordination requirements upon reaching age 65 (or otherwise becoming Medicare eligible). Only about 29% of large employers offered retiree health benefits at all in 2009, with only about two-thirds of those offering benefits to Medicare-eligible retirees. *

Since 2002, annual premium increases for UT SELECT have averaged about 4.1% compared with a national average estimated to be between 5% and 14% annually since 2000.*


Complete Coverage in a Program Designed by and for UT

Medical and prescription coverage are included under a single plan and premium.

Mental health benefits, including expanded benefits for serious mental illness, are included.

Employee Assistance Programs at each UT institution are funded through the plan with many services available at no additional cost to participants.

Basic life insurance is automatically included with UT SELECT coverage for employees and retirees.

Because UT SELECT is self-funded, the benefits design is controlled by UT System rather than by an outside insurer. This helps to keep administrative costs down and allows greater flexibility in adjusting the plan design to ensure that sufficient resources are available to pay claims and that the benefits offered continue to meet the changing needs of UT employees, retirees, and their families.

The overall impact to plan participants is carefully balanced when plan design changes are required to meet financial needs of the plan. Recommendations on potential plan design changes are provided by the System Wide Insurance Advisory Committee following the members’ consideration of opinions and input from faculty and staff at each of the 16 UT System Institutions.


Low Overall Out-of-Pocket Costs

The UT SELECT deductible is significantly lower than average. The individual network deductible for the upcoming plan year ($350) is only about 55% of the national average deductible for employer-based PPO plans in 2009 ($634).*

The out-of-pocket maximum protects participants when significant costs are incurred for care. For the 2008-2009 plan year, only about 6.5% of participants had to pay the full out-of-pocket maximum for care received. Those who reach the full network out-of-pocket maximum of $2,500 during the upcoming plan year will have received medical services costing a minimum of $10,750 in total plan costs. Many will receive significantly more costly services with no additional out-of-pocket obligation.

Specialty medications, such as those used to treat serious conditions such as cancer or multiple sclerosis (which are very costly), are available on the same copayment basis as other less-costly medications. As a result, participants who need these critical medications pay less than 2% out-of-pocket on average of the total cost for these specialty medications. In comparison, many pay significantly higher costs through other employer plans that require coinsurance of 31% on average for such medications.*

Programs such as step therapy and prior authorization for certain medications and services are utilized to help ensure that when proven and effective treatments are available at lower costs, these options are considered first before relying on a more costly alternative. If lower cost options do not work for a particular individual, other treatment options remain available with full applicable plan benefits.

Coordination of benefits with other plans, including Medicare, helps to keep overall costs down for the plan and participants. This is especially true for Medicare-eligible retirees who can often receive services with no out-of-pocket costs despite the overall average level of need for medical services being significantly higher in this group than for other groups of plan participants.


High Level of Benefits Available to All Participants

There is no annual or lifetime maximum on the overall dollar value of benefits.

Over 400 participants had medical claims during the last plan year for which the Plan paid more than $100,000 per participant, while each participant paid a maximum of $1,750 out-of-pocket for treatment through network providers and facilities.

Nearly 100 participants had claims during the last plan year for which the plan paid more than $250,000 per participant, while each participant paid a maximum of $1,750 out-of-pocket for treatment through network providers and facilities.

92.9% of plan participants had at least one claim for medical services during the last plan year.

The UT SELECT Plan paid a total of over $600 Million in medical and prescription claims on behalf of approximately 170,000 participants during the 2008-2009 plan year.

Dependent children are currently eligible to remain on the plan until the age of 25 regardless of student status or financial dependence upon parents.


Preventive Care Services Available in Network with
No Additional Out-of-Pocket Cost

Immunizations up to age 6

Routine Mammograms

Preventive Colonoscopy

Osteoporosis Screening

Diagnostic Lab and X-ray Services (office and outpatient settings)


Value Added Programs and Features Are Included at No Additional Cost**

24/7 Nurseline

Condition and Case Management

Prescription Interaction Warnings

Mail Order for Prescription Medications (offers increased convenience,  accuracy, and lower cost for 90-day supply)

Special Beginnings

Tobacco Cessation

Health Quotient (Comprehensive Health Risk Assessment)

Health Coaching and Lifestyle Improvement Programs

*Data on averages and other plans obtained primarily from the 2009 Annual Survey of Employer Health Benefits conducted by the Kaiser Family Foundation and the Health Research & Educational Trust.

**Please visit the UT System Living Well; Make it a Priority website as well as UT SELECT plan specific websites to learn more about these value added features and programs and any applicable requirements for participation.

Take Advantage of the New Online Beneficiary Management System

Beginning July 1, 2010, a great new feature available to all UT employees/retirees is the online Beneficiary Management system provided by Dearborn National to elect or change your beneficiary designation(s) for your Group Term Life insurance and your Accidental Death and Dismemberment insurance coverages.

Your beneficiary is a person or estate that will receive a life insurance benefit payment upon your death.  You can have more than one beneficiary, and common choices for beneficiaries include spouses, children, other family members, friends, charitable organizations or trusts.  If you do not designate a beneficiary, your group life insurance benefits could revert to the state, causing benefits to be distributed in a way you had not intended.  This is why choosing a beneficiary is so important. 

Your online beneficiaries can be access year round from the My UT Benefits enrollment system.  Logon with the ID of your choosing and your secure password/PIN, and proceed to the Benefits Summary tab. Once you enter the Beneficiary Designation homepage, you will find listed on the left side of the page scanned copies of all Beneficiary Designation Forms that you have completed in the past.  The information on the most recent form is not loaded into the online system; therefore, you should follow the instructions to manually enter your beneficiary designations. You will be able to view your information, make any changes you wish, and even print out the form to store with your other important records. If you are married and do not select your spouse as the Primary Beneficiary, you will be required by Texas law to print out the form and have your spouse sign in agreement.

Although you may still use your original paper form or complete a new paper form, you are encouraged to take advantage of this convenient Online Beneficiary Designation feature.  By entering your choice(s) online, they are effective immediately, and generally there is no paperwork to send in. Also, it will be much easier to make any future changes as needed.

Please contact Dearborn National’s Customer Service at 1-866-628-2606 if you have any questions.

 

Important Reminders

Contact Us

If you have a Benefits question, submit your question by replying to the “newsletter email” or by sending an email to benefits@utsystem.edu.

UT System Employee Benefits Web site: www.utsystem.edu/benefits/
UT System Retirement Programs Web site: www.utretirement.utsystem.edu
Your Local Benefits Office: http://www.utsystem.edu/benefits/contacts#1