Benefits

Health Plan Frequently Asked Questions: Retiree

The following reflect some of the more commonly asked questions regarding MSU Retiree Health Care Programs by category. We hope this quick reference is helpful. To get answers to other questions, please contact MSU Human Resources Benefits at (517) 353-4434, toll-free at (800) 353-4434 ext. 0 or via email at benefitsinfo@hr.msu.edu.

Retiree Contributions  Coverage Options Access to MSU Health Plan Coverage for Spouse or MSU Recognized Same-sex Domestic Partner  Caremark Prescription Drug Plan

Retiree Contributions

Will I have to contribute toward the cost of the health plan I choose? I am a retiree, not yet eligible for Medicare, with a family member enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage? I am a retiree not enrolled in Medicare with no family member(s) enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage? I am a retiree enrolled in Medicare and my spouse is also enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage? My spouse and I are both covered under PHP through MSU and we do not have any dependents. Is it less costly for MSU if we each have single coverage in our own name, or if both of us are covered together under one enrollment?

Coverage Options

I am an MSU retiree with Medicare and all of my enrolled family members also have Medicare. What health coverage options can I choose from? I am an MSU retiree and all members of my family (including me) are not enrolled in Medicare. What health coverage options can I choose from? I am an MSU retiree and the members of my family are a mix of Medicare and non-Medicare enrollees. What health coverage options can I choose from? What are the differences between the BCBS Traditional Plan and the BCBS Transition Plan? If the coverage of this new BCBS Transition plan is the same as my current BCBS Traditional coverage, how can it be less costly?

Access to MSU Health Plan Coverage for Spouse or MSU Recognized Same-sex Domestic Partner

I have a spouse or MSU recognized same-sex domestic partner (who currently works for or is retired from another employer) and could purchase single health care coverage for a premium contribution of $800 or less per year from that employer. I plan to have him/her enroll in that plan. Is there anything else I need to do? My spouse or MSU recognized same-sex domestic partner does not have access to other health plan coverage. Do I still need to complete the Health Plan Affidavit for Spouse or MSU Recognized Same-Sex Domestic Partner? My spouse or MSU recognized same-sex domestic partner currently works for another employer and is required to take that employer’s health plan coverage. Is my spouse or MSU recognized same-sex domestic partner also required to cover our dependent children under his/her employer’s health plan? When does my spouse or MSU recognized same-sex domestic partner need to enroll in his employer’s health plan?

Caremark Prescription Drug Plan   What are the prescription drug co-pays? Are the co-pays the same for mail order (90-day supply)? Are the formulary drugs the same at mail service and retail network pharmacies? My medication was removed from the formulary list. How will my medication be filled in the future? My medication was removed from the formulary list. How will my physician(s) know about this change? Do I need to enroll in the Caremark prescription drug plan if I change health plans?

Retiree Contributions

Will I have to contribute toward the cost of the health plan I choose? MSU’s contribution toward retiree health plan coverage will pay the full cost of the lowest cost health plan (and a prorated amount for those eligible for part-time contributions). The lowest cost health plan, depending on your eligibility, is either BCBS Traditional, BCBS Transition, or PHP. If you are enrolled in Community Blue, the higher cost plan, you will have a choice between contributing toward the cost of Community Blue, or making no contribution by electing the lowest cost health plan if you are eligible for the full university contribution. I am a retiree, not yet eligible for Medicare, with a family member enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage? Retirees with a family member enrolled in Medicare may choose between the Blue Cross Blue Shield Transition plan or PHP. The full university contribution toward retiree health plan coverage pays the full cost of the BCBS Transition coverage for eligible retirees, their spouses or MSU recognized same-sex domestic partners, and their dependents (prorated for part-time). Retirees who select PHP must pay the premium difference between PHP and BCBS Transition plan (the lowest cost plan). For 2008-09, see the chart below for the monthly cost: Coverage Tier   BCBS Transition PHP Faculty Staff 2 person, 1 with Medicare -0- $195.46 $193.68 Family, 1 with Medicare -0- $179.53 $179.53 Family, 2 with Medicare -0- $72.43 $72.43 I am a retiree not enrolled in Medicare with no family member(s) enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage? Retirees without any family member(s) enrolled in Medicare may choose between the Community Blue or PHP health plans. The current university contribution toward retiree health plan coverage pays the full cost of PHP (the lowest cost health plan). Retirees who select Community Blue must pay the premium difference between the cost of PHP and Community Blue.  For 2008-09, see the chart below for the monthly cost: Coverage Tier Community Blue PHP Retiree only $7.64 -0- 2 person $16.03 -0- Family $18.66 -0- I am a retiree enrolled in Medicare and my spouse is also enrolled in Medicare. Will I need to contribute toward the cost of my health plan coverage? Retirees with all family members enrolled in Medicare may choose between the Blue Cross Blue Shield Traditional or PHP health plans. The current university contribution toward retiree health plan coverage pays the full cost of BCBS Traditional coverage for retirees, their spouse or MSU recognized same-sex domestic partner, and their dependents (prorated for part-time). Retirees who select PHP must pay the premium difference between PHP and BCBS Traditional plan.  For 2008-09, see the chart below for the monthly cost: Coverage Tier   BCBS Traditional PHP Faculty Staff Retiree with Medicare -0- $47.53 $45.59 2 person, both with Medicare -0- $95.53 $90.85 Family, all with Medicare -0- $148.68 $142.87 My spouse and I are both covered under PHP through MSU and we do not have any dependents. Is it less costly for MSU if we each have single coverage in our own name, or if both of us are covered together under one enrollment? For PHP, it is less expensive to MSU if spouses cover themselves in their own names. The opposite is true for any of the Blue Cross Blue Shield plans. Because MSU pays an administration fee for each Blue Cross Blue Shield plan, it is less costly to MSU for both spouses to be covered under one retiree’s enrollment.

Coverage Options

I am an MSU retiree with Medicare and all of my enrolled family members also have Medicare. What health coverage options can I choose from? You have a choice between the Blue Cross Blue Shield Traditional Plan (BCBS Traditional Plan) and Physicians Health Plan (PHP). I am an MSU retiree and all members of my family (including me) are not enrolled in Medicare. What health coverage options can I choose from? You have a choice between the BCBS Community Blue Plan and PHP for you and any family members you enroll. In the future, when you or any family member becomes covered under Medicare, you may be required to cover everyone in the family under either PHP or the BCBS Transition Plan. I am an MSU retiree and the members of my family are a mix of Medicare and non-Medicare enrollees. What health coverage options can I choose from? You have a choice between the BCBS Transition Plan and PHP. In the future when all members of the family have Medicare, you may be required to select either the BCBS Traditional Plan or PHP. What are the differences between the BCBS Traditional Plan and the BCBS Transition Plan? If you, your spouse, or any dependents are enrolled in the BCBS Transition Plan please refer to the following chart for the differences between these two plans:   BCBS Traditional Plan BCBS Transition Plan Facility Services (including hospital & skilled nursing facilities) 365 day maximum 60 day renewal No dollar maximum No day maximum Lifetime payment maximum of $5 million Professional Services Master Medical services* paid as percentage of charge Master Medical services* paid as percentage of UCR** *Master Medical services include office visits and consultations, allergy testing and treatment, chiropractic manipulations, outpatient mental health, prosthetics, orthotics, durable medical equipment, ambulance, and prenatal care. **UCR is a Blue Cross term for a payment level that providers of medical care have agreed to in exchange for participation in the Blue Cross network. Providers in the Blue Cross network have agreed to accept Blue Cross payments as payment in full after you have paid any applicable deductibles and co-pays. Facility and professional networks in Michigan are comparable. Out-of-state facility and professional claims are generally paid as BCBS Traditional claims. If the coverage of this new BCBS Transition plan is the same as my current BCBS Traditional coverage, how can it be less costly? Under the new BCBS Transition Plan, claims for services received by non-Medicare covered retirees, spouses, and dependents are processed according to a less costly Blue Cross negotiated provider discount.

Spouse or MSU Recognized Same-sex Domestic Partner Access to MSU Health Plan Coverage

I have a spouse or MSU recognized same-sex domestic partner (who currently works for or is retired from another employer) and could purchase single health care coverage for a premium contribution of $800 or less per year from that employer. I plan to have him/her enroll in that plan. Is there anything else I need to do? Yes, retirees with a spouse or MSU recognized same-sex domestic partner must complete a Health Plan Affidavit for Spouse or MSU Recognized Same-Sex Domestic Partner to inform MSU of other coverage enrollment. Completion of this Affidavit is required regardless of whether the other coverage costs the spouse or MSU recognized same-sex domestic partner more or less than $800 per year in premium contributions. My spouse or MSU recognized same-sex domestic partner does not have access to other health plan coverage. Do I still need to complete the Health Plan Affidavit for Spouse or MSU Recognized Same-Sex Domestic Partner? Yes, retirees with a spouse or MSU recognized same-sex domestic partner, who are not retired or work at MSU, and do not have access to other health plan coverage still need to complete a Health Plan Affidavit for Spouse or MSU Recognized Same-Sex Domestic Partner to inform MSU that their spouse or MSU recognized same-sex domestic partner does not have access to other health plan coverage. My spouse or MSU recognized same-sex domestic partner currently works for another employer and is required to take that employer’s health plan coverage. Is my spouse or MSU recognized same-sex domestic partner also required to cover our dependent children under his/her employer’s health plan? No, MSU does not require your dependent children to be covered under your spouse’s or MSU recognized same-sex domestic partner's employer’s health plan. However, you may wish to have them covered under the other employer’s plan depending on your cost for this coverage and your health plan needs. When does my spouse or MSU recognized same-sex domestic partner need to enroll in his employer’s health plan? Your spouse or MSU recognized same-sex domestic partner must enroll upon eligibility or no later than July 1 during the year of MSU's Open Enrollment.  Caremark Prescription Drug Plan What are the prescription drug co-pays? The Caremark prescription drug co-pays will remain in effect for all retirees through the next plan year: Source Retail Pharmacy Caremark Mail Service MSU Pharmacy Days Supply 1-34 35-90 1-34 35-90 Generic $10 $20 $10 $20 Brand Name on Formulary $20 $40 $20 $40 Brand Name not on the Formulary $40 $80 $40 $80 Bio-Tech Rx $50 $100 $50 $100 Are the formulary drugs the same at mail service and retail network pharmacies? Yes, Caremark has one formulary, which is used for both mail and retail services. My medication was removed from the formulary list. How will my medication be filled in the future? You can still receive a non-formulary drug, however, you will be required to pay the higher co-pay for the drug. My medication was removed from the formulary list. How will my physician(s) know about this change? Physicians are notified of these changes by Caremark with an updated personalized patient profile for their patient files. You should also talk with your physician at your next appointment about options that may be more cost effective. Do I need to enroll in the Caremark prescription drug plan if I change health plans? No, if you are enrolled in any of the MSU health plans, you’ll automatically be covered by the Caremark prescription drug plan.