Medical Insurance

Medical Insurance and NUFlex

NUFlex provides you with several medical options which differ in the deductible, coinsurance and stop-loss amounts. The medical options described below cover services such as hospital room and board, hospital supplies, surgery, office visits, outpatient treatment, laboratory tests, and x-rays.

The Blue Cross Blue Shield of Nebraska plan provides comprehensive medical insurance coverage for the treatment of an illness or injury. After a deductible is met, the plan pays a percentage of the covered medical expenses (coinsurance) until the annual stop-loss limit is reached. Thereafter, the medical plan pays 100 percent of all covered medical expenses which do not exceed the maximum benefit amount.

A component of any Blue Cross Blue Shield medical option is a preferred provider health care program (NEtwork BLUE). By choosing a physician or hospital that is a member of the NEtwork BLUE network, you file no claim and save money through:

• Discounted fees by the provider
• Reduced deductible and stop-loss limit
• Lower coinsurance payments
• No balance billing by the provider

The only differences between these three options lie in the deductible, coinsurance and stop-loss limits. CVS Caremark prescription drug copays and the annual prescription drug deductible are the same for any Blue Cross Blue Shield of Nebraska medical option, as are the benefits for wellness.

The current medical PPO network directory may be viewed on the University of Nebraska benefits webpage at www.nebraska.edu/benefits. PPO participation information may also be obtained by calling Blue Cross Blue Shield at (888) 368-2227.

Summary of Medical Options 2011

Disease Management Program

The university offers you and your covered family members a valuable health service called BluePartners, a disease management program provided by Blue Cross Blue Shield of Nebraska. The program is available at no additional cost to members who are dealing with any of four chronic medical conditions: diabetes, heart disease, chronic pulmonary disease and asthma.

The BluePartners program offers personalized attention from a team of health care professionals, custom- designed to fit individual needs, lifestyles and doctors' instructions. BluePartners strives to educate and empower program participants by providing a wide variety of support: personal phone contact with a registered nurse, educational materials and Internet tools. Health care professionals can answer questions about specified chronic conditions, as well as consult with you and your doctor regarding treatment plans. The university and BluePartners are working together to reach those who would benefit most from this program.

Be Sure the Option You Select is "Cost Efficient"

In selecting your medical option, you are strongly encouraged to compare the annual difference in price tags between options, to the difference in medical cost exposure (deductible and stop-loss) between options. In most instances, the Basic Option is a more economical choice than the High Option, regardless of the medical expenses you may incur. In such cases, the difference in the deductible, coinsurance and stop-loss amounts you receive through the High Option cannot equal the savings in premium expense provided by the Basic Option for the same coverage category. For most employees, the Basic Option is always the best choice, from a purely economic perspective.

Some individuals may still select the High Option for cash management purposes, preferring to pay more per month in order to ensure a more affordable deductible and coinsurance payment when medical expenses do occur. You are urged to be aware of the cost of your choice, however, because the savings can be significant, depending on your coverage category and medical claims experience.

Extension of Coverage

Medical and prescription drug coverage for dependent children may be extended beyond age 26 (the plan's limiting age), or when a dependent no longer satisfies the group eligibility criteria. Extension of coverage is available to age 30 for a dependent who is unmarried, a resident of Nebraska, and not covered by any other health plan. Coverage ends when the dependent no longer meets the extension of coverage eligibility criteria or the parent separates from the University of Nebraska.

A dependent child must be enrolled in the university's medical plan to be eligible for the extension of coverage. At the time of initial eligibility, a dependent will be offered an opportunity to enroll for COBRA or extension of coverage. If extension of coverage is elected, the dependent will not be eligible for COBRA coverage at a later date. A dependent must enroll for the extension of coverage within 31 days of eligibility.

Blue Cross Blue Shield must be contacted to obtain the Extension of Coverage Request for Extended Eligibility to Age 30 enrollment form.

Health Risk Assessment

In addition to your insured benefits and retirement plans, the University of Nebraska has a commitment to our employees' wellness. As part of that commitment, we offer you the opportunity to complete a Health Risk Assessment (HRA).

The HRA is a valuable educational tool designed to help you learn important information about your current health status and how to improve it. Participation is voluntary; however, by completing this short survey (it will take 15 - 20 minutes to complete), you will receive a Personal Health Report that will help you assess and monitor your personal health status. Survey questions will include health-related information such as blood pressure and cholesterol/ blood sugar. We encourage you to "know your numbers" and have them available while you complete the survey. Employees who are enrolled in the university's Blue Cross Blue Shield medical plan and complete the HRA will be eligible for enhanced wellness and preventive services benefits for themselves as well as their covered family members. Enhanced wellness and preventive services include:

• Annual preventive care allowance of $300 (for insureds age 2 and over)
• Dependent child (under age 2) preventive care allowance of $600
• 100 percent coverage, up to $2,500 maximum, for routine preventive colonoscopy once every 10 years beginning at age 50 (services must be provided by a Blue Cross Blue Shield PPO Provider)
• $0 copay for generic prescription drugs through CVS Caremark's mail service

Your personal health information will remain confidential as the university will only have access to the aggregate information obtained from the survey. This website is part of Wellstream, a third party vendor, to help assure the confidentiality of your information. Aggregate data from each campus will be used to create programming to set goals for improving the health and well-being of employees. The HRA maybe completed online at https://unl.wellstreamonline.com

You will note the Username and Password have been prepopulated by Wellstream. Before you can advance to the HRA survey, you will be required to change and/or update your password.

You have 31 days from date of hire to complete the HRA. At the completion of the HRA survey, you will be able to view and print a Personal Health Report detailing your health risk status, as well as tips to become healthier based on your results. The Personal Health Report must be printed and/or saved in order for you to receive credit for completing the HRA survey and be eligible for the enhanced wellness and preventive services benefit. Once you print and/or save your Personal Health Report, the enhanced benefits will be included in your medical and prescription drug coverage as of your benefits effective date.

Once you complete the HRA survey (as a newly eligible employee), you must complete the survey each year in order to receive the enhanced wellness and preventive services benefit for the following calendar year.

Issues to Consider

• You and your dependents may enroll in any medical option without proof of insurance or pre-existing condition limitation.
• If you are covered by your spouse's medical plan, duplicate coverage may not be the most cost effective approach.
• If you use the Health Care Reimbursement Account to pay non-covered medical expenses, you may want to elect a medical option with a higher deductible.
• If your spouse is employed by the university and is benefits-eligible, your Campus Benefits Office should be contacted for the applicable medical plan price tags.
• Enrollment of any dependent into one of the Blue Cross Blue Shield medical options requires completion of the Dependent Information Request Form, which is available on the university's benefits webpage.
• If you use the services of a non-Blue Cross Blue Shield network provider (non-PPO provider), you will experience higher out-of-pocket costs due to the higher deductible, higher coinsurance, higher stop- loss limit, and potential balance billing by the provider.
• Participation in the prescription drug program is dependent upon your enrollment in the Blue Cross Blue Shield medical plan and does not require any additional premium to participate.
• Medical coverage for a newborn child will begin at the dependent child's date of birth. To continue the child's coverage beyond 31 days, you must contact the Campus Benefits Office within 31 days of a dependent's date of birth to add the newborn child to your medical insurance policy. You must complete and deliver to the Campus Benefits Office a Dependent Information Request Form to add the new dependent child to the medical insurance policy even if you are currently enrolled for Employee & Child or Employee & Family coverage. If the newborn child is added, the coverage change and related increase in premiums will be effective the first of the month following the dependent's date of birth. If you do not complete and deliver the properly completed Dependent Information Request Form to the Campus Benefits Office within 31 days of the newborn's birth and then want to cover the child, the child will be considered a late enrollee and benefits will not be provided to the child until the next annual NUFlex enrollment. (No coverage changes are allowed as a result of a Permitted Election Change Event.)

Medical Insurance Notice

If you are declining medical insurance enrollment for yourself or your dependents (including your spouse) because of other medical coverage, you may in the future enroll yourself or your dependents in one of the university-provided options, provided that you request enrollment within 31 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth or adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 31 days after the marriage, birth or adoption.

Blue Cross Blue Shield Insurance Benefits Summary 2011