Medical with Prescription Coverage
- Medical coverage-at-a-glance
- Prescription coverage at-a-glance
- Request Reimbursement for OTC COVID-19 Tests
- Rights and Protections Against Surprise Medical Bills
2022 Plan Rates
|Single Plan||Two-Person Plan||Family Plan|
*Full-time staff bi-weekly deduction is over 26 pays; less than full-time staff who do not collect 26 pays will have their deduction spread appropriately. **Faculty bi-weekly deduction is over 20 pays (10 in Winter and 10 in Fall)
NMU offers its employees dental coverage administered by Blue Cross Blue Shield (BCBS) of Michigan.
2022 Plan Rates
|AAUP/NMUFA/TOP/AFSCME||$ 0||$ 0||$ 12.24|
|Non-Reps/AP's||$ 0||$0||$ 0|
Flexible Spending Accounts
NMU offers two types of Flexible Spending Accounts (FSA's) which allows full-time employees to deposit money on a pre-tax basis from their paycheck into an account. The two accounts are:
Funds can then be withdrawn from your account to cover approved out-of-pocket expenses for health care or dependent care.
For year 2022, the annual maximum contribution for the health care FSA is $2,850. IRS regulations allow for a maximum of 20% ($750) of the maximum contribution established to carry-over to 2023. The annual maximum for the dependent care FSA is $5,000 and there is no carry-over provision for this account.
If you are not certain what your out-of-pocket expenses may be, we encourage you to make a conservative estimate regarding your contribution amount.
Upon separation of service, you may still be reimbursed for services incurred prior to the end of the month in which you left employment. You will have 30 days after your benefit termination date to process eligible expenses for reimbursement. After 30 days, any remaining funds in the health care FSA will be forfeited.
Life Insurance Coverage
Northern Michigan University provides group term life insurance through The Hartford for employees working half-time or more. The amount of Basic Life Insurance is equal to one times annual salary rounded to the next thousand. There is also a double indemnity clause which doubles the benefit for accidental death. At termination of employment, coverage ends and employees are given the information needed to contact The Hartford regarding conversion and portability options.
Disability Insurance Coverage
After one year of full-time employment and after sick leave has been exhausted, eligible employees are paid 75% of their base salary for up to six months. Employees who accumulate annual leave will use accumulated and unused annual leave to make up the difference between short-term disability payments and full salary.
Long-term disability is a benefit to employees after they have been employed for one year. After six (6) months of disability, the policy pays up to 60% of basic annual salary less social security, retirement, workers’ compensation, etc. Premiums are currently paid by the University.
NMU has partnered with The Hartford to provide long-term disability insurance to employees who work at least thirty (30) hours per week and to faculty who teach twelve (12) or more credited hours in a semester.
Additional Dental/Vision Coverage Information
Dental coverage is provided through Blue Cross Blue Shield of Michigan (BCBSM)
Vision coverage is provided through EyeMed Vision
Coverage for both:
- is effective the date of hire.
- must be applied for within the first 30 days of hire.
- may be changed if the Human Resources Department (227-2470) is notified within 30 days of a status change.
- may be applied for or changed during the annual Open Enrollment period in December.
- coverage will continue for dependent children, if enrolled, to the end of the month in which he/she turns age 26.
Bi-weekly deductions, if any,
- are based on 26 pay periods,
- are dependent on the employee group, and the number of family members covered,
- are subject to change.
Additional Medical Insurance Coverage Information
NMU’s PPO Plan through Blue Cross Blue Shield of Michigan (BCBSM) uses a network of physicians, hospitals, and other health care specialists who have signed agreements with us to accept the approved amount as payment in full for covered services. When you use PPO network providers, your out-of-pocket costs for covered services are limited to the co-pays and deductibles stated in the summary of benefits. Here’s what you need to do when you need medical care:
- Choose a provider from the BCBS Provider Directory.
- Make your appointment directly with that provider. You can also ask your provider if they are in the PPO Network.
You do not have to choose just one provider for your care and you do not have to notify us if you decide to change physicians. Just remember to select your provider from the directory and you will stay in-network. If you would like to verify if a provider is in the BCBS network, please review the Provider Directory or contact BCBS's customer service line at 800-879-1945.
To receive benefits at the in-network level, your care must be received from a Community Blue PPO provider. You do not need to use Community Blue PPO network provider for the following services, you must, however, follow coverage requirements.
- Services where there is no network available.
- Services covered under a separate dental, or vision plan.
Special Note for Parents of Students: If you have dependents attending school, but living away from home, you should help them choose a Community Blue Preferred PPO physician near their school. Please refer to the nation-wide provider directory.
When you receive care from a provider who is not part of the Community Blue PPO network, without a referral from a PPO provider, your care is considered out-of-network.
Before choosing a non-network provider, you should verify if the service would be covered. Some services, such as your preventative care services, are not covered out-of-network.
If you choose to receive services from a non-network provider, you can still limit your out-of-pocket costs if the provider participated in traditional BCBS plans.
If you use BCBS participating providers outside the PPO network:
- The provider will bill BCBS directly for your services.
- You will not be billed for any differences between BCBS’s approved amount and the provider charges.
The Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, allows you to continue group medical insurance, prescription drug, dental and vision coverage on an individual basis when you or your dependents become ineligible for University benefits. At that time, the COBRA notice and current rates will be mailed to your, or your dependents losing the health benefits.
COVID19 Flex Spending Questions
Q: Am I permitted to increase or decrease my election for my health care flexible spending account (FSA) or cancel my election entirely due to the cancellation or rescheduling of medical procedures due to the COVID-19 pandemic?
A: Yes. Participating employees in an FSA plan may make election changes on a prospective basis until the end of this 2021 calendar year. With respect to the health care FSA, employees may 1) revoke an election entirely; or 2) decrease or increase an existing election. An existing election may not be decreased to an amount that would not cover amounts already reimbursed. In addition, employees not currently participating may now enroll. If you are interested in making any changes, please e-mail Kimberly Hongisto, Benefits Assistant, at email@example.com and she will send you the appropriate change form.
Q: Am I permitted to increase or decrease my election for my dependent care flexible spending account (FSA) or cancel my election entirely due to closures and/or re-opening of my daycare facility due to the COVID-19 pandemic?
A: Yes. Participating employees in the dependent care FSA may make election changes on a prospective basis until the end of this 2021 calendar year. With respect to the dependent care FSA, employees may 1) revoke an election entirely; or 2) decrease or increase an existing election. An existing election may not be decreased to an amount that would not cover amounts already reimbursed. In addition, employees not currently participating may now enroll. If you are interested in making any changes, please e-mail Kimberly Hongisto, Benefits Assistant, at firstname.lastname@example.org and she will send you the appropriate change form.
Q: What effect does the CARES Act have on my health care flexible spending account (FSA)?
A: Within the CARES Act are provisions that may help faculty and staff who are enrolled in a health care flexible spending account (FSA). The following provisions are included in the Act:
- The use of health care FSA funds to purchase over-the-counter (OTC) drugs and medicines without a prescription from a physician.
- Adds feminine hygiene products, including tampons, pads, liners, and similar products, to the list of OTC items eligible for reimbursement from a health care FSA.
The OTC changes are effective for expenses incurred after December 31, 2019.
Using your FSA VISA card (debit card) for OTC drugs without a prescription and menstrual products is dependent on the updated eligible product list managed by the Special Interest Group for IIAS Standards (SIGIS), then merchants updating their systems. In the interim, members will need to submit manual claims with the proper documentation.
Q: What happens to the unused funds in my health FSA at the end of the calendar year 2021?
A: The Consolidated Appropriations Act of 2021 permits any unused contributions remaining in your health FSA to be carried forward to the 2022 calendar year. This provision removes the $550 cap on carryover of unused funds that previously existed. This does not apply to the dependent care FSA.
Q: Is there an extended period for dependent care incurred claims?
A: Yes. You are permitted to apply unused contributions remaining in the dependent care FSA from 2020 to pay or reimburse dependent care expenses incurred through 12/31/2021.
Dependent Life Option
Employees may purchase term life insurance for their spouses and/or dependent children (through age 26). Three benefit levels of supplemental dependent life insurance exist, as specified below.
|OPTION 1: $10,000 spouse / $5,000 child||$.44 bi-weekly|
|OPTION 2: $15,000 spouse / $10,000 child||$.67 bi-weekly|
|OPTION 3: $20,000 spouse / $10,000 child||$.86 bi-weekly|
Supplemental life coverage (employee and dependent) may be elected within 30 days of hire or qualifying change of status. Additional enrollment options are available during annual enrollment in November of each year.
HARTFORD Value Added Services (effective 10/01/2019)
There are some life conversations that no one wants to have - especially when it involves planning for financial matters, insurance needs, making end-of-life decisions or planning for the loss of a loved one.
As part of your life and long-term disability insurance plan with The Hartford, you have access to value-added services, designed to help you and your loved ones make more informed decisions. Services include:
Provides access to Master’s- and PhD-degreed clinicians for 24/7 assistance if you’re enrolled in our long term disability plan. This includes 3 face-to-face visits per occurrence per year for emotional concerns and unlimited phone consultations for financial, legal, and work-life concerns.
For more information on Ability Assist® Counseling Services:
Company name: Abili
Company ID: HLF902
Provides a suite of online tools to guide you through key decisions before a loss, including help comparing funeral-related costs. After a loss, this service includes family advocacy and professional negotiation of funeral prices with local providers—often resulting in significant financial savings.
For more information on Funeral Planning and Concierge Services:
Use Code: HFEVLC
Offers compassionate expertise to help you or your beneficiaries (those you name in your policy) cope with emotional, financial and legal issues that arise after a loss. Includes unlimited phone contact with a counselor, attorney or financial planner for up to a year, and five face-to-face sessions.
For more information on Beneficiary Assist® Counseling Services, call 1-800-411-7239.
Helps you protect your family’s future by creating a will online—backed by online support from licensed attorneys. Your will is customized and legally binding.
For more information on EstateGuidance® Will Services:
Use Code: WILLHLF
Includes pre-trip information to help you feel more secure while traveling. It can also help you access medical professionals across the globe for medical assistance when traveling 100+ miles away from home for 90 days or less when unexpected detours arise. The ID theft services are available to you and your family at home or when you travel.
For more information on Travel Assistance Services or ID Theft Services:
Call from United States: 1-800-243-6108
Call collect from other locations: 202-828-5885
Travel Assistance Identification Number: GLD-09012
You’ll be asked to provide your employer’s name, a phone number where you can be reached, nature of the problem, Travel Assistance Identification Number, and your company policy number which can be obtained through your Human Resources/Personnel department.
If you have a serious medical emergency, please obtain emergency medical services first, and then contact Europ Assistance USA for follow-up.
Offers unlimited access to benefit specialists and nurses for administrative and clinical support to address medical care and health insurance claims concerns if you’re enrolled in our long term disability plan. Service includes: guidance on health insurance claims and billing support, explanation of benefits, cost estimates and fee negotiation, information related to conditions and available treatments, and support to help prepare for medical visits.
For more information on HealthChampionSM Services
Company name: Abili
Company ID: HLF902
Medical and Prescription Coverage Resources
- 24 Hour Nurse Line
- Summary of Benefits Coverage
- All group and individual health plans must provide a uniform summary of benefits and coverage (SBC) to applicants and enrollees. The Affordable Care Act (ACA) requires insurers and health plans to provide consumers with standardized and easy-to-read information about the plan using a common form that is intended to make it easier for consumers to compare plans. The SBC must describe the main features of the plan, including covered benefits along with any limitations or exclusions, cost sharing requirements, and whether it meets minimum essential coverage and value standards. The SBC must also include examples of how the policy or plan would cover care for certain health conditions or scenarios, showing hypothetical costs for consumers and how much the plan would pay. Finally, the SBC includes uniform definitions of common insurance-related terms.
- A Guide to Reading your EOB
- Your Benefits Guide
- Go Paperless using your Blue Cross Member Account
- BCBS Global Core - Coverage Abroad
- A Guide to Reading your EOB
- How do I appeal a health plan decision?
- Blues 365
- How to Register at www.bcbsm.com
- BCBSM.com site FAQ's
- Experian Identity Works ID Protection
- Experian Identity Works Fact Sheet
- Uniform Glossary of Health Coverage and Medical Terms
CVS/Caremark Prescription Coverage Information
Flexible Spending Additional Resources
- HRA and FSA Qualified Expenses
- FSA Summary Plan Description (SPD)
- Healthcare Flexible Spending Account
- Dependent Care Flexible Spending Account
- FSA Store
- Change of Status/Termination Election Form
Please visit healthequity.com/wageworks to learn more about the plan and, if enrolled, access your account information.
If you have questions, please utilize the Live Chat function within your participant portal at www.healthequity.com/wageworks or call the HealthEquity team at 866-242-3458. They are available 24/7.
Supplemental Life Option
Additional life insurance may be purchased and paid for through payroll deduction. Amounts are multiples of salary (from 1/2 up to 5x salary, subject to maximum of $500,000). Supplemental life may be purchased within 30 days of enrollment, without having to provide evidence of good health. Rates are based on your age, and are shown below.
|Age Range||Rate (per thousand dollars of coverage)|
EXAMPLE: A 42 year old employee with an annual salary of $47,900 elects 3 times their annual base salary in supplemental life insurance.
$47,900 x 3 = $143,700 rounded to the nearest thousand would provide $144,000 in supplemental life insurance.
$.0674 (rate for age range) x 144 (amount of coverage in thousands) = $9.71/bi-weekly