Open Enrollment
Plan Year 2004
The open enrollment period will be from October 14, 2003 through
November 14, 2003. The Open Enrollment Election Form, applications
for enrollment and requests to change or drop coverage will be accepted
in the Personnel Office from 8:00 a.m. - 4:00 p.m. daily during
the open enrollment period. If you wish to make a change to your
benefits, all forms must be in the Personnel Office by close of business
on November 14, 2003. All changes made during the open
enrollment period will become effective January 1, 2004, or when evidence
of insurability, if applicable, is approved by the insurance carrier.
If you have any questions, please make an appointment. Note: Personnel
Services has moved to the corner of Katherine and Pickens Street, across
from Boykin Wright Hall.
Because some ASU benefit plans are administered under Section 125 of
the Internal Revenue Code (premiums paid with pre-tax dollars), the IRS
prohibits changes to benefit elections outside of the open enrollment period
unless they are due to change in family status, i.e. marriage, divorce,
birth, death of a dependent, loss of spouse's employment, etc. Changes
allowed during open enrollment include enrolling or dropping coverage and/or
adding or dropping dependents.
PPO/Indemnity
Health Benefits Comparison Chart for Plan Year 2004 (pdf, 470k)
Comparison of the health plan options effective
January 1, 2003.
Indemnity Health
Plan - Blue Cross & Blue Shield
HMO Standard Plan - Blue Choice
HMO Consumer Choice Plan
- Blue Choice
PPO Standard Plan
PPO Consumer Choice Plan
Basic Life Insurance, Supplemental and
Dependent Life Insurance - Metropolitan Life
Long Term Disability
Insurance - Hartford Life
AFLAC - Cancer and Short Term Disability Insurance
Dental Insurance - Brokers National Life Assurance
Company and DeltaCare Inc.
USG Indemnity Dental Plan
Dependent
Care and Health Care Flexible Spending Accounts
Optional Retirement Plans (ORP)
Tax Sheltered Annuities - 403(b) and Deferred
Compensation Plans - 457(b)
529 College Savings Plan
DEPENDENT
CARE AND HEALTH CARE FLEXIBLE SPENDING ACCOUNTS
The Dependent Care and Health Care Flexible Spending Accounts allow
you to pay for those dependent and/or non-covered health care expenses
with pre-tax dollars. The 2004 plan year will cover the period of January
1, 2004 through December 31, 2004.
To open your spending account, you must make an election by completing
an election form and returning it to the Personnel Office during the open
enrollment period. If you are currently participating in the Dependent
Care and Health Care Flexible Spending Account plans and wish to continue
participation,
you must submit a new enrollment form for the plan
year January 1, 2004 through December 31, 2004. If you do not
complete the Open Enrollment Election Form by November 14, 2003, you will
be deemed to have elected not to make any salary reduction contributions
to pay for eligible dependent and/or health care expenses you may incur
during the plan year.
(Use-It-Or-Lose-It Rule for Spending Accounts)
The IRS has imposed several rules regarding the use of spending accounts.
The most significant rule is the Use-It-Or-Lose-It Rule. Unused funds at
the end of the plan year must be forfeited and cannot be returned in any
manner. Because of this rule, it is very important that employees estimate
their eligible expenses very carefully and conservatively. If employment
should terminate during the plan year, all contributions to the spending
account will cease, effective the date of termination. However, employees
will be entitled to submit claims for eligible expenses through the end
of that plan year or until the account has been depleted, whichever comes
first.
OPTIONAL RETIREMENT PROGRAM - A change in companies under the
Optional Retirement Plan (a retirement plan available to faculty status
employees) is allowed only during the open enrollment period. The
four ORP companies are: TIAA-CREF, VALIC, Fidelity, and American Centuries.
Click here for additional information in the ORP Plans.
Brief History of Retirement Plans
The plans offer excellent vehicles to defer income taxes and build retirement
income exclusive of your contributions to either TRS or ORP. As a result
of the economic growth and Tax reconciliation Act of 2001, effective 2002,
these plans have became more attractive for eligible employees.
New for ASU are the addition of two 403(b) Tax Sheltered Annuity Company plans with Fidelity Investments and the Vanguard Group. Also, there are two new 457(b) plans available through VALIC and TIAA-CREF. Click on company name below for additional information.
Vanguard Group
Fidelity Investments
Georgia House Bill 1434 finalized approval for the Georgia Higher Education
Savings Plan, which is the State of Georgia's Internal Revenue Code Section
529 College Savings Plan. Guidelines for the plan have been released by
the Board of Regents policy (802.1301) for the University System of Georgia.
Under this program, any eligible employee may open a college savings account
for designated beneficiaries. The plan is available to benefit eligible
employees, adjunct employees, temporary employees, or student employees,
provided
he/she has current payroll activity.
College saving accounts are managed by investment professionals and
generate assets that are tax-free from federal and state income
tax. Tuition financing, Inc, (TFI) a wholly owned subsidiary of Teachers
Insurance Annuity Association (TIAA) has been licensed in Georgia to provide
the Georgia Higher Education Savings Plan.
As stated, withdrawals from college savings accounts, when used for
qualified expenses, will be exempt from both Federal and Georgia income
tax. The education expenses include tuition, fees, required books, supplies,
room and board, and other verifiable college expenses.
For general information the Georgia Higher Education Plan program has
provided a web site at www.gacollegesavings.com.
Also, a toll-free number (1-877-424-4377) is available for program participants
to request information or assistance. Please call Personnel Services at
extension 1763 for information or assistance.
There will be a premium increase for the Indemnity Plan, effective January 1, 2004. The premiums are increasing again to reflect the true cost of indemnity type coverage. For Plan year 2004, the Outpatient Short Term Rehabilitation Services benefit for physical, occupational, cardiac, and speech therapies, has been changed to 40 visits per incident type per plan year. This change in indemnity healthcare plan design affords consistency with the PPO healthcare plan design. The University System of Georgia accesses the Blue Cross Blue Shield National Participating Provider Network for medical care provided to an indemnity plan participant who resides/works outside of the State of Georgia (See the inside cover of the 2004 PPO/Indemnity Comparison Chart for details). You must complete the open enrollment election form and enrollment/change form for this plan year, if you request an action.
Indemnity Plan Resource Links
2003
2004
Employer
Coverage
Monthly Rate
Monthly Rate
Contributions
Employee only
$110.38
$112.56
$337.66
Employee (+) Spouse
$209.58
$236.38
$709.10
Employee (+) Child
$209.58
$202.60
$607.80
Family
$309.24
$326.42
$979.24
Retiree w/Medicare
$59.88
$65.88
$197.60
Retiree (+) one w/Medicare
$119.76
$131.76
$395.20
There will be a premium increase for the HMO Plan, effective January
1, 2004. For Plan Year 2004, there will be two important plan design
changes in the respective HMO healthcare plan options. There will
be an increase in the physician office visit co-payment from $10 to $15
and there will be an increase in the member pharmacy co-payment from $20
to $25 for brand name prescription medications. You must choose a primary
care physician from the HMO participating approved list before using this
plan. An updated list is available to all participants from the Personnel
Services Office or Blue Choice provider web site(www.bcbsga.com). You must
complete the open enrollment election form and enrollment/change form for
this plan, if you request an action.
2003
2004
Employer
Coverage
Monthly Rate
Monthly Rate
Contribution
Employee only
$44.18
$53.52
$160.52
Employee (+) Spouse
$88.36
$112.38
$337.10
Employee (+) Child
$88.36
$96.32
$288.96
Family
$132.54
$155.18
$465.54
There will be a premium increase for the HMO Plan, effective January
1, 2004. A consumer choice option is available for the Blue Choice
HMO Plan. The choice allows members to "nominate" non-network providers
to render care for covered members at in-network levels of benefit coverage.
The nominated physician (health care provider) must agree to the in-network
fee schedules and must be approved by the Blue Choice HMO group before
treatment will be approved. The premiums are higher than the basic HMO
option and will remain in effect for a full year, whether or not the physician
agrees to the rates or Blue Choice HMO approves the nomination. This option
is available only to health care providers who are licensed within the
state of Georgia or those within a select 25 mile radius across the Georgia
border into South Carolina - defined by zip codes. You must complete the
open enrollment election form and enrollment/change form for this plan,
if you request an action.
2003
2004
Employer
Coverage
Monthly Rate
Monthly Rate
Contribution
Employee only
$75.12
$90.98
$160.52
Employee (+) Spouse
$150.20
$191.04
$337.10
Employee (+) Child
$150.20
$163.74
$288.96
Family
$225.32
$263.80
$465.54
There will be a premium increase for the PPO Plan, effective January 1, 2004. Effective January 1, 2004, the name of the Georgia-In-Network PPO will be called the 1st Medical Network. A PPO (Preferred Provider Option) is a comprehensive network of doctors, ancillary providers, and hospitals that have agreed to offer quality health services at discounted rates. Members may choose to use this provider network for the higher level of benefit coverage, or choose any licensed provider they wish for a lower level of benefit coverage. The highest level of paid benefit coverage is available only through the in-network providers. PPO members do not have to select a primary care physician as with the HMO option. The plan is available to all benefits eligible employees. The discounted rates with the PPO allow the plan to combat increasing cost while also enhancing benefits. The PPO Option is not only available to healthcare providers within the state of Georgia (1st Medical Network), but has been expanded to a National PPO network called Beech Street. An updated list of 1st Medical Network and Beech Street providers is available on their web site (www.healthgeorgia.com). You must complete the open enrollment election form and enrollment/change form for this plan, if you request an action.
Employee only
$68.40
$72.32
$216.92
Employee (+) Spouse
$129.88
$151.86
$455.56
Employee (+) Child
$129.88
$130.16
$390.48
Family
$191.64
$209.70
$629.10
Retiree w/Medicare
$37.12
$40.84
$122.44
Retiree (+) one w/Medicare
$74.22
$81.68
$244.88
..
There will be a premium increase for the PPO Plan, effective
January 1, 2004. The consumer choice option also applies to the PPO
plan. The eligibility rules and benefits are identical to the Standard
PPO option, except an employee has the option to "nominate" non-network
providers to render care for covered members at in-network levels of benefit
coverage. The providers must be licensed in Georgia to be nominated and
must accept the in-network fee schedule and approved by the PPO. The PPO
Service area is defined as within the state of Georgia. You must complete
the open enrollment election form and enrollment/change form for this plan,
if you request an action.
2003
2004
Employer
Coverage
Monthly Rate
Monthly Rate
Contribution
Employee only
$95.76
$101.26
$216.92
Employee (+) Spouse
$181.84
$212.62
$455.56
Employee (+) Child
$181.84
$182.24
$390.48
Family
$268.30
$293.60
$629.10
Retiree w/Medicare
$51.96
$57.18
$122.44
Retiree (+) one w/Medicare
$103.92
$114.36
$244.88
There will be no increase in the life insurance rates. ASU provides basic life insurance coverage of $25,000 at no cost to employees. The coverage pays in the event of your death or dismemberment and provides for supplemental insurance options in increments of one, two, or three times your annual salary, up to a maximum of $250,000. You must complete the open enrollment election form, enrollment/change form and statement of health (if applicable) form for this plan, if you request an action.
Evidence of insurability is required. Any amount of insurance for which evidence of insurability is required will be effective on the date that Metropolitan gives approva
To compute your monthly supplemental life insurance premium, determine
the amount of coverage you desire (1, 2, or 3 times your annual salary,
rounded to the nearest 1000) as indicated below. Divide that amount by
$1,000, then multiply by the rate which corresponds with your age group.
Age Rate (per $1,000 of coverage)
> 30
$0.15/ $1,000
30 - 34
$0.19/ $1,000
35 - 39
$0.19/ $1,000
40 - 44
$0.22/ $1,000
45 - 49
$0.30/ $1,000
50 - 54
$0.38/ $1,000
55 - 59
$0.54/ $1,000
60 - 64
$0.64/ $1,000
65 - 69
$1.03/ $1,000
70 and above
$2.49/ $1,000
Dependent life insurance is also available. It is underwritten as a family unit and covers the spouse and all children under the age of 19, or to age 25 if a full-time student. The total dependent life insurance monthly cost is $3.40.
During each annual enrollment period, you may choose one of the following for the next policy year for life insurance:
1. A decrease or cancellation of coverage.
2. An increase in your life and accidental death and dismemberment coverage with evidence of insurability satisfactory to Metropolitan.
3. Enrollment in the plans with proof of insurability.
Brokers National Assurance Dental
Plan
A
Plan
B
Basic
Plan
University System of Georgia (USG) Indemnity Dental Plan
Dental
Benefits Plan Booklet
The University System of Georgia is allowing a “one time only” open
enrollment for their improved indemnity BCBS dental plan. The open
enrollment will be held for active employees and their dependents that
have not been included in the plan previously. Note: Augusta
State University is one of the institutions that were not included in this
plan. However, this year our employees will be given the opportunity
to enroll in the plan, if they wish to do so. Please consider the
plan carefully to determine if it meets you or your family’s needs.
It is not likely that the plan will be open again for active employees
for several years. The plan is not open on an annual basis.
Effective October 1, 2003, the University System gained access to a
national dental network. Blue Cross and Blue Shield will continue
to provide coverage within the State of Georgia. The national network
will provide additional dental providers both within the State of Georgia,
as well as, outside the state. Customer service will be handled by
a special group in California which is assigned to the Georgia group.
In January 2004, all indemnity dental plan members will receive a new identification
card with the new claims address and a toll-free telephone number listed
on the back. A dental claim form, with the new claims address will
be posted to the USG web site, effective January 1, 2004.
Effective October 1, 2003, dental claims incurred by a member will be
reimbursed at the “allowable charge” rather than at the “billed charge”.
Previously claims incurred by a member using a nonparticipating provider
within the state of Georgia or using an out-of-state provider were reimbursed
at the “billed charge”. The “allowable charge” will be based upon
the contracted rate that the national participating provider has agreed
to accept from the local Blue Cross and Blue Shield plan. The use
of the enhanced dental network will result in a member minimizing his/her
out-of-pocket expenses for covered dental services. Indemnity dental
plan participants, who access the enhanced dental network, will not be
subject to balance billing. Failure to utilize the service of a participating
provider will result in balance billing. Cost incurred for balance
billing will not apply toward one’s annual deductible.
To determine if a dental provider is a participant in the Blue Cross
and Blue Shield of Georgia dental network, please contact BCBS Customer
Service (Effective January 1, 2004, 1-800-627-0004). Also, you may
obtain this information by accessing the University System of Georgia web
site at www.usg.edu/admin/humres/benefits/dental.
A new indemnity dental plan summary document is attached. Several
key features of the plan include:
* When a member retirees from active service
with the University System of Georgia, participation may be continued providing
the member complies with all necessary
requirements for retirement prescribed by the Board of Regents.
* You do not have to be a member of the BCBS Indemnity Plan or any other
Blue Cross and Blue Shield health insurance plan.
* This year the plan will gain access to a national dental network.
* When a participating provider is used, 80% of the network rate will
be paid.
Dental
- Brokers National Life Assurance Company - The renewal rates
effective January 1, 2004, represent an approximate 15% increase for all
plans. The increases are due to our participation level and a 91% utilization
review. No claim forms are required and employees may choose any
dentist! Three plans are available: The Edge Plus Plan A, Plan B, and
the Basic Plan. A detail outline of the available plans are listed on the
following pages.
You must complete the open enrollment election form
and enrollment/change form for this plan, if you request an action.
BROKERS NATIONAL LIFE ASSURANCE COMPANY
DENTAL PLANS
Choose any dentist - Choose any of 3 Plans
Fluoride Treatments, X-rays, Cleanings, Periodic Exams
Deductible
Company Pays 0
100% 0
100% 0
100% Extractions, Fillings, Oral Surgery, Root Canals
Deductible
Company Pays $50
80% $50
80% $50
80% Bridges, Crowns, Dentures, Partials
Deductible
Company Pays Not Covered $50
50% $50
50% Type I, II, and III Deductible
Company Pays Not Covered Not Covered $50 Life Time
50% Orthodonia Benefits Premiums:
Employee
$36.70
Employee (+) one
$70.70
Family
$105.20
Fluoride Treatments, X-rays, Cleanings, Periodic Exams
Deductible
Company Pays 0
100% 0
100% 0
100% Extractions, Fillings, Oral Surgery, Root Canals
Deductible
Company Pays $50
60% $50
60% $50
60% Bridges, Crowns, Dentures, Partials
Deductible
Company Pays Not Covered $50
40% $50
40% Type I, II, and III Premiums:
Employee
$25.20
Employee (+) one
$49.90
Family
$72.50
Fluoride Treatments, X-rays, Cleanings, Periodic Exams
Deductible
Company Pays $25
80% Extractions, Fillings, Oral Surgery, Root Canals
Deductible
Company Pays $50
70% Bridges, Crowns, Dentures, Partials
Deductible
Company Pays Not Covered Type I, II, and III Premiums:
Employee
$15.50
Employee (+) one
$31.50
Family
$58.20
Dental - DeltaCare Insurance Company - You must complete
the open enrollment election form and enrollment/change form for this plan,
if you request an action. The monthly rates for 2004 have increase
by 5%. You must complete the open enrollment election form and enrollment/change
form for this plan, if you request an action. DeltaCare requires
members to pay one month premium in advance. You must select a dentist
from the provider list (enclosed). The DeltaCare network includes
endodontist, periodontist, pedodontist, orthodontist and oral surgeons.
DeltaCare enrollees can look forward to quality dental care from private
practice dentists, knowing that there are no deductibles, claim forms,
or maximum dollar limits for services.
Premiums
2003
2004
Employee only
$11.39
$11.96
There will be a one cent (.01) increase for the 90 day TRS Plan and
a decrease for each of the other plans as indicated below. You must
complete the open enrollment election form, enrollment/change form and
statement of health (if applicable) form for this plan, if you request
an action. The Hartford Plan is a group plan composed of other colleges
and universities within the University System of Georgia commonly referred
to as the Valdosta Plan.
Employees will have an option of one of two plans based on whether they
are currently enrolled in the Teachers Retirement System (TRS) or the Optional
Retirement Program (ORP). Two options are available to each group, either
a 90 day elimination period (EP) or a 150 day elimination period. The 90
day or 150 day elimination period refers to the period of time you must
be disabled before benefits are paid. You may choose a 90 day or
150 day elimination period.
2003
2004
90 days EP - TRS
$0.49 per $100 of salary
$0.50 per $100 of salary
The plan pays 60% up to 70% of your base monthly salary not to exceed
a monthly maximum of $7500, less other sources of income such as social
security, workers compensation, sick leave or retirement benefits.
There will be no increase in premium for the Long Term Disability
Plan, effective January 1, 2003. You must complete the open enrollment
election form, enrollment/change form and statement of health (if applicable)
form for this plan, if you request an action. The Hartford Plan is
a group plan composed of other colleges and universities within the University
System of Georgia commonly referred to as the Valdosta Plan.
Employees will have an option of one of two plans based on whether they
are currently enrolled in the Teachers Retirement System (TRS) or the Optional
Retirement Program (ORP). Two options are available to each group, either
a 90 day elimination period (EP) or a 150 day elimination period. The 90
day or 150 day elimination period refers to the period of time you must
be disabled before benefits are paid. You may choose a 90 day or 150 day
option.
Options Rates
90 days EP - TRS
$0.49 per $100 of salary
90 days EP - ORP
$0.33 per $100 of salary
The plan pays 60% up to 70% of your base monthly salary not to exceed
a monthly maximum of $7500, less other sources of income such as social
security, workers compensation, sick leave or retirement benefits.
There will be no increase in the AFLAC rate structure. Supplemental
Insurance Policiesavailable for Cancer and Short Term Disability.
Although Augusta State University has excellent medical coverage that may
pay most medical cost associated with injuries, illness, etc., there are
often deductibles, co-payments and other non-medical expenses that are
not covered. AFLAC's supplemental policies are designed to help offset
your out of pocket expenses. Benefits are paid directly to employees or
their families regardless of any other insurance they may have. Use the
money where your family needs it most. (Policies cannot be canceled because
of a change in your health.) The AFLAC Policies available for ASU include:
Short Term Disability
Cancer Protection Insurance
Monthly Benefits
First-Occurrence Benefit
Note: AFLAC Plans are flexible and tailored to meet individual needs.
Therefore, employees may complete the information request form and return
to Personnel Services or fax to (706) 738-7172. If you have questions,
please contact Ms. Diane McCullum (company representative directly) 706-738-7171.
Open Enrollment Forms Form Name
1. *Open Enrollment Election Form
2. Health Insurance Application
3. Health Insurance Change Form
4. DeltaCare Enrollment/Change Form
5. Brokers National Dental Enrollment Application
6. Brokers National Dental Change Form
7. Metropolitan Life Enrollment Form
8. Metropolitan Life Statement of Health Form
9. Metropolitan Life Beneficiary Change Form
10. Hartford LTD Enrollment Form
11. Hartford Statement of Insurability Form
12. AFLAC Information Request Form
* (The Open Enrollment Election Form must be submitted along
with all enrollment/change forms.)
Provider
Directory
Dental
Benefits Claim Form
BENEFIT STRUCTURE
1ST YEAR
2ND YEAR
THEREAFTER
Type 1 -Preventive/Diagnostic
Type II - Restorative
Type III - Major Restorative
Maximum Benefit Year
Type IV - Orthodontia Benefits
Life Time Benefits
BENEFIT STRUCTURE
1ST YEAR
2ND YEAR
THEREAFTER
Type 1 -Preventive/Diagnostic
Type II - Restorative
Type III - Major Restorative
Maximum Benefit Year
BENEFIT STRUCTURE
ANNUALLY
Type 1 -Preventive/Diagnostic
Type II - Restorative
Type III - Major Restorative
Maximum Benefit Year
Coverage
Monthly Rate
Monthly Rate
Employee (+) One
$19.78
$20.77
Family
$29.25
$30.71
Coverage
Monthly Rates
Monthly Rates
150 days EP - TRS
$0.27 per $100 of salary
$0.24 per $100 of salary
90 days EP - ORP
$0.33 per $100 of salary
$0.30 per $100 of salary
150 days EP - ORP
$0.25 per $100 of salary
$0.22 per $100 of salary
150 days EP - TRS
$0.27 per $100 of salary
150 days EP - ORP
$0.25 per $100 of salary
Various Benefits
Hospital Confinement Benefit
Flexible Elimination Periods
Experimental Treatment Period
Anti-Nausea Benefit
Nursing Services Benefit
Home Health Care Benefit
Stem Cell Transplantation Benefit
NCI Evaluation/Consultation Benefit