Employee Benefits - Fringe Benefits
CESP 8-2: Health Insurance
Date Revised: 1-1-2018
Summary: Establishes policies for participation in the University of Arkansas Group Health Insurance Program.
The University of Arkansas Health Plan is self-insured and self-funded. UMR is the third party administrator and processes all medical claims. MedImpact is the pharmacy benefit manager and processes all prescription claims.
As of January 2018, there are three plans options to choose from: Classic, Premier and Health Savings. The Point of Service Plan will no longer be available after 12-31-2017. All plans cover a wide range of traditional expenses such as doctor visits, surgical services, pregnancy, emergency room services, hospital stays, mental health services and diagnostic testing. With a goal of assisting employees in being healthy, most preventive care performed in-network is covered in full (such as annual physicals, flu shots, cancer screenings and well-baby care).
Employees may cover their spouse, as legally recognized by the State of Arkansas. Employees are required to provide documentation proving dependent eligibility (e.g. marriage license, birth certificate) in order to add a spouse or child. Employees may cover their children until the child reaches age 26th birthday, regardless of their marital, employment or student status.
Premium cost is based on which plan the employee elects, the percent of time the employee works and the family members the employee elects to cover.
New employees must make their enrollment election within their first 31 days of employment. Benefit coverage will begin on the first day of the month following the date enrollment forms are received in the Human Resources Office.
Should an employee experience a qualifying event, the employee may have a special 31-day window to make changes to their coverage.
The Classic Plan has a mid-range monthly premium because all health care is handled through in- network physicians and specialists. The employee and each family member covered by the plan may choose to receive services from any Primary Care Physician (PCP) within the UMR Network. There are no benefits if services are received outside the network, except for emergencies that arise while traveling. The network is nationwide.
The Premier Plan has the highest premiums, but the plan works the same way as the Classic Plan. Employees will pay the least out-of-pocket expenses of the three medical plan options when care is received from in-network providers.
The Health Savings Plan has the lowest premiums. But until the employee meets the deductible, the employee must pay for ALL medical expenses. There are no copays. Once the deductible is reached, the employee will share the cost of covered medical and prescription drug expenses with the Plan through coinsurance. For employees that reach the medical out-of-pocket maximum, the Plan pays 100% of all eligible expenses for the rest of the Plan Year. Employees have the option to see an out-of-network provider, but will pay more for care.
This plan includes a Health Savings Account (HSA) – a tax-advantaged account used to pay eligible medical, dental, vision and prescription expenses. Money in the HSA remains with the employee. If the entire account balance is not used, it will roll over to the next year. There is no “use it or lose it” rule. If the employee leaves The University or retires, the account goes with the employee. The HSA grows through contributions made by the University and the employee. Employees cannot enroll in this plan if they have other health coverage or are eligible for Medicare.
Refer to the side-by-side comparison charts to help decide which plan is better for you and your family. The benefits offered and the premium costs should be carefully reviewed prior to making an election. Employees also have access to UAMS SmartCare when care is received at UAMS.
If you have questions about the medical plans, you may call UMR (1-888-438-6105) or the Extension Human Resources Office (501-671-2219).
Prescription drug coverage is offered under all three medical plan options from MedImpact, which has a nationwide network of pharmacies including most chains. For questions regarding the prescription drug coverage, call MedImpact (1-800-788-2949) or UMR (1-888-438-6105).
*As a reminder, the full formulary contains a large number of prescription medications, this document is only a summary of the most often prescribed generic and brand name drugs and the most often prescribed dosage of those drugs covered by The Plan. This list is not all-inclusive and is not a guarantee of coverage as the formulary may change at any time, many medications are subject to Prior Authorization review, Quantity Level Limits, or Step Therapy and are restricted to the FDA approved treatment guidelines. We recommend that members log in to Medimpact to check the coverage for a specific drug and dosage, since the website is more comprehensive and is updated more frequently than this list.
Many doctors and providers are in-network throughout the United States. Please note that in the Little Rock area, the in-network hospitals are UAMS, St. Vincent’s Infirmary, Arkansas Children’s Hospital, Baptist and The Heart Hospital.
You may save when you use UAMS physicians, clinics and facilities. The savings under UAMS SmartCare will automatically be applied when you get your care at a UAMS SmartCare facility.
Once an employee receives their insurance card with their member ID number, they should visit UMR’s website and register for on-line access. Employees can view their claims, print a temporary ID card, and access resources made available through the University’s Plan(s).
Coordination of Benefits - This plan coordinates with other group plans under which an individual is covered so that the total benefits available will not exceed 100% of the allowable expenses.
Resignation - Under the federal regulation called COBRA (Consolidated Omnibus Budget Reconciliation Act), you have the option of continuing your current group health insurance coverage for up to 18 months after termination (or 36 months under certain conditions). To keep this coverage, you must pay the total premium (employee and employer share of the cost) plus 2%.
Retirement - You may continue the UA health insurance by paying both the employee and employer share of premiums under the “10-70 rule” if you have been insured under the plan for at least 10 continuous years prior to retirement and your age plus length of service equals at least 70.
In addition to the “10-70 rule” to be eligible to continue UA health insurance beyond separation from employment, eligible employees age 65 or older at the time of separation from employment must meet the following stipulations:
- For the last five consecutive years been in a benefits-eligible position; and
- For the last five consecutive years been a participant in the health plan.
Retirees may only continue the Classic Plan.
- UMR network of University of Arkansas Providers
- Medical Plan 2018 side-by-side comparison
- Medical Plan 2018 side-by-side UAMS Comparison Chart
- UAMS SmartCare Summary Page
- Flexible Spending Account SPD
- 75-100 Percent Medical Premiums
- 50-74 Percent Medical Premiums
- Summary Plan Description 2018 (insurance booklet)
- Summary of Benefits - Health Savings Plan No Wellness 2018
- Summary of Benefits - Classic Smartcare Wellness 2018
- Summary of Benefits - Classic No Wellness 2018
- Summary of Benefits - Premier Smartcare Wellness
- Summary of Benefits - Premier No Wellness 2018
- Summary of Benefits MedImpact -- (Pending 2018 Update)
- *Drug Formulary
- Maternity Management
- Pre-Authorization Listing
- Nutritional Counseling and Weight Management Program (see below for required forms)
- Diabetes Management Program; free test strips and meters from Abbott or Bayer
- Healthy Heart Program (free meds and blood pressure monitor)
- Tobacco-free 4 life program (2 free office visits and Chantix prescription)
- Preventive versus Routine Diagnostic Visits
- UMR Appeal Process
- Nondiscrimination Statement
- EBEN-227 - University of Arkansas Group Benefits Enrollment Form (PDF)
- EBEN-106 - UMR/University of Arkansas Enrollment Application Form (PDF)
- EBEN-110 - UMR Health Savings Account Form
- UMR Weight Loss Physician Attestation Form
- UMR Weight Loss Reimbursement Form
- UMR Appeal Request Form
- FSA Dependent Care and/or Health Care Reimbursement Form
- UAS Copay Exception MRF RX Form
- Notice of Privacy Practices (PDF)
- Medicare Certificate of Creditable Service (PDF)
- Children's Health Insurance Program [CHIP] (PDF)
- HIPAA Overview (PDF)
- Security Checklist (PDF)
- Health Plan Notice of nondiscrimination
Consult your Summary Plan Description or contact the Human Resources Office (501-671-2219) for more information.