USA Health and Dental Plan

 

 


 

Transparency in Coverage Rule

The link below leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

USA Choice Plan

University of South Alabama

63-0477348

https://www.bcbsal.org/web/tcr

 

Frequently Asked Questions

▼   Are employee premiums changing for 2024? NEW!!!!

Due to increased claims expenses, the USA Fringe Benefits Committee (FBC) recommended, an employee premium increase of $10 per month for single coverage and $30 per month for family coverage. In addition to the premium increases, it is necessary to make benefit design changes for the USA Choice and USA Select Plans.

Below are the approved benefit design changes for the USA Choice and USA Select Plans, effective January 1, 2024:


  • The USA Choice Plan will implement a new calendar year deductible structure for 2024. For single coverage, the calendar year deductible will be $125 and family coverage will have a calendar year deductible of $250. This will replace the existing $400 per person major medical deductible which
    currently applies only to specific services such as ambulance services, cardiac rehab, physical therapy, etc.

  • The USA Select Plan will also have a new calendar year deductible implemented. For single coverage, the calendar year deductible will be $125 and family coverage will have a calendar year deductible of $250.

  • The calendar year deductible on both the USA Choice and USA Select Plan must be fulfilled before the Plan’s benefits take effect. This means that you will be responsible for satisfying the applicable calendar year deductible before benefits are paid by the Plan.

  • The new calendar year deductible will be in addition to the existing calendar year prescription drug deductible of $100 per individual (maximum of 3 per family).
  • Urgent Care copay increase to $50 per visit on both the USA Choice and USA Select Plan; and will apply to the USA Health Network (currently $15) and BCBS PPO Network (currently $40).
USA Choice Plan - Base Premiums (employee hired before 1/1/2013)
 
  • Single coverage premiums will be $134 per month ($184 per month without the non-tobacco wellness incentive)
  • Family coverage premiums will be $445 per month ($495 per month without the non-tobacco wellness incentive)
  • The University's monthly contribution to the USA Choice Plan - Base Premiums will increase to $633 for single and $1,337 for family coverage
USA Choice Plan - Standard Premiums (employees hired on or after 1/1/2013)
 
  • Single coverage will be $154 per month ($204 per month without the non-tobacco wellness incentive)
  • Family coverage will be $509 per month ($559 per month without the non-tobacco wellness incentive)
  • The University's monthly contribution to the USA Choice Plan - Standard Premiums will increase to $613 for single and $1,273 for family coverage

Premiums for health and dental coverage are paid one month in advance and the employee contribution for bi-weekly paid employees is split equally between the first two paydays of the month. The employee contribution is exempt from federal, state and FICA taxes with participation in the Premium Conversion Plan (automatic enrollment).

Wellness Incentive

The USA Choice Plan and the USA Select Plan implemented a Tobacco Cessation Program to help participants stop the use of tobacco. The program includes a wellness incentive that reduces the employee premium cost sharing by $50 per month, if both the employee and covered spouse do not use tobacco products. As a current USA health insurance member, if you are not receiving the wellness incentive and both you and your covered spouse do not use tobacco products (and have not for at least six months), you must complete the Tobacco Declaration Form.  No action is required by employees that currently receive the wellness incentive.

The USA Choice Plan and the USA Select Plan are committed to helping you achieve your best health. Rewards for participating in the Wellness Incentive Program are available to all employees. If you think you may be unable to meet the standard for the reward under this program, you may qualify for an opportunity to earn the same reward by different means. Contact the Human Resources Department for additional information.

The USA Choice Plan and the Select Plan along with other plan information is available in Human Resources on campus and at USA Health Human Resources.

University of South Alabama
USA Choice Plan - Plan Benefits 
USA Select Plan - Plan Benefits 
Glossary of Health Coverage and Medical Terms 


Human Resources office addresses

 

▼   Pharmacy Benefit: Deductible and 6-tier copay structure

The USA Choice Plan and the USA Select Plan pharmacy annual deductible is $100 per individual (maximum of 3 per family).

The USA Choice Plan and the USA Select Plan copay structure 6-tier plan6-tier plan:

• Generic (preferred) COPAY $10
• Generic (non-preferred) COPAY $10
• Preferred Brand Name COPAY $50
• Non-Preferred Brand Name COPAY $75
• Specialty (preferred) COPAY $150
• Specialty (non-preferred) 50% COINSURANCE

▼   Who is eligible for health insurance coverage?

Employees are eligible for participation in the USA Choice Plan or the USA Select Plan based solely on hours of service. The Affordable Care Act requires an offer of coverage to employees credited with 30 hours of service per week or 130 hours of service per month on average. The Plans may defer the offer of coverage if the employee is determined as having “variable hours” in which case benefits-eligible status will be determined using a 12-month measurement period with a corresponding 12-month coverage period in compliance with the Affordable Care Act.

Eligible Employees include:

  • An employee with a specific appointment with no termination date, occupying a permanently budgeted position, and working a minimum of 30 hours per week on a regular basis.
  • An employee with an employment start date on or after January 1, 2013, who is credited with 30 hours of service per week or 130 hours of service per month on average.

Eligible Employees may also enroll their legal spouse, as recognized by the state of Alabama, and children under age 26. Coverage with the selected Plan will begin on the first day of the month following the first day of employment, contingent upon timely application to the Human Resources department and payment of any required employee contribution.

▼   When will my medical/dental coverage be effective if I am a new employee?
Coverage with the selected Plan will begin on the first day of the month following the first day of employment, contingent upon timely application to the Human Resources department and payment of any required employee contribution.
▼   What is premium conversion?
The USA Choice Plan and the USA Select Plan premiums are deducted before any Federal, State or Social Security taxes are withheld. Your gross income is reduced by the amount of your premiums and therefore, you pay fewer taxes. New employees are automatically enrolled in Premium Conversion. However, Premium Conversion is optional for employees. Contact the Human Resources department for information regarding opting out of Premium Conversion.
▼   Who are eligible dependents for the USA sponsored health plans?
  • Spouse – As recognized by the state of Alabama.
  • Dependent child –
    • Your natural-born child under the age of 26.
    • Your stepchild under the age of 26.
    • Your legally adopted child, including a legally adopted child living with you as the adopting parent, during a period of probation.
    • A child under age 26 over whom you have legal guardian status by court appointment.
    • A child under age 26 for whom you are legally required to provide health insurance coverage pursuant to a Qualified Medical Child Support Order (QMCSO).
    • Your disabled child of any age provided the disability commenced prior to age 19. Coverage under the Plan continues without interruption for the duration of the disability as long as the employee maintains dependent coverage.
▼   If I am not a new employee, when can I enroll in the USA sponsored health plans?

You may enroll in a selected plan, enroll your eligible dependents or terminate coverage for yourself or a dependent when certain events cause a Change-In-Status. To make an enrollment change due to a Change-in-Status event, you must make application and provide documented proof of the Change-In-Status event to the Human Resources department within 30 days of the event. The effective date of the election would be the date of the qualifying event. If you fail to notify Human Resources within 30 days of the qualifying event, you must wait until the Open Enrollment Period.

Some examples of qualifying events include, but are not limited to:

  • Marriage / Divorce
  • Birth of Child
  • Adoption or placement for adoption
  • Death
  • Change in your spouse’s employment status
▼   When is the Open Enrollment Period?

There is a one-month Open Enrollment Period, usually the month of November, during which an employee may enroll in the USA Choice Plan, or the USA Select Plan, and/or add eligible dependents. During this period, you may file an application with the Human Resources department and coverage will begin on the first day of the following calendar year. During this time, employees can also re-enroll in SouthFlex Flexible Spending Accounts if they wish to participate the following calendar year.

▼   How do I sign up for my benefits?

All new employees must complete New Employee Orientation. During orientation, you will have the opportunity to complete enrollment forms. You will be notified as to the date/time of your scheduled orientation.

▼   How much is the monthly premium and how is it deducted from my paycheck?
USA Choice Plan - Base Premiums (employees hired prior to 1/1/13) Single Family
Non-Tobacco $124 $415
Tobacco $174 $465
USA Choice - Standard Premiums (employees hired on or after 1/1/13) Single Family
Non-Tobacco $144 $479
Tobacco $194 $529

Note: Premiums for health & dental insurance are pre-tax dollars and are paid one month in advance so the initial deduction may reflect a retroactive adjustment.

▼   How does the Tobacco Cessation program/wellness incentive work?

The University of South Alabama encourages all employees to adopt healthy lifestyle choices. That effort will benefit you, your family and your fellow employees. The University’s Fringe Benefits Committee recommended, and the University adopted, a tobacco cessation program which is intended to help employees stop using tobacco products. Tobacco use and especially smoking will increase your risk of heart disease, stroke, respiratory diseases such as emphysema and bronchitis, as well as cancer including: lung, throat, mouth, esophagus, pancreas, bladder, and leukemia. The benefits from stopping the use of tobacco are almost immediate regardless of how long you have been smoking or using tobacco.

For new employees the Tobacco Declaration information/election is provided within the USA Health & Dental insurance enrollment form.

Existing employees that do not currently participate in this wellness incentive may begin participation by completing the Tobacco Declaration form. On this form employees will declare that they and their covered spouse do not use tobacco products; and have not used tobacco products within six months prior to the date on the form. This will qualify for a wellness incentive of $50 per month (one per family). The wellness incentive will be applied to the monthly insurance premium effective the pay period following the date on the Tobacco Declaration form (payroll deadlines can affect when this discount will be applied).

For employees enrolled in any of the University sponsored health plans seeking assistance with tobacco cessation please call 866) 784-8454 or visit  https://www.quitnow.net/Alabama to obtain information about the Blue Cross Blue Shield - Quit for Life Program. The Program is provided at no cost to employees and covered spouses who want to stop using tobacco products and offers a 24-hour support hotline, customized phone counseling sessions and nicotine replacement patches, gum or lozenges.

For additional tobacco cessation resources you may also contact the Employee Assistance Program office at 461-1346.

▼   If I resign, terminate employment or retire, when would my coverage end?

Premiums for health & dental insurance are paid one month in advance. Your cancellation date will be based on your last day of employment. Example: If your last day of employment is December 14, your last paycheck will be December 30. Premiums paid in December through payroll deduction have paid for coverage for January. Your insurance will cancel effective January 31.

Note: The above information applies only to employees in a paid status. For employees on a leave of absence in an unpaid status, please contact Human Resources for an effective date of cancellation. 

▼   BCBS of Alabama Mobile Apps and Online Tools

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General Information
Tips for Safely Getting Childhood Vaccinations During the Pandemic
Tips for Safely Getting a Pneumonia Vaccination During the Pandemic
Glossary of Health Coverage and Medical Terms
Identity Protection Services
USA Health and Dental Plan Notice of Privacy Practices
University of South Alabama Notice of Exchange
HealthCare Management, LLC Notice of Exchange
Health Care Authority Notice of Exchange
Notice of Nondiscrimination