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Health Insurance

The College offers the EHA Blue Cross/Blue Shield PPO health plan to full-time exempt and non-exempt employees. Under the BCBS PPO, eligible employees receive comprehensive health benefits and may choose in-network or out-of-network providers with each health care situation. Employees share in the cost of medical services by paying “out-of-pocket” costs (office visit and prescription co-pays, deductibles, and co-insurance.) The amount of cost share varies depending on the health care services and whether in-network or out-of-network providers are utilized.

Choice of Providers: While the BCBS network of PPO providers is extensive, not all local providers are included in the network. (Refer to BCBS PPO Directory of Providers at www.nebraskablue.com and go to "Find a Doctor". When preferred in-network providers are utilized, members receive the highest level of benefits possible under the plan. If out-of-network providers are utilized, members are still eligible to receive benefits, but a reduced benefit level.

Effective Date: New employees must enroll within 31 days of employment, and coverage becomes effective the first of the month following the beginning date of employment.

Pre-Existing Health Conditions: New employees and “special enrollees” have up to a 12-month waiting period before pre-existing health conditions are covered. When applicable, the waiting period may be reduced by previous creditable health coverage under the Health Insurance Portability and Accountability Act (HIPAA).

Dependent Children: Children are covered until age 26.

EHA HEALTH PLAN OPTION 1
	IN-NETWORK	OUT-OF-NETWORK
Calendar year deductible Individual Family	$350 $700	$700 $1,400
Calendar year coinsurance maximum Individual Family	$2,000 $4,000	$4,000 $8,000
Coinsurance you pay for most covered services after satisfaction of the calendar year deductible	20% of allowable charges	40% of allowable charges
Physician office visit exam	$35 copay per visit	Subject to deductible and 40% coinsurance
Preventive services	Benefits for covered services paid at 100%, subject to age, gender and frequency limits. Refer to Benefits for Preventive Services chart.	Subject to deductible and 40% coinsurance
Inpatient and outpatient mental illness and/or substance abuse treatment	Subject to deductible and 20% coinsurance	Subject to deductible and 40% coinsurance

PRESCRIPTION, DRUG BENEFITS
TIER	CLASSIFICATION	COPAY/COINSURANCE PER 30-DAY SUPPLY		OUT-OF-POCKET MINIMUMS AND MAXIMUMS PER PRESCRIPTION
		In-Network	Out-of-Network
1	Generic Drugs	25%	25% + 25% penalty	$5 minimum /$25 maximum*
2	Formulary brand name drugs	25%	25% + 25% penalty	$30 minimum / $60 maximum*
3	Nonformulary brand name drugs	50%	50% + 25% penalty	$60 minimum /$90 maximum*
4	Speciality drugs	25%	50%	In-Network	Out-of Network
				$50 minimum/ $100 maximum	$150 minimum/ $300 maximum
INSULIN, DIABETIC AND OSTOMY SUPPLY BENEFITS
Member Coinsurance per 30-day supply
		In-Network		Out-of-Network
Insulin and diabetic supplies Generic and formulary Nonformulary		20% 30%		20% + 25% penalty 30% + 25% penalty
Ostomy supplies		20%		20% + 25% penalty
CALENDAR YEAR PRESCRIPTION DRUG OUT-OF-POCKET MAXIMUMS
Per individual $2,500 Family maximum $5,000		Once the applicable out-of-pocket maximum is reached, you pay nothing for covered prescription drugs for the remainder of the calendar year.
* Does not include 25% out-of-network penalty, if applicable.
BENEFITS FOR PREVENTIVE SERVICES

Preventive Service Recommended US Preventive Services Task Force	Gender				Age	Frequency
	Men	Women	Pregnant Women	Children
Abdominal Aortic Aneurysm, Screening	*				65 and older	Once per lifetime
Alcohol Misuse Screening and Behavioral Counseling Intervention	*	*				One per calendar year
Alcohol and Drug Assessment, Developmental /Behavioral Assessment				*
Aspirin for the Prevention of Cardiovascular Disease	*	*			Men:45 to 79 Women:55 to 79	Subject to plan's retail day supply limit
Asymptomatic Bacteriuria in Adults, Screening			*
Autism Screening, Developmental/Behavioral Assessment				*	up to age 3
Breast Cancer, Screening (mammogram)		*	*		40 and older	One per calendar year
Breast Cancer, Discuss Chemoprevention When at High Risk		*
Breast and Ovarian Cancer Susceptibility, Genetic Risk Assessment and discussion of BRCA Mutation Testing (based on family risk factors)		*	*
Breastfeeding, Primary Care Interventions to Promote Breastfeeding		*	*
Breastfeeding Support, Supplies, and Counseling		*	*			Pumps: One pump per pregnancy; Lactation support and counseling: No frequency restrictions
Cervical Cancer, Screening (Pap smear)		*	*	*		One per calendar year
Chlamydial Infection, Screening		*	*
Colorectal Cancer, Screening (Screening include: colonoscopy, sigmoidoscopy, proctosigmoidoscopy, barium enema, fecal occult blood testing, laboratory tests, and related services)	*	*			50 and older	One every 5 calendar years, One per calendar year for fecal occult blood test
Congenital Hypothyroidism Screening (newborns)				*	Up to age 1
Contraceptive Methods and Counseling (female contraceptive methods)		*
Contraceptive Methods (Pharmacy) (excluding over-the-counter)		*				Subject to plan's retail day supply limit
Dental Caries in Preschool Children, Prevention (prescribe oral fluoride if deficient in water)				*	6 months up to age 6	Subject to plan's retail day supply limit
Depression (Adults) Screening	*	*
Development Screening, Development/Behavioral Assessment				*	Up to age 3
Developmental Surveillance, Development/Behavioral Assessment				*
Diabetes Mellitus (Type 2) in Adults, Screening	*	*		*
Diabetes, Screening for Gestational Diabetes			*
Diet, Behavioral Counseling in Primary Care to Promote Healthy Diet (adults with hyperlipidemia and other risk factors)	*	*				Up to 9 visits per calendar year
Evaluation and Management Services (E/M)(periodic preventive examination/office visit)	*	*	*	*		Newborn up to age 6 unlimited; annually thereafter
Folic Acid, Daily supplement of		*	*			Subject to plan's retail day supply limit
Gonorrhea, Screening		*	*
Gonorrhea, Prophylactic Eye Medication (newborns)				*
Hearing Loss in Newborns, Screening				*	Up to age 1 month
Hearing, Sensory Screening (beyond newborn screening)				*	Up to age 22	One per calendar year
Hepatitis B Virus Infection, Screening			*
High Blood Pressure, Screening	*	*		*
HIV Screening and Counseling (at risk and all pregnant women)	*	*	*	*
Human papillomarlus (HPV), Screening		*
Interpersonal and Domestic Violence, Screening and Counseling		*
Immunizations	*	*	*	*
Iron Deficiency Anemia, Prevention-Hemocrit or Hermoglobin Screening (at risk older babies)				*	Up to age 2	Lab tests have not frequency restriction; Drugs are subject to plan's retail day supply limit
Iron Deficiency Anemia, Screening			*
Lead Screening				*	Up to age 7
Lipid Disorders in Adults, Screening (cholesterol)	*	*				One every 5 calendar years
Lipid Dyslipidemia Screening for Children (cholesterol)				*		One every 5 calendar years
Major Depressive Disorders in Children and Adolescents, Screening				*
Obesity in Adults, Screening	*	*
Obesity in Children, Screening				*
Oral Health Screening				*
Osteoporosis in Women, Screening (bone density testing)		*			60 and older	One every 2 calendar years
Phenylketonuria (PKU), Screening (newborns)				*	Up to age 1	One per lifetime
Psychosocial Assessment, Developmental/Behavioral Assessment				*
RH (D) Incompatibility, Screening			*
Sexually Transmitted Infections, Counseling	*	*		*
Sickle Cell Disease, Screening (newborns)				*	Up to age 1
Syphilis Infection, Screening	*	*	*	*
Tobacco Use and Tobacco-Caused Disease, Counseling (including tobacco/nicotine cessation drugs and deterrents)	*	*		*		Medical: Up to 8 visits per calendar year. Drugs and deterrents are subject to plan's retail day supply limit
Tubercluine Test, Screening				*	Up to age 22
Vision, Sensory Screening				*	Up to age 22	One per calendar year
Visual Impairment in Children Younger than 5 years, Screening				*	Up to age 5	One per calendar year

Prescription Drug Mail Order Service: BCBS members can save money when filling prescriptions for “maintenance” medication used to treat chronic or long-term conditions; for example, blood pressure and diabetes. When you use PrimeMail, the most you will pay for a 180-day supply of a covered drug is five times maximum for a 30-day supply, subject to the applicable coinsurance maximum.

*IMPORTANT: The mail order service program benefits are subject to a specific list of covered maintenance medications. For more information on the prescription mail service program, go to www.nebraskablue.com and go to "Member Services".

MyRxHealth.com: MyRxHealth.com is the powerful and secure pharmacy benefit website for Blue Cross/Blue Shield members. Features include: on-line refills for existing PrimeMail (mail order) prescriptions, review your drug history, perform drug list/formulary search, compare estimated retail costs to mail service costs, learn about generic alternative, and access detailed information on health and disease topics.

Discount Program: BCBS members are eligible to receive discounts on vision care and hearing care services. Members also enjoy exclusive discount offers on fitness, travel, weight management, and more, through Blue365! For more information, go to www.nebraskablue.com and click on "Member Services".

To obtain the above discounts, you must show the participating vision or hearing care provider your BCBS ID card and pay for the services at the time care is received. This is a discount program only. No BCBS claims are filed. For more information, go to www.nebraskablue.com and click on "Member Services".

EXEMPT & NON-EXEMPT EMPLOYEES EMPLOYEE HEALTH & DENTAL COSTS
HEALTH/DENTAL COVERAGE	EMPLOYEE COSTS THRU 8/31/12 (Per pay period)	EMPLOYEE COSTS EFFECTIVE 9/1/12 (Per pay period)
EE only Health/EE only Dental	$0.00	$0.00
EE only Health/EE & Child Dental	$9.45	$9.73
EE only Health/EE & Spouse Dental	$12.23	$12.60
EE only Health/Family Dental	$20.25	$20.86

EE & Child Health/EE only Dental	$94.02	$96.83
EE & Child Health/EE & Child Dental	$95.91	$98.78
EE & Child Health/EE & Spouse Dental	$96.46	$99.35
EE & Child Health/EE & Family Dental	$98.07	$101.00

EE & Spouse Health/EE only Dental	$106.42	$109.60
EE & Spouse Health/EE & Child Dental	$108.31	$111.55
EE & Spouse Health/EE & Spouse Dental	$108.87	$112.12
EE & Spouse Health/EE & Family Dental	$110.47	$113.77

EE & Family Health/EE only Dental	$142.14	$146.38
EE & Family Health/EE & Child Dental	$144.02	$148.33
EE & Family Health/EE & Spouse Dental	$144.58	$148.90
EE & Family Health/EE & Family Dental	$146.19	$150.55

EE only Dental (no Health)	$11.13	$11.46
EE & Child Dental (no Health)	$20.58	$21.19
EE & Spouse Dental (no Health)	$23.36	$24.06
EE & Family Dental (no Health)	$31.38	$32.32

IMPORTANT: Employees may pay their share of the health and dental costs on a "before-tax" basis through a Section 125 Compensation Reduction Agreement. In accordance with IRS regulations, an employee may change his/her pre-tax election mid-year only if the employee (or eligible dependent) experiences an IRS-qualifying “change-in-status” event and the change is consistent with the event.

Employees must contact the Human Resources Office immediately in the event of “change of status” event such as: involuntary loss of other health insurance coverage; marriage, divorce, birth, adoption; spouse changes employers or spouse’s employer offers an open enrollment; or child reaches the limiting age of 26. There is a limited 30-day special enrollment period from the date of the qualifying event to apply for a change in health insurance coverage.

Members of the ESP union (Education Support Professional) and Local 571 union (International Union of Operating Engineers), please refer to the cash-in-lieu section of the union agreement.

BCBS Customer Service: 1-877-721-2583.

Website:www.nebraskablue.com

HR Contact: Julie Nohrenberg, 402-457-2232 or Karla Stoltenberg, 402-457-2235