Medical Coverage
Here’s an overview of the 2021 plan changes for each University medical plan:
Classic Plan
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SmartCare
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Non-SmartCare
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Disposable Medical Supplies (test strips, oxygen filters, lancets)
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Plan covers $800 of disposable medical equipment and supply charges at 100%; then you pay deductible and 25% coinsurance
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Emergency Room
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Emergency: $250 copay
Non-emergency: $350 copay
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Therapy Services (speech, physical, and occupational)
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$40 evaluation copay; then you pay deductible and 20% coinsurance
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$55 evaluation copay; then you pay deductible and 25% coinsurance
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Premier Plan
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SmartCare
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Non-SmartCare
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Disposable Medical Supplies (test strips, oxygen filters, lancets)
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Plan covers $800 of disposable medical equipment and supply charges at 100%; then, you pay deductible and 20% coinsurance
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Hospital Inpatient Services
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$150 copay; then you pay deductible and 15% coinsurance
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$300 copay; then you pay deductible and 20% coinsurance
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Emergency Room
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Emergency: $250 copay
Non-emergency: $350 copay
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Therapy Services (speech, physical, and occupational)
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$30 evaluation copay; then you pay deductible and 15% coinsurance
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$45 evaluation copay; then you pay deductible and 20% coinsurance
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Outpatient Diagnostic Lab Services
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You pay 15% coinsurance
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You pay 20% coinsurance
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Outpatient Diagnostic Testing and Surgical Services
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You pay deductible and 15% coinsurance
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$75 copay; then you pay deductible and 20% coinsurance
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Advanced Imaging (CT, PET, MRI)
Prior authorization required
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$25 copay; then you pay deductible and 15% coinsurance
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$50 copay; then you pay deductible and 20% coinsurance
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Health Savings Plan
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SmartCare
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Non-SmartCare
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Therapy Services (speech, physical, and occupational)
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You pay deductible and 5% coinsurance
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You pay deductible and 10% coinsurance
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Prescription Drug Coverage
Prescription drug copays are changing for two of the health plans:
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Classic Plan
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Premier Plan
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2020
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2021
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2020
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2021
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Tier 1
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$17
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$18
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$12
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$14
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Tier II
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$60
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$62
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$55
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$57
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Tier III
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$95
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$97
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$90
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$92
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Diabetes Management and Healthy Heart Programs
The Diabetes Management Program and the Healthy Heart Program through UMR will not offer $0 medical and supply incentives in 2021, but you may still be eligible for up to $800 in no-cost disposable medical supplies through the health plan.
Starting January 1, 2021, prescriptions previously covered under the incentive programs will require a standard pharmacy copay. Most medications covered under the incentive programs are Tier I medications. Note: If the cost of your medication is lower than the copay, you’ll pay the lower amount.
Here’s an idea of the average you will pay in 2021 for some of the most common medications currently covered under the incentive programs:*
- Glimepiride: $6.12
- Humalog: $62.00
- Lantus Solostar: $62.00
- Metformin: $4.99
- Amlodipine Besylate: $4.34
- Metoprolol: $12.52
- Diltiazem: $17.84
- Lisinopril: $3.77
*Examples are based on a 30-day supply of a medication for a participant covered under the Classic Plan (Tier I: $18, Tier II: $62, Tier III: $97). Actual copays will vary based on your plan enrollment and the retail pharmacy you use and by the dosing level and quantity prescribed by your doctor.
Work with a Health Coach
In 2021, continue to work with a health coach! Program coaches help you create health care goals and adhere to your diabetes and healthy heart treatment plan. If you are identified as high-risk, you may be invited to work with a health coach to bring these and other health conditions under control. You can also self-enroll by calling UMR Care Management at 866.575.2540.
Health Savings Account
2021 contribution limits will increase:
- Individual: $3,600
- Family: $7,200
Remember that an additional $1,000 catch-up contribution is allowed if you are 55 or older by December 31, 2021.
Flexible Spending Account
- Flexible Spending Account 2020 contribution limits (set by the IRS):
- Healthcare FSA: $2,750*
- Dependent Care FSA: $5,000*
- The annual rollover limit for Healthcare Flexible Spending Accounts (FSAs) will increase to $550 in 2021—a $50 increase from 2020.
*As of October 1, 2020, the IRS has not issued updated limits for 2021. Given campus-level coding and publication deadlines, the University will use 2020 maximums for 2021.
Retirement Plan
The 1% increase (to 5%) in required employee contributions to the University Retirement Plan, previously scheduled for July 2020, will take effect July 1, 2021. Note: Participants enrolled before July 1, 2020 at the two-year campuses will continue in those closed-group contribution formulas.
What You Need to Do
- For most benefits, if you do not want to change your coverage, no action is required. However, if you want to contribute to an FSA for 2021, you must enroll. Your current FSA elections will not roll over automatically to 2021—you must enroll if you want to contribute.
- If you want to enroll in or make changes to your coverage, follow the instructions in your Open Enrollment packet.
- Complete the Tobacco Pledge and Notice and, if applicable, enroll in a tobacco cessation program to avoid the monthly $50 tobacco surcharge. If you’re enrolled in a University medical plan, you’re required to complete the Pledge every year to avoid the $50 tobacco surcharge—even if you’re not a tobacco user.
- Add or remove dependents from medical, dental, and/or vision coverage, if applicable. If you’re enrolling a dependent for the first time, you must provide completed copies of required dependent documentation. Send the completed form and related dependent documentation to your campus Human Resources office by November 30, 2020.
- Add or remove dependents from medical, dental, and/or vision coverage, if applicable. If you’re enrolling a dependent for the first time, you must provide completed copies of required dependent documentation through Workday.
Enrolling for Coverage
Review your Open Enrollment packet or check with your campus Human Resources office for information on how to enroll or make changes to your coverage.
If you’re in Cohort 1, you must complete your 2021 Open Enrollment benefit elections through Workday. Use this helpful how-to guide for assistance with making your elections.
Paying for Your Benefits with Pre- or Post-Tax Premiums
Federal and state tax regulations determine which benefits may be paid through pre-tax payroll deductions and which must be post-tax payments. For example, medical plan premiums may be paid pre-tax or post-tax, while auto insurance can only be paid post-tax.
Pre-tax premiums are paid through payroll before state and federal taxes are calculated. That means the income amount used in calculating your payroll taxes is lower—most often meaning your net pay will be higher. Historically, for benefits where it’s allowed, the University has provided employees with the option to choose pre- or post-tax premium payments.
Starting January 1, 2021, the University will implement uniform premium guidelines. Premiums for medical, dental and vision benefits will be paid through pre-tax elections. Premiums for life insurance, AD&D insurance and other voluntary benefits will continue as post-tax elections. While there is the option for a pre-tax election, disability insurance premiums will be paid as a post-tax election. Disability benefits are taxable if premiums were paid on a pre-tax basis but not taxable if premiums were paid with post-tax dollars. For most participants a post-tax disability premium payment is the better choice.
The University is making this change to support a more efficient Workday enrollment system and streamline the enrollment process.
Important: Pre- and post-tax enrollments influence your ability to make mid-year benefit changes. You can make changes to pre-tax elections during the year if you experience a qualified family status change, like a birth, death, divorce or change in employment. Your post-tax coverage elections may be changed during the year without a qualified family status change.
Contribute to Your Retirement!
If you’re on the University payroll, you’re eligible to contribute to an unmatched 403(b) Supplemental Retirement Account on a voluntary basis, up to IRS limits. Your contributions are always 100% vested. You can select investment funds available through both of the University’s Retirement Plan recordkeepers/vendors—TIAA and Fidelity Investments. While voluntary contributions receive no employer match, you can increase, decrease, or end your contributions at any time.
Eligibility
If you’re on the University payroll, you can participate if you are:
- A student worker, an extra help or temporary employee, or other non-benefits-eligible employee
- An employee with grandfathered participation in APERS and ATRS
For additional information, please contact your campus Human Resources.
