Talent Development & Human Resources
Office of Benefits Administration
Akron, OH 44325-0602
t: 330-972-7090 | f: 330-972-2336
e: [email protected]
http://www.uakron.edu/hr/benefits/
November 13, 2015
Dependent Name
Dependent Address
Dear Retiree Dependent(s):
Open Enrollment is your opportunity to review, renew, and make changes to your retiree
dependent benefit plan election. Enclosed you will find benefit information, election form, and
a working spouse form. The election form and working spouse form need to be completed
and returned to Benefits Administration by November 30, 2015. All changes will be effective
January 1, 2016.
The University is pleased to continue to offer comprehensive medical coverage for retiree
dependents with Apex Health Solutions. The University plan will continue to offer the same
benefits with minimal network changes. Locally, the network has changed to SC Premier while
nationally it remains the PHCS PPO network. The SC Premier network continues to offer choice
in local providers and access to more than 50 hospitals and thousands of providers.
In 2016, Akron General Health System will NOT continue as an in-network provider. If you
utilize Akron General facilities or physicians who are exclusively affiliated with Akron General,
you will be paying for services on an-out of- network basis. This means that you will pay for all
services (including office visits) up to the out-of-network deductible before the plan will
pay. Once you have reached your out-of-network deductible, the services will be paid at the
out-of-network coinsurance level, which means, the amount you pay will be higher than if you
used an in-network provider.
Out-of-network providers may choose to balance bill you for any portion over the allowed
amount. For example, an out-of-network provider charges $1,000 for a service and the allowed
amount is $500, you may have to pay the $500 difference.
The University of Akron is an Equal Education and Employer Institution – uakron.edu/eeo
To determine if your physician will continue to be in the network, you should search the Apex
website.




Go to http://www.apex-healthsolutions.com/networks/ and select the SC Premier
network.
Enter the search criteria and click the continue button.
Select a specific network radio button.
Choose the SC Premier (Self-Funded) network and click the search button.
Retiree dependents in an active course of treatment may be able to continue accessing their
current providers in an effort to avoid disruption in their treatment. Continued access will be
allowed for a period of time up to 90 days during which time Apex Health Solutions will work
with the retiree dependent to identify and transition to an in-network provider.
If you believe this may apply to you or your dependent, you should call Apex Health Solutions
at 1-800-753-8429 and request a Continuation of Care Evaluation. Apex customer service will
send the information to their Health Services Management (HSM) department to be
reviewed. The clinical designee and Medical Director will evaluate the facts of the case and
make a determination for continued care as appropriate. If approved, Apex Health Services
Management will notify the member and the provider that the service has been approved and
for number of visits and/or the period of time that the approval covers. Apex HSM will enter
an authorization for approved services to pay at the in- network benefit level.
The prescription plan remains available with the medical plan. For 2016, The University
continues to contract with CVS CareMark to provide prescription benefit coverage. You will
continue to have access to a large network of local pharmacies and mail order services with the
added option of obtaining a 90 day supply of medications at a local CVS pharmacy or by mail
order. If you have prescription benefit questions, please contact CVS CareMark at 1-888-2021654.
Everyone will receive new medical identification cards. Please discard the old Apex card when
the new one arrives. You will only receive a new CVS prescription card if you make enrollment
changes. This card would come separately from CVS CareMark.
The working spouse rule remains in place. This policy requires spouses of University retirees
who have access to employer subsidized (at least 50%) medical and prescription insurance to
enroll in that insurance for primary coverage. These spouses will be permitted to have only
secondary access to University benefits. If you are covering a spouse, the enclosed 2016
Working Spouse – Primary Coverage Certification form must be completed and returned to
the Benefits Office by November 30, 2015.
Talent Development & Human Resources
Office of Benefits Administration
Akron, OH 44325-0602
t: 330-972-7090 | f: 330-972-2336
e: [email protected]
http://www.uakron.edu/hr/benefits/
Retiree dependents will continue to pay 15% of the premium for their medical and prescription
coverage in 2016. The monthly premium rates are listed on the enrollment form. Apex Health
Solutions will continue to send monthly invoices and administer the collection of the premium
payments in 2016.
Sincerely,
Benefits Administration
Talent Development and Human Resources
The University of Akron is an Equal Education and Employer Institution – uakron.edu/eeo
Notices
Women’s Health and Cancer Rights Act (WHCRA): In 1998, the Women’s Health and Cancer
Rights Act was signed into law. Group health plans offering mastectomy coverage must also
provide coverage for reconstructive surgery in a manner determined in consultation with the
attending physician and the patient. This coverage includes reconstruction of the breast on
which the mastectomy was performed, surgery and reconstruction of the other breast to
present a symmetrical appearance, prostheses and treatment of physical complications at all
stages of the mastectomy procedure, including lymphedemas (swelling of the hand and arm on
the operated side).
The University of Akron is required to notify employees and retirees of these provisions
annually. Despite the name of the act, nothing in the law limits WHCRA entitlements to women
only. If you have any questions about this or other healthcare benefits, please contact your
healthcare provider by calling the Customer Service number listed on your insurance
identification card.
Summary of Benefits and Coverage (SBC) and Uniform Glossary: Under the Affordable Care
Act, group health plans and insurance companies must provide participants with SBCs and a
uniform glossary of terms commonly used in health insurance coverage. All group health plans
and insurance companies use the same standard SBC and glossary. Our SBC and uniform
glossary documents are enclosed in this communication.
Health Insurance Marketplace Coverage Options and Your Health Coverage: In 2014, there
was a new way to buy health insurance: the Health Insurance Marketplace. The enclosed
notice provides basic information about the Marketplace and the health coverage offered to
employees and retiree dependents of the University.
Notice of Creditable Coverage for: The Medicare Modernization Act (MMA) requires entities
(whose policies include prescription drug coverage) to notify Medicare eligible policyholders
whether their prescription drug coverage is creditable coverage, which means that the
coverage is expected to pay on average as much as the standard Medicare prescription drug
coverage. The annual Important Notice from The University of Akron About Your Prescription
Drug Coverage and Medicare was mailed to you in a separate mailing.