2014
Your Benefits
Summary
We provide • You decide
The University System of Georgia (USG) provides you with a
range of healthcare and voluntary benefits. Each year, you have the
chance to review your options and decide what works for you.
The best place to start? Right here, with a summary of the
healthcare and voluntary benefits for all of the USG institutions.
Stay healthy
Healthcare benefit options
When it comes to keeping you and your family healthy, we’ve got you covered with these
healthcare options:
•Health Savings Account (HSA) Open Access POS — This plan has a high deductible, but
lower monthly premiums. You can contribute to your HSA with tax-free dollars, up to $3,300 for an
individual or $6,550 for a family. When you contribute, the University System of Georgia will match
you dollar‑for-dollar until your contributions reach $375 for an individual or $750 for a family. And
your HSA is always yours, even if you leave the University System of Georgia.
•Open Access Point-of-Service (POS) — This healthcare coverage includes both in‑network and
out-of-network providers.
•BlueChoice HMO — You receive benefits when your care is coordinated by your Blue Cross Blue
Shield of Georgia (BCBSGa) primary care physician (PCP).
Good habits
pay off!
You’ll pay less when you
confirm that you don’t use
tobacco products!
A $50 tobacco surcharge
will apply to your
healthcare premium if you
use tobacco and a $50
monthly tobacco surcharge
will apply per covered
dependent age 18+ who
uses tobacco.
Action Required!
Tobacco use certification is
required upon enrollment
in healthcare coverage for
2014. If you do not certify,
your status will default to
tobacco user and a $50
monthly surcharge will be
added to your premium.
•Kaiser Permanente HMO — You receive benefits when your care is coordinated by your
Kaiser Permanente PCP.
University System of Georgia Benefits
we provide • you decide
Your Healthcare Options
HSA Open Access POS
In-network
Out-of-network†
Open Access POS
In-network
Out-of-network†
BlueChoice HMO
In-network only
Kaiser HMO
In-network only
Deductible
(Single/Family)
$1,500/ $3,000
$2,500/ $5,000
$300/ $900
$500/ $1,500
None
None
Out-of-pocket max
(Single/Family)
$3,000/ $6,000
$6,000/ $12,000
$1,000/ $2,000
$3,000/ $5,000
$6,350/ $12,700
$6,350/ $12,700
Yes
Yes
Primary care
physician (PCP)
required
No
No
Wellness visits
Paid at 100%
Paid at 70%
Paid at 100%
Not covered
Paid at 100%
Paid at 100%
Physician office
visit
85% of
network rate
70%
$20 copay not
subject to deductible
60% of
network rate
PCP: $20 copay
Specialist: $25 copay
PCP: $20 copay
Specialist: $25 copay
Lab services
(X-rays)
85% of
network rate
70%
90% of network
rate
60% of network
rate
Covered at 100%
Covered at 100%
Inpatient hospital
services
85% of
network rate
70%
90% of
network rate
60% of
network rate
$250 copay
(semi-private room)
$250 copay
(semi-private room)
Emergency care
85% of
network rate
70%
$150 copay, then 90% of network rate,
subject to deductible
$150 copay,
waived if admitted
$150 copay,
waived if admitted
$10 copay
$10 copay
$10 copay*
$20 copay**
$35 copay*
20% copay**
$25 copay
$25 copay*
$35 copay**
Prescription drugs
• Generic
• Brand
85% of the network rate,
subject to deductible
*Preferred brand
**Non-preferred brand
†
Balance billing applies
Your Dental Options
You can choose from these dental options through Delta Dental.
Delta Dental Base Plan
In-network
Annual maximum
Deductible (Single/Family)
Out-of-network
Delta Dental High Plan
In-network
$1,000 per person*
Out-of-network
$1,500 per person*
$50/$150
$50/$150
$50/$150
$50/$150
Diagnostic/preventive services*
100%
100%
100%
100%
Basic benefit services
80%
80%
80%
80%
Major benefit services**
Orthodontia (child and adult)
50%
50%
80%
80%
No coverage
No coverage
80%
80%
Lifetime orthodontia maximum
N/A
$1,000
*Preventive and diagnostic services don’t count toward the annual maximum.
**Benefit limits on full replacement of existing dentures or crowns apply.
Your Vision Option
You can choose to enroll in Vision coverage through EyeMed. Its provider network includes top national retail chains, such as LensCrafters®,
Sears OpticalSM, Target Optical®, JCPenney Optical® and many Pearle Vision® locations. Vision benefits are provided for the following services
and supplies once per 12-month period.
EyeMed Vision
In-network
Out-of-network reimbursement
Exam
$10 copay
$40
Single vision lens
$25 copay
$40
Frames contribution
$150 allowance
$58
Contact lenses
$150 allowance
$130
Paid in full
$210
Medically necessary contact lenses
Save money on healthcare
and dependent care
A U.S. Bank Health Savings Account (HSA) and/or Flexible Spending
Account (FSA) can save you money on everyday expenses. Your
contributions to these accounts are tax-free, saving you money on
federal and state income taxes and Social Security taxes.
Health Savings Account (HSA)
If you are enrolled in the HSA Open Access POS, you’re eligible to
have an HSA. Unlike an FSA, money left in your HSA at the end of
the year rolls over to next year.
•You can contribute up to $3,300* (single) or $6,550* (family) a year.
•USG will match your contributions dollar-for-dollar
up to $375 (single) or $750 (family) a year.
*Includes USG matching contributions
New Limited Purpose FSA
A Limited Purpose FSA is an additional tax-free account for those
enrolled in the HSA Open Access POS. You may contribute up
to $2,500 for eligible dental and vision expenses.
Health Care FSA
A Health Care FSA can save you money on healthcare, prescription
drug, dental, or vision expenses. The FSA includes other important
features:
•You can contribute up to $2,500 a year.
•For a list of eligible expenses, go to
http://www.irs.gov/pub/irs-pdf/p502.pdf.
Dependent Care FSA
A Dependent Care FSA can save you money on dependent care
expenses you pay while you’re at work. These include day care
and summer camps for children under age 13 and care for an
elderly parent.
•You can contribute up to $5,000 a year or $2,500 if you’re
married and file separate income tax returns.
•For a list of eligible expenses, go to
http://www.irs.gov/pub/irs-pdf/p503.pdf.
Plan carefully! Money left in either FSA at the end of the year is
not returned to you.
Protect those who matter
Your University System of Georgia benefits also cover your
eligible dependents:
Healthcare benefits: Your legal spouse; your natural, adopted,
or stepchild(ren), up to age 26; your disabled child(ren) with proof
of disability.
Dental, Vision, Life, and AD&D benefits: Your legal spouse
or domestic partner; your natural, adopted, or stepchild(ren) who
live with you, up to age 19; or up to age 26 with proof of full-time
student status; your disabled child(ren) with proof of disability.
You may be required to show documentation of your relationship or
your child’s age. Examples include a marriage certificate, birth certificate,
adoption certificate, and income tax returns. If both you and your
spouse are eligible University System of Georgia employees, only one
may elect to cover the other spouse and/or dependent children.
Protect your income
We provide you with coverage to help protect your family’s income
against the unexpected.
Disability coverage
If you’re unable to work because of a non-work related illness or
accident, these disability benefits can replace some of the income
you’ll lose by not working:
•Short-term disability (STD) — After you’ve been disabled
for 14 days, this benefit replaces 60% of weekly salary, up to
$2,500. Benefits may last up to 11 weeks.
•Long-term disability (LTD) — Replaces 60% of salary, up to
$15,000 monthly. Benefits start 90 days after disability begins.
Have a condition? You may not be eligible for LTD benefits for
12 months if you received treatment for a condition within three
months of when your disability coverage begins.
Life insurance
You can protect your family’s income in the event of a death due to
illness or accident.
•Basic life and AD&D — You’ll receive life and AD&D
insurance equal to $25,000 at no cost to you.
•Supplemental life insurance — You can buy additional life
insurance coverage from one to eight times your salary, up to
a maximum of $2.5 million. Proof of good health is needed
for coverage over $500,000. Each year, you can increase your
coverage by one times your salary without having to provide
proof of good health.
•Dependent coverage — You can choose life insurance
coverage for your dependents, too:
–– Spouse coverage options of $10,000 to $500,000. Your
spouse will need to show proof of good health for amounts
over $50,000.
–– Child(ren) coverage options of $5,000, $10,000, or $15,000.
•Supplemental AD&D insurance — You can buy supplemental
AD&D insurance in amounts of $10,000 to $500,000. Coverage is
available for you alone or you and your family.
Bonus! When you elect supplemental life or AD&D coverage, you’ll
also receive these benefits:
•Beneficiary financial counseling
•Legacy planning services
•Legal services
•Travel assistance
Handle life’s challenges
Save for tomorrow
EmployeeConnect Services, your free and confidential Employee
Assistance Program (EAP) can help you with the challenges of life,
including work, family, money, relationships, and more. The EAP is
available 24/7, 365 days a year. When life’s difficulties become too
much, contact the EAP at:
You can save for your future with a 403(b) and/or 457(b) plan.
Both offer tax-deferred savings and a range of investment options
to help your savings grow. To learn more, contact your
institution’s HR department.
•1-877-757-7587
•www.eapadvantage.com
Get help when you need it
Have questions about your benefits? We have answers. Visit http://www.usg.edu/hr/benefits or call your institution’s HR department.
When you need to contact our benefits partners…
Healthcare
BlueChoice HMO
1-800-424-8950
bcbsga.com/ga/bor
Kaiser Permanente HMO
1-404-261-2590
kp.org
Open Access POS
1-800-424-8950
bcbsga.com/ga/bor
HSA Open Access POS
1-800-424-8950
bcbsga.com/ga/bor
Dental
Delta Dental
1-800-521-2651
www.deltadentalins.com
Vision
EyeMed
1-866-800-5457
www.eyemed.com
HSA & FSA
U.S. Bank
1-877-470-1771
mycdh.usbank.com
Life and AD&D
Minnesota Life
1-866-293-6047
www.lifebenefits.com
EAP
EmployeeConnect Services
1-877-757-7587
www.eapadvantage.com
The University System of Georgia Health Plan meets the Affordability requirement under the Affordable Care Act. Therefore, generally, the University System of Georgia
employees will not be eligible for a tax credit in 2014 through the Health Insurance Marketplace created under the Affordable Care Act.
BENEFITS SUMMARY