Contact Us
Phone: 610-526-5261

Human Resources
101 N. Merion Ave.
Bryn Mawr College
Bryn Mawr, PA 19010-2899

Mapping Address:
140 Morris Ave.
Bryn Mawr, PA 19010-2899

Fax: 610-526-7478
(Recruitment, General)
Fax: 610-526-7850
(Director, Benefits, HRIS)

Flexible Benefit Plan (cont'd)

 

FLEXIBLE BENEFITS

 

Choosing Medical Coverage
To assist you in choosing a medical plan, the College provides a comparison of benefits for each medical insurance plan offered. For a clear description of the medical plans, please refer to the appropriate descriptive booklets provided by each of the medical insurance carriers.

Waiving Medical Coverage
Bryn Mawr College requires benefits-eligible employees to have medical insurance because medical care costs can be enormous. Medical coverage provides financial security to meet these sometimes unexpected costs.

You may waive medical insurance only if you have adequate coverage elsewhere and present the name and policy number of the plan on the Flexible Benefit Plan Election Form.

If you have medical coverage, you may want to consider using your budget for other benefits.

In order to maintain continuance of a medical insurance waiver, you must make an election each year during the Open Enrollment Period by completing and returning either the Flexible Benefit Election Form or Confirmation Statement. If one of these forms is not returned, the waiver will be rescinded.

Medical Plan Re-entry
If you waive the Bryn Mawr College Medical Plan because you have coverage under a spouse's plan, or other comparable medical insurance, you may join any of the medical options offered through the College's program if you lose that other medical coverage (See "Changes in Your Benefit Selection - Life/Qualifying Event Changes"). Confirmation of loss of coverage must be provided to Human Resources within 31 days of the termination date for the other medical coverage.

MEDICAL PLANS (By Medical Carrier)

BLUE CROSS / BLUE SHIELD / MAJOR MEDICAL

Personal Choice PPO
Personal Choice is a Preferred Provider Organization (PPO) and is designed to allow you to choose your health care providers from a network. Unlike an HMO, you do not need to enroll with a primary care physician and you do not need a referral to see a specialist.

You receive maximum benefits by selecting physicians, specialists and facilities from the network directory. There is a $20 co-payment for office visits to a primary-care in-network physician - $30 for specialists - and preventive care is covered in-network. Care can be obtained outside of the Philadelphia area on an in-network basis by using the BlueCard PPO program.

Prescription benefits are provided through the Independence Blue Cross Select Drug Program. This program includes a formulary, which is a list of approved drugs with a lower co-payment than non-listed drugs. Currently, all available generic drugs are on the formulary and have the lowest co-payment. If a brand name drug is on the formulary, it will have a lower co-payment than a brand name drug that is not on the formulary. The result is a three-tier co-payment structure as follows:

 

 
Generic
Brand Name Formulary
Brand Name Non-Formulary
Personal Choice
$20
$40
$60

 

A mail-order prescription program is also available. See this document for more information about the formulary.

When using providers and facilities outside the network, you will pay more out-of-pocket costs for benefits and services, including an annual deductible and coinsurance. Inpatient and selected outpatient services obtained out of the network must be pre-authorized.

KEYSTONE HEALTH PLAN EAST

 

Keystone POS
Keystone Point-of-Service (POS) is a health care program which will give you the flexibility to receive referred care provided by your primary care physician or referred specialist at little or no cost or obtain self-referred care from a physician of your choice that can be reimbursed subject to an annual deductible and coinsurance.

A POS plan is positioned between a PPO and an HMO. Like an HMO, you do need to enroll with a primary care physician. However, when you require care - the "point-of-service" - you choose whether to seek that care through your primary care physician (referred care) or from any other provider (self-referred care).

A POS plan is similar to a PPO in that there is a high and a low level of coverage available. However, a POS plan requires that you enroll with a single primary care physician and that a referral be provided in order to receive the higher level of coverage. By contrast, you do not enroll with a primary care doctor in a PPO, and you can self-refer to an in-network specialist and receive the higher level of benefits in a PPO.

There is a $15 co-payment for office visits to your primary care physician and to referred specialists.

Prescription benefits are provided through the Independence Blue Cross Select Drug Program. This program includes a formulary, which is a list of approved drugs with a lower co-payment than non-listed drugs. Currently, all available generic drugs are on the formulary and have the lowest co-payment. If a brand name drug is on the formulary, it will have a lower co-payment than a brand name drug that is not on the formulary. The result is a three-tier co-payment structure as follows:

 

 
Generic
Brand Name Formulary
Brand Name Non-Formulary
Keystone
$20
$40
$60

 

A mail-order prescription program is also available. See this document for more information about the formulary.

Keystone HMO
Keystone Health Maintenance Organization Plan (HMO) provides comprehensive health services including preventive care (routine visits) provided physicians and hospitals in the network are used and that the care is coordinated by a primary care physician.

There is a $25 co-payment for office visits to your primary care physician.

Prescription benefits are provided through the Independence Blue Cross Select Drug Program. This program includes a formulary, which is a list of approved drugs with a lower co-payment than non-listed drugs. Currently, all available generic drugs are on the formulary and have the lowest co-payment. If a brand name drug is on the formulary, it will have a lower co-payment than a brand name drug that is not on the formulary. The result is a three-tier co-payment structure as follows:

 
Generic
Brand Name Formulary
Brand Name Non-Formulary
Keystone
$20
$40
$60

Personal Choice PPO High Deductible Plan

The HDHP plan uses the Personal Choice network.  However, unlike the regular Personal Choice plan, the HDHP provides no coverage for in-network services until a plan year (November 1 – October 31) deductible has been met.  The plan year deductibles are $1,500 for single coverage and $3,000 for family coverage.  Routine vision exam and glasses/contact lens reimbursement (every two years) and preventive services (as defined by health care reform) are not subject to the plan year deductible. 

Once the $1,500 or $3,000 deductible is met, in-network expenses are reimbursed at 100%.  The exception is for prescriptions, which are subject to a $5 generic, $20 brand name formulary and $45 brand name non-formulary copay once the applicable deductible has been met.  Unlike the regular Personal Choice plan, the individual deductible does not apply to family enrollment.  The $3,000 must be met in its entirety under a family contract before 100% in-network coverage goes into effect.

HDHP enrollees who use in-network providers should not pay for services on the date of the visit.  An explanation of benefits will be mailed by Independence Blue Cross after the visit has occurred which will specify the exact amount that is to be paid to the in-network provider.  Out-of-network benefits are covered at 50% of allowed charges after a $5,000 single and $10,000 family plan year deductible are met.

The HSA is an optional feature of the HDHP and can be used to pay for medical expenses with pretax dollars.  Annual contributions to the HSA are determined by the IRS.  The maximum annual contribution that an individual, with individual coverage, can make to an HSA is $3,250 for 2013 and $3,300 for 2014.  In the case of a family, with family coverage, the maximum annual contribution is $6,450 in 2013 and $6,550 in 2014.  HSA holders age 55 and older may make an additional annual contribution of $1,000.

HSA enrollment is limited to HDHP enrollees who have no other health coverage.  This includes participation in an FSA health care savings account.  HDHP enrollees should also not participate in the HSA if enrolled in Medicare (Parts A or B) or Medicaid.

HSA contributions will deposited at an FDIC-insured account that each participant establishes at The Bancorp Bank, with contributions made through payroll deduction, or at another institution without payroll deduction.  Bancorp HSA enrollees will receive a debit card and checks for which distributions from the account will be made. 

A mail-order prescription program is also available. See this document for more information about the formulary.

Except for emergency situations, no coverage is available unless treatment has been coordinated by your primary care physician.

COBRA (Consolidated Omnibus Budget Reconciliation Act)

Continuation of medical coverage is available through Bryn Mawr College to all qualified individuals under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended. Coverage is available for the statutory periods at the employee's expense.

Women's Health and Cancer Rights Act

This 1998 federal law requires all group medical plans to provide for the following services to an individual receiving plan benefits in connection with a mastectomy:

  • Reconstruction of the breast on which the mastectomy has been performed
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance and
  • Prostheses and physical complications of all stages of mastectomy, including lymphedemas (swelling associated with the removal of lymph nodes).

The group medical plan must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services will be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.

Please contact Human Resources if you have any questions on these provisions.

 

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