Attention All BCBS Participants: Our rates for the Health/Dental plan will be increasing effective 1/1/2015. The new employee rates are as follows:
- Individual Coverage: $128.44
- 2-Person Coverage: $259.74
- Family Coverage: $302.38
Effective October 1, 2011 revisions were made to the Group Health Plan in regards to services rendered at Samford University's on campus clinic. Please click here to view the revisions.
- Blue Cross and Blue Shield of Alabama is our medical and dental provider.
- The plan is a PPO plan which allows participants to seek medical services from any Doctor who participates in the BlueCard Preferred Provider Organization.
- Full time employees are eligible to participate in the plan upon hire. Benefits will be effective upon date of hire.
- We offer three tiers of coverage: individual, two-person, family.
- When you enroll in the plans, you must enroll in both or none. You cannot enroll in medical only or dental only. However, there will be separate deductions on your paycheck for medical and dental.
- Prescription coverage is included as a point-of-sale reimbursement plan.
- Routine vision coverage is included in the medical plan.
- Eligible dependents for the plan include:
- Your spouse
- Your child up to age 26
- An incapacitated child who is not able to support himself and who depends on you for support, if the incapacity occurred before age 26
- The plan runs from January 1 – December 31
- The deductible runs from January 1 – December 31
- Use the following link to access the Blue Cross Blue Shield website: BCBS.
- When using an in-network doctor, primary physician office visit co-pay is $25.00. Specialist physician co-pay is $40.00
- Annual calendar year deductible is $350/person or $1,050.00 maximum for family.
- Pre-certification is required for all hospital admissions except maternity. Emergency admissions require notification within 48 hours of admission.
- There is a $150 per day hospital co-pay for days 1-5 for each admission.
- In network Outpatient Hospital is subject to a $150 facility co-pay.
- Prescription drug coverage is offered through a point-of-sale drug program.
- Prescription drug benefits are only available for prescriptions purchased from Participating Pharmacies, which are available in all states.
- In some cases, drugs may require prior authorization. Your participating pharmacist will advise if this is a requirement.
- Prescriptions purchased from Non-Participating Pharmacies are not covered.
- Participating Pharmacies give you a number which you must give BCBS when you file your drug claim. This is called the claim authorization number.
- You can determine if a pharmacy is participating by going to the Blue Cross website and clicking on the link Pharmacy.
- When purchased at a participating pharmacy, reimbursement schedule is as follows:
- Tier 1: 100% no deductible
- Tier 2: 80%, subject to the calendar year deductible
- Tier 3: 60%, subject to the calendar year deductible
- Tier 4: 50%, subject to the calendar year deductible
- Reimbursement claims can be made online at BCBSAL.com. This is the fastest way to be reimbursed.
- Instructions on how to submit your prescriptions claims online can be found under the Forms section of the HR website.
- Claims may also be submitted via mail by completing the BC/BS Prescription Claim Form.
Pharmacy Updates Effective January 1, 2015:
1, 2015 we will be moving to a drug tier structure vs. the current generic,
preferred, and non-preferred structure. Medications will be classified as
either Tier 1, Tier 2, Tier 3, and specialty drugs, Tier 4. Drugs currently
being covered as generic should move to Tier 1, preferred brand drugs should
move to Tier 2, and non-preferred or other brand drugs should move to Tier 3. Specialty
medications will fall into the Tier 4 category.
effective January 1, 2015 the 90 day maintenance drug list will be updated.
Several medications will be transitioned off the 90 day maintenance list. The
drugs that will no longer be considered maintenance drugs are those that
require dose changes or monitoring, drugs intended to be used as needed,
controlled substances, and drugs with the potential for abuse or overuse.
Medications impacted by this change include drugs used to treat asthma,
attention deficit hyperactivity disorder (ADHD), non-steroidal
anti-inflammatory drugs (NSAIDs), seizure, erectile dysfunction (ED),
benzodiazepines, testosterone, human immunodeficiency virus (HIV), and drugs
that have safety and/or efficacy concerns. These drugs are not recommended to
be filled at more than a one month supply due to dosage changes and potential
waste. These medications may still be obtained at a local pharmacy but
may only be purchased in a 30 day supply vs a 90 day supply. Members impacted
should have already received a disruption letter.
Insulin Strategy- Starting January 1, 2015, the preferred insulin products will
be Lantus, Levemir, Novolin, and Novolog. Apidra, Humalog and Humulin
insulins will no longer be covered. We are making the change to cover the most
cost-effective products that are equally as safe and effective.
- Coverage is limited to $1,000 per member each calendar year.
- There is a $25 calendar year deductible per member each calendar year (three per family)
- The deductible does not apply to diagnostic and preventative services
- Orthodontic Services are available for dependent children age 19 and under and are covered at 50% subject to the calendar year deductible and the $1,000.00 limit per member each calendar year. It is also limited is a lifetime max of $2,000.00 per member.
- Routine vision coverage is included in the medical plan.
- Routine vision coverage is covered at 80% of the Allowed Amount, with no deductible
- Coverage is limited to $200.00 per person each 24-month period.
• COBRA is the Consolidated Omnibus Reconciliation Act of 1985(Public Law 99-272, Title X).
• If you are a covered employee, COBRA allows you to temporarily continue coverage under the plan beyond the point at which coverage would otherwise end.
• COBRA coverage may be offered to each person who is a qualified beneficiary.
• By law, COBRA benefits are required to be the same as those made available to similarly situated active employees. If the plan changes for active employees, coverage will also change for those covered under COBRA.
• COBRA premium will be paid by the participant as a rate equal to the full cost of the coverage plus a two-percent administrative fee. Your cost may change over time, as the cost of benefits under the plan changes.
COBRA Rights for Current Employees:
• If you are a covered employee, you will become eligible for COBRA coverage if you lose coverage under the plan because either one of the following qualifying events occur:
o Your status changes from full-time to part-time
o Your employment ends for any reason other than your gross misconduct
• COBRA coverage will continue for up to a total of 18 months from the date of your termination or employment or reduction in hours, assuming you pay your premiums on time.
COBRA rights for a Covered Spouse and Dependent Children: • If you are covered under the plan as a spouse or a dependent child of a covered employee, your will become eligible for COBRA coverage if you lose coverage under the plan as a result of any of the following events
o The covered employee dies
o The covered employee's hours of employment are reduced
o The covered employee's employment ends for any reason other than his or her gross misconduct
o Divorce of the covered employee and spouse
o For a dependent child: the dependent child loses dependent child status under the plan
• If you are a covered spouse or dependent child, the period of COBRA coverage will generally last up to a total of 18 months in the case of a termination of employment of reduction in hours.
• If you are a covered spouse or dependent child, the period of COBRA coverage will generally last up to a total of 36 months in the case of divorce, loss of dependent child status, or death of the employee.
Medical/Dental/Vision/Rx Frequently Asked Questions
- Are our premiums taken out before or after taxes?
Our plan is a pre-tax plan so the premiums are taken out before taxes.
- How long do I have to decide if I want to enroll in the plan?
You have 30 days from the day of hire to enroll in the plan. After the 30 day period has expired, you will not be allowed to enroll until open enrollment or until you experience a qualified change in family status.
- Can I cancel my coverage at any time?
You can only cancel your coverage during open enrollment or for a qualified change in family status.
- Why can I not make changes outside of open enrollment unless I have a qualified change in family status?
Because our plan is pre-tax, the IRS has rules concerning enrollment and changes made to the plan during a plan year.
- What is a qualified change in family status?
A qualified change in family status is a life changing event which allows a window in which to change your benefits during a plan year. Examples include but are not limited to: marriage, divorce, birth of a child, adoption, and death of a dependent.
- I have had a change in family status. How long do I have to make changes to my plan?
You have 30 days from the date of the status change to make changes to your plan. After the 30 day window expires, you will not be allowed to make changes until the next open enrollment period, or in the event you should experience another qualified status change during the plan year.
- Whom do I notify when I have a change in family status?
Contact Human Resources as soon as possible to make any changes needed to your plan.
- What is a Point of Sale prescription program?
With this program, you are required to pay for your prescriptions when they are filled at the pharmacy. You will then send in a request for reimbursement to BCBS. The amount of reimbursement depends on the type of drug filled and the portion of the deductible you have already met.
- If I need to be reimbursed for prescription drugs where would I find the forms?
You can apply for reimbursement directly on the BCBS website or you can complete and mail a Prescription Claim Form to BCBS.
- How do I know if my doctor is in the preferred provider network?
You may search for in-network doctors on the BCSB website in the Find A Doctor link.
- What happens to my coverage if I leave Samford?
You will be offered COBRA which will allow you to continue coverage for a period of 18 months. The full cost of the premium will be borne by the employee.
- What happens to my child's coverage when he/she is no longer an eligible dependent?
The child will be offered COBRA which will allow you to continue coverage for a period of 36 months. The full cost of the premium will be borne by the dependent.