University of Toledo

FREQUENTLY ASKED QUESTIONS

To help you understand your 2024 benefits options, below is information provided by UToledo Human Resources.

Why is the University Making Changes to 2024 Healthcare Benefits?

Each year the University strives to offer healthcare plans and other benefits options to meet the various needs of a widely diverse workforce, while also trying to contain rising healthcare costs. 

To help continue to meet these goals, the University encourages you to protect your health. In addition to understanding your options and selecting the plans that best meets your household's needs, be sure to partner with your primary care provider; practice a healthy lifestyle; and participate in the University's many free offerings throughout the year, provided by Rocket Health.

Will My Healthcare Costs Increase for 2024?

There will be a 4.1% average increase to medical premiums. This is due to a number of factors including increased medical costs, increased UToledo member claims experience, and increased pharmaceutical cost. This increase for 2024 is below the national trend increase of nearly 8%. 

Are There Any Other Changes to UToledo 2024 Benefits?

The IRS increased the minimum deductible on high deductible plans. The Blue Plan Tier 1 deductible will increase from $1,500 Single/$3,000 Family to $1,600 Single/$3,200 Family. 

Is Anything Changing with Dental and Vision Benefits?

Dental and Vision premiums have been adjusted to better align with plan features and plan performance. This means there is a slight premium increase to the Gold Plans and a significant decrease to the Blue Plans.

Dental: Gold +1.3%, Blue -12.6% Vision: Gold +1.9%, Blue -12.6%

Dependent eiligibility for both Dental and Vision is moving from age 24 to age 26.

Must I Enroll for 2024 Benefits During Open Enrollment?

Yes. Each employee is required to participate in open enrollment for 2024 to review healthcare plan options and ensure their benefits still meet their needs.

• Current Flexible Spending Account (FSA) and Health Savings Account (HSA) elections will not carry over to 2024; you must enroll to select either to participate again.

Can I Get Healthcare Coverage for My Children (Dependents) and/or Spouse?

Each plan sets specific guidelines for who is eligible for coverage; therefore, be sure to review plan details for this information.

UToledo requires documentation as proof of dependency if you request to add your dependents to any employee healthcare coverage option (medical/prescription drug, dental and vision). Documentation is required at initial enrollment for each dependent. Further, an annual spousal affidavit is required to cover a spouse on your Gold healthcare plan.

Are There Advantages If I choose UT Physicians or the University of Toledo Medical Center for Healthcare?

If you choose to receive your care through the University, you will have significant savings by seeing a UT Physician, including primary care providers and specialists, as well as having diagnostic testing and medical treatment performed at a UToledo facility, including UTMC. Those services include blood draws and other laboratory tests, imaging services (X-rays, CT scan, MRI, etc.), physical or occupational therapy, and many other healthcare services.

Because all of your medical-related records are legally protected health information, HIPAA ensures your privacy among colleagues. To find a UToledo-affiliated healthcare provider, visit utphysicians.utoledo.edu. A complete list of UTMC services is available at utmc.utoledo.edu.

What Are The Benefits of Using UToledo Outpatient Pharmacies for Prescriptions?

There are many advantages of using our on-campus pharmacies, including:

• You will have lower out-of-pocket costs for prescriptions filled at our on-campus pharmacies.
• If the cost of a medication is less than your co-pay, you pay the lesser amount.
• To save money and trips to the pharmacy, 90-day prescriptions are available at UToledo outpatient pharmacies.
• If a UT Physician writes a prescription and you fill it at one of our outpatient pharmacies, you will receive an extra 15% discount on the cost of your prescription.
• All UToledo outpatient pharmacists are trained to provide individual counseling on medications and disease states.
• All recommended adult immunizations are available at all UToledo outpatient pharmacies.
• You can request refills via the RX App.
• The onsite UToledo outpatient pharmacies offer convenient hours of operation for easy pickup of your prescriptions during the workday.
• You can schedule a free, confidential appointment with a clinical pharmacist to discuss your medications; call Bree Meinzer, Pharm.D., 419.383.1591.

Where Can I Find List of Tier 1 Providers?

For your convenience, a list of University of Toledo Medical Center/UT Physician providers can be found at: https://www.utoledo.edu/depts/hr/benefits

All other Tier 2 providers will be found by logging in to your Medical Mutual account.

Is the Health Savings Account Changing?

The Health Savings Account (HSA) connected to the Blue medical plan will remain the same for 2024. The IRS limits have been adjusted to reflect the new amounts for 2024. The HSA is administered through Optum. Please note that you will not receive a new HSA card (unless you are new to the plan). The UToledo and voluntary contribution amounts are listed below.

 I Am In A Collective Bargaining Unit (AFSCME, CWA, FOP or UTPPA). In Previous Years, I’ve Been Able To Elect Only The Blue Plan. Is This Still The Case?

Yes, per your collective bargaining agreement (CBA), members of these units hired after a certain date are eligible only for the Blue plan. Please refer to your respective CBA for more information.

What is a “Wrap Network” and When Can I Use It?

A wrap network supplements the regional network (MMO) by providing access to a (CIGNA) national network of providers that will be covered as in-network (Tier 2). A wrap network is intended to be used when you travel outside the regular network area, or if a provider is not covered by the regional network. The wrap network being used by Medical Mutual is Cigna.

What is Rocket Health, and Should I Consider Participating in This Program?

Rocket Health is UToledo’s employee wellness program. Employees are encouraged to participate to learn more about healthy lifestyle options and participate in fun, informative programs. More information can be found at utoledo.edu/offices/rocketwellness/healthyu.

 For Questions or Help to Enroll

If you still have questions after reviewing this information or need help enrolling online, please contact benefits@utoledo.edu or 419.530.4747 - Option 4. We look forward to serving you.

HEALTHCARE PLAN TERMS DEFINED

Below are commonly used terms that may help you understand healthcare plans and other materials related to your benefits.

Co-insurance – a percentage you pay for medical services other than office visits after the deductible is met. (Example: 80/20 plan: the plan will pay 80% and you will pay 20%.)

Co-pay – a fixed amount you pay at an office visit; the co-pay does not count towards the deductible.

Deductible – an amount you pay before insurance benefits will begin paying.

Excluded services –services not be covered by the insurance plan. You will have to pay for the entire cost of these services.

Flexible Spending Account (FSA) – a tax-free account that you can use to pay for medical expenses. Money left at the end of the year is lost.

Health Savings Account (HSA) – a tax-free account that you can use to pay for medical expenses. It carries over from year to year and consists of both your and your employer’s contributions.

Open enrollment – a set period every year when you elect benefits for the following year without a qualifying life event.

Premium –the amount you pay for insurance coverage.

Prior authorization –services that must be approved by the insurance company before you receive care. If pre-authorization is not obtained, the service may not be covered and you could be charged for the entire amount of services delivered! Healthcare providers will sometimes obtain pre-authorization for you, but it still is always your responsibility to check first with your insurance company before you receive healthcare services.

Qualifying life event – a life event that allows you to change your benefit during the year (e.g., marriage, divorce, birth of a child, loss of other coverage, etc.).

Summary of Benefits and Coverage (SBC) – a brief, easy-to-understand summary of your plan’s coverage. It is intended to be a uniform document that enables you to compare plans.

Summary Plan Description (SPD) – a booklet explaining your benefits, eligibility requirements, pre-authorization requirements, plan exclusions and other relevant details.

Tier 1 –these providers generally include University of Toledo Medical Center and UT Physicians.

Tier 2 –in-network providers.

Tier 3 –out-of-network providers.

Prescription Drugs / Pharmacy Benefits

Co-insurance – a specified percentage of the cost of the drug or service that you are responsible to pay. (Example: Depending on your plan, perhaps 20% of the total cost of your prescription medications.)

Compounded medications – medications not made or packaged to be dispensed at a traditional pharmacy. They are made based on a healthcare provider’s prescription, and individual ingredients are mixed together in the exact strength and dosage form required by the patient.

Co-pay – a pre-determined amount you pay for each medication or medical service you receive; not related to the cost of the medication or service. (Example: A $7 co-pay for generic medications —regardless of its entire cost, and a $15 co-pay for brand name prescription medications— regardless of its entire cost. If your prescription actually totals $85 for a name brand drug, you still would pay only $15 for that name brand drug each time you get it refilled.)

DAW – an abbreviation for “Dispense as Written.” This is used when a doctor decides you should receive a brand name medication even though a generic form of that drug is available. A special notation from the doctor is required to qualify.

Deductible – the maximum dollar amount you will pay each calendar year before your insurance plan begins covering certain costs. (After reaching your deductible, you are still responsible for copays.)

Formulary – a list of medications that are covered under your prescription plan.

Generic drug (Tier 1 drug) – a generic medication that contains the same active ingredient as a brand name drug. It usually is considered identical in efficacy, safety, side effects and dosing. It costs significantly less than their brand name counterparts.

Maximum out-of-pocket – the maximum dollar amount you are responsible for within a calendar year.

Non-preferred drug (Tier 3 drug) – a brand name medication that is considered non-preferred. This usually means there is a preferred alternative (and less expensive drug) within Tier 2.

Preferred brand drug – a brand name drug that has a trade name and is protected by a patent. This means that only the company holding the patent may sell or produce the medication for a specified amount of years.

Prior (or pre-) authorization – a process that requires a prescriber (your healthcare provider) to complete paperwork for the insurance company’s review before the prescribed medication will be covered under your prescription plan.

Prior authorization list – a list of medications that would need to undergo a prior authorization in order to be covered under your prescription benefit.

Dental Benefits

Dental care major services – dental services beyond basic, routine services, such as dental surgery, root canals, treatment for gum disease, crowns, bridges and dentures.

Dental care preventive services – routine dental services, such as cleanings, exams and X-rays