Asbury University Employee Health Insurance Plans
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GOOD NEWS! No rate Increases for 2024!
Aspirant – Website and Mobile App Information
To access Aspirant’s website for information regarding claims, benefits, ID card, and health insurance plan document please see the flyer below.
Details on the Mobile App and how to set up the Mobile App can be found in the flyer below.
Mobile App Information and Set Up Instructions
Pharmacy Information
CVS Caremark pharmacy will continue as prescription drug network.
CVS Caremark Information – 2024
CVS -01-2024 Advanced Control Choice Formulary
NEW THIS YEAR
Aspirant (via Anthem (our network provider)) is offering 3 free EAP (Employer Assistance Program) visits to employees who are enrolled in AU’s health insurance plan.
Please see flyer below for more information including how to access this benefit.
Aspirant EAP Service Summary Flier
Reminders
Employees who are enrolled in the Asbury University Health Insurance plan are able to obtain additional vaccines at the pharmacy. Previously, vaccines such as Tetnus or TDAP were only available at a doctor’s office. This change makes it easier and more convenient to get vaccines. Please check with your local pharmacist to see if the vaccine that you need is approved to be given at the pharmacy. Please note that the flu shot has a co-pay of $10.00 if administered at the pharmacy. If you receive the vaccine at a doctor’s office you will have an office co-pay of $30.00.
One eye exam is covered per calendar year per employee/family member who is covered under the health insurance plan. This exam is covered with a $30.00 co-pay and includes refraction.
Anthem is utilized as our provider network. Please visit www.anthem.com (click on Find Care and select use member ID from your health insurance ID card for Basic Search) to search for providers who are in network. You will need to enter the prefix of your health insurance member ID# which is ASZ.
Anthem Term Life Insurance Benefit
Employees who are enrolled in the health insurance plan are eligible for $15,000 in term life and accidental death insurance with Anthem.
At the age of 65 this benefit will be reduced as follows: 35% reduction at age 65; 50% reduction at age 70.
For more information on this life insurance benefit click on the flyer below.
Reminder of Spousal Coverage Change
Effective January 1, 2020, if your spouse is eligible for other “qualified” medical coverage as an active employee or as a retiree through his or her employer or former employer, then he or she is no longer eligible for medical coverage under an Asbury University medical plan. For this purpose, “qualified” medical coverage means a group health plan that pays, on average, at least 60% of the total cost toward essential health benefits received in-network, including physician and inpatient hospital services. All employees enrolled on the health insurance plan are required to complete the spousal eligibility for medical coverage affidavit in order to be covered under Asbury University’s health insurance plan. The waiver form will be sent to each benefit eligible employee’s Asbury University e-mail via Adobe Sign. The form will need to be completed and signed electronically and received in the Human Resources Office by no later than 5:00 p.m. on Friday, November 3, 2023.
If you are making dependent changes to your health insurance or going to a single plan you will need to complete the enrollment/change form ASBURY ENROLLMENT CHANGE FORM S as well as the AU Spousal Eligibility Affidavit.
Live Health Online
- LiveHealth Online provides a doctor by your side 24/7. LiveHealth Online lets you talk face to face with a doctor through your mobile device pr a computer with a webcam. No appointments, no driving, and no waiting at an Urgent Care Center or emergency room.
- LiveHealth Online can be used for common health concerns like colds, the flu, fevers, rashes, infections, allergies and more. It’s faster, easier, and more convenient.
- The co-pay is $20.00 versus $30.00 for a regular office visit.
Health Care Reform and Asbury University
Asbury University believes that its Health Insurance Plans are “grandfathered health plans” under the Patient Protection and Affordable Act [the Affordable Care Act]. As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your health insurance plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator, Director of Human Resources, at ext. 2357. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans.
2024 Rates (Monthly)
| FULL-TIME EMPLOYEES | ||||||
| Single Rates | Family Rates | |||||
| Core | Buy-up |
Core | Buy-up |
|||
| Total cost | $617.76 | $722.94 | $1799.85 | $2294.65 | ||
| AU pays | $584.18 | $584.18 | $1419.91 | $1419.91 | ||
| You pay | $33.58 | $138.76 | $379.94 | $874.74 | ||
Plan Summaries
- Summary of Benefits and Coverage – Core Plan
- Summary of Benefits and Coverage – Buy Up Plan
- Benefit Grid – Core Plan
- Benefit Grid – Buy Up Plan
Health Insurance Plan Document
Asbury University Health Insurance Plan Document
This document may also be found by logging in to Aspirant’s website at www.aspirant.us
If you are enrolling in the health insurance plan or changing plans both forms listed below must be completed and returned to HR:
If you are dropping a dependent or changing your address, please complete the change form and return to HR:
Important Information
SPECIAL ENROLLMENT NOTICE
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage) provided that you meet participation requirements. However, you must request enrollment within 31 days or any longer period that applies under the plan, after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days or any longer period that applies under the plan, after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact Human Resources.
QMCSO (Qualified Medical Child Support Order)
QMCSO is a medical child support order issued under state law that creates or recognizes the existence of an “alternate recipient’s” right to receive benefits for which a participant or beneficiary is eligible under a group health plan. An “alternate recipient” is any child of a participant (including a child adopted by or placed for adoption with a participant in a group health plan) who is recognized under a medical child support order as having a right to enrollment under a group health plan with respect to such participant is an alternate recipient. Upon receipt, the administrator of a group health plan is required to determine, within a reasonable period of time, whether a medical child support order is qualified, and to administer benefits in accordance with the applicable terms of each order that is qualified. In the event you are served with a notice to provide medical coverage for a dependent child as the result of a legal determination, you may obtain information from your employer; know the rules for seeking to enact such coverage. These rules are provided at no cost to you and may be requested from your employer at any time.
WHCRA
The Women’s Health and Cancer Rights Act (WHCRA) of 1998, provides benefits for mastectomy-related services including reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy (including lymphedema). Call your health insurance issuer for more information.
This notice informs you of the Federal regulation that requires all health plans that cover mastectomies to also cover reconstruction of the removed breast. If you have had or are going to have a mastectomy, you may be entitled to certain benefits. For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
- All stages of reconstruction of the breast on which the mastectomy was performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of the mastectomy, including lymphedemas.
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call ARC.
NMHPA
Newborns’ and Mothers’ Health Protection Act requires that group health plans and health insurance issuers who offer childbirth coverage generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Refer to your plan document for specific information about childbirth coverage or contact your plan administrator.
For additional information about NMHPA provisions and how Self-funded non Federal governmental plans may opt-out of the NMHPA requirements, visit http://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/nmhpa_factsheet.html.
MHPA/MHPAEA
Mental Health Parity and Addiction Equity Act (MHPA/MHPAEA) require that group health plans not unfairly restrict treatment with regards to benefits/services applicable to mental health or substance use disorders. Additional information and details can be found by visiting the Department of Labor’s Mental Health Parity webpage locate at https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity.
USERRA
The Uniformed Services Employment and Reemployment Rights Act (USERRA), protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake military service or certain types of service in the National Disaster Medical System. USERRA also prohibits employers from discriminating against past and present members of the uniformed services, and applicants to the uniformed services.
Reemployment Rights
You have the right to be reemployed in your civilian job if you leave that job to perform service in the uniformed service and:
- You ensure that your employer receives advance written or verbal notice of your service;
- You have five years or less of cumulative service in the uniformed services while with that particular employer;
- You return to work or apply for reemployment in a timely manner after conclusion of service; and
- You have not been separated from service with a disqualifying discharge or under other than honorable conditions.
If you are eligible to be reemployed, you must be restored to the job and benefits you would have attained if you had not been absent due to military service or, in some cases, a comparable job.
Right to Be Free From Discrimination and Retaliation
If you are a past or present member of the uniformed service; have applied for membership in the uniformed service; or are obligated to serve in the uniformed service; then an employer may not deny you: initial employment; reemployment; retention in employment; promotion; or any benefit of employment because of this status. In addition, an employer may not retaliate against anyone assisting in the enforcement of USERRA rights, including testifying or making a statement in connection with a proceeding under USERRA, even if that person has no service connection.
Health Insurance Protection
If you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military. Even if you don’t elect to continue coverage during your military service, you have the right to be reinstated in your employer’s health plan when you are reemployed, generally without any waiting periods or exclusions (e.g., pre-existing condition exclusions) except for service-connected illnesses or injuries.
Enforcement
The U.S. Department of Labor, Veterans Employment and Training Service (VETS) is authorized to investigate and resolve complaints of USERRA violations. For assistance in filing a complaint, or for any other information on USERRA, contact VETS at 1-866-4-USA-DOL or visit its website at http://www.dol.gov/vets. An interactive online USERRA Advisor can be viewed at https://webapps.dol.gov/elaws/vets/userra/. If you file a complaint with VETS and VETS is unable to resolve it, you may request that your case be referred to the Department of Justice or the Office of Special Counsel, as applicable, for representation. You may also bypass the VETS process and bring a civil action against an employer for violations of USERRA.
GINA
The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to any requests for medical information, if applicable. ‘Genetic information,’ as defined by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.