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Oxford Healthcare for Faculty & Administrators

PLAN DESIGN

Barnard offers two benefit plans through Oxford Health Plan.  The plans are identified as Plan A and Plan B.  Employees may select Plan B, which provides for a lower deductible and lower out-of-pocket maximum, but requires an employee contribution toward individual coverage.  Employees may then enroll their dependents in the plan they have selected for themselves. 

PLAN A

  • In-network care at no charge or with $25 copay

  • Drug card:  $15 generic/$25 brand/$50 non-preferred

  • Out-of-network deductible: $1,000 individual/$2,500 family

  • Coinsurance: 70% Oxford/30% Participant

  • Out-of-pocket maximum: $8,500 ind/$17,000 employee + 1 or family

PLAN B

  • In-network care at no charge or with $25 copay

  • Drug card:  $15 generic/$25 for brand/$50 non-preferred brand

  • Out-of-network deductible: $500 individual/$1,250 family

  • Coinsurance: 80% Oxford/20% Participant

  • Out-of-pocket maximum: $1,500 ind/$3,000 employee + 1 or family

Note:  All other plan provisions are the same for Plans A and B, including the enhanced benefits listed below.  A comparison chart has been included for your convenience.

Monthly Costs: These rates are effective as of January 1, 2014.

PLAN A - Monthly Cost  

Salary Band

Individual Employee Cost / College Cost

* Plus 1 Dependent Employee Cost / College Cost

* Plus 2 or More Dependents Employee Cost / College Cost

 

< $50,000

$33.90 / $768.62

$163.85 / $1,362.41

$293.80 / $2,129.80

 

$50,000-$74,999

$39.55 / $762.97

$186.45 / $1,362.41

$344.65 / $2,078.95

 

$75,000-$99,999

$50.85 / $751.67

$242.95 / $1,305.91

$401.15 / $2,022.45

 

$100,000-$124,999

$62.15 / $740.37

$282.50 / $1,266.36

$491.55/ $1,932.05

 

≥ $125,000

$73.45 / $729.07

$327.70 / $1,221.16

$565.00 / $1,858.60

 

TOTAL MONTHLY PREMIUM

$802.52

$1,548.86

$2,423.60

 

*may be spouse, partner or child

PLAN B - Monthly Cost

Salary Band

Individual Employee Cost / College Cost

* Plus 1 Dependent Employee Cost / College Cost

* Plus 2 or More Dependents Employee Cost / College Cost

< $50,000

$199.30 / $768.62

$483.07/ $1,385.01

$793.31 / $2,129.80

$50,000-$74,999

$204.95 / $762.97

$505.67 / $1,362.41

$844.16 / $2,078.95

$75,000-$99,999

$216.25 / $751.67

$562.17 / $1,305.91

$900.66 / $2,022.45

$100,000-$124,999

$227.55 / $740.37

$601.72 / $1,266.36

$991.06 / $1,932.05

≥ $125,000

$238.85 / $729.07

$646.92/ $1,221.16

$1,064.51/ $1,858.60

TOTAL MONTHLY PREMIUM

$967.92

$1,868.08

$2,923.11

*may be spouse, partner or child

MAKING CHOICES

Whether you choose Plan A or Plan B, whenever you elect to use non-network healthcare providers, you will be responsible for paying a higher portion of your medical expenses including a deductible and coinsurance.  However, your expenses will be greater than Plan A.  Before electing either plan it is important to review the following out-of-network plan provisions.  Coverage under these Plans is subject to coinsurance and deductibles. 

Coinsurance:  Coinsurance is the percentage of the cost of covered services that Oxford will pay towards your submitted claims once you have met your deductible. 

Deductible:  The deductible is the amount of dollars in claims for covered services for which you will be responsible before plan coverage is available.  The amount of the deductible varies by plan design.

Out-of-Pocket Maximums

Out-of-Pocket Maximum limits the amount of coinsurance and deductible you will pay in any calendar year.  Once the out-of-pocket maximum is reached for a calendar year, the plan will pay 100% of covered services for the remainder of that year.

For example:  A plan requires a $500 deductible plus your coinsurance of 20%.  The out-of-pocket maximum for the plan is $1,500 for a single participant.  When the member pays the $500 deductible and 20% of the next $5,000 worth of covered services, the member will have paid $1,500 out of pocket.  Having reached the maximum, Oxford would reimburse the remaining covered services for the calendar year at 100%.

Usual, Customary and Reasonable (UCR)

A UCR schedule is a compilation of maximum allowable charges for various medical services.  They vary according to the type of provider and geographic location.  Fee schedules are calculated using data compiled by the Health Insurance Association of America (HIAA) and other recognized sources.  What Oxford reimburses is based on the UCR.  For example:  If the benefit is 80% of the cost of covered services.  Oxford will reimburse you 80% of the UCR for that service.  If the charges exceed the UCR, you must pay the difference plus 20% coinsurance.

Coordination of Benefits

Employees may be covered by two or more plans (theirs and their spouse/partner) at the time that services are rendered.  In considering double coverage you should review the Coordination of Benefits clauses of both plans to determine whether it is cost effective to pay for two coverages.  Oxford provides detailed information about their Coordination of Benefits provision.

QUESTIONS TO ASK YOURSELF BEFORE ELECTING COLLEGE COVERAGE FOR DEPENDENTS

Are you or other family members covered by another plan?  Have you compared the coverage?  Is it cost effective to have two plans?  Did you compare the deductible?  How do the benefits coordinate? 

How much did you pay out of your pocket for your health care last year?  Did you meet your individual or family deductible?  How about out-of-pocket limit? 

Do you regularly use in-network providers?  How often do you go out-of-network? 

In a medical emergency, how much could you afford to spend? 

Can you anticipate your medical expenses from the time you enroll through December.  (You may switch plans during open enrollment in the fall of the following year for an effective date of January 1.)

ENHANCED BENEFITS

Chiropractic Care

The out-of-pocket benefit for chiropractic care has been expanded from 50% coverage after deductible, with a maximum of $500, to 50% coverage after deductible, with a maximum of $1,000.  A network chiropractor referred by a network primary physician will require a $25 copay.

Physical Therapy

This benefit is expanded from 60 visits to 90 visits per condition per lifetime.

Domestic Partners

Oxford insures both the same sex and opposite sex domestic partners.  Employees interested in this coverage should contact Human Resources at (212) 854-2551.

Alternative Medicine Program 

In February 1997, Oxford established this program as an addition to their healthcare services. You have access to Oxford's Alternative Medicine providers at any time.  However, expenses from these providers are not reimbursable by Oxford.  Oxford has arranged discounted fees for Acupuncturists, Massage Therapists, Yoga Instructors, Nutritionists and Dietitians.

ENROLLMENT DEADLINE

New employees have 31 days from their eligibility date to enroll in the Oxford Medical Plan.

ELECTION FORM (PINK FORM)

All employees are required to complete an election form. 

FLEXIBLE SPENDING ACCOUNT

Health Care Account

This program allows you to set aside a portion of your salary in pre-tax dollars to help meet your needs for medical care not covered by your health plan (such as eye glasses, hearing aids, health plan deductibles and out of pocket dental expenses).  A list of eligible expenses is available in the Human Resources Office.  This account is governed by the Internal Revenue Code, which has established certain rules for reimbursement accounts.  Reimbursement accounts are "use it or lose it" accounts; if by December 31 of the plan year you do not use the funds in this account, you will lose them.

(REV. 1/6/14)