The open enrollment period for benefit elections effective January 1, 2017 begins Monday, October 17, 2016 and ends at:
5:00 pm on Friday, November 11, 2016.
1. Election Participation Forms:
Due to new regulations in 2017 related to the Affordable Care Act Reporting
Requirements, the Payroll Manager MUST have a current mailing address on file. If
you moved during 2016, you MUST complete the attached Election Participation Form.
Please click on this link: 2017 ELECTION PARTICIPATION FORM
Complete all sections of the form as it relates to you and your coverage needs for
2017. Forms must be completed and returned to the HR Office
by November 11, 2016.
2. FSA Plans for 2017:
1. The Health Care allowable contribution is $2,550.00. You still have until March 31st
of the following year to submit expenses incurred in the current year.
2. HSC allows a Rollover option of unused funds at the end of the plan year.
Participants may carry over health care balances up to $500.00 into the following
3. The maximum contribution amount for Dependent Care reimbursement is
Reminder: You MUST complete a new application every year in order to
participate in the FSA.
3. Vision Buy Up Plans:
Vision benefits will continue to be offered through UniCare in collaboration with
Anthem. The UniView vision plan offered by UniCare is a voluntary buy-up
plan. There are no changes in coverage or in the premium cost. To view the
rates for 2017 please click on this link: 2017 Insurance Rates.
4. Anthem Medical Plans:
Benefits will remain the same; however rates have increased. To view the new rates
for 2017 please click on this link: 2017 Insurance Rates.
5. Delta Dental Plans:
Low and High Plan options will remain the same. New for 2017: The Low and
High dental plans will now include coverage for Occlusal Guards for bruxism (treats
grinding or clenching of teeth) under Basic services. Low and High rates have
increased. To view the new rates for 2017 please click on this link:
2017 Insurance Rates.
6. Express Scripts:
RX benefits and copays will remain the same.
* Retail: $10/$40/$60
* Mail Order: $10/$80/$120
* 4th tier cover specialty drugs at 20% up to $200 per script
maximum; Mail order - 20% up to $400 per script maximum.
* Standard Preventative Care Medications benefits will remain the same
with no Co-pays. There will be no charge for these drugs. You can view
a list of ESI standard preventive care medications below under
Prescription Drug Coverage.
If you want to add/change Medical, Dental or Vision you MUST complete an application
and the 2017 ELECTION PARTICIPATION FORM for the plan(s) you are adding/changing
only. Application forms for each benefit are provided below. You can complete the
application online. It can be saved to your computer. Completed forms should
be sent to:
Debbie Herndon, Benefits Manager, at one of the following:
email@example.com, or fax (434.223.7049), or Campus Box 127, or delivered to the
office on the 2nd Floor, Cabell House.
Forms must be RECEIVED by 5:00 pm on Friday, November 11, 2016.
|Anthem (Medical):||Information Booklet|
|Summary of Benefits and Coverage|
|CHIP (Children's Health Insurance Program)|
|Women's Health & Cancer Rights Act|
|Coverage for Spectrum Disorder|
|HIPAA Special Enrollment Rights|
|HIPAA Privacy Notice|
|Americans with Disability Act Notice|
|Delta (Dental):||Information On Low Option|
|Information on High Option|
|Delta Dental Network Providers|
|UniView (Vision):||Information Booklet on High Option|
|UniCare Member Online Services|
Prescription Drug Coverage
Express Scripts (Prescriptions): Information On Coverage
ESI Standard Preventative Care Medications
ESI Home Delivery & Mobile App Information
ESI Mobile App Registration Instructions
Flexible Spending Accounts
|LD&B (FSA):||Information Enrollment Packet|
|HIPAA Privacy Notice LD&B|