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SPU’s medical plan is self-insured and administered by Cigna. The University pays the full premium for a full-time employee’s coverage. The employee pays premiums for dependents, and part-time employees also share a portion of the employer rate ( see “Cost of Medical Plans"). You have the flexibility to see in-network or out-of-network providers, and you’ll receive the highest level of benefit utilizing in-network providers within the Open Access Plus (OAP) network of providers.

For information about Flexible Spending Accounts, please visit the Flexible Spending Accounts page.

 

 

High-Deductible Health Plan (HDHP)


SPU offers a fully comprehensive, qualified High Deductible Health Plan (HDHP) that is partnered with different tax-advantaged account options to pay for qualified medical expenses - the Health Savings Account (HSA) and the Health Reimbursement Account (HRA).

The charts below illustrate how the funds in these accounts work with the structure of the plan to pay for medical expenses:

 

New This Year!  Our health plans will be transitioning from an academic year (July - June) to a calendar year effective 1/1/2019

The Board approved some changes to our budget planning process to better address the current realities of the higher education economic cycle. Part of these changes include moving from a fiscal/academic year to a calendar year for our benefit plan year and annual renewal with our insurance carriers. 



 



How will SPU help offset the deductible in this transitional year?

To help with the transitional six-month plan year and reset of the deductible on 1/1/2019, SPU will be increasing contributions into the HSA between 01/01/2019 – 06/30/2019, giving a 50% increase in the monthly contribution into your HSA accounts.  The increased contribution will continue for the first six-months of the year and then drop back down to the previous standard monthly amounts.  An equivalent increase will be applied to individuals participating in the Health Reimbursement Account (HRA). This increase is intended to frontload some additional funding to offset any potential expenses as the deductible resets on 1/1/2019. 


2019 Calendar Year Contributions


 



Deductible: $2,000 Individual/$4,000 Family

Co-insurance: Plan will 90% of all expenses after deductible for in-network providers/ 60% for out-of-network providers.

Out-of-pocket Maximum: $3,425 Individual/$6,850 Family


Frequently Asked Questions


 

 How much does it cost to be on the plan?

 

The University pays the full premium for regular full-time employees' high deductible health plan (HDHP) coverage (subject to change each year, based on renewal of program contracts).

For regular part-time employees (.5 FTE through .79 FTE for Staff and .5 FTE through .74 for Faculty), the University pays a prorated portion of the premium for employee coverage, based on the employee's FTE. Employees pay the remainder of the employee premium via payroll deduction. The rates are noted below.

Employees who elect spouse and/or children coverage pay for the entire cost of their dependents' premiums by payroll deduction.

All medical insurance premiums deducted from employee earnings are taken on a pretax basis.  

MONTHLY PREMIUM COSTS: 1/1/2019 - 12/31/2019


 

CoverageHDHP
 Full-timePart-time
Employee Only$0$220
Employee + Spouse$414$634
Employee + Children$136$356
Employee + Family$640$860

 

 Do I need to report my medical insurance coverage on my taxes?

As part of the Affordable Care Act, institutions that employ more than 50 people became required to report on the health coverage offered to its full-time employees. SPU produces and distributes the 1095-C form each year to comply with this requirement. For more information on this, please see the Healthcare Tax Reporting Requirements page.

 How do the Health Savings Account and Health Reimbursement Account work with the plan?

The funds in both the Health Savings Account (HSA) and the Health Reimbursement Account (HRA) can be used to pay for qualified health expenses (i.e. medical bills, prescriptions, etc). For more information on how those accounts are funded, please see the HSA and the HRA pages.

 When can I make changes to my benefits?

You can make changes to your benefits if you experience any of the following situations:

  1. A "Qualified Life Event," such as:
    1. Loss of Coverage: If you or your dependents lose eligibility for other coverage or if the employer stops contributing towards your or your dependents’ other coverage. Ex., spouse loses a job and the corresponding insurance coverage with that job. Enrollment must be requested within 31 days after your coverage ends (or after the employer stops contributing toward the other coverage.

    2. Family Status Change: 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. Enrollment must be requested in most cases within 31 days after the marriage, and 60 days after the birth/adoption or placement for adoption. Likewise, in the case of a divorce, legal separation, annulment, or dependent becoming independent, you must request changes within 31 days of such an event.

    3. Change in Job Status: In addition to the above special enrollments, you may also enroll if you previously waived benefits when initially eligible because your position was part-time (.50 -.79 FTE for staff, .50 -.74 FTE for faculty) but recently experienced an increase in FTE (expected to continue for three months or longer). Changes must be requested within 30 days of such an event.

  1. Open Enrollment: SPU's Open Enrollment period is generally held in October, and all changes made during that time will be effective on January 1st.

Plan Documents


Cigna Contact Information