Human Resources

University of Mississippi

State and School Employee’s Health Insurance Plan

The State Health Plan offers two options: Select Coverage and Base Coverage (high deductible health plan).   Some  differences in these options are monthly premiums, calendar year deductibles, maximum out-of-pocket costs, and pharmacy deductibles.

The University pays 100% of the employee’s premium for Base Coverage.  Under the Select Coverage option, the Univesity $20.00/month for a legacy participants in the Select Covverage, and $38.00/month for horizon participants.   The employee is responsible for the dependent premium which is a pre-tax payroll deduction.

  • Legacy Employees All current UM employees hired prior to January 1, 2006 OR new employees hired on or after January 1, 2006 who have been employed full-time by any State of Mississippi agency covered by the Plan (such as a community/junior college, public library, public school district, other State agency or university).
  • Horizon Employees Any employees initially hired by any State of Mississippi agency on or after January 1, 2006.

A summary of coverage for each plan option and premium rates are available on the State Health Plan’s website.

2017 Summary of Select Coverage

2017 Summary of Base Coverage (high deductible health plan)

2017 Premium Rates

 Legacy Participant Rates

 

Select Coverage Option

Base Coverage Option

Coverage

Legacy Monthly Premiums

Legacy Monthly Premiums

12-month

9-month

12-Month

9-Month

*Employee

$  20.00

$  26.68

$0

$0

Employee & Spouse

$463.00

$617.32

$389.00

$518.68

Employee & 1 Child

$175.00

$233.32

$101.00

$134.68

Employee & Children (2 or more)

$332.00

$442.68

$258.00

$344.00

Employee, Spouse, & Children

$667.00

$889.32

$593.00

$790.68

*The University pays $356.00 for employee only coverage

 

Horizon Participant Rates

 

Select Coverage Option

Base Coverage Option

Coverage

Horizon Monthly Premiums

Horizon Monthly Premiums

12-month

9-month

12-Month

9-Month

*Employee

$  38.00

$  50.68

$0

$0

Employee & Spouse

$481.00

$641.32

$389.00

$518.68

Employee & 1 Child

$193.00

$257.32

$101.00

$134.68

Employee & Children (2 or more)

$350.00

$466.68

$258.00

$344.00

Employee, Spouse, & Children

$685.00

$913.32

$593.00

$790.68

*The University pays $356.00 for employee only coverage.

Prescription Benefits – Prime Therapeutics, LLC (Prime) is benefits manager for the Plan’s co-payment prescription drug program.  Each Select Coverage participant must satisfy a $75 calendar year deductible prior to receiving the co-pay rates.  Once a $150 family calendar year deductible is satisfied, all family members may being receiving co-pay benefits.  Base Coverage participants must satisfy the individual or family annual deductible for all expenses (medical and pharmacy) prior to receiving the co-pay rates.  The co-payment amount for covered drugs is as follows:

 

 

Prescription Drug Type

Co-pay

 (1-30 day supply)

Generic Drug

$12

Preferred Brand Drug

$45

Other Brand Drug (no generic equivalent)

$70

 

Home Delivery Service for Prescriptions – Participants taking prescription drugs regularly for a chronic health condition may purchase a 90-day supply of the prescription drug at a 60-day rate through mail order service. The co-payment for mail order prescriptions is as follows:

                    Prescription Drug Type

Mail Co-payment

 (90-day supply)

Generic Drug $24
Preferred Brand Drug $90
Non-preferred Brand & Other Brand Drug $140

 

The Prime Specialty Drug Management Program provides a dedicated specialty pharmacy program for participants who are receiving specialty medications.  Medications must be purchased through an approved specialty pharmacy.  Through the program, participants have access to experienced pharmacists trained in complex health conditions and medication therapies  The participant will pay a $70 co-pay for each 30-day supply when purchased through a network provider.  For additional information, see the SPD, or contact Prime at 1-877-627-6337.  Out-of-Network services are not available with this program.

Telemedicine

 

 

More detail information about plan options, prescription benefits, telemedicine, wellness benefits, plan exclusion, the appeals process, and contact information can be found in the 2017 Plan Document.

Coverage Effective Date – Employees electing coverage within the first 31 days of hire are covered as of their date of employment, upon completion of Application for Enrollment.  Those who fail to make application by the 31 day deadline may not apply for coverage until Open Erollment which is held during the month of October.  The only exception to this rule are qualifying events for a special enrollment period (see Plan Document).  The application deadline for a special enrollment period is 60 days following the date of the qualifying event.

Premium Payment – The employee is responsible for a full month’s premium if hired on or before the 15th of the month and a half-month’s premium when hired after the 15th.  The same rule applies when adding a dependent due to a qualifying event.  Open Enrollment elections are effective January 1st of the following  year.  Premiums for health insurance coverage are payable one month in advance of the coverage period.  A benefits team member will inform you of premiums in arrears and the additional amount to be collected.

Network Providers – Participants are encouraged to utilize Network providers to receive maximum benefit from the Plan, but have a choice to be treated by any provider and to change providers at any time. Participants utilizing non-participating providers will be responsible for any charges in excess of the allowable charge, in addition to the higher calendar year deductible and coinsurance.

  • AHS State Network (Advanced Health Systems, Inc.) – network of physicians, hospitals, and other medical care providers within the State of Mississippi.  A searchable database is available for locating a participating provider.
  • Blue Card Program is a national program through the Blue Cross and Blue Shield Association that enables Plan participants to receive services at an in-network level.  Find a medical care provider via an online search.

Keys to Health Living – The Plan offers information, programs, and consultation services in an effort to provider a healthier lifestyle.  Learn more about the benefits of lowering your cholesterol, being tobacco free, developing an exercise program, and eating healthy.

 

 

 

 

Utilization Review Program – Through a clinical review and certification process, the Plan ensures that care participants receive is medically necessary, with services provided in the most appropriate facility and location.  It is the participant’s responsibility to make sure that ActiveHealth is notified of services that require utilization review and within the allotted period of time.  Certification determination does not guarantee either payment of benefits or the amount of benefits that will be paid.  Plan participants are strongly encouraged to read The Plan’s Utilization Review Program section of the SPD.

 

Notification requirements for inpatient hospital admission

Non-emergency As soon as possible, but at least five (5) days prior to admission
Emergency admissions Within forty-eight (48) hours of admission

 

More detailed information about notification requirements and penalties is available in the SPD which can be accessed on the State Health Plan website.

 

Penalties are as follows: Late notification, $250; No notification, $500; No notification plus determined “Not Medically Necessary,” not covered.

 

 

Maternity – Benefits are available to covered enrollees and covered spouses, with limited benefits available to other female dependents.  An all-inclusive list of services and benefits are available in the SPD.

 

Well-Child Care This benefit is available for covered dependents up to age 18.  Services received by network provider are covered at 100% and not subject to the calendar year deductible.

 

Well-newborn nursery care expenses, which include room, board, and other normal care, are covered at 100% when services are provided at a network hospital or by a network physician.

 

This benefit is also available for well-child physician office visits, certain diagnostic tests, and immunizations.

 

A list of covered preventive service is available at http://knowyourbenefits.dfa.ms.gov/.

 

Wellness/Preventive Coverage for AdultsBenefits for wellness and preventive services are available for participants ages 18 and older.  Benefits are payable at 100% of allowable charge for up to two (2) office visits and certain diagnostic tests based on age and gender as defined by the plan.  Services must be rendered by a Network provider. An all-inclusive list of covered procedures is available by visiting the state health plan’s website at http://knowyourbenefits.dfa.ms.gov/.

 

 

 

 

                    Prescription Drug Type

Mail Co-payment

 (90-day supply)

Generic Drug $24
Preferred Brand Drug $90
Non-preferred Brand & Other Brand Drug $140