State and School Employee’s Health Insurance Plan
The University of Mississippi offers an array of pre- and post-tax insurance benefits. A brief description of each benefit is provided along with links to each provider website.
The State and School Employees’ Health Plan
Benefits-eligible employees, their spouses and children
An employee may choose Base Coverage or Select Coverage at initial enrollment. If timely application is made and the appropriate premium amount is paid, the effective date of coverage for the employee and any eligible dependent(s) begins the first day of employment. If an employee does not enroll or if he waives coverage within 31 days of employment, application may be made only during an open enrollment or as a result of a qualifying event.
The University pays 100% of the premium for employee coverage under the Base Plan (high deductible health plan) and a portion of the employee premium for the Select Plan. The employee is responsible for the cost of dependent coverage.
The State and School Employees’ Health Insurance Plan will experience a premium/rate change effective January 1, 2020. To review the new rates you can visit the knowyourbenefits website. The State and School Employees’ Health Insurance Plan is a self-funded plan that provides 2 plan options (the Select Plan and the Base Plan, also referred to as the high deductible health plan-HDHP). Under both options the participant must meet a calendar year deducible before the Plan is responsible for payment of covered expenses.
Detailed information about each plan option is available in the Plan’s Summary Plan Description. This document provides detailed information about plan deductibles, co-insurances, medical benefits, pharmacy benefits, adult wellness/preventive and well-child benefits in addition to other important Plan information.The following link will provide you with a comparison of benefits for the Base Coverage (high deduchttp://knowyourbenefits.dfa.ms.gov/publications/tible health plan) and Select Coverage; rate for active employees, retirees, and COBRA participants; and federal notices and summaries of coverage.
Wellness & Preventative Coverage
Refer to the following link for a comprehensive explanation of the wellness & preventive coverage.
Utilization Review Management (Change effective July 1, 2021)
Effective July 1, 2021, Kepro will provide utilization review for certification of medical necessity care and clinical review for such services as inpatient hospital admission, diabetic self-management training/education, and residential treatment facilities. Information about the transition to Kepro, continued services available through ActiveHealth Management, and a more defining list of services that require prior authorization is provided in the Department of Finance and Administration notice. The Plan also recently mailed correspondence about this change to participants.
Wellness and preventive care benefits are provided at 100 percent of the allowable charge for certain diagnostic tests and up to two office visits each year. Wellness services are not subject to the calendar year deductible. Diagnostic tests are based on the participant’s age and gender. Wellness and preventive care benefits are only provided when a participating provider renders the service and the wellness services are filed with a wellness diagnosis.
Benefits are provided for well-child care services for covered dependents up to age 18 at 100 percent. Services are not subject to the calendar year deductible. Benefits are only provided when a participating provider renders the service and the wellness services are filed with a wellness diagnosis.
Well-newborn nursery care is covered at 100 percent while a newborn is hospital-confined after birth. Well-newborn nursery care includes room, board and other normal care provided for which a network hospital or physician makes a charge. Also, well-child physician office visits, certain diagnostic tests and immunizations are covered at 100 percent.
If you have questions about this coverage, please contact Blue Cross & Blue Shield of Mississippi at 800-709-7881.
CVS Caremark, is the pharmacy benefit manager (PBM) for the Plan’s prescription drug program and serves approximately 26 million members across the country. CVS Caremark processes prescription claims from participating pharmacies, mail order claims and paper claims filed by participants and is focused on keeping prescriptions affordable while providing a customer service experience that makes it easy to get necessary medicines.
Frequently asked questions about the pharmacy benefits manager transition.
Are you looking for a pharmacy or interested in knowing if your prescription is covered? Visit the Plan’s prescription drug webpage.
CVS Caremark provides online access to a wide range of tools and service to assist you in managing your prescriptions.
Have you misplaced you prescription drug card? You can order a replacement online. Select Plan and Benefits.
Online Provider Visits (Telemedicine)
Employees and their family members who are enrolled in the State and School Employees’ Health Insurance Plan have the opportunity to seek online services for minor medical care. Telemedicine services through Amwell provides an opportunity to consult with a board-certified medical care provider for common medical issues, such as, headache, fever, rashes, sore throat, cold and flu, insect bites, and constipation. Generally, a diagnosis can be made and treatment prescribed but in some cases, the patient may receive a referral for in-office services. There are times when symptoms alone are not enough to provide diagnosis so lab work or diagnostics may be necessary.
Notices (Benefits Summary; Enrollment Rights; HIPAA, COBRA, and Marketplace Notices)
- Summary of Benefits and Coverage (Base and Select Plans)
- Notice of Enrollment Rights
- HIPAA Notice of Privacy Practices
- COBRA Initial Notice Continuation of Coverage
- Marketplace Notice
- Department of Finance and Administration
- Plan Document
- Base verses Select Coverage
- Premium Rates
- Wellness/Preventive Coverage Guidelines
- Motivating Mississippi Keys to Healthy Living
Online access for managing your prescriptions.