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Ypsilanti, MI, USA 48197
University Information:
(734) 487-1849
About this web site
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FREQUENTLY ASKED QUESTIONS (FAQ) Self-insured means that EMU pays the actual costs of claims for EMU covered employees. This is important because almost 95% of the $16 million of 2005 health care costs are for actual claims of covered employees that are paid by the University. The remaining 5% of the total cost paid by the University is for administrative fees to the healthcare vendors and stop-loss insurance premiums. Stop loss insurance is insurance purchased by the University to avoid unpredictable risks and very large claims. For any claims that exceed the stop loss limit (ex. $175,000 per contract member per month), this insurance will provide reimbursement to the University. 2. Why does EMU feel a change is necessary in the healthcare benefits available to employees at this time?Virtually every non-profit and for-profit organization in the nation is facing challenges in containing its healthcare costs. In recent years healthcare costs have been rising at rates far greater than inflation. EMU’s experience has been no different. Over the past 5 years (2001-2005), EMU’s annual healthcare costs have increased 61%. BCBS projects that the University’s costs will increase by 12% in 2006. Claims for the first sixth months of the year are tracking consistently with (in fact, higher than) the BCBS estimate:
EMU’s average annual cost for an employee enrolled in the University’s healthcare program:
As a result, like other Michigan public universities, EMU must curtail its rising healthcare costs, and implement more cost efficient provisions for all University employees. 3. What is EMU doing to control the rising cost of healthcare?Blue Cross Blue Shield is the lowest cost provider of healthcare coverage in Michigan, and its lowest cost plan is a PPO. Over the past five years, 94% of all EMU employees covered by health care insurance have moved to a BCBS PPO plan. 102 faculty members continue to be covered by a Blue Cross Blue Shield Traditional plan and an additional 19 faculty members are covered under the Care Choice HMO. The move from the traditional BCBS plan and HMO plans to the Community Blue PPO has proven to be beneficial to the University in terms of minimizing and avoiding rising health care costs. Based on BCBSM data, the Community Blue plan processes claims an average of 6% less than their traditional plan. 4. Is it true that faculty healthcare costs have actually declined?Yes and no…depending on the time frame examined. For the University’s largest employee group – EMU faculty – healthcare cost per employee increased a total of 46% from 2001 to 2005 (compared to 61% for all other employees). For the first six months of 2006, EMU healthcare costs per individual faculty member are trending up 18.5% over comparable 2005 costs:
EMU faculty are the only employee group eligible for the BC/BS Traditional plan (102 currently enrolled) and Care Choices (19 currently enrolled). 5. What was the per person cost of each plan offered by the University in 2005?
6. Could an individual currently on the BCBS traditional plan lose their doctor if they move to the BCBS PPO plan? No one would be required to change doctors under the PPO plan. In fact, 98% of physicians and 100% of hospitals used in 2005 under the traditional plan are also PPO participating providers. Of the 271 total providers used in 2005 under the traditional plan, only 15 providers -- 3 physicians, 5 x-ray and lab providers, 2 anesthesiologists, 2 orthopedics, 1 physical therapist, 1 vision provider and 1 oxygen supplier were not included in the PPO plan. If an individual’s doctor or hospital does not belong to the PPO, the employee can still go to that physician and pay a co-insurance percentage for going to an out-of-network provider (20% under Option #1 and 30% under Option #2) which is capped by the co-insurance maximum for the Option plan selected. 7. Are there advantages to the Blue Cross/Blue Shield PPO versus the BC/BS Traditional Plan? There are several advantages the PPO provides: Comprehensive nationwide network Freedom to go out of network Wellness/Preventative Coverage Well Baby Care Routine/annual physicals covered Skilled Nursing Care Hearing/Vision Benefits No receipts or claim forms for in network services Convenience of mail order which delivers to your home Durable medical supplies (Insulin strips) 100% International Coverage Birth control coverage Office visit and Emergency Room Co-payments rather than full payment No referrals needed Lower cost claims Compared to the Traditional Plan: Must pay for services then get reimbursed Must keep track of receipts No preventive/wellness coverage No hearing or vision benefits No skilled nursing care No annual physical coverage No birth control coverage No child immunizations Claim forms must be turned in on time More expensive claims International Coverage 8. Is it true not all prescription drugs are covered under the two proposed health care insurance options?No. All prescriptions are covered. The difference in out-of-pocket costs to you depend on whether the prescription is a Tier 1, Tier 2, or Tier 3 drug. The co-pays per month will be $10 for a Tier 1 (all generic drugs are in this group including generics that are included on BCBS’s “formulary” drug list), $20 for a Tier 2 drug (a brand name drug that is on the formulary list), and $30 for a Tier 3 drug (brand name drugs not on the formulary list). BCBS develops its formulary list regularly based on the evaluations and recommendations of physicians. BCBS explanations of the three tiers along with information about the formulary list are available at http://www.bcbsm.com/home/drug_formulary/drug_formulary_custom_clinical.shtml. There is a quick formulary guide listing the most commonly prescribed drugs as well as a full updated formulary guide available at this site. You can also phone BCBS Customer Service at 1-800-637-2227 to check what co-pay group your prescription falls into. 9. Does EMU’s PPO health care plan offer any choice to employees?Some employee groups have plan choice options within the Community Blue PPO. Effective February 1, 2006, the 100% Lecturer group was provided with Community Blue PPO Options 1 and 2.
Effective January 1, 2007, roughly 284 non-bargained for EMU employees will have the choice of selecting to participate in either of the two BCBS Community Blue plans or electing to opt out of the EMU healthcare coverage completely. These plans were presented to the EMU-AAUP at the opening session of faculty contract negotiations on June 9. Full plan descriptions are available at: www.emich.edu/hr/healthcareinfo The decision about which plan would be best depends on the employee and his or her family’s health care usage. You can use the plan descriptions along with the tool available at that site to estimate the cost to you given your family’s expected health care usage. 10. What if I need to go to a doctor or hospital outside the State of Michigan? BC/BS Community Blue PPO is a national product, not specific to the State of Michigan. If you are traveling or on vacation, you can either contact BC/BS directly or view their website for PPO physicians in the area which you are traveling. Please visit www.bcbsm.cm or call BC/BS of Michigan at 1-800-637-2227 for more details. 11. Why did the University proposal suggest mandatory use of mail order for any prescription taken longer than three consecutive months? The rate at which claims are paid under mail order is less than the rate pharmacy claims are paid for the same prescription drugs. The University wanted to maintain the convenience factor for prescriptions taken for shorter lengths of time while at the same time taking advantage of savings in cases where prescriptions are needed for longer periods of time. Home | Contact EMU | Site Map | Directories | Calendars | My.emich | Search |