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Medical Insurance

Group Health Insurance

Carleton College offers benefit-eligible employees with a selection of three different plans provided by BlueCross BlueShield of Minnesota.  Our carrier allows same sex and opposite sex domestic partner coverage. Participation is voluntary and health care premiums are taken as a pre-tax deduction.

Benefits are effective the first of the month following your first month of employment.  If your employment date occurs on the first working day of the month, your benefits become effective immediately. New employees will have 30 days from the date employment begins to apply for health coverage. If the 30-day period has elapsed, the employee will be considered a late entrant and may be subject to pre-existing conditions. An employee must elect or waive participation through our on line enrollment process (benefitsCONNECT).

A change in options may be made once every year during the Open Enrollment process unless you experience a qualifying event.  Open enrollment is offered on an annual basis.

 

Group Health Insurance Plan Options:

Options Blue (Aware)

This is a high deductible option offering preventative and catastrophic coverage with an employer funded health reimbursement account (HRA). This plan also offers a large network of providers. Preventive care is covered at 100% to a maximum of $500. Routine cancer screenings are covered at 100%. Prescription drugs require a $15 co-pay for generic drugs, a $35 co-pay for brand name preferred drugs, or a $55 co-pay for non-preferred brand name drugs. You may also receive coverage with non-network providers but can expect higher out-of-pocket costs and other restrictions.

Certificates of Insurance:

Summary of Benefits and Coverage (SBC):

AWARE Preferred Provider Organization (PPO)

This option offers preventative and catastrophic coverage through a large network of health care providers.  This option covers eligible services at 80% through a large network of health care providers. Office visits require a $35 co-pay. Preventive care is covered at 100%. Prescription drugs require at $15 co-pay for generic drugs, a $35 co-pay for brand name preferred drugs, or a $55 co-pay for non-preferred brand name drugs. You may also receive coverage with non-network providers but can expect higher out-of-pocket costs and other restrictions.  

Certificates of Insurance:

Summary of Benefits and Coverage (SBC):

Accord HRA

This is a high deductible option offering preventative and catastrophic coverage with an employer funded health reimbursement account (HRA).  This plan also offers a large network of providers, however differs slightly from the Options Blue aware Network (Mayo and Hazelton are not in network). Preventive care is covered at 100% to a maximum of $500. Routine cancer screenings are covered at 100%. Prescription drugs require a $15 co-pay for generic drugs, a $35 co-pay for brand name preferred drugs, or a $55 co-pay for non-preferred brand name drugs. You may also receive coverage with non-network providers but can expect higher out-of-pocket costs and other restrictions.  

Certificates of Insurance:

Summary of Benefits and Coverage (SBC):

Medical Plan Premium Information:

The cost associated with health coverage is not pro-rated for less than full-time employees. Participation in the group health insurance is optional.  

 

Medical Plan Comparison Interactive Tool:

Human Resources has an interactive tool that can assist employees in determining the "right" plan option.   We encourage individuals to take a few minutes to access the health plan selector tool; it provides good information regarding total costs (by plan comparison) that could be encountered via the case scenarios you choose to enter.

Prescription Drug Information:

Carleton College participates in the richest of the two prescription drug formularies offered by BlueCross BlueShield.   You will want to familiarize yourself with the Blue Cross FlexRx formluary, as it can assist you in determining the drugs you have typically used.  The formulary lists the types of generic and name brand medications by type.  

 

Mandated Changes from BlueCross BlueShield:

2010:

Effective in 2010, BlueCross BlueShield has informed Carleton College of some mandated  changes.   This information is listed below in the Blue Cross Renewal Bulletin.  Specifically of interest to you will be the implementation of a prescription drug "step therapy" process for certain medications.  We recommend employees review this to determine how it may affect you or your dependents.  

2011:

2012:

2013:

Miscellaneous Information and Forms:

Should you elect a high deductible plan with an associated health reimbursement account (HRA), Carleton College has set up some automatic processes that can be changed, should you have an interest in doing so.  Please contact our office (x5989) for specifics regarding:

  • Pay the Provider Option
    Use this form to request HRA claim dollars are paid to you first; then you forward to your provider.
  • HRA SelectAccount Crossover Option
    Turning off the automatic crossover option results in your immediate responsibility for health care costs without utilizing money from your HRA account.  Individuals who participate in a health care flexible spending account may wish to submit health care costs for reimbursement in order to decrease risk of forfeiture.  Ultimately, this could help to retain HRA dollars for possible year-to-year carry over.
  • MN 90-Day Pharmacies
    Use this list to gain information on pharmacies in Minnesota that offer the 90-day retail prescriptions.

Would you appreciate a tool to help you track your medical costs?  If so, try utilizing one of these forms.

Is my dependent a qualified or non-qualified dependent?   Please review the information below.

 

Medicare and Medical Insurance Information

Are you Medicare eligible (65 or over) and a participant on one of the College's two high deductible plans (Options Blue HRA or Accord HRA)?  If so, the automatic crossover feature that permits Select Account (the holders of your HRA dollars) to forward HRA dollars to your providers will not work for you, as Medicare is considered a secondary plan.  What this means for you is that you will need to submit a claim form to request HRA dollars when medical care is utilized.  The HRA dollars will be forwarded to you; you, in turn, will be responsible for paying your provider.  The Select Account claim form is below.

Medicare Eligibility:
As a general rule, if an an individual entitled to age-based Medicare does not sign up for Medicare Part B when they are first eligible at age 65, they have to pay a penalty if they sign up later.  The individual can avoid this penalty if they qualify for a "special enrollment period" (SEP).  An individual will qualify for a SEP if they have coverage under an employer's group health plan because of that individual's current employment status with the employer or because they are the spouse of such an individual at the time of Medicare eligibility and then lose that coverage. 

To summarize, if you (the employee) continue to work past age 65 and carry our health insurance, you will qualify for this "special enrollment period" when you decide to end your employment with Carleton College.  This is also the case if you carry coverage for your spouse.

However, if you (the employee) have a domestic partner on your Carleton group plan who is nearing Medicare eligibility (at age 65), you'll want to read on for information on ineligibility for your domestic partner to be eligible for the Medicare "special enrollment period" (SEP).

While your domestic partner has coverage under Carleton's group health plan, that coverage is not because of the domestic partner's current employment with Carleton (they are not an employee), nor are they the spouse of such an individual (not married to the employee).  As a result, the domestic partner will not qualify for an SEP when the Carleton group coverage ends (e.g. due to the employee's retirement), so the domestic partner would have to pay the Part B late enrollment penalty.

In order to avoid the Part B late enrollment penalty, domestic partners will need to enroll in Medicare Part B when they become eligible for Medicare if they wish to avoid the penalty later.