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What are the medical plan changes for 2019?
The University’s medical plan will be modified in the following ways as of Jan. 1, 2019:
- Copays for outpatient treatment related to mental health and substance use in SUBlue and SUOrange will be reduced to be consistent with that of a primary care office visit when using an in-network provider. Modification under SUPro does not apply as these services already have the same coinsurance.
- Biofeedback, which is used to help manage many physical and mental health issues, including anxiety and stress, high blood pressure and chronic pain, will now be covered when deemed medically necessary by a prescribing physician. The patient cost for a biofeedback office visit will be based on where the service is rendered (primary care physician or specialist). It is recommended that you consult with your primary care physician regarding any questions about biofeedback.
A comprehensive list of deductibles, copays, and coinsurance can be found in the schedule of benefits documents.
What are the medical plan per-paycheck contributions going to be?
Employees’ per-paycheck contributions for 2019 will remain the same as 2018. This marks the second year in a row employee rates have not changed.
Are any medical plan copays increasing?
There will be no increases to existing deductibles, copays, or coinsurance for SUBlue, SUOrange, or SUPro. A comprehensive list of the patient cost sharing requirements can be found in the schedule of benefits documents.
What are the key differences among the medical plan options?
The following table highlights some key differences among the three plan options:
| SUBlue | SUOrange | SUPro | |
|---|---|---|---|
| Network coverage | Provides in-network and out-of-network coverage | Provides in-network coverage only | Provides in-network and out-of-network coverage |
| Referrals | Not required | Not required | Not required |
| Your cost when you use an in-network provider | Generally deductible and copays | Generally deductible and copays | Generally deductible and coinsurance |
| Schedule of benefits document | SUBlue [PDF] | SUOrange [PDF] | SUPro [PDF] |
What is an annual deductible and how does it work?
A deductible is a dollar amount members pay toward covered medical care each year, before their health plan begins to pay for covered medical expenses. The SUBlue and SUOrange plans have an annual in-network deductible of $100 per person with a maximum of $250 for a family. The SUPro plan has an annual in-network deductible of $200 per person with a maximum of $400 for a family. Once the annual deductible has been met, additional in-network services for the remainder of the year will be covered at the copay and/or coinsurance percentage that applies to that service. As we prepare for Open Enrollment, employees are encouraged to examine the best benefit plan for their needs. A comprehensive list of the patient cost sharing requirements can be found in the schedule of benefits documents.
Reference our Coverage Examples Guide [PDF] to see, in general, how the deductible and copay/coinsurance are applied to certain services for SUBlue, SUOrange, and SUPro.
How do I select the medical plan that is appropriate for my needs?
Syracuse University offers three medical plan options to benefits-eligible employees. All three plan options include medical benefits administered by Excellus BlueCross BlueShield. Prescription drug benefits are administered by OptumRx.
The same health care services are covered under SUBlue, SUOrange, and SUPro, but your share of the cost will be different. For a high level overview, please review At a Glance: A Comparison of Health Care Plans [PDF] which highlights commonly-used services and their associated costs.
Which preventive services are covered at no cost to me?
The following preventive health care services and prescription medications are covered by the University health plans at no cost to you:
In-Network Preventive Services with $0 Copay:
- Routine Mammograms
- Routine Gynecological Exam
- Routine Prostate Cancer Screening
- Routine Cervical Cancer Screening
- Routine Osteoporosis Screening
- Colonoscopies
- Well Child Visits
- Routine Adult Physicals
- Nutritional Counseling
- Tobacco Use Cessation Counseling
Other In-Network Medical Services with $0 Copay:
- Breast Pumps (within 3 years of delivery)
Prescription Drugs with $0 Copay:
Age/gender limits or other restrictions may apply. Plan copays may apply if criteria for $0 copay are not met. Free product will usually be a generic or over-the-counter (OTC) product unless branded product does not have a generic equivalent.
- Smoking Cessation Aids (FDA approved)
- Women’s Contraceptives (drugs and devices)
- Folic Acid & Prenatal Vitamins
- Aspirin
- Fluoride Products
- Iron Supplements
- Vitamin D
- Bowel Prep Agents for Colorectal Cancer Screening
- Breast Cancer Prevention and Treatment
- Statins (cholesterol lowering drugs)
Can I look online to see if my doctors participate with the Excellus BlueCross BlueShield network?
Yes, you can access Excellus’ online provider directory to view doctors, hospitals and other facilities that participate with the network. Follow these steps to assist with your search:
- Select your provider location:
- Upstate New York
- Nationwide
- International
- Based on the location you selected:
- Upstate New York providers:
- Select your health plan: SUBlue, SUOrange, or SUPro.
- Complete the remaining steps to narrow your search.
- National Network providers:
- Next to “Your Location”, enter the location of the provider.
- Enter your plan. You will be asked to enter the first three letters of your Member I.D. card. Enter VYK.
- Complete the remaining steps to narrow your search.
- International Network providers:
- Review and accept the terms and conditions for using the website.
- You will be asked to enter the first three letters of your Member I.D. card. Enter VYK.
- Complete the remaining steps to narrow your search.
- Upstate New York providers:
What if my doctors do not participate with the Excellus BlueCross BlueShield network?
You will maximize the value of your benefit when your physician or facility participates in the Excellus BCBS network. If your provider does not participate and you would like Excellus BCBS to attempt to recruit him or her, please contact Excellus at 800.493.0318 (TTY/TTD 800.662.1220). Excellus BCBS will reach out to providers who do not participate with their network and are recommended by Syracuse University’s health plan members.
Does Syracuse University have a local call center for medical plan questions?
Yes. Excellus has a local, DeWitt-based dedicated customer service center for Syracuse University. The phone number and expanded hours of operation are:
800.493.0318 (TTY/TTD: 800.662.1220)
Monday – Thursday: 8 a.m. – 8 p.m.
Friday: 9 a.m. – 8 p.m.
These experienced representatives are well-versed in the Syracuse University plan designs and stand ready to assist you with any health plan questions that you may have.
What happens to my coverage if I travel internationally?
Excellus BlueCross BlueShield has an expansive network and you will be able to access care in many countries around the world, and anywhere within the U.S. through the BlueCard Program. BlueCard network providers are found throughout Africa, Asia, Australia, the Caribbean, Central and South America, Europe, Russia, the Middle East, and all of North America.
If you seek services from a BlueCard network provider, you will only need to pay your copay, coinsurance or applicable deductible at the time of service. However, if you seek services from a non-participating provider, you will need to pay the full amount for those services at the time of your visit, and then you will be reimbursed per the plan benefit after you submit a paper claim to Excellus.
What are the monthly costs for the medical plans?
The monthly costs listed below are based on the 12-month calendar year. Actual deductions from each paycheck will vary depending upon your deduction cycle (e.g., weekly vs. semi-monthly, academic year vs. calendar year).
Monthly Medical Rates for 2019
| Schedule A | SUBlue | SUOrange | SUPro |
|---|---|---|---|
| Employee Only | $142.15 | $138.02 | $129.64 |
| Employee + Spouse/Domestic Partner | $312.73 | $303.63 | $285.21 |
| Employee + Child(ren) | $274.35 | $266.37 | $250.21 |
| Employee + Spouse/Domestic Partner + Child(ren) | $444.93 | $431.98 | $405.77 |
| Schedule B | SUBlue | SUOrange | SUPro |
| Employee Only | $124.53 | $120.90 | $113.57 |
| Employee + Spouse/Domestic Partner | $273.95 | $265.98 | $249.84 |
| Employee + Child(ren) | $240.33 | $233.34 | $219.18 |
| Employee + Spouse/Domestic Partner + Child(ren) | $389.76 | $378.42 | $355.46 |
Qualifying for Schedule B Reduced Medical Contributions
Depending on your household income and size, you may be eligible for lower medical contributions. Certain employees specified by a collective bargaining agreement automatically qualify for Schedule B rates. Please review the chart below. If you think you may qualify, the Schedule B Application [PDF] will need to be completed and returned by Dec. 7 to Human Resources.
| Household Size | Household Income |
|---|---|
| 1 | Less than $50,000 |
| 2 | Less than $70,000 |
| 3 | Less than $90,000 |
| 4 and up | Less than $110,000 |
How much will be deducted from my paycheck if I am paid weekly during the fiscal (calendar) year?
The following rates will apply for employees who are paid weekly during the fiscal year (calendar year), for a total of 52 paychecks.
| Schedule A | SUBlue | SUOrange | SUPro |
|---|---|---|---|
| Employee Only | $32.80 | $31.85 | $29.92 |
| Employee + Spouse/Domestic Partner | $72.17 | $70.07 | $65.82 |
| Employee + Child(ren) | $63.31 | $61.47 | $57.74 |
| Employee + Spouse/DP + Child(ren) | $102.68 | $99.69 | $93.64 |
| Schedule B | SUBlue | SUOrange | SUPro |
| Employee Only | $28.74 | $27.90 | $26.21 |
| Employee + Spouse/Domestic Partner | $63.22 | $61.38 | $57.66 |
| Employee + Child(ren) | $55.46 | $53.85 | $50.58 |
| Employee + Spouse/DP + Child(ren) | $89.94 | $87.33 | $82.03 |
How much will be deducted from my paycheck for medical coverage if I am paid weekly during the academic year?
The following rates apply for employees who work during the academic year and are paid weekly, for a total of 37 pays.
| Schedule A | SUBlue | SUOrange | SUPro |
|---|---|---|---|
| Employee Only | $46.10 | $44.76 | $42.05 |
| Employee + Spouse/Domestic Partner | $101.43 | $98.47 | $92.50 |
| Employee + Child(ren) | $88.98 | $86.39 | $81.15 |
| Employee + Spouse/DP + Child(ren) | $144.30 | $140.10 | $131.60 |
| Schedule B | SUBlue | SUOrange | SUPro |
| Employee Only | $40.39 | $39.21 | $36.83 |
| Employee + Spouse/Domestic Partner | $88.85 | $86.26 | $81.03 |
| Employee + Child(ren) | $77.95 | $75.68 | $71.09 |
| Employee + Spouse/DP + Child(ren) | $126.41 | $122.73 | $115.28 |
How much will be deducted from my paycheck for medical coverage if I am paid semi-monthly during the fiscal year (calendar year)?
The following rates apply for employees who work during the fiscal (calendar) year and are paid semi-monthly, for a total of 24 pays.
| Schedule A | SUBlue | SUOrange | SUPro |
|---|---|---|---|
| Employee Only | $71.08 | $69.01 | $64.82 |
| Employee + Spouse/Domestic Partner | $156.38 | $151.81 | $142.60 |
| Employee + Child(ren) | $137.18 | $133.18 | $125.10 |
| Employee + Spouse/DP + Child(ren) | $222.47 | $215.99 | $202.89 |
| Schedule B | SUBlue | SUOrange | SUPro |
| Employee Only | $62.26 | $60.45 | $56.78 |
| Employee + Spouse/Domestic Partner | $136.98 | $132.99 | $124.92 |
| Employee + Child(ren) | $120.17 | $116.67 | $109.59 |
| Employee + Spouse/DP + Child(ren) | $194.88 | $189.21 | $177.73 |
How much will be deducted from my paycheck for medical coverage if I am paid semi-monthly during the academic year?
The following rates apply for employees who work during the academic year and are paid semi-monthly, for a total of 18 pays.
| Schedule A | SUBlue | SUOrange | SUPro |
|---|---|---|---|
| Employee Only | $94.77 | $92.01 | $86.43 |
| Employee + Spouse/Domestic Partner | $208.49 | $202.42 | $190.14 |
| Employee + Child(ren) | $182.90 | $177.58 | $166.81 |
| Employee + Spouse/DP + Child(ren) | $296.62 | $287.99 | $270.50 |
| Schedule B | SUBlue | SUOrange | SUPro |
| Employee Only | $83.02 | $80.60 | $75.71 |
| Employee + Spouse/Domestic Partner | $182.63 | $177.32 | $166.56 |
| Employee + Child(ren) | $160.22 | $155.56 | $146.12 |
| Employee + Spouse/DP + Child(ren) | $259.84 | $252.28 | $236.97 |
Why are the medical rates higher for Faculty than for Staff?
Paycheck deductions for Faculty and Staff who work during the academic year only, are taken over nine months instead of a full twelve month year. The accelerated deductions cover payments during the summer when paychecks are not issued, but benefits continue. While it may appear that the increase is larger, the same total dollar amount is charged over the course of the year.
Should I expect to receive an Explanation of Benefits (EOB) each time I receive a service from a provider?
Each month, you will receive a Monthly Health Statement, which shows the claims that Excellus has processed for you and your family for the previous month. Your Explanation of Benefits (EOBs) are available online, unless you specifically request a paper copy from your dedicated customer service representative. As an exception, if you receive care from a non-participating provider, you will automatically receive an EOB at your home address on file.
I will be enrolling in the medical plan for 2019 as a new participant. How can I receive a copy of my member ID card?
You will receive a welcome packet at the permanent address you have on file with the University as recorded in MySlice, which will include two member ID cards with your name on both. In addition, each dependent who is over the age of 18 and is enrolled under your plan will also receive a welcome packet with two member ID cards at their home address as recorded in MySlice. If you cover any dependents under the age of 18, please provide your ID card to their provider when they seek services.
If you wish to obtain additional member ID cards, contact our dedicated Excellus customer service center at 800.493.0318 (TTY/TTD: 800.662.1220). Once your coverage is active, you may also view your ID card online by registering your account at ExcellusBCBS.com/syredu or by downloading the Excellus BCBS app.