2015 Colby Health Plan Options

 

PLAN HIGHLIGHTS for 2015

 

Benefit Elections

Colby's health plan and FSA's are maintained pursuant to Internal Revenue Code rules governing "cafeteria" plans.  In order to achieve the tax-savings under such plans, employees sign an irrevocable benefit election for each plan year (January 1 - December 31). Changes are only permitted in limited circumstances.
 

Open-Access Plus In-Network (OAPIN) Plan:

  • No increase to employee contributions in 2015!
  • No changes to deductibles or coinsurance amounts.
  • There is a $250 individual or a $500 family deductible.  Office visit co-pays do not apply to your deductible.
  • A 90/10% coinsurance is applicable once the deductible has been met.
  • Preventive office visits and related procedures performed in the doctor's office (coded as preventive by your physician) are covered at 100%.  Recommended procedures performed outside the doctor's office may result in deductible and coinsurance charges.
  • Maximum Out-of-Pocket amounts are $1,250 for individual coverage or $2,500 for family coverage. 
  • There are no co-pays for high-tech scans (CT/MRI/PET scans) or Emergency Room visits. HOWEVER, deductibles and coinsurance will apply.

 Open-Access Plus (OAP) Plan: 

  • No increase to employee contributions in 2015!
  • No changes to deductibles or coinsurance amounts.
  • Preventive office visits and related procedures performed in the doctor's office (coded as preventive by your physician) are covered at 100%.  Recommended procedures performed outside the doctor's office may result in deductible and coinsurance charges.

CIGNA Choice Fund High-Deductible (HSA) Plan: 

  • No increase to employee contributions in 2015!
  • No changes to deductible or coinsurance amounts.
  • Colby makes a monthly contribution to employee's health savings account! (Click here for 2015 HSA annual contribution limits.)
  • Limited Purpose Flexible Spending Account available for HSA participants.

PLEASE NOTE:  In light of the change in Maine law that permits same-sex marriage, only legally recognized married partners will be eligible for participation in Colby's insurance plans, effective January 1, 2015.

 

For additional information call the CIGNA Enrollment Information line at
1-800-401-4041

 
 
Open Access In-Network Plan (OAPIN)

The CIGNA Open Access Plus In-Network plan (OAPIN) offers access to CIGNA's broad national provider networks, while allowing members to make their own health care choices. This plan continues to have a deductible and coinsurance.  Important points about the plan include:

  • No referrals are necessary to see any physicians or specialists in the network. Just choose the participating in-network doctor you prefer and make an appointment.
  • The option to choose a Primary Care Physician (PCP) to serve as a personal physician providing routine care and referrals to specialists.  See information below about providers.
  • Only health care professionals who are part of the CIGNA network are covered by this plan. If you chose a doctor who is not in the network, your care will not be covered except in emergencies.
  • Emergency care is covered 24 hours a day, no matter where you receive it. You may go to any emergency facility, anywhere. Deductibles and coinsurance will apply.
  • There is a $250 individual or a $500 family deductible. 
  • A 90/10% coinsurance is applicable once the deductible has been met.
  • Maximum Out-of-Pocket amounts are $1,250 for individual coverage or $2,500 for family coverage.
  • Preventive office visits and related procedures performed in the doctor's office (coded as preventive by your physician) are covered at 100%.  Recommended procedures performed outside the doctor's office may result in deductible and coinsurance charges.
  • Office co-pays are $20 for a sick office visit or $25 for a specialist.  Please note that co-pays to do not apply to your deductible.
  • There are no copays for high-tech scans (CT/MRI/PET scans) or Emergency Room visits.  HOWEVER, deductibles and coinsurance will apply.
  • Prescription co-pays are $10 for generic, $30 for preferred brands and $50 for non-preferred brands.
  • Includes the CIGNA Vision Plan.  One routine eye exam is covered every 24 months, at an eye doctor who is a CIGNA VISION provider (as opposed to, or in addition to being a CIGNA MEDICAL provider.)  A $20 co-pay is applicable. 

Click here for more information on the Open Access In-Network Plan.
Click here for the detailed OAPIN Plan Summary.  There are no changes in coverage for 2015.
For a summary of benefits and co-pays for all plans, click here.

 

PROVIDERS

Locally and nationally, CIGNA's broad provider network very closely matches the competitor networks.  However, there may be isolated instances when that is not the case. Since provider information can change, please confirm with your doctor's office that they are in CIGNA's network.

Search CIGNA's Provider Directory for your doctor(s): 

  • Enter either doctor's name and City/State OR zip
  • Click "Next"
  • For Type of Plan, select "Open Access Plus/CareLink"
  • For Type of Provider, select "Primary Care Physician" or "Specialist"
  • From drop-down list, select the type of PCP or Specialist.
  • Click Search.

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Open Access Plus Plan (OAP)

The Open Access Plus Plan (OAP) allows you to see any licensed provider you choose, though benefits are higher when you receive care from a provider in the Open Access Plus network.  Members have the option to choose a Primary Care Physician (PCP) to serve as a personal physician to help coordinate health needs.

  • No referrals are necessary to see physicians and specialists within the network. Members choose the participating doctor you prefer and schedule an appointment. See information above about providers.
  • When selecting physicians or specialists outside of the CIGNA network, your costs will be higher and you may need to file a claim form.
  • Emergency care is covered 24 hours a day, no matter where you receive it. You may go to any emergency facility.
  • Deductibles are $500 for individual and $1,000 for family coverage.
  • For in-network doctors, a 80/20% coinsurance is applicable once the deductible has been met.  For out-of-network doctors, the coinsurance is 60/40%.
  • Maximum Out-of-Pocket amounts are $1,500 for individual or $3,000 for family coverage.
  • Preventive office visits -- covered at IN-NETWORK doctors only -- and related procedures performed in the doctor's office (coded as preventive by the physician) are covered at 100%.  Recommended procedures performed outside the doctor's office may result in deductible and coinsurance charges.
  • Office co-pays are $20 for a sick office visit or a specialist for in-network office visits OR deductible and coinsurance for out-of-network office visits.
  • Prescription co-pays are $10 for generic, $25 for preferred brands and $40 for non-preferred brands.

Click here for more information on the Open Access Plus Plan.
Click here for the detailed OAP Plan Summary.  There are no changes in coverage for 2015.
For a summary of benefits, co-pays and deductibles for all plans, click here.

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Choice Fund - Health Savings Account Plan (HSA)

This high-deductible health savings account plan (HSA) was introduced in 2010 and is designed for people who are prepared to take a more active role in their health care. The plan offers a tax-deferred health savings account to help pay for covered health care expenses, administered by JP Morgan Chase. Colby will contribute $84/month for individual coverage or $167/month for family coverage into your HSA account. This enhanced contribution by the College can add up to $1,000 for individual or $2,000 for family coverage. The money in this account accumulates from year to year and should you leave Colby, any monies in the account are still accessible to you. Please note that Colby cannot guarantee continued contributions at these levels.  Click here for maximum annual contribution limits. For instructions on reimbursing yourself from your HSA for eligible expenses, click here.

HSA participants can choose to contribute to a Limited Purpose Flexible Spending Account through Group Dynamics.  For more information, please contact Human Resources.

In addition to health plan coverage, a CIGNA Choice Fund HSA offers:

  • Control over how health care dollars are spent
  • Freedom to choose doctors
  • Convenient, online information and tools to help decide which doctors and services are desired
  • Programs and services to help you stay well

Deductibles and out-of-pocket maximums are as follows:

HSA DEDUCTIBLES
   In-Network Out-of Network
Individual $1,500 $3,000
Family $3,000 $6,000
HSA OUT OF POCKET MAXIMUMS
Individual $3,000 $6,000
Family $6,000 $12,000


  • No co-pays are due at the time of an office visit. 
  • Preventive office visits -- covered at IN-NETWORK doctors only -- and related procedures performed in the doctor's office (coded as preventive by your physician) are covered at 100%.  Recommended procedures performed outside the doctor's office may result in deductible and coinsurance charges.
  • Some preventive drugs are covered at 100% for the HSA plan, with no co-pay or deductible.   Click here for a list of the most commonly used drugs that are covered at 100%.
  • Deductibles - If enrolled in a family plan, all family members contribute to the family deductible which must be satisfied before the plan coinsurance is applied to any family member claim.
  • Out-of-Pocket Maximums - If enrolled in a family plan, all family members contribute to the family out-of-pocket maximum, which must be satisfied before any family members' claims are covered 100%.

Click here for general information on how an HSA plan works.
Click here for instructions on reimbursing yourself from your HSA for eligible expenses.
Click here for the detailed HSA Plan Summary.  There are no changes in coverage for 2015.
Click here for a list of eligible and ineligible expenses for the HSA.
Click here for a list of preventive care coverage.
Click here to review the maximum annual contribution limits.
For a list of Frequently Asked Questions, click here.  These are questions posed by Colby employees at the benefit information sessions.
For a summary of benefits, co-pays and deductibles for all plans, click here.

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Employee Health Insurance Monthly Contribution Rates - 2015

Employee contributions for health coverage will remain the same in 2015 for all plans.  Colby will be absorbing the increase in premiums, in order to keep employee rates from increasing.

Open Access In-Network Plan (OAPIN)

Employee Only Employee +1 Employee +2 or more
Under $34,500 $24.00 $187.00 $248.00
$34,500 to $72,499 $46.00 $264.00 $356.00
$72,500 and above $70.00 $348.00 $449.00


Open Access Plan (OAP)

Employee Only Employee +1 Employee +2 or more
Under $34,500 $20.00 $170.00 $230.00
$34,500 to $72,499 $40.00 $239.00 $331.00
$72,500 and above $60.00 $298.00 $399.00


Choice Fund Health Savings Account Plan (HSA)

Employee Only Employee +1 Employee +2 or more
Under $34,500 $14.00 $120.00 $180.00
$34,500 to $72,499 $23.00 $175.00 $275.00
$72,500 and above $36.00 $250.00 $350.00
 
Colby Monthly Contribution to Employee HSA Account $84.00 $167.00 $167.00

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Prescription Drug Coverage

Drug co-pays are as follows:

Type Open Access
In-Network Plan
Open Access
Plus Plan
Health Savings Account *
Generic $10 $10 Deductible +
10% Coinsurance
Preferred Brand Name $30 $25 Deductible +
 20% Coinsurance
Non-Preferred Brand
Name
$50 $40 Deductible +
30% Coinsurance
90 Day Supply 2 Co-pays 2 co-pays Deductible then
10% / 20% / 30%


* Some Preventive Drugs are covered at 100% under the HSA, no plan deductible.  Click here for a list of the most commonly used drugs that are covered at 100%.

To see how your medications are covered, click here for an online search option.  Click here for a pdf version of CIGNA's prescription drug list.

For a list of Maine pharmacies offering a 90-day supply for two co-pays, click here.  

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Emergency Care

 

Type of Care Open Access
In-Network Plan
Open Access
Plus Plan
Health Savings Account
Ambulance Deductible +
Coinsurance
Deductible +
Coinsurance
Deductible +
Coinsurance
Emergency Room Deductible +
Coinsurance
Deductible +
Coinsurance
Deductible +
 Coinsurance


Click here for a list of CIGNA in-network Urgent Care Facilities in Maine. 

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Preventive Screenings

Today, Americans are faced with huge health care challenges, including rising costs, rising obesity, heart disease and diabetes rates, and more. We can do our part by proactively taking care of ourselves. This January do your part by scheduling your annual physical and makings sure all preventive screenings and immunizations are up to date!

Here are a few tips to help you prepare for your annual physical:

  • Review family history
  • Determine if you are due for screenings or immunizations
  • Write a list of questions for your doctor
  • Starting a new diet or exercise program? Consult your physician

Click on the link(s) below to review recommended preventive health screenings and schedule your screenings today!

 
Summary Plan Descriptions

There are no significant changes from 2014 to 2015.  Please click here to view the Summary Plan Descriptions and the most recent riders for the Colby health insurance plans.  Also known as certificates of coverage, these documents detail the terms of each plan, including covered benefits, prescription drug benefits, exclusions, COBRA coverage, federally required notices and more.

 
Special Enrollment Information

Please click here for special enrollment information, including notices on the Children's Health Insurance Program (CHIP), the Women's Health and Cancer Rights Act (WHCRA) and Cigna's confidentiality statement with respect to the HIPAA Privacy Rule.