2006 - 2007 Annual Enrollment
July 1, 2006 - July 31, 2007
FAQ's Frequently Asked Questions
Why are the HMO premiums so high?
A combination of health expenses is driving up the cost of the HMO plan including increased office visits, childbirths, and prescription medication.
I want to continue being enrolled in HMO Blue for the next plan year, what should I do?
You must (re)elect HMO Blue during Annual Enrollment (July 1, 2006 – July 31, 2006). If you do not, you will be defaulted into the PPO plan starting September 1, 2006.
If I am defaulted into the PPO plan, do I have to provide evidence insurability?
No. You do not have to provide evidence of insurability to be in the PPO plan if you either elect it or are defaulted into it.
If I am defaulted into the PPO, will I be able to afford doctor office visits?
Under the PPO Plan, office visits, including lab work and x-rays, have the same payment structure as the HMO.
- $25 family physician
- $30 specialist
If I am in the PPO plan, what happens if I or my family member needs hospitalization?
The co-payments for both the HMO and the PPO for hospitalization are the same (see below):
- Co-payments
- HMO-$100/day co-pay, $500 maximum
- PPO-$100/day co-pay, $500 maximum
Under the PPO, you also pay a $250 deductible plus 20% of the cost up to a maximum of $1,750. This means that under the PPO, you would be responsible for a maximum of $2,250 ($1,750 for deductible and co-insurance + $500 for co-pay) for a five day or more hospital stay. This deductible and co-insurance applies to each covered person, but after three family members meet the maximum amount, the university health plan pays 100% of the remaining bill.
What are some differences between the HMO and the PPO?
- PPO has a larger network of physicians
- PPO does not require you to name a Primary Care Physician (PCP)
- PPO does not require a referral from your Primary Care Physician (PCP) to see a specialist.
What can I do to keep my costs down if I enroll in the PPO?
The university offers a Flexible Spending Account (FSA) to help you pay for qualified expenses on a pre-tax basis. This means you do not pay federal income or social security taxes on the money you set aside from your paycheck for these expenses. The program is called the UT Flex medical reimbursement plan.
How does the UT Flex medical reimbursement plan work?
Estimate how much you will spend from September 1, 2006 through August 31, 2007 on eligible expenses (e.g., co-payments for office visits, prescription medication, deductibles and co-insurance for inpatient hospital care and physical therapy, over-the-counter medicine, and eyeglasses). Over the plan year (September 1, 2006 - August 31, 2007) that amount will be deducted from your monthly paycheck, before taxes, and deposited into your UT Flex account. When you have an expense, you can either use the Flex Convenience Debit Card or submit a claim for reimbursement.
