2018-2019 Benefits and Enrollment Guide - UNC Medical Center
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2018-2019 Benefits and Enrollment Guide
UNC Hospitals
Graduate Medical Education
Health | HSA | Dental | Life | Disability | FSA | Deferred Compensation | Legal | Home & Auto
Benefits Overview
Being part of UNC Hospitals Office of Graduate Medical Education (GME) is more than just a job. UNC Hospitals GME is focused on
your health, your wealth and your career. UNC Hospitals GME realizes your benefits are an important part of your workplace journey.
UNC Hospitals GME proudly offers residents, physicians, staff and their families a comprehensive benefits program that is flexible in
design, provides for varying levels of coverage, offers voluntary supplemental programs and provides personal tax advantages
whenever possible. The benefits contained in this guide are designed around improving your health, wealth and career, as well as
providing quality, affordable benefits that are highly competitive within the healthcare industry.
Contents Open Enrollment: Open enrollment is your opportunity to
make changes to your benefit elections. Once you have
made your elections you may not make changes for most
2 Benefits Overview coverages until our next annual Open Enrollment, unless you
experience a qualifying change in status. These include
3 Eligibility marriage, separation or divorce, birth or adoption or change in
custody of a child, death of a dependent, change in your
4-9 Medical Insurance Plans employment status or loss of spouse’s work-related coverage.
You may make changes to your benefit elections within 30 days
10-11 UNCHCS Pharmacy Services of a qualifying change in status.
12-13 UNC Personal Health Advocate Medical: Our medical plans are administered by UMR and
UNC Hospitals GME offers three medical plans for you to choose
14 UMR Resources
from. UNC Hospitals GME contributes substantially toward the
cost of this coverage for you and your dependents. You will
15 Urgent Care vs ER receive a member ID card if you enroll. Your card will have a
sticker on it for you to call UMR and register the ID card upon
16-17 Preventive Care receipt. Please complete the registration process and have “other
coverage” information for dependents available for the call.
18 Health Savings Account
19 Flexible Spending Accounts Dental: Our dental plans are with MetLife and we offer two
dental plans for you to choose from. Please refer to the dental
20 Medical Insurance Rates & plan page for details.
UNC Urgent Care 24/7 Virtual Care Life: UNC Hospitals GME provides eligible employees with
Basic Life insurance through MetLife at no cost. You may
21-23 Dental Insurance and Rates purchase additional supplemental life insurance for yourself and
your dependents.
24-26 Basic and Voluntary Life Insurance
27 Long Term Disability Insurance
Disability: UNC Hospitals GME provides Long Term
Disability coverage through Guardian.
28 Deferred Compensation
Flexible Spending Accounts: UNC Hospitals GME offers
29 Legal Plan Medical Care, Dependent Care and Limited Purpose Health Care
Flexible Spending Accounts. These accounts are administered
30 Home & Auto Insurance by P & A Group.
31-33 Additional Resources for OGME Online Enrollment: You will enroll for your benefits online at
www.ebenefitsnow.com Please update your personal
Residents
information. For website assistance call (866) 239-1055.
34 Professional Liability Coverage
35 Physician Recruitment
36-53 Important Disclosures
54 Contact Information
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In the
case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2 2018 Benefits and Enrollment Guide
Eligibility
UNC Hospitals Office of Graduate Medical Education offers
benefits to all eligible individuals as defined by GME.
Dependent Eligibility: If you wish, your dependents may
also be covered. Eligible dependents include:
Legal spouse, as defined by Federal Law; and Domestic
Partners
MEDICAL - Your children up to the end of the month in
which they reach age 26 regardless of marital status,
financial dependency, residency with the Eligible
Employee, student status, employment status, or
eligibility for other coverage.
DENTAL - Your children up to the end of the month in
which they turn 26.
SUPPLEMENTAL LIFE - Your unmarried children to
Annual Elections: You have the opportunity to pay for
the end of the month in which they reach age 19 or to
medical, dental and supplemental life coverage, and make
age 26 if full-time student.
HSA or FSA contributions on a pre-tax basis. IRS rules
stipulate that once you have made your elections for the plan
It is your responsibility to provide the GME Office with
year, you may not change them until the next annual
proof of your dependents’ eligibility, in the form of: (a)
enrollment unless a qualifying event occurs. This restriction
your most recent Federal Income Tax Return, (b)
does not apply to HSA contributions. It is important that you
Court Order specifying your responsibility to provide
make your choices carefully. Changes are allowed only if
“group health care coverage” to your dependent
there is a qualifying event and the change requested is
children, or (c) Copy of birth or marriage certificate. It
consistent with the event. Qualifying events include, but are
is also your responsibility to notify the GME
not limited to:
Office when your dependents no longer meet the
eligibility criteria. Marriage, divorce, or legal separation
Birth or adoption (or placement of adoption) of a child
New Hire Coverage: Your benefits are effective on your Death of a covered dependent
date of hire. New residents have up to 30 days after their
Loss or gain of eligibility for group insurance
eligibility date to enroll. If you do not enroll by that deadline,
coverage for you or a covered dependent
you will not be eligible for coverage until the following annual
open enrollment period. Change in your employment status (i.e. changing
from full-time to part-time or from casual to benefits
eligible and vice versa)
Change in dependent’s employment status, including
termination or commencement of employment for a
covered dependent
Change in health insurance eligibility due to a
relocation of residence or workplace
If you have a family status change, you must change your
benefit elections within 30 days of the qualifying event, or you
will need to wait until the next annual open enrollment period.
COBRA Continuation Coverage: When you or any of your
dependents no longer meet the eligibility requirements for
health and welfare plans, you may be eligible for continued
coverage as required by the Consolidated Omnibus Budget
Reconciliation Act (COBRA) of 1986. Please refer to the
COBRA explanation in this guide.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In the
case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2018 Benefits and Enrollment Guide 3
Medical Plan Summary: PPO Core Plan (Rates on page 20.)
Healthcare is one of the most important and necessary parts of your benefit package. The following is a summary of our benefit plan.
For a more detailed explanation of benefits, please refer to your Summary Plan Description and Summary of Benefits and Coverage
(SBC).
PPO CORE PLAN- BENEFIT PLAN 008
NON-NETWORK SERVICES
DOMESTIC NETWORK IN-NETWORK SERVICES
SUMMARY OF BENEFITS Out-of-Network
UNC Providers UHC Choice Plus Providers
Providers
DEDUCTIBLES & M AXIMUMS
Lifetime Benefit Maximum Unlimited Unlimited Unlimited
$250 Single $1,000 Single $2,000 Single
Annual Deductible
$500 Family $2,000 Family $4,000 Family
Member Coinsurance 10% 30% 40%
Out-of-Pocket Maximum – $1,000 Single $2,000 Single $4,000 Single
Includes Coinsurance. $2,000 Family $4,000 Family $8,000 Family
THE DEDUCTIBLE AND OUT-OF-POCKET M AX AMOUNTS FOR THE
DOMESTIC NETWORK (UNC PROVIDERS) AND UHC CHOICE PLUS PROVIDERS CROSS-FEED.
THE DOMESTIC DEDUCTIBLE APPLIES TO UNC FACILITY SERVICES ONLY.
PREVENTIVE CARE & OFFICE VISITS
Physician Office Visit Covered at 60% after
$10 Copay then 100% $35 Copay then 100%
Primary Care providers deductible
Covered at 60% after
Specialist Office Visit $20 Copay then 100% $50 Copay then 100%
deductible
Preventive Office Visit
Covered at 100% Covered at 100% Not Covered
Primary Care or Specialist
Well Baby Office Visit Covered at 100% Covered at 100% Not Covered
Routine Lab & X-rays Covered at 60% after
Covered at 100% Covered at 100%
Primary Care or Specialist deductible
Outpatient Preventive Covered at 60% after
Covered at 100% Covered at 100%
Mammography deductible
Prenatal Care
Covered at 100% Covered at 100% Not Covered
Does not include Sonograms
Covered at 90% after Covered at 70% after Covered at 60% after
Postnatal Care
deductible deductible deductible
Routine Eye Exam $10 Copay then 100% $35 Copay then 100% $35 Copay then 100%
Lenses and Frames Covered up to $80 at 100%, then 90% for all 3 Tiers
INPATIENT & OUTPATIENT SERVICES
Inpatient Facility & Physician Covered at 90% after Covered at 70% after Covered at 60% after
Services deductible deductible deductible
Outpatient Hospital & Surgery
Covered at 90% after Covered at 70% after Covered at 60% after
Services including Physician &
deductible deductible deductible
Surgeon Charges
DIAGNOSTIC SERVICES
Hospital Services: $20 Copay Hospital Services: Covered at
Outpatient Hospital Lab
then 100% 70% after deductible Covered at 60% after
Charges when performed
Physician Services: Physician Services: Covered at deductible
alone
Covered at 100% 70% after deductible
Outpatient Hospital X-rays Covered at 70% after Covered at 60% after
$20 Copay then 100%
Charges deductible deductible
Independent Clinical Lab Covered at 90% after Covered at 70% after Covered at 60% after
Facilities deductible deductible deductible
Outpatient Advanced Imaging Covered at 70% after Covered at 60% after
$20 Copay then 100%
(MRI, MRA, CT, CAT Scan) deductible deductible
Covered at 70% after Covered at 60% after
PET Scans $20 Copay then 100%
deductible deductible
4 2018 Benefits and Enrollment Guide
Medical Plan Summary: PPO Core Plan (Rates on page 20.)
PPO CORE PLAN- BENEFIT PLAN 008 CONTINUED
IN-NETWORK SERVICES NON-NETWORK SERVICES
DOMESTIC NETWORK
SUMMARY OF BENEFITS UHC Choice Plus Out-of-Network
UNC Providers
Providers Providers
URGENT CARE & EMERGENCY SERVICES
Urgent Care
Includes Lab & X-ray & Physician $50 Copay then 100% $50 Copay then 100% $50 Copay then 100%
Charges
Emergency Room Facility Services &
$150 Copay and then 100% $150 Copay and then 100% $150 Copay and then 100%
Physician Charges
MENTAL HEALTH/SUBSTANCE DEPENDENCY
Covered at 90% after Covered at 70% after Covered at 60% after
Inpatient Facility Services
deductible deductible deductible
Covered at 90% after Covered at 70% after Covered at 60% after
Inpatient Physician Charges
deductible deductible deductible
Covered at 60% after
Outpatient Hospital Services Covered at 100% Covered at 100%
deductible
Outpatient Hospital Physician Covered at 60% after
Covered at 100% Covered at 100%
Charges deductible
Physician Office Visit Covered at 60% after
Covered at 100% Covered at 100%
Primary Care providers deductible
Covered at 60% after
Specialist Office Visit Covered at 100% Covered at 100%
deductible
OTHER SERVICES
Chiropractic Care
30 Visits per Calendar Year combined Covered at 60% after
for all tier levels. Also combined with $20 Copay then 100% $50 Copay then 100%
deductible
Physical Therapy and Occupational
Therapy.
Covered at 90% after Covered at 70% after Covered at 60% after
Durable Medical Equipment
deductible deductible deductible
Occupational and Physical Therapy
30 Visits per Calendar Year for Occupa-
tional Therapy combined for all tier Outpatient Hospital Setting
and Office Setting Covered at 60% after
levels. Also combined with Chiropractic. $20 Copay then 100%
deductible
30 Visits per Calendar Year for Physical $50 Copay then 100%
Therapy combined for all tier levels.
Also combined with Chiropractic.
Speech Therapy Outpatient Hospital Setting
Covered at 60% after
30 Visits per Plan Year combined $20 Copay then 100% and Office Setting
deductible
for all tier levels $50 Copay then 100%
Benefit varies based on the Benefit varies based on the Benefit varies based on the
facility in which it is per- facility in which it is performed. facility in which it is per-
Infertility Treatment
formed. Lifetime benefit Lifetime benefit maximum of formed. Lifetime benefit
maximum of $7500 $7500 maximum of $7500
PHARMACY INFORMATION
Prescription Drugs UNC In-house Pharmacies UNC In-house Pharmacies Retail Pharmacies
Member Cost Share 30-day Supply Mail Order 90-day Supply 30-day Supply
Generic $0 Copay $10 Copay $10 Copay
Preferred Brand Covered at 80% Covered at 60% Covered at 60%
Non-Preferred Brand Covered at 80% Covered at 60% Covered at 60%
Specialty Covered at 80% No Coverage No Coverage
2018 Benefits and Enrollment Guide 5
Medical Plan Summary: PPO Buy-Up Plan (Rates on page 20.)
Healthcare is one of the most important and necessary parts of your benefit package. The following is a summary of our benefit plan.
For a more detailed explanation of benefits, please refer to your Summary Plan Description and Summary of Benefits and Coverage
(SBC).
PPO BUY-UP PLAN- BENEFIT PLAN 009
DOMESTIC NETWORK IN-NETWORK SERVICES NON-NETWORK SERVICES
SUMMARY OF BENEFITS
UNC Providers UHC Choice Plus Providers Out-of-Network Providers
DEDUCTIBLES & M AXIMUMS
Lifetime Benefit Maximum Unlimited Unlimited Unlimited
$250 Single $500 Single $1,000 Single
Annual Deductible
$500 Family $1,000 Family $2,000 Family
Member Coinsurance 10% 20% 30%
Out-of-Pocket Maximum – $1,000 Single $2,000 Single $4,000 Single
Includes Coinsurance. $2,000 Family $4,000 Family $8,000 Family
THE DEDUCTIBLE AND OUT-OF-POCKET MAX AMOUNTS FOR THE
DOMESTIC NETWORK (UNC PROVIDERS) AND UHC CHOICE PLUS PROVIDERS CROSS-FEED.
THE DOMESTIC DEDUCTIBLE APPLIES TO UNC FACILITY SERVICES ONLY.
PREVENTIVE CARE & OFFICE VISITS
Physician Office Visit
$10 Copay then 100% $25 Copay then 100% Covered at 70% after deductible
Primary Care providers
Specialist Office Visit $20 Copay then 100% $40 Copay then 100% Covered at 70% after deductible
Preventive Office Visit
Covered at 100% Covered at 100% Not Covered
Primary Care or Specialist
Well Baby Office Visit Covered at 100% Covered at 100 Not Covered
Routine Lab & X-rays
Covered at 100% Covered at 100% Covered at 70% after deductible
Primary Care or Specialist
Outpatient Preventive
Covered at 100% Covered at 100% Covered at 70% after deductible
Mammography
Prenatal Care
Covered at 100% Covered at 100% Not Covered
Does not include Sonograms
Covered at 90% after Covered at 80% after Covered at 70% after
Postnatal Care
deductible deductible deductible
Routine Eye Exam $10 Copay then 100% $25 Copay then 100% $25 Copay then 100%
Lenses and Frames Covered up to $80 at 100%, then 90% for all 3 tiers
INPATIENT & OUTPATIENT SERVICES
Inpatient Facility & Physician Covered at 90% after Covered at 80% after Covered at 70% after
Services deductible deductible deductible
Outpatient Hospital & Surgery
Covered at 90% after Covered at 80% after Covered at 70% after
Services including Physician &
deductible deductible deductible
Surgeon Charges
DIAGNOSTIC SERVICES
Hospital Services: Hospital Services: Covered at
Outpatient Lab Charges when $20 Copay then 100% 80% after deductible
Covered at 70% after deductible
performed alone Physician Services: Physician Services: Covered at
Covered at 100% 80% after deductible
Outpatient Hospital X-rays
$20 Copay then 100% Covered at 80% after deductible Covered at 70% after deductible
Charges
Independent Clinical Lab Covered at 90% after Covered at 80% after Covered at 70% after
Facilities deductible deductible deductible
Outpatient Advanced Imaging
$20 Copay then 100% Covered at 80% after deductible Covered at 70% after deductible
(MRI, MRA, CT, CAT Scan)
PET Scans $20 Copay then 100% Covered at 80% after deductible Covered at 70% after deductible
6 2018 Benefits and Enrollment Guide
Medical Plan Summary: PPO Buy-Up Plan (Rates on page 20.)
PPO BUY-UP PLAN- BENEFIT PLAN 009 CONTINUED
DOMESTIC NETWORK IN-NETWORK SERVICES NON-NETWORK SERVICES
SUMMARY OF BENEFITS
UNC Providers UHC Choice Plus Providers Out-of-Network Providers
URGENT CARE & EMERGENCY SERVICES
Urgent Care
Includes Lab & X-ray & Physician $50 Copay then 100% $50 Copay then 100% $50 Copay then 100%
Charges
Emergency Room Facility Services
$150 Copay and then 100% $150 Copay and then 100% $150 Copay and then 100%
& Physician Charges
MENTAL HEALTH/SUBSTANCE DEPENDENCY
Covered at 90% after Covered at 80% after Covered at 70% after
Inpatient Facility Services
deductible deductible deductible
Covered at 90% after Covered at 80% after Covered at 70% after
Inpatient Physician Charges
deductible deductible deductible
Covered at 70% after
Outpatient Hospital Services Covered at 100% Covered at 100%
deductible
Outpatient Hospital Physician Covered at 70% after
Covered at 100% Covered at 100%
Charges deductible
Physician Office Visit Covered at 70% after
Covered at 100% Covered at 100%
Primary Care providers deductible
Covered at 70% after
Specialist Office Visit Covered at 100% Covered at 100%
deductible
OTHER SERVICES
Chiropractic Care
30 Visits per Calendar Year combined Covered at 70% after
for all tier levels. Also combined $20 Copay then 100% $50 Copay then 100%
deductible
with Physical Therapy and Occupa-
tional Therapy
Covered at 90% after Covered at 80% after Covered at 70% after
Durable Medical Equipment
deductible deductible deductible
Occupational and Physical Therapy
30 Visits per Calendar Year for Occu-
pational Therapy combined for all
tier levels. Also combined with Outpatient Hospital Setting
and Office Setting Covered at 70% after
Chiropractic Care. $20 Copay then 100%
deductible
30 Visits per Calendar Year for Physi- $40 Copay then 100%
cal Therapy combined for all tier
levels. Also combined with Chiropractic
Care.
Speech Therapy Outpatient Hospital Setting
and Office Setting Covered at 70% after
30 Visits per Plan Year combined for $20 Copay then 100%
deductible
all tier levels $40 Copay then 100%
Benefit varies based on the
Benefit varies based on the facility in Benefit varies based on the facility
facility in which it is performed.
Infertility Treatment Lifetime benefit maximum of
which it is performed. Lifetime in which it is performed. Lifetime
benefit maximum of $7500 benefit maximum of $7500
$7500
PHARMACY INFORMATION
Prescription Drugs UNC In-house Pharmacies UNC In-house Pharmacies Retail Pharmacies
Member Cost Share 30-day Supply Mail Order 90-day Supply 30-day Supply
Generic $0 Copay $10 Copay $10 Copay
Preferred Brand $10 Copay $20 Copay $20 Copay
Non-Preferred Brand $20 Copay $40 Copay $35 Copay
Specialty Covered at 85% No Coverage No Coverage
2018 Benefits and Enrollment Guide 7
Medical Plan Summary: HSA (Rates on page 20.)
Healthcare is one of the most important and necessary parts of your benefit package. The following is a summary of our benefit plan. For
a more detailed explanation of benefits, please refer to your Summary Plan Description and Summary of Benefits and Coverage (SBC).
HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
DOMESTIC NETWORK IN-NETWORK SERVICES NON-NETWORK SERVICES
SUMMARY OF BENEFITS
UNC Providers UHC Choice Plus Providers Out-of-Network Providers
DEDUCTIBLES & M AXIMUMS
Lifetime Benefit Maximum Unlimited Unlimited Unlimited
$1,500 Single $2,750 Single $3,000 Single
Annual Deductible
$3,000 Family $5,500 Family $6,000 Family
Member Coinsurance 15% 25% 35%
Out-of-Pocket Maximum – In-
$3,000 Single $5,000 Single $5,000 Single
cludes Calendar Year Deductible &
$6,000 Family $10,000 Family $10,000 Family
Member Coinsurance
THE DEDUCTIBLE AND OUT-OF-POCKET MAX AMOUNTS FOR THE
DOMESTIC NETWORK (UNC PROVIDERS) AND UHC CHOICE PLUS PROVIDERS CROSS-FEED.
THE DOMESTIC DEDUCTIBLE APPLIES TO UNC FACILITY SERVICES ONLY.
PREVENTIVE CARE & OFFICE VISITS
Physician Office Visit Covered at 85% after Covered at 75% after
Covered at 65% after deductible
Primary Care & Specialist deductible deductible
Preventive Office Visit
Covered at 100% Covered at 100% Covered at 65% after deductible
Primary Care or Specialist
Well Baby Office Visit Covered at 100% Covered at 100% Covered at 65% after deductible
Routine Lab & X-rays
Covered at 100% Covered at 100% Covered at 65% after deductible
Primary Care or Specialist
Routine Eye Exam Covered at 100% Covered at 100% Covered at 100%
Lenses and Frames Covered up to $80 at 100%, then 90% for all 3 Tiers
Prenatal Care
Covered at 100% Covered at 100% Covered at 65% after deductible
Does not include Sonograms
Covered at 85% after Covered at 75% after Covered at 65% after
Postnatal Care
deductible deductible deductible
INPATIENT & OUTPATIENT SERVICES
Covered at 85% after Covered at 75% after Covered at 65% after
Inpatient Facility Services
deductible deductible deductible
Covered at 85% after Covered at 75% after Covered at 65% after
Inpatient Physician Charges
deductible deductible deductible
Outpatient Hospital & Surgery Covered at 85% after Covered at 75% after Covered at 65% after deductible
Services deductible deductible Note: Surgery is excluded
Outpatient Hospital Physician & Covered at 85% after Covered at 75% after Covered at 65% after deductible
Surgeon Charges deductible deductible Note: Surgery is excluded
DIAGNOSTIC SERVICES
Outpatient Hospital Lab and Covered at 85% after Covered at 75% after Covered at 65% after
X-rays Charges deductible deductible deductible
Independent Clinical Lab Covered at 85% after Covered at 75% after Covered at 65% after
Facilities deductible deductible deductible
Outpatient Advanced Imaging Covered at 85% after Covered at 75% after Covered at 65% after
(MRI, MRA, CT, CAT Scan) deductible deductible deductible
Covered at 85% after Covered at 75% after Covered at 65% after
PET Scans
deductible deductible deductible
8 2018 Benefits and Enrollment Guide
Medical Plan Summary: HSA (Rates on page 20.)
HIGH DEDUCTIBLE HEALTH PLAN (HDHP) CONTINUED
IN-NETWORK SERVICES
DOMESTIC NETWORK NON-NETWORK SERVICES
SUMMARY OF BENEFITS UHC Choice Plus
UNC Providers Out-of-Network Providers
Providers
URGENT CARE & EMERGENCY SERVICES
Urgent Care
Covered at 85% after Covered at 75% after Covered at 65% after
Includes Lab & X-ray & Physician
deductible deductible deductible
Charges
Emergency Room Facility Covered at 85% after Covered at 85% after Covered at 85% after
Services & Physician Charges deductible deductible deductible
MENTAL HEALTH/SUBSTANCE DEPENDENCY
Covered at 85% after Covered at 75% after Covered at 65% after
Inpatient Facility Services
deductible deductible deductible
Covered at 85% after Covered at 75% after Covered at 65% after
Inpatient Physician Charges
deductible deductible deductible
Covered at 85% after Covered at 75% after Covered at 65% after
Outpatient Hospital Services
deductible deductible deductible
Outpatient Hospital Physician Covered at 85% after Covered at 75% after Covered at 65% after
Charges deductible deductible deductible
Physician Office Visit Covered at 85% after Covered at 75% after Covered at 65% after
Primary Care providers deductible deductible deductible
Covered at 85% after Covered at 75% after Covered at 65% after
Specialist Office Visit
deductible deductible deductible
OTHER SERVICES
Chiropractic Care
Covered at 85% after Covered at 75% after Covered at 65% after
30 Visits per Calendar Year com- deductible deductible deductible
bined for all tier levels
Covered at 85% after Covered at 75% after Covered at 65% after
Durable Medical Equipment
deductible deductible deductible
Occupational and Physical Therapy
30 Visits per Calendar Year for Occupa-
tional Therapy combined for all tier Covered at 85% after Covered at 75% after Covered at 65% after
levels. deductible deductible deductible
30 Visits per Calendar Year for Physical
Therapy combined for all tier levels.
Speech Therapy
Covered at 85% after Covered at 75% after Covered at 65% after
30 Visits per Plan Year combined for
deductible deductible deductible
all tier levels
Benefit varies based on the facility Benefit varies based on the facility Benefit varies based on the facility
Infertility Treatment in which it is performed. Lifetime in which it is performed. Lifetime in which it is performed. Lifetime
benefit maximum of $7,500. benefit maximum of $7,500. benefit maximum of $7,500.
PHARMACY INFORMATION
UNC In-house UNC In-house UNC In-house
Prescription Drugs Retail Pharmacies
Pharmacies Pharmacies Pharmacies
Member Cost Share 30-day Supply
30-day Supply 60-day Supply Mail Order 90-day Supply
Covered at 90% Covered at 90% Covered at 90% Covered at 80%
Generic
after deductible after deductible after deductible after deductible
Covered at 90% Covered at 90% Covered at 90% Covered at 80%
Preferred Brand
after deductible after deductible after deductible after deductible
Covered at 80% Covered at 80% Covered at 80% Covered at 70%
Non-Preferred Brand
after deductible after deductible after deductible after deductible
Covered at 80%
Specialty No coverage No Coverage No Coverage
after deductible
Covered at 80% or 70%
Covered at 100%, Covered at 100%, Covered at 100%,
Preventive Medications (dependent on medication)
Deductible Waived Deductible Waived Deductible Waived
after deductible
2018 Benefits and Enrollment Guide 9
UNCHCS Pharmacy Services
UNC Health Care System GME Health Plan
Pharmacy Benefits—Domestic Incentive Program
Get the most out of your pharmacy benefit
Save Money
Did you know you could save money on your prescriptions by using one of the UNCHCS Domestic
Pharmacies? All you have to do is transfer your prescriptions to one of the UNCHCS Domestic Pharmacies to
begin saving TODAY!
Save Time
Enroll into home delivery and enjoy prescriptions delivered directly to your home for up to a 90 day supply!
Currently, your pharmacy benefit includes two home delivery options: UNC Shared Services Center Pharmacy
(for all members) & Rex Pharmacy of Raleigh (for Rex Members).
Do You Need Specialty Pharmacy Services?
All Specialty Prescriptions are provided through the UNCHCS Domestic Pharmacy Network.
Please note Specialty prescriptions are limited to a 30 day supply.
UNCHCS
Address City Phone
Domestic Pharmacy Network
Ambulatory Care Center Pharmacy 102 Mason Farm Road Chapel Hill (984) 974-5770
Central Outpatient Pharmacy 101 Manning Drive Chapel Hill (984) 974-2374
Community Pharmacy 321 Mulberry Street Lenoir (828) 757-5162
Eden Drug 103 West Stadium Drive Eden (336) 627-4854
Employee Pharmacy for UNC Medical 101 Manning Drive Chapel Hill (984) 974-5415
(336) 878-
High Point Regional Retail Pharmacy 601 North Elm Street High Point
6599
Johnston Health Outpatient Pharmacy 509 North Bright Leaf Blvd Smithfield (919) 938-7386
Kinston Clinic Pharmacy 701 Doctors Drive, Suite P Kinston (252) 523-3187
Layne’s Family Pharmacy 509 South Van Buren Rd Eden (336) 627-4600
Mitchell’s Discount Drugs, Inc. 544 Morgan Road Eden (336) 623-7747
Nash Hospital Employee Pharmacy 2460 Curtis Ellis Drive Rocky Mount (252) 962-3880
Pardee Outpatient Pharmacy 800 North Justice Street Hendersonville (828) 696-1078
Rex Pharmacy of Raleigh 4420 Lake Boone Trail Raleigh (919) 784-3242
Realo Discount Drugs 300 N Queen Street Kinston (252) 527-6929
Realo Discount Drugs 1302 W Vernon Ave Kinston (252) 523-6069
Shared Services Pharmacy 4400 Emperor Boulevard Durham (919) 957-6900
Siler City Pharmacy 202 East Raleigh Street Siler City (919) 663-5541
UNC Hillsborough Outpatient Pharmacy 430 Waterstone Drive Hillsborough (984) 215-2060
Wayne UNC Health Care Pharmacy 2700 Wayne Memorial Drive Goldsboro (919) 731-6057
This
booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents.
In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
10 2018 Benefits and Enrollment GuideUNCHCS Pharmacy Services
UNC Health Care System GME Health Plan
Pharmacy Benefits—Domestic Incentive Program
Pharmacy Information – PPO Core Plan
UNC Domestic
UNC Domestic UNC Domestic Retail
Prescription Drugs Pharmacies
Pharmacies Pharmacies Pharmacies
Member Cost Share Mail Order 30-day Supply
30-day Supply 60-day Supply
90-day Supply
Generic $0 Copay $7.50 Copay $10 Copay $10 Copay
Preferred Brand Covered at 80% $30 Copay Covered at 60% Covered at 60%
Non-Preferred Brand Covered at 80% $52.50 Copay Covered at 60% Covered at 60%
Specialty Covered at 80% No coverage No Coverage No Coverage
Pharmacy Information – PPO Buy-Up Plan
UNC Domestic
UNC Domestic UNC Domestic Retail
Prescription Drugs Pharmacies
Pharmacies Pharmacies Pharmacies
Member Cost Share Mail Order 30-day Supply
30-day Supply 60-day Supply
90-day Supply
Generic $0 Copay $7.50 Copay $10 Copay $10 Copay
Preferred Brand $10 Copay $30 Copay $20 Copay $20 Copay
Non-Preferred Brand $20 Copay $52.50 Copay $40 Copay $40 Copay
Specialty Covered at 85% No coverage No Coverage No Coverage
Pharmacy Information – High Deductible Health Plan
UNC Domestic
Prescription Drugs UNC Domestic UNC Domestic Retail
Pharmacies
Pharmacies Pharmacies Pharmacies
Member Cost Share Mail Order
30-day Supply 60-day Supply 30-day Supply
90-day Supply
Covered at 90% after Covered at 90% Covered at 90% Covered at 80%
Generic
deductible after deductible after deductible after deductible
Covered at 90% after Covered at 90% Covered at 90% Covered at 80%
Preferred Brand
deductible after deductible after deductible after deductible
Covered at 80% after Covered at 80% Covered at 80% Covered at 70%
Non-Preferred Brand
deductible after deductible after deductible after deductible
Specialty Covered at 80% after No coverage No Coverage No Coverage
Covered at 80% or
Covered at 100%,
Covered at 100%, Covered at 100%, 70% (dependent on
Preventive Medications Deductible
Deductible Waived Deductible Waived medication) after
Waived
deductible
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In
the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2018 Benefits and Enrollment Guide 11Personal Health Advocate This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern. 12 2018 Benefits and Enrollment Guide
Personal Health Advocate
What is UNC Hospitals Health Care Network Health Plan? What is the cost?
This is the health plan offered to UNCHC Co-workers and their This benefit is part of your health insurance plan and there is
dependents across the system except for those Co-workers who are no additional cost to you.
NC state Co-workers and their dependents who are offered the
State Health Plan. Most Co-workers will recognize the UNC Health To use this benefit, am I limited to UNCHC physicians
Care Network Health Plan as the health plan of their direct employer and facilities for care?
(e.g., “UNC Hospitals Office of GME). No, you may see any health care providers you choose and
your Personal Health Advocate will work directly with your
Who will be invited to join the program? providers whether or not they are part of UNCHC. If you do
not have a primary care physician, or would like to switch to
Enrollment in 2018 is by invitation only to members with specific a new one, we will help you with that.
conditions or need for extra support such as members taking many
medications or members with multiple disease states, cancer, What’s the benefit to UNCHC? Why are they offering
autoimmune disease, recent hospital discharges or multiple ER this program?
visits. The good health of our Co-workers and their dependents is
very important to us. Our ultimate goal is to provide better
Are all Co-workers covered by the UNCHC Network Health Plan care for members that have more complex care needs so
eligible to enroll? that our Co-workers and their dependents can be healthier
and happier.
Only Co-workers who have primary health care coverage through
the UNCHC Network Health Plan administered by UMR are eligible Do I have to join if asked?
and during 2018, Co-workers and dependents must be invited to No, the program is optional. However, there is a financial
enroll. benefit and other valuable care coordination benefits
associated with participation.
If I get sick, can I request access to the program? How is this different from other programs offered by
No, but if you are suffering from an illness that causes you to access health insurance plans?
multiple physicians, be admitted to the hospital or take more than Unlike other programs, we will support your current
ten prescription medications or certain medications, you may be treatment plan by coordinating directly with your physicians,
eligible for the program. the hospital or other health care providers that you may
benefit from seeing through comprehensive care
I don’t want my employer to know my health information. Who management tailored to meet your needs. If you don’t
sees my health information? currently have a treatment plan or access to appropriate
providers, we can help you with these.
Under federal HIPAA requirements, your private health information
is private. Personal Health Advocate is part of UNCHC’s clinical How is this different from the UNCHC health benefit,
operations, separate from UNCHC Human Resources or Employee Nurseline?
Health. All personal health information used as part of this program The UNC HealthLink Nurseline is another benefit of the UNC
is protected with the same precautions as our patients’ health
information. Health Care Network Health Plan for all plan members and
their enrolled dependents. You can call the toll free number
24/7 and an experienced registered nurse will review
I received a call or letter encouraging me to join. Why was I
symptoms and determine if and when you should go to your
contacted?
primary care provider, urgent care or emergency room. They
We are here to support you to achieve optimum health, based on will suggest home care advice for urgent issues, discuss
your individual needs. A review of your claims history and health
medications and can recommend a primary care physician
information suggests you could benefit from additional resources to
help you manage your medical condition. within UNCHC. Members of the Personal Health Advocate
program can use the UNC HealthLink Nurseline for urgent
Can dependents enroll in the program?
issues. The nurse assisting you will communicate with your
Yes, if invited. Personal Health Advocate to ensure we provide you with
continuity of care.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2018 Benefits and Enrollment Guide 13UMR Resources
By registering online at www.umr.com, you have access to helpful information, including the ability to:
View your claims and download copies of your Explanation of Benefits (EOB’s)
View your health plan benefit information such as copays and deductible amounts
Find out how much you have paid towards your deductible and out-of-pocket maximum
Order duplicate or replacement ID cards
Search for network providers and medical facilities in your area
Find a glossary of common health care terms
You are encouraged to use this resource. The key to controlling health care costs is your informed engagement in
spending and treatment decisions. The information you need is at your fingertips.
Compare provider costs and become a more educated consumer at umr.com!
Health Education Library – offers health education content including Care Guides, DrugNotes, Drug Interaction
checker and Symptom Navigator.
myHealthcare Cost Estimator – provides fee schedule estimates of care costs and integrates health plan coverage
to estimate patient responsibility. Includes UHC Choice Plus network data grading physician quality and efficiency. The
tool allows you to comparison shop based on cost and quality before services are received.
Health Center – here you can search your health symptoms and find first aid information, utilize health education tools
including healthy body apps and calculators, watch step-by-step recipe videos, read health articles and much more!
Plan Cost Estimator – this tool helps you compare estimated healthcare expenses between our health plans so you
can decide which health plan is most appropriate for you and your family.
UMR Mobile
You can access your health plan benefit and
claim information on the go from a mobile
device. Just go to www.umr.com on a mobile
device and log in using the same username and
password that you use on the full site. It’s quick
and easy! There's no app to download, nothing
to install and no waiting. Go mobile today!
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
14 2018 Benefits and Enrollment GuideEmergency Care/Urgent Care
Emergency Room (ER) vs. Urgent Care (Express Care)
It’s second nature for many of us to visit the emergency room (ER) if we’re suddenly sick or injured – a sound idea, in
many cases. But what if you have an urgent, but non-life-threatening medical issue like a sinus infection or ankle
sprain?
A hefty ER wait time, and an even heftier hospital bill might not be your best option. Quicker, more affordable and more
convenient treatment is closer than you think: your local urgent care center. Many of these facilities are open seven
days a week, nights, weekends and even holidays with no appointments necessary.
Patients should be aware that their out of pocket cost is based on the facility they visit. It is usually much cheaper to go
to urgent care centers than ERs. The average urgent care visit costs patients $71-125 for basic care, with additional
costs added for shots, x-rays, and labs. The average emergency room visit costs $1,318.
Being informed about the differences and similarities between these kinds of facilities is important. Whether you choose
to receive care from an urgent care center or an emergency room, it is important to follow-up with additional treatments
as necessary.
Comparisons for treatment for some of the most common
EXAMPLES OF TIMES YOU
ailments at an emergency room vs. an urgent care center
SHOULD GO TO THE ER
Emergency Urgent Care Potential Poisoning
Ailments
Room Center Savings
Sudden, severe abdominal pain
Acute Bronchitis $814 $122 85%
Coughing up or vomiting blood
Sore Throat $620 $93 85%
Low Back Pain $751 $113 85%
Cut or wound that will not stop
bleeding
Attention to Dressing/
$343 $76 78% Major trauma or accident
Removal of Sutures
Heart attack or chest pain
Loss of consciousness
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2018 Benefits and Enrollment Guide 15Preventive Care
UMR is dedicated to helping people live healthier lives. You are encouraged to obtain preventive care services and
health screenings, as appropriate for your age, to help maintain or improve your health and achieve your health and
wellness goals. Regular preventive care visits and health screenings may help to identify potential health risks for early
diagnosis and treatment. Consult your doctor for your specific preventive care recommendations, as he or she is your
most important source of information about your health. Below and on the next page you will find a summary of
preventive care services covered under your health plan with UMR.
All Members Men’s Health Services
Preventive medicine for adults, all stand- Screening for:
ard immunizations recommended by the Advisory Abdominal aortic aneurysm for men who are 65-75
Committee on Immunization Practices of the Centers years old who have ever smoked
for Disease Control and Prevention (CDC)
Cardiovascular disease aspirin use counseling for
ages 45+
All Members at an Appropriate Age High blood pressure
and/or Risk Status Diabetes for certain populations
Screening for: Tobacco use
Obesity Diet and nutrition
Cholesterol level and lipids Alcohol abuse
Colorectal cancer for ages 50-plus Depression
Certain sexually transmitted diseases, including Well-man exam
HIV Hepatitis C screening
Lung cancer with low-dose computer tomography
Note: Not all preventive care services are eligible for Vitality Points. Please visit www.powerofvitality.com for
more information.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
16 2018 Benefits and Enrollment GuidePreventive Care
Women’s Health Services Children’s Health Services
Services at each of these preventive visits
will vary based on age, but will include
Screening mammography (film and digital) for all some of the following:
adult women
Measurement of child’s head size
Cervical cancer screening, including Pap smears
Measurement of length/height and weight
Breast cancer genetic test evaluation and counseling
(BRCA) Screening blood tests, if appropriate
Counseling for certain sexually transmitted diseases Providing age appropriate immunizations
Osteoporosis for certain populations Vision screening
Pregnant women screenings for: Hearing screening
Iron-deficiency anemia Counseling on oral health
Bacteria in urine Psychological and behavioral development
assessment
Hepatitis B virus
Counseling on the harmful effects of smoking and
Rh incompatibility illicit use of drugs (for older children and
adolescents)
Rubella
Counseling for children and their parents on
Yearly well-women visits
nutrition and exercise
Sexually transmitted infections counseling
Screening certain children at high risk for
Contraception methods and counseling cholesterol, sexually transmitted diseases, lead
poisoning, tuberculosis and more
Domestic violence screening
Fluoride application in primary care
Gestational diabetes screening
HIV screening and counseling
HPV testing (beginning at age 30)
Breastfeeding support and supplies, including renting
or purchase of specified breast-feeding equipment
from an approved vendor and counseling
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2018 Benefits and Enrollment Guide 17Health Savings Account (HSA)
UNC Hospitals GME is pleased to be able to offer a HSA as part of the HDHP Medical Plan. The Health Savings
Accounts are administered by Optum Bank. Below are highlights of a Health Savings Account.
For calendar year 2018, you may deposit up to $3,450 if you have single
health coverage, and up to $6,900 if you cover dependents.
Contributions made to your HSA by UNC GME ($500 for single
coverage and $1,000 if dependents are covered) must be included in
those limits. If you are age 55 or older you may also make “catch up”
contributions of up to an additional $1,000 per calendar year.
If you are paid by UNC Hospitals GME you may deposit funds to your
HSA on a pre-tax basis through payroll deductions. UNC Hospitals GME
participates with you in funding your HSA by making a contribution of
$500 for single coverage and $1,000 if you cover dependents. UNC
Hospitals GME funds 50% of our contribution in July, and the other 50%
in January. Contributions are prorated based on your effective date.
You may change, discontinue and resume HSA payroll deduction deposits at any time.
You are not required to spend the funds in your account each year as you are when you have an FSA. Unspent
funds at the end of the year remain in your account to be spent as needed in the future.
Your funds will earn interest while in your HSA. After a minimum balance is reached, you may invest your funds in a
variety of mutual funds. Interest and investment earnings accrue in your account tax-free.
If you open an HSA you may not participate in our regular Medical Flexible Spending Account. You may participate
in a Limited Purpose FSA covering dental costs.
You may spend funds in your account tax-free for all eligible medical and dental expenses for you and your family
members, regardless of whether family members are covered by our health plan. If you spend the funds for expens-
es that are not eligible, you will pay income tax on these expenditures plus a 20% penalty tax if you have not yet
reached Social Security retirement age. After you reach retirement age, expenditures that are not eligible will be
taxed as ordinary income, the same as withdrawals from qualified retirement plans.
You may also pay certain insurance premiums tax-free from your HSA:
COBRA premiums
Qualified long term care insurance premiums
Medicare premiums
You will not be required to provide documentation or receipts to Optum Bank. However, it is important to keep
receipts in case the IRS audits your expenditures.
You can reach Optum Bank at 1-866-234-8913 or online at www.optumbank.com.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
18 2018 Benefits and Enrollment GuideFlexible Spending Accounts
Residents who are paid by UNC Hospitals GME payroll Important Rules
have the option of enrolling in Flexible Spending Accounts
for health care and/or dependent care expenses. If you are There are important rules which you must understand
not paid by the hospital, you will not be eligible to partici- before electing to participate. For example, once you
pate in the FSA plan. have elected to have a specified amount deducted from
each paycheck, you cannot change your election until the
The IRS permits you to pay certain health and dependent end of the plan year unless you experience a qualified
related expenses with earnings that are not taxed. change in status. You must re-enroll annually for this
If you or your family have predictable medical, dental or coverage. There is also a risk of forfeiture of funds not
eye care costs that are not fully reimbursed by insurance, used by the end of the grace period. If you currently pay
you could benefit from our Medical Care Reimbursement daycare in order to work, you may receive a tax credit on
Account. Eligible expenses include your deductibles, your tax return. In lower tax brackets the tax credit may
copays and coinsurance under our health insurance plans, be more valuable than the benefits of the Dependent Care
dental expenses, orthodontics, eye exams, glasses and Account. You should consult your tax advisor.
contact lenses, Lasik eye surgery, hearing aids, etc. IMPORTANT: IRS allows an extended period of two
Under Health Care Reform over-the-counter and one-half months for employees to incur (date of ser-
medications are not considered eligible expenses for vice) expenses against their Medical and Dependent Care
the Medical Care Account without a prescription from Reimbursement Accounts. UNC Hospitals GME
your physician. Healthcare will give you until September 15, 2019 to incur
eligible expenses against your 2018-2019 plan year
The Dependent Care Account allows you to pay for elections. This extra two and one-half month extended
daycare expenses for children under age 13, or for a grace period is designed to give you more time to incur
disabled dependent of any age living in your home, if such expenses to reduce your chance of losing money under
daycare is necessary to enable you to work. From your the Reimbursement Accounts.
Dependent Care Account, you may deduct expenses for
day care centers or in-home child care, preschool tuition, What is a Limited Purpose Health
before or after school care, daytime summer camp, or
adult day care. FSA?
When you enroll in an HSA medical plan and open a
Health Savings Account, you can also contribute to a
How Does It Work? Limited Purpose Flexible Spending Account to pay for
You choose the dollar amount you want to contribute to eligible dental and vision expenses. You cannot use your
each account based on your estimated expenses for the Limited Purpose FSA to pay medical expenses. You may
upcoming year. For the Medical Care Account the entire contribute up to $2,650 per year in a Limited Purpose
contribution you have elected will be available FSA, however, we encourage you to max out your HSA
immediately. For the Dependent Care Account only the contribution before contributing to the limited purpose
amounts that have been deposited from your pay will be FSA.
available. Your contributions will be deducted in equal
amounts from each paycheck pre-tax throughout the plan Our Flexible Spending Accounts are administered by P&A
year. The important thing is that the deposits to your Group. You may call a specialist at 1-800-688-2611.
account are not taxed and are used by you tax-free. The You may track your balance and transactions by logging
result is a direct saving to you equal to the taxes you would in at www.padmin.com.
otherwise pay on this income.
How Much Can I Contribute to the FSA Plan?
Medical Flexible Spending or Limited Purpose FSA:
$2,650 Maximum
Dependent Care Flexible Spending:
$5,000 married couple filing jointly OR
$2,500 per person if filing separate returns
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2018 Benefits and Enrollment Guide 19Medical Insurance Payroll Deductions & New UNC Urgent Care 24/7
Employee Medical Contributions Effective 7/1/2018
Core Plan Core Plan Buy-Up Plan Buy-Up Plan HDHP Plan HDHP Plan
Monthly Bi-weekly Monthly Bi-weekly Monthly Bi-weekly
Employee $21.06 $10.53 $50.04 $25.02 $15.00 $7.50
Employee + Spouse $236.84 $118.42 $312.82 $156.41 $202.64 $101.32
Employee + Child(ren) $209.52 $104.76 $260.26 $130.13 $173.24 $86.62
Employee + Family $528.30 $264.15 $598.06 $299.03 $356.00 $178.00
New This Year
UNC Urgent Care 24/7: Access to virtual care for patients and co-workers
Employees across UNC Health Care have a new virtual care option available called UNC Urgent
Care 24/7 to provide access to board-certified doctors via a smartphone, tablet, computer or
telephone.
UNC Urgent Care 24/7 offers around-the-clock video or phone access to health care
professionals for non-emergency medical issues such as:
• Acne • Insect Bites
• Allergies • Nausea
• Constipation • Pink Eye
• •
• Diarrhea • Respiratory Problems
• •
• •
• •
• •
Get started today!
• Create your account – visit https://UNCUrgentCare247.com to create your free account.
• Click “Connect Now” and select your group benefit.
• Cost per visit:
• UNC GME employees who have the PPO Core or Buy-Up plan pay $0.
• Employees on the HDHP and others pay only $49.00.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
20 2018 Benefits and Enrollment GuideDental Insurance
For 2018, UNC Hospitals GME offers residents and subspecialty residents the opportunity to participate in a voluntary
dental plan with MetLife. Premiums are paid by the participant via payroll deduction on a pre-tax basis.
The Voluntary Dental Plan is currently insured by MetLife. Two plan options are being offered with the Annual
Maximum Benefit of $1,000 for the Low Option and $1,250 for the High Option.
A summary of both the Low and High Options are included in this guide. You will want to refer to the Plan Highlights
for important information including the financial advantage of using the Preferred Dental Provider network.
To see a list of participating providers go to: www.metlife.com/mybenefits or contact MetLife’s Customer Service
Line (800) 275-4638, enter company/group name Office of Graduate Medical Education (OMGE) or P&A.
The Dental Network is MetLife Preferred Dentist Program (PDP) and our group number is 141644.
Changes for ALL employees must be completed online at
www. eBenefitsNow.com
• If you and your dependents enroll in either of the plan offerings during the initial
enrollment period, you will not be subject to a waiting period for any services.
New Employees
• If you decide at a later date to enroll, there will be a 12 month waiting period on
Major / Type C services.
• Current dental insurance participants will remain active
for the July 1, 2018 plan year with MetLife.
Returning
• You may change your plan option from Low to High without penalty.
Employees
• Employees and dependents not currently covered will have a 12 month waiting
period for Major / Type C Services
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
2018 Benefits and Enrollment Guide 21Dental Insurance Rates
For 2018, UNC Hospitals GME offers residents and subspecialty residents the opportunity to participate in the MetLife
Low Dental Plan or the High Dental Plan. A summary of benefits are shown below:
Summary of Dental Plan Benefits
Plan Opt 1: Low Plan Plan Option 2: High Plan
In Network Out of Network In Network Out of Network
Preventive 100% of 100% of 100% of 100% of
Services negotiated fee* R&C fee** negotiated fee* R&C fee**
Basic Services 50% of 50% of 80% of 80% of
(Type B)
Major Services 25% of 25% of 50% of 50% of
(Type C) negotiated fee* R&C fee** negotiated fee* R&C fee**
Deductible Calendar Year Deductible
(Applies to Type B & C)
Individual $75 $50
Family $225 $150
Reimbursement % of Reasonable % of Reasonable
Negotiated Fee Negotiated Fee
Level & Customary & Customary
Maximum Annual
$1,000 $1,250
Benefit
One Year waiting period for all One Year waiting period for all
Late Enrollment
Type C / Major Services Type C / Major Services
*Negotiated Fee refers to the fees that
Bi-Weekly & Monthly Payroll Deductions
participating dentists have agreed to accept as
payment in full, subject to any copayments,
Low Option Plan High Option Plan
deductibles, cost sharing and benefit
maximums. Negotiated Fee fees are subject to
Coverage Bi-Weekly Monthly Bi-Weekly Monthly change.
Emp Only $12.05 $24.10 $21.51 $43.02 **R&C Fees refers to the Reasonable and
Customary (R&C) charge, which is based on
Emp & Sp $24.38 $48.76 $43.52 $87.04 the lowest of (1) the dentist’s actual charge, (2)
the dentist’s usual charge for the same or
similar services or (3) the charge of most
Emp & Child $28.20 $56.40 $50.33 $100.66 dentists in the same geographic area for the
same or similar services, as determined by
Family $34.01 $68.02 $60.61 $121.22 MetLife.
This booklet is intended for illustrative and information purposes only. The plan documents, insurance certificates and policies will serve as the governing
documents. In the case of conflict between the information in this booklet and the official plan documents, the plan documents will always govern.
22 2018 Benefits and Enrollment GuideYou can also read
