2022 Choose Your Benefits for
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MSU Faculty and Academic Staff
OPEN ENROLLMENT GUIDE
Time to
Choose Your
Benefits for
2022
HIGHLIGHTS:
Page 1 Page 4 Page 5 Page 23
See contact info for all Determine if you need Find instructions to Learn about vision, critical
benefit providers. to participate this year. complete enrollment. illness & legal insurance.
hr.msu.edu/open-enrollment
DEAR MSU EMPLOYEE, Table of Contents
MSU Open Enrollment will be held from October 1-31, 2021. 1 Benefits Provider Contact Info
During this time, you can re-evaluate your benefit needs
and make changes to benefit selections, which are effective 2 Steps to Complete Open
January 1 – December 31, 2022. This guide contains information Enrollment
about the benefits options available for eligible faculty and
academic staff employees. Find all the open enrollment
3 New or Notable for 2022
guides – including those for retirees or individuals on a leave of 4 Determine if You Need to Take
absence – at hr.msu.edu/open-enrollment. Action
Questions? 5 Open Enrollment Instructions
Please contact MSU Human Resources or our benefits
providers using the contact information below. We encourage
6 Making Critical Decisions
you to ask HR questions via phone or email. Limited in-person 7 Summary of Health Plan Provisions
help is available by appointment only. To get in touch or make
an appointment, call the Solutions Center using the details 9 Faculty Monthly Health Plan
below: Premiums
MSU HUMAN RESOURCES: 10 Academic Year Faculty Monthly
SolutionsCenter@hr.msu.edu Health Plan Premiums
517-353-4434 (toll-free: 800-353-4434)
hr.msu.edu/open-enrollment 11 Health Plan Coverage Summary
MSU BENEFIT PROVIDERS: 15 Glossary of Terms
Aetna Dental HealthEquity
877-238-6200 HSA: 16 Prescription Drug Information
aetna.com 877-219-4506
17 Dental Plan Information
my.healthequity.com
BCN
800-662-6667 FSA: 19 Life Insurance Information
877-924-3967
bcbsm.com
participant.wageworks.com 20 Accidental Death &
Dismemberment Insurance
Community Blue
Prudential
888-288-1726
877-232-3555 21 Flexible Spending Accounts
bcbsm.com
CDHP (by BCBSM)
Prudential.com
23 Voluntary Benefits
MSU Benefits Plus
888-288-1726
888-758-7575
25 Teladoc for Online Medical Care
bcbsm.com
MSUBenefitsPlus.com 25 Teladoc Medical Experts
CVS/Caremark
800-565-7105 VISIT 26 Livongo
caremark.com hr.msu.edu
for brochures about MSU
26 Retirement Programs at MSU
Delta Dental
800-524-0149
benefits plans and options.
Appendix Legal Notices
deltadentalmi.com
Steps to Complete Open Enrollment
Please use the following steps to help you complete Open Enrollment by October 31. Check the boxes as
you complete each step.
1. Review Open Enrollment Materials
Review this Open Enrollment guide completely.
2. Ask Questions or Learn More
Ask questions or learn more about your benefit options.
• Page 1 provides contact information for MSU Human Resources and benefit vendors.
• MSU Benefits Fair and HR Site Lab Options: We’re dedicated to helping you learn
more and ask questions about your benefit options. Please visit the HR website
at hr.msu.edu/open-enrollment to find the most updated details about the MSU
Benefits Fair and HR Site Lab options in October.
3. Make Decisions
Read page 4 to determine if you need to take any action by October 31.
• If you do need to take action, continue to step 4.
• If you don't need to take any action, then you don't need to complete step 4.
Continue to step 5.
4. Take Action
Find instructions for how to complete necessary actions by October 31:
• Page 5 provides instructions to complete the spouse/other eligible individual (OEI)
affidavit and enroll in, change or cancel health, dental, life insurance and/or flexible
spending accounts.
• Page 23 provides instructions to enroll in, change or cancel voluntary benefts.
IMPORTANT: You may only enroll in, change or cancel voluntary vision, legal or critical
illness insurance during the Open Enrollment period.
5. Other Items to Consider
You many want to check if your life insurance beneficiaries are correct (if applicable).
Find instructions at hr.msu.edu/benefits/beneficiaries.html
Questions? Visit hr.msu.edu/open-enrollment │ 2
New or Notable for 2022
Read the following important changes, updates, and/or reminders regarding this year’s Open Enrollment and the
2022 plan year. Visit the HR website (hr.msu.edu) for the most up-to-date information.
NEW INFORMATION $1,500 or less. You may still cover your spouse/OEI on
your MSU health coverage as a secondary plan.
MSU Benefits Fair and Site Lab Options
Due to the changing nature of the pandemic, please Federal Regulations Allowing Benefit Changes
visit the HR website at hr.msu.edu/open-enrollment During Emergency Situation
to find the most updated details about the MSU Effective March 1, 2020, the Department of Labor
Benefits Fair and HR Site Lab options in October. (DOL) and Internal Revenue Services (IRS) provided
provisions to extend deadlines for birth, marriage and
Increase to Maximum Benefit for Accidental
loss of coverage and relax rules for adding, canceling
Death and Dismemberment (AD&D) Insurance
and changing health, dental and flexible spending
You can enroll in AD&D coverage at 1 to 10 times your
account (FSA) plans. Learn more on page 6.
annual salary, up to a maximum of $1,500,000 for the
employee (increased from 1,000,000), $750,000 for Flexible Spending Accounts (FSA): Difference
a spouse/OEI (increased from 600,000), or $100,000 Between Dependent Care and Health Care FSA
per child (no change). Learn more on page 20. MSU’s FSA vendor offers eligible employees two
different FSAs: Dependent Care FSA and/or Health
Upgrades to Critical Illness Insurance Coverage
Care FSA. Before you enroll, make sure you know the
Effective January 1, 2022
difference between the two options. Learn more on
The upgraded plan offers more benefits with
page 21.
coverage for different, distinct medical conditions.
Contact MSUBenefitsPlus at 888-758-7575 or visit Review Your Voluntary Benefit Options, Such as
MSUBenefitsPlus.com for details. If you’re currently Vision, Legal and Critical Illness Insurance
enrolled and you do not change your coverage Some voluntary benefits – like vision, legal, and critical
election during open enrollment, your plan will be illness insurance – require you to enroll, make changes
upgraded automatically as of January 1, 2022. Learn or cancel during the Open Enrollment period. Learn
how to enroll on page 23. more on page 23.
MSU Health Care Services
NOTABLE INFORMATION
MSU Health Care provides pharmacy, radiology,
Premium Threshold for Spousal Affidavit primary care provider, and specialty care provider
If your spouse/other eligible individual (OEI) has services. Save time by taking advantage of these on
access to health care coverage through their own campus services! Learn more at pharmacy.msu.edu,
current or former employer, they must purchase the radiology.msu.edu, and healthcare.msu.edu.
coverage their own employer offers if the annual
employee premium cost for single-person coverage is
3 │ Faculty and Academic Staff Open Enrollment Guide – 2022 Edition
Determine if You Need to Take Action
Do you need to take any action during the Open Enrollment period? Answer the following question:
As an MSU benefits-eligible employee, which of the following statements is true regarding your
benefits? Check all boxes that apply to you.
I currently cover a spouse/other eligible I do not cover a spouse/OEI under my health
individual (OEI) under my health benefits benefits.
(who is NOT an MSU benefits-eligible
employee or retiree), and I want to continue I do not want to make any changes to my
their coverage in 2022. You must complete health or dental insurance and want to keep
a Spouse/OEI Affidavit every plan year to the exact same coverage in 2022.
continue coverage. See page 5 for instructions.
I do not want to enroll in, change or cancel
I want to enroll in, change or cancel health or my life or accidental death & dismemberment
dental insurance coverage for myself and/or insurance.
my eligible dependent(s).
I do not want to enroll in, change or cancel my
I want to enroll in, change or cancel life or voluntary vision insurance, legal and/or critical
accidental death & dismemberment insurance illness insurance.
for myself and/or my eligible dependent(s).
I do not want to enroll in a Flexible Spending
I want to enroll in, change or cancel my Account (FSA) for 2022.
voluntary benefits (e.g. vision, legal, critical
I currently elect to waive my health care
illness insurance, etc.) options for myself and/
coverage through MSU, and I want to continue
or my eligible dependent(s). See page 23 for
to waive my health care coverage through
more information about voluntary benefits.
MSU. See page 8 for more details.
I want to enroll or re-enroll in a Flexible
Spending Account (FSA). You must re-enroll in
an FSA every plan year.
I elect to waive my health care coverage
through MSU. See page 8 for how to enroll in
the waiver.
RESULT: RESULT:
If you selected any of the above options, you must If you only selected the above option(s), and did not
participate in Open Enrollment between Oct. 1–31. select any options in the left column, you do not need
to take any action during Open Enrollment.
See page 5 for instructions.
However, we encourage you to review your benefits
options to ensure you’re getting the best coverage.
Questions? Visit hr.msu.edu/open-enrollment │ 4Open Enrollment Instructions
Use the Enterprise Business System (EBS) to complete Open Enrollment for health, dental, life and
flexible spending accounts between October 1–31. Follow these steps:
1 Visit ebs.msu.edu. Log in with your MSU
NetID. No NetID? Visit netid.msu.edu or call
9 The next screens display the different plans
available (health plans, flexible spending
MSU IT at 517-432-6200. accounts, life/accident plans, etc.). You can
Add, Edit or Delete enrollment in these plans.
2 Click the My Benefits top navigation tab. To exit, click Cancel – all changes will be lost.
10 When you reach the Review and Save screen
you can Add, Change or Remove coverage by
3 Click the Benefit/Retirement Enrollment
and Changes tile. Select the Open Enrollment
using the top navigation to navigate back to
previous screens. Click Save.
option from the dropdown menu, then click
11
Next. On the final screen, review info on the Benefit
Elections Summary. You have the option to
4 A CDHP/HSA plan disclaimer will appear
(regardless of your eligibility for CDHP/HSA).
click additional links such as MSU Benefits
Plus or Retirement/Health Savings Accounts.
Read and click OK.
12 You have completed the enrollment steps for
the MSU administered benefit programs. You
5 If the Health Plan Affidavit for Spouse/OEI
appears, answer Yes or No and click Next.
should receive a confirmation email shortly.
The following statement will confirm your
answer. If the info is correct, click Next.
6 On the Personal Profile screen, verify name
and address info and click Next. To make
corrections, find instructions at hr.msu.edu/
ebshelp/personalprofile/addresses.html.
7 On the Dependents screen, verify all family
members/dependents and click Next. If info
Enrollment Instructions Video
The visually inclined can watch a How-To
is missing, exit Open Enrollment and submit
Enroll Video on the HR website at hr.msu.edu/
the Add a Family Member or Dependent
open-enrollment/instructions.html.
form. If it is inaccurate, contact MSU HR.
Other Enrollment Instructions
8 The Benefits Summary screen displays
current coverage. When finished reviewing, Page 23: Voluntary Benefits (vision, legal,
click Next. critical illness insurance, among others)
Page 26: Retirement Programs
5 │ Faculty and Academic Staff Open Enrollment Guide – 2022 EditionMaking Critical Decisions
During the Open Enrollment period (Oct. 1–31) you • Cancel or change life or accidental death and
make important decisions that impact your benefits dismemberment insurance.
for the upcoming plan period. However, due to
• Enroll or re-enroll in a flexible spending account
the changing nature of the pandemic, the federal
plan.
government has provided provisions to extend
deadlines and relax rules related to your benefits. • Add, cancel or change voluntary vision, legal
services and critical illness insurance.
Since these provisions are currently expected
to end on December 31, 2021, we strongly Your choices are permanent until the next Open
encourage you to carefully review and make Enrollment period, with changes effective January 1.
any necessary changes to your benefits options Carefully review Open Enrollment materials to help
during the Open Enrollment period for the 2022 plan you select the plans that best meet your coverage
year. and financial needs.
Note on Vision, Legal and Critical
COVID-19 Provisions from the Federal Illness Insurance:
Government that Impact Your Benefits
This temporary change from the DOL and IRS does
Effective March 1, 2020, the Department of Labor
NOT extend to voluntary vision, legal, and critical
(DOL) and Internal Revenue Services (IRS) provided
illness insurance. If you need to cancel, add or change
provisions to extend deadlines for birth, marriage and
any of these voluntary benefits options you must do
loss of coverage and relax rules for adding, canceling
so during Open Enrollment in October.
and changing health, dental and flexible spending
account (FSA) plans. Qualifying Life Events
These provisions are currently expected to end on Outside of Open Enrollment and after the federal
December 31, 2021, and subject to change by the DOL government determines the COVID-19 emergency
and IRS at any time due to the changing nature of the period has officially ended, changes can be made to
pandemic. We strongly encourage you to carefully your benefits for certain qualifying life events. These
review and make any necessary changes to your life events include marriage, childbirth/adoption, loss
benefits options for the 2022 plan year during the of existing coverage for you and your family members
Open Enrollment period in October. or retirement. Changes must be made within 30 days
of the qualifying event. Learn more at hr.msu.edu/
benefits/life-change.
What Happens When the COVID-19
Emergency Period Ends?
After December 31, 2021, the provisions provided by
the DOL and IRS will no longer be in effect and you
WILL NOT be able to reverse or change your benefits,
which includes the following:
• Switch from one health or dental plan to another.
• Add yourself or additional dependents to health
or dental coverage.
• Cancel or change health or dental coverage for
you or your dependent(s).
Questions? Visit hr.msu.edu/open-enrollment │ 6Summary of Health Plan Provisions
Blue Care Network (BCN) For questions about specific coverage details or to
BCN is a Health Maintenance Organization (HMO), access a listing of PPO participating providers, visit
which means you select and work closely with BCBSM.com or call 888-288-1726.
a primary care physician to manage your care. Highlights of the Community Blue PPO Plan:
Deductibles, co-insurance and prior authorization
• An in-network deductible of $100/single or
requirements apply in some circumstances.
$200/family.
The in-network deductible is $100 per individual and • Higher premium cost.
$200 per family. After meeting the deductible, a 20%
• More flexibility in managing care.
co-insurance may apply, up to a maximum of $3,000/
• Does not require you to choose a primary care
single or $6,000/family, per calendar year.
physician.
For questions about specific coverage details or to
For more information, see the Health Plan Coverage
access a listing of BCN participating providers, visit
Summary on page 11.
BCBSM.com or call 1-800-662-6667.
Highlights of the BCN Plan: Consumer Driven Health Plan (CDHP)
• Lower premium cost. with Health Savings Account (HSA)
• Only eligible to employees who live in Michigan. If you do not anticipate having high health care needs and
are looking for a sound strategy to save for your retirement
• Access coverage with BlueCard when traveling out-
health expenses, this plan may be the most cost-effective
of-state and Blue Cross Blue Shield Global Core for
option for you.
traveling outside of the USA.
• Plan does not require a referral, but some services Consumer Driven Health Plan (CDHP)
are subject to prior authorization. While you pay a deductible ($2,000/single and $4,000/
• You must choose a primary care physician. family) first before the plan pays medical and prescription
benefits, preventive care and certain generic medications
For more information, see the Health Plan Coverage
for chronic conditions (asthma, cholesterol, diabetes, and
Summary on page 11.
anti-hypertensives) are 100% covered with no deductible
or co-pays when using an in-network provider. Review the
Community Blue PPO
Health Plan Coverage Summary on page 11 to anticipate
Community Blue is a Preferred Provider Organization your annual costs under this plan – you may find that most
(PPO), which gives you the flexibility to manage of your annual medical costs are 100% covered.
your own care. Deductibles, co-insurance and
prior authorization requirements apply in some The provider network for this plan is the same as the
circumstances. There is a worldwide network of Community Blue PPO plan, which means you can choose
participating PPO physicians and hospitals. from a larger provider network.
The deductible for in-network services is $100/single This plan limits the maximum amount you pay for any
or $200/family and $250/single or $500/family for covered services in a year to $3,000/single and $6,000/
out-of-network services. After meeting the out-of- family using in-network providers. After expenses reach this
network deductible, a 20% co-insurance may apply, up amount, you do not have to pay for any other health care
to a maximum of $2,000/single or $4,000/family, per costs, including prescription drugs.
calendar year.
7 │ Faculty and Academic Staff Open Enrollment Guide – 2022 EditionHealth Savings Account (HSA) Summaries of Benefits and Coverage
Along with the CDHP, you should enroll for the HSA at (SBC)
the same time. MSU contributes up to $750 to the HSA The Affordable Care Act requires health plans and
each year and you may add funds to the HSA tax-free. If employers who provide self-insured plans to provide
you do not enroll during Open Enrollment, you will lose comparative information to consumers on health
MSU’s contribution. You can use these HSA funds to pay plan options. Find SBC documents for the health plan
for any eligible medical expenses or doctor visits you options at hr.msu.edu/benefits/summaries.
do incur. Employer and employee combined annual HSA
contributions are limited to the 2022 IRS limits of $3,650/ Legal Notices
single and $7,300/family. These contributions are triple
Our legal notice publication is attached to the end of this
tax-free! You make contributions pre-tax, your account
PDF (if viewing online at hr.msu.edu/open-enrollment).
balance earns interest tax-free, and your distributions are
It includes important legal notices regarding health care
tax-free if they are used for eligible medical expenses.
privacy and other laws.
Please Note: due to IRS regulations, Health Care FSAs
are not compatible with Health Savings Accounts
(HSA). You are unable to participate in a Health Care
FSA if you enroll in the HSA offered with the CDHP.
Do you have an existing HSA from a previous employer?
You can add those funds into your new HSA. The money
in the HSA is yours to take with you – even if you leave
MSU for a different employer or retire. In fact, investing
in your HSA now to use in your retirement is a sound
strategy to fund your medical expenses in retirement.
For questions about the CDHP, contact Blue Cross Blue
Shield of Michigan at 888-288-1726. For questions about
the HSA, contact Health Equity at 877-219-4506.
Health Plan Waivers
If you are covered by another health plan that
adequately meets your health care needs, you may
want to consider waiving your MSU health coverage.
Individuals who waive coverage will receive a payment
of up to $600 per year. Payments occur in February
for the previous plan year. This means if you enroll in
the waiver for the 2022 plan year, you will receive your
payment in February 2023.
Enrollment is not automatic, you must enroll online for
the waiver during Open Enrollment.
Note: Employees and spouses who are both employed
at MSU are not eligible for the waiver option. Find
detailed waiver info at
hr.msu.edu/benefits/healthcare/waiver.html.
Questions? Visit hr.msu.edu/open-enrollment │ 8Faculty Monthly Health Plan Premiums
Contributions are made pre-tax through PLAN COVERAGE FULL-TIME 3/4 TIME 1/2 TIME
payroll deduction on a monthly basis. TIER FACULTY (65%–89.9%) (50%–64.9%)
Dependent Age Criteria FACULTY FACULTY
Blue Care Single $64.79 $213.61 $362.43
Children (biological, step or adopted) are
Network (BCN) 2 person $136.06 $448.58 $761.11
eligible through the end of the calendar with CVS/ Family $161.98 $534.03 $906.08
year in which they turn age 26. Caremark
Non-adopted grandchildren, nieces, CDHP with Single $26.92 $82.50 $216.25
nephews or wards are eligible through HSA with CVS/ 2 person $51.59 $109.22 $386.87
legal guardianship through the end of the Caremark Family $60.22 $107.24 $435.99
calendar year in which they turn age 23. Community Blue Single $301.58 $450.40 $599.22
PPO with CVS/ 2 person $633.32 $945.84 $1,258.37
You will receive an email from HR with Caremark Family $753.96 $1,126.01 $1,498.06
options to continue coverage for children 1. Dependents who become incapacitated before age 19 can continue coverage after age
once they have aged out of coverage. 23 or 26 by completing the MSU Dependent Disability Certification Form at hr.msu.edu/
benefits/documents/DependentDisabilityCertForm.pdf.
Health Plan Premiums for Sponsored Dependents
This is the monthly premium rate if you wish to PLAN SPONSORED DEPENDENT
add a sponsored dependent to your health and Blue Care Network (BCN) with
$714.35
prescription coverage. A sponsored dependent is CVS/Caremark
someone who is related to you by blood, marriage CDHP with HSA with CVS/
$402.70
or legal adoption, is a member of your household Caremark
and is dependent on you for more than half of Community Blue PPO with CVS/
$998.50
their support. The dependent must meet the IRS Caremark
The sponsored dependent premium is in addition to the faculty monthly premium
dependency test. More details can be found on the
rates listed above.
HR website at hr.msu.edu.
Health Plan Premiums for PLAN FAMILY CONTINUATION
Family Continuation Blue Care Network (BCN) with
CVS/Caremark
$297.63
This is the premium rate if you wish to add a non- CDHP with HSA with CVS/
$167.78
Caremark
adopted grandchild, niece, nephew or ward through
Community Blue PPO with CVS/
legal guardianship (age 23 to 25) to your health and $416.04
Caremark
prescription coverage. More details can be found on
The family continuation premium is in addition to the faculty monthly premium
the HR website at hr.msu.edu. rates listed above.
9 │ Faculty and Academic Staff Open Enrollment Guide – 2022 EditionAcademic Year (AY) Faculty Monthly Health Plan
Premiums
These charts are for faculty and academic staff on nine-month academic year (AY) appointments. Instead of
receiving 12 monthly paychecks throughout the year, faculty and academic staff who have nine-month AY
appointments receive 10 monthly checks over the duty period (August 16 through May 15).
Health plan contributions are made PLAN COVERAGE FULL-TIME 3/4 TIME 1/2 TIME
pre-tax through payroll deduction, TIER FACULTY (65%–89.9%) (50%–64.9%)
and taken out of eight of the ten FACULTY FACULTY
paychecks (September through April). Blue Care Network Single $97.19 $320.42 $543.65
(BCN) with CVS/ 2 person $204.09 $672.87 $1,141.66
Caremark Family $242.97 $801.05 $1,359.13
VISIT
CDHP with Single $40.38 $123.76 $324.37
hr.msu.edu/employment/ay-pay-
HSA with CVS/ 2 person $77.38 $163.84 $580.30
schedule.html Caremark Family $90.33 $160.86 $654.00
to learn more. Community Blue Single $452.38 $675.61 $898.83
PPO with CVS/ 2 person $949.98 $1,418.76 $1,887.55
Caremark Family $1,130.94 $1,689.02 $2,247.10
Health Plan Premiums for Sponsored Dependents
Note: The health plan contributions listed for AY PLAN SPONSORED DEPENDENT
faculty will be taken out of 8 of 10 paychecks (Sep.– Blue Care Network (BCN)
$1,071.53
April). Deductions taken from Jan. through April cover with CVS/Caremark
the time period Jan. through June, and deductions CDHP with HSA with CVS/
$616.13
taken from Sept. through Dec. cover the time period Caremark
July through Dec. Community Blue PPO with
$1,497.75
CVS/Caremark
A termination or retirement that is effective after July
A sponsored dependent is someone who is related to you by blood, marriage or
1 will result in you being billed for your health and/or legal adoption; a member of your household; dependent on you for more than
half of their support; meeting the IRS dependency test. The sponsored dependent
dental premiums. A termination or retirement before premium is in addition to the faculty monthly premium rates listed above.
July 1 will result in a refund.
Health Plan Premiums for Family PLAN FAMILY CONTINUATION
Continuation Blue Care Network (BCN)
with CVS/Caremark
$446.45
This is the AY faculty premium rate if you wish to add CDHP with HSA with CVS/
$256.70
Caremark
a non-adopted grandchild, niece, nephew or ward
Community Blue PPO with
through legal guardianship (age 23 to 25) to your health $624.06
CVS/Caremark
and prescription coverage. Find more details on the HR
The family continuation premium is in addition to the faculty monthly premium
website at hr.msu.edu. rates listed above.
Questions? Visit hr.msu.edu/open-enrollment │ 10Health Plan Coverage Summary
Community Blue Blue Care Network CDHP w/HSA
Benefit In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
PREVENTIVE SERVICES
Health Maintenance Exam Covered 100%(1) Not covered Covered 100%(1) Not covered Covered 100%(1) Not covered
1 per calendar year
Annual Gynecological Exam Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
1 per calendar year
Pap Smear Screening (lab services Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
only) 1 per calendar year
Mammography Screening Covered 100% Covered 80% after Covered 100% Covered 80% of Covered 100% Covered 60%
1 per calendar year deductible eligible expenses after deductible
after deductible(2)
Prior authorization
may be required(3)
Contraceptive Devices (IUD, Covered 100% Covered 100% after Covered 100% Not covered Covered 100% Covered 60%
Diaphragm, Norplant) deductible after deductible
Contraceptive Injections Covered 100% Covered 80% after Covered 100% Not covered Covered 100% Covered 60%
deductible after deductible
Well-Baby and Child Care Exams Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
Immunizations (as recommended Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
by the Advisory Committee on
Immunization Practices or mandated
by the Affordable Care Act)
Flu Shots Covered 100% Not covered Covered 100% Covered 100% Covered 100% Not covered
Fecal Occult Blood Screening Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
1 per calendar year
Preventive Colonoscopy(4) Covered 100% Covered 80% after Covered 100% Covered 80% of Covered 100% Covered 60%
1 per calendar year deductible eligible expenses after deductible
after deductible(2)
Prior authorization
may be required(3)
Flexible Sigmoidoscopy Exam Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
1 per calendar year
Prostate Exam Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
1 per calendar year(4)
Prostate Specific Antigen Screen Covered 100% Not covered Covered 100% Not covered Covered 100% Not covered
1 per calendar year(4)
PHYSICIAN OFFICE SERVICES (MEDICALLY NECESSARY)
Office Visits/Consultations Co-pay: $20 Covered 80% after Co-pay: $20 Covered 80% after Covered 80% Not covered
deductible deductible after deductible
EMERGENCY MEDICAL CARE
Hospital Emergency Room Co-pay: $250 Co-pay: $250 Co-pay: $250 Co-pay: $250 Covered 80% Covered 80%
(waived based (waived based (waived based (waived based after deductible after deductible
on signs and on signs and on signs and on signs and
symptoms, accident symptoms, accident symptoms, accident symptoms, accident
or if admitted) or if admitted) or if admitted) or if admitted)
Emergency Room Physician’s Co-pay: $20 (when Covered 80% after Covered 100% Covered 100% Covered 80% Covered 80%
Services medical emergency deductible after deductible after deductible
criteria not met)
Urgent Care Center Co-pay: $25 Covered 80% after Co-pay: $25 Co-pay: $25 Covered 80% Not covered
deductible after deductible
Ambulance Service Covered 100% Covered 100% Covered 80% after Covered 80% after Covered 80% Covered 80%
Must be medically necessary of the approved of the approved deductible, ground deductible, ground after deductible after deductible
amount. Subject to amount. Subject to and air and air
faculty deductible deductible.
11 │ Faculty and Academic Staff Open Enrollment Guide – 2022 EditionCommunity Blue Blue Care Network CDHP w/HSA
Benefit In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
DIAGNOSTIC SERVICES
Laboratory and Covered 100% Covered 80% after Covered 100% Covered 100% Covered 80% after Covered 80% after
Pathology Tests Subject to faculty deductible deductible deductible
deductible
Diagnostic Tests and Covered 100% Covered 80% after Covered 100% after Covered 80% after Covered 80% after Covered 60% after
X-Rays Subject to faculty deductible deductible. Prior deductible. Prior deductible deductible
deductible authorization may be authorization may
required(3) be required(3)
Radiation Therapy Covered 100% Covered 80% after Covered 100% after Covered 80% after Covered 80% after Covered 60% after
Subject to faculty deductible deductible deductible deductible deductible
deductible
MATERNITY SERVICES PROVIDED BY A PHYSICIAN
Pre-Natal and Post-Natal Covered 100% Covered 80% after Covered 100% Covered 80% after Pre-Natal: Covered Covered 60% after
Care deductible deductible(2) 100% deductible
Prior authorization Post-Natal: Covered
may be required 80% after deductible
Delivery and Nursery Covered 100% Covered 80% after Covered 100% after Covered 80% after Covered 80% after Covered 60% after
Care Subject to faculty deductible deductible deductible(2) deductible deductible
deductible Prior authorization Prior authorization
may be required(3) may be required(3)
HOSPITAL CARE
Semi-Private Room, Covered 100% Covered 80% after Covered 100% after Covered 80% Covered 80% Covered 60% after
General Nursing Care, (unlimited days) deductible deductible (unlimited after deductible(2) after deductible deductible
Hospital Services and Prior authorization may Prior authorization days) (unlimited days) (unlimited days)
Supplies be required(3) Subject may be required(3) Prior authorization Prior authorization Prior authorization
to faculty deductible required(3) required(3) may be required(3)
Inpatient Consultations Covered 100% Covered 80% after Covered 100% after Covered 80% after Covered 80% after Covered 60% after
Subject to faculty deductible deductible deductible(2) deductible deductible
deductible
Chemotherapy Covered 100% Covered 80% after Covered 100% after Covered 80% after Covered 80% after Covered 60% after
Subject to faculty deductible deductible deductible deductible deductible
deductible
SURGICAL SERVICES
Surgery and Related Covered 100% Covered 80% after Covered 100% after Covered 80% after Covered 80% after Covered 60% after
Surgical Services Prior authorization may deductible deductible deductible deductible deductible
be required(3) Prior authorization Prior authorization Prior authorization Prior authorization
Subject to faculty may be required(3) may be required(3) may be required(3) may be required(3)
deductible
Voluntary Sterilization Covered 100% Covered 80% after Male Sterilization: Not covered Male Sterilization: Female sterilization:
Subject to faculty deductible Covered 100% after Covered 50% after Covered 60% after
deductible deductible deductible deductible
Female Sterilization: Female Sterilization: Male sterilization:
Covered 100% under Covered 100% under Not covered
preventive benefit preventive benefit
HUMAN ORGAN TRANSPLANTS
Such as: liver, heart, Covered 100% Covered 80% - Covered 100% after Not covered Covered 80% after Covered 80% after
lung, pancreas, heart- Prior authorization may 100% depending deductible deductible deductible
lung, kidney, cornea and be required(3) on the type Prior authorization is Prior authorization
skin and bone marrow Subject to faculty of approved required(3) may be required(3)
(subject to program deductible transplant. Prior
guidelines) Must be authorization may
provided at a BCBSM be required.(3)
designated facility
and may need to be
coordinated through the
BCBSM Human Organ
Transplant Program.
NATIONAL CANCER INSTITUTE CLINICAL TRIALS
Cancer and life- Covered 100% Covered 80% after Covered 100% after Not covered Covered 80% after Covered 60% after
threatening conditions Prior authorization may deductible deductible deductible deductible
(all stages, including be required(3) Prior authorization Prior authorization
routine care) Subject to faculty may be required(3) may be required(3)
deductible Questions? Visit hr.msu.edu/open-enrollment │ 12Community Blue Blue Care Network CDHP w/HSA
Benefit In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
ALTERNATIVES TO HOSPITAL CARE
Skilled Nursing Care Covered 100%(2) in approved facilities (up to Covered 100% after Covered 80% Covered 80% Covered 80%
(must meet medical 120 days per calendar year) deductible (combined after deductible after deductible after deductible
necessity guidelines Prior authorization may be required(3) in- and out-of-network (combined in- and (combined in- and (combined in- and
for skilled care) Subject to faculty deductible benefits limited out-of-network out-of-network out-of-network
to 100 days per benefits limited benefits limited benefits limited
calendar year) Prior to 100 days per to 90 days per to 90 days per
authorization calendar year) calendar year) calendar year)
required(3) Prior authorization Prior authorization
required(3) required(3)
Hospice Care Covered 100%(2) with approved providers Covered 100% after Covered 80% Covered 100% Covered 100% after
deductible. Prior after deductible. after deductible deductible
authorization Prior authorization when authorized.
required(3) required(3) Prior authorization
required(3)
Home Health Care Covered 100%(2) with approved providers Covered 100% after Covered 80% Covered 80% Covered 80%
(medically necessary) (unlimited visits) deductible (combined after deductible after deductible after deductible
Subject to faculty deductible in- and out-of-network (combined in- and (combined in- and (combined in- and
benefits limited to out-of-network out-of-network out-of-network
60 days per calendar benefits limited to benefits limited to benefits limited
year) 60 days per calendar 60 days per calendar to 60 days per
year) year) calendar year)
MENTAL HEALTH CARE AND SUBSTANCE ABUSE TREATMENT (IN APPROVED FACILITIES)
Inpatient Mental Covered 100% Covered 80% after Covered 100% after Covered 80% after Covered 80% after Covered 60% after
Health/Substance Prior authorization deductible deductible deductible(2) deductible(2) deductible
Abuse Care may be required(3) Prior authorization Prior authorization Prior authorization Prior authorization
Subject to faculty may be required(3) required(3) required(3) may be required(3)
deductible
Outpatient Mental Covered 100% Covered 80% after Covered 100% Covered 80% after Covered 80% after Covered 60% after
Health/Substance deductible Prior authorization deductible(2) deductible deductible
Abuse Care - Office may be required(3) Prior authorization Prior authorization
Visits may be required(3) may be required(3)
Outpatient Mental Covered 100% Covered 100% Covered 100% Covered 80% after Covered 80% after Covered 80%
Health/Substance Subject to faculty Prior authorization deductible(2) deductible after deductible
Abuse Care – Facility deductible may be required(3) Prior authorization Prior authorization in participating
may be required(3) may be required(3) facilities only
OTHER SERVICES
Allergy Testing and Covered 100% Covered 80% after Covered 100% Covered 80% after Covered 80% after Covered 60% after
Therapy (includes deductible Office visit co-pay may deductible(2) deductible deductible
allergy injections) apply to consultations Prior authorization
may be required(3)
Spinal Manipulation Co-pay: $20 Covered 80% after Co-pay: $20 Not covered Covered 80% after Chiropractic Spinal
and Osteopathic (In- and out-of- deductible (in- and (In-network only. deductible Manipulations: 60%
Manipulation network services out-of-network Annual max. of 24 (In- and out-of- after deductible.
have an annual services have an visits) network services Osteopathic
combined max. of annual combined Prior authorization have an annual Manipulation: Not
24 visits) max. of 24 visits) required for combined max. of 24 covered
chiropractic services(3) visits)
Outpatient Diabetes Covered 100% Covered 80% after Covered 100% Not covered Covered 80% after Covered 60% after
Management deductible deductible deductible
(certified providers)
Outpatient Covered 100% Covered 80% after Co-pay: $20 Covered 80% Covered 80% Covered 60% after
Physical, Speech, (in- and out-of- deductible (in- and (combined in- and after deductible after deductible deductible
and Occupational network services out-of-network out-of-network (combined in- and (combined in- and (Services at
Therapy (subject to have an annual services have an benefits limited to 60 out-of-network out-of-network nonparticipating
medical criteria)* combined max. of annual combined visits per calendar benefits limited benefits limited outpatient physical
60 visits) max. of 60 visits) year) to 60 visits per to 60 visits per therapy facilities are
Prior authorization calendar year)(2) calendar year) not covered)
required(3) Prior authorization Prior authorization
required(3) required(3)
*Autism Spectrum Disorder services are not subject to Outpatient Physical, Speech, and Occupational Therapy visit limit.
13 │ Faculty and Academic Staff Open Enrollment Guide – 2022 EditionCommunity Blue Blue Care Network CDHP w/HSA
Benefit In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Durable Medical Covered 100%(2) of the approved amount Covered 80% Not covered Covered 80% Covered 80% after
Equipment and Medical Prior authorization Prior authorization deductible
Supplies (including may be required(3) may be required(3)
breastfeeding supplies)
Private Duty Nursing Covered 50% Covered 50% Not covered Not covered Not covered Not covered
Subject to faculty Subject to faculty
deductible deductible
Autism Spectrum Covered 100% for Covered 100% for Co-pay: $20 per Covered 80% after Covered 80% after Covered 80% after
Disorder applied behavioral applied behavioral visit for applied deductible for applied deductible deductible
(Applied behavioral analysis analysis behavioral analysis behavioral analysis Prior authorization Prior authorization
analysis treatment - Prior authorization Prior authorization Prior authorization Prior authorization required required
must be provided by required required required required
an Approved Autism Subject to faculty Subject to faculty
Evaluation Center deductible deductible
(AAEC) - limited through
age 19)
FOREIGN TRAVEL
Foreign Travel Covered for non- Covered for non- Only covered for Only covered for Covered for non- Covered for non-
emergency and emergency and emergency care emergency care and emergency and emergency and
emergency care as emergency care as and accidental accidental injuries emergency care as emergency care as
well as accidental well as accidental injuries when when traveling well as accidental well as accidental
injuries injuries traveling abroad abroad injuries injuries
DEDUCTIBLES, CO-PAYS AND DOLLAR MAXIMUMS
Deductibles Faculty/Acad $250 per member/ $100 per member/ $500 per member/ $2,000 for $4,000 for
Staff: $100 per $500 per family $200 per family $1,000 family per single/$4,000 for single/$8,000
member/$200 per calendar year per calendar year calendar year family-level coverage for family-level
per family per (services where no per calendar year coverage per
calendar year network exists are (Deductible is calendar year
covered at the in- combined for medical
network level) and prescription
drug coverage. The
full family deductible
must be met under
a two-person or
family contract before
benefits are paid for
any person on the
contract)
Out-of-Pocket Maximum $2,000 per $2,000 per member/ $3,000 per $3,000 per $3,000 for $6,000 for
(Amount includes member/ $4,000 $4,000 per family per member/ $6,000 member/$6,000 per single/$6,000 for single/$12,000
deductible, co-insurance per family per calendar year for co- per family per family per calendar family-level coverage for family-level
and co-pays, where calendar year insurance, plus $250 calendar year for year for co-insurance, per calendar year for coverage
applicable) per member/$500 medical services plus $500 per both medical and
per family out-of- only member/$1,000 per prescription services
network deductible(2) family out-of-network
deductible(2)
Prescription Drug Benefit $1,000 per member /$2,000 per family $1,000 per member /$2,000 per family Subject to deductible, co-insurance and
out-of-pocket maximum out-of-pocket maximum out-of-pocket max
(see page 15 for co-pays) (see page 15 for co-pays)
1. Chemical profile, complete blood count, urinalysis, cholesterol testing, chest x-ray and EKG are payable as part of the Health Maintenance Exam. These services become
subject to the faculty deductible when billed as medical/diagnostic.
2. You may be responsible for the difference between BCBSM’s or BCN’s approved amount and the provider’s charge when services are rendered by a non-participating
provider, premiums and health care this plan doesn’t cover, where applicable.
3. Referrals to specialists are not required.
4. Age restrictions may apply.
Questions? Visit hr.msu.edu/open-enrollment │ 14Glossary of Terms
Allowed Amount participate in the health plan’s provider and hospital
Maximum amount on which payment is based for network.
covered health care services. If your provider charges
more than the allowed amount, you may have to pay Out-of-network
the difference. Refers to the use of health care professionals who are
not contracted with the health insurance plan.
Academic Year Appointment (AY)
Refers to a full 12-month period with a nine-month Out-of-pocket Maximum(s)
assignment of duties and responsibilities. The highest amount you are required to pay for
covered services. Once you reach the out-of-pocket
Annual Year Appointment (AN) maximum(s), the plan pays 100% of expenses for
Refers to a full-year assignment of duties and covered services.
responsibilities including periods of annual leave and
paid holidays. Prior Authorization
A decision by your health insurer or plan that a health
Coordination of Benefits (COB) care service, treatment plan, prescription drug or
A provision to help avoid claims payment delays and durable medical equipment is medically necessary.
duplication of benefits when a person is covered by Sometimes called preauthorization, prior approval or
two or more plans providing benefits or services for precertification. Your health insurance or plan may
medical, dental or other care/treatment. One plan require prior authorization for certain services before
becomes the “primary” plan and the other becomes you receive them, except in an emergency. Prior
the “secondary” plan. This establishes an order in authorization isn’t a promise your health insurance or
which the plans pay their benefits. plan will cover the cost.
Co-pay Premium
A fixed amount you pay for a covered health care The amount that must be paid for your health
service, usually when you receive the service. The insurance or plan. You and/or your employer usually
amount can vary by the type of service. pay it monthly, quarterly or yearly.
Deductible Referral
A set dollar amount that you must pay out-of-pocket Specific directions or instructions from a your primary
toward certain health care services before insurance care physician that direct a member to a participating
starts to pay. Deductibles run on a calendar-year health care professional for medically necessary care. A
basis. referral may be written or electronic.
Durable Medical Equipment (DME)
Equipment and supplies ordered by the health care
provider for everyday or extended use. Coverage for
DME may include: oxygen equipment, wheelchairs,
Benefits 101
crutches or blood testing strips for diabetics.
In-network
Refers to the use of health care professionals who
15 │ Faculty and Academic Staff Open Enrollment Guide – 2022 EditionPrescription Drug Information
The prescription drug plan is administered through CVS/Caremark. You
will continue to be automatically enrolled for prescription drug coverage
in CVS/Caremark when you enroll in one of the health plans (Community
Blue PPO, Blue Care Network (BCN) or the Consumer Driven Health Plan
with Health Savings Account (CDHP with HSA)).
The table below shows co-pay rates for various types of prescription
drugs for Community Blue and BCN enrollees effective January 1, 2022.
Enrollees can use any in-network pharmacy for this benefit.
CVS/Caremark Customer
Service
CVS/Caremark Prescription Plan Co-Pays for BCN & Community Blue
1-800-565-7105
# DRUG TIER 34-DAY SUPPLY CO-PAYS 90-DAY SUPPLY CO-PAYS*
Caremark.com – create a 1. Generic Medications $10 $20
member profile 2. Preferred Brand-Name Medications $30 $60
Download the Caremark app 3. Non-Preferred Brand-Name $60 $120
Medications
VISIT 4. Specialty Drugs $75 90-day supplies of specialty
drugs are not offered
hr.msu.edu/benefits/
ANNUAL OUT-OF-POCKET CO-PAY MAXIMUM
prescription-drug-plan/ Individual: $1000 Family: $2000
for detailed prescription drug
*90-day supply (except Bio-Tech/Specialty Drugs) may only be filled at MSU
coverage information.
Pharmacies or through CVS/Caremark mail order.
Important Note for CDHP with HSA Enrollees:
MSU Health Care Pharmacy
517-353-3500 If you are a CDHP with HSA enrollee, you have different prescription
pharmacy.msu.edu/ benefits. Prescription drug costs under this plan are subject to plan
deductible and co-insurance, and then the total cost is covered after you
MSU Health Care is offering flu reach the out-of-pocket maximum. This means that you pay 100% of
shots by appointment. Please visit prescription costs until you reach the deductible. Once the deductible is
pharmacy.msu.edu to make an met, the plan covers 80% of the costs while you pay 20% co-insurance.
appointment. Once the out-of-pocket maximum is reached, prescriptions are 100%
covered.
Certain preventive generic prescription drugs for chronic conditions
(asthma, cholesterol, diabetes and anti-hypertensives) are 100% covered
without a deductible or co-insurance.
Be sure to enroll in the HSA when you enroll in the CDHP plan to receive
MSU’s HSA contribution of $750. You can use this money to pay for
eligible medical and prescription costs.
Questions? Visit hr.msu.edu/open-enrollment │ 16Dental Plan Information
MSU offers two dental plans to benefits-eligible faculty and academic
staff: Aetna Premium DMO and Delta Dental.
In a Dental Maintenance Organization (DMO) like Aetna Premium DMO,
you select a participating primary care dentist. Your primary dental care
is provided by that dentist and only at locations and by dentists that
participate in the plan. Although choice of providers is more limited, a PROVIDER
DMO tends to cover a greater range of services at lower co-pays than CONTACT INFO
traditional dental plans.
Aetna Dental
If you plan to enroll in the Aetna Premium DMO, please verify that 877-238-6200
the dentist you want to use accepts “Aetna DMO” rather than just aetna.com
“Aetna” to avoid rejected claims. Download the Aetna app
Delta Dental
The Delta Dental PPO plan typically allows more freedom in selecting 800-524-0149
service providers and services performed but tends to have higher deltadentalmi.com
out-of-pocket costs compared to a DMO plan. Delta offers hundreds Download the Delta Dental
of participating providers and allows you to seek care from both app
participating and non-participating providers. Note: You may incur
additional costs if you use a non-participating provider. Contact Delta VISIT
Dental for information on participating providers. hr.msu.edu/benefits/
dental/
Dependent Age Criteria: Children (biological, step or adopted),
to learn more about MSU
non-adopted grandchildren, nieces, nephews or wards through legal
dental plans.
guardianship are eligible through the end of the calendar year in which
they turn age 23. Dependents who become incapacitated before age 19
can continue coverage after age 23 by completing the MSU Dependent
Disability Certification Form at hr.msu.edu/benefits/documents/
DependentDisabilityCertForm.pdf.
Monthly Dental Plan Premiums
Faculty Monthly Dental Plan Contributions AY Faculty Monthly Dental Plan Contributions
PLAN FULL-TIME 3/4 TIME 1/2 TIME PLAN FULL-TIME 3/4 TIME 1/2 TIME
(90%–100%) (65%–89.9%) (50%–64.9%) (90%–100%) (65%–89.9%) (50%–64.9%)
AETNA PREMIUM DMO AETNA PREMIUM DMO
Single $11.34 $16.20 $21.06 Single $17.01 $24.31 $31.60
2 Person $21.19 $30.49 $39.80 2 Person $31.79 $45.75 $59.70
Family $36.47 $51.68 $66.89 Family $54.71 $77.52 $100.34
DELTA DENTAL PPO DELTA DENTAL PPO
Single Paid by MSU Paid by MSU Paid by MSU Single Paid by MSU Paid by MSU Paid by MSU
2 Person Paid by MSU Paid by MSU $6.79 2 Person Paid by MSU Paid by MSU $10.19
Family Paid by MSU $15.21 $30.42 Family Paid by MSU $22.82 $45.63
These rates are for faculty and academic staff on 9-month academic year
(AY) appointments.
17 │ Faculty and Academic Staff Open Enrollment Guide – 2022 EditionDental Plan Summary of Benefits
DENTAL SERVICE AETNA PREMIUM DMO DELTA DENTAL
DIAGNOSTIC AND PREVENTIVE
Exams No co–pay 50% co–pay
Cleanings No co–pay 50% co–pay
X–rays No co–pay 50% co–pay
Fluoride No co–pay (1 per year under age 16) 50% co-pay (age 18 and under)
Sealants (to prevent decay of permanent molars for $10 co–pay per tooth Not covered
dependents)
Space maintainers $80 co–pay (fixed and removable) 50% co–pay (age 18 and under)
MINOR RESTORATIVE
Amalgam (silver) fillings No co–pay 50% co–pay
Composite (resin) fillings (anterior teeth) No co–pay 50% co–pay
PROSTHETICS
Crowns (semi–precious) $315 co–pay 50% co–pay
Bridges (per unit) $315 co–pay 50% co–pay
Denture (each) $320 co–pay 50% co–pay
Partial (each) $320 co–pay 50% co–pay
ORAL SURGERY
Simple extraction No co–pay 50% co–pay
Extraction – erupted tooth No co–pay 50% co–pay
Extraction – soft tissue impaction $60 co–pay 50% co–pay
Extraction – partial bony impaction $80 co–pay 50% co–pay
Extraction – complete bony impaction $120 co–pay 50% co–pay
ENDODONTICS
Root canal – anterior $120 co–pay 50% co–pay
Root canal – bicuspid $180 co–pay 50% co–pay
Root canal – molar $300 co–pay 50% co–pay
Apicoectomy $170 co–pay 50% co–pay
PERIODONTICS
Gingivectomy (per quadrant) $125 co–pay 50% co–pay
Osseous surgery (per quadrant) $375 co–pay 50% co–pay
Root scaling (per quadrant) $60 co–pay 50% co–pay
ORTHODONTICS
Child (up to age 19) $1,500 co–pay(1) 50% co–pay
Adult (age 19 or older) $1,500 co–pay (1)
Not covered
DENTAL PLAN MAXIMUMS
Annual No maximum $600 maximum
Lifetime Orthodontics No maximum $600 maximum
1. Includes screening exam, diagnostic records, orthodontic treatment and orthodontic retention. Phase 1 orthodontic services are not covered, which includes
treatment to prepare the mouth to be fully banded or possibly avoid a comprehensive treatment plan.
Questions? Visit hr.msu.edu/open-enrollment │ 18Life Insurance Information PROVIDER
CONTACT INFO
MSU offers optional employee-paid life insurance to all regular full- and Prudential
part-time (50% or more) employees, as well as to your spouse/other eligible 877-232-3555
individual (OEI) and dependent children. You do not need to be enrolled to add Prudential.com
your children or spouse/OEI.
VISIT
Life insurance is offered at 1 to 10 times your annual salary. There are various
hr.msu.edu/benefits/life-
levels of coverage for your spouse/OEI and children. You must provide
insurance/
evidence of insurability when enrolling or increasing your life insurance
to learn more and read the
coverage for yourself or your spouse/OEI. Evidence of insurability is not
Prudential brochure.
required for children. Prudential will contact you via your MSU NetID email
address with instructions on how to submit evidence of insurability. Please see
Dependent Age Criteria at the bottom of page 20. VISIT
Prudential.com/
Optional Life Insurance Cost
EZLifeNeeds
Use the charts and formulas below to calculate the monthly cost for you, your
to estimate your insurance
spouse/OEI, and/or your children. Rates are different for faculty and academic
needs.
year (AY) faculty. Note: rates will change on the date you enter a new age
bracket or if your salary changes.
EMPLOYEE LIFE INSURANCE COST Chart A. Employee Rates Per $1,000 of Coverage by Age
STEP ONE – determine the following: AGE FACULTY RATE AY FACULTY RATEAccidental Death & PROVIDER
Dismemberment Insurance CONTACT INFO
Prudential
Optional employee-paid accidental death and dismemberment (AD&D) 877-232-3555
insurance provides various amounts of coverage for accidental death or Prudential.com
dismemberment or loss of sight whether in the course of business or pleasure.
VISIT
Optional family coverage is also offered. Prudential is the plan administrator for
hr.msu.edu/benefits/life-
AD&D insurance. This is available to all regular full- and part-time (50% or more)
insurance/
employees, your spouse/other eligible individual (OEI) and dependent children.
to learn more and read the
You can enroll in AD&D coverage at 1 to 10 times your annual salary. Benefit Prudential brochure.
levels vary by type of insurance selected (employee-only or family) and the
extent of the injury. Evidence of insurability is not required. Benefit amounts
for spouse/OEI and/or child(ren) are based on a percentage of your benefit
amount. Please refer to the Prudential brochure for more info (see side panel).
Optional AD&D Insurance Cost
Use the chart and formula below to find the cost of insurance for you, your
spouse/OEI, and your children. Rates are subject to change.
AD&D INSURANCE COST Chart A. Rates Per $1,000 of Coverage
COVERAGE TYPE RATE
STEP ONE – determine the following: Employee-only (faculty) $0.015
Employee-only (AY faculty) $0.023
1. Your salary. Family (faculty) $0.023
2. Your rate (see Chart A.) Family (AY faculty) $0.035
3. Your benefit level. Choose from 1 – 10 times your salary, up to a maximum of $1,500,000 for the employee,
$750,000 for a spouse/OEI, or $100,000 per child.
STEP TWO – use the following formula and your answers from step one to calculate monthly cost:
Salary x Rate x Benefit Level ÷ 1,000 = $ /month
EXAMPLE
1. Salary = $50,000
2. Employee rate = $0.015 (according to Chart A.)
3. Benefit level chosen = 5 x salary
$50,000 (salary) x $0.015 (rate) x 5 (benefit level) ÷ 1,000 = $3.75/month
Important Note: Academic Year (AY) faculty and academic staff order to stop premium deductions.
on 9-month appointments have their contributions taken out of 8 Children who become incapacitated before the age limit can
paychecks. continue coverage after the age limit if (1) the child is mentally and/
Dependent Age Criteria: AD&D and life insurance dependent or physically incapable of earning a living AND (2) Prudential has
child(ren) are eligible to the end of the calendar year during received proof of incapacity within 31 days. If the child becomes
which the child turns age 23 with no restrictions such as student incapacitated after the age limit, they will not be able to continue
enrollment or IRS dependency. It is the enrollee’s responsibility coverage.
to cancel coverage when dependent children no longer qualify in
Questions? Visit hr.msu.edu/open-enrollment │ 20You can also read
