USG COMPARISON GUIDE 2021 - University System of Georgia
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2021 USG COMPARISON GUIDE
Table of Contents
Spotlight on 2021....................................................................................................................................3-4
USG Healthcare Plan Surcharges................................................................................................................5
Making Changes to Your Benefits...............................................................................................................6
USG Well-being.......................................................................................................................................7-9
Accolade.................................................................................................................................................10
2021 Premium Rates for Active Employees...............................................................................................11
2021 Premium Rates for Pre-65 Retirees...................................................................................................12
2021 Healthcare Benefits at a Glance..................................................................................................13-17
CVS Pharmacy....................................................................................................................................18-20
HMO Service Area by County....................................................................................................................21
Kaiser Permanente..............................................................................................................................22-24
Anthem...............................................................................................................................................25-26
Flexible Spending Accounts......................................................................................................................27
Health Savings Accounts.....................................................................................................................28-29
Employee Assistance Program (EAP)........................................................................................................30
Dental .....................................................................................................................................................31
Vision .....................................................................................................................................................32
Life Insurance..........................................................................................................................................33
Disability Insurance .................................................................................................................................34
USG Accident Plan ..................................................................................................................................35
USG Hospital Indemnity Plan ..............................................................................................................36-37
USG Critical Illness Plan......................................................................................................................38-39
USG Legal Plan........................................................................................................................................40
Identity Protection ...................................................................................................................................41
Pet Insurance ..........................................................................................................................................42
Purchasing Power ...................................................................................................................................43
USG Perks at Work...................................................................................................................................44
USG Retirement...................................................................................................................................45-48
Important Numbers ......................................................................................................................49-50
2
Spotlight on 2021
The University System of Georgia (USG) is composed of 26 higher education institutions, including four research
universities, four comprehensive universities, nine state universities and nine state colleges, as well as the Georgia Public
Library Service. Your benefits are provided through USG. We know that USG benefits are important to you and your family.
They offer protection, peace of mind and comfort ― and you want to make the most of them. Your life changes and your
needs change, so it’s always a good idea to review your options so you can make smart benefit choices.
USG Healthcare Changes N
ew for 2021: Personalized health
For 2021, there will be no plan design changes to the and benefits support with Accolade
healthcare plans. There will be a slight $3–$10 (or 1%–2%) Starting January 1, 2021, employees and all covered
increase in premiums for employees enrolled in coverage dependents enrolled in an Anthem plan, will have an
for the family tier to align premiums with the other tiers. Accolade Health Assistant. Your Accolade Health
Assistant will help you with things like finding a provider,
Healthcare and Pharmacy questions requesting an ID card or understanding a claim and/or
healthcare bill. Additionally, Accolade’s registered nurses
Beginning January 1, 2021, Accolade will be your single and clinicians will help you navigate your more complex
point of contact for all of your healthcare and pharmacy healthcare concerns, like understanding a diagnosis or
questions. Employees enrolled in an Anthem healthcare treatment plan, coordinating care and/or connecting you
plan will receive a new ID card for 2021. Your plan with the help you need to manage a condition.
information will remain the same, but Accolade will replace
the Anthem member services number on the back of your As your single point of contact, your Accolade Health
ID Card. For questions prior to that, call the number on the Assistant will simplify your healthcare and benefit
back of your ID card. experience – helping you to save time, receive better care
and get the most of out your USG healthcare benefits.
Anthem Appeal Process Need help after hours? Accolade also has a 24/7 nurse line
to ensure you get the right care, at the right place, when you
The appeals process must be followed for any medical need it.
claims in question. Once all appeals are exhausted through
Make sure your personal contact information is updated
Anthem, decisions will be considered final and will not be
when you enroll. Your information will always be
eligible for further review.
confidential, and you can opt-out at any point.
Pharmacy Benefits N
ew for 2021: Livongo makes
The formulary can change throughout the year, so it’s a managing your health easier
good idea to periodically check your medications against
the approved drug list. Employees enrolled in an Anthem healthcare plan don’t have
to manage their well-being journey alone. In addition to a
To view the current formulary: new diabetes prevention program, USG will also offer new
• Visit the USG Benefits Pharmacy website, weight management and diabetes care management
usg.edu/hr/benefits/2021_benefits/pharmacy programs for those who qualify.
or download the CVS Caremark app. • Diabetes Management: personalized support that
• Visit the Kaiser Permanente website at helps you understand your blood sugar, develop healthy
my.kp.org/usg/ or download the KP app. lifestyle habits and improve glycemic control.
• Diabetes Prevention Program: fully CDC-recognized
program that helps you focus on lifestyle change(s) to
prevent diabetes.
• Weight Management: evidence-based program that
helps you lose weight by focusing on lifestyle change(s).
3
Spotlight on 2021
InfoArmour: New name, same coverage
InfoAmour is changing its name to Allstate Identity Protection. If you are currently enrolled, your coverage will continue under
the “Pro Plus plan” and no additional action is required.
Identity theft remains a real threat in our day-to-day digital lives. If you are not currently enrolled, but you want more information
about how to add a layer of protection through the Identity Theft plan, please visit MyAIP.com or call 1-800-789-2720.
CAPTRUST
CAPTRUST provides unbiased financial and retirement advice, at no additional cost to you. Connect with an independent
CAPTRUST financial advisor to see if you are on track to achieve your financial goals - plus earn $20 in well-being credits
when you complete an appointment.
Whether your retirement savings are with AIG, Fidelity, TIAA or TRS, visit captrustadvice.com/usg or call the advice desk at
1-800-967-9948 to get started.
4
USG Healthcare Plan Surcharges
Tobacco surcharge Working spouse surcharge
Employees enrolled in a USG healthcare plan must certify To keep costs as low as possible for all of our employees
their spouse and their covered dependents' (age 18+) and the State of Georgia’s taxpayers, the University System
tobacco user status upon initial enrollment and annually of Georgia will apply a $100 per month working spouse
for each enrollment period. Employees who certify that surcharge for employees who choose to cover their
they are a tobacco user will incur an additional $100 per spouse under a USG Healthcare plan, if the employee’s
month for each tobacco user age 18+. Additionally, spouse works for another employer and receives an offer
employees who do not complete their tobacco user of coverage from that employer.
certification through OneUSG Connect- Benefits will be The Working Spouse Surcharge applies if your Spouse:
subject to the $100 surcharge.
• works for any employer other than the University
‘Tobacco user’ refers to the use of tobacco products System of Georgia and has an offer of other
within the past 3 consecutive months, but does not include coverage from that employer where the employer
religious or ceremonial use of tobacco. The term ‘tobacco makes a contribution to the cost of the healthcare
products’ refers to any tobacco product including coverage. Non-USG employers include private sector
cigarettes, cigars, pipes, all forms of smokeless tobacco, organizations, the State of Georgia and/or other
clove cigarettes, and any other smoking devices that use government agencies.
tobacco, such as hookahs, or simulate the use of tobacco,
The Working Spouse Surcharge does not apply
such as electronic cigarettes.
if your Spouse:
• works for the University System of Georgia or
Resources to help you quit is not covered by the USG Healthcare plan
We know it's not easy to quit, but we'll give you the support
• is covered under COBRA and/or is eligible or enrolled
you need. Therefore, a reasonable alternative is made
in Medicare or Tricare
available during the certification process for individuals
who want to become non-tobacco users. The opportunity • is unemployed, self-employed or ineligible
allows 90 days to complete a tobacco cessation program. for healthcare coverage
Tobacco cessation programs are available at no cost to
you and your dependents. Please contact these helpful • has healthcare available through his or her employer
resources to help you quit: but the employer does not contribute to insurance.
• Georgia Tobacco Quit Line: 1-877-270-7867 During benefits enrollment, employees who elect to cover
a spouse in the USG Healthcare plan will be required
• Kaiser Permanente: 1-866- 862-4295
to complete the working spouse certification through
• Virgin Pulse: Schedule by going to the USG Well-being OneUSG Connect – Benefits. This certification is required
platform. Select Programs > Coaching by phone with upon initial enrollment and annually during each open
Virgin Pulse > Start Now > Be Tobacco-Free. enrollment period. Employees who cover a spouse with an
offer of other coverage or who do not certify their working
If you become a non tobacco user or complete a cessation spouse status will have the $100 surcharge applied. No
program, you must update your tobacco user status with refunds will be given.
OneUSG Connect - Benefits, within 90 days of your If you have questions or need to update your surcharge
cessation election. No refunds will be given. certifications, please visit oneusgconnect.usg.edu
or call the OneUSG Connect – Benefits Call Center at
1-844-5-USGBEN (1-844-587-4236).
5
Making Changes to Your Benefits
Generally, after your initial benefit elections, you can only Note: you may be required to provide documentation to
change your benefit elections during the Open Enrollment support the Life Event change and dependent status,
period, unless you experience a qualifying life event, if adding new dependents.
defined by IRS 125 guidelines. The most common life
events are listed below:
Protect those who matter
• Birth and adoption of a child (including stepchildren
and legally placed foster children) As an active benefits-eligible employee, working 30+
hours per week, you can cover your eligible dependents.
• Death of a covered dependent
Eligible Dependents*:
• Marriage or divorce
• Your legal spouse
• Change in employment status that impacts benefits
eligibility (for covered employee and eligible dependents) • Your natural, adopted or stepchildren, up to age 26
• Your disabled child(ren), over the age of 26
For a complete list of qualifying life events and
with proof of disability
documentation required to make a change,
visit oneusgconnect.usg.edu
*H
ealthcare, Dental, Vision, Life and Disability. Some other voluntary
plans have additional eligibility criteria. Documentation is required
to add dependents to your coverage. Common examples include a
How to Make Benefit Changes marriage certificate, birth certificate, income tax return and/or joint
utility. Visit oneusgconnect for a complete list of requirements.
If you experience a qualifying life event, benefit updates
must be completed within 30 days of the life event.
Visit oneusgconnect.usg.edu, select Manage My
Benefits, and click the Change Your Coverage tile.
C
all OneUSG Connect - Benefits Call center at
1-844-587-4236. 8am - 5pm, EST, Monday - Friday
OneUSG Connect - Benefits Call
Center has translation services
at 1-844-587-4236
The OneUSG Connect - Benefits Call Center offers
translation services for all calls, in over 160 languages.
A Customer Care Representative will contact an
interpreter by phone, remain on the line during the
entirety of your phone call, and be available if any
follow-up calls are required. Our interpreters are
available during all hours that the OneUSG Connect
- Benefits Call Center is operating. All you need to do
is call the OneUSG Connect - Benefits Call Center,
and ask for an interpreter. Our Customer Care
Representative will take care of the rest!
6
USG Well-being
The 2021 program will continue to offer a $100 well-being credit, as well as an expanded list of activities to earn the
credit. USG Well-being will ensure members have access to resources surrounding diabetes education, prevention
and management as well as weight loss programming for those who qualify. This year employees and spouses must
complete the health assessment to participate in earning well-being credits. Complete healthy activities by Sept. 30,
2021. To receive the credit, you must be a current full-time employee or spouse enrolled in a USG healthcare plan
during the pay period in which the credit is paid.
The well-being credit is only available to employees and spouses covered by a USG healthcare plan. USG has partnered
with Virgin Pulse for well-being services. Your health information is confidential and will not be shared with USG.
The USG Well-being program is entirely voluntary and confidential. Have a question about your privacy or other details
of the program? Find answers in the FAQ, which is available at usg.edu/well-being. You can also read the Virgin Pulse
privacy policy at virginpulse.com/privacy-policy.
Choose your path to better health Activity tracking – Earn $10
USG Well-being provides you with a variety of tools that Track 10,000 steps for 20 or more days in a month to earn
make it easy for you to incorporate healthy habits into $10 each month, up to five times! If you use a wearable
your daily life. You can search for the topics and programs device or fitness app, you can sync it and watch your
that most interest you. Choose from tracking your daily steps add up automatically. If you are new to USG Well-
healthy habits, participating in wellness challenges, being or never connected a device before, you can also
utilizing financial or health coaching, joining community earn $5 for syncing! Devices and apps include Fitbit,
events and more. Garmin, Apple Health, MapMyFitness, Jawbone, Misfit,
Moves, Runkeeper, and Withings. Earning period: Jan. 1,
2021 - Sept. 30, 2021.
NEW! Health assessment
This year employees and spouses must complete the Financial coaching – Earn $20
health assessment to participate in earning well-being
credits. Answer questions about your daily nutrition, Complete a financial coaching appointment at no cost.
exercise, sleep and general health habits, emotional state Get answers to your financial questions and become better
and coping strategies.You’ll see your results and be able to prepared for your future. Appointments are offered with
measure the improvements to your well-being over time. CAPTRUST, Fidelity, TIAA and AIG Retirement. Mention you
are a USG Well-being participant. Note that calls for balance
Answer questions online or on your mobile device to get inquiries are not eligible for credit. Earning period: Oct. 1,
feedback and insights about your health. 2020 – Sept. 30, 2021.
USG has partnered with Virgin Pulse for the well-being CAPTRUST: 1-800-967-9948
services. Your health information is confidential and will Fidelity: 1-800-343-0860
not be shared with the USG. Earning period: Oct. 1, 2020 TIAA: 1-800-732-8353
– Sept. 30, 2021. AIG Retirement: 1-866-279-1444
Here is how to get active on the 2021 platform:
Employees: Register or sign in through One USG Connect - Benefits
at oneusgconnect.usg.edu > click on Manage My Benefits > click on
the USG Well-being tile from the home page.
Spouses: Register or sign in through ourwellbeing.usg.edu
You can also do it all from the app! Download the app by searching
for Virgin Pulse on the App Store® or Google Play™.
7
USG Well-being (Cont.)
Phone coaching – Earn $25 Money Monday – Earn $5
One-on-one expert guidance and support Participate in Money Monday, a monthly financial
education workshop. Earn $5 for each workshop, up to
Complete four or more Virgin Pulse coaching calls at no five times. You can participate in as many webinars as
cost. Coaching offers the opportunity to work with an you wish! Visit usg.edu/well-being under “events”
expert and develop a plan to support you in nutrition, to register. Earning period: Oct. 1, 2020 – Sept. 30, 2021.
weight management, stress, diabetes management, This workshop provides:
pharmacy, or various other topics. Talk with a coach when
it works for your schedule. Earning period: Oct. 1, 2020 – • Guidance to employees who may be stressed about
Sept. 30, 2021. economic conditions, market fluctuations and personal
finances.
• Virgin Pulse: Schedule by going to The USG Well-being
platform. Select Programs > Coaching by phone with • Education about benefits in the context of personal
Virgin Pulse > Start Now > Choose the type of coaching financial planning, including saving, investing, debt
that's best for you. management and planning for the unexpected.
Community and local events – JOURNEYS®– Earn $10
Earn $10 Complete a Journey (Digital Coaching) and earn $10 for
each journey, up to three times. Reaching a personal
Record on the programs page any volunteer work or
health goal starts with a single step. Journeys® are daily,
participation in a community event and earn $10 for
self-guided courses to help you build healthy habits. You
each activity, up to two times. Earn well-being credit for
can use the Virgin Pulse digital coaching tool to make
volunteering, participating in events such as a community
changes to your health and build daily habits, one step at
5K run/walk, or other events of your choosing—any
a time. Get a motivation boost, read evidence-based tips
activity where you feel you donate your time and give back
and start experiencing real results. Earning period: Oct. 1,
to your community counts. Additional examples include
2020 – Sept. 30, 2021.
donating blood, helping out at a local homeless shelter or
packing food at a food pantry. Note that the activity does Choose from titles such as Make Time for Play, Get Strong
not need to be physically demanding. Earning period: Oct. at Home, Bedtime Game Plan, Go Lean to Get Lean, and
1, 2020 – Sept. 30, 2021. dozens more. You’ll find that changing habits doesn’t have
to be hard, and trying something new can be fun.
Flu shots – Earn $10
Stay healthy and help prevent the flu with an annual
vaccine. Get well-being credit if you receive a flu shot.
Earning period: Oct. 1, 2020 – Sept. 30, 2021.
• The flu shot is available at no cost for employees,
spouses, and dependents on a USG healthcare plan.
• Flu shots are covered at 100% when received at
a plan pharmacy, doctor’s office, or retail health clinic.
• Anthem members: Use your Anthem ID card.
• Kaiser Permanente members: Receive a flu shot
at any Kaiser Permanente facility.
• Receive a flu shot at your local pharmacy or retail
health clinic.
8
USG Well-being (Cont.)
Well-being Wednesday – Earn $5 Daily cards – Earn $5
Participate in Well-being Wednesday, a monthly health Complete 20 or more daily cards in a month and earn
and well-being education workshop. Earn $5 for each $5, up to three times. Daily cards are personalized
workshop, up to five times. You can participate in as many recommendations, information and inspiration that exist
webinars as you wish! Visit www.usg.edu/well-being on your home page online and in the app. Earning period:
under “events” to register. The various workshops will Jan. 1, 2021 - Sept. 30, 2021.
raise awareness about health, stress and disease to
motivate you to make essential changes that will reduce
health risks and enhance your life quality. Earning period: NEW! Weight Management and
Oct. 1, 2020 – Sept. 30, 2021. Diabetes Support - Earn $50
Complete 16 weeks or more of a USG approved diabetes
USG challenges – Earn $20 or weight management program. These programs will
help you reach your health goals, whether losing weight,
Join a USG challenge and track your steps at least once a gaining energy or improving your overall health. Earning
week for each week of the challenge to earn $20, up to period: Jan. 1, 2021 - Sept. 30, 2021.
twice a year. Challenges are a fun way to focus on a new
healthy habit or get in more physical activity. They will be • Anthem members: Livongo
added throughout the year. Earning period: Jan. 1, 2021 -
• Kaiser Permanente members: Omada
Sept. 30, 2021.
Invite USG friends – Earn $5 NEW! Biometric Screening – Earn $50
Get well-being credit if you complete a biometric
Invite at least five USG friends to participate in USG Well-
screening. Knowing where you stand is an essential first
being and earn $5. Your invitees can participate in
step toward improving your health. Blood cholesterol,
challenges, digital coaching, activity tracking and more.
blood glucose and body composition measurements are
The credit is only available to new participants or anyone
critical health numbers that can help determine your
that has not earned it in previous years. Earning period:
cardiovascular disease and diabetes risk. Annual
Jan. 1, 2021 - Sept. 30, 2021.
monitoring helps you stay on top of any risks you may
have. Complete an onsite biometric screening to learn
Healthy habits – Earn $5 essential health numbers and keep track of your health
over time. Earning period: Oct. 1, 2020 – Sept. 30, 2021.
Track healthy habits for 20 or more days in a month
to earn $5, up to five times. Habits include staying
organized, drinking water, keeping good posture, bringing
your lunch to work and more. Earning period: Jan. 1,
2021 - Sept. 30, 2021.
Note: To receive credits for activities completed through Kaiser
Permanente, you must sign your Wellness Program Agreement
each year. Visit kp.org/engage, sign in and accept the agreement.
9
Accolade
Navigating your health and benefits When YOU ask Accolade,
is easy. Just ask Accolade. you will experience:
Starting January 1, 2021, employees enrolled in an Reduced stress — They help you coordinate necessary
Anthem healthcare plan will contact Accolade for all of services for a smoother health care experience.
their healthcare and pharmacy questions. Your Accolade
Health Assistant will take the time to get to know you Time and money savings — They answer benefits and claims
and understand your needs, while partnering with a team questions and help you access the right care at the right time.
of nurses and benefits specialists to help support you Increased knowledge — They educate you and your family on
each step of the way and guide you to the right care. the best use of your benefits and how to better manage costs.
Additionally, your Health Assistant helps with ID cards,
finding a doctor, benefit coverage questions and more.
Occasionally, your Health Assistant may check in with
you to make sure you and your family are doing well
and are accessing the care you need. Whether it is
following up on a doctor’s visit or hospital stay, or
understanding and following a treatment plan, your
Health Assistant is here to help you navigate your
healthcare and make the best decisions possible.
Accolade is completely confidential and takes the
hassle out of benefits for USG employees.
Health or benefits questions? Ask Accolade. Call your
You can ask your Health Assistant Accolade Health Assistant or nurse at 866-204-9818,
questions like these: Monday through Friday, 8AM to 11PM ET (nurses also
available after hours), visit member.accolade.com, or
download the Accolade mobile app.
What other benefit programs might help me?
After-hours support
Get the help you need, when you need it. Connect with your
When am I eligible for benefits election?
Accolade Health Assistant Monday through Friday, 8AM to
11PM ET, or speak with a nurse after hours, or on weekends
I was just diagnosed with diabetes - now what? and holidays. Accolade’s 24/7 nurse line will triage you or
your covered family member to the right level of care. They’ll
keep your Accolade nurse in the know, so they can follow up
Why was I billed for this test?
with you the next business day to make sure you received the
care you need and understand any next steps.
Can you help me find an in-network provider?
What questions should I ask my doctor?
Accolade does not practice medicine or provide patient care. It is an independent resource to support and assist you as you use the healthcare
system and receive medical care from your own doctors, nurses and healthcare professionals. If you have a medical emergency, please contact
911 immediately. © 2020 Accolade. All rights reserved. All product names, logos, and brands are the property of their respective owners.
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9
To print a temporary ID card: Keep your ID card handy
1. Visit member.accolade.com and click on the Anthem
Medical Plan tile.
on your mobile device.
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your ID card to your provider whenever
3. Select the Customer Support link in the top right or wherever you are.
corner of your screen.
1. Download the Accolade mobile
4. Choose the Print temporary ID card link.
app on the App Store or
5. Use the drop-down box to select the name of the Google Play and register or log in.
person who needs a temporary ID card. The system
will display the temporary ID card for the selected 2. Click on Profile
member as a PDF embedded in the page.
3. Select Benefits Cards
6. Select the print icon that appears within the PDF to
print your temporary card. It’s important to remember
4. Click + to Add your benefits card
that your temporary ID card expires after 30 days. 5. Select which type of card to add
The temporary ID card is not meant to replace your (Medical, Rx, etc.)
permanent ID card.
6. Snap a photo of the front and back
of the ID card, and click Save!
How to find a doctor or other provider — Accolade makes it easy.
For Anthem members:
Starting January 1, connect with your Accolade Health Assistant for help. They know your benefits inside and out and
can help you find an in-network provider with ease.
1. Call
1-866-204-9818, visit member.accolade.com or 2. From
the online portal or mobile app, click on Find Care
download the Accolade mobile app. to search for a nearby provider who is right for you. No
need to confirm your plan type — the Accolade Find Care
tool knows your plan and will only show providers in
your network.
11Start Your Livongo Journey Today, A New Benefit
Offered for Anthem Members
What is Livongo: Livongo is a new healthcare plan benefit at no additional cost to you that combines advanced
technology, coaching, and support for weight and mental health to help you live a healthier life.
Diabetes Management: Make Who can join:
diabetes management easier. The program is offered at no additional cost to qualified
• Connected meter and real-time insights employees, pre-65 retirees and their spouses who are
enrolled in one of the USG Anthem healthcare plans.
• Unlimited strips shipped right to you
• 24/7 support from expert coaches What you get:
• You may also receive a smart scale and/or Advanced technology. Get a new blood glucose meter
blood pressure monitor (depending on your with unlimited strips and lancets. It’s all at no additional
health status) cost to you. Track your progress and manage your
health in the Livongo app.
Diabetes Prevention: Lower your Better health monitoring. Livongo’s connected devices
automatically upload your readings right to your app.
risk of developing type 2 diabetes. You’ll also get personalized tips to support you on your
• Connected smart scale health journey.
• Unlimited one-on-one coaching Expert support when you need it. Expert health
coaches are ready to help, on your terms. Get tips on
• Community support & more managing your blood sugar, healthy eating, weight,
blood pressure and more.
Weight Management: Take the USG Well-being: For participants in USG Well-being,
guesswork out of weight loss. by completing 16+ weeks of Weight Management,
Diabetes Prevention Program (DPP) or Diabetes
• Connected smart scale Management, you can earn a $50 well-being credit
• Unlimited one-on-one coaching (1x/year). Remember, this year employees and spouses
must complete the health assessment to participate
• Mini guided challenges & more in earning the well-being credits. Note: that only active
employees and spouses on a USG healthcare plan can
earn the credit.
To sign up or to learn more about this program, visit
well.livongo.com/USGBENEFITS or you can call
Livongo Member Support at (800) 945-4355 and have
your registration code “USGBENEFITS” ready.
122021 Premium Rates for Active Employees
2021 Monthly Plan Costs
Kaiser
Consumer Comprehensive
BlueChoice HMO Permanente
Choice HSA Care
HMO
Employee Only $81.86 $187.96 $222.98 $170.66
Employer $459.16 $459.98 $460.05 $381.22
Total Rates $541.02 $647.94 $683.03 $551.88
Employee + Child(ren) $173.52 $364.50 $427.54 $327.40
Employer $800.32 $801.79 $801.91 $665.98
Total Rates $973.84 $1166.29 $1229.45 $993.38
Employee + Spouse $202.44 $425.26 $498.80 $381.96
Employer $933.70 $935.41 $935.56 $776.99
Total Rates $1136.14 $1360.67 $1434.36 $1158.95
Family $283.18 $603.94 $709.20 $545.68
Employer $1339.88 $1339.88 $1339.89 $1109.96
Total Rates $1623.06 $1943.82 $2049.09 $1655.64
Action Required!
If you enroll in a USG healthcare plan in 2021, you’ll need to certify you and your enrolled dependents’ (age 18+)
tobacco user status. Additionally, if you choose to cover a spouse, you’ll also need to certify the status of your
working spouse. (The working spouse surcharge does not apply to retirees.)
Employees who certify their tobacco use or working spouse status, will have an $100 surcharge applied each month
for each covered member. Additionally, the surcharges will be applied for employees who do not complete their
surcharge elections.
Important Note: Surcharge Certifications
Please be advised that when you certify your tobacco use or working spouse status, you are attesting that the information is true and
correct to the best of your knowledge. USG expects employees to uphold the highest standards of intellectual honesty and integrity,
in compliance with the USG Ethics policy. Therefore, you should respond honestly in regards to your status. If you knowingly and
willfully make a false or fraudulent statement to the University System of Georgia regarding your insurance coverage, you may be
subject to criminal prosecution. Under state law (at O.C.G.A. Section 16-10-20), if you are convicted, you shall be punished by a fine
no more than $1,000 or by imprisonment for no less than one nor more than five years, or both.
132021 Premium Rates for Pre-65 Retirees
2021 Monthly Plan Costs
Consumer Comprehensive BlueChoice Kaiser
Non-Medicare Eligible Permanente
Choice HSA Care HMO HMO
Non-Medicare Retiree Only $81.86 $187.96 $222.98 $170.66
Non-Medicare Spouse Only $120.58 $237.30 $275.82 $211.30
Child(ren) $91.66 $176.54 $204.56 $156.74
Non-Medicare Retiree + 1 Child(ren) $173.52 $364.50 $427.54 $327.40
Non-Medicare Spouse + 1 Child(ren) $212.24 $413.84 $480.38 $368.04
Non-Medicare Retiree + Non-Medicare Spouse $202.44 $425.26 $498.80 $381.96
Family (Non-Medicare Retiree + Non-Medicare
$283.18 $603.94 $709.20 $545.68
Spouse + Child(ren))
Family (Non-Medicare Retiree + Child(ren)) $173.52 $364.50 $427.54 $327.40
Family (Non-Medicare Spouse + Child(ren)) $212.24 $413.84 $480.38 $368.04
2021 Monthly Plan Costs
Kaiser
Consumer Comprehensive BlueChoice
Pre-65 Medicare Eligible Permanente
Choice HSA Care HMO HMO
Pre-65 Medicare Retiree or
Pre-65 Medicare Spouse Only or $81.86 $164.46 N/A $135.22
Pre-65 Medicare Child +26 yrs old
Pre-65 Medicare Retiree or
$173.52 $341.00 N/A $291.96
Pre-65 Medicare Spouse + Child(ren)
Non-Medicare Retiree + Pre-65 Medicare Spouse $163.72 $352.42 $498.80 $305.88
Pre-65 Medicare Retiree + Pre-65 Medicare Spouse $163.72 $328.92 N/A $270.44
Family (Non-Medicare Retiree +
$255.38 $528.96 $709.20 $462.62
Pre-65 Medicare Spouse + Child(ren))
Pre-65 Medicare Retiree + Non-Medicare Spouse $202.44 $401.76 N/A $346.52
Family (Pre-65 Medicare Retiree +
$294.10 $578.30 N/A $503.26
Non-Medicare Spouse + Child(ren))
Family (Pre-65 Medicare Retiree + Child(ren)) $173.52 $341.00 N/A $291.96
Family (Pre-65 Medicare Spouse + Child(ren)) $173.52 $341.00 N/A $291.96
Family (Pre-65 Medicare Retiree +
$255.38 $505.46 N/A $427.18
Pre-65 Medicare Spouse + Child(ren))
Important Note: Important Note:
All Pre-65 Medicare eligible retirees and dependents If you would like to review the total cost of your
will remain on the USG healthcare plans until they healthcare plan, including the employer contribution,
reach age 65. At age 65, they will move to the Aon please visit the USG website: usg.edu/hr/benefits.
Exchange where Medicare will become primary.
142021 Healthcare Benefits at a Glance
Consumer Choice HSA Comprehensive Care BlueChoice HMO Kaiser Permanente HMO
In-network Out-of-network In-network Out-of-network In-network In-network
Lifetime maximum
Unlimited Unlimited Unlimited Unlimited
Deductible: All services are subject to the deductible unless otherwise indicated.
Individual
single $2,200 $4,400 $750 $2,250
coverage
Employee +
1 (spouse or $4,400 $8,800 $1,500 $4,500 None None
child)
Employee
+ 2 or more
$4,400 $8,800 $2,250 $6,750
covered
members
Once individual deductible is met,
Once individual deductible is met, claims will pay at 90%. For a family,
claims will pay at 80%. this can be met in any combination.
Notes For a family, the deductible must However, the family deductible does N/A N/A
be met in total before the plan not have to be satisfied for persons
pays at 80%. meeting their individual deductible
of $750 to have claims paid at 90%.
Maximum annual out-of-pocket limit
Individual
single $3,700 $7,400 $1,750 $5,250 $5,500 $6,350
coverage
Employee +
1 (spouse or $7,400 $14,800 $3,500 $10,500 $9,900 $12,700
child)
Employee
+ 2 or more
$7,400 $14,800 $3,500 $10,500 $9,900 $12,700
covered
members
Member copays for office visits,
This includes the maximum annual Member deductible, copays, and
inpatient admissions and emergency Member copays for
deductible. In- and -out-of-network coinsurance apply toward the
room services apply toward the physician office visit services,
coinsurance amounts accumulated annual medical out-of-pocket
Notes remain separate. Both medical limit(s). The prescription drug
annual medical out-of-pocket inpatient admission, ER visits, and
limit(s). The prescription drug Rx copays apply toward the annual
and pharmacy coinsurance apply benefits have a separate
benefits have a separate out-of-pocket.
toward the out-of-pocket limit. out-of-pocket limit. See page 18.
out-of-pocket limit. See page 18.
Pre-existing conditions
Not Applicable Not Applicable Not Applicable Not Applicable
Out-of-state/out-of-country coverage
In-network coverage that is out-of-state utilizes the Emergency Care only You’re covered for emergency and
BlueCard national program. Out-of-country uses urgent care anywhere in the world.
Blue Cross Blue Shield Global Core at 1-800-810-2583. Call the new Away From Home
Travel Line from both inside and
outside the U.S. at 1-951-268-3900
for assistance before, during and
after travel.
Primary Care Physician/referral required
No No Yes No
Note: All in-network services are subject to the deductible unless otherwise stated. All out-of-network services are subject to the out-of-network deductible and balance
billing unless otherwise stated.
Note: Annual deductibles, annual maximum out-of-pocket limits and annual visit limitations are based on a January 1–December 31 plan year.
Note: BlueChoice HMO and Kaiser Permanente HMO have no out-of-network coverage. BlueChoice HMO members must receive referrals from a Primary Care Physician
(PCP). No referrals needed to see most Kaiser Permanente specialists. Referral required for non-Kaiser Permanente, independent specialists.
Note: All Anthem Blue Cross and Blue Shield healthcare plans and the Kaiser Permanente HMO cover the surgical extraction of impacted wisdom teeth only, and claims
should be filed with your medical benefits.
152021 Healthcare Benefits at a Glance (Cont.)
Consumer Choice HSA Comprehensive Care BlueChoice HMO Kaiser Permanente HMO
In-network Out-of-network In-network Out-of-network In-network In-network
Physician services provided in an office or virtual setting
Primary Care Physician Visit
80% 60% 100% after $20 copay per visit; 60% Plan pays 100% after Plan pays 100% after $20
not subject to deductible; $35 copay copay
$20 copay applies to
office visit service only
Retail Health Clinics
Plan pays 100% after N/A Plan pays 100% after
80% N/A N/A
$15 copay $15 copay
LiveHealth Online Visit
80%; $59 Plan pays 100% for the first Plan pays 100% for the first
N/A Plan pays 100%;
prior to N/A 3 visits; then 100% after 3 visits; then 100% after
no visit limit
deductible $15 copay per visit $15 copay per visit
Wellness/Preventive Care* (Calendar Year)
Not covered;
noncovered charges
Paid at 100%; Paid at 60%;
Paid at 100%; not subject do not apply to
not subject not subject to Plan pays 100% Plan pays 100%
to deductible annual deductible or
to deductible deductible
annual out-of-pocket
maximum
Routine Eye Exam with Ophthalmologist or Optometrist
Not covered;
Paid at noncovered charges
Paid at 60%; Plan pays 100%
100%; not Paid at 100%; not subject do not apply to
not subject to Not covered after $35 copay
subject to to deductible annual deductible or
deductible to Optometrist
deductible annual out-of-pocket
maximum
Specialist Visit
80% 60% 100% after $35 copay per 60% 100% 100%
visit; not subject to after $70 copay after $35 copay
deductible; $35 copay applies
to office visit service only
Laboratory Services
80% 60% 90% 60% 100% 100% covered in
when lab is when lab is LabCorp when lab is LabCorp Kaiser Permanente medical
LabCorp office; $100 copay in
outpatient setting
Maternity Care
80% 60% 90% after an initial visit 60% All physician charges related Prenatal and first
copay of $20; not to prenatal, delivery and postpartum visit
subject to deductible; postpartum care covered at covered at 100%
no copays charged for 100% after an initial copay of
subsequent visits $70 at first office visit
Surgery In-Office
80% 60% 90% 60% 100% 100% after $35 copay
after $70 copay in Kaiser Permanente
medical office;
$100 copay in
outpatient setting
* Preventive 3-D mammograms are covered by Anthem.
* For at-home Colon Cancer screening test options, please call the number on the back of your ID card.
162021 Healthcare Benefits at a Glance (Cont.)
Consumer Choice HSA Comprehensive Care BlueChoice HMO Kaiser Permanente HMO
In-network Out-of-network In-network Out-of-network In-network In-network
Allergy Testing
100% 100%
80% 60% 90% 60%
after $70 copay after $35 copay
Allergy Shots & Serum
100%; not subject
to deductible
100%
if a physician is seen, 100%
80% 60% 60% after $35 copay;
the visit is treated as an after $70 copay
$0 copay for serum
office visit and subject to the
$35 copay per visit.
Inpatient Hospital Services — Pre-certification required, except for emergencies
Physician Services (may include surgery, anesthesiology, pathology, radiology and/or maternity care/delivery)
80% 60% 90% 60% 100% 100%
Hospital Facility Services inpatient care (includes inpatient short-term rehabilitation services)
90% limited to 100% 100%
80% 60% 60%
semi-private room after $500 copay after $250 copay
Maternity Delivery
100% 100%
80% 60% 90% 60%
after $500 copay after $250 copay
Laboratory Services (LabCorp is in-network)
80% 60% 90% 60% 100% 100%
Skilled Nursing Facility
80% 60% 90% 60% 100%; 100%;
30-day limit 60-day limit per
30 days per calendar year 30-day calendar-year maximum combined
per calendar year calendar year
combined in- and out-of-network in- and out-of-network
Hospice Care
100% 100% 100% 60% 100% 100%
Outpatient Hospital/Facility Services - Pre-certification required except for emergency
Physician Services (may include surgery, anesthesiology, pathology, radiology and/or maternity care/delivery)
80% 60% 90% 60% 100% 100%
Hospital Facility Services outpatient care (including outpatient surgery and diagnostic testing)
100% 100%
80% 60% 90% 60%
after $250 copay after $100 copay
Note: All in-network services are subject to the deductible unless otherwise stated. All out-of-network services are subject to the out-of-network
deductible and balance billing unless otherwise stated.
Note: Annual deductibles, annual maximum out-of-pocket limits and annual visit limitations are based on a January 1–December 31 plan year.
Note: BlueChoice HMO and Kaiser Permanente HMO have no out-of-network coverage. BlueChoice HMO members must receive referrals from
a Primary Care Physician (PCP). No referrals needed to see most Kaiser Permanente specialists. Referral required for non-Kaiser Permanente,
independent specialists.
172021 Healthcare Benefits at a Glance (Cont.)
Consumer Choice HSA Comprehensive Care BlueChoice HMO Kaiser Permanente
HMO
In-network Out-of-network In-network Out-of-network In-network In-network
Care in Hospital Emergency Room
90% after a $250 90% after a $250
copay per visit; copay per visit;
100% 100%
80% 80% subject to deductible; subject to deductible;
after $300 copay after $250 copay
copay waived if admitted copay waived if admitted
within 24 hours within 24 hours
Ambulance Services (Land or air ambulance for medically necessary emergency transportation only)
100% after $75
80% 60% 90%; subject to deductible 100%
copay per trip
Urgent Care services
100% after $35 copay; 100% 100%
80% 60% 60% after $70 copay after $30 copay
not subject to deductible
Subject to balance billing for nonparticipating providers; balance bill amounts will not apply to the deductible or out-of-pocket maximum.
Other services
Home Health
80% 60% 90% 60% 100%; up to 120 visits 100%; 120 visits
Home Nursing Care
80% 60% 90% 60% 100% Contact plan for details.
Durable Medical Equipment
80% 60% 90% 60% 100% 50%
Hearing Aids — Children (18 years of age and under)
80% 60% 90% 60% 100% 50%
Initial: 1 hearing aid per ear, Initial: 1 hearing aid per ear, Initial: 1 hearing aid per ear,
with a limit of $3,000 per ear Initial: 1 hearing aid per ear, with a limit of $3,000 per ear with a limit of $3,000 per ear with a limit of $3,000 per ear
Replacement: 1 hearing aid per Replacement: 1 hearing aid per ear every 48 months Replacement: 1 hearing aid Replacement: 1 hearing aid
ear every 48 months per ear every 48 months per ear every 48 months
Cochlear Implants
Covered if deemed Covered if deemed
80% 60% 90% 60% medically necessary; medically necessary;
pre-authorization required pre-authorization required
Chiropractic Care; Physical Therapy; Speech Therapy; Occupational Therapy; Cardiac Therapy
100% after 100% after $35
80% 60% 90% 60%
$70 copay; copay; 20 visits
Physical, occupational,
and chiropractic care: 100% after $35
combined 20 visits Chiropractic care: 20 visits
Chiropractic care: 40 visits copay; up to 20 visits for
Speech therapy: 20 visits Physical and occupational
Physical, speech, occupational, and physical, occupational and
therapy: 40 visits
Respiratory therapy: 30 visits cardiac therapies: 40 visits per therapy speech combined
Speech therapy: 30 visits
Note: In- and out-of-network Note: In- and out-of-network visit limits are combined. 100% after $35 copay: up
Cardiac Rehabilitation: no
visit limits are combined. to 36 visits for
visit limit
Cardiac Rehabilitation: Cardiac Rehabilitation
no visit limit
182021 Healthcare Benefits at a Glance (Cont.)
Consumer Choice HSA Comprehensive Care BlueChoice HMO Kaiser Permanente HMO
In-network Out-of-network In-network Out-of-network In-network In-network
Behavioral Health & Substance Abuse
Inpatient
80% 60% 90% 60% 100% after $500 copay 100% after $250 copay
Partial Hospitalization
80% 60% 90% 60% 100% Contact plan for details.
Office Visit
80% 60% $20 60% 100% Contact plan for details.
Outpatient Facility
80% 60% 90% 60% 100% 100% after $20 copay
Intensive Outpatient
80% 60% 90% 60% 100% Contact plan for details.
Applied Behavioral Analysis (ABA)/Autism Therapy
100% after $20 copay 100% after $30 copay
per office visit; refer to per office visit; refer to 100% after $20 copay per office visit;
80% 60% plan benefits above for 60% plan benefits above for unlimited visits; treatment requires
treatment outside of office treatment outside of office prior authorization
visit setting visit setting
Pharmacy Services
Prescription Drugs
See page 18. See page 18. See page 18. See page 24.
Note: All in-network services are subject to the deductible unless otherwise stated. All out-of-network services are subject to the out-of-network
deductible and balance billing unless otherwise stated.
Note: Annual deductibles, annual maximum out-of-pocket limits and annual visit limitations are based on a January 1–December 31 plan year.
Note: BlueChoice HMO and Kaiser Permanente HMO have no out-of-network coverage. BlueChoice HMO members must receive referrals from a
Primary Care Physician (PCP). No referrals needed to see most Kaiser Permanente specialists. Referral required for non-Kaiser Permanente
independent specialists.
19CVS Pharmacy Benefits Summary
When you enroll in an Anthem healthcare plan, you are automatically enrolled in the prescription drug benefit through CVS Caremark.
Your formulary offers a wide selection of clinically-sound, cost-effective generic and brand-name prescription drugs. Additionally,
CVS Caremark offers many convenient and affordable options to fill your prescriptions, such as retail pharmacies,
mail-order and specialty orders.
Your plan includes several utilization management programs to promote safety along with appropriate and cost-effective use of
prescription medications.
Consumer Choice HSA Comprehensive Care Blue Choice HMO
Coinsurance after Deductible Copay/Coinsurance Copay/Coinsurance
Generic 20% $15 $15
Retail (30 day supply) Preferred Brand 20% 20% with $40 min and $100 max 20% with $40 min and $100 max
20% 35% with $100 min and $200 max 35% with $100 min and $200 max
Non-preferred brand
Non-preferred drug coinsurance amounts do not apply to out of pocket maximums
Generic 20% $37.50 $37.50
Mail Order Preferred Brand 20% 20% with $100 min and $250 max 20% with $100 min and $250 max
(90 day supply)
20% 35% with $250 min and $500 max 35% with $250 min and $500 max
Non-preferred brand
Non-preferred drug coinsurance amounts do not apply to out of pocket maximums
Employee The annual out-of-pocket maximum $1,500
amounts for members enrolled in
Employee+CH the Consumer Choice HSA plan and $3,000
for generic or preferred brand-name
Annual OOP Max prescription medication will be com-
Employee+Spouse bined with the medical out-of-pocket $3,000
maximum amounts (i.e., single or
Family family coverage). $4,500
If your doctor prescribes a brand-name drug when equivalent generic drugs are available, you will automatically receive
an FDA-approved generic drug* unless:
Important -Your doctor writes “dispense as written” (DAW) on the prescription; or
Information -You request the brand-name drug at the time you fill your prescription
*When more than one generic drug is approved, CVS Caremark may fill your prescription with any approved generic equivalent.
Did You Know?
To promote good health and help prevent the need for costly care, your plan offers coverage for a number of preventive
medications at $0 copayment. These include women’s contraceptives and several over-the-counter drugs recommended for
coverage by the U.S. Preventive Services Task Force. Coverage of these drugs requires a prescription (even for over the counter
items) and are subject to certain age and gender criteria. https://www.healthcare.gov/coverage/preventive-care-benefits/
202021 CVS Prescription Drug
Cost-saving Options and Considerations
If you are currently taking a preferred brand or nonpreferred brand drug, you may see changes in the out-of-pocket cost
of your prescriptions in 2021 based on the example shown below.
How It Works
Under your USG prescription benefit, preferred and non-preferred medications will be paid by fixed percentage of the total
cost each time you fill a prescription, with caps in place to limit the amount you will spend on your prescription (referred
to as a maximum).
To understand how the plan will work and your out-of-pocket costs with coinsurance, review the example below:
Example assumes Comprehensive Care at a retail pharmacy
Out of Coinsurance/ Maximum per
Type If the Cost is You pay
pocket costs Copay medication
Generic $ $200 $15 copay Up to $15 copay Up to $15 copay
Preferred $$ $350 20% ($40 Minimum) $70 $100 Maximum
Non-Preferred $$$ $500 35% ($100 Minimum) $175 $200 Maximum
Specialty: Prescription medications that require special handling, administration or monitoring. These drugs are
used to treat complex, chronic and often costly conditions, such as multiple sclerosis, rheumatoid arthritis,
hepatitis C and hemophilia.
Exceptions:
• Non-preferred drug coinsurance amounts do not apply to out-of- pocket maximums.
• If a generic is available, but you or your doctor request a brand name drug, you will pay the generic copay plus the cost
difference between the generic and brand-name drug. In this case, the cost could exceed the co-payment maximum.
Prescription Coinsurance:
• If the full cost of the medication is less than the minimum amount listed, you will pay the full cost of the medication.
• If the coinsurance is less than the minimum amount listed, you pay the minimum.
• If the coinsurance calculation is greater than the maximum amount, you pay the maximum amount.
212021 CVS Prescription Drug
Cost-saving Options and Considerations
Save Money Prior Authorization
If you are taking a non-generic, talk to your Prescriptions for certain medications require a prior
doctor to determine if switching to a lower cost authorization, also known as a coverage review, to ensure
alternative medication may be an option for you. the drug is safe, clinically appropriate and cost effective
If your doctor prescribes a brand name drug when for your condition. The review uses both formulary and
an equivalent generic is available, you will clinical guidelines to determine if the plan will pay for
automatically receive a generic. certain medicines. If your prescription requires a prior
authorization, your doctor must submit a request for
Mail Order. If you are taking ongoing maintenance coverage review for approval.
medication, save time and money by trying mail-order!
Although you can get your 90-day supply from an in-
network retail pharmacy, you will pay more (Retail Dispense as Written (DAW)
copay x 3). Sign up at caremark.com/mailservice.
If, on the rare occasion you are not able to take the
Copay Card Programs. You can use a manufacturer generic medicine, your doctor can request a brand penalty
copay card program with your prescription benefit. exception that may allow you to purchase the brand-name
These programs may lower your copayment or drug without paying the ancillary charge. The brand
coinsurance amounts for prescription drugs. penalty exception process may be initiated by contacting
CVS Caremark customer care.
Don’t Trade Up. If a generic is available, but you or
your doctor request the brand-name drug, you will
pay the generic copayment PLUS the full difference CVS Digital Tools
in cost between the brand-name drug and the
CVS digital tools make it easy to find ways to save money
generic equivalent. This difference in cost is
on your medications, and save time managing them for you
referred to as the ancillary fee. The cost could
and your family. Cost and time-saving tools to assist with
exceed the copayment maximum.
reducing out-of-pocket costs for prescription drugs include:
Tip! Use your HSA or FSA to pay for your prescriptions. • A price checking tool for your prescriptions and
alternative options at caremark.com. The drug cost
checking tools are also available on the USG Pharmacy
Benefits page at usg.edu/hr/benefits.
22You can also read
