Changes in benefits outlined


Between Saturday, Oct. 28, and Monday, Nov. 13, eligible members of the MIT community may make changes in their health, dental and life insurance coverages and enroll in medical-dental and dependent care expense accounts under the flexible reimbursement account Plan (FRAP).

Open enrollment elections will be made on BenChoice, the Benefits Office interactive telephone enrollment system. Elections may be made 24 hours a day, 7 days a week.

Personal Enrollment Guides that provide instructions for making changes to benefit elections for 1996 will be included in an open enrollment package distributed the week of October 23. Individuals who want to keep all the same benefit plans and levels of coverage in effect for 1996 do not need to do anything. Only those who want to enroll in FRAP for 1996 and those who want to enroll for the first time or make a change in benefits must make elections using the BenChoice telephone system.

BENEFIT FAIRS

The Benefits Office will also sponsor Benefit Fairs to assist members of the community in making decisions about their benefit elections during the week of October 23. There will be health screenings, door prizes and giveaways offered by the participating plans.

Representatives from each of the health plans, the dental plan and the life insurance plan will be available at the Benefit Fairs to answer questions. Benefits Office staff members will also be there to answer any other benefits questions.

Information sessions will also be offered on campus on Tuesday, Oct. 24. Sessions will be offered on the Flexible Reimbursement Account Plan (FRAP), the MIT Life Insurance Plan and the MIT 401(k) Plan. Each presentation will run between 20 and 30 minutes and conclude with a question and answer period.

CHANGES IN COVERAGE

Most of the benefit plans have announced changes beginning in January 1996:

MIT Traditional Health Plan

Effective September 1, 1995, unmarried dependent children are covered to the end of the calendar month in which they turn age 25, as long as they are not eligible for coverage through an employer or other group plan. This means coverage is now available without regard to the dependent's full-time student status.

Effective January 1, 1996, there will be a $10 copayment for all oral and injectable travel vaccines.

MIT Flexible Health Plan

Effective September 1, 1995, unmarried dependent children are covered to the end of the calendar month in which they turn age 25, as long as they are not eligible for coverage through an employer or other group plan. This means coverage is now available without regard to the dependent's full-time student status.

Effective January 1, 1996, there will be no coverage for travel vaccines when you arrange your own care through Blue Cross and Blue Shield participating providers. When your care is arranged by an MIT Medical Department provider, you pay a $10 copayment for oral and injectable travel vaccines.

Tufts Associated Health Plan

Women may now refer themselves to participating OB/GYNs for their annual routine exams. Referrals from their primary care physicians (PCPs) for this service are no longer necessary. Follow-up or longer-term care still requires referral from the PCP, however.

The network has expanded to include all of Massachusetts and southern New Hampshire. This increases the base to more than 10,000 physicians and 60 hospitals, including Children's and Brigham and Women's hospitals.

Effective January 1, 1996, chiropractic benefits will be available to plan members. Coverage is for up to 12 visits per year for manual spinal manipulation only with a participating provider.

Plan benefits now include a 20 percent discount on purchases at Herman's Sporting Goods stores.

Bay State Health Care

Members may now visit any pharmacy which is a member of the PAID Prescriptions Coordinated Care Network, show their plan cards and pay a copayment ($5 for generic, $15 for brand name drugs), regardless of whether the pharmacy is in Massachusetts or out-of-state. This will replace all prescription claim filing for out-of-state claims and significantly expand the network of pharmacies both within and outside of Massachusetts. Refills would continue to be ordered through the mail.

Durable Medical Equipment (DME) DME will be covered at 100 percent of allowed charges up to the $1,500 calendar year maximum; benefits for DME repairs are now included in the DME benefit. Prosthetics and their repair will be covered at 80 percent of allowed charges with no calendar year maximum. Oxygen and equipment for its administration will be covered at 100 percent of allowed charges with no calendar year maximum. Ostomy supplies will be covered at 100 percent of allowed charges with no calendar year maximum. Disposable supplies (e.g., gauze, dressings) are not covered as DME; these items do not meet the definition of DME. They may be covered as a part of a home health treatment plan, however.

The out-of-area notification policy changed on March 1, 1995. Members are now required to notify the Plan of out-of-area urgent or emergency treatment within 48 hours of treatment or the first business day following the care, whichever is earlier. To notify the Plan, call the customer service telephone number on the plan identification card

Central Massachusetts Health Care

Pharmacy network has expanded to include the PAID Prescriptions Coordinated Care Network. Pharmacy benefit has been increased to a 90-day supply when prescriptions are ordered through the mail for the same price as a 30-day supply purchased at a retail pharmacy.

Blue Cross and Blue Shield

"Living Healthy" fitness network benefit was added as of January 1, 1995 through the International Health, Racquet & Sportsclub Association (IHRSA). Members may call 1-800-262-BLUE for a copy of the directory.

MIT Dental Plan

The following enhancements will occur in the dental plan effective January 1,1996:

  • ������������������The plan payment will increase to 70 percent for basic restorative services such as fillings, oral surgery and periodontics.
  • The plan payment will increase to 30 percent for major restorative services such as crowns, bridges and dentures.
  • The maximum annual plan payment will increase to $1,500 per person.
  • Plan members are eligible to receive two dental cleanings and examinations per calendar year. As of May 1, 1995, these services may be scheduled at any time during the year, rather than at six-month intervals.
MIT Life Insurance Plan

During the open enrollment period, you may increase your supplemental life insurance coverage by one multiple of your base annual salary up to the greater of three times your annual salary or $200,000 without providing evidence of insurability.

MIT Flexible Reimbursement Account Plan (FRAP)

Effective January 1, 1996, the Medical-Dental Expense Account will be offered as part of our COBRA coverage for members who become ineligible for the plan. A change in federal regulations prohibits the plan from reimbursing claims for services received after plan members become ineligible. Continuing contributions on an after-tax basis through COBRA prevents plan members from forfeiting account balances by allowing them to file claims for services received after they become ineligible.

Effective January 1, 1996, participants in the Dependent Care Expense Account will be eligible to submit claims for services received only up until the date they become ineligible. COBRA continuation is not available for the Dependent Care Expense Account.

If you have any questions about your 1996 benefit choices, please call the Benefits Office on campus at x3-0500, or at Lincoln Laboratory at x7060.

A version of this article appeared in MIT Tech Talk on October 18, 1995.


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