Human Resources Home / Staff Benefits / Important Notices and Changes
Important Notices and Changes
Benefit Changes for 2015:
Beginning in 2015, the office visit co pay will be increased to $25
for Family/General Practice Physicians and $40 for Specialists.
Your Out-of-Pocket Maximum for the medical plan will be $3500 per person
per year with a $7000 family maximum. There will also be an
increase in the Emergency Room Visit co pay to $200.
The Prescription Drug benefit will have an annual Out-of-Pocket Maximum
of $2500 ($5000 for family) beginning in 2015. Previously, there has
not been a limit to the amount that you would pay in a calendar year.
Lifetime and Annual Limits:
Affordable Care Act prohibits health plans from putting a "lifetime"
dollar limit on most benefits you receive. The act also restricts the
"annual" dollar limits a health plan can place on most of your benefits.
Effective January 1, 2011, all annual and lifetime limits on the dollar
value of benefits under ISU's health plan will no longer apply.
Individuals whose coverage ended by reason of reaching a lifetime limit
under the plan are eligible to enroll in the plan
Individuals whose coverage ended, or who were denied coverage, or were not eligible for coverage, because
the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in
ISU's health plan. Individuals may request enrollment for such children during Open enrollment each year or,
with a qualifying event, through "Special Enrollment". Children are eligible to stay on the plan until the
end of the year they attain age 26.
New beginning 2014, under the Affordable Care Act, health plans cannot limit or deny benefits or deny coverage simply because the
person has a pre-existing condition. There are no pre-existing
conditions limitation on
ISU's health plan for anyone.
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Medicaid and the Children's Health Insurance Program (CHIP):
If you are eligible for health coverage from your employer but are unable to afford the premiums, some
states have premium assistance programs that can help pay for coverage. These states use funds from their
Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need
assistance in paying their health premiums.
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If you have declined enrollment for yourself or your dependents (including your spouse) because of other
health insurance or group health plan coverage, you may be able to enroll yourself and your/or
your dependents in
ISU's plan if you or your dependents lose eligibility for other coverage (or if the employer stops
contributing toward your or your dependents' other coverage). However, you must request enrollment within
30 days after your or your dependents' other coverage ends (or after the employer stops contributing toward
the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for
adoption, you may be able to enroll your dependents. However, you must request enrollment within 30 days
after the marriage, birth, adoption or placement for adoption.
Finally, you and/or your dependents may have special enrollment rights if coverage is lost under Medicaid
or a State health insurance (SCHIP) program, or when you and/or your dependents gain eligibility for state
premium assistance. You have 60 days from the occurrence of one of these events to notify Staff Benefits
and enroll in the plan.
Special Enrollment Application
To request special enrollment or obtain more information, contact Staff Benefits, 300 Rankin Hall or call ext. 4150.
Newborn's and Mother's Health Protection Act (NMHPA):
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for
any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48
hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal
law generally does not prohibit the mother's or newborn's attending provider, after consulting with the
mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In
any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from
the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96hours).
Women's Health and Cancer Rights Act:
Under Federal law, Group Health Plans and health insurance issuers providing benefits for mastectomy must
also provide, in connection with the mastectomy for which the participant or beneficiary is receiving benefits,
- reconstruction of the breast on which the mastectomy has been performed;
- surgery and reconstruction of the other breast to produce a symmetrical appearance;
- prostheses and physical complications of mastectomy, including lymphedemas;
These services must be provided in a manner determined in consultation between the attending Physician
and the patient. For more information regarding your rights after a mastectomy go to:
Affordable Care Act and Health Insurance Marketplace/Exchange
Starting October 1st, 2013, the Marketplace is available online at
HeathCare.gov. This is part of
the Affordable Care Act that will help you get quality health coverage at a
price you can afford. Open enrollment in the Health Insurance Marketplace
continues until March 31, 2014. Click here for