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2016 Open Enrollment FAQ's

If you have any specific question regarding your benefits, we recommend that you review the Q&A below and review the information on the College's Benefits website. You may find your answers very quickly. If you do not find the answers to your question, please email us at and we will respond within one business day.

How do I contact Aetna ?
You can call Aetna at 1-800-323-9930 or via
If I'm out of the Country or in another state what coverage do I have?
You'll always have emergency coverage but if you have HRA or POS and there's a network in the area you are travelling in, you will be able to access that network.
Is there a limit to the number of visits to a specialist during the year?
There is no limit to the number of visits an individual can make to a specialist. The number of visits is determined by the doctor and the patient. However, there are limits to the number of visits for some therapies.
Why are the co-pays higher in the POS plan, while I am already paying a higher premium than similarly situated individuals in the HRA?
Due to the nature of the POS plan, the costs are higher, which necessitates a higher premium. Also, due to the flexibility of having the Out of Network Benefits, contracted rates with providers are not as favorable to you, or the plan.
How long must new employees stay in the HRA?
New employees must remain in the HRA for at least 1 full year of employment. For example, an individual hired January 10, 2014 will be enrolled in the HRA effective March 1st. This individual is NOT eligible to select the POS until the Open Enrollment period for 2016.
Can I decline health coverage?
Yes, you can decline coverage. In this case, you will receive an annual supplement in the amount of $1150 to be added to your gross salary and divided by 26 paychecks. You must complete a Cash Option Form and provide proof of coverage from another plan to begin receiving the supplement.
What is the definition of emergency?
If, in your opinion, your symptoms suggest an emergency situation, for example, difficulty breathing and pain in your arm, you should go to the emergency room. If an individual has a runny nose and cough, this is not an emergency situation, and a visit to an Urgent Care Center would be more appropriate or perhaps a Minute Clinic. Minute Clinics are located in many CVS locations. Minute Clinics are at the Specialist co-pay level.
Do I have to designate a Primary Care Physician?
No, you do not. This is an Open Access plan, which means that you can go to any doctor within the network and do not need referrals to see a specialist.
Who does lab work for Aetna and how is it covered?
Aetna has a contract with Quest Diagnostics. If the doctor is in the network, his/her contract specifies that he/she must use the lab to which Aetna has contracted. Lab work is covered at 100%. If you are in the POS plan and use an Out-of-Network doctor, the office can send lab work to any lab and you are responsible for 20% of the charge if it is any other lab than Quest.
Can you clarify the difference between the Annual Deductible vs. Out-of-Pocket Maximum in the POS Out-of-Network coverage?
The deductible is the amount of money the individual or family must pay for covered expenses before the plan starts to make payments on behalf of the patient. The Out of Pocket maximum is the maximum amount of money the individual or family is responsible for in terms of co-pay or co-insurance, for covered expenses. Once this amount is reached, the plan pays 100% of covered expenses.
Do I have to go to a particular pharmacy to have my prescriptions filled?
Yes, most large pharmacy chains are in the Aetna network, including CVS, Walgreens, Target, Wal-Mart. You can locate a pharmacy by going to Aetna 's website.
Is Aetna's level of drug coverage (also known as the formulary) available to be reviewed?
Yes, you can go to the Aetna website, click on “look up a drug”, and you can find the formulary. The plan type is “Three-Tier Formulary”.
Can I elect dental coverage only, without taking medical?
Yes, you can elect dental coverage only, but if you waive the medical, remember, there is a requirement that you have medical coverage elsewhere.
Can I change from the DHMO to the DPPO?
Yes, you can change plans from DHMO to DPPO, or vice versa during the open enrollment period.
Can I decline dental coverage?
Yes, you can decline coverage. In this case, you will receive an annual supplement in the amount of $100 to be added to your gross salary and divided by 26 paychecks. You must complete a Cash Option Form.


If I am already enrolled in the Health or Dependent Care Reimbursement Account, do I have to re-enroll?
Yes, you do have to re-enroll during Open Enrollment. Your current enrollment will not roll over to 2016. 
Can I use contributions from my Health Care Reimbursement Account to pay for charges incurred by my child or spouse?
Yes, contributions made to the Health Care Reimbursement Account (HRA) can be used for charges incurred by a dependent. However, the dependent MUST be covered by a qualified medical plan. They do not have to be covered by the Miami Dade College plan.
Can I continue my Health and Dependant Care Reimbursement Accounts under COBRA?
Yes, if you have a remaining balance upon termination of employment.
Does the Health and Dependent Care Reimbursement Accounts have an extended plan year as it did before?
Yes. You can use current year contributions until March 15, 2016.
Have the plan benefits changed?
No, the provider is still The Hartford.  Employees may continue to purchase one, two or three times their annual salary. Please see the College Benefits website for more information.
What life insurance coverage is the College providing?
The College will provide all full-time employees life insurance coverage in an amount equal to 1 times base wage (age base reduction applies), rounded down to the next lowest $100.
What is the cost of optional life insurance?
The employee cost is based on two factors: the age of the employee and the base wage. The benefit is base wage, rounded to the next lowest $100, and the rate per $1,000 of coverage is posted on the Employee Benefits webpage. When going through the benefit selection process, the Open Enrollment system calculates the cost for you.
I am already participating in the life insurance plan. Do I have to do anything?
No, you do not have to do anything, but it is strongly recommended you review your beneficiaries to be certain those listed are who you want, or to be certain you have identified your beneficiary.
Do I have to prove insurability if I elect the voluntary life insurance coverage?
Yes. Medical underwriting is required for employees wishing to increase coverage or purchase coverage.
What is the definition of dependent?
A dependent is a spouse, child, (either natural, adopted, or who you are financially responsible for), or domestic partner. You will be required to provide documentation as proof of your dependents ie. birth certificate, marriage,domestic partner certification, etc. Parents and grandparents are not eligible for inclusion under the health and welfare plans. They are, however, eligible for benefits under the Long-Term Care program.
Does the College offer Disability Insurance?
Disability coverage is offered by the College in a voluntary basis. We have six plans available with various elimination periods and benefit durations.
Have the plan benefits changed?
No, the provider is still CNA Insurance.
Who is or can be covered by the Long-Term Care plan?
The Long-Term Care plan covers costs associated with home care, assisted living, and nursing home care. This can be used not only by employees and their dependents, but also for parents, parents-in-laws and grandparents. For more information contact CNA at 1-877-777-9072.
Is the long-term care plan a pretax deduction?
No, it is post tax.
If I want to enroll or change my coverage (increase/decrease) do I have to fill out a health questionnaire?
Yes, medical underwriting is required and approval from the insurance company.
How do we know the quality of the lawyers that can be used through ARAG?
ARAG qualifies the lawyers in the network in the same manner doctors are qualified by insurance companies. They must be licensed to practice in the state, and meet the standards set by ARAG.
Do I have to do anything to continue my participation in the Sick Leave Pool?
No, if you are already participating in the pool, you do not need to do anything.
If I am already enrolled in the Tax Shelter Annuity (TSA) plan, do I have to re-enroll?
No, you do not have to re-enroll, unless you are changing the amount you wish to contribute.
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