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2017 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 openenrollment@mdc.edu and we will respond within one business day.

Click headings to collapse and expand for more information.

HEALTH PLAN

How do I contact Aetna?
You can call Aetna at 1-800-323-9930 or via http://www.aetna.com

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.

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.

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 may be 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”.

DENTAL PLAN

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.

FLEXIBLE SPENDING ACCOUNTS (Health & Dependent Care)

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 2017.

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 Dependent 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, 2018.

LIFE INSURANCE

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, you will see the cost when the options are presented.

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.

GENERAL

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 i.e., birth certificate, marriage certificate, domestic partner certification, etc. Parents and grandparents are not eligible for inclusion under the health and welfare plans.

DISABILITY

Does the College offer Disability Insurance?
Disability coverage is offered by the College in a voluntary basis. We have four plans available with various elimination periods and benefit durations.

LEGAL

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.

SICK LEAVE POOL

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.

TSA

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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