Answers to Frequently Asked Benefits Questions
- published: 2021/01/01
- contact: UNO/UNMC Human Resources
- email: unobenefits@unomaha.edu
This past October, the UNO/UNMC Human Resources Office asked members of the UNO community what benefits they would like to know more about, and what questions they had about what is included as part of UNO's total compensation package.
Included below are important resources and answers to the most frequently asked questions raised by the UNO community. Please review these important items, which provide a wealth of information and answers to questions you may be wondering about yourself.
Flexible Spending and Health Savings Accounts
General Tips
Is Your Password Current?
Before preparing to go through the enrollment process, make sure your Firefly password is current. If you have trouble logging in, please contact the UNO Helpdesk at 402.554.HELP.
Adding a New Dependent?
If you are planning to add new dependent to your coverage in the future, be sure to review and collect the verification documents you will need. A list can be found here.
Considering Employee Plus One Plans?
If you are interested in adding your spouse or life partner to your insurance, please make sure you review this important information.
Have You Had a Life Change Event in the Last 12 Months?
Review your current life insurance beneficiary designation by logging into Firefly, click on Employee Self Service, and then click on the Life Insurance Beneficiaries tile.
Medical Benefits
These are the most frequently asked questions, and relevant answers, regarding the important aspects of medical benefits coverage provided to UNO by UMR.
What is a deductible?
A deductible is the amount you will pay prior to the insurance company sharing the cost of medical expenses. The only exception to this would be preventative services.
What are preventative services?
A: Preventative services consist of services that include check-ups and screenings to prevent illness, disease, and other health-related problems. This can also include vaccinations. Please reference the Medical Chart to review the preventative service applicable to each University medical plan.
What is co-insurance?
Co-insurance is the cost sharing percentage of covered health care services split between you and the insurance company once you have met your deductible. If you look at the medical chart provided, the first percentage listed is how much the insurance company pays and the second percentage is the employee and/or dependent’s responsibility.
What is a Stop-Loss?
The Stop-Loss is how much an employee pays under the co-insurance on covered services before the insurance company picks up covered service expenses at 100%.
What is the difference between the Preferred Tier, In-Network Tier, and Out-of-Network Tier for providers?
The Preferred Tier includes providers, such as Nebraska Medicine and Children’s Hospital, that are offering a discount on their services. The lower cost is reflected in the lower deductible, co-insurance, and stop-loss. The In-Network providers are providers that have contracts with UMR to provide services at a specific dollar amount. Out-of-Network providers are providers who do not have a contract under the university plan. Out-of-Network providers can charge over the negotiated rate that In-Network providers can charge. This means that if a provider charges over what UMR’s contractual rate is for a service, the provider can bill the employee and/or dependent for the additional amount.
Can you provide an example of how a bill gets processed under each Tier?
This is an example using the Basic Option PPO Plan. The employee did not have any charges prior to this procedure: Cost of the procedure is $15,000.
Preferred Tier Example
The employee would be responsible for the first $300 of this bill ($15,000-$300= $14,700). Then co-insurance would be applied at the 85%/15% rate, so you subtract the 85% that insurance will pay ($14,700-$12,495=$2,205). The balance is $2,205 at the 15% rate of co-insurance, however, the stop-loss for this tier is $1,450. You will only be responsible for the $1,450. The insurance company will pick up the remaining $755. They will also pay 100% of Preferred Tier covered services on the employee for the remainder of the calendar year. Total out of pocket expense for the employee is $1,750.
In-Network Tier Example
The employee would be responsible for the first $450 of this bill ($15,000-$450= $14,550). Then co-insurance would be applied at the 70%/30% rate, so you would subtract the 70% that insurance will pay ($14,550-$10,185=$4,365). The balance is $4,365 at the 30% rate of co-insurance, however, the stop-loss for this tier is $1,600. You will only be responsible for the $1,600. The insurance company will pick up the remaining $2,765. They will also pay 100% of In-Network covered services on the employee for the remainder of the calendar year. Total out of pocket expense for the employee is $2,050.
Out-of-Network Tier Example
This provider, due to being out of network, charges $17,000 for the same procedure. The insurance company will only pay at the contractual rate set with In-Network Providers.
The employee will be responsible for the first $650 of this bill ($15,000-$650=$14,350). Then co-insurance would be applied at the 55%/45% rate, so you would subtract the 55% that insurance will pay ($14,350-$7,892.50=$6,457.50). The balance is $6,457.50 at the 45% rate of co-insurance, however, the stop-loss for this tier is $2,000. You will be responsible for the $2,000. The insurance company will pick up the remaining $4,457.50. Remember that the additional $2,000 that the provider charged for this procedure over the insurance company’s contracted rate? You will also be billed that amount. The insurance company will pay 100% of Out-of-Network covered services at the contractual rate on the employee for the remainder of the calendar year. If there are additional charges over the contractual rate, the employee will be responsible for those charges. Total out of pocket expense for the employee is $4,650.
As a reminder, if there are any other Out-of-Network charges during the calendar year, any amount of the contractual rate set with In-Network Providers will be the employee’s responsibility.
Where can I find a list of Preferred Tier and/or In-Network Providers?
This can be found on the UMR website.
You will need to create an account with UMR. To create an account please have your UMR insurance card available. Once you have an account, you can log in and on the right-hand side click on the “Find a provider” button.
On the right-hand side, you will select the person on your plan you are wanting to find a provider for. Then in the middle section you will click the “View Providers” button. A separate screen will pop up with four links. The first link is for In-Network providers. The second link is for the Behavioral Health Directory. The third link is a list of National Contracted Vendors. Finally, the fourth link is the Enhanced Tier.
The Enhanced Tier will list those who are in the Preferred Tier. To find a provider in the Enhanced Tier, click on the link, and a new screen will appear. On this screen you can set the parameters for your search by including a provider’s specialty and location. This same method will apply to the In-Network provider links as well.
What is a Preferred Provider Organization (PPO) Plan?
A PPO is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network.
What is a High Deductible Health Plan (HDHP)?
A High Deductible Health Plan is a type of health insurance with higher deductibles and lower premiums.
Are pre-existing conditions covered?
The University’s coverage does not have a pre-existing condition exclusion on the medical plans.
How can I determine how much a procedure will cost?
If you go to the UMR website and log in, you will scroll down on the home page until you see the Health Cost Estimator. Click on this tile, then click the “Estimate your care” button. The cost estimator will allow you to choose your location and type of procedure.
Dental Benefits
These are the most frequently asked questions, and relevant answers, regarding the important aspects of medical benefits coverage provided to UNO by Ameritas.
How do the deductible, co-insurance, and stop-loss apply to the Ameritas dental coverage?
Preventative and Diagnostic services, such is teeth cleanings, do not have a deductible; however, there is a co-insurance. If the services were provided at a preferred provider, the co-insurance will be 85%/15%, meaning you will be responsible for 15% of the bill. Under Restorative and Major Services, there is a $35 deductible, meaning that the first $35 of the bill will be your responsibility. The remainder is then applied to the co-insurance.
View comprehensive summary of UNO's plan
This plan has a $1,500/person annual maximum benefit. This means that the maximum amount the insurance will pay on a covered person each calendar year, which includes Preventative, Restorative, and Major Services, is $1,500. This Benefit Maximum restarts every year on Jan. 1.
Where can I find more information on my dental benefits, such as finding a preferred provider or getting a cost estimate on a procedure?
Please visit the Ameritas Dental website at www.ameritas.com and create an account. Once you log in and click on the Dental, you are able to review claims, request ID cards, find a Preferred Dental Provider, and get a cost estimate for various procedures.
Who can utilize the Orthodontia benefit under the dental coverage?
The Orthodontia benefit can be utilized by anyone on this coverage. This does include Adult Orthodontia.
What is the coverage for Orthodontia?
The covered individual who utilizes this service will have a $40 deductible. Once this is paid, there is a 50%/50% co-insurance. At that 50% rate, the insurance will pay a life-time maximum amount of $2,000.
Can I continue this coverage as a retiree?
Yes. Please contact the Benefits Office at unobenefits@unomaha.edu to request additional information concerning retiree benefits.
Vision Benefits
These are the most frequently asked questions, and relevant answers, regarding the important aspects of medical benefits coverage provided to UNO by EyeMed.
What are co-pays and how do they work?
Co-pays are fixed amounts you pay for services. Below is a list of all the services provided by our vision coverage, as well as the co-pays for each.
How does the frame/contact allowance work?
Each year covered individuals are given a $150 allowance for frames and $130 for contact lenses.
An example of how this works would be purchasing a $200 pair of frames. Insurance covers the first $150. The remaining balance is $50. The covered individual will then be responsible for 80% of the remaining cost of the frames, in this example that would be $40 and insurance would pay an additional $10. In addition to the remaining balance on the frames, the employee will also be responsible for the co-pays on the lenses and any coatings added.
View a comprehensive summary of UNO's plan
Do we have a Lasik benefit?
Our plan provides covered dependents a 15% discount on Lasik or a 5% discount on promotional pricing.
Voluntary Life Insurance
Where can I designate my beneficiary?
You can designate your beneficiary for the 1x Annual Salary Life Insurance and Voluntary Life Insurance by logging into Firefly, clicking the Employee Self Service (ESS) tile, then on the Beneficiary tile under the Benefits heading.
How are premiums calculated?
Premiums are based on your age and tobacco/nicotine designation. As a reminder, each year the tobacco/nicotine designation needs to be resubmitted during NuFlex Annual Enrollment.
Spouse Life Insurance
Who is the beneficiary of this policy?
Since you, as the employee, are electing this coverage on your spouse, you are the beneficiary.
What are the coverage election options for this coverage?
The coverage election options for this coverage are $10,000, $20,000, and $50,000. If you are electing this coverage or increasing the amount of your current election during NuFlex Annual Enrollment, you will need to complete the Statement of Health form.
Child Life Insurance
Who is the beneficiary of this policy?
Since you, as the employee, are electing this coverage on your child(ren), you are the beneficiary.
What are the coverage election options for this coverage?
The coverage election options for this coverage are $5,000 and $10,000. If you are electing this coverage or increasing the amount of your current election during NuFlex Annual Enrollment, you will need to complete the Statement of Health form on each child that is not currently covered or that you are increasing the coverage level on.
Accidental Death & Dismemberment
Who is the beneficiary of this policy?
Since you, as the employee, are electing this coverage on your family, you would be the beneficiary if an accidental death or dismemberment occurred. In the event that you are dismembered, the policy would pay out to you. If an accident resulted in your death, then the person(s) you have listed as your primary beneficiary under your life insurance with the university would be the beneficiary to this policy.
How does this policy cover dependents?
When you elect a coverage amount, your spouse is covered at 50% of that value and children are covered at 10% of that value. An example would be electing the $100,000 coverage. The employee is covered at $100,000; their spouse is covered at $50,000 and any children on the coverage are each covered at $10,000.
When would this policy payout?
Unlike other life insurance policies, there is not a Statement of Health required on this coverage, since it only pays out in the event of an accident or dismemberment.
Long-Term Disability (LTD)
What do the different coverage levels under this plan mean?
When looking at the different coverage options under this plan, there are 50% and 66 2/3% coverage options. These percentages are how much of your income will be paid in the event you become disabled. In addition, there is a 90-day and 180-day waiting period. This is the amount of time you would need to be deemed disabled before the insurance company would begin to pay the percentage of your university salary that was elected.
How does the pre-existing clause work on this coverage?
When you enroll or increase the coverage for this benefit, there is a pre-existing condition clause that will apply for the first 12 months of coverage. After the initial 12 months, the pre-existing condition clause no longer applies.
An example of how this coverage works would be if an employee elects the 66 2/3 income and 180-day waiting period. In the first year of coverage, the employee files a claim due to their back. When reviewing that claim, the LTD Company will look back 3 months prior to the effective date of the coverage to see if the employee has had any sort of treatment for their back. If there was treatment, then the claim would be denied due to it begin a pre-existing condition.
If that same claim was filed after 18 months from the effective date of coverage, the pre-existing condition would not apply, even if there was treatment for this condition prior to enrolling in the coverage.
As a reminder, the premiums for this coverage have decreased 20% this year.
Flexible Spending Accounts (FSA)
What is the difference between the Health and Dependent Care Flexible Spending Accounts?
The Health Flexible Spending Account is for medical, dental, and vision expenses. The Dependent Care Flexible Spending Account is for daycare expenses.
What is the benefit to these plans?
Both accounts are set up so that you can contribute funds on a pre-tax basis. This lowers your taxable income for the year.
What is the disadvantage to these accounts?
These accounts are use it or lose it accounts. This means that you will need to have enough expenses by the end of the year in order to claim the full amount elected. New this year, the university will allow you to roll a remainder of the balance of your Health Flexible Spending Account over (no rollover for Dependent Care) to the next calendar year.
Who is eligible to contribute to these accounts?
Those that are enrolled in the PPO medical plans through the university are eligible for the Health Flexible Spending Account. Those that have dependents and are utilizing daycare are eligible for the Dependent Care Account.
Health Savings Accounts (HSA)
What is the difference between the Flexible Spending Account (FSA) and Health Savings Account (HSA)?
Only employees that are enrolled in the Qualified High Deductible Health Plan (QHDHP) with the university are eligible to set up a Health Savings Account (HSA) that is payroll deducted. The Health Savings Account (HSA) allows you to contribute funds on a pre-tax basis, however, these funds can rollover from year to year. You also have the ability to invest these funds in order to help grow this account.
How do I set this account up?
If you are enrolled in the Qualified High Deductible Health Plan (QHDHP), you will need to set this account up through Fidelity Investments. This is also where you will elect the contribution you will make from your university paycheck.
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