Human Resources - Benefits

The following is a summary of benefits for employees that occupy the University Assistant job category.  For more details please contact Maureen Jeans in the Human Resources Department at 203-837-8631.



I. Sick Leave

Public Act 11-52 - Paid Sick Leave

Paid Sick Leave for University Assistants

II.  Health Benefits

The State Medical/Dental plans have a new option for employees called the  Health Enhancement Program (HEP).  Please click on the link below for the handout published by the State Comptroller's Office that describes HEP in detail.  Click Here: Health Enhancement Program Information  

  • Enrollment & Dependent Information
  • Making Changes to Insurance
  • Medical Insurance Benefits
  • Health Insurance Summaries
  • Telephone numbers and Websites of Health Insurance Carriers
  • Claim Forms for Anthem Preferred or BlueCare Plans
  • Monthly Insurance Rates
  • Prescription Drug Benefits 

Enrollment & Dependent Information

University Assistant employees have thirty (30) days from their employment date to enroll themselves and their eligible dependents onto the health and/or dental insurance coverage. The insurance coverage will be effective the 1st of the month, following one full month of employment.  An enrollment application may be obtained from the Human Resources Department.  University Assistant employees enrolling onto the insurance plans will be required to submit their first payment at the time they complete the enrollment application.  Payments should be made to the State of Connecticut.  Thereafter, the employee will receive a monthly bill from the WCSU Payroll Department.  Failure to make a scheduled monthly payment for two (2) months will result in the insurance coverage being terminated for non-payment.  Termination of coverage for non-payment voids the employee’s right to COBRA insurance.  

Children's Coverage At Age Nineteen (19):

 

Dental:  A dependent child’s dental coverage must terminate at the age of 19.   When the coverage ends, the child will be offered the option of purchasing dental coverage through COBRA regulations.

 

Medical: In accordance with the "Affordable Care Act" medical/prescription drug eligibility rules are revised to allow enrollment of the Subscriber's natural, adopted child, or stepchild who are:

  1. Up to age 26;

  2. Any age if permanently and totally disabled, and who are enrolled as a dependent in the State plan or an equivalent plan at the time the disability occurred;

  3. and, whether or not they are:

  • married (a dependent's spouse or the employee's grandchildren are still not eligible for coverage);

  • living in Connecticut

  • living with the employee;

  • In school;

  • financially dependent on the employee; or

  • eligible to enroll in their employer's health coverage.

When a dependent's medical coverage ends the child will be offered the option of purchasing medical coverage through COBRA regulations.

 

Making Changes to Insurance

Changes to insurance such as adding dependents, changing insurance company or changing plan level may only be made during the Open Enrollment period or through a Qualifying Event, according to the Office of State Comptroller’s rules.

        Open Enrollment:  The Office of State Comptroller annually conducts an Insurance Open Enrollment period, which allows employees to make changes to their insurance plans.  This is a time for employees to make changes such as; changing insurance company, plan level or adding dependents. Open Enrollment normally takes place during the month of May, with an effective date of change on July 1st.

        Qualifying Event:  During the year an employee may experience a Qualifying Event, which allows them a thirty (30) day open window to enroll a dependent and/or spouse onto their health and/or dental insurance. Employees must complete the required paperwork within thirty (30) days from the date of the event.  Failure to do so will result in having to wait until an annual Open Enrollment period to make a change.

Qualifying Events & Required Paperwork

Marriage: Copy of marriage certificate required.

Birth/Adoption of Child: Copy of adoption papers required.

Loss of Coverage: Documentation required stating employment termination date and insurance end date.)

Other: Court Orders:  Documentation required.

An employee, who has an enrolled dependent on their insurance plan, has the responsibility to inform the State of Connecticut of a change in the dependents status such as divorce, legal separation, or a child losing dependent status eligibility.

Employees may cancel insurance coverage anytime during the year.  Employees must contact the Human Resources Department to cancel their coverage.

 

Medical Insurance Benefits

 

Currently the State of Connecticut has three (3) medical insurance companies offering coverage to state employees; Anthem Insurance, Health Net Insurance, and Oxford Insurance.  Employees select a company to provide benefits, and also select a Plan Level of care.  The different Plan Levels are noted below, and refer to requirements such as in-network benefits only, out-of network services, or requirements such as gatekeeper coordination.

For employees who reside outside of Connecticut the State of Connecticut offers two (2) out-of-area plans.  Employees may choose from Anthem Insurance or Oxford USA.

Health Insurance Summaries
 

Point of Service: Under the Point of Service (POS) option, health care services are available both within and outside a defined network of physicians and other health care providers. POS members who obtain health care services from network providers pay a small co-payment, and are eligible for all benefits provided by the plan according to the schedule of benefits. Services may be obtained from participating providers without a referral.  Covered services obtained from non-participating providers are reimbursed at the rate of 80% of the plan allowance for in-network services, after the annual deductible has been met. Pre-authorizations may be required for non-network services, unless the care is necessitated by a bona fide emergency.  Four POS options are offered.

Point of Enrollment (No Gatekeeper): Under the Point of Enrollment (POE) option, health care services are available only from a defined network of physicians and other health care providers.   Each covered member must choose a Primary Care Physician (PCP); however, no referral from the PCP is necessary to receive care from participating providers.  POE members who obtain health care services from providers outside the network must pay the full cost of these services, unless the care is necessitated by a bona fide emergency.  Three POE options are offered. 

Point of Enrollment (Gatekeeper): Under the Point of Enrollment with Gatekeeper (POE-G) option, health care services are available only from a defined network of physicians and other health care providers.  Each covered member must choose a Primary Care Physician (PCP) who coordinates all care. A referral from the PCP is required for all specialist services. POE members who obtain health care services from providers outside the network, or without a referral from their PCP, must pay the full cost of these services, unless the care is necessitated by a bona fide emergency. Three POE-G options are offered. 

Out of State Residents: State employees who reside outside of Connecticut have the option of enrolling in the Anthem Out of Area Plan or the Oxford Out of Area medical plans.      

Telephone Numbers and Websites of Health Insurance Carriers and Prescription Drug Carrier

Anthem Blue Cross

Oxford Medical

Caremark    

800-922-2232

800-385-9055

800-318-2572    

www.anthem.com/statect

www.oxfordhealth.com

www.caremark.com/members/stateofct

Claim Forms for Anthem Preferred or BlueCare POS Plan

For Out-of-Network Claim Forms for Anthem Preferred or BlueCare POS Plans only: To secure an online claim form go to www.anthem.com/statect select FAQ, then select Claims, then select How do I file a claim?, then select Secure Online Form.    Employees will be instructed to provide information so a claim form can be mailed to them.

Monthly Insurance Payments

University Assistants are required to send their insurance payment's) monthly into the Payroll Department at Western Connecticut State University.  Payment's) must reach the Payroll Department by the 10th of each month for coverage the following month.  Failure to have your check received by the 10th of each month could possibly result in removal from the insurance plan. Checks should be made out to the insurance carrier chosen and are to be mailed into Western Connecticut State University, 181 White Street, Danbury, CT 06810,  Attention: Payroll Department, University Hall.  Initial Enrollment into an insurance plan must be done by coming into the Human Resource Department.  The first payment is due at initial enrollment. 
 

 Monthly Insurance Rates - Effective July 1, 2011 through June 30, 2012

Types of Plans

Subscriber

Subscriber Plus One

Family

Point of Service Plans (POS) $15.00 office visit co-pay. In-network & out-of-network benefits

Anthem State BlueCare POS $624.24 $1,373.33 $1,685.45
Oxford Freedom Select POS $506.53 $1,114.37 $1,367.63

Point of Enrollment Plans (POE) $10.00 office visit co-pay.  In-network benefits only

Anthem State BlueCare POE $604.18 $1,329.20 $1,631.29
Oxford HMO Select POE $481.97 $1,060.33 $1,301.32

Point of Enrollment - Gatekeeper Plans (POE-G) $10.00 office visit co-pay.  In-network benefits only. Referrals required.

Anthem State BlueCare POE Gatekeeper $601.78 $1,323.92 $1,624.81
Oxford HMO $443.33 $975.33 $1,196.99

Out of State - Out of Area Plans (OOA) $15.00 office visit co-pay.

Anthem - Out of Area Plan $855.41 $1,881.91 $2,309.61
Oxford USA - Out of Area Plan $537.23 $1,181.91 $1,450.52

Adjunct faculty may be eligible for state sponsored medical and/or dental insurance rates.  To be eligible for state sponsored insurance rates you must be teaching nine (9) or more credits in the aggregate, per semester, at multiple locations within any of the State of Connecticut university or college systems: Connecticut State University Systems (CCSU, ECSU, SCSU, WCSU), University of Connecticut, or any of the state community colleges.  If eligible for this benefit,  lecturers would be required to pay monthly premiums and then receive a reimbursement payment at the end of the semester.  For more information regarding this benefit please contact Lisa Lengel in the Human Resources Department at 203-837-8666.

 

Prescription Drug Benefits

 

Caremark is the State of Connecticut pharmacy benefits provider for all covered employees, retirees, and their eligible dependents. 

 

Co-pays: $5.00 generic/$10.00 brand name prescription for up to 34-day supply. $25.00 Non-preferred brands (that have a preferred alternative)

 

*The prescription benefits plan is a mandatory generic substitution plan, except that a physician may authorize an override for a brand name prescription based upon medical necessity certified by the physician in accordance with the Pharmacy Benefit Manager’s (PBM) process. Contact Caremark at 800-318-2572 for information about the PBM process.

 

Caremark 's prescription drug plan will enable you to:

  • Obtain prescriptions through Caremark 's network of over 52,000 chain and independent retail pharmacies.

  • Obtain maintenance prescriptions through Caremark 's Mail Service Pharmacy.  Your medications will be delivered directly to your home within seven to ten days. Co-pays will apply.

  • Caremark's HealthLine, a telephone information and education center you can call for answers to common health and medication related questions.

  • Utilize www.caremark.com/members/stateofct to easily view your plan design and co-pay information, search for details on prescription medications, locate a pharmacy near you, review your claim history, and order your refills through Caremark Direct.

  • Employees are only allowed to use an Out-of-Network pharmacy in an emergency situation or when overseas.  Contact Caremark for further details.

 

Telephone Number and Website

 

Caremark:    800-318-2572           www.caremark.com/members/stateofct

 

Claim Form:  In the event a prescription is filled at a non-participating pharmacy (emergency situations or overseas travel only) employees will have to submit a claim form to request reimbursement.

 

Claim forms are available on-line at  www.caremark.com/members/stateofct,  Select Members,  select Services,  under My Benefits select Forms,  select Direct Membership Reimbursement. To submit a claim follow the instructions on the claim form.  Reimbursement may take approximately 6 to 8 weeks to process. 

 


III. Dental Benefits
 

  • Dental Benefits Description
  • Dental Plan Comparison 
  • Telephone Numbers and Websites of Dental Carriers
  • Monthly Rates
  • Claim Forms for United Healthcare Basic & Enhanced PPO Plans

Dental Insurance Benefits Summaries

Currently the State of Connecticut offers three (3) different dental plans to provide dental benefits to employees.

United HealthCare Basic Dental Plan:  A plan which has no defined network and allows employees the freedom to select a dentist of their choice. Because there is no defined network, the percentage of benefits covered is based on usual and customary rates prevailing in the geographic area in which the expenses are incurred.

United HealthCare Enhanced PPO:  This is an expanded dental plan that covers a broader array of procedures, from either a defined network or out of network dentists.  If services are provided from an out of network dentist the benefit percentage applies to the schedule of maximum allowable charges.  Maximum allowable charges are limitations on billed charges in the geographic area in which the expenses are incurred. Some orthodontia coverage is available with this plan.

CIGNA Dental Care® DHMO:  CIGNA Dental Health Maintenance Organization covers employees for some procedures at one hundred percent (100%).  Employees must remain in-network at all times.   No out of network benefits are allowed. Upon hire, employees will be required to select a dental office from the network, and will be required to receive treatment from their dentist location selected.  Employees wishing to change dental locations must call Aetna first to register with another dental office. Employees using another dental location without contacting Aetna will result in no benefit coverage.  Some orthodontia coverage is available with this plan.

Dental Plan Comparison

UHC Basic UNC Enhanced PPO CIGNA
Service Areas

Any Licensed Dentist

Check with United HealthCare for participating PPO dentists in your area

Check with Cigna Dental Care® for Cigna DHMO network dentists in your area.

Annual Deductible

None

$25 individual/$75 family

None

Annual Maximum

None

$3,000 per individual

(not including Ortho)

None

Diagnostic & Preventive Care
Exam Covered at 80% Covered at 100% Covered at 100%
X-Rays Covered at 80% Covered at 100% Covered at 100%
 
Simple Restoration
Fillings Covered at 80%1 Covered at 80%1 Covered at 100%2
Oral Surgery Covered at 67% Covered at 67% Covered at 100%2
 
Orthodontia

Children

(under 19)

Not Covered Plan pays $1,500 per individual per lifetime Patient pays $1,500 fixed co-pay

Adults & Children

Age 19 and older

Not Covered Plan pays $1,500 per individual per lifetime Patient pays $1,500 fixed co-pay

1 For fillings and crowns on molars, the least expensive equally effective procedure will be reimbursed

2 Additional charges may apply for other than simple restoration.

 

Telephone Numbers and Websites of Dental Carriers

UnitedHealthCare Dental® 800-896-4834 www.myuhcdental.com/statect
CIGNA Dental Care® - DHMO 800-244-6224 www.cigna.com

Dental Monthly Rates - Effective July 1, 2010 through June 30, 2011

 

Subscriber only

Subscriber Plus One

Family

United HealthCare Basic Dental Plan $40.03 $122.09 $122.09
United HealthCare Enhanced PPO Dental Plan $36.83 $112.33 $112.33
CIGNA Dental Care® - DHMO $24.94 $54.87 $67.34

* The Family Less Employed Spouse rate is available only when both spouse are employed by the State of Connecticut, eligible for health insurance, and enrolled in the same plan, along with at least one child.

Claim Forms for United Healthcare Basic & Enhanced PPO Plans only

To secure an online claim form go to www.myuhcdental.com/statect, select Claims Information, then select Claim Form, then select Claim Form again.  At this point you may print the online claim form.  Claim forms should be mailed to the address on the back of the employees United Healthcare identification card.


IV. Direct Deposit

Employees of Western Connecticut State University may elect to have their paychecks automatically deposited into a personal checking or statement savings account.

 

Employees may choose any bank or credit union for Direct Deposit.  Some banks offer free checking to depositors who enroll in Direct Deposit; you should check with your bank for details.

 

Funds from checks directly deposited will be available at 9:00 a.m. on the Thursday preceding the check dates.

  

For more information, please access our Direct Deposit link: ../procedures/direct_deposit.asp

WCSU is an AA/EEO Educator/Employer. 

 

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