High Deductible Plan with HSA

Effective January 1, 2019 AUI's domestic medical plan will transition to Anthem/Blue Cross Blue Shield.

Provider directories are available below. If you have questions regarding the change please contact your HR representative or the Benefits Office.

New Mexico Providers West Virginia Providers Virginia Providers

The High Deductible Plan has two levels of deductible: Single ($1,500) and Family ($3,000) for in-network services. Deductibles are annual and reset each January. Additional details of the plan are available below.

Plan Info	Enrollment	Use Anthem	HSA vs HRA
Medical Plan Highlights Active employees may participate in a high deductible plan with Health Savings Account (HSA) through PNC Bank. Medical benefits are provided by Anthem Enrollment is allowed only as a new hire, through qualifying events, or open enrollment Coverage is continuous unless actively changed Preventive medical care is covered at 100% Preventive Services List Preventive drugs covered outside of the deductible, at coinsurance level Preventive Drug List If you are traveling abroad and need services: Cigna will cover your claim as in-network if it is considered a "true emergency" (heart attack, bone break, seizure, etc.). You will have to pay at the time of service and submit the claim later. Claim forms are available on this page, or from MyCigna.com. Assistance with claims payment may be available through our Cigna Travel Insurance. Non-emergency services can be handled through Telemed (MDLive).	2-Step Enrollment There are two steps to enroll in the High Deductible Plan with Health Savings Account: 1. Complete the Medical/Dental/Vision enrollment form - HSA/HDHP option - HRA/HDHP option (if you have other insurance coverage, including Medicare, Medicaid, spouse plan, flexible spending, etc.) 2. Complete the Salary Reduction Agreement form (optional) - if you intend to contribute your own money to your HSA. - HRA participants cannot contribute their own money.	Anthem Member Services: Call Anthem if you have any issues regarding your coverage at: 833-820-8990 Anthem Online: Anthem.com Website registration is required Track HSA and claims Download Explanations of Benefits Pay bills out of your HSA Verify coverage for prescription drugs In-network provider look-up Manage plan ID cards Anthem Portal Guide Specialty Pharmacy Mail Order	Health Savings Account (HSA) Highlights Tax-exempt contributions to an HSA remain exempt if you use them (and their earnings) to pay for qualifying Medical expenses. Certain restrictions exist for participation in an HSA: Must be enrolled in a high deductible health plan. Must not have any other insurance coverage. Dependents with other coverage may impact the amount you can save. AUI will make a $500/$1000 employer contribution to the HSA for participating HDHP employees. Eligible HSA Expenses Accessing your HSA Bank Account without MyCigna Sample Anthem HSA/HRA Card
How much does it cost? Current Year Medical Premiums What is covered? Summary Plan Description (SPD) Click the SPD to see what your Cigna plan pays. Legal Plan Document AUI Comprehensive Medical Plan Document. Legal document outlining who can be covered and how the plan works.	Enrollment Forms and Links Medical/Dental/Vision enrollment form Salary Reduction Agreement - HSA HSA contributions can be changed at any time during the year. You must manually assign your beneficiary for your HSA. If you do not do so, your HSA will be assigned to your estate. See the document below for more information. HSA Beneficiary Assignment Instructions	Claim and Pre-Authorization Forms Medical Claim Form Medical Claim Form for out-of network claims, not for use with prescriptions. Rx Drug Claim Form Cigna uses a 3-step plan for prescription drugs. Step-1 and Step-2 drugs don't require pre-authorization. Use this form to file claims. Rx Pre-Authorization Form Use this form to receive pre-authorization for Step-3 prescription drugs.	Health Reimbursement Account (HRA) Highlights Individuals who are not eligible for an HSA due to other medical coverage (Medicare, Medicaid, spouse insurance, flexible spending accounts, etc.) may receive the employer contribution given to HSAs through an HRA. HRAs only have balances if an employer contribution is made to employee HSA accounts. For 2019, there is a $500/$1000 AUI contribution to the HRA.
"Summary of Coverage and Benefits" document The Patient Protection and Affordable Care Act (PPACA) requires the AUI Comprehensive Medical Insurance Plan to provide a “Summary of Coverage and Benefits” to plan participants prior to the close of annual open enrollment. These documents were produced by Cigna HealthCare and follow specific federal guidelines. Please note that these are only summaries and do not outline the comprehensive details of your plan. For complete coverage details you should refer to the Summary Plan Description for your plan as posted on this site. The updated current year Summary Plan Descriptions will be available online and in hard copy form upon request in the first quarter of the current year. You have a right to receive a paper copy of the Summary of Coverage and Benefits upon request at no charge to you. If you would like to request a paper copy, or if you have any questions, please contact the benefits office.

Plan Info

Enrollment

Use Anthem

HSA vs HRA

Medical Plan Highlights

Active employees may participate in a high deductible plan with Health Savings Account (HSA) through PNC Bank.
Medical benefits are provided by Anthem
Enrollment is allowed only as a new hire, through qualifying events, or open enrollment
Coverage is continuous unless actively changed
Preventive medical care is covered at 100%

Preventive Services List

Preventive drugs covered outside of the deductible, at coinsurance level

Preventive Drug List

If you are traveling abroad and need services:

Cigna will cover your claim as in-network if it is considered a "true emergency" (heart attack, bone break, seizure, etc.).
You will have to pay at the time of service and submit the claim later. Claim forms are available on this page, or from MyCigna.com.
Assistance with claims payment may be available through our Cigna Travel Insurance.
Non-emergency services can be handled through Telemed (MDLive).

2-Step Enrollment

There are two steps to enroll in the High Deductible Plan with Health Savings Account:

1. Complete the Medical/Dental/Vision enrollment form

- HSA/HDHP option

- HRA/HDHP option (if you have other insurance coverage, including Medicare, Medicaid, spouse plan, flexible spending, etc.)

2. Complete the Salary Reduction Agreement form (optional)
- if you intend to contribute your own money to your HSA.

- HRA participants cannot contribute their own money.

Anthem Member Services: Call Anthem if you have any issues regarding your coverage at: 833-820-8990

Anthem Online:

Anthem.com
Website registration is required

Track HSA and claims
Download Explanations of Benefits
Pay bills out of your HSA
Verify coverage for prescription drugs
In-network provider look-up
Manage plan ID cards

Anthem Portal Guide

Specialty Pharmacy

Mail Order

Health Savings Account (HSA)

Highlights

Tax-exempt contributions to an HSA remain exempt if you use them (and their earnings) to pay for qualifying Medical expenses.

Certain restrictions exist for participation in an HSA:

Must be enrolled in a high deductible health plan.
Must not have any other insurance coverage.
Dependents with other coverage may impact the amount you can save.

AUI will make a $500/$1000 employer contribution to the HSA for participating HDHP employees.

Eligible HSA Expenses

Accessing your HSA Bank Account without MyCigna

Sample Anthem HSA/HRA Card

How much does it cost?

Current Year Medical Premiums

What is covered?

Summary Plan Description (SPD)

Click the SPD to see what your Cigna plan pays.

Legal Plan Document

AUI Comprehensive Medical Plan Document.

Legal document outlining who can be covered and how the plan works.

Enrollment Forms and Links

Medical/Dental/Vision enrollment form

Salary Reduction Agreement - HSA

HSA contributions can be changed at any time during the year.

You must manually assign your beneficiary for your HSA. If you do not do so, your HSA will be assigned to your estate. See the document below for more information.

HSA Beneficiary Assignment Instructions

Claim and Pre-Authorization Forms

Medical Claim Form
Medical Claim Form for out-of network claims, not for use with prescriptions.

Rx Drug Claim Form
Cigna uses a 3-step plan for prescription drugs. Step-1 and Step-2 drugs don't require pre-authorization. Use this form to file claims.

Rx Pre-Authorization Form
Use this form to receive pre-authorization for Step-3 prescription drugs.

Health Reimbursement Account (HRA)

Highlights

Individuals who are not eligible for an HSA due to other medical coverage (Medicare, Medicaid, spouse insurance, flexible spending accounts, etc.) may receive the employer contribution given to HSAs through an HRA.

HRAs only have balances if an employer contribution is made to employee HSA accounts. For 2019, there is a $500/$1000 AUI contribution to the HRA.

"Summary of Coverage and Benefits" document

The Patient Protection and Affordable Care Act (PPACA) requires the AUI Comprehensive Medical Insurance Plan to provide a “Summary of Coverage and Benefits” to plan participants prior to the close of annual open enrollment.

These documents were produced by Cigna HealthCare and follow specific federal guidelines. Please note that these are only summaries and do not outline the comprehensive details of your plan. For complete coverage details you should refer to the Summary Plan Description for your plan as posted on this site.

The updated current year Summary Plan Descriptions will be available online and in hard copy form upon request in the first quarter of the current year.

You have a right to receive a paper copy of the Summary of Coverage and Benefits upon request at no charge to you. If you would like to request a paper copy, or if you have any questions, please contact the benefits office.

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