USA Health and Dental Plan
Transparency in Coverage Rule
The link below leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
USA Choice Plan
University of South Alabama
Frequently Asked Questions
Your USA Fringe Benefits Committee (FBC) recommended, and the USA Board of Trustees and President Jo Bonner approved, an employee premium increase of $2 per month for single coverage and $7 per month for family coverage for employees enrolled in the current USA Choice plan for the 2023 plan year. The USA Select plan will have no increase in premiums for the 2023 plan year.
Medical Benefit Changes and Enhancements:
- To help combat the rising cost of medical care we are implementing a copay structure
to some benefits for the USA Health Network, in the USA Choice & USA Select Plans.
Effective January 1, 2023, the following will have a copay when you use these benefits:
- $15 copayment for Physician, Physical, Occupational and Speech Therapy visits
- $150 Outpatient Surgery copayment
- $200 Emergency Room copayment/waived if admitted
- ABA Therapy Benefits - we have increased ABA therapy annual benefit limits!
- Ages birth – 9: $40,000
- Ages 10 – 13: $30,000
- Ages 14 – 18: $20,000
- Enriched Preventative Care - we have added additional preventative care services if
you or your covered dependents have been diagnosed with specific medical conditions:
- Coverage for Blood Pressure Monitor
- Peak Flow Meter testing if you or your covered dependents have asthma
- International Normalized Ratio (INR) testing if you have certain liver or blood disorders
- Additional Lipoprotein LDL testing if you have heart disease
- Additional Hemoglobin A1C testing and Retinopathy screening if you have diabetes
- Introducing Virta: Virta is a treatment that safely reverses type 2 diabetes & prediabetes without the risks, cost or side effects of medications or surgery. If you or your spouse is enrolled in the medical plan, have prediabetes or type 2 diabetes, this benefit is offered at no additional cost! To get started go to www.virtahealth.com/join/bcbsalabama and apply.
- Dental Annual Maximum Increase: We are increasing the dental annual maximum from $1,250 to $1,500 per person covered on your dental plan!
- VSP Vision – New Benefit Offering: We are pleased to offer voluntary Vision benefits through VSP!
|USA Choice Plan - Base Premiums (employee hired before 1/1/2013)|
|USA Choice Plan - Standard Premiums (employees hired on or after 1/1/2013)|
Premiums for health and dental coverage are paid one month in advance and the employee
contribution for bi-weekly paid employees is split equally between the first two paydays
of the month. The employee contribution is exempt from federal, state and FICA taxes
with participation in the Premium Conversion Plan (automatic enrollment).
The USA Choice Plan and the USA Select Plan implemented a Tobacco Cessation Program
to help participants stop the use of tobacco. The program includes a wellness incentive
that reduces the employee premium cost sharing by $50 per month, if both the employee
and covered spouse do not use tobacco products. As a current USA health insurance member,
if you are not receiving the wellness incentive and both you and your covered spouse do not use tobacco products (and have not for at
least six months), you must complete the Tobacco Declaration Form. No action is required by employees that currently receive the wellness incentive.
The USA Choice Plan and the USA Select Plan are committed to helping you achieve your best health. Rewards for participating in the Wellness Incentive Program are available to all employees. If you think you may be unable to meet the standard for the reward under this program, you may qualify for an opportunity to earn the same reward by different means. Contact the Human Resources Department for additional information.
The USA Choice Plan and the Select Plan along with other plan information is available in Human Resources on campus and at USA Health Human Resources.
|University of South Alabama|
|USA Choice Plan - Plan Benefits|
|USA Select Plan - Plan Benefits|
|Glossary of Health Coverage and Medical Terms|
Human Resources office addresses
The USA Choice Plan and the USA Select Plan pharmacy annual deductible is $100 per individual (maximum of 3 per family).
The USA Choice Plan and the USA Select Plan copay structure 6-tier plan6-tier plan:
• Generic (preferred) COPAY $10
• Generic (non-preferred) COPAY $10
• Preferred Brand Name COPAY $50
• Non-Preferred Brand Name COPAY $75
• Specialty (preferred) COPAY $150
• Specialty (non-preferred) 50% COINSURANCE
Employees are eligible for participation in the USA Choice Plan or the USA Select Plan based solely on hours of service. The Affordable Care Act requires an offer of coverage to employees credited with 30 hours of service per week or 130 hours of service per month on average. The Plans may defer the offer of coverage if the employee is determined as having “variable hours” in which case benefits-eligible status will be determined using a 12-month measurement period with a corresponding 12-month coverage period in compliance with the Affordable Care Act.
Eligible Employees include:
- An employee with a specific appointment with no termination date, occupying a permanently budgeted position, and working a minimum of 30 hours per week on a regular basis.
- An employee with an employment start date on or after January 1, 2013, who is credited with 30 hours of service per week or 130 hours of service per month on average.
Eligible Employees may also enroll their legal spouse, as recognized by the state of Alabama, and children under age 26. Coverage with the selected Plan will begin on the first day of the month following the first day of employment, contingent upon timely application to the Human Resources department and payment of any required employee contribution.
- Spouse – As recognized by the state of Alabama.
- Dependent child –
- Your natural-born child under the age of 26.
- Your stepchild under the age of 26.
- Your legally adopted child, including a legally adopted child living with you as the adopting parent, during a period of probation.
- A child under age 26 over whom you have legal guardian status by court appointment.
- A child under age 26 for whom you are legally required to provide health insurance coverage pursuant to a Qualified Medical Child Support Order (QMCSO).
- Your disabled child of any age provided the disability commenced prior to age 19. Coverage under the Plan continues without interruption for the duration of the disability as long as the employee maintains dependent coverage.
You may enroll in a selected plan, enroll your eligible dependents or terminate coverage for yourself or a dependent when certain events cause a Change-In-Status. To make an enrollment change due to a Change-in-Status event, you must make application and provide documented proof of the Change-In-Status event to the Human Resources department within 30 days of the event. The effective date of the election would be the date of the qualifying event. If you fail to notify Human Resources within 30 days of the qualifying event, you must wait until the Open Enrollment Period.
Some examples of qualifying events include, but are not limited to:
- Marriage / Divorce
- Birth of Child
- Adoption or placement for adoption
- Change in your spouse’s employment status
There is a one-month Open Enrollment Period, usually the month of November, during which an employee may enroll in the USA Choice Plan, or the USA Select Plan, and/or add eligible dependents. During this period, you may file an application with the Human Resources department and coverage will begin on the first day of the following calendar year. During this time, employees can also re-enroll in SouthFlex Flexible Spending Accounts if they wish to participate the following calendar year.
All new employees must complete New Employee Orientation. During orientation, you will have the opportunity to complete enrollment forms. You will be notified as to the date/time of your scheduled orientation.
|USA Choice Plan - Base Premiums (employees hired prior to 1/1/13)||Single||Family|
|USA Choice - Standard Premiums (employees hired on or after 1/1/13)||Single||Family|
Note: Premiums for health & dental insurance are pre-tax dollars and are paid one month in advance so the initial deduction may reflect a retroactive adjustment.
The University of South Alabama encourages all employees to adopt healthy lifestyle choices. That effort will benefit you, your family and your fellow employees. The University’s Fringe Benefits Committee recommended, and the University adopted, a tobacco cessation program which is intended to help employees stop using tobacco products. Tobacco use and especially smoking will increase your risk of heart disease, stroke, respiratory diseases such as emphysema and bronchitis, as well as cancer including: lung, throat, mouth, esophagus, pancreas, bladder, and leukemia. The benefits from stopping the use of tobacco are almost immediate regardless of how long you have been smoking or using tobacco.
For new employees the Tobacco Declaration information/election is provided within the USA Health & Dental insurance enrollment form.
Existing employees that do not currently participate in this wellness incentive may begin participation by completing the Tobacco Declaration form. On this form employees will declare that they and their covered spouse do not use tobacco products; and have not used tobacco products within six months prior to the date on the form. This will qualify for a wellness incentive of $50 per month (one per family). The wellness incentive will be applied to the monthly insurance premium effective the pay period following the date on the Tobacco Declaration form (payroll deadlines can affect when this discount will be applied).
For employees enrolled in any of the University sponsored health plans seeking assistance with tobacco cessation please call 866) 784-8454 or visit https://www.quitnow.net/Alabama to obtain information about the Blue Cross Blue Shield - Quit for Life Program. The Program is provided at no cost to employees and covered spouses who want to stop using tobacco products and offers a 24-hour support hotline, customized phone counseling sessions and nicotine replacement patches, gum or lozenges.
For additional tobacco cessation resources you may also contact the Employee Assistance Program office at 461-1346.
Premiums for health & dental insurance are paid one month in advance. Your cancellation date will be based on your last day of employment. Example: If your last day of employment is December 14, your last paycheck will be December 30. Premiums paid in December through payroll deduction have paid for coverage for January. Your insurance will cancel effective January 31.
Note: The above information applies only to employees in a paid status. For employees on a leave of absence in an unpaid status, please contact Human Resources for an effective date of cancellation.
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