Benefits: Overview of ERAU Health Care Plan

This Overview webpage provides brief definitions of terms and coverage for the ERAU Health Care Plan. Please note that this overview is a summary, not a plan document.
   

• Accident Expense Benefit
• Alcoholism & Drug Addiction
• Birthing Centers
• Chiropractic Care Benefit
• Deductible
• Dental
• Hospice Care

• Lifetime Maximum per Individual
• Mental Illness
• Out of Pocket Maximum - NETWORK
• Out of Pocket Maximum - NON-NETWORK
• Pre-Admission Testing
• Pre-existing Condition
• Preferred Providers

• Pregnancy
• Prescription Drug Program
• Second Surgical Opinion
• TMJ (Temporomandibular Joint)
• Utilization Review Program
• Vision
• Waiting Period/Eligibility
• Well Child Care
• Wellness Benefits

Waiting Period/Eligibility

Coverage begins the 1st of the month following 1 month after date of hire. Must work 30+ hours per week to be eligible. Dependent children are eligible until age 19 or up to 26 if attending school full time. 

Pre-existing Condition

• Pre-existing Condition A condition for which medical advice, diagnosis, care or treatment was recommended or received within 6-month period prior to coverage
• Pre-existing Condition Exclusions 1 year coverage exclusion applies to a timely entrant (the first period in which you are eligible to enroll) and 18 months to late entrants. Certificates of Creditable Coverage may be presented for pre-existing condition.

Deductible

$250 per person per calendar year; $500 maximum per family per calendar year.

Out of Pocket Maximum - NETWORK & PLAN B

• $1,500 plus $250 deductible per individual per calendar year
• $3,000 plus $500 deductible per family per calendar year 

Out of Pocket Maximum - NON-NETWORK

• $3,000 plus $250 deductible per individual per calendar year
• $6,000 plus $500 deductible per family per calendar year. 

Lifetime Maximum per Individual

$2 million. 

Preferred Providers

• Volusia Health Network Preferred Provider Directory. VHN's website offers a directory of in-network healthcare providers, as well as contact information for precertification and claims processing.
• Florida Memorial Health Network. FMHN's website provides a Provider search for Physicians and Facilities.
• Blue Cross/Blue Shield Providers: To find BC/BS providers, choose the "Blue Preferred (PPO)" option on the Blue Cross/Blue Shield Arizona website.

Utilization Review Program

Precertification is required on ALL hospital admissions, surgery and review for second surgical opinion and purchase of medical equipment. Provides concurrent review and large case management. $200 penalty for noncompliance. 

Second Surgical Opinion

If required, paid 100%.

Wellness Benefits

Covers routine physical exams, gynecological exams, mammograms, pap tests, prostate exams and any other preventive maintenance testing. Employee and spouse maximum benefit of $250 per calendar year per individual. Covered children age 7 and up, maximum of $100 per calendar year, per child. 

Supplemental Accident Expense Benefit

Services and supplies furnished within 90 days of an accident are paid 100% of reasonable and customary fees up to $300 maximum if filed within 90 days. 

Pre-Admissions Testing

Paid at 100% of reasonable and customary fee. 

Prescription Drug Program

• Walgreens Retail Pharmacy Network
  • $10.00 co-payment for generic drugs
  • $35.00 co-payment for name-brand drugs
• Walgreens Mail Order (90-day supply of maintenance medication)
  • $20.00 co-payment for generic drugs
  • $70.00 co-payment for name-brand drugs  
• Non-Network Provider -- paid at 50% through the medical plan and does not apply to deductible or co-insurance

Birthing Center

Paid at 100% of reasonable and customary fee. 

Hospice Care

• Inpatient: Paid at 100% up to $150/day for 6 months
• $2,000 out-patient maximum benefit
• $10,000 combined inpatient/outpatient lifetime maximum benefit
• $200 bereavement counseling maximum benefit.

Well Child Care

Pays the same % as other ELIGIBLE MEDICALLY NECESSARY services. 12 visits from birth to age 6, not subject to deductible.

Mental Illness

• In-patient care: Covered at 50% ELIGIBLE MEDICALLY NECESSARY services after deductible subject to a 30-day maximum benefit per calendar year. 
• Out-patient care: Covered at 50% ELIGIBLE MEDICALLY NECESSARY services after deductible subject to a maximum benefit of 20 visits per calendar year.

Alcoholism & Drug Abuse Treatment

• In-patient care: Covered at 50% after deductible subject to a 30-day maximum benefit per calendar year and a lifetime maximum benefit of $10,000 combined in-patient and out-patient treatment. 
• Out-patient care: Covered at 50% to a calendar year maximum benefit of $1500.

Chiropractic Care Benefit

Chiropractic care is covered at 50% after deductible to a maximum of $1,000 per calendar year.

Pregnancy

Coverage for employees and spouses only. Coverage allows for elective abortions. No coverage for infertility. Voluntary sterilizations are covered; reversals are not covered. Birth control pills are covered under the Mail Order Program. If medically necessary, birth control pills will be covered under the medical plan.

TMJ (Temporomandibular Joint Dysfunction)

Covered at 50% after deductible.

Pre-Authorization

Employees are encouraged to pre-authorize all non-emergency dental treatment in excess of $300. Pre-authorization allows the employee to identify their out-of-pocket dental expenses before treatment is rendered. 

Vision Exam
Up to $50 for one Examination per Calendar Year

Single Vision
Lenses Up to $40 per Calendar Year

Bifocal Lenses
Up to $50 per Calendar Year

Trifocal Lenses
Up to $60 per Calendar Year

Medically Necessary Contact Lenses
Up to $60 per Calendar Year

Dental Care

The University reserves the right to change the employee benefits plan as business necessity and/or legislation dictate. Please note that this overview is a summary, not a plan document.