Questions and answers from the Oct. 4 benefits town hall

As part of a broader effort to help faculty and staff understand and prepare for changes to their medical insurance plans for 2024, benefits director Ed Holland and associate vice president for finance Heather Paris led a virtual town hall on Wednesday, Oct 4. During the town hall, they responded to faculty and staff participants' questions, many of which are summarized below. The town hall was recorded and archived. A link is on the benefits' open enrollment website (under "communications").

Why are we trying to bridge the health insurance cost gap in one year?

Actually, we're not. This effort will take a few years to fully close the gap, and the changes being made for 2024 are a first step. The university previously had reserves to help offset the gap between premiums collected and medical claims paid each year, but those reserves are now depleted. To maintain this health benefit for our employees, we must have a different strategy to share the full cost between employees and university departments. 

It's difficult to predict what our plans will look like in 2025. We'll need to watch what happens with health care costs in the next year as well as how employees utilize the services in our plans.

What employee input was considered before making these changes?

The Employee Benefit Advisory Committee (EBAC) representatives are faculty, professional and scientific and merit employees. As it does every year, last spring, the members reviewed the information and options for plan changes they received from our health care consultant. They also were able to discuss the potential savings with their constituents. They then voted for this recommendation, which was taken to senior leadership.

Has the university considered a high-deductible health plan with a health savings account?

Yes, EBAC looks at those plans from time to time. Our plan is not a high-deductible plan, even after the changes we put in place for the upcoming year. For 2024, the deductible required by the IRS in a high-deductible plan is $1,600 (single coverage) and $3,200 (family). Those required deductible levels are more than our HMO out-of-pocket maximums for 2024. There still are premiums and even higher out-of-pocket maximums for those plans as well.

This question reflects the continuum among our employees -- some prefer a lower premium and potential higher out-of-pocket liability, and others prefer a lower liability for out-of-pocket costs with higher premiums. 

Has Iowa State considered setting premiums based on the number of people covered in a plan?

We actively review the employee benefits market for new ways to offer plans and to develop our premiums. Typically, what we see in the market is the four tiers we offer. Sometimes we see fewer tiers; it is rare to see more tiers than we offer. There likely is little value in offering additional tiers of coverage.

Will counseling and therapy sessions still be covered in 2024?

No changes are being made to ISU's overall health care coverage. Your health care benefits will continue to include mental health and substance abuse services. What is changing is that now you will pay a copay each time you visit a provider for these services. If you're in the HMO plan, the copay is $15 per visit. If you're in the PPO plan, the copay is $25 per visit. Beyond the copay, you will not pay additional expenses for these services. Every copay counts towards your annual out-of-pocket maximum. If you reach your out-of-pocket maximum at any time in 2024, you'll no longer pay a copay the rest of the calendar year.

With the growing concern for employee mental health, why is that not considered preventive care?

There are multiple mental health screenings that fall under preventive care services that are at no cost to our employees and their dependents. The federal government determines what's defined as preventive services (under the 2010 Affordable Care Act), and that list has grown since 2010.

Why does this plan have coinsurance if ISU is already adding a deductible?

This arrangement is standard in health insurance plans. Early in the plan year, you're paying the full cost of the (nonpreventive) services you receive; your deductible is a dollar amount you need to reach. Once you meet it, there still are out-of-pocket costs, but now you switch to paying a percentage of the cost of services (10% co-insurance in the HMO plan, 20% in the PPO plan). The co-insurance is how you get from your deductible to your annual out-of-pocket maximum.

Two educational tools are available to help employees. On the UHR Benefits website, the Medical Insurance Glossary and Understanding Your Medical Coverage Costs video help define plan elements such as a deductible, coinsurance and out-of-pocket maximum, as well as how these elements interact and apply to care received.

Do office copays count toward the deductible or the out-of-pocket maximum?

On the ISU Plan, our co-pay is inclusive, so when you have an office copay, there isn't a deductible requirement. However, copays, the deductible and coinsurance all count towards the out-of-pocket maximum.

What's the difference between an office visit copay and an emergency room copay?

In an office visit copay, coinsurance does not follow. The lone exception is when you go to the emergency room. You will have a copay of $125, plus you'll pay coinsurance for the services you receive in the ER. Coinsurance is 10% (HMO) or 20% (PPO).

Do employees have to reach their deductible before coinsurance begins?

Yes, you must meet your deductible. Once you do, coinsurance kicks in and you only pay coinsurance. A couple of exceptions are:

• When you pay a copay, you don't have to pay toward the deductible.
• Under family coverage, when an individual in the family meets the $250 deductible, from that point forward, that family member pays coinsurance. An individual in a family plan doesn't have to meet the $500 family deductible.

Is the pharmacy benefit changing?

No, the pharmacy plan isn't changing. Everything about how that portion of the plan works for employees will continue. You will pay whatever the copay or coinsurance is, depending on what tier of drug you receive. Whatever you pay goes toward the pharmacy out-of-pocket maximum (which is separate from the medical out-of-pocket maximum).

Can ALEX pull in an employee's health care spending history to help with planning for the upcoming year?

The ALEX tool asks questions about your history, and your claims history is available to you in your mywellmark.com account. When you enter your health care spending information into ALEX, it will base its recommendations on what you provide.

With the ALEX GO app version, you also can enter the information for a spouse's health care plan (with another employer), and your comparison will consider Iowa State's HMO and PPO plans as well as the spouse's plan.

If labs or additional services are ordered during my office visit but not available to me that day, do I pay another copay when I return for them?

The copay reflects date of service. So, if you return later that day for services, the copay would apply. But if you return on another day, depending on how the provider bills it, you could pay a copay or co-insurance for that service.

How soon can I use the money in my health care flexible spending account?

On Jan. 1, you have access to the full amount you have elected to put into your account. One caveat: The reimbursement comes from our vendor, ASIFlex, so there might be a slight delay in you receiving that money until ASIFlex receives ISU's first payment.

How do these plan changes impact ISU retirees?

Our expectation -- and the message we're sharing with our retirees -- is that very little of these plan changes will impact retirees because nearly all our retirees are Medicare-eligible. For them, Medicare pays first.

Learn more:

• Study the 2024 plan details in the Open Enrollment section of the benefits website. This includes documents, a video and slide set.
• Ask a benefits specialist. Call 294-4800, email benefits@iastate.edu, or schedule a meeting through the online scheduler, Bookings.
• Watch for the Oct. 12 edition of Inside Iowa State, which will highlight helpful examples and information.