Benefits - Medical and Prescription Drug Plan Options

Benefits

Medical and Prescription Drug Plan Options

SU offers the following medical and prescription drug plan options to all benefits-eligible employees:

SUBlue
SUOrange
SUPro

All three plan options include medical benefits administered by POMCO and prescription drug benefits administered by Medco.

SUBlue and SUOrange Medical Plans

There are three levels of coverage in the SUBlue plan.

Level One - Services must be performed by a provider that participates with the POMCO-PHCS/MultiPlan network and must be coordinated by your Primary Care Physician (PCP).
Level Two - Services are performed by any provider participating in the POMCO-PHCS/MultiPlan network, but are not coordinated by your PCP.
Level Three - Services are performed by a provider that does not participate in the POMCO-PHCS/MultiPlan network.

All services performed by providers that are participating in the POMCO-PHCS/MultiPlan network are paid at level one, regardless of their location, when referred by your Primary Care Physician.

If your provider does not participate with POMCO and you would like him or her added to the network, please complete the Recruit a Physician form on the POMCO web site. POMCO will contact the physician and invite him or her to become a POMCO preferred provider.

SUOrange coverage is nearly identical to SUBlue coverage except that services are restricted to those that qualify under Level One.

SUBlue and SUOrange Prescription Drug Plan

Prescription drug benefits for SUBlue and SUOrange are as follows:

Retail

Generic: 20% coinsurance
Preferred Brand: 20% coinsurance
Non-preferred Brand: 40% coinsurance
Contraceptives (generic and preferred brands only): 50% coinsurance

This includes prescriptions filled for a 90 day supply at local participating pharmacies.

Mail Order

Generic: $20 co-payment
Preferred Brand: $40 co-payment
Non-preferred Brand: $80 co-payment
Contraceptives (generic and preferred brand only): 50% coinsurance

To determine if your prescription is generic, preferred, or non-preferred, check Medco's online Formulary.

Prescription drugs in the Biotech/Specialty class, required to be filled through mail order, will be limited to a 30 day supply per refill. The payment schedule is the same as the mail order schedule.

There is an annual out-of-pocket maximum for prescription expenses paid of $2000 for each individual to a maximum of $4,000 for a family.

If a generic equivalent is available and you choose to have the brand name drug, or your doctor prescribes "Dispense as Written" (DAW), you will be required to pay the difference between the actual cost of the brand name drug and the amount the plan would have paid for the generic equivalent.

SUPro Medical Plan

In general, the same services covered under SUBlue and SUOrange are also covered under SUPro, but with a different payment structure. There are two levels of benefit coverage in the SU Pro plan:

Level One:

Covers services performed by a provider participating in the POMCO-PHCS/MultiPlan network anywhere in the United States.
Preventive care services are not subject to the deductible or coinsurance.
There is an annual deductible of $200 for each individual to a maximum of $400 for a family.
After the deductible is met, members pay 20% coinsurance for all services, with the exception of a 5% coinsurance for Inpatient Hospitalization.
There is an annual out-of-pocket maximum for medical expenses paid of $1,500 for each individual to a maximum of $3,000 for a family.

Level Two:

Covers services performed by providers or facilities that do not participate in the POMCO-PHCS/MultiPlan network.
There is an annual deductible of $300 for each individual to a maximum of $1,000 for a family.
After the deductible is met, members pay 30% coinsurance of the allowable amount plus the difference between the submitted charges and the allowable amount. As an exception, Inpatient Hospitalization services have a 5% coinsurance of the allowable amount plus the difference between the submitted charges and the allowable amount.
There is an annual out-of -pocket maximum for medical expenses paid of $6,000 for each individual to a maximum of $12,000 for a family.

There are no referrals needed to see a specialist under this plan. However, select services require prior authorization.

SUPro Prescription Drug Benefits

Prescription drug benefits for SUPro, including contraceptives, are as follows:

Retail

Generic: 15% coinsurance
Preferred Brand: 25% coinsurance
Non-preferred Brand: 40% coinsurance

This includes prescriptions filled for a 90 day supply at local participating pharmacies.

Mail Order

Generic: lesser of $15 co-payment or 15% coinsurance
Preferred Brand: lesser of $45 co-payment or 25% coinsurance
Non-preferred Brand: lesser of $90 co-payment or 40% coinsurance

There is an annual out-of-pocket maximum for prescription expenses paid of $2000 for each individual to a maximum of $4,000 for a family. Consistent with coverage under SUBlue and SUOrange, if a generic equivalent is available and you choose to have the brand name drug, or your doctor prescribes "Dispensed as Written" (DAW), you will be required to pay the difference between the actual cost of the brand name drug and the amount the plan would have paid for the generic equivalent.

Employee Contributions for SUBlue, SUOrange, and SUPro

SU pays most of the cost of your medical coverage and you pay the remaining cost of the premium through pre-tax payroll deduction. Qualified same-sex domestic partner premiums are paid on an after-tax basis.

2009 Monthly Contributions*
SUBlue

SUOrange

SUPro

Employee $ 76.38 $ 72.30 $ 69.67

Employee +1 $162.90 $154.19 $148.58

Family $212.27 $200.92 $193.61

*Rates listed here are based on the 12-month calendar year. Actual deductions from each paycheck will vary depending upon your deduction cycle.

Helpful Links

Plan Designs

POMCO

Medco

Questions? Contact the HR Service Center at 443-4042 or e-mail hrservic@syr.edu.

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The web pages summarize your Syracuse University benefit options. Every effort has been made to ensure this information is accurate. However, the programs are governed by legal documents and insurance contracts. If there is any difference between the information on these web pages and the official documents and contracts, the official documents and contracts will rule. Our benefits are governed by current laws and operated according to Internal Revenue Service (IRS) regulations. We will notify you if changes in plans are necessary to comply with the law or with IRS regulations.

Employees electing to participate in the SU benefit plans are bound by the terms of the governing Plan documents. If you have any questions regarding the plans, you may request a copy of the Plan document from the Plan Administrator by contacting the HR Service Center at the number indicated at the end of this page.

As is the case with all benefits offered by SU, (1) the Plan Administrator has the discretionary authority to interpret the terms of the Plan and such interpretation will be binding on all interested parties to the fullest extent permitted by law, and (2) the University reserves the right to modify or terminate the Plan at any time.

2009 Monthly Contributions*	SUBlue	SUOrange	SUPro
Employee	$ 76.38	$ 72.30	$ 69.67
Employee +1	$162.90	$154.19	$148.58
Family	$212.27	$200.92	$193.61