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 Express Scripts, formerly Medco. (Note: Some Express Scripts forms may still include the Medco name. You may submit these forms to Express Scripts.)

Plan Design

In general, the same services are covered under SUBlue, SUOrange and SUPro but with different payment structures.

A one-page summary of the three plans is provided in the Medical and Prescription Drug Plans at a Glance.

More comprehensive reviews of the cost sharing required for services under the plans are provided in the Schedule of Benefits. In addition, should you wish to review the Medical Benefits Summary Plan Description (SPD) or the Medical Benefits Booklet, these can be found on MySlice under Employee Resources.

The following table highlights some key differences among the plans:

SUBlue SUOrange SUPro
Network Coverage Provides in-network and out-of-network coverage Provides in-network coverage only Provides in-network and out-of-network coverage
Referrals Necessary for maximum (Level 1) benefits Necessary Not necessary
Cost Sharing
(in- network – Level 1 benefits)
Generally copays Generally copays Generally deductible and coinsurance

The following online tools are available (see “Helpful Links” below) to help employees determine which plan will be most effective for their needs:

    • Online summaries with detailed coverage information for SUBlue, SUOrange, and SUPro.
    • A sample POMCO Explanation of Benefits (EOB) to help you navigate the layout and codes of this document. Reviewing your EOB documents (you can find online on the POMCO web site) may help you evaluate which plan option is best for you.
Participating Provider Network

The level of medical coverage you receive for medical services is based on whether your physician participates in the POMCO-PHCS/Multiplan network. You should confirm that your medical providers are in the network. If your provider does not participate and you would like POMCO to attempt to recruit him or her, please complete the “Recruit a Physician” form on the POMCO website.

Special Prescription Drug Programs
  • The prescription benefit features “RationalMed,” a program in which Express Scripts (formerly Medco) coordinates directly with your doctor if a medication you are prescribed has potential health and safety issues based on your other prescribed medications or medical conditions. There is no action for you to take to implement this service.
  • To encourage the use of generics, if a generic equivalent is available and you choose to have the brand name drug, or your doctor prescribes the script “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.
Contributions

SU pays most of the cost of your medical coverage and you pay the remaining cost of the premium through pre-tax payroll deduction. Benefits-eligible employees default into the Schedule A contribution rates for medical coverage unless they qualify, apply and are approved for Schedule B contributions. Graduate Assistants and Fellows are automatically defaulted to Schedule B contributions.

Premiums for domestic partners and their children are paid on an after-tax basis.

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

2014 MONTHLY MEDICAL PLAN EMPLOYEE CONTRIBUTIONS
SUBlue
SUOrange
SUPro
Schedule A Schedule B Schedule A Schedule B Schedule A Schedule B
Employee $125.71 $110.12 $122.02 $106.89 $114.65 $100.43
Employee +
Spouse/Domestic
Partner
$276.55 $242.26 $268.44 $235.15 $252.21 $220.94
Employee +
Child(ren)
$242.62 $212.53 $235.50 $206.30 $221.26 $193.82
Employee +
Spouse/Domestic
Partner +
Child(ren)
$393.46 $344.67 $381.92 $334.56 $358.84 $314.34
Healthcare Credit

When the Supreme Court struck down Section Three of the Defense of Marriage Act as unconstitutional, it eliminated the federal “tax penalty” for couples that are legally married in states or jurisdictions that recognize same-sex marriages, including New York. This means employee contributions toward benefits for same-sex spouses can now be paid on a pre-tax basis, and SU’s contribution toward same-sex spousal benefits is no longer considered income and subject to federal taxes. Now that employees do have a legal remedy to offset the disparate tax treatment for same-sex spouses, the University has eliminated its health care credit for same-sex spouses or same-sex domestic partners enrolled in SU’s health plan.

 

Helpful Links

Plan Designs


POMCO

Express Scripts (formerly Medco)

Online Tools

Marketplace Coverage Notice

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.