Medical/Dental/Vision/Rx
- Blue Cross and Blue Shield of Alabama is our medical and dental provider.
- The plan is a PMD plan which allows participants to seek medical service from any Doctor who participates in the BlueCard Preferred Provider Organization.
- Full time employees are eligible to participate in the plan upon hire. Benefits will be effective upon date of hire.
- We offer three tiers of coverage: individual, two-person, family.
- When you enroll in the plans, you must enroll in both or none. You cannot just enroll in medical or just enroll in dental. However, there will be separate deductions on your paycheck for medical and dental.
- Prescription coverage is included as a point-of-sale reimbursement plan.
- Routine vision coverage is included in the medical plan.
- Eligible dependents for the plan include:
- Your spouse of the opposite sex
- An unmarried child under age 19
- An unmarried child under age 26 while a full time student in a state accredited school, not working full time and chiefly depending on you for support
- An incapacitated child who is not able to support himself and who depends on you for support, if the incapacity occurred before age 19 or 26 if a full time student
- The plan runs from June 1 – May 31
- The deductible runs from January 1 – December 31
- Use the following link to access the Blue Cross Blue Shield website: BCBS.
Medical
- The current rates for the medical plan are as follows:
- Individual Coverage - $101.75/month
- Two-person Coverage - $204.50/month
- Family Coverage - $236.75/month
- When using an in-network doctor, physician office visit co-pay is $25.00.
- When going out of network, physician office visit is covered at 80% of the allowed amount, subject to the calendar year deductible.
- Annual calendar year deductible is $200.00/person or $600.00 maximum for family.
- Pre-certification is required for all hospital admissions except maternity. Emergency admissions require notification within 48 hours of admission.
- There is a $200 deductible per admission when using an in-network hospital.
- When going to out of network, the deductible is $400 per admission.
- In network Outpatient Hospital is subject to a $100 facility co-pay.
- When using out of network outpatient hospital, facility co-pay is $100 when services are rendered within 72 hours of the accident. After 72 hours, coverage is 80% of the allowed amount subject to the calendar year deductible.
- Lifetime maximum is $1,000,000.00 for each covered member.
- Click here for a copy of the Summary Plan Description for the health plan.
Prescription Coverage
- Prescription drug coverage is offered through a point-of-sale drug program.
- Prescription drug benefits are only available for prescriptions purchased from Participating Pharmacies, which are available in all states.
- In some cases, drugs may require prior authorization. Your participating pharmacist will advise if this is a requirement.
- Prescriptions purchased from Non-Participating Pharmacies are not covered.
- Participating Pharmacies give you a number which you must give BCBS when you file your drug claim. This is called the claim authorization number.
- You can determine if a pharmacy is participating by going to bcbsal.com.
- When purchased at a participating pharmacy, reimbursement schedule is as follows:
- Generic: 100% no deductible
- Preferred Name Brand: 80%, subject to the calendar year deductible
- Non-Preferred Name Brand: 60%, subject to the calendar year deductible
- Specialty: 50%, subject to the calendar year deductible
- Reimbursement claims can be made online at BCBSAL.com. This is the fastest way to be reimbursed.
- Click here for instructions on how to submit your prescriptions cliams online. *Please note: The instructions ask you to log in to customer access. Customer access is now My Blue Cross For Members.
- Claims may also be submitted via mail. Forms are located in Human Resources.
Dental
- Current rates for the dental plan are as follows:
- Individual: $7.25/month
- Employee plus one: $13.50/month
- Family: $18.25/month
- Coverage is limited to $1,000 per member each calendar year.
- There is a $25 calendar year deductible per member each calendar year (three per family)
- The deductible does not apply to diagnostic and preventative services
- Orthodontic Services are available for dependent children age 19 and under and are covered at 50% subject to the calendar year deductible and the $1,000.00 limit per member each calendar year. It is also limited is a lifetime max of $2,000.00 per member.
- Click here for a copy of the Summary Plan Description for the dental plan.
Vision
- Routine vision coverage is included in the medical plan.
- Routine vision coverage is covered at 80% of the Allowed Amount, with no deductible
- Coverage is limited to $200.00 per person each 24-month period.
Medical/Dental/Vision/Rx Frequently Asked Questions
- Are our premiums taken out before or after taxes?
Our plan is a pre-tax plan so the premiums are taken out before taxes.
- How long do I have to decide if I want to enroll in the plan?
You have 30 days from the day of hire to enroll in the plan. After the 30 day period has expired, you will not be allowed to enroll until open enrollment or until you experience a qualified change in family status.
- Can I cancel my coverage at any time?
You can only cancel your coverage during open enrollment or for a qualified change in family status.
- Why can I not make changes outside of open enrollment unless I have a qualified change in family status?
Because our plan is pre-tax, the IRS has rules concerning enrollment and changes made to the plan during a plan year.
- What is a qualified change in family status?
A qualified change in family status is a life changing event which allows a window in which to change your benefits during a plan year. Examples include but are not limited to: marriage, divorce, birth of a child, adoption, and death of a dependent.
- I have had a change in family status. How long do I have to make changes to my plan?
You have 30 days from the date of the status change to make changes to your plan. After the 30 day window expires, you will not be allowed to make changes until the next open enrollment period, or in the event you should experience another qualified status change during the plan year.
- Whom do I notify when I have a change in family status?
Contact Human Resources as soon as possible to make any changes needed to your plan.
- What is a Point of Sale prescription program?
With this program, you are required to pay for your prescriptions when they are filled at the pharmacy. You will then send in a request for reimbursement to BCBS. The amount of reimbursement depends on the type of drug filled and the portion of the deductible you have already met.
- If I need to be reimbursed for prescription drugs where would I find the forms?
You can apply for reimbursement directly on the BCBS website (www. bcbsal.com) or you can contact Human Resources for a paper form.
- How do I know if my doctor is in the preferred provider network?
There is a link to a listing of all doctors who are in the network on the BCBS webpage.
- What happens to my coverage if I leave Samford?
You will be offered COBRA which will allow you to continue coverage for a period of 18 months. The full cost of the premium will be borne by the employee.
- What happens to my child's coverage when he/she is no longer an eligible dependent?
The child will be offered COBRA which will allow you to continue coverage for a period of 36 months. The full cost of the premium will be borne by the dependent.
