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Important Changes to the Anthem Formulary Effective January 1, 2009

The University of Maine System offers a choice between two different medical plans, both of which cover a wide range of services, from hospitalization to doctor’s office visits, from prescription drugs to surgery. Whichever medical plan selected, employees can be sure that it is there to protect them from financially burdensome medical bills.  Both plans are insured with Anthem Blue Cross Blue Shield.   Click here to view a Side By Side Plan Comparison Chart.

Both plans offer:

The employee and University share the cost of coverage for both employee and dependents, the cost to the employee will depend on employment status.


COMP-CARE

COMPREHENSIVE GROUP HEALTH PLAN

(Anthem COMP-CARE website)


The COMP-CARE Plan allows complete freedom of provider choice so that participants needing care may select any medical care provider they wish.  However, before charges are covered, participants must satisfy an annual deductible and pay 20% of the provider’s billed charges. Once the annual out of pocket charges are satisfied, covered services are paid at 100%.


This program requires pre-certification and utilization review by Anthem BCBS for inpatient hospital stays and other listed procedures.

COMP-CARE Plan Documents

COMP-CARE Premiums

TOTAL MONTHLY GROUP HEALTH PREMIUMS

COMPREHENSIVE COMP-CARE HEALTH PLAN

 

Single Coverage

Single +One Coverage

Family Coverage
$534.30 $1,175.48 $1,495.99

 

EMPLOYEE SHARE OF GROUP HEALTH PREMIUMS

COMPREHENSIVE COMP-CARE HEALTH PLAN*

 Full-time Regular Active Employees

Also includes BR status employees, shared appointments, and partial/phased retirement.

Single Coverage

Single +One Coverage

Family Coverage

Faculty – Monthly Premium

57.42 138.57 179.15

Non-Represented Professional (including Law School) Faculty and UMPSA - Monthly Premium

60.11 145.07 187.53

Non-Rep. Classified Confidential/University Supervisors, Police, Service & Maintenance, & COLT - Biweekly Premium

 27.74 66.96 86.55

 

Eligible Part-time Active Employees

Single Coverage

Single +One Coverage

Family Coverage

Regular Employees Working 50%-74% time (except PATFA) – Monthly Premium

267.15 587.74 748.00

Regular Employees Working 50%-74% time - Biweekly Premium

123.30 271.27 345.23

Regular Employees Working 75%-99% time (except PATFA) - Monthly Premium

213.72 470.19 598.40

Regular Employees Working 75%-99% time - Biweekly Premium

98.64 217.01 276.18
Temporary PATFA – Monthly Premium 213.72 470.19 598.40
Regular PATFA - Monthly Premium 267.15 587.74 748.00

*Subject to ratification and execution of collective bargaining agreements where appropriate.

 

 


HMO CHOICE

POINT-OF-SERVICE (POS) PLAN

(Anthem HMO Choice website)


The POS plan offers a higher level of benefits than the COMP-CARE Plan, overall. The POS plan is a managed care program that utilizes a network of health care providers. The Anthem BCBS network currently includes all hospitals in Maine and is the largest physician network in Maine. The network includes primary care physicians, as well as specialty providers such as internists, chiropractors, cardiologists and neurologists.


Each participant must choose a network provider to act as his or her Primary Care Physician (PCP) and provide the Benefits office with each covered member's PCP identification number.   To find a PCP, visit Anthem's online Network Provider Directory or call Anthem directly at 1-800-527-7706 to obtain a hardcopy.  PCP's are responsible for coordinating the care of their patients to ensure that patients receive the most appropriate care available.  Participants in the POS program have the option to use network or non-network providers.  Participants using network providers are covered 100% for hospitalization and pay only a co-payment for physician services. There are no deductibles or claim forms when using network providers.   

Participants choosing to use non-network providers receive benefits similar to the COMPCARE Plan, but with a higher out-of-pocket maximum. When participants receive care outside the network, this program also requires pre-certification and utilization review by Anthem BCBS for inpatient hospital stays and other listed procedures.

 

HMO Choice - POS Plan Documents

 

HMO Choice / POS Premiums

TOTAL MONTHLY GROUP HEALTH PREMIUMS

HMO CHOICE / POINT-OF-SERVICE HEALTH PLAN

 

Single Coverage

Single +One Coverage

Family Coverage
$502.44 $1,105.34 $1,406.79

 

EMPLOYEE SHARE OF GROUP HEALTH PREMIUMS

HMO CHOICE / POINT-OF-SERVICE HEALTH PLAN*

 Full-time Regular Active Employees

Also includes BR status employees, shared appointments, and partial/phased retirement.

Single Coverage

Single +One Coverage

Family Coverage

Faculty – Monthly Premium

57.42 138.57 179.15

Non-Represented Professional (including Law School) Faculty and UMPSA - Monthly Premium

56.53 136.41 176.36

Non-Rep. Classified Confidential/University Supervisors, Police, Service & Maintenance, & COLT - Biweekly Premium

 26.09 62.96 81.40

 

Eligible Part-time Active Employees

Single Coverage

Single +One Coverage

Family Coverage

Regular Employees Working 50%-74% time (except PATFA) – Monthly Premium

251.22 552.67 703.40

Regular Employees Working 50%-74% time - Biweekly Premium

115.95 255.08 324.64

Regular Employees Working 75%-99% time (except PATFA) - Monthly Premium

200.98 442.14 562.72

Regular Employees Working 75%-99% time - Biweekly Premium

98.64 217.01 276.18
Temporary PATFA – Monthly Premium 200.98 442.14 562.72
Regular PATFA - Monthly Premium 251.22 552.67 703.40

*Subject to ratification and execution of collective bargaining agreements where appropriate.

 

 

PRESCRIPTION DRUG COVERAGE


Both medical plan options offered by the University of Maine System provide employees with prescription drug coverage.  All employees are covered for both generic drugs and brand name drugs. Because brand name drugs are typically more expensive than generic drugs, you should ask your physician to prescribe a generic drug, if appropriate. 


All HMO Choice (POS) and COMP-CARE enrollees have the opportunity to use the mail order program. The mail order program allows the convenience of having a three-month supply of maintenance drugs delivered right to their home!


Any questions on how to best utilize prescription drug coverage should be directed to Anthem BCBS at 1-800-527-7706.


 
 

Related Information

 
Domestic Partner Benefits
Anthem Claim Form (PDF)
Employee Assistance Programs (EAP)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Notice of Privacy Practices - Revised 9/03

Health Information Policy

Authorization for the Use and/or Disclosure of Protected Health Information

UMS HIPAA General Operating Policy and Forms

UMS Health and Wellness
Family Leave Policies
Paid Leave (Vacation & Sick Time)
Retirees Health Plans
COBRA Continuation of Coverage


   See also:  Understand Your Pay Stub

 

 

UMS Question logoContact Benefits

The above is a brief summary of benefits offered by the University of Maine System. Detailed brochures/booklets are available online, at the local University Office of Human Resources, or at the System Office of Human Resources.

If you have a question about your benefits coverage, benefit deduction amounts or any other benefit related question, contact your Campus Benefits Office.  Be prepared to give your Employee ID number.

 

Last Updated:  November 10, 2009