Common Questions and Answers 2016 Benefit Survey for Medical, Dental and Vision Plans

MEDICAL/PRESCRIPTION/DENTAL/VISION

Q: I don’t know where to find information on what the current prescription plans is and what card I should have. Where do I find this information?

A: The current prescription provider is Express Scripts (formerly Medco). Your current card should show Express Scripts as the name of the provider on the card with the Group Number SONMRXP. If you do not have this card, you can request a new card at https://www.express-scripts.com/ or by calling 877-852-4060. You can also login as a member to the Express Scripts website above and print a temporary card. You can find additional information on the prescription program on the benefits website at http://benefits.nmsu.edu/insurance/prescription/.

Q: I don’t know how the vision plan works. Where do I find information on this?

A: The vision plan is offered through VSP. You will not receive a card for this program as all claims are processed through a web portal at the in-network provider office. To schedule an appointment, you simply call an in-network provider, let them know you are with VSP, and provide the information they request from you as part of the appointment setup. Once you are at the vision appointment, they will print your VSP benefits and let you know how much you will owe as part of your benefits structure. You can also view your benefits by logging into the member portal at www.vsp.com. If by chance you are asked for a group number, that number is 12340658 and can be found on the benefits website at http://benefits.nmsu.edu/insurance/vision/ along with information regarding your plan benefits, such as copay information and plan limits.

Q: I do not like that we can have an eye exam every year but we can only get glasses every other year. What if my prescription changes each year?

A: The vision plan allows for frames for glasses every other year, but it also allows for lenses every year. You can also choose to get new frames every year, but you will pay the cost on your own, with a built in discount for using an in-network provider.

Details regarding the vision plan benefits can be found at http://benefits.nmsu.edu/insurance/vision/.

Q: Why do state/city/county employees pay less premiums than NMSU employees?

A: Employers who participate in the state of New Mexico Risk Management Division’s (RMD) health plans basically pay the same monthly premium for the plans. However, the employer decides what portion of that monthly premium is split between the employee and the employer. State employees, who also participate in the same health plans as NMSU through RMD, may pay a different portion based on the splits determined by the state employer. The city and county do not participate in the state RMD benefit plans. Their rates are based on their specific plans and they do not equate to what NMSU participates in with RMD.

Q: Why does NMSU only have two health plan providers? Can’t NMSU negotiate to have more providers?

A: NMSU participates in the medical, prescription and dental plans offered through the state of New Mexico Risk Management Division. This means that NMSU is not directly involved in any of the contracts for those benefits, nor do we have any ability to negotiate what plans are available or how much they cost.

Q: Why don’t the NMSU health plans recognize El Paso providers as in-network?

A: NMSU has access to three medical plans through the state of New Mexico Risk Management Division. Each plan offers their own network access to providers. The most restrictive plan to El Paso is the BCBSNM HMO plan. This plan is designed to primarily serve New Mexico residents, with limited coverage for emergency and urgent care outside NM. The other two plans offer nationwide coverage with extensive coverage in El Paso. Employees have the opportunity to change plans each year during the annual open enrollment that usually takes place in October. All changes initiated during the open enrollment go into effect on January 1. Information regarding the medical plans and network coverage can be found at http://benefits.nmsu.edu/insurance/medical/. Information regarding making changes to your benefits can be found at http://benefits.nmsu.edu/enrollment/changes/. Information regarding open enrollment can be found at http://benefits.nmsu.edu/enrollment/open/.

Q: Being that NMSU is such a large community, lower premium rates should be offered to our employees. It should not be limited or regulated by the government.

A: In general, benefit programs are highly regulated by governmental agencies, both state and federal. In recent years, due to the regulations under the Affordable Care Act, many health plans have experienced increases in rates due to more substantial coverage requirements. In general, there are two ways to keep costs low: 1. Offer reduced benefit coverage (higher copays, deductibles and out of pocket costs) and 2. Efficient use of plan benefits (use lower cost services, preventive care to reduce high cost claims). Specifically for NMSU, since we participate in the state on New Mexico’s health plans, we do not control the plan design. NMSU also does not have any control over the amount of premium charged to us by the state of New Mexico.

Q: Whatever happened to the health insurance we had 12 years ago?

A: In 2006, NMSU made the decision to leave a self-funded plan model to participate in the state of New Mexico health plans.

Q: It is very hard to find dentists or oral surgeons in the PPO. My dentist is considered premium so if I need any work done outside my cleanings I have to shop around.

A: Delta Dental has a website that allows you to search for providers by zip code. You can also search by specialty, such as oral surgery. To receive the largest discounted rate, you want to search for a provider in the PPO New Mexico network, although you do receive discounted contract rates throughout the entire Delta Dental PPO network. If you are seeking the lowest costs for services, then it would be in your best interest to contact several providers to price out the higher cost services, such as root canals or oral surgery.

Picture of Find a Dentist interface.

Q: The federal VSP plan is about the same price as the one offered by NMSU, yet the federal plan covers 3 times as much. Could you check with them why the plans are not equal even though they cost the same?

A: While NMSU cannot speak to specific plan/rates for other organizations, it is important to note that many factors contribute to a plan’s pricing so it is difficult to make an apples to apples comparison.  The NMSU plan design is VSP’s most popular for plan frequency with a comprehensive eye exam and lenses available every year and a frame every other year.  Other employers may offer a similar plan design, but based on the size of their enrolled members and member usage, the rates may differ for each employer.

FLEXIBLE SPENDING ACCOUNTS

Q: I am currently on the flexible spending account plan but when I call Erisa (the state) with questions they cannot answer them. Why?

A: The flexible spending account plans are offered through Stanley, Hunt, Dupree and Rhine (SHDR). NMSU has a direct contract with SHDR for these programs so they are not part of the state benefits. All questions regarding the flexible spending account plans should be directed to Benefit Services at benefits@nmsu.edu or by calling 575-646-8000. If you have questions about your claims or reimbursements, you can call SHDR directly at 800-930-2441 or login to your personal account at http://www.shdr.com/flex. You can find plan details on the benefits website at http://benefits.nmsu.edu/insurance/fsa/.

Q: Can we increase the amount allowed on the flexible spending account?

A: The limits allowed on the flexible spending accounts are determined by the Internal Revenue Service (IRS). NMSU can choose to allow a smaller amount, but cannot allow a larger amount than allowed by the IRS. Currently the NMSU plan provides for the maximum allowed under the IRS regulations.

Q: The flexible spending account is too prohibitive and requires that every time the debit card is used that I provide follow up documents. Why is this required?

A: The IRS allows debit cards to be used with the flexible spending accounts, if certain rules are followed.  These rules state that if an employer offers the debit card, then all debit card transactions must be substantiated by using IRS approved methodology.  The software system used by our current vendor, SHDR, uses resources to auto substantiate as many debit cards as possible while staying within IRS guidelines.  The IRS allows auto substantiation for the following transactions:

  • Using IIAS approved merchants (such as pharmacies, Target, Wal Mart).
  • Co-Pay Match.  The amount of your group health insurance co-pays are loaded into our software and any transactions that match the copay amounts are auto substantiated.
  • Reoccurring Expenses.  After several charges to the same provider in the same amount have been substantiated the system will recognize future transactions and auto substantiate reoccurring transactions.

If a debit card transaction cannot be substantiated by one of the above methods, then the system automatically generates a letter requesting documentation.  If proper documentation is not received in a specified amount of time, then the software system automatically suspends the debit card until the transaction is cleared.  This process is done automatically by using IRS approved software system.  It is not a manual process.

With our current vendor, past experience shows us that most pharmacy transactions and office visit co-pays are auto substantiated by the system.  Unfortunately most dental transactions are not exact co-pay matches and therefore documentation is needed.  The same is true for items such as lab work or radiology co-insurance.  If most employee transactions are for office visit co-pays or prescriptions then documentation will not be required as often.  However, if the transactions are for other items such as dental, then documentation will be required more often.

SHDR also shows that, on average, 70 – 80% of debit card transactions are auto substantiated.  Participants who utilize the card for more non-office visit services will see a lower percentage auto substantiated.  Participants usually find it helpful to log into their personal account and review the items that require substantiation.  This way they will know which expenses/providers will probably require documentation and will be prepared with that documentation when it is requested.

AFFORDABLE CARE ACT/COMPLIANCE

Q: I understand that if the health plan is not affordable then I don’t have to pay a penalty if I don’t have medical insurance, right?

A: Under the Affordable Care Act (ACA), most individuals residing in the United States, and some citizens residing outside of the United States, are required to secure health insurance, also known as Minimum Essential Coverage. NMSU’s health insurance is Minimum Essential Coverage. Those who do not get it through their employer can buy it through government-run health-insurance exchanges.

NMSU cannot determine whether or not an employee will be required to pay a penalty for not having health insurance coverage. You should speak to a tax consultant or you can find information on the government website at https://www.healthcare.gov/get-answers/.

RETIREMENT

Q: Why are we required to contribute to the NMERB retirement? Why don’t we have other options available?

A: In New Mexico, educational institutions, as defined under state law, are required to participate in the New Mexico Educational Retirement Board defined benefit plan as a condition of employment, subject to the eligibility rules. As eligible employees are mandated to participate, employees cannot choose to decline participation or change the amount to be contributed. However, employees do also have the opportunity to save additional money toward retirement through the voluntary retirement plans; however NMSU does not contribute toward these plans. NMSU has two different voluntary retirement plans available – 403b and 457b. Employees can contribute a minimum of $7.50 per paycheck to an account of their choosing and invest those contributions in a variety of funds available with each vendor. A list of vendors and plan details are available on the benefits website at http://benefits.nmsu.edu/retire/voluntary/.

Q: Why can’t employees cash out the employer contributions under the NMERB when we are fully vested at 5 years?

A: Under state law, employee contributions are credited to individual ERB member accounts and may only be refunded following termination from employment in accordance with IRS rules.  Under state law, employer contributions are credited directly to the retirement trust fund and are not subject to a refund.  The concept of vesting relates to an entitlement to pension benefits and has no bearing on the refund process.

LEAVE BENEFITS

Q: Sick leave is not ALL paid upon termination of employment. What happens to the money from the 600 hours that doesn’t get paid out?

A: Sick leave does not have any monetary value tied to it until it is actually used. Since it is basically your regular salary being paid when you use it, there is no “fund” that houses money waiting to pay out use of sick leave. NMSU is, however, required to book a liability for the amount that would be paid out upon termination.  When there is a payout upon termination, it is paid from a central fund, not your salary budget.

Q: How does all this affect FMLA? What if you need more than 3-6 months?

A: For information regarding FMLA rights and process, please refer to the benefits website at http://benefits.nmsu.edu/leave-holidays/fmla/. Questions about FMLA can be directed to fmla@nmsu.edu. Questions about benefits in general can be directed to benefits@nmsu.edu.

Q: I wish NMSU offered some sort of paid maternity leave for faculty. Most faculty cannot afford to take time off without pay.

A: In the fall of 2015, Chancellor Carruthers rolled out a new Faculty Care Leave (FCL) Program that provides accrued paid leave for 9 month faculty for FMLA related absences. The program allows full time 9 month faculty to accrue up to 9 working days of paid FCL per academic year. 9 month faculty members can accrue up to 100 days of FCL over time and use FCL to provide paid time off when experiencing Family Medical Leave qualifying events. Details regarding the program can be found on the faculty leave website at http://hr.nmsu.edu/academicpersonnel/sabbatical-and-other-leaves/.

MISCELLANEOUS

Q: I’m non-exempt staff, does that mean hourly?

A: Yes, if you are non-exempt you are paid on an hourly basis and subject to overtime compensation rules. The term “non-exempt” simply means you are not exempt from the overtime compensation rules.