WHAT ARE THE TYPES OF MEDICAL PLANS OFFERED BY DREXEL?

•  POINT-OF-SERVICE (POS) – a mix of HMO and PPO plans – the POS works like a HMO if care is obtained through primary care physicians and referrals made to POS network doctors and providers. You also retain the freedom of seeking care outside the established POS network. You may access care directly but then must pay a deductible and coinsurance . This type of plan is available through both Keystone and Tenet provider networks.

•  PREFERRED PROVIDER PLAN (PPO) – this allows you direct access to all medical care including specialists. If the doctor or provider is in the network only a small co-payment is required. If the doctor or provider is not a member of the network, the participant must pay a deductible and coinsurance. Preventive care is covered if obtained through network providers. Independence Blue Cross' Personal Choice Plans are Drexel's Preferred Provider options.

WHAT TYPES OF EXPENSES MIGHT MY FAMILY OR I INCUR?

•  DEDUCTIBLE – the dollar amount you must pay each year before your medical and/or dental plan begins to pay benefits for certain covered expenses.

•  CO-INSURANCE – after you meet the deductible, your health plan pays a specified percentage for the charges for covered services. You pay the remaining charges, called co-insurance.

•  UCR OR R&C – refers to the usual, customary and reasonable fees that physicians, health care facilities or other health care providers in the same geographic charge for similar services. Plans that pay 100% of UCR or R&C pay 100% of the usual, customary and reasonable fees for that service. If providers have an affiliation with the plan, they are obligated to accept the plans UCR or R&C as payment in full. If providers are not affiliated with the plan, they are not obligated to accept the UCR or R&C and you may have to pay charges in excess of the payment made by the plan.

•  CO-PAYMENT/CO-PAY – a flat per-service charge that you pay for services such as doctor visits or prescriptions.

•  OUT-OF-POCKET MAXIMUM – the most you have to pay out of your own pocket during the plan year in co-insurance after you meet your deductible, as long as your providers accept your plan's UCR or R&C. Once you reach this limit, the plan pays 100% of UCR or R&C.

•  LIFETIME MAXIMUM – the greatest amount payable by the plan in a subscriber's lifetime.

WHAT TYPES OF EXPENSES MIGHT MY FAMILY OR I INCUR?

•  BENEFIT MAXIMUM – the greatest amount payable by the plan for a specific covered service.

•  PRIOR AUTHORIZATON – Independence Blue Cross requires that members obtain pre-approval for the purchase of certain covered drugs that have been approved by the Food and Drug Administration for specific medical conditions.

•  PRECERTIFICATION – a program that requires a medical review before hospital admissions and surgical procedures are approved

WHAT TYPES OF PROVIDERS ARE COVERED?

•  PREFERRED PROVIDERS – physicians, hospitals and other health care providers who are part of the Personal Choice provider network. When you use Preferred Providers, you do not have to meet a deductible and the plan pays 100% (after co-pay for a physician office visits) for most services.

•  NON-PREFERRED PROVIDERS – physician, hospitals and other health care providers who are not part of the Personal Choice provider network. When using these providers, benefits are paid like an indemnity plan; payment for services is based on UCR and R&C; you must file claim forms and pay deductibles and co-insurance.

•  PRIMARY CARE PHYSICIAN (PCP) – the physician who manages your care. In a POS plan, you must obtain a referral from your POS PCP in order to access care from a specialist or other in-network provider or facility. Under a PPO plan, you can elect to obtain a referral or self-refer .

•  REFERRED CARE – specialist care provided by a network provider through a referral from your Tenet or Keystone PCP . Services are generally paid at 100% after payment of the co-pay for an office visit. Under a POS plan, all in-network care received beyond your PCP must be referred.

•  SELF-REFERRED CARE – specialist care provided by a network or non-network provider without a referral from a PCP . Payment for services is subject to a deductible and co-insurance .

WHAT IS A QUALIFYING LIFE EVENT?

•  Contributions to Drexel's benefit/health plans are on a pre-tax basis. The Internal Revenue Service states that elections under this type of plan that are made during an enrollment period, including contributions to Flexible Spending Accounts (Medical and Dependent Care) must stay in effect for the entire Plan Year (January 1 – December 31), unless you experience one of the following qualifying life change events:

Change in Status (includes):

•  Legal Marital Status change

•  Change in number of dependents

•  Dependent Satisfies/Ceases to Satisfy Eligibility Requirements

•  Employment Status Change

•  Change in Residence such that your plan no longer is available to you

Significant Cost or Coverage Changes

Spouse's or Dependent's Open Enrollment

Dependent Care Changes

HIPAA Special Enrollment Rights

FMLA Special Requirements

Changes Due to a Judgment, Decree, or Court Order

Entitlement to Medicare or Medicaid (including CHIP)

•  If you experience a qualifying life event, you can change your coverage by calling The Employee Benefits Service Center within 31 days following the event. Changes must be consistent with the qualifying life event.

•  You must not add or drop dependents during the plan year unless you experience a qualifying life event.

WHAT FLEXIBLE SPENDING (PRE-TAX REIMBURSEMENT) ACCOUNTS ARE AVAILABLE?

•  MEDICAL SPENDING ACCOUNT – lets you set aside money on a pre-tax basis to pay for unreimbursed medical expenses

•  DEPENDENT CARE ACCOUNT – lets you set aside money on a pre-tax basis to pay for qualified child or elder care expenses

•  PRE-TAX TRANSPORTATION ACCOUNTS – lets you set aside money on a pre-tax basis to pay for mass transportation or commuter parking expenses.

HOW DO I GET MEDICAL CARE IF I AM AWAY FROM HOME?

•  To locate a provider when away from home you can access the following web site: www.bcbs.com or call 1-800-810-Blue.