Please review this document, Core Plan (PDF), to get more details regarding the benefits covered by the Core plan.
Flexible Spending Account
Employees who are part of a PPO plan (Core or Plus) are eligible to participate in a Flexible Spending Account.
Apta Health Resources
For information regarding your medical, vision or dental plans, contact your APTA Health Coordinator at 877-610-8817. You can also visit the APTA MyQ Health web portal to access your online ID card, contact APTA Care Coordinators, find providers, learn about the details of your plan and much more.
MagellanRx is our pharmacy benefit manager for 2020. If you use Maintenance Medications or Specialty Medications please review the Magellan Mail Order Member Overview and the Magellan Rx Home Order Form. These documents provide very important information regarding action you must take in order to continue to receive your medications without interruption. If you fill regular prescriptions at your local retail pharmacy, you do not need to take this action.
For more information, including how to begin home delivery, log in to the MagellanRX Member portal or contact your APTA Health Care Coordinator.
Dependents no longer have to be full-time students if over the age of 19 and still tax dependents of the employee. New spouse and dependent enrollments require submission of appropriate dependent eligibility documentation. Dependents age-out of medical, dental, vision and life insurance on December 31 of the calendar year in which the dependent turns 26 years of age.
In-Network and Out-of-Network Providers
It is important to always make sure your provider is in the United Healthcare Choice Plus network because you will receive a higher level of benefit. Providers in our network have agreed to charge a reduced, negotiated fee for their services. Our coverage is national and you can find an in-network provider even while traveling.
To find an in-network provider contact your Apta Health Care Coordinator or go to the UHC Choice Plus “Find a Provider” tool and click on “search for a medical provider”.
Our plans have benefits at a reduced level when you receive care from out-of-network providers. Please keep in mind that you have to meet your out-of-network deductible before the plan will pay. Even if you’ve met your deductible with an in-network provider, you have to meet it again with an out-of-network provider. You will also be billed for charges in excess of the Usual & Reasonable reimbursement paid by the plan. Prior-authorization is required for all out-of-network services.
Other Insurance: Are you or your dependents covered under more than one group medical plan? If so, UMR needs to know in order to coordinate coverage with other plans correctly. Please provide UMR with information on any other insurance coverage that might be responsible for healthcare claims for yourself, your spouse, and your dependents. Please review the “UMR Other Insurance” flyer for more information and instruction on how to provide other insurance information directly to UMR.
Accidents Happen: If you have suffered an injury as a result of an accident, you might not be responsible for all costs related to your medical treatment. To help you and your employer manage your health care costs and avoid paying medical claims for which you aren’t responsible, UMR may ask you to provide additional information about claims identified as accident-related. Please review the “UMR Accidents Happen” flyer for more information and instruction on how to provide accident information directly to UMR. REMEMBER -If you have been in an accident, your claim may not be paid until UMR hears from you!
Our plan will pay in-network benefits when you need care for an emergency. However, even in an emergency, out-of-network providers may bill you for their charges in excess of the Usual & Reasonable reimbursement paid by the plan. You will be responsible for the excess charges.
With our PPO plans, you are not required to get a referral to see a specialist, but if you don’t you will pay a higher copay in the specialist’s office. You will want to make sure the specialist is in the network. There are times when an in-network provider will refer you to a specialist. A referral from your doctor does not mean that the provider is in-network. It is always the patient’s responsibility to verify the network status of a referred physician or facility. Your Apta Health Care Coordinator can help you with this.
Affordable Care Act (ACA) Compliance
The following statements are included in compliance with the Affordable Care Act (ACA) and refer to medical insurance offered by Butler University as an employer.
Does this Coverage Provide Minimum Essential Coverage?
The Affordable Care Act requires most people to have health care coverage that qualifies as “minimum essential coverage.” This plan or policy does provide minimum essential coverage.
Does this Coverage Meet the Minimum Value Standard?
The Affordable Care Act establishes a minimum value standard of benefits of a health plan. The minimum value standard is 60% (actuarial value). This health coverage does meet the minimum value standard for the benefits it provides.