Thursday, March 18, 2010

Wellness programs

BCBS offers wellness programs:

1- Blue access: online member portal. As a member you get access to this site and can view medical visits, claim status etc. Check BCBS website.

2- Special beginnings: information for expectant mothers, such as on the health of the mother and baby. They have a 24hr toll-free number staffed by maternity nurses.

3- Personal health manager: online health resource; info and tools to help maintain you health.

Life Insurance

Every post-doc is automatically enrolled in life insurance ($12,000) and the university pays for all of it. You also get $12,000 in case of accidental death. Additional insurance can be purchased in $10K increments, max $200K.

J-1 and J-2 visa holders will also be covered for medical evacuation and repatriation of mortal remains.

Dental insurance

Dental insurance is voluntary, so you need to actively choose to enroll. You can only do this during open enrollment period each year (usually in November) or within 30 days of when you first start as a post-doc at the university. Exceptions are if you have a life changing event (marriage, birth of child, your spouse lost health insurance etc) then within 30 days of the life-changing eventyou can make changes outside the open enrollment period. If you missed this period or made a mistake and chose the wrong plan, you will need to wait until the next open enrollment to make any changes. We will again continue to have PPO dental insurance just like last year, which means you can pick and choose any doctor whenever you need to see one, as long as they are in-network. However, you have 2 options to choose from within this PPO; high and low options.

Here’s a summary of benefits but as always, you can find more info on the GP website:

At a glance:

High-option costs $48.77 per month per individual ($167.11 for family); $1500 max benefit per person per year

Low-option costs $21.82 per month per individual ($54.55 for family); $5000 max benefit per person per year

There’s quite a bit of a price difference between the two and it’s confusing at first why this is; especially since it seems it should be the other way around when it comes to the premium you pay vs. the benefit you get. From what I understand, high option is the best if you’re planning to use out-of network doctors a lot, since the insurance pays the same if you see an out-of-network doctor or an in-network one. But this freedom comes at another cost, i.e. the max benefit you can claim is much lower in the high option. The only instance that I can think of when this may make sense is if you have a spouse/children in another state and you want to include them in your plan. Otherwise, you’re better off with the low option. Not only you pay less premium, you also get a higher max benefit.

Other than the difference between the premiums and max benefits, both options come with the same basic procedures included in the plan. They include, but are not limited to, 2 routine exams per year, 2 teeth cleanings per year, x-rays etc. So if you’ve paid your premiums all year, you should at least make an appointment to get your teeth cleaning done before the end of December; you’ve earned it. For more complex procedures such as fillings, wisdom teeth removal, root canal etc, both options pay about 80% of the bill for in-network doctors, but you need to first satisfy a $60 deductible if you have the high option before the insurance kicks in. For a list of all included procedures, please check the website.

Vision benefits

Health insurance through Garnett-Powers comes with vision benefits, through Davis Vision.

Vision benefits (Davis vision discount program):

one eye exam and contact lens evaluation/fitting every 12 months ($10 copay) in HMO

one eye exam and contact lens evaluation/fitting every 24 months ($15 copay) in PPO

If you have HMO, you don’t need referral from your PCP. Insurance pays some of the cost on glasses and contact lenses. You also get discount on Laser vision correction. For a list of Davis Vision providers, go to or visit

Health Insurance

I went to a seminar by a representative from Garnett-Powers in December 09 and here is a summary of what I understand it was all about. I hope it helps post-docs in making decisions about which healthcare plan to choose. The numbers represented here is for individual medical coverage only. For family coverage, or for a complete list of things covered, please check GP website (

The healthcare coverage that post-docs held for the year 2009 is changed from UHC PPO to Blue Cross Blue Shield of Illinois (BCBSIL) starting January 1st, 2010. Post-docs did not have a choice other than a PPO plan for the previous year, but with the BCBSIL, we now can choose between a PPO and a HMO plan for medical insurance. If you did not make any changes, then you are automatically enrolled in the new PPO plan as of January 1st. With the new BCBSIL plan, rates have also gone up (your paycheck will be ~$10 less a month). PPO is more expensive than HMO but only by a couple of dollars and you have the option of choosing.

We will continue to have PPO dental insurance but have the option of PPO or HMO for medical insurance.


Calendar year deductible: the total amount you pay in a calendar year before the insurance begins paying.


If you choose HMO, you have to choose an in-network primary care physician (PCP) and he/she becomes the gatekeeper. You need to go to your PCP for all non-emergency medical related issues. He/she will then refer you to an appropriate specialist, which means a second trip to the doctor’s. You cannot just pick a doctor when you need to see one without seeing your PCP first. One nice thing is that, any doctor in the hospital that’s available that day can be your PCP, even a registered nurse (RN). You can also change your PCP once a month. In HMO plan, if you see an out-of network doctor, you pay it all out of pocket (no benefit at all).

HMO doesn’t have deductibles, so every time you are admitted to a hospital you need to pay $250 until you reach $1500/individual, then you don’t pay anymore and there’s no lifetime max on the benefits received. Co-pay is $10 for routine exams.


PPO plan is more flexible than HMO in that you don’t need to see a PCP, you can just pick any doctor you want. Benefits are also greater for in-network doctors, i.e the insurance will cover more if the doctor is within their network, which means less out-of-pocket costs to you. If you see an out-of-network, you’ll pay more out-of pocket.

There’s a $250 yearly deductible, it pays 100% once you satisfy this deductible. This means that max out-of-pocket is $250 but it’s hard to reach that limit unless you get hospitalized and have major surgery. Co-pays do not count towards the deductible. Routine physical exam is $15 co-pay, as well as mental health visits. There is a lifetime max benefit, which is $2 million per individual. This may seem like a high amount, but if you have major accident or get a long-term illness, it’s very easy to reach that limit. There’s no such limit if you have HMO.

Going to the ER is $75 but if you go to an urgent care center the co-pay is $30.


HMO doesn’t have deductibles, so every time you are admitted to a hospital (does not include regular exams) you need to pay $250, until you reach the $1500 max out-of pocket (in PPO, once you satisfy the deductible, you are covered %100).

i.e. if you go to a doctor for regular exam (outpatient service):

PPO $15 co-pay, rest is covered 100%

HMO $10 co-pay, rest is covered 100%

If you check into a hospital (inpatient service):

PPO: $250 once and you can check in 5 times a year and don’t pay anything but lifetime max benefit is $2 million.

HMO: $250 every time, until you reach $1500 (6 visits), then you don’t pay anything beyond that. Also, no limit on the benefits received.

U OF CHICAGO IS NOT PART OF HMO!! U of C doctors only take PPO plan, so if you choose HMO you need to go somewhere else.

Also, here’s the downside of seeing a doctor at the U of Chicago. When you see a doctor there, the visit is billed as an outpatient service (that’s the way they do it and they have no intention of changing it). This means that instead of the $15 copay, you are billed your annual deductible (up to $250). But beyond the $250, all future visits are 100% covered. This also means that if you had even only a routine exam, you pay whatever it normally costs if you didn’t have insurance (say $160). The next time you see a doctor for any reason, you pay only $80 and you are fully covered for the rest of the year. So if you see a doctor once or twice a year, you end up with your $160-$250 dollar bill instead of $15 you could have paid if only you went to Northwestern hospital. From what I understand, going to U of C only makes sense if you go to the doctor regularly, such as if you are pregnant or seeing a therapist.