Open Enrollment for Active Employees » Medical Plan Choices
Because the Laboratory is eliminating ALL current medical plans and replacing them with new plans administered by Blue Cross Blue Shield of New Mexico, you must make a positive election for your medical benefits this year.
If you do nothing, you will default to no coverage for medical insurance.
If you fail to elect coverage at open enrollment we will not be able to make an exception for late enrollment except in the case of gross administrative error (or if you experience a subsequent qualified change in status). This is a matter of Federal Law under Section 125 I.R.C. and ERISA; it is not Laboratory internal policy or regulation that is subject to review.
Please refer to the Medical Plan Comparison Chart (pdf) to assist in making a fully informed decision for your new health insurance coverage. Blue Cross Blue Shield is prepared to answer more detailed questions regarding plan coverage and exclusions.
2010 Premiums for Active Employees
| Medical Plan Choices for 2010 |
|---|
| National EPO (pdf) |
| National PPO (pdf) |
| National Consumer‐Directed Health Plan (CDHP) (pdf) |
The EPO offered through Blue Cross Blue Shield of New Mexico is similar in most respects to the United Healthcare EPO that it replaces. This plan helps keep costs in control by restricting coverage to in-network doctors and facilities (except in the case of emergency or prior medical approval). You are responsible for a $20 co-payment for in-network office visits. Any additional costs (for example: diagnostic X-rays or lab work) are subject to deductible and co-insurance. For specific details on the plan design, please see the EPO summary chart (pdf).
The PPO offered through Blue Cross Blue Shield of New Mexico is similar in most respects to the United Healthcare PPO that it replaces. This plan helps keep costs in control by paying a more substantial benefit for services that are rendered with in-network doctors and facilities. Out-of-network services are covered at a reduced amount, and subject to Blue Cross Blue Shield of New Mexico’s allowable cost. Like the EPO, you are responsible for a $20 co-payment for in-network office visits. Any additional costs (for example: diagnostic X-rays or lab work) are subject to deductible and co-insurance. For specific details on the plan design, please see the PPO summary chart (pdf).
The CDHP plan offered through Blue Cross Blue Shield of New Mexico is similar in most respects to the United Healthcare Definity plan that it replaces. This type of plan is known as a consumer-directed health plan – it places greater control of healthcare expenditures in the hands of the plan participant. The Laboratory contributes one-half of your total deductible into a Health Reimbursement Account, or HRA. Until this HRA is exhausted, you pay nothing out of pocket for eligible services. If the HRA is exhausted, then you must pay the remainder of the deductible. After the deductible has been met, you are responsible to pay 10 percent co-insurance for eligible services. If there are any funds remaining in your HRA at the end of the plan year, that money will be rolled over into the next plan year’s HRA (subject to a three-year maximum roll-over). For details on the plan design, please see the CDHP summary chart (pdf).
All prescription coverage for 2010 will be through Blue Cross Blue Shield of New Mexico (Prime Therapeutics). With a new carrier and prescription drug administrator, there is a new formulary of covered drugs; however, the co-pay structure will remain the same.
| Tier 1 (Generic Drug) | $15 |
| Tier 2 (Brand-Name Drug On Drug List) | $30 |
| Tier 3 (Brand-Name Drug NOT On Drug List) | $45 |
Current medications will be picked up by Blue Cross Blue Shield of New Mexico directly from MedCo, and should not require your physician to write you a new prescription. Mail order will also continue to be available. For more details, please refer to the new drug formulary, available in October, 2009.
The medical programs sponsored by LANS will not restrict benefits if you or your dependent receives benefits for a mastectomy, and elects breast reconstruction in connection with the mastectomy. Benefits will not be restricted provided that the breast reconstruction is performed in a manner determined in consultation with you or your dependent’s physician and may include:
Benefits for breast reconstruction will be subject to annual deductibles and coinsurance amounts consistent with benefits for other covered services under the program. For details on any state laws that may apply to your medical program, please refer to the benefit program material for the medical program in which you are enrolled.
Under a federal law called the Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA, you (a LANS retiree) and/or your dependents may be eligible to continue health program coverage (called "COBRA coverage") at group rates. Health benefit program coverage includes medical, dental, vision, and health care reimbursement account (HCRA) benefits.
COBRA coverage is available in certain instances, called "qualifying events," where health benefit program coverage would otherwise end. You may elect to continue coverage at your own expense on an after‐tax basis when the coverage that you have through the Plan ends. The coverage described below may change as permitted or required by changes in any applicable law.
For more information please reference pages 28‐34 of the LANL Health and Welfare Benefit Plan for Retirees (pdf).
If you do not have access to this document online, a hard copy will be provided upon request.
