University of Minnesota
Office of Human Resources
http://www.umn.edu/ohr
612-625-2016

UPlan Members' Frequently Asked Questions


New Employee

As a new employee, how do I know when to enroll for benefits?
Employee Benefits will send an email to you when the self-service online enrollment at http://hrss.umn.edu is ready. You need your Internet ID and password to log in. You have 60 days from your first day of employment to complete enrollment.
What happens if I do not enroll during my first 60 days of employment?

If you do not enroll during the 60-day window you will not have coverage. There is no default plan.

However, you may add medical and dental coverage during the year if you have an eligible family status change; for example, loss of other health coverage. Short-term disability and optional life insurance can be applied for at any time with the coverage subject to underwriting.


Medical Plans

Am I able to change my medical or dental plan election at any time?
You may change plans within your first 60 days of employment or eligibility. After 60 days, you may change plans during the year if you move outside of the plan's service area. You may also change plans annually during Open Enrollment.
What is a base medical plan?
The plans' provider networks differ by geographic location or zone. Each zone has a base plan that offers the lowest rates and copayments. Medica Elect/Essential is the base plan for the Twin Cities and Duluth areas. Medica Choice Regional is the base plan for Greater Minnesota. You may choose a plan based on where you live or work.  
Why isn't Medica Choice Regional available to me if I live and work in the Twin Cities?
As an employee living in the Twin Cities or in Duluth you have access to several plan options while in some areas provider access is very limited, such as the Greater Minnesota area. Medica Choice Regional is the base plan with a statewide network that is provided for employees living and working outside of the Twin Cities and Duluth areas.  
How does the health savings account (HSA) plan work?
A health savings account plan (HSA) is a high deductible medical plan that enables you to make decisions about how you spend your health care dollars. In Medica HSA, the University provides the high deductible medical plan and also contributes a set amount of benefit dollars to the Health Savings Account (HSA) on each pay date. You can also make your own pre-tax contributions to the HSA and decide how to invest them in options from Wells Fargo. Contributions limits are established by the federal government each year. You own the HSA contributions and can decide whether to use them for current medical expenses or save the money for future expenses when you retire. The HSA uses the Medica Choice network which gives members a broad selection of providers in the Medica service area, and also makes the United Healthcare Options PPO national network available when traveling or working outside the service area. There is no need to select a primary care provider and you may see any providers within the network without a referral.
What is an open access plan?
This plan type gives you access to any provider in the national network without a referral or the need to select a primary care clinic when enrolling. Medica Choice National and Medica HSA are open access plans in the UPlan that allow you to travel or work outside the service area and access in-network providers.
What is a tiered health care system?
This plan type analyzes primary care physicians, specialists, and other health care providers on cost, efficiency, and quality measures and then ranks them into three tiers. In the UPlan, Insights by Medica is a tiered plan in which the copayments differ depending on the provider's tier.
Is vision coverage separate?
No, vision coverage is provided in the medical plan, and routine eye exams performed by an in-network provider are covered as preventive care at 100% coverage. Costs for eyeglasses and contact lenses can be reimbursed with funds in the Health Care Flexible Spending Account.

Clinics

Do I need a referral from my primary care clinic to see a specialist?
Whether you need a referral depends on your plan and the care system you are using in that plan. Medica Elect/Essential may require a referral depending on your care system choice. If you are unsure whether or not a referral is necessary, contact Medica for further details. The other medical plans do not require that you get a referral.
What are primary care clinic (PCC) numbers and where do I find them?
Medica Elect/Essential requires that you choose a primary care clinic when you enroll. The PCC number is listed with the clinic information. You can find the PCC number by calling the plan or reviewing the online provider directories.

Dependents

When can I add or drop my dependents?

You can add your dependents when you are first eligible, and you can add or drop dependents during the annual Open Enrollment. Otherwise, you must have a change in family or work status to make a change.

Status changes include:

  • Change in legal marital status, including marriage, divorce or annulment
  • Registration of your same-sex domestic partnership or termination of same-sex domestic partnership
  • Death of your spouse/registered same-sex domestic partner or last eligible dependent child
  • Birth or adoption of your eligible dependent child
  • Last dependent child is no longer eligible because he/she has reached age 26 (For specific eligibility information, please refer to the UPlan Summary of Benefits)
  • Commencement or termination of employment for you, spouse/registered same-sex domestic partner or dependent
  • Change in your or your spouse/registered same-sex domestic partner's employment status from part time to full time or from full time to part time
  • Change in place of residence or worksite for you, spouse/registered same-sex domestic partner or dependent to a location outside of the current plan's service area and the current plan is not available 

You must make your request for a change in your coverage, consistent with the status change, within 30 days of the date of change. Contact Employee Benefits for enrollment information.

Can I cover my stepchild?
Yes, provided that your stepchild is dependent on you, the employee, for his/her principal support and maintenance. in addition, the stepchild must maintain residence with you or must not be a dependent child for tax purposes of any other individual. A stepchild means the child of your spouse/same-sex domestic partner by a previous marriage/partnership.

Principal support means more than half of the dependent child's support.

Pharmacy

What is the role of Prime Therapeutics as a pharmacy benefit manager?
As a pharmacy benefit manager, Prime Therapeutics is the claims administrator for the prescription drug program and is responsible for processing and paying prescription drug claims. Prime Therapeutics is also responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, drug utilization review, outcomes management, and disease management. However, for most specialty medications, Fairview Specialty Pharmacy is the exclusive provider.

Fit Choices

What is the Fit Choices program?

The UPlan Fit Choices program provides up to a $20 per month reimbursement or credit toward health club membership dues when you visit a participating fitness center at least eight times each month. The monthly $20 credit is available for up to two individual fitness center memberships and also for a family membership.


Flexible Spending Accounts

How much can I put in my flexible spending account (FSA) if my spouse also works?

For the Health Care FSA:

  • You may contribute up to the maximum of $2,500 each calendar year. If your spouse works at the University he/she may also contribute $2,500, or if working elsewhere, the maximum amount at that employer. 

 For the Dependent Daycare FSA,

  • The maximum amount is $5,000 per family each calendar year.
Do my dependents need to be on my medical plan to submit claims in the health care FSA for them?

No, you may use the health care FSA for expenses incurred by an eligible dependent whether or not that dependent is covered under your medical or dental plan. Eligible dependents include:

  • Spouse
  • Dependent children
  • Any other person (including a registered same-sex domestic partner and the children of your registered same-sex partner) who is considered an eligible dependent for federal income tax purposes by meeting all of the following requirements:

    • the person lived with you for the entire year as a member of your household, and
    • the person was a U.S. resident or citizen or a resident of Canada or Mexico, and
    • you provided more than half of the person's total financial support for the calendar year.
What happens to my FSA if I leave the University in the middle of the year?
If you leave, retire, or are laid off from the University, your FSA contributions terminate at the end of the payroll period that includes your last day of work. You will not be reimbursed for expenses incurred after your termination unless you elect to have the deductions for the balance of the calendar year taken on a pre-tax basis from your last paycheck or you elect to continue your FSA under COBRA. If so, you may continue to submit claims for expenses incurred after your employment ends through the end of the claim period.
Can I get reimbursed from my health care FSA for cosmetic expenses?

Generally, you cannot include the cost of medical expenses for cosmetic surgery. This includes any procedure that is directed at improving the patient's appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. This includes medical expenses for procedures such as face lifts, hair transplants, hair removal (electrolysis), and liposuction.

You can include medical expenses you pay for cosmetic surgery if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease.

Can I get reimbursed from my health care FSA for weight loss expenses?

Expenses incurred for weight loss are not eligible for reimbursement if the purpose of the weight loss is the improvement of appearance, general health, or sense of well-being. You cannot include amounts you pay to lose weight unless the weight loss is a treatment for a specific disease diagnosed by a physician (such as obesity, hypertension, or heart disease). This includes fees you pay for membership in a weight reduction group and attendance at periodic meetings. Also, you cannot include membership dues in a gym, health club, or spa.

You cannot include the cost of diet food or beverages in medical expenses because the diet food and beverages substitute for what is normally consumed to satisfy nutritional needs. You cannot include the cost of special food in medical expenses unless all three of the following requirements are met.

  • The food does not satisfy normal nutritional needs.
  • The food alleviates or treats an illness.
  • The need for the food is substantiated by a physician.

The amount you can include in medical expenses is limited to the amount by which the cost of the special food exceeds the cost of a normal diet.

What happens if I don't use all of the money in my FSA?
The IRS requires that if you do not use your full balance for expenses incurred between your effective date and March 15 of the following year, you lose the unused portion. Any remaining balance in your FSA is forfeited and retained by the plan to cover administrative costs. For this reason, you should calculate your expenses carefully before making your election to ensure you will use the full amount.

Open Enrollment

What and when is Open Enrollment?

During Open Enrollment each year in November you can choose different medical and dental plans for the next calendar year. You can add or cancel dependents on your coverage. If you don't have medical or dental coverage, you can add it; or if you no longer need it, you can cancel coverage.

You must re-enroll each year during Open Enrollment to continue your participation in the Health Care and Dependent Daycare Flexible Spending Accounts. 

On occasion, you may have the opportunity to enroll in certain amounts of optional coverage such as employee life or disability insurance during Open Enrollment.