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MACC Health Plan (Gold)


Effective January 1, 2015

The following charts summarize benefit information. Please refer to specific benefit sections in the Plan Document and Summary Plan Description for more detailed explanations.

 

Copay applies to the Physician office visit component only. All other services are paid subject to any Deductible and Coinsurance percentages. For HMO Providers, there is no additional cost to the Covered Person once the $20 Copay is paid.

MEDICAL SCHEDULE OF BENEFITS – GOLD PLAN

 

HMO
PROVIDERS

PARTICIPATING PROVIDERS

NON-PARTICIPATING PROVIDERS
(Subject to Usual and Customary Charges)

LIFETIME MAXIMUM BENEFIT Unlimited
CALENDAR YEAR MAXIMUM BENEFIT Unlimited

CALENDAR YEAR DEDUCTIBLE

Single
Family

 

$0
$0

 

$250
$500

 

$500
$1000

CALENDAR YEAR OUT-OF-POCKET MAXIMUM
(excludes Deductible)

Single
Family


 

$1000
$2000


 

$2000
$4000


 

$3000
$6000

MEDICAL BENEFITS

Allergy Services (all)

100%

80% after Deductible

60% after Deductible

Ambulance Services

80%

80% (Deductible waived) 

Paid at Participating Provider level of benefits

Ambulatory Surgical Center

$125 Copay then 90% 

80% after Deductible 

60% after Deductible 

Chiropractic Care/Spinal Manipulation

$20 Copay then 100% 

80% after Deductible 

70% after Deductible 

Diagnostic Testing, X-Ray and Lab Services (Outpatient)

90%

80% after Deductible

60% after Deductible

Durable Medical Equipment (DME)

80%

80% after Deductible

60% after Deductible

Emergency Room Services

$100 Copay then 100% 

$100 Copay then 80% (Deductible waived) 

$100 Copay then 70% (Deductible waived) 

NOTE: The Copay will be waived if the person is admitted directly as an Inpatient to the Hospital.

Home Health Care

 80%

80% after Deductible 

60% after Deductible 

Calendar Year Maximum Benefit

100 visits

Hospice Care

90%

80% after Deductible 

60% after Deductible 

Hospice Bereavement Counseling
(within 6 months of Covered Person's death)

90%

80% after Deductible

60% after Deductible

Hospital Expenses or Long-Term Acute Care Facility/Hospital
(facility charges)

 

Inpatient

$250 Copay per admission then 90%

80% after Deductible

60% after Deductible

Room and Board Allowance

Semi-Private Room rate*

Semi-Private Room rate*

Semi-Private Room rate*

Intensive Care

$250 Copay per admission then 90% ICU/CCU Room rate

80% after Deductible ICU/CCU Room rate

60% after Deductible ICU/CCU Room rate

Miscellaneous Services & Supplies

90%

80% after Deductible

60% after Deductible

Outpatient

90%

80% after Deductible

60% after Deductible

* A private room will be considered eligible when Medically Necessary. Charges made by a Hospital having only single or private rooms will be considered at 80% of the least ex pensive rate for a single or private room.

Infertility* 

90%

80% after Deductible 

60% after Deductible 

* Benefits are limited to initial exam and diagnostic testing.

Maternity (Prenatal, Delivery and Postnatal)

 90%

80% after Deductible 

60% after Deductible 

Mental Disorders and Substance Use Disorders

 

 

 

Inpatient

$250 Copay per
admission then 90% 

80% after Deductible 

60% after Deductible 

Outpatient 

$20 Copay then 100% 

$30 Copay then 100%
(Deductible waived) 

60% after Deductible 

Emergency Care (ambulance and Emergency Room)

$100 Copay, then 100% 

$100 Copay, then 100% 
(Deductible waived)

$100 Copay, then 100%
(Deductible waived)

Occupational Therapy (OT) (Outpatient)

80% 

80% after Deductible 

60% after Deductible 

 Physical Therapy (PT) (Outpatient)

80% 

80% after Deductible 

60% after Deductible 

 Physician's Services

 

 

 

 Inpatient/Outpatient Services

90% 

80% after Deductible 

60% after Deductible 

 Office Visits

$20 Copay then 100%* 

$30 Copay then 100% (Deductible waived)* 

60% after Deductible 

 Physician Office Surgery

100% 

80% after Deductible 

60% after Deductible 

*Copay applies to the Physician office visit component only. All other services are paid subject to any Deductible and Coinsurance percentages. For HMO Providers, there is no additional cost to the Covered Person once the $20 Copay is paid. 

Private Duty Nursing

80%

80% after Deductible

60% after Deductible

Prosthetics and Orthotics

80%

80% after Deductible

60% after Deductible

Routine Care
(includes but is not limited to routine physicals, well child care, immunizations, tine test, flu shots, and B-12 injections)

 

Routine Colorectal Cancer Examination (including related laboratory test)

 100%

100% (Deductible waived) 

60% after Deductible 

Calendar Year Maximum Benefit

 1 examination

Routine Mammogram

 90%

80% (Deductible waived) 

60% after Deductible 

Maximum Benefit Ages 35-39

 1 baseline procedure

Maximum Benefit Ages 40 and over

 1 procedure per Calendar Year

Routine Pap Smear

 100%

 100% (Deductible waived)

 60% after Deductible

 Calendar Year Maximum Benefit

 1 pap smear

 Routine Pelvic Examination

 100%

 100% (Deductible waived)

 60% after Deductible

 Calendar Year Maximum Benefit

 1 examination

 Routine PSA

 100%

 100% (Deductible waived)

 60% after Deductible

 Calendar Year Maximum Benefit

 1 test

 Routine Care – All Other

 100%

 100% (Deductible waived)

 Not Covered

 NOTE: Flu shots rendered by Randolph County Health Department will be covered at 100% (Deductible waived).

Routine Eye Examination
(includes refraction)

 100%

 100% (Deductible waived)

 Not Covered

 Calendar Year Maximum Benefit

 1 examination

 Skilled Nursing Facility and Rehabilitation Facility

 80%

 80% after Deductible

 60% after Deductible

 Combined Calendar Year Maximum Benefit

 100 days

Speech Therapy (ST) (Outpatient)

80% 

80% after Deductible 

60% after Deductible 

Temporomandibular Joint Dysfunction (TMJ) 

90% 

80% after Deductible 

60% after Deductible 

Transplants 

100% 

$1,000 Copay per
transplant then 80%
(Deductible waived)

Not Covered 

Urgent Care Facility 

$35 Copay then 100% 

$50 Copay then 80%
(Deductible waived) 

Not Covered 

Copay applies to the Physician office visit component only. All other services are paid subject to any Deductible and Coinsurance percentages. For HMO Providers, there is no additional cost to the Covered Person once the $20 Copay is paid.

Vision Care – Hardware (up to age 19) 

100% 

100% (Deductible waived) 

60% after Deductible 

Maximum Benefit 

1 pair of lenses per Calendar Year and 1 pair of frames every 2 Calendar Years; OR 1 pair of contact lenses per Calendar Year

NOTE: A Covered Person may receive one pair of lenses or one pair of contact lenses per Calendar Year. Disposable contacts will not be subject to the "one pair of lenses" maximum. 

All Other Eligible Medical Expenses 

90% 

80% after Deductible 

60% after Deductible 

 

PRESCRIPTION DRUG SCHEDULE OF BENEFITS – GOLD AND SILVER PLANS

 BENEFIT DESCRIPTION

BENEFIT

NOTE: The Covered Person will be reimbursed the amount that would have been paid to a Participating Provider less the applicable Copay if Prescription Drugs are obtained from a Non-Participating Provider.  

Retail Pharmacy: 30-day supply

 

 Generic Drug

 $15 Copay, then 100%

 Formulary Drug

 $25 Copay, then 100%

 Non-Formulary Drug

 $40 Copay, then 100%

Mail Order Pharmacy: 90-day supply

 

 Generic Drug

 $30 Copay, then 100%

 Formulary Drug

 $50 Copay, then 100%

 Non-Formulary Drug

 $80 Copay, then 100%

 

PRE-CERTIFICATION ADDENDUM – GOLD AND SILVER PLANS

Note: Pre-Certification Requirements will be revised and updated as necessitated by evolving health care industry standards.

The following list of services will be utilized for Services Requiring Pre-Certification:

 Inpatient Services (Medical, Surgical, Behavioral)

• Bariatric Surgery
• Cervical Spine Surgery (as of 1/1/15)
• Computer Navigation for Orthopedic Surgery
• Elective Admissions
• Emergency Admissions
• Hospice

• LTAC Admissions
• Lumbar Spine Surgery
• Rehabilitation Facility Admissions
• Skilled Nursing Facility Admissions
• Transplants

 Surgical Procedures - Ambulatory

• Bariatric Surgery
• Cartilage Transplant Knee
• Cervical Spine Surgery (as of 1/1/15)
• Cochlear Implant
• Computer Navigation for Orthopedic Surgery

• Lumbar Spine Surgery
• Nasal Septoplasty
• Rhinoplasty
• Sinus Endoscopy
• Sleep Apnea Surgery - LAUP/UPPP, Nasal, and Uvulopalatoplasty

 Ancillary Services

• Home Infusion Services
• Home Health Services
• Home Hospice 

• Occupational Therapy
• Physical Therapy
• Speech Therapy

 Durable Medical Equipment

• Bone Stimulator
• Cardio/External Defibrillator
• Cooling Devices
• CPAP/BIPAP
• Electric Scooters
• Limb Prosthetics 

• Myoelectric prosthetics
• Neuromuscular Stimulators
• TENS Unit
• Wheelchairs (Custom)
• Wheelchairs (Power)
• Wound Vacs

 Diagnostic Imaging - Ambulatory

• Coronary CT Angiography (CCTA)
• Coronary MRA
• Cardiac MRI
• MRA of the Head and/or Neck

• MRI of the Brain
• MRI of the Spine – Cervical, Throacic, Lumbar, Sacral
• PET Scan

 Specialty Infusion Drugs

• Alemtuzumab (Campath)
• Azatidine (Vidaza)
• Bevacizumab (Avastin)
• Bortezomib (Velcade)
• Fulvestrant (Faslodex)
• Immune Globulin (Intravenous)
• Infliximab (Remicade) (as of 1/1/15)
• Mitaxantrone (Novantrone) 

• Oxaliplatin (Eloxatin)
• Paclitaxel (Taxol and Abraxane)
• Panitumubab (Vectibix)
• Pemetrexed (Alimta)
• Rituximab (RituXan)
• Trastuzumab (Herceptin)
• Zoledronic Acid (Zometa) 

 

Download printable version

 

 
 

2015 Rate Schedule-MACC Group Health Plan


Group Health Insurance

2015 MONTHLY PREMIUMS

 
  GOLD SILVER
Employee    

 

Health $ 730.06   $ 671.14  

 

Life $ 2.32   $ 2.32  

 

Total $ 732.38*   $ 673.46  
         
Spouse $ 543.97   $ 503.29  
         
Children $ 331.03   $ 303.49  
         
Family $ 875.03   $ 806.81  
         
Retired employee without medicare $ 487.59   $ 448.12  
Retired employee with medicare $ 294.36   $ 270.78  
Retired employee's spouse w/out medicare $ 503.27   $ 462.57  
Retired employee's spouse with medicare $ 369.29   $ 339.02  
 
*Employee pays $58.92

 

 


MACC Benefits

The following is a listing of employee benefits offered to full time employees at Moberly Area Community College. Additional information is provided in the MACC Policy Handbook.

A full-time employee is defined as an employee with a full-time teaching load or working a minimum of a 37 1/2 hour week for at least 9 1/4 months per year.

 

Benefits Summary

MACC Benefits Summary

The following is a listing of employee benefits offered to full time employees at Moberly Area Community College. Additional information is provided in the MACC Policy Handbook.

A full-time employee is defined as an employee with a full-time teaching load or working a minimum of a 37 1/2 hour week for at least 9 1/4 months per year.

BenefitEligibility Effective Brief Description of Benefit
Tuition Waiver Beginning of semester after commencement of employment

Full-time employees and their spouses may attend up to nine hours of developmental and college classes per semester with a waiver of incidental fees and tuition, technology fee, and student activity/support services fee, on a space available basis with the approval of the employee's supervisor/dean. The cost of books, supplies, and laboratory fees is the responsibility of the individual. Online and hybrid courses contain additional per credit hour fees, which will be the responsibility of the individual.

Dependents of full-time employees may attend up to 12 credit hours of developmental and college-credit courses per semester with a waiver of incidental fees and tuition, technology fee, and student activity/support services fee. The cost of books, supplies, and laboratory fees is the responsibility of the individual. Online and hybrid courses contain additional per credit hour fees, which will be the responsibility of the individual. Dependents are those members of the employee’s family meeting the IRS definition of a dependent. Dependents using this benefit must meet federal academic progress guidelines.

After two consecutive years of employment

Reimbursement up to $150 per credit hour is available for up to 6 credit hours per academic year of college coursework beyond the Associate's or Bachelor's Degree. Some restrictions apply.

Employee Assistance Program (EAP) Upon employment

The EAP is a free and confidential service designed to help employees and families with personal or work/life balance issues. Common issues include: stress management, depression or anxiety, relationship problems, chemical dependency, domestic violence, career frustration, elder care resources, financial concerns, legal assistance, nutrition/health, etc. Call toll free 800.832.8302 or 314.845.8302.

Health Insurance 1st of the month after commencement of employment

Major medical coverage is available for full-time employees and is effective on the first day of the month following full-time employment. This coverage is currently provided by a self-funded plan, the Moberly Area Community College Health Plan, which utilizes the HealthLink Open Access III provider network. Two options are available: the Base Plan or the HSA plan. On the Base plan, the copay for an in-network office visit is $30 HMO, $40 PPO; copay for an in-network specialist is $30 HMO, $40 PPO;--no referral needed. Copayments for prescriptions are $15 for generics, $25 for brand names, and $40 for non-formulary medications. The HSA plan is a high deductible plan with a health savings account. Once the deductible is met the plan pays 100%. For more information, see the applicable schedule of benefits.

Life Insurance (Basic) 1st of the month after commencement of employment

All Full-time employees are enrolled for a life insurance benefit of $20,000 and an accidental death and dismemberment benefit of $20,000.

Life Insurance (Voluntary)
1st of the month after commencement of employment

Full-time employees may elect coverage for additional life insurance benefits in $25,000 increments up to $150,000 guaranteed issue. Coverage may also be elected for up to $50,000 for a spouse and up to $10,000 for children.

Long-term Disability 1st of the month after commencement of employment

Full-time employees may elect coverage for full or partial disability lasting longer than 90 days.

Short-term Disability After first day of employment on completion of enrollment application

Employees may elect coverage through Aflac that pays benefits for full or partial disability lasting less than 90 days.

Dental Insurance 1st of the month after commencement of employment

Full-time employees and their families may elect coverage provided by Assurant Employee Benefits. Preventative services are covered at 100% of UCR, Basic and major services are covered at 80% and 50% respectively, with a $50 per year, per person deductible (maximum deductible of $150 per family).

Vision Insurance 1st of the month after commencement of employment

Full-time employees and their families may elect coverage provided by Assurant Employee Benefits. When utilizing the VSP Signature network, the plan pays for eye exams and glasses with $10 copays for each. Out of network services are reimbursed up to specified limits. Contact lenses, including the exam, are reimbursed up to $120 out of network, $130 in network, every 12 months.

Long-Term Care Insurance 1st of the month after policy is issued, after 6 months of employment

Full-time employees and their families may elect a coverage plan provided through LTC Financial Partners, LLC, the policies are underwritten by United of Omaha Insurance Company. For an overview and explanation of our Long-Term Care Benefit view our online newsletter – Long-Term Care Today.

Accident Insurance After first day of employment on completion of enrollment application

This is an accident only insurance policy providing limited benefits. For covered accidental injuries, fixed benefits are paid directly to you regardless of any other coverage you may have. Coverage is provided by Aflac.

Critical Illness Insurance After first day of employment on completion of enrollment application

This insurance pays a fixed benefit upon initial diagnosis of a covered critical illness up to $50,000, depending on the amount of coverage elected. Coverage is provided by Aflac.

Hospital Indemnity Insurance After first day of employment on completion of enrollment application

This insurance provides benefits for hospital admissions/confinements, emergency room visits, out-of-hospital prescription drug, and well-baby care. Coverage is provided by Aflac.

Flex Plan 1st of the month after commencement of employment

There are three components to this "cafeteria plan." Participation in this plan allows the College to provide a non-taxable benefit through salary reduction within the meaning of Section 125 of the Internal Revenue Code for eligible group health insurance premiums, health savings account and/or flexible spending account for eligible medical expenses, and dependent care reimbursement up to the limits defined by the IRS.

Retirement Program Upon employment

All full-time staff are covered by either the Public School Retirement System of Missouri (PSRS) or the Public Education Employee Retirement System of Missouri (PEERS).

Additionally, employees participate in the Medicare and social security programs as follows:

Certified Staff

Public School Retirement (14.5% pre-tax deduction)

Medicare (1.45%)

   

Part-time
Certified Staff

Public School Retirement (9.67% pre-tax deduction)

Social Security (6.2%)

Medicare (1.45%)

   

Other Eligible Staff (Non-teaching)

Public Education Employee Retirement (6.86% pre-tax deduction)

Social Security (6.2%)

Medicare (1.45%)

These employee deductions are matched by the college.

Tax Sheltered Annuity Upon employment

Employees working on a regular basis are eligible to purchase a TSA (tax sheltered annuity) and make contributions pursuant to a salary reduction agreement, as defined in Section 403(b) of the Internal Revenue Code.

Medical Leave After 1st month of employment

Employees accrue 1 1/3 sick days per month to a maximum of 72 days. Sick leave may be granted for the employee and immediate family, and may be taken in half hour increments. "Immediate family" is defined as spouse, children, parents, grandparents, grandchildren, brother, sister, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, and sister-in-law.

Medical Leave Pool After 1 year of employment and donation of sick day

Provides eligible employees up to 15 days of salary continuation for qualifying medical leaves. See the full policy for donating to and requesting leave from the pool.

Family Medical Leave After 12 months and 1,250 hours of employment

MACC complies with federal and state law allowing up to 12 weeks leave for birth or adoption of a child, for a serious health condition of the employee or to care for a family member with a serious health condition, any qualifying exigency arising out of the fact that the employee's spouse, son, daughter, or parent is a covered military member on "covered active duty;" or up to twenty-six workweeks of leave during a single 12-month period to care for a covered servicemember with a serious injury or illness if the eligible employee is the servicemember's spouse, son, daughter, parent, or next of kin (military caregiver leave).

Personal Leave After 1st month of employment

Three sick days may be used as personal days each fiscal year. Personal leave may be requested due to inclement weather as well as for personal business. Personal leave may be taken in half hour increments.

Vacation 11 1/2 months after commencement of employment

All full-time, 12 month employees are entitled to 5 days of vacation upon employment (must meet conditions) and 10 paid vacation days after 11 1/2 months of employment. One additional vacation day is added for each consecutive year of service beyond 5 consecutive years, up to 15 days. Up to 5 days may be carried over to the next year. Maximum possible vacation period is 4 weeks (20 days). Vacation leave may be requested in one hour increments.

Sabbatical Leave

On completion of a sequence of six full years of satisfactory professional services

The college also has a sabbatical leave policy that covers contracted staff certified under the Public School Retirement System.

Jury Duty Upon employment

Absence is with pay for service on jury or as subpoenaed witness.

Military Leave Upon employment

Paid and unpaid time off and reinstatement according to federal and state law.

Holidays Upon employment

There are currently 11 designated paid holidays. These days are approved at the beginning of each college year.

Direct Deposit Upon employment

Direct deposit of earnings into personal checking or savings account.

Unemployment compensation Upon employment

Unemployment benefits as determined by the Missouri Department of Labor and Industrial Relations.

Workers' Compensation Upon employment

Coverage for medical expenses and partial compensation for loss of salary for absences from work arising from on-the-job injuries or occupational diseases.

Parking Upon employment

Full-time employees on the Main campus have reserved parking spaces.

Cultural Events Upon employment

Free admission to College events such as MACC Music Department concerts, MACC Drama Department performances, and regular season Greyhound/Lady Greyhound home basketball games. Through a partnership with the Moberly Area Council on the Arts, free admission to visual arts exhibits, films, and a performing arts series.

Recreational Facilities Upon employment

The Activity Center walking concourse, weight room, basketball court (when available), and intramural basketball leagues are available to full-time employees at no charge.

Library Upon employment

The collection is housed in the Kate Stamper Wilhite Library. Services are also available through the MOBIUS system.

MACC Bookstore Discount Upon employment

All employees of MACC receive a twenty percent (20%) discount on regularly priced items with the College name or logo sold in the campus bookstore.

MOST--Missouri's 529 College Savings Plan Upon employment

Employees working at least 20 hours per week on a regular basis are eligible to contribute to this college savings plan. For more information, visit their website at http://www.missourimost.org/emp

YMCA Membership Upon employment

Area YMCA's may offer discounted rates for membership fees, which can be conveniently deducted from paychecks.

Educational Benefits

Tuition Waiver

Effective: Beginning of semester after commencement of employment

Full-time employees and their spouses/domestic partners may attend MACC developmental and college classes with a waiver of incidental fees and tuition, technology fee, and student activity/support services fee. Attendance is subject to approval of the employee’s supervisor/dean. The cost of books, supplies, and laboratory fees is the responsibility of the individual.

In addition, full-time employees are eligible to apply for participation in one non-credit course/workshop per semester. If approved by the employee’s supervisor/dean, all fees and tuition will be waived. Books, workbooks, manuals, software, luncheon and/or dinner costs must be borne by the employee.

Dependents of full-time employees of MACC may attend MACC developmental and college-credit courses with a waiver of incidental fees and tuition, technology fee, and student activity/support services fee. The cost of books, supplies, and laboratory fees is the responsibility of the individual. Dependents are those members of the employee’s family meeting the IRS definition of a dependent. Dependents using this benefit must meet federal academic progress guidelines. Dependents who are eligible and meeting criteria for the Missouri A+ scholarship may receive an MACC voucher for college textbooks, course fees and lab fees in the fall and spring semesters for up to $500 and an MACC voucher for college textbooks, course fees and lab fees in the summer semester for up to $250.

Should the dependent’s parent cease to be employed at MACC, whether through resignation or termination during the course of a semester in which the dependent is enrolled at MACC, in accordance with this policy, the dependent will be allowed to complete the semester but will not be allowed to use the dependent tuition/fee waiver for future enrollment.

Retirees of Moberly Area Community College may also attend MACC courses with a waiver of incidental fees and tuition, technology fee, and student activity/support services fee. Courses may be audited or completed for credit.

 

 

Professional Growth

Effective: After two consecutive years of employment

All full-time employees of Moberly Area Community College who have completed two successive years of full-time employment are eligible to apply to the President's Council for reimbursement for college credit classes. Maximum reimbursement is $150 per credit hour or the actual credit-hour fee, whichever is less, for college coursework from accredited institutions beyond the Associate's Degree or Bachelor's Degree. Reimbursement is limited to six credit hours per academic year and may not be allowed if the employee is receiving another form of financial aid for the coursework. The college coursework is to be taken outside of the employee's designated work schedule or the employee’s hours of work may be adjusted with approval of the supervisor.

Requests for this benefit must be made before enrolling in the course. To qualify for reimbursement, the applicant must earn a grade of C or higher. Application procedures and final authorization and reimbursement will be determined by the President's Council.