The below FAQs are available through a presentation to download/save for future reference. 

What is open enrollment?{expander}

Unless you have a qualifying event, open enrollment is your annual opportunity to update or choose the benefit options that best meet your needs for 2025.

You can elect or make changes to:

What is a qualifying event?{expander}

A qualifying life event is a change in your life, either planned or unplanned, that has an impact on your insurance coverage. Some examples include:

  • Losing or gaining health coverage through a spouse’s plan
  • Turning 26 and losing coverage through a parent’s plan
  • Getting married or divorced
  • Having a baby or adopting a child
  • Death in the family

Supporting documents must be submitted to Human Resources within 30 days of the event.

 

When is open enrollment?{expander}

Enrollment for the 2025 plan year begins on November 4th and ends on November 15, 2024. All plan changes must be submitted to jestevez@sarahlawrence.edu by November 15, 2024 for a January 1, 2025 effective date.

 

How do my health benefits work?{expander}

  • edHealth: Sarah Lawrence College is a member of a consortium of higher education institutions who work together in an effort to contain health insurance costs. In a consortium model through edHEALTH, the College, along with its consortium peers, have the ability to select a (1) separate insurance network, (2) third-party administrator (TPA), and (3) pharmacy provider, resulting in increased competition for these services.
    1. Cigna PPO: Insurance network of doctors, hospitals and facilities that accept our plan, and provide negotiated rates for services.
    2. Luminare Health: A third-party administrator (TPA) is responsible for the customer-facing functions of a health insurance plan. These functions include claims processing and resolution and general customer service.
    3. Optum Rx: Pharmacy provider that determines the pricing of prescription medications.

When you present your insurance card at the doctor’s office or pharmacy it will be clear that your insurance network is Cigna and that your prescription carrier is Optum Rx. Doctors and facilities will contact Luminare Health to verify your insurance coverage and employees will contact Luminare Health for any billing or claims questions.

 

What are the three different Cigna PPO plans?{expander}

  • POS (highest cost plan): provides both in and out-of-network benefits. There is a small deductible and 20% coinsurance for out-of-network services. This plan provides the greatest out-of-network benefits and is often best suited for employees who would like the option to regularly access out-of-network care.

 

  • EPO (mid cost plan): The EPO plan provides the same in-network benefits as the POS plan, with an identical network of providers as the POS and HDHP. Unlike the POS, the EPO has no out-of-network benefits and may be best suited for employees who routinely access care from in-network physicians.

 

  • High Deductible Health Plan (lowest cost plan): This plan has the same provider network as the POS and EPO plans and will require enrolled participants to first meet a deductible ($2,000 single / $4,000 family) before the insurance company pays all in-network claims at 100% (with the exception of prescriptions, which will be covered at the three-tier structure of the EPO and POS plans). While there is an out-of-network benefit on the HDHP plan, (unlike the EPO, where there is none) there is a significant deductible which must be met for out-of-network services.
    • The College will contribute 50% of the deductible ($1000 single / $2,000 family) to a health savings account for employees who enroll in the HDHP option.

How do I know which plan is right for me?{expander}

  • Review and understand the 2025 plan offerings and differences.
  • Consider creating an account through Luminare to access details regarding your insurance usage over the last year and help you understand:
    • How often (if at all) you have accessed services out-of-network
    • Which types of benefits you have used most frequently
    • The costs and benefits associated with each of the individual plan options for your particular utilization of your insurance
  • Review the Cigna network of providers, which will allow you to confirm if your current doctors participate in the Cigna network.
  • Contact the Office of Human Resources to request a meeting

Does the College benefit from me enrolling in the least expensive (HDHP) plan option?{expander}

  • The College does not benefit from an employee’s enrollment in any given plan. 
  • The College contributes the same amount towards the cost of all single plans and the same amount towards the cost of all family plans.
  • Insurance selections are a very personal choice, and the College encourages you to enroll in the plan that best suits your needs.

Will employee premiums (payroll deductions) for health insurance coverage change in 2025?{expander}

  • Health insurance premiums were initially increased by 13.8%, however, as a result of adjustments to prescription coverage, there will be a 9.8% increase in medical premiums.
  • Benefit-eligible, long term guest faculty (those with 10 or more years of service) are eligible to enroll in health insurance coverage under the same terms as tenure- and tenure-track faculty (based upon salary tier).

What changes is the College making to health insurance this year?{expander}

  • The College’s three tier prescription coverage and pharmacy formulary will change effective January 1, 2025.
  • Prescription tiers will change to $15/30/$50
  • The College’s plan will utilize the premium formulary
  • There are no changes to office visit co-payments, deductibles, or the PPO Cigna insurance network for the College’s health insurance coverage.

 

{expander}Why is the College’s prescription coverage changing?

  • The edHEALTH consortium has been working to align its member institutions’ benefit offerings.
  • Sarah Lawrence is currently the only member institution with a three-tier pharmacy benefit of $10/$20/$35, with all others providing coverage minimally at the $15/$30/$50 level.
  • In addition, more than eighty percent of edHEALTH’s member schools currently utilize the premium formulary for their prescription coverage.
  • Making these adjustments to the College’s health insurance plan will also reduce the premium increase for employees from 13.8% to 9.8%.

{expander}What is three tier prescription coverage?

  • Health insurance plans typically have three tiers for covered prescriptions, as described below:
    • Tier 1: The least expensive drugs, usually generic drugs, with a low or no copay
    • Tier 2: Higher-priced generic drugs and lower-priced brand-name drugs, with a medium copay
    • Tier 3: Higher-priced brand-name drugs and some higher-cost generic drugs, with the highest copay
  • The dollar value of each of the tiers is a cap on the out-of-pocket cost paid by plan participants per prescription.
  • In most cases, participants pay less than this cap as a result of further discounting at the pharmacy. 
  • In addition, participants who elect to fill their eligible prescriptions by mail or online will receive more than a 30% discount on a 90-day supply of medication.
  • For more information on the mail order prescription benefit, contact OptumRX.

What is a pharmacy formulary?{expander}

  • A pharmacy formulary is a list of prescription drugs that are covered by a health insurance plan. Premium formularies are typically developed with the understanding that some very expensive specialty medications often have lower-cost, chemically identical alternatives. 
  • In the rare case that there is no alternative prescription in the premium formulary, participants have a pathway to request that an exception be made for their specific medication to allow for coverage. 
  • Participants who take medications that are impacted by this change in formulary will be notified directly by OptumRX. Less than 10% of participants in the College’s health plan will be impacted by this change in formulary.
  • Beginning January 1, 2025, the College’s prescription coverage will utilize a premium formulary for prescription coverage. 

Will there be any changes in the cost of dental or vision coverage?{expander}

  • There will be no change is the cost of coverage for Aetna Dental nor Vision VSP.

What if I was just hired or don’t need to make any changes. Do I have to enroll again for 2025?{expander}

  • Sarah Lawrence College’s benefit plans renew on a calendar year.
  • You will automatically be defaulted into all of your current benefit elections for 2025. 

No action needed if you are staying in the same:

Medical (HDHP, EPO, PPO) plan option

Dental plan

Vision plan

 

  • Reminder: Even if you are currently enrolled in a health savings account, flexible spending account, or a dependent care account, new enrollment forms must be submitted every year.

 

What elections can I make anytime, outside open enrollment?{expander}

Other benefits that may be changed either during open enrollment OR throughout the year, without a qualifying event, include:

 

The choice of one of 3 health plans:

  1. Low Plan: A HDHP with an HSA
  2. Medium Plan: EPO plan (In-network only)
  3. High Plan: PPO

Need to look up providers? Check out the step-by-step instructions on how to search the Cigna network.  Once you have that information, go to the Cigna website to search.

To create an account with Luminare Health, please view the Online Registration Guide

Get Virtual Care With Teladoc

If the condition isn't serious, you can use Teladoc instead.

With Teladoc, you can:

  • Access doctors 24/7, 365 days a year
  • Receive an examination, treatment plan or recommendation to visit an urgent care or ER facility
  • Get prescriptions sent to the pharmacy of your choice

Go to the Teladoc website to get started and learn how to use Teladoc

Two different dental plan options through Aetna Dental.

The Aetna DMO plan which is an in-network only plan and the Aetna PPO plan which provides coverage in and out-of-network. Both dental plans cost the same.

DMO Summary of Benefits

PPO Summary of Benefits

 

To find an in-network provider, go to the website. If searching in the DMO plan select the DMO/DNO and if the PPO select the Dental PPO/PDN.

Vision Care through VSP

To keep your vision in top shape, we encourage you to review the vision plan summary and explore the options available.

We offer coverage that includes an annual eye exam, plus necessary options such as frames, lenses, or contact lenses (up to a certain amount in-network and out-of-network). 

Go to the VSP website to learn more and search for in-network providers.

Health Savings Account (HSA){expander}

 

  • If you enroll in the HDHP (HSA) plan, SLC will contribute $1,000 for individual coverage and $2,000 for family coverage.

 

  • As a participant, you can also set aside money on a tax-free basis through payroll deduction to pay for qualified medical expenses up to IRS maximums which are inclusive of SLC's contribution.

 

  • To contribute towards your HSA, the HSA authorization form must be submitted every year during open enrolment.

 

  • Contribution amounts can be changed throughout the year.

 

  • Funds roll over each year, so you don't lose them if you don't use them!

Flexible Spending Account (FSA){expander}

  • A Flexible Spending Account (FSA) is an account that lets you set aside funds through payroll deduction on a tax-free basis (up to the IRS contribution limit) to pay for qualified medical expenses such as copays, deductibles, prescriptions, OTC medications, vision & dental expenses.

 

  • FSA form must be submitted every year during open enrollment.

 

Dependent Care Account (DCA){expander}

  • A Dependent Care Account (DCA) lets you set aside funds through payroll deduction on a tax-free basis (up to the IRS contribution limit) to pay for qualified dependent care expenses for dependents:
    • Under the age of 12
    • A dependent that is physically or mentally incapable of self-care

 

Please make sure to check the 2025 IRS limits when calculating your payroll deductions! 

The Hartford Group

 

Life and Accidental Death and Dismemberment Insurance

  • Life Insurance provides the financial support your loved ones need if you pass away.
  • AD&D insurance pays you or your beneficiaries a set amount of money if your death or dismemberment is the direct result of an accident.

The College pays the full premiums for basic life & accidental death & dismemberment insurance for eligible employees, up to $50,000 in coverage, contingent on the employee's salary and age. 

Supplemental Life insurance

The College also provides access to supplemental life insurance, which employees may elect and pay for through payroll deduction. This supplemental life benefit allows employees to purchase additional life insurance for themselves, spouse, and/or dependent(s).

To enroll in The Hartford Group supplemental life insurance:

1. Check out the premium weekly cost through payroll deduction

AND

2. Fill out the form and email jestevez@sarahlawrence.edu

Unexpected legal questions arise every day, and with LegalShield on your side, you’ll have access to a quality law firm for covered personal situations, even 24/7 for emergency situations, no matter how traumatic or how trivial they may seem. 

LegalShield Plan Benefits Include:

  • Direct Access to a Dedicated Provider Law Firm
  • Document Review & Preparation
  • Court Representation
  • Speeding Ticket Assistance

Go to the Legal Shield website to enroll and learn more about this benefit. You can also view the flyer for an overview.