Benefits Enrollment Ended Nov. 13

Benefits Enrollment for 2016 has ended. Your choices are effective January 1, 2016. You can review your enrollment for next year on your 2016 Confirmation Statement through Employee Self-Service. Contact Human Resources with questions or changes by Nov. 24. 

Medical Insurance

Each employee's needs are different. OU offers three different medical plans to meet those needs and provide flexibility to you and your family.

BlueCross BlueShield of Oklahoma

This open access plan features an two extensive Oklahoma and national networks of physicians and health care providers. Participants have access to any provider that is part of the networks without the need to select a primary care physician when enrolling. Any specialist within the plan networks can be seen without getting a referral from a primary care physician. The out-of-network benefit offers even more flexibility when selecting a provider. This plan also features a three-tiered pharmacy benefit with co-pays for generic, brand formulary and brand non-formulary prescriptions. The BlueOptions PPO plan has a deductible and co-insurance amounts.

There are no pre-existing condition limitations in this plan.

The BlueLincs HMO plan is a network medical plan that provides access to credentialed providers for low out-of-pocket expenses. Participants have an annual deductible and pay flat dollar amount co-pays for services. A primary care physician must be selected by those enrolling in the HMO plan, and referrals by the primary care physician are required. Authorization is required for all care outside of the primary care physician. The BlueLincs HMO plan has a limited network, and there is no out-of-network benefit, except in the case of a life-threatening emergency. This plan features a three-tiered pharmacy benefit with co-pays for generic, brand formulary and brand non-formulary prescriptions. 

There are no pre-existing condition limitations in this plan.

The BlueEdge HCA will be replaced by the BlueEdge Health Savings Account (HSA) in 2016 (see Changes section below). The BlueEdge HSA is a high deductible PPO plan with a health savings account that employees can contribute to. The funds in the HSA can be used to pay for eligible medical expenses and gives members control over how their medical care dollars are spent. Reimbursement for eligible medical expenses are tax-free and unused funds roll over from year to year. Learn more about the BlueEdge HSA here.

At the start of the year, the university allocates a fund to help the participant pay for medical expenses covered by the plan. The employee can also contribute to this fund through payroll deduction. The fund is used to pay for eligible medical care expenses up to the health savings account fund amount. Preventive care, such as routine physicals and immunizations, is covered at 100% and is not counted against the member’s fund. Fund money left at the end of the year is added to the next year’s fund balance. This allows members to plan for future expenses as long as they remain in the plan. Although this plan has a lower monthly premium, it does have a higher deductible and higher out-of-pocket expenses and may be best suited for individuals without a large amount of medical expense. 

The BlueEdge HSA features an extensive Oklahoma and national network of physicians and health care providers. A primary care physician does not have to be selected. Any specialist within the plan network can be seen without a referral. The plan also has an out-of-network benefit, as well as a three-tiered pharmacy benefit for generic, brand formulary and brand non-formulary prescriptions.

There are no pre-existing condition limitations in this plan.

What should I consider when choosing between the PPO, HMO, and HCA plan options? Premium rates are not the only things to consider when choosing a medical plan. There are significant differences between the plans that should be looked at. Here are some factors to consider. 

1. Benefit Design

There are notable differences between the plans, which impact the coverage and the out-of-pocket costs you’ll have when you utilize your benefits. The BlueLincs HMO is a health maintenance organization type of plan, otherwise known as a “managed care” plan. It requires selection and use of a primary care physician (PCP), and referrals are usually needed for specialty care. The BlueLincs HMO has very low out-of-pocket costs with just applicable copays. The calendar year deductible is only $300  per person, with no family maximum.

The BlueOptions PPO plan is a preferred provider organization type of plan, which gives you the flexibility to choose between a PPO provider and non-PPO provider. Your out-of-pocket costs are usually lower if you use a PPO provider. The BlueOptions PPO has a calendar year deductible to satisfy before coverage begins. But, like the HMO plan, many services are covered with just a copay, so depending on the type of services you need, you may not even need to meet your deductible during the year.

The BlueEdge HCA is a high deductible PPO plan with a health fund. It has a notably higher deductible to satisfy each year, and most services, except for some of your preventive care benefits, are subject to that deductible before your coverage begins. To help offset the higher deductible with this plan, money is put into a health care account each year on your behalf, which can be applied to your deductible or other eligible out-of-pocket medical expenses.

2. Price & Cost Comparisons

Compared to the HMO, the PPO premium rate is lower. Check 2016 rates here. Review the charts below to better understand the cost comparisons between OU's medical insurance plans.

NOTE: The HMO plan is closed to new participants in 2016. The costs below are estimates for current participants.

Procedure: First MRI        
  BlueLincs HMO BlueOptions PPO (BlueChoice Network) BlueOptions PPO (BluePreferred Network) BlueEdge HSA
Billable Price of Service $1,600 $1,600 $1,600 $1,600
Your Deductible $300 $500 $400 $1,000*
Your Copay or Coinsurance $100 $220 $240 $15
Your Total Cost $400 $720 $640 $1,015
         
Additional MRI's $100 $220 $240  
        *Deductible is $1,500; apply HSA $500 fund amount


Procedure: Hospitalization        
  BlueLincs HMO BlueOptions PPO (BlueChoice Network) BlueOptions PPO (BluePreferred Network) BlueEdge HSA
Billable Price of Service $10,000 $10,000 $10,000 $10,000
Your Deductible $300 $500 $400 $1,000*
Your Copay or Coinsurance $250 $1,900 $1,920 $1,275
Your Total Cost $550 $2,400 $2,320 $2,275
        *Deductible is $1,500; apply HSA $500 fund amount


Procedure: Out-Patient Surgery        
  BlueLincs HMO BlueOptions PPO (BlueChoice Network) BlueOptions PPO (BluePreferred Network) BlueEdge HSA
Billable Price of Service $5,000 $5,000 $5,000 $5,000
Your Deductible $300 $500 $400 $1,000*
Your Copay or Coinsurance $100 $900 $920 $525
Your Total Cost $400 $1,400 $1,320 $1,525
        *Deductible is $1,500; apply HSA $500 fund amount


Premiums Employee Only Employee & Spouse Employee & Child(ren) Employee & Family
The BlueLincs HMO premiums are higher than the BlueOptions PPO by this much per year: $1,230.24 $2,954.16 $2,338.56 $3,630.24

3. Choice of Doctors & Facilities

If you are considering the HMO, make sure your current physician(s) is in the HMO network. If you are joining the HMO and want to choose a new primary care physician, make sure that physician is accepting new patients.

4. Medical Management

The HMO plan has a higher level of medical management, meaning that some tests or prescription drugs may take longer to be approved, more substitutes may be suggested, and more tests may be denied, relative to the BlueOptions PPO or BlueEdge HCA.

5. Out-of-State Coverage

Generally on the HMO plan, out-of-state coverage for the employee is limited to emergency treatment. If you have a dependent living out-of-state or moving out of state during the year, and are considering the HMO, call Blue Cross Blue Shield at (888) 881-4648 to learn about your options.

BlueOptions PPO and BlueEdge HCA members have nationwide access to contracting providers through the BlueCard® Program when you or your covered family members live, work, or travel anywhere in the country. Additionally, when you travel outside the United States, these members have access to contracting providers in more than 200 countries through BlueCard Worldwide®.

6. Medical Procedure Availability

Some elective procedures may be available only under a particular plan. Bariatric surgery (obesity reduction) is currently covered only under the BlueLincs HMO plan.

7. Pre-existing Conditions

None of OU's medical insurance plans have pre-existing condition restrictions.

Insurance Changes in 2016

Medical insurance plan benefits remain the same in 2016. Other changes are described below.

  • BlueOptions PPO - No Changes: The plan design and rates for the BlueOptions PPO remain unchanged in 2016.
  • BlueLincs HMO Changes: Enrollment in the BlueLincs HMO plan is closed starting in 2016. This means current HMO members can make changes, but no new members will be enrolled. The HMO plan will be fully replaced in 2017. The BlueLincs HMO rates have increased. An employee’s share of the HMO premiums will increase according to their contribution tier and the coverage level they choose.  
  • BlueEdge High Deductible Plan Changes: Beginning in 2016, the high deductible plan will include a Health Savings Account that employees can contribute to. This means that the BlueEdge HCA will be replaced with the BlueEdge Health Savings Account (HSA). Reimbursement for eligible medical expenses are tax-free and unused funds roll over from year to year. The 2016 BlueEdge HSA will have the same plan benefits and rates that the HCA plan did in 2015 except that the out-of-network co-insurance will be 40% after the deductible. Learn more about the BlueEdge HSA here.
  • Waiver of Coverage Credit: There will no longer be a $50 per month credit for waiving OU medical insurance coverage. 
  • Review year-to-year rate comparisons (PDF) here. 
  • The federal Affordable Care Act (ACA) continues to provide the Health Insurance Marketplace for 2015. Find information about how the ACA Health Insurance Marketplace may affect OU employees here.

Retirees

  • Retirees under age 65 - Same medical insurance options as active employees. See changes above.
  • Visit the Retiree page to review other changes for retiree medical insurance for 2016.

Plan Information

What do you want to do?

  • BlueCross Online to:
    • Find doctors
    • Review plan information
    • Log in to Blue Access for Members

Contact

Things to Consider

Protect Your SSN with Health ID

Because keeping your personal identity safe is a top priority at the university, you will use your Health ID instead of your Social Security number for all medical and dental transactions at the doctor's office and with insurance providers. Click here to learn more about your Health ID Number.

Spouses Working at OU

Medical yearly deductibles and out-of-pocket maximums can be linked for families that have children and two spouses who both work at OU. Call  BlueCross BlueShield at 1-888-881-4648.

Flexible Spending Accounts

Did you know that health care and dependent care reimbursement accounts can decrease the amount of taxes you pay on your income? OU and PayFlex 
(a BlueCross partner) offer a debit card with the healthcare reimbursement Flexible Spending Account (FSA). Get more information on the PayFlex Flexible Spending Accounts page.