USA Health and Dental Plan
Transparency in Coverage Rule
The link below leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
USA Choice Plan
University of South Alabama
63-0477348
https://www.bcbsal.org/web/tcr
Frequently Asked Questions
Due to increased claims expenses, the USA Fringe Benefits Committee (FBC) recommended, an employee premium increase of $3 per month for single coverage and $9 per month for family coverage. In addition to the premium increases, it is necessary to make benefit design changes for the USA Choice Plan.
Below are the approved benefit design changes for the USA Choice Plan, effective January 1, 2025:
- The medical emergency facility copay of $200 will apply to both the USA Health Network and the BCBS PPO Network, which will result in a decrease in copy for the BCBS PPO Network.
| USA Choice Plan - Base Premiums | |
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| USA Choice Plan - Standard Premiums | |
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Premiums for health and dental coverage are paid one month in advance and the employee
contribution for bi-weekly paid employees is split equally between the first two paydays
of the month. The employee contribution is exempt from federal, state and FICA taxes
with participation in the Premium Conversion Plan (automatic enrollment).
Wellness Incentive
The USA Choice Plan implemented a Tobacco Cessation Program to help participants stop
the use of tobacco. The program includes a wellness incentive that reduces the employee
premium cost sharing by $50 per month, if both the employee and covered spouse do
not use tobacco products. As a current USA health insurance member, if you are not
receiving the wellness incentive and both you and your covered spouse do not use tobacco products (and have not for at
least six months), you must update your status is Employee Navigator. No action is required by employees that currently receive the wellness incentive.
The USA Choice Plan is committed to helping you achieve your best health. Rewards
for participating in the Wellness Incentive Program are available to all employees.
If you think you may be unable to meet the standard for the reward under this program,
you may qualify for an opportunity to earn the same reward by different means. Contact
the Human Resources Department for additional information.
The USA Choice Plan along with other plan information is available in Human Resources on campus and at
USA Health Human Resources.
| University of South Alabama |
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| USA Choice Plan - Plan Benefits |
| Glossary of Health Coverage and Medical Terms |
The USA Choice Plan pharmacy annual deductible is $100 per individual (maximum of 3 per family).
The USA Choice Plan copay structure 6-tier plan6-tier plan:
• Generic (preferred) COPAY $10
• Generic (non-preferred) COPAY $10
• Preferred Brand Name COPAY $50
• Non-Preferred Brand Name COPAY $75
• Specialty (preferred) COPAY $150
• Specialty (non-preferred) 50% COINSURANCE
Employees are eligible for participation in the USA Choice Plan or the USA Select Plan based solely on hours of service. The Affordable Care Act requires an offer of coverage to employees credited with 30 hours of service per week or 130 hours of service per month on average. The Plans may defer the offer of coverage if the employee is determined as having “variable hours” in which case benefits-eligible status will be determined using a 12-month measurement period with a corresponding 12-month coverage period in compliance with the Affordable Care Act.
Eligible Employees include:
- An employee with a specific appointment with no termination date, occupying a permanently budgeted position, and working a minimum of 20 hours per week on a regular basis.
- An employee with an employment start date on or after January 1, 2013, who is credited with 20 hours of service per week or 87 hours of service per month on average.
Eligible Employees may also enroll their legal spouse, as recognized by the state of Alabama, and children under age 26. Coverage with the selected Plan will begin on the first day of the month following the first day of employment, contingent upon timely application to the Human Resources department and payment of any required employee contribution.
- Spouse – As recognized by the state of Alabama.
- Dependent child –
- Your natural-born child under the age of 26.
- Your stepchild under the age of 26.
- Your legally adopted child, including a legally adopted child living with you as the adopting parent, during a period of probation.
- A child under age 26 over whom you have legal guardian status by court appointment.
- A child under age 26 for whom you are legally required to provide health insurance coverage pursuant to a Qualified Medical Child Support Order (QMCSO).
- Your disabled child of any age provided the disability commenced prior to age 19. Coverage under the Plan continues without interruption for the duration of the disability as long as the employee maintains dependent coverage.
You may enroll in a selected plan, enroll your eligible dependents or terminate coverage for yourself or a dependent when certain events cause a Change-In-Status. To make an enrollment change due to a Change-in-Status event, you must make application and provide documented proof of the Change-In-Status event to the Human Resources department within 30 days of the event. The effective date of the election would be the date of the qualifying event. If you fail to notify Human Resources within 30 days of the qualifying event, you must wait until the Open Enrollment Period.
Some examples of qualifying events include, but are not limited to:
- Marriage / Divorce
- Birth of Child
- Adoption or placement for adoption
- Death
- Change in your spouse’s employment status
The Open Enrollment Period is offered annually during which an employee may enroll in the USA Choice Plan, and/or add eligible dependents. During this period, you may file an application with the Human Resources department and coverage will begin on the first day of the following calendar year. During this time, employees can also re-enroll in SouthFlex Flexible Spending Accounts if they wish to participate the following calendar year.
All new employees must complete New Employee Orientation. During orientation, you will have the opportunity to complete enrollment forms. You will be notified as to the date/time of your scheduled orientation.
| USA Choice Plan - Base Premiums | Single | Family |
|---|---|---|
| Non-Tobacco | $137 | $454 |
| Tobacco | $187 | $504 |
| USA Choice Plan - Standard Premiums | Single | Family |
|---|---|---|
| Non-Tobacco | $157 | $518 |
| Tobacco | $207 | $568 |
Note: Premiums for health & dental insurance are pre-tax dollars and are paid one month in advance so the initial deduction may reflect a retroactive adjustment.
The University of South Alabama encourages all employees to adopt healthy lifestyle choices. That effort will benefit you, your family and your fellow employees. The University’s Fringe Benefits Committee recommended, and the University adopted, a tobacco cessation program which is intended to help employees stop using tobacco products. Tobacco use and especially smoking will increase your risk of heart disease, stroke, respiratory diseases such as emphysema and bronchitis, as well as cancer including: lung, throat, mouth, esophagus, pancreas, bladder, and leukemia. The benefits from stopping the use of tobacco are almost immediate regardless of how long you have been smoking or using tobacco.
For new employees the Tobacco Declaration information/election is made in Employee Navigator.
Existing employees that do not currently participate in this wellness incentive may begin participation by updating their tobacco status in Employee Navigator. Employees will declare that they and their covered spouse do not use tobacco products; and have not used tobacco products within six months prior to the date on the form. This will qualify for a wellness incentive of $50 per month (one per family). The wellness incentive will be applied to the monthly insurance premium effective the pay period following the date of the new election (payroll deadlines can affect when this discount will be applied).
For employees enrolled in any of the University sponsored health plans seeking assistance with tobacco cessation please visit pivot.co/bcbsal6 and use access code: bcbsal6. The Program is provided at no cost to employees and covered spouses who want to stop using tobacco products and offers a personalized choice of tools and support.
For additional tobacco cessation resources you may also contact the Employee Assistance Program office at 461-1346.
Premiums for health & dental insurance are paid one month in advance. Your cancellation date will be based on your last day of employment. Example: If your last day of employment is December 14, your last paycheck will be December 30. Premiums paid in December through payroll deduction have paid for coverage for January. Your insurance will cancel effective January 31.
Note: The above information applies only to employees in a paid status. For employees on a leave of absence in an unpaid status, please contact Human Resources for an effective date of cancellation.
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