Human Resources - Benefits

Administration Division

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GRA Healthcare

Beginning in 2015, the University System of Georgia will offer a healthcare option for Graduate Research Assistants. This option is in addition to the Student Health Insurance coverage offered through your institution. Under this healthcare plan, you have the option of covering (1) yourself, or (2) yourself and any eligible child dependents. Spousal coverage is not available under this plan, therefore, family coverage under this plan includes you and your dependent child or children. Upon enrollment, participants will receive one ID card with both the medical and pharmacy plan coverage verification information. If you have questions about your eligibility or enrollment in this plan, please contact your institution’s Human Resources Office.

Summary of Medical Plan Benefits
Benefit In-Network BCBSGa Open Access POS Out-of-Network
Lifetime Maximum None None
Maximum Annual Deductible - Medical
All services are subject to deductible
$3,250 Individual
$6,500 Family
For single coverage, once the $3,250 deductible is met, claims will be paid at 50%. If 2 or more individuals are covered, the $6,500 deductible must be met in total (from one or all covered members) before the plan pays 50%
$6,500 Individual
$13,000 Family
For single coverage, once the $6,500 deductible is met, claims will be paid at 50%. If 2 or more individuals are covered, the $13,000 deductible must be met in total (from one or all covered members) before the plan pays 50%
Deductibles do not cross accumulate
Maximum Annual Out-of-Pocket Limit $5,250 Individual
$10,500 Family
$10,500 Individual
$21,000 Family
Deductibles, coinsurance and out of pocket maximums accumulate separately for in-network and out-of-network services. Pharmacy benefits are subject to separate deductibles and out-of-pocket limits. The maximum annual out-of-pocket limit is the maximum amount an individual or family would pay out of pocket during the year for medical expenses under the plan and does not apply to the following: non-covered items, plan premiums, and balance billing due to out-of-network services.
Out-of-State/Out-of-Country coverage In-network coverage out-of-state utilizes the BlueCard National network and out-of-county uses the BlueCard WorldWide network
Co-insurance for Covered Services 50% of network rate
Wellness/Preventive Care Paid at 100% of network rate; not subject to deductible Not covered
Office Visit 50% Co-insurance after deductible 50% Co-insurance after deductible
Outpatient Hospital Services 50% Co-insurance after deductible 50% Co-insurance after deductible
Inpatient Hospital Services 50% Co-insurance after deductible 50% Co-insurance after deductible
Urgent Care 50% Co-insurance after deductible 50% Co-insurance after deductible
Emergency Care 50% Co-insurance after deductible 50% Co-insurance after deductible

Pharmacy Benefits are provided by CVS/Caremark. You will have access to more than 68,000 pharmacies across the country.

Summary of Pharmacy Benefits
Annual Deductible
All services are subject to deductible
$500 Single
$1,000 Employee +Child(ren)
Deductible must be met before plan benefits will pay; $1,000 Family deductible may be met by one or all covered members
Generic
All services are subject to deductible
50%
Preferred Brand
All services are subject to deductible
50%
Nonpreferred Brand
All services are subject to deductible
50%
Annual Out-of-Pocket Maximum The annual out-of-pocket maximum amounts for members who obtain generic and preferred brand-name prescriptions are as follows:

$1,600 Single
$3,200 Family

Upon reaching the annual out-of-pocket maximum, out-of-pocket costs for generic and brand name prescriptions will be waived for the remainder of the plan year.

Step Therapy and Prior Authorization Some medications are not covered unless you receive approval through a coverage review (prior authorization). This review uses plan rules based on FDA-approved prescribing and safety information, clinical guidelines, and uses that are considered reasonable, safe and effective. There are other medications that may be covered, but with limits (for example, only for a certain amount or for certain uses) unless you received approval through a review. During this review, CVS/Caremark asks your doctor for more information than what is on the prescription before the medication may be covered under your plan. If you go to a pharmacy and you are informed that your prescription cannot be filled because it requires a prior authorization, please have your physician contact CVS/Caremark to complete the coverage review.
Other Information If the member purchases a preferred brand-name prescription drug that is not indicated at “Brand Necessary,” and there is a generic equivalent available; only the generic member co-insurance will be applied to the annual out-of-pocket member benefit. The difference in cost between the generic equivalent and the preferred brand-name medication will NOT apply to the annual maximum out-of-pocket member benefit.
Pharmacy Benefits Information
CVS/Caremark: 1-877-362-3922
TDD: 800-231-4403

This summary of benefits provided on this page is for informational purposes only and is intended to highlight the principal benefits of the medical plans. For more details regarding the coverage under this plan, please refer to the Summary Plan Description.

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