Annual Open Enrollment

Benefits enrollment and edits are managed through BenefitFocus, Xavier’s benefits administrator. To access the portal, go to benefits.xavier.edu and use your Xavier credentials to login. Click enroll now and then next. To view your current benefits, click view benefits under active benefits. To make changes or complete Open Enrollment, click edit your benefits.

You will need your date of birth (DOB) and social security number (SSN) along with the DOB and SSN for your spouse and/or dependents if you will be enrolling them in any of your benefits. Once your enrollment is complete, you are required to upload documentation establishing the relationship (marriage certificate for spouse, birth certificate for child), unless you have previously provided this information.

Yes, IRS regulations do allow you to make changes during the plan year if you experience a Qualifying Life Event (QLE). Plan changes must be made within 30 days of the QLE. The QLE list includes:

• Change in marital status (marriage, divorce, legal separation, annulment)
• Birth or adoption of a child
• Obtaining legal guardianship of a child
• A court order requiring coverage for a child or dependent foster child
• Death of a spouse or dependent
• Change in Medicare or Medicaid eligibility

Documentation is required for all QLE changes. Contact the Office of Human Resources if you’re unsure of what documentation is required.

Your spouse’s Open Enrollment is considered a Qualifying Life Event (QLE) and would allow you to make mid-year changes to your benefit elections. Additionally, Xavier’s Open Enrollment is considered a Qualifying Life Event and allows your spouse to make mid-year changes to their benefit elections.

In an effort to maintain high-quality, cost-effective coverage for all employees, Xavier assesses a spousal surcharge to employees whose spouses have access to their own employer’s coverage. There is no spousal surcharge for spouses who do NOT have access to other employer sponsored coverage. If the spouse is employed by Xavier, there is no spousal surcharge assessed. When an employee adds a spouse to their medical coverage, they will complete a Spousal Insurance Inquiry Form.  Effective January 1, 2024, the spousal surcharge is $400.

When adding a spouse in BenefitFocus, employees will complete a survey indicating if their spouse has access to other coverage. OHR will then send the employee the Spousal Insurance Inquiry Form for completion.

Yes. With each coverage type, you will select which family members should be covered on each benefit. For example, you may elect Employee+Child(ren) coverage for medical, Employee+1 for dental, and Employee Only for vision. Just because a spouse or child is on one benefit does not mean the employee must carry them on all benefits. 

Xavier encourages all employees to elect or decline coverage every year during OE to ensure the benefit elections still match the needs of the employee and/or their family. If an employee does not enroll/decline benefits during OE, then the prior year benefits will rollover into the new calendar.

An important exception to this rule is the tax advantage accounts (HSA, FSA, DCFSA). These accounts are subject to IRS regulations and therefore require an active election every year.

Follow the prompts to add/remove a dependent or coverage. After saving changes you will be able to upload documentation from the home page under ‘To Do Items’. After viewing the list of To Do items, follow the prompts to upload the appropriate document(s).

Once complete, a benefit summary can be printed and a confirmation email is sent. After logging out of the open enrollment site, go to benefits.xavier.edu and use your Xavier credentials to login. Click Enroll Now! Select next. Review “Your benefits at a glance” in the blue box OR “view benefits” under the active benefits in the welcome box. Changes can continue to be made any time during the open enrollment period.

For 2024, all medical plan enrollees will receive a medical ID card in late December even if there are no changes to coverage. You will only receive a new dental or vision ID card if you newly enroll in coverage, change plans, or add/drop family members.  

For the dental insurance, only the subscriber’s name will be listed on the card. Spouses and dependents are covered under the subscriber’s member number and employees will receive an additional card for each member age 18 or older.

Employees may also access their medical and dental ID cards through the vendor online portals and/or mobile apps.

When adding the dependent in BenefitFocus, select “Disabled Child” in the relationship drop down box and complete the benefit elections. The Office of Human Resources will email a Disabled Dependent Certification Form. This form has one section to be completed by the subscriber (employee) and one section to be completed by the attending physician. The completed form should be returned to Anthem via fax (818-234-4482) or mail to PO Box 629, Woodland Hills, CA 91365.

If you will not work any days in the next calendar year, there is no need to complete Open Enrollment (OE). The Office of Human Resources (OHR) will review with you the retiree benefit options and provide you with a paper enrollment form. If you are not yet certain of your retirement date and could possibly continue working in the next calendar year, the OHR recommends you complete Open Enrollment.

Tiered health plans build on traditional health plans and include additional features that can help both employees and employers save money. Tiered health plans feature lower copays and/or co-insurance when members seek care from a Tier 1 care provider for their primary care physician (PCP), specialist, or hospital inpatient or outpatient services.

There is no change to current networks. Anthem’s network is a national network and is not local to the Greater Cincinnati area. To locate an In-Network Provider or Facility, got to Anthem.com and click on ‘Find Care’. Log in or chose ‘Guest’. If choosing Guest you will need to answer the following questions:

• Select the type of plan or network: Medical
• Select the state where the plan is offered: Ohio
• Select how you get health insurance: Medical (Employer-Sponsored)
• Select Plan or Network: Blue Access PPO Options

Tier 1 and Tier 2 providers are all in network providers. The tiers are determined by negotiations between Anthem and the providers.

It depends on which plan you choose and the tier of your providers. If you remain on your current plan (HDHP or PPO): 

PPO Plan: If your provider is in Tier 2, your costs will not increase but utilizing a Tier 1 provider may cost you less than a Tier 2 provider.

HDHP Plan: Utilizing a Tier 2 provider will not increase costs until you meet the deductible and subsequently the out of pocket maximum compared to the current HDHP plan.

The deductible and out of pocket maximum for Tier 2 is the same as the current PPO. If your is met deductible with a Tier 2 provider/service, and are on the current PPO plan, you will pay the same coinsurance that you pay now (20%) to the out of pocket maximum.

Tier 2 deductibles are the same amount as the current HDHP. You will pay 20% coinsurance for Tier 2 providers/services until you reach the out of pocket maximum. If you choose a Tier 1 provider/service, you will have a lower deductible ($3,200 individual/$6,400 family) and you pay 10% coinsurance until you reach the out of pocket maximum. Both Tier 1 and Tier 2 have the same out of pocket maximum of $4000 individual/$8000 family. This is an increase of $500/$1000 from the current HDHP.

No, monthly medical premiums have never counted towards your medical deductible or out-of-pocket maximum. Co-payments and co-insurance amounts apply to your deductible and out-of-pocket maximum.

Familiarize yourself with the types of plans being offered. Next, evaluate the needs of you and the family members who will be covered on your plan. Consider questions such as:

• How often do you or your family visit your Primary Care Provider (PCP)?
• How often do you or your family visit specialists?
• Do you or a family member have an upcoming surgery?
• Do you or your family member have a chronic condition?
• Do you frequently seek emergency care?
• What prescriptions do you or your family take regularly?

Regardless of the plan choice, there is always risk if something were to happen early in the year. Xavier does not contribute to the HSA account so the best way to lessen that risk is to begin contributing to your HSA at the beginning of the year. Contribution limits for 2024 are $4,150 (individual) and $8,300 (family).

No. The medical plan covers an annual physical (preventative/well visit) once per calendar year. You do not have to wait 365 days in between.

Preapproval or prior authorization for medical procedures has been in place for several years. Currently, there is no preapproval or prior authorization for pharmacy benefits. Similar to prior authorization for medical procedures, pharmacy prior authorization is a process in which the insurance company confirms with a prescribing physician that certain medications are medically necessary before filling.   

Employees who do not have a PA in place today within Anthems pharmacy system will go through the PA process upon their first fill of a medication after the 1/1/2024 effective date if their medication has a PA edit attached to it. The full list of drugs and which Utilization Management edits apply can be found here-Essential Split - Closed (formularynavigator.com).

Anthem utilizes an Electronic PA process through the integration of medical and pharmacy claims to auto-approve any PA’s that they are able so that the member is not disrupted and those claims will not reject.  Typically, PA’s are approved for one year and then a member would need to go through the process when it expires.  Members can view and track PA’s on the Sydney app or anthem.com.  If a member knows when their PA is set to expire, they can contact CarelonRx to proactively initiate a new PA close to the expiration date.

Trying medicines and medical products in a step-by-step way is called step therapy.   A step therapy program helps you and your doctor choose medicines and products that are right for you.

When your doctor prescribes a medicine that’s part of the step therapy program, your pharmacy’s computer gets a message. The message lets the pharmacist know you must first try a different, similar medicine that is covered by your plan — think of it as the “first step.”

Employees who have not gone through ST will go through the process after the 1/1/2024 effective date.  Anthem has an automated lookback in place to check within a member’s Rx claims history to see if they have a history of the first line products and if so they will be auto-approved and continue to receive their current medication. If not, the member’s physician will need to provide documentation that they have tried and failed the first line agents. The full list of drugs and which Utilization Management edits apply can be found here-Essential Split - Closed (formularynavigator.com).

Tax advantage accounts are an opportunity for employees to set aside pre-tax dollars to help cover the cost of out-of-pocket medical, dental, and vision expenses and/or dependent care expenses. There are 4 tax advantage accounts available to Xavier employees: Health Savings Account (HSA), Healthcare Flexible Spending Account (FSA), Limited Purpose Flexible Spending Account and Dependent Care Flexible Spending Account (DCFSA).

Both the HSA and Healthcare FSA can be used for medical, dental, and vision out-of-pocket expenses for the employee and/or their spouse and tax-dependent children, even if they are not covered on the employee’s medical plan. An employee cannot contribute to both an HSA and Healthcare FSA. The Limited Purpose FSA can only be used towards dental and vision out-of-pocket expenses and this can be paired with an HSA and/or FSA. The DCFSA can only be used towards dependent care expenses. This can be paired with any of the other tax advantage accounts or elected on its own.

Each of these accounts are subject to contribution limits as set by the IRS. The 2024 limits** are:

• HSA- $4,150 (single) $8,300 (family)
• FSA- $3,050 (2023 limit)
• Limited Purpose- FSA $3,050 (2023 limit)
• DCFSA- $5,000 (2023 limit)

*Age 55 and older can contribute an additional $1,000 “catch-up” contribution to the HSA.

**At this time only the 2024 HSA limits have been released by the IRS.

Both the HSA and FSA offer employees the opportunity to set aside pre-tax dollars to help cover the cost of out-of-pocket medical, dental, and vision expenses.

Health Savings Account

• Must be enrolled in the HDHP to be eligible
• Cannot be paired with a Healthcare FSA (Can be paired with a Limited Purpose FSA)
• Offer higher contribution limits
• Funds are available as contributions are made
• Unused contributions roll from year to year

Healthcare Flexible Spending Account

• Can be enrolled in any or none of the medical plans
• Cannot be paired with an HSA
• Have lower contribution limits
• The full yearly contribution amount is available upfront
• Unused contributions are forfeited at the end of the year

Yes, a welcome kit will be sent to your home address from HealthEquity, Xavier’s HSA administrator. The welcome kit will include your new debit card and information about how to access your personalized member portal.

The HealthEquity card helps you stay in compliance with IRS rules and can be used at health-related merchants and vendors to pay for your eligible health expenses. Even if you accidentally try to use your HSA card for a tank of gas, or movie tickets, your HealthEquity debit card won’t let you make that mistake. Your card knows that the money in your account is meant to be used for eligible expenses like: purchasing prescriptions, making co-pays, paying for an urgent care situation or visiting the dentist.

No. HealthEquity offers free online reimbursements into your personal checking/savings account.

Unused HSA dollars rollover from year to year and there is no maximum account balance.

Superior Dental Care (SDC) continues to be the dental insurance carrier. Coverage allows for in and out of network providers. To locate a provider or view other value-added benefits from SDC, please visit SDCs Member Support Center.

If you are not making any changes to your dental coverage you will not receive new cards in the mail. If changes in coverage are made during open enrollment, new dental cards will be mailed prior to the beginning of the year to the home address listed in BenefitFocus in a plain white envelope.

Each enrolled member and their dependents may have two regular cleanings and exams in the calendar year. These visits are not subject to the deductible and are covered 100%.

Coverage is dependent on the provider’s network affiliation and the dental service received. Refer to the Dental Plan Benefit Summary for details.

Both dental plans have a $50 per person ($150 per family) deductible. Once an individual meets the deductible, future claims are paid at the set co-insurance levels until the individual maximum plan benefit is reached. If 3 or more family members reach the $150 deductible, claims for all covered persons on the plan will be covered at the set co-insurance levels until each individual’s annual maximum plan benefit is reached. The maximum benefit is $1,000 per covered person on the Core Plan and $1,250 per covered person on the Enhanced Plan.

Accident coverage can help offset expenses incurred if you or a covered family member seek treatment for covered injuries due to an accident.

Critical Illness coverage can help offset expenses incurred if you or a covered family member are diagnosed with a covered illness (for example: heart attack, stroke, cancer, organ failure).

If enrolled in Critical Illness, employees who complete a covered preventive exam receive a $100 Health Screening Benefit by submitting the claim to New York Life. Claim forms can be found on the OHR Voluntary Benefits page.

Xavier provides a Life and Accidental Death and Dismemberment (AD&D) policy equal to the employee’s annual salary up to $150,000 at no cost to the employee. The life insurance will pay the beneficiary a lump sum should the employee pass away. AD&D pays an additional benefit if the employee should pass away or be severely injured as the result of a covered accident.

Voluntary Life provides the opportunity for employees to purchase additional Life and AD&D coverage for themselves, their spouse, and/or dependent children. The employee should assess what their needs may be if the unthinkable happens to determine if purchasing additional Life and AD&D is right for their situation.

An EAP provides voluntary, confidential services and resources at no cost to employees and their household members. Services include:

• Counseling
• Legal Consultation
• Financial Consultation
• ID Recovery
• Daily living and dependent care resources
• Crisis Consultation
• Available 24/7

All employees, not just those enrolled in Xavier’s medical plans, may utilize Anthem’s EAP. Effective January 1, 2024, Benefit eligible employees may utilize TriHealth’s EAP+.

Through the Healthier You at XU program and Xavier Wellbeing, Xavier encourages employees to engage in healthy behavior and proactive health management. Employees who complete the Healthier You at XU program qualify for the medical wellbeing rate for the next calendar year. The medical wellbeing rate is $600 less than the standard rate for the year ($50 per month). Employees who complete a preventative physical with their Primary Care Physician and a biometric screening qualify for the wellbeing rate. For employees enrolling their spouse in medical coverage, the spouse will also need to complete those two requirements for the employee to receive the wellbeing rate. Additional information can be found on the benefits website.