Health Insurance

Health Care Plan Major Features

Luther College is “self-funded” (self-insured) for employee medical and hospital care. Our Third Party Administrator (TPA) processes all medical and hospital claims. Luther College pays the actual incurred claim costs and administration fees. Benefits are designed with annual deductibles, co-insurance, and out-of-pocket maximums.

  • Plan 1 – Traditional PPO Plan
    • Preventive care covered at 100%
    • Co-pays for office visits and prescriptions
    • Deductible is $1,000 single/$2,000 E+1 or family
    • After deductible is met, 80/20 coinsurance
    • Out-of-pocket maximum is $4,500 single/$9,000 E+1 or family (includes deductibles and co-pays)
    • Vision benefit
  • Plan 2 – High-Deductible Health Plan with Health Savings Account
    • Preventive care covered at 100%
    • Deductible is $3,000 single / $6,000 family
    • After deductible is met, 90/10 coinsurance
    • Out-of-pocket maximum is $4,500 single/$9,000 E+1 or family (includes deductibles)
    • Vision benefit

Pre-certification is required prior to all elective overnight hospital admissions and all admissions to skilled nursing facilities; mental health institutions, hospice, and home health care. Pre-certification is required within 24 hours of all emergency and obstetrical admissions.

Notice: The UMR/UHC 2022 health care summary plan description is on the website.

Employees should log in to UMR.com to view their insurance and claims information.

Prescription and Pharmacy Benefits

RxBenefits Manages Prescriptions for the Health Plan as of Jan. 1, 2020.

  • RxBenefits manages prescriptions for employees on Luther’s UMR health care plan.
  • The “member ID” is your member ID on your UMR health card.
  • The other pieces of required information are also on the UMR health card.

Teladoc

Teladoc connects you and your dependents 24/7/365 to a national network of U.S. board-certified doctors. When you request a doctor visit either by phone, web or mobile app, you’ll be connected within minutes to an experienced physician who can diagnose and treat the non-emergency health issue.

If medically necessary, a prescription can also be sent to your pharmacy of choice.

  • 24/7/365 access – U.S. board-certified doctors with an average of 20 years’ experience.
  • Connect in minutes – Connect with a doctor by phone or video in minutes.
  • Get a diagnosis – Diagnose, treat and prescribe medications (if necessary) for common health issues such as cold and flu, allergies, ear infections, rash and much more!
  • Proven ROI – transition unnecessary ER and urgent care visits to a more cost-effective mode of care.

Three ways to complete your medical history

  • Online – the fastest and easiest option. Log into Teladoc.com and complete the “Medical Info” section.
  • Mobile app – Log into your account on your mobile device and complete the “medical history” section. Visit Teladoc.com/mobile to download the app.
  • Call Teladoc – Call Teladoc if you would like a customer service rep to help you complete your medical history over the phone. 1-800-Teladoc

Talk to a doctor anytime for $49 or less!

  • Teladoc.com
  • Facebook.com/Teladoc
  • 1-800-Teladoc
  • Teladoc.com/mobile

Health Savings Account (HSA)

If you enroll in the High Deductible Health Plan (HDHP) option, you may be eligible for a college-sponsored Health Savings Account (HSA), administered by Optum Bank

HSAs offer you the following advantages:

  • Tax Savings. You contribute pre-tax dollars to the HSA. Interest accumulates tax-free and funds are tax-free to withdraw for qualified medical expenses
  • Reduce your out-of-pocket costs. You can use the money in your HSA to pay for eligible medical expenses and prescriptions
  • Invest the funds and take them with you. Unused account dollars are yours to keep even if you retire or leave the college. You can also invest your HSA funds so that your available health care dollars can grow over time
  • The opportunity for long-term savings. Unlike Flexible Spending Accounts (FSA), HSAs do not have a “use it or lose it” rule. Unused HSA funds roll over from year to year–money you can use to reduce future out-of-pocket health expenses. You can even save HSA dollars to use after you retire

Healthcare Flexible Spending Account (FSA)

If you enroll in the traditional health plan (PPO) option, you may be eligible for a healthcare Flexible Spending Account (FSA), administered by UMR.

FSAs offer you the following advantages:

  • Tax Savings. You contribute pre-tax dollars to the FSA. Funds are tax-free to withdraw for qualified medical expenses
  • Reduce your out-of-pocket costs. You can use the money in your FSA to pay for eligible medical expenses and prescriptions

EyeMed and Amplifon

All Luther college employees, whether or not they enroll in health insurance, have access to:

  • EyeMed Vision Discount Program
  • Amplifon Hearing Discount Program

Self-Audit Billing Credit

The Plan offers an incentive credit to all employees to encourage examinations and self-auditing of eligible medical bills to ensure the amount billed by any provider of service accurately reflects the services and supplies received by the employee or a covered dependent. The employee is voluntarily asked to review all hospital and doctor bills and verify that he/she has received each itemized service and the bill does not misrepresent either (regardless of the reason).

In the event an employees self-audit results in elimination or reduction of charges, 25 percent of the amount so eliminated or reduced will be paid directly to the employee (subject to a $10.00 minimum savings), provided the savings are accurately documented, satisfactory evidence (a copy of the incorrect bill and a copy of the corrected billing) of a reduction in charges is submitted to the Claims Supervisor. Credit payment is limited to $500 per calendar year.

This self-audit is in addition to the payment of all other applicable plan benefits for legitimate medical expenses. Participation in the self-auditing procedure is strictly voluntary; however, it is to the advantage of the plan as well as the employee, to avoid unnecessary payment of health care dollars and any subsequent remaining balance (the employees liability) on an incorrect billing.

This credit will not be payable for charges in excess of the reasonable and customary fee, regardless of whether the charge is or is not reduced.

Questions?

For additional information, please contact Human Resources at hr@luther.edu or x1134.