Frequently Asked Questions s13

FREQUENTLY ASKED QUESTIONS

Q. When do I need to enroll in a medical plan?

A. You need to choose a medical plan by June 2, 2007. Open enrollment begins on May 7, 2007. Instructions on how to enroll in the medical plan are available at our website at www.pace.edu/hr and follow link to HR News/Medical Plan Open Enrollment.

Q: What if I do not choose a plan by June 2, 2007? Will I have a medical plan effective July 1, 2007?

A: If you do not choose a plan by June 2, 2007 and you were enrolled in a medical plan offered at Pace University as of June 2, 2007 we will default your enrollment into the Oxford EPO, Option #1, individual coverage.

You will not be able to change your medical plan until the next open enrollment period.

Q.: I am currently enrolled in the Oxford Liberty plan that Pace offers. Do I need to re- enroll?

A: Yes, you will need to choose a new plan from among the three plans that are being offered effective July 1, 2007. The Oxford Liberty Plan will no longer be offered after June 30, 2007. If you do not choose a plan, you will default to the Oxford EPO, Option #1.

Q: How do I waive my medical coverage at Pace University? Will I receive cash in lieu of a medical plan enrollment?

A: If you have medical coverage through another insurance carrier not offered at Pace University, you are eligible to receive an annual cash option of $750. , In order to receive this cash option, you must complete a Pace University Medical Plan Waiver form which can be found at our website at www.pace.edu/hr and follow link to HR News/Medical Plan Open Enrollment. Please complete it and forward it to the University Benefits Office in Pleasantville by June 2, 2007. The completion of this form will make you eligible to receive $750 cash annually which will be paid throughout the year at $31.25 per paycheck.

Q: If I waive medical coverage, can I re-enroll in Pace University’s medical plan in the future?

A: You can re-enroll in Pace University’s medical plan during any open enrollment period. You can also enroll within 31 days from termination of your current medical coverage. This is a change in family status that will require documentation.

Q. Do I need a referral to see a specialist?

A. No, the three plans that are being offered to you do not require a referral from your primary care physician to see a specialist. This is an enhancement to the current HMOs that had been offered at Pace University.

Q. How can I find which doctors participate in the Freedom network (locally) or United HealthCare Choice Plus networks (nationally)? A. Go to the Oxford website at www.oxfordhealth.com and click onto “Search for an Oxford Doctor,” which is located at the bottom of the web page. Select the Oxford Freedom network to search for doctors or facilities. If you live outside the tri-state area, visit the United Healthcare website, at www.unitedhealthcare.com and click onto “Find a Physician,” which is located at the top of the web page. Select the United Health Care Choice Plus network for your search. You can also contact Oxford at the special number that has been set up for our Pace employees. Pace employees can call 800-760-4566. The number will be in effect through June 30. 2007.

Q. How does the 90/70 plan work?

A. The 90/70 plan provides participants with in network and out of network coverage. Participants will pay a $20 co-payment for office visits to a primary care or specialists that participate in-network visit. A deductible and 10% co-insurance based upon Oxford contracted rates will apply for hospitalization, diagnostic procedures and facilities. Once a participant has paid $750 in out of pocket expenses for the plan year for individual coverage, or $1,500 for family, the plan will then pay 100%.

A participant also has access to physicians and hospitals that do not participate in the network. A deductible needs to be met before the plan pays 70% of usual, customary and reasonable charges. Once a participant has paid the annual out pocket maximum of $2,000 for individual and $4,000 for family, the plan will pay 100% of usual, customary and reasonable charges.

The employee and a retiree contribution will be less for this option than for the 100/70 plan or Option 3.

Q. Does Pace’s gym at the Goldstein Fitness Center qualify for the gym reimbursement offered through the Oxford plans? How do I get reimbursed?

A. Yes. Employees who pay a $260 annual fee will be able to receive up to $260 annual reimbursement. A gym reimbursement form has been included in your enrollment package with information on what qualifies as a gym and instructions on how to get reimbursed.

Q. What are tier designations and how do they affect what I actually pay at the pharmacy? Prescription medications are categorized within three tiers. Each tier is assigned a co-payment, this is an amount you pay when you fill a prescription at a participating retail pharmacy or refill your ongoing prescription through the network mail-order pharmacy service.

 Your Lowest-Cost Option- tier 1 is your lowest co-payment option. For the lowest out-of- pocket expense, you should always consider Tier 1 medications if you and your doctor decide they are appropriate for your treatment. Co-payment in this tier is $15 for a 30 day supply;  Midrange-Cost Option-tier 2 is your middle co-payment option. Consider Tier 2 medications if you and your doctor decide that a Tier 2 medication is the most appropriate to treat your condition. Co-payment in this tier is $25 for a 30 day supply;  Your Highest-Cost Option - tier 3 is your highest co-payment option. Sometimes there are alternatives available in Tier 1 or Tier 2. If you are currently taking a medication in Tier 3, ask your doctor whether there are Tier 1 or Tier 2 alternatives that may be appropriate for your treatment. Co-payment in this tier is $50 for a 30 day supply;

You can view the listing of prescriptions that are in each tier at the oxford website, www.oxfordhealth.com. Click onto “Oxford Member,” which is located at the bottom of the web page. Click onto the “Prescription Drug Information” to view the prescriptions within each tier. You can also call 800-760-4566 to receive this information.

Q. What does 2X mean in the mail order pharmacy program?

A: 2X means that you will pay 2 co-payments for a 90 day supply of a prescription. For example, Lipitor is currently listed in Tier 2. This means that if Lipitor is purchased through the mail order program, then you would pay $50 (2 X $25 co-pay) for 90 day supply. You would be a saving 1 co-payment for this prescription, if you had purchased it each month at a retail pharmacy.

Q. Are we required to use the mail order program to purchase maintenance medication as was currently required through the HealthNet POS program as of January 1, 2007?

A. No. You are not required to use the mail order program through Oxford. You can purchase your maintenance prescriptions through a retail pharmacy.

Q. Is Express Scripts the mail order pharmacy benefit manager?

A. No. Medco is now responsible for the mail order pharmacy for Oxford Health Plans effective July 1, 2007.

Q. Do I need to get new prescriptions from my physician?

A. If you were using Express Scripts for HealthNet POS or HealthNet HMO or any mail order program for Aetna, Blue Cross, or HIP, you will need to get new prescriptions from your physician. In order to be in compliance with privacy regulations governed by HIPAA, information from these mail order pharmacies cannot be transferred to Medco. If you are currently participating in the current Oxford Liberty HMO, new prescriptions from your physician are not required since they are currently on file with Medco.

Q. Is the dental plan that is offered at Pace University also being changed effective July 1, 2007?

A. No. Pace University still offers two dental plans through Delta Dental. These programs are not changing on July 1, 2007. Open enrollment is not being extended to the dental plan at this time.

Q. As a retiree or long-term disabled faculty and staff, do all of the plans coordinate with Medicare?

A. All of the plans that are being offered coordinate with Medicare. For retirees and long-term disabled faculty and staff, Medicare is primary and Oxford Health Plans is secondary.

Q. I was unable to attend the presentations that Pace offered. Can I obtain the presentations or handouts?

A. The Powerpoint presentations that were conducted by the University Benefits Office and Oxford Health Plans are available at our website at www.pace.edu/hr and follow link to HR News/Medical Plan Open Enrollment. Q. What will I pay for the medical plan that I select?

A. Contribution Comparison per Paycheck: January 1, 2007 Employee Contribution and New Employee Contributions effective July 1, 2007

Coverage 2007 Option 1- Option 2- Option 3 – POS Contribution EPO POS 90/70 100/70 - POS *

Ind-Pre 2004 $49.67 $31.62 $44.14 $66.76

Individual- $52.50 $31.62 $44.14 $66.76 Post 2004 Employee + 1 $232.73 $143.66 $171.88 $233.97

Family $312.30 $214.71 $256.89 $349.70

* Currently Pace is paying the difference for employee between the 1/1/07 employee contribution and the 1/1/06 employee contribution.

Retired and Long-Term Disabled Faculty and Staff:

Current Retired and Long-term Disabled Faculty and Staff would be provided the opportunity to elect individual coverage for Choice 1 - EPO or Choice 2 - 90/70 POS plan(s), under their current cost share arrangement – no cost or minimal cost for individual coverage. If current retired or long-term disabled faculty and staff wish to elect Choice 3 -the 100/70 POS plan, they would pay the difference (i.e., buy up) between the newly quoted active employee contribution for Choice 2 – 90/70 POS and the newly quoted active employee contribution for Choice 3 – 100/70 POS (i.e. the difference between $88.28 and $133.52 or $45.24 per month). This rate, in addition to their current contribution, would then be frozen for the balance of their lifetime.

Future Retiree and Long-term Disabled Faculty and Staff would be provided with access to individual coverage for all of the medical plan options including the 100/70 plan. They will contribute at the same premium cost share level throughout retirement as immediately prior to retirement.

Retired and Long-term Disabled Faculty and Staff should contact the Pace University Benefits Office for newly quoted rates for Plus One and Family Coverage.