NSU Belongs to the ICUBA Health Insurance Consortium . ICUBA is comprised of 10 colleges and universities and 17 secondary schools . Approximately 10,000 enrolled employees covering 16,000 lives . NSU’s 3,200 enrolled employees represent 34% of ICUBA’s participating employees Products and Services Provided by ICUBA Medical Insurance Prescription Drug Coverage Behavioral Health Coverage Dental Insurance Vision Plan Health/Dependent Care FSA Health Reimbursement Account COBRA/Retiree Health Administration Benefit Enrollment Site Health Care Compliance Administration Rally Wellness Program Employee Assistance Program ICUBA Health Insurance Consortium Members Barry University Beacon College The Bolles School Canterbury School of Fort Myers Central Florida AHEC Corbett Preparatory School of IDS Edward Waters College Everglades AHEC Florida Institute of Technology Good Shepherd Episcopal School Grace Episcopal Day School Jacksonville Country Day School Nova Southeastern University Palm Beach Atlantic University The Poynter Institute Rollins College Saint Edward’s School Saint Leo University St. Mark’s Episcopal Day School Saint Paul’s School Saint Stephen’s Episcopal School San Jose Episcopal Day School Tampa Preparatory School University of Tampa Unity School Warner University Westminster Christian School Visit the Benefits Website https://www.nova.edu/hr/benefits Enroll on The ICUBA Portal http://icubabenefits.org 1) Follow login instructions (see red box) 2) Add dependents (if you have them) 3) Ask Emma (if you need help) 4) Elect benefits (date of hire + 30 days) If you have questions while enrolling for benefits Emma is a decision support tool designed to help you make an informed decision about benefits for you & your family. Emma will guide you through a short series of questions about how you use your benefits and estimates your annual costs using real-life scenarios based on the answers you provide. Dependent Verification Who is an eligible dependent? • Your legally recognized spouse or domestic partner; • Your natural child, stepchild, legally adopted child, your legal ward, foster child or a child covered by a Qualified Medical Child Support Order (QMCSO); • Your child is considered an eligible dependent until the end of the calendar year in which they turn 26; • Your adult child who is disabled and incapable of self- support may be considered an eligible dependent if documented by SSI or SSA. Medical Highlights Premier PPO Plan Preferred PPO Plan $4K/$8K PPO Plan $2,500 Individual Deductible $2,500 Individual Deductible $4,000 Individual Deductible $5,000 Family Deductible $5,000 Family Deductible $8,000 Family Deductible $4,000 Individual OOP Max $4,000 Individual OOP Max $5,350 Individual OOP Max $8,000 Family OOP Max $8,000 Family OOP Max $10,700 Family OOP Max Hospital Inpatient: Hospital Inpatient: Hospital Inpatient: 20% Coinsurance After Deductible 20% Coinsurance After Deductible 30% Coinsurance After Deductible Physician’s Office Visit Physician’s Office Visit Physician’s Office Visit $25 Copay 20% Coinsurance $35 Copay Specialist’s Office Visit Specialist’s Office Visit Specialist’s Office Visit $50 Copay 20% Coinsurance $70 Copay $50 Urgent Care Copay $30 Urgent Care Copay $70 Urgent Care Copay $300 Emergency Room Copay $300 Emergency Room Copay $500 Emergency Room Copay Mental & Behavioral Health Mental & Behavioral Health Mental & Behavioral Health Outpatient: $25 Copay Outpatient: 20% Outpatient: $35 Copay Medical Premium Premier PPO Monthly Premium Preferred PPO Monthly Premium $4K/$8K PPO Monthly Premium Coverage Monthly HRA Coverage Monthly HRA Coverage Monthly HRA Election Tier Premium from NSU Election Tier Premium from NSU Election Tier Premium from NSU Employee Only $243 $50 Employee Only $99 $50 Employee Only $94 $50 + Spouse $944 $100 + Spouse $681 $100 + Spouse $674 $100 + Child(ren) $696 $100 + Child(ren) $437 $100 + Child(ren) $241 $100 + Family $1,206 $100 + Family $863 $100 + Family $644 $100 + Dual Enrolled $940 $150 + Dual Enrolled $538 $150 + Dual Enrolled $351 $150 The Dual Enrolled tier is for married employees who cover themselves & eligible dependent children. This tier combines the premium for Employee Only and Employee plus Child(ren). This way Dual Enrolled NSU families aggregate the deductible and out-of-pocket expenses which eliminates the need to meet an extra deductible. Medical Premium IMPORTANT POINTS TO KEEP IN MIND ABOUT COLLECTION OF PREMIUMS: • Coverage and premium collection begin on the hire date • The new hire enrollment period starts on the hire date and ends 30 days later • A premium payment may be missed when enrollment occurs later in the enrollment period • Should this happen, the missed premium will be collected retroactively Eliminating Barriers to Care • ICUBA collects premium to pay claims for medical, pharmacy and behavioral health and plan administrative services – premium collected is used for the exclusive benefit of members • ICUBA and its members designed a value-based plan that provides free and low-cost wellness benefits • These value-based benefits eliminate barriers to care, provide members access to wellness benefits that identify emergent health issues early • Investment in a long-term culture of wellness enables members to maintain optimal health Eliminating Barriers to Care NO-COST BENEFITS • In-network Annual Wellness Exams • Blue Distinction Primary Care Physician Visits • Routine Medically Necessary Labs performed at Quest Diagnostics • Prescribed Diabetic Supplies, Meters, Lancets, Test Strips, Needles And Syringes • ICUBAcares Pharmacist Advocate • Surgery Plus + Surgical Services • EAP SERVICES FREE FOR ALL NSU EMPLOYEES Eliminating Barriers to Care NO-COST BENEFITS SurgeryPlus+ • Specialized PPO network for non-emergent surgical procedures • Deductibles and out-of-pocket expenses are waived for consultations, surgical procedure, and follow up care for up to 90 days following the surgery • Care Advocates provide full concierge service will collect medical records, arrange the initial consultation, schedule the procedure, and coordinate post-operative care • Hundreds of surgeries available including, but not limited to: Knee Disk Repair/Replace Spine Hip Rotator Cuff GI Shoulder Tendon Repair Cardiac Ankle Carpal Tunnel Eliminating Barriers to Care NO-COST BENEFITS • Lab Tests • Electrocardiograms • Our Employee • Prescribed diabetic • Pap Tests • Echocardiograms Assistance Program supplies including • Urinalysis • Mammograms is available to all meters, lancing • Colorectal • Colonoscopies and members of your devices, lancets, Screenings Sigmoidoscopies household test strips, control • Prostate Cancer • Immunizations • Receive up to 6 solution, needles, Screenings • Allergy Injections FREE face-to-face and syringes • Bone Mineral counseling sessions • Prescribed Aspirin Please note: Lab tests Density Tests per plan year for adults performed at an in- • Ultrasounds of the • Prescribed generic network physicians Breast Call the Resources folic acid and office and not sent to • Primary Care BDTC for Living EAP generic prenatal Quest Diagnostics may Visits 24-hours a day at vitamins for be subject to 1-877-398-5816 pregnancy coinsurance • Prescribed generic (deductible does not statins (if eligible) apply beginning 04/01/1). Eliminating Barriers to Care BE AN EDUCATED HEALTHCARE CONSUMER UNDERSTAND HOW YOUR PLAN PAYS FOR SERVICES BEFORE YOU SEE A PROVIDER NO-DEDUCTIBLE IN-NETWORK BENEFITS Advanced Imaging Immunizations Primary Care Visits Chiropractic Care Maternity Visits Specialist Office Visits Emergency Room Occupational Therapy Speech Therapy Emergency Transportation Outpatient Mental Health Urgent Care Hospice Care Prescription Copays TELADOC - $5 COPAY Single Sign-On through the ICUBA Portal & BCBS Set up account at www.Teladoc.com use Company Code: ICUBA Eliminating Barriers to Care Teladoc gives you access 24/7 to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits. Set up your account today so when you need care now, a Teladoc doctor is just a call or click away. Pharmacy Benefits Coverage is attached to medical insurance & administered by OptumRx PRESCRIPTION DRUG COPAYS ARE THE SAME FOR ALL ICUBA MEDICAL PLANS 30‐day 90‐day Retail 90‐day Mail PREFERRED GENERICS AT NSU PHARMACY $0 $0 N/A PREFERRED GENERICS AT RETAIL PHARMACY $5 $10 $10 NON‐PREFERRED GENERICS $10 $20 $20 PREFERRED BRAND $40 $80 $80 NON‐PREFERRED BRAND $75 $150 $150 *SPECIALTY MEDICATION IS FULFILLED THROUGH $75 N/A N/A BRIOVA ICUBAcares PHARMACIST ADVOCATE NAVIGATE COPAY TIERS, OBTAIN PRIOR AUTHORIZATIONS, IDENTIFY LOWER COST DRUGS CALL 877-286-3967 Behavioral Health & EAP Benefits Coverage is attached to medical insurance & administered by Aetna. Aetna also provides EAP services to all NSU employees regardless of participation in a medical plan. You can access both services by calling one number! Call 877-398-5816 and press 1 after the prompt for EAP, or press 2 after the prompt for Behavioral Health. Talkspace is an online therapy platform that makes mental healthcare more convenient and accessible by connecting users with licensed therapists 1. Call Resources for Living for authorization 2. Register at talkspace.com/rfl 3. Organization Name is your Employer/School Send unlimited multimedia messages HRA & Optional FLEX SPENDING HRA (FROM NSU) HCFSA DCFSA Health Reimbursement Accounts Health Care Flexible Spending Account Dependent Care Flexible Spending Account Funded by NSU and provided when you All employees