New hires and employees newly eligible for benefits can elect healthcare coverage within their first 30 days of employment. An eligible employee means an employee of UChicago Argonne, LLC who is scheduled to work a minimum of 20 hours per week and who is: a regular employee; a temporary employee with a term appointment of six months or more; a temporary employee with a term of appointment of less than six months who pays the full cost of coverage.
Employees can cover legal dependents under the healthcare plans: spouse (regardless of sexual orientation), civil union partner, child(ren) under the age of 26 or under the age of 30 (military dependents), stepchild(ren), adopted child(ren), child(ren) for whom legal guardianship was obtained, disabled child(ren) over the age of 26. Employee premium contributions are required and the contributions are made on a pretax basis via automatic payroll deduction.
Medical Insurance Plans
Chicago area employees have the choice of two medical plans: Blue Cross and Blue Shield of Illinois (BCBSIL) PPO or Blue Advantage HMO. All other employees can be covered under the BCBSIL PPO. All medical plans are effective the first day of hire if a medical plan is elected by the employee within 30 days of employment. There are no pre-existing condition clauses under Argonne’s medical plans.
- This plan has a deductible of $400/single or $800/family. If the provider is in-network, after the deductible has been met, the plan will pay 85% of the eligible charge with a co-pay of 15%. If the provider is out-of-network, after the deductible, the plan will pay 70% of the eligible charge with a co-pay of 30%. Preventive services using an in-network provider are covered at 100% of the eligible charge. Specific specialty care received in a Blue Distinction Center is paid at 90% and in a Blue Distinction Center Plus (+) at 95%.
- There is an out-of-pocket limit each calendar year for in-network expenses of $2,800/single, $5,600/single+1, and $8,100/ family. Once the limit is reached, in-network expenses are then paid at 100% of the contracted rate for the remainder of the calendar year. The out-of-pocket limit for out-of-network expenses is $3,100/single, $6,200/single+1, and $9,000/family. The deductible is included in the out-of-pocket limit.
- The BCBSIL PPO plan covers physician visits, diagnostic tests, hospital charges, hospice care, surgery, home healthcare, and skilled nursing facility care. Chiropractic care is limited to 40 visits, home healthcare is limited to 40 days in a calendar year, and skilled nursing facility care is limited to 60 days in a calendar year.
- BCBSIL PPO Prescription Drug Plan: The BCBSIL PPO has a carve-out prescription drug plan through Optum Rx. There is no deductible for prescription drugs, but co-insurance applies. Annual out-of-pocket maximum for all prescription drugs, including retail, mail order, and specialty, is $2,300/single and $4,600/family. When a generic drug is available, participants must use generic or pay the cost difference along with brand co-pay for both retail and mail order.
Blue Advantage HMO
- HMOs are best known for their preventive care benefits. These plans will cover most healthcare services such as physician visits, surgical costs, x-rays, hospital charges, diagnostic tests, and well care exams. A primary care physician (PCP) must be chosen and the PCP will coordinate all care. If the PCP provides a referral to a specialist or for diagnostic tests and hospital charges, these services are covered. If a member receives services not authorized by the PCP, those services are not covered.
- HMO plan services are based on a co-pay schedule. Most services are paid in full after making a co-payment at the time of service. Co-pays will vary depending on the type of service rendered.
- Blue Advantage HMO Prescription Drug Plan: Blue Advantage HMO has a prescription drug plan. This plan is a co-pay plan. Depending on the type of prescription (generic, formulary brand, non-formulary brand, specialty drug), members will be charged a co-payment at the time of purchase. When a generic drug is available, participants must use generic or pay the cost difference along with brand co-pay whether using retail or mail order.
- The Delta Dental PPO program allows you to go to any in- or out-of-network general or specialty dentist at the time of treatment. Argonne National Laboratory dental enrollees have access to two networks, Delta Dental PPO and Delta Dental Premier managed fee-for-service. Your out-of-pocket costs will vary depending on whether your dentist participates in Delta Dental PPO, Premier, or neither (i.e., “out-of-network”). You will maximize your benefits by receiving care from a Delta Dental PPO network dentist.
- This plan has an annual deductible of $100 per covered individual or a $300 maximum deductible per family. Preventive and diagnostic services are covered at 100% of the reduced fee or maximum plan allowance, and basic and major services are covered at 75% of the reduced fee or maximum plan allowance.
- There is a maximum benefit limit of $3,000 per calendar year and a separate $3,000 lifetime orthodontia benefit (no age limit).
EyeMed Vision Plan
- The voluntary vision plan is administered by EyeMed. Regular and long-term employees working more than 20 hours per week are eligible to enroll. The plan is voluntary and employees pay the entire premium. The premium is a pre-tax payroll deduction.
- The plan covers services from both in-network and out-of-network providers and includes, but is not limited to, discounts and allowances on exams, frames, standard lenses, contact lenses and laser vision correction. Additional discounts of up to 40% apply for services rendered by an in-network provider.
Flexible Spending Accounts (FSA)
Argonne offers two FSA programs, one for the payment of healthcare expenses and the other for dependent day care expense. Each calendar year, you decide whether you want to participate in one or both of the accounts. Once you have made that decision, you then estimate the amount of eligible expenses you are likely to have during the year and decide how much of your earnings you want to set aside to help pay for them. Because FSA contributions are untaxed at deposit and untaxed at withdrawal, you decrease your taxable income while increasing your spendable cash.
- The Healthcare FSA allows you to contribute up to an annual maximum of $2,650 to be used for eligible healthcare expenses not paid for by insurance that will incur in 2019. Re-enrollment in an FSA is required from year to year. Only $500 of an unused balance in a healthcare FSA can be carried over to the next plan year. Additional information regarding eligible expenses can be found on the WageWorks website at www.wageworks.com.
Minimum and Maximum Carryover Amounts: The minimum amount that will carry over to the next year is $10. The maximum carryover amount is $500.
Number of Times Allowed for Carryover: Employees can re-enroll in FSA every year. If no new account is established in the next year, any remaining balance between $10 and $500 will carry over for a maximum of two years.
Dependent Care FSA
- Please see Work-Life for details.