Benefited Faculty and Staff

Employees may enroll in or modify health insurance coverage:

• Within 21 calendar days of hire into a benefited position
  Enrollment information is provided at orientation.
• During annual open enrollment (this occurs each April) with plan changes effective the following July 1. During open enrollment members may change health insurance plan and add/remove qualified dependents.
• Within 60 calendar days of, and with documentation of, a qualifying event. Please reference the GIC qualifying event chart for a list of changes that may be made and required supporting documentation. The GIC determines effective date of changes.

The Massachusetts Group Insurance Commission (GIC) Benefits Guide provides an overview of the health insurance options available to benefited UMass employees (and corresponding premiums). Page 4 outlines which plans are available based on where we live; page 5 provides the premiums & pages 6-7 provides a high level plan comparison.

Prescription coverage across all GIC plans is identical (administrated by Express Scripts).

Most individuals and families want to keep the physicians they are currently using & also have a preference of what hospitals they can access, looking to balance a) access to our preferred providers, b) cost of the plans and c) how flexible the plans are.

In reviewing your options:

1. Which plans are available where you live?
   Start by reviewing the Guide:  find the county in which you live & identify which plans are available to you based on where you live.
2. Which hospitals and doctors are in network and at what tier?
   This key step is where you may want to:
   1. Contact your doctors’ offices to inquire which plans they accept (when inquiring please use the full plan name. For instance the GIC offers many Wellpoint plans, some doctors accept some, but not all of, the plans) & what their co-pay tier is, and/or
   2. Visit the plan websites (provided in the Guide) to find if your doctor is in a plan’s network and at what co-pay tier.
   3. Review the hospital listing on the GIC's website.
3. How flexible is each plan?
   On pages 6&7 of the Guide you’ll notice that many copays are the same across plans – key differences between the plans include:
   1. If the plan requires you to have a Primary Care Physician (PCP)
   2. If the plan requires you to obtain a referral to see a specialist
   3. If you have coverage seeing an out-of-network provider (all plans provide coverage in the case of emergency regardless of if the provider is in-network):
      1. Indemnity plans do not rely on a network of providers, but focuses on paying a set fee depending on the procedure, provider, or service rendered
      2. HMO (health maintenance organization) plans do not offer out-of-network benefits with the exception of emergency care. Selection of a Primary Care Provider (PCP) is required.
      3. POS (point of service) plans require selection of a Primary Care Provider (PCP). To get the lowest out-of-pocket cost a member must get a referral for care by a specialist.
      4. PPO (preferred provider organization) plans allow treatment by out-of-network providers at a lower level of coverage. Selection of a Primary Care Provider (PCP) is encouraged
      5. PPO-type plans in-network providers and hospitals for the lowest out-of-pocket cost. Selection of a Primary Care Provider (PCP) is encouraged but not required.

4. Weigh these answers against the premiums on page 5.

    

How do I modify coverage due to: 

• Enroll for coverage based on involuntary loss of coverage under another plan
• Cancel coverage based on gain of other coverage under another plan
• Add a dependent to your GIC health insurance plan
• Divorce