Health Insurance

Medical Mutual

To view your account details & claims go to: www.medmutual.com
Member Services: 1-800-228-6472

See below for a summary of benefit information:

  • Website: www.medmutual.com

    • Network Name (Traditional/PPO plans): SuperMed Plus
    • One Level of Traditional Coverage
      • $250 deductible for individual/$500 deductible for family
      • $1,000 out-of-pocket max for individual/$2,000 max for family
      • No lifetime maximum on benefits
      • No co-pays
      • Once the deductible is satisfied, employee is responsible for 10% of the charges (for in-network providers) up to the maximum level for individual and/or family coverage
      • If an out-of-network provider is used, the deductible increases to $500/person and $1,000/family. The out-of-pocket max increases to $2,000 person/$4,000 family
      • If you use an out-of-network provider, Medical Mutual will send the reimbursement to the employee. Employee is then responsible for forwarding payment to the provider
      • Any amount paid towards the deductible in October, November and/or December in any year is applied to the next calendar year (amount paid towards out-of-pocket max does not carry over)
    • Preventive Care Services covered at 100% (deductible does not apply)
      • Routine physical exams
      • Pap tests
      • Prostrate screening
      • Immunizations (if done at pharmacy, must pay in full up front and file a paper claim)
      • Newborn care
      • Well child Care
      • Routine GYN exam
      • Colon cancer screening
    • LabCorp and Quest are network providers for laboratory services
    • Don’t need to obtain a referral to go to a specialist
    • Separate ID cards will be issued to each employee for Medical/Rx, Dental and Vision. ID Cards are issued in pairs. Additional cards can be requested online or by calling customer support. ID cards will only list the employee
    • Open enrollment for NC State will occur between October and December each year and will be effective January 1. Any changes to coverage (except for qualifying events) can only be made during this time
    • 24/7 NurseLine (1-888-912-0636) is a source for health information and support. Gives you access through one toll-free telephone number to a wide range of health and well-being information such as:
      • Routine illness
      • Minor injuries
      • General health information
      • Help finding a doctor
      • Information on medications
      • Spousal Waiver- working spouse is not eligible for primary coverage with COG if they have coverage through their own employer’s health plan
    • Dependent age limits:
      • Up to age 26, dependents will be eligible to enroll in medical and Rx even if they do not live at home, are not a dependent on the employee’s tax return, are not a student, have coverage available through employment and can be married or unmarried
      • For dental and vision coverage only, dependent children are covered to the end of the month of their 19th birthday or the end of the month of their 26th birthday if the dependent is a full-time student (12 credits for undergrad; 9 credits for grad students)
      • Between age 26 and 28, dependents can be covered at an extra cost to employees.
      • It is the responsibility of the employee to notify Human Resources when a dependent ceases to be eligible. Claims incurred and processed when a dependent is not eligible will totally become the responsibility of the employee
  • Caremark
    www.caremark.com

    Caremark Prescription Benefit Program

    * Generic drugs, where available, will be substituted for brand name drugs. Failure to follow these provisions will result in the employee paying 100% of the drug cost.

    : When to Use Your Benefit
    Retail Pharmacy: For immediate medicine needs or short-term medicines
    Mail Service Pharmacy: For maintenance or long-term medicines
    : Cost to You
    Retail Pharmacy: 20%*
    Mail Service Pharmacy: 20%*
    : Days Supply Limit
    Retail Pharmacy: 34-day supply
    Mail Service Pharmacy: 90-day supply
    : Caremark Customer Care
    Retail Pharmacy: 1-888-202-1654 or www.caremark.com
    Mail Service Pharmacy: 1-888-202-1654 or www.caremark.com

    Visit www.caremark.com to:

    • Order prescription refills
    • Check order status
    • View prescription history
    • Verify drug payment and coverage
    • View a list of Caremark participating pharmacies
    • Access to trusted healthcare web sites and healthcare information
    • Obtain detailed drug information

  • Benefits: Annual Benefit Maximum by Calendar Year per Insured Person
    : $2,500
    Benefits: Annual Maximum Carryover
    : No
    Benefits: Orthodontic Lifetime Benefit Maximum per Insured Person
    : $1,200
    Benefits: Annual Deductible per Insured Person, Family Maximum
    : $25 person, $75 family
    Benefits: Deductible Waived for Diagnostic/Preventive Services
    : Yes
    Dental Services: Diagnostic and Preventive Services, for example:

    • Periodic oral exam
    • Teeth cleaning (prophylaxis)
    • Bitewing X-rays: 1x per 12 months
    • Intraoral X-rays

    : 100% of R&C
    Dental Services: Basic Services
    Fillings, for example:

    • Amalgam (silver-colored)
    • Front composite (tooth-colored)
    • Back composite - alternated to amalgam benefit

    : 80% of R&C
    Dental Services: Major Services

    • Crowns
    • Prosthetics, for example:
      • Dentures
      • Bridges
    • Prosthetic Repairs/Adjustments
    • Endodontics, for example:
      • Root Canal
    • Peridontics, for example:
      • Scaling and Root Planning
    • Oral Surgery

    : 80% of R&C
    Dental Services: Orthodontic Services
    : 60% of R&C
  • Benefit Coverage with a VSP Doctor: WellVision Exam
    Description:

    • Focuses on your eyes and overall wellness
    • Every 12 months

    Benefit: $40 allowance
    Prescription Glasses: Frame
    : One pair in each 24 consecutive month period
    : $30 allowance
    Prescription Glasses: Lenses
    :

    • Single vision, lined bifocal, and lined trifocal lenses
    • Every 12 months

    : $40 per pair
    Prescription Glasses: Lens Options
    :

    • Bifocals
    • Trifocals
    • Lenticular
    • Average 35-40% off other lens options

    :

    • $60 per pair
    • $80 per pair
    • $200 per pair

    Prescription Glasses: Contacts
    :

    • One pair in each 12 consecutive month period
    • If frames are not required, the frame payment may be applied toward the cost of contacts

    : $70 per pair

Health Insurance Premiums - Full-Time Faculty/Staff

Deducted bi-weekly, effective 7/1/14

: Single
Medical/RX: $53.00
Dental: $6.73
Vision: $1.41
: Family
Medical/RX: $128.74
Dental: $16.60
Vision: $3.53