Williams College Group Insurance Plan

Group Insurance Plan . | . Human Resources

Health Insurance Benefit

Options Available

Eligible faculty and staff may enroll in one of two health insurance options - one health maintenance organization (HMO) and one point of service (POS) plan. A third option, the preferred provider organization (PPO) option, is reserved for eligible faculty or staff residing outside of New England for three months or more. Each health plan option is fully insured by the carrier. Employees may elect either individual or family coverage. Appendix 1 is a comparison of health and dental costs for 2010. Plan summaries are available on request from the Benefits Office. Provider directories are available online at the Blue Cross Blue Shield of Massachusetts website or can be obtained from the Benefits Office.

This document does not provide a detailed description of the benefits offered under each health insurance option. The policies, certificates, and other material from the insurer that are separately provided to employees describe those benefits and include details on each option. Along with such material, provider lists or directories are supplied to employees at no charge. These materials are all available in the Benefits Office at no charge.

HMO Option

The HMO option is HMO Blue Value Plus New England. The plan typically pays only for care provided by or authorized by a primary care physician. These features generally result in lower premiums and lower participant out-of-pocket expenses than other types of health plans. Employees must select a primary care physician from among those affiliated with the HMO. HMO Blue Value Plus has their own list of affiliated providers and each may service slightly different geographic areas. The location of the employee's primary residence and his/her choice of primary care physician may determine the HMO choice. Once a Primary Care Physician has been obtained all care must generally take place in the state where the Primary Care Physician is located.

POS Options

The POS options is: Blue Choice Value Plus New England. A POS plan provides access to a network of providers (referred to as in-network or HMO care) plus self-referred services. In-network you receive a higher level of benefits. Self-referred services are subject to an annual deductible and coinsurance. When members self-refer under the Blue Choice Point of Service plan, there are calendar year deductibles of $250 for an individual and $500 for a family, then 20% co-insurance. The Out-of-Pocket maximum is $5,000 per year for an individual and $10,000 a year for a family. The Out-of-Pocket maximum includes the deductible, the co-insurance and certain copays. Be sure to see the plan summary for details. Members are strongly encouraged to seek referrals and use network providers.

The following table compares the deductible and coinsurance costs for the plan. 

Self-Referral Features of the POS Options

The freedom of choice offered by a POS plan generally results in higher premiums and higher out-of-pocket costs than the HMO options. A POS plan is recommended, and sometimes required, for an employee who resides outside the local area on a permanent or temporary basis.

PPO Option

The PPO option is Blue Care Elect Preferred. In-network you receive a higher level of benefits. Preferred providers are available in Massachusetts and outside of Massachusetts. You can also choose non-preferred (out-of-network) providers, but out-of pocket expenses are higher. When you choose a non-preferred provider, you must pay a calendar-year deductible for most out-of-network services. The following table illustrates the deductible and coinsurance cost for the PPO plan.

Out of Network Costs for PPO

The benefits offered by a PPO plan generally result in higher premiums and higher out-of-pocket costs than the HMO options. A PPO plan is recommended, and sometimes required, for an employee who resides outside of New England for three months or more.

Dependent and Student Benefits for HMO Blue, Blue Choice Value Plus New England, and Blue Care Elect Plans

The medical plans cover dependents to age 26, or for two calendar years after the dependent is no longer claimed on the subscriber's or spouse's federal tax return, whichever comes first. During the two calendar year after the dependent is no longer claimed on the federal tax return, he or she would be a "non-qualifying individual" as defined by the IRS. The federal tax code requires that the fair market value of health benefits provided under an employer-sponsored plan to "non-qualifying individuals" be included as gross income to those employees electing coverage for "non-qualifying individuals". This requirement is known as imputed income. Additionally, this plan may cover unmarried full-time students or other unmarried dependents who do not otherwise qualify as eligible dependents. Please see the IRS 1040 Booklet for definitions of "qualifying" and "non-qualifying individuals", the subscriber certificate (and riders, if any) and the plan summary sheets for additional information and coverage limitations. Copies are available in the Benefits Office and online at http://www.williams.edu/admin/hr/benefits/.

Health Insurance Costs

Faculty, Administrative and Support Staff can conveniently pay for their share of the health insurance benefit on a pre-tax basis by payroll deduction. (see Pre-tax Premium Payment Plan).

The College continues to contribute approximately 75% of the average of the individual or family premiums weighted by participation, which results in the same College contribution for all employees choosing individual coverage and the same College contribution for all employees choosing family coverage. The College reserves the right to change, at any time, the percentage of its premium contribution.

Additional Health Insurance Information

Booklets containing more detail about each health plan's benefits and premium information are available without cost in the Benefits Office or online at http://www.williams.edu/admin/hr/benefits/.

Below is the address of each health plan insurer:

Blue Cross Blue Shield of Massachusetts
Landmark Center
401 Park Drive
Boston, MA 02215-3326

Group Insurance Plan . | . Human Resources