OFFICE OF HUMAN RESOURCES Cortez 129 * 80 Fort Brown * Brownsville, TX 78520 * Phone: (956) 882-8205 * Fax: (956) 882-7476

The University of Texas at Brownsville

Overview of Changes Employee Group Insurance Plan Year 2012-13

(Effective September 1, 2012)

Annual Enrollment Period: July 15 – 31 • During this two week period of time, you can make changes to your benefits, add or remove dependents or

enroll in UT Flex on the My UT Benefits Website: www.utsystem.edu/myutbenefits.

• You may use your campus username and password to log in to the My UT Benefits Website.

• Your coverage except for UT Flex will automatically continue into the new plan year if you take no action. UT Select Medical and Prescription Drug Plan (Blue Cross Blue Shield-TX/Medco Health)

• No changes to copayments, deductibles or out of pocket maximums.

• Minimal premium rate increase. See rate chart below.

ENROLLMENT TIER CURRENT PREMIUM NEW PREMIUM Employee Only $0.00 $0.00 no change Employee & Spouse $199.02 $207.98 increase of $8.96 Employee & Child(ren) $208.15 $217.52 increase of $9.37 Employee & Family $391.93 $409.57 increase of $17.64

New! Tobacco Premium Program New tobacco premium program surcharge ($30 per tobacco user, $90 maximum per family) will apply to tobacco user(s) enrolled in UT Select Medical Plan.

UT Flex Plan (PayFlex Services USA) Maximum annual election for UT Flex Health Care Reimbursement Account will remain at $5,000.

UT Select Dental Basic Plan (Delta Dental) Occlusal (night) guard will be covered at 50%.

New! UT Select Dental Plus Plan (Delta Dental) Plus plan coordinates with basic dental plan. See plan summary and rates for basic and plus plan below.

SUMMARY OF BENEFITS BASIC PLAN PLUS PLAN TOTAL Deductible $25 $0 $0 Annual Maximum $1250 $1750 $3000 Orthodontic Maximum (Lifetime) $1250 $1750 $3000 Diagnostic & Preventive Services 100% 0% 100% Basic Services 80% 20% 100% Major Services 50% 30% 80% Orthodontic Services 50% 30% 80% Employee Only $30.86 $53.19 $84.05 Employee & Spouse $58.58 $101.01 $159.59 Employee & Child(ren) $64.57 $111.46 $176.03 Employee & Family $91.81 $158.80 $250.61

OFFICE OF HUMAN RESOURCES Cortez 129 * 80 Fort Brown * Brownsville, TX 78520 * Phone: (956) 882-8205 * Fax: (956) 882-7476

The University of Texas at Brownsville New! Dental HMO Plan (Delta Dental) • Delta Dental, the new vendor for the dental HMO plan, has expanded coverage area (includes Cameron

County), a new list of network providers and a simplified fee schedule. • Minimal rate decrease. See rate chart below.

ENROLLMENT TIER CURRENT PREMIUM NEW PREMIUM Employee Only $10.05 $8.55 decrease of $1.50 Employee & Spouse $19.10 $16.25 decrease of $2.85 Employee & Children $21.11 $17.96 decrease of $3.15 Employee & Family $30.15 $25.65 decrease of $4.50

Vision Basic Plan (Superior Vision) No plan design changes or rate increases.

New! Vision Plus Plan (Superior Vision) Plus plan offers expanded, richer benefits, including lens options covered in full and higher retail allowances. See plan summary and rates for basic and plus plan below.

SUMMARY OF BENEFITS BASIC PLAN PLUS PLAN Eye Exam $35 $35 Materials $0 $0 Contact Lens Fitting $35 $35 Frames $140 retail allowance $150 retail allowance

Lenses (standard): Single Vision Bifocal Trifocal

Covered in Full Covered in Full Covered in Full Covered in Full

Covered in Full Covered in Full Covered in Full Covered in Full

Polycarbonate, dependents to age 25 Not covered Covered in Full Scratch coat (factory) Not covered Covered in Full Ultraviolet coat Not covered Covered in Full Progressive lens See description * $120 retail allowance

Contact Lenses $125 retail allowance $150 retail allowance

Employee Only $6.80 $10.80 Employee & Spouse $10.76 $16.76 Employee & Child(ren) $10.96 $17.96 Employee & Family $17.40 $25.40

*Covered at the provider’s in-office retail price for a standard lined trifocal; member pays difference between the progressive and the trifocal plus applicable co-pay.

Short Term Disability Plan (Dearborn National) No plan design changes. Minimal premium rate increase of $0.302 per $100 of monthly earnings up to a maximum of $5,000.

Long Term Disability Plan (Dearborn National) No plan design changes or rate increases.

Long Term Care Plan (Dearborn National) No plan design changes or rate increases.

Group Term Life Insurance & Accidental Death & Dismemberment Plan (Dearborn National) No plan design changes or rate increases.

Please study the information on this document and in your Annual Enrollment Packet very carefully before making your benefit selections for September 1, 2012. Please call the Office of Human Resources at 882-8205 or send an email to benefits@utb.edu if you have any questions.