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Medical

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Related Information
Marketplace Coverage Options
Medical Plan Costs 2014
Medical Plan Comparison Chart
Glossary of Benefit Terms
Excellus Creditable Coverage Notice
Excellus Noncreditable Coverage Notice
Health Plan Privacy Notice
NazFlex Summary Plan Description
Summary Plan Description of Employee Benefits
Summary Plan Description Chart
Excellus SBC 25-250
Excellus SBC 30-500
Excellus SBC HDHP
Open Enrollment

You will have an opportunity to change your medical options during open enrollment, effective January 1 of the following year. Proof of good health will not be required to enroll in any of the options and no restrictions for pre-existing conditions will apply.

Nazareth College wants you to have the best medical care possible when you need it.  We also want you to be able to protect yourself and your family against the high cost of catastrophic illness. At the same time, however, we recognize that every individual and every family has unique medical care needs.

NazFlex is the solution.  Whether you are single or have a family, have frequent medical expenses or very few, have coverage available elsewhere or rely totally on our medical benefits, NazFlex will enable you to select medical protection that meets your needs.

What Are My Medical Options?

NazFlex offers you several medical options:

  • Excellus SimplyBlue 25-250 Copay and Deductible Plan
  • Excellus SimplyBlue 30-500 Copay and Deductible Plan
  • Excellus SimplyBlue High Deductible Health Plan
  • No coverage

When you select one of the medical plans, you may choose from one of several coverage levels:

  • Employee only - coverage just for you
  • Employee + Spouse - coverage for you and your spouse
  • Employee + Child(ren) - coverage for you and one or more dependent children. 
  • Family - coverage for you, your spouse and dependent children

 Eligible family members include:

  • Your spouse or eligible domestic partner
  • Your child:  natural, adopted or step child, or eligible child of your domestic partner who is under age 26 and unmarried
  • A handicapped child 19 or older, who became incapable of supporting himself or herself because of a physical or mental handicap before age 19 and who is dependent upon you for more than half of his or her support (special application required prior to age 19)

Dependents Age 26 – 30:

  • New York State law allows young adults age 29 or under to obtain single coverage identical to that of their parents if the young adult is unmarried, ineligible for comprehensive health insurance through their own employer; lives, works or resides in New York State or the health insurance company's service area; and is not covered by Medicare.   Contact the Human Resources Department for further details.

Your College provided benefit credits are based on your medical option choice of single, two-person, family, family no spouse or no medical coverage.  Please refer to your personal NazFlex Enrollment Form for your specific benefit credits.

Program Details

Choosing a Medical Care Option

How do you decide which medical option is right for you? Only you can make that decision, but here are some considerations which may be of some help:

  • Look through the Medical Benefits Comparison Charts at the end of this section to examine the benefits offered for each plan, comparing the co-payments and out-of-pocket expenses for the various services outlined. Which plan provides the best coverage for your medical needs?
  • Estimate what your medical expenses (co-payments, etc.) will be next year. Looking at past expenses may help you predict future expenses.
  • Weigh the monthly cost of each medical plan against your estimated expenses. Would you potentially benefit from the lower premium cost of one health plan in exchange for the higher co-pays for various medical services?
  • Do you require the services of a specific doctor or specialist? If so, is that doctor or specialist on the Excellus list of participating physicians?
  • Determine whether it is more beneficial to be covered under your spouse's or domestic partner's medical plan. Compare the benefits and cost of your spouse's or domestic partner's employer's plan to your NazFlex medical options. Would waiving medical coverage under NazFlex, and using your credits for other benefits or more take home pay (taxable) be more advantageous?
  • Remember that you can choose to use your FSA Health Reimbursement account to lower your out-of-pocket medical care expenses by paying for them pre-tax.

Prescription Drug Benefits

Nazareth College recognizes the high costs of prescription drugs and offers you a way to reduce this cost. While all of the Nazareth College medical plans include a prescription drug rider, some plans cover both generic and brand name drugs. While others only cover generic drugs. Be sure to take this into consideration when selecting your medical plan.

Prescription Drug Pre-approval or Step Therapy

Some drugs require pre-approval by the insurance carrier before your prescription can be filled. Other drugs require that you try other lower cost drugs (step therapy) before your prescription for a higher cost drug will be approved. Be sure to check with your doctor or pharmacy when given a prescription for a new medication.

Mail Order Prescriptions

Maintenance drugs must be ordered through the mail order service offered by Excellus, and offers you savings over the retail copayments. PrimeMail prescription drug mail service information is available in the Human Resources Department.

Maximum Allowable Cost (MAC) Pricing

Some drugs have an FDA-approved generic drug available and are affected by MAC (Maximum Allowable Cost) pricing. For further details, please refer to the specific health care brochures.

Making Your Election

If you choose any one of the medical options, you must indicate your election in the medical category of your NazFlex Enrollment Form.

If you elect the "no coverage" option, you are encouraged to have medical coverage elsewhere. You also must indicate "no coverage" election in the medical category.

Please note your medical election is binding for the entire plan year, which is January 1 to December 31. If, however, you have a qualified "change in family status," you may change your medical elections, and other NazFlex elections, in a manner consistent with the family status change that occurred. Here are two examples:

  • If you elected no coverage because you have medical coverage elsewhere and you lose your coverage during the year because your spouse or eligible domestic partner loses his/her job, you may change your election to single, two person or family medical coverage in any of the medical options for the remainder of the year.
  • If you elected single medical coverage during the NazFlex open enrollment period and you marry or become eligible for domestic partner benefits during the plan year, you may change your election to two person or family medical coverage in your choice of medical options for the remainder of the plan year, or you may change your election to no coverage if you choose to have medical coverage elsewhere after your marriage date or becoming eligible for domestic partner benefits.

Covered Services

All of the NazFlex medical options cover a wide range of medical services. Covered services are paid based on the benefits provided by each plan. For specific details on coverage, refer to the brochure and the plan contract.

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