Health Insurance

Auburn University has a self insured group health insurance program for full-time employees with Blue Cross/Blue Shield of Alabama acting as an administrator for the processing of medical claims and American Behavioral providing mental health and substance abuse coverage. Below is a brief summary of the health insurance benefits.

Eligibility

  • Active full-time, non-student employees are eligible if the most recent appointment period is continuous for a minimum of one year (nine or twelve months as appropriate to the appointment).
  • Auburn University also offers health insurance to all employees who work an average of 30 or more hours per week over a measurement period. Student employees and part-time employees who are not benefits eligible, but work an average of 30 hours or more weekly (1,560 hours/year) during a 12-month period, will be ACA-eligible for the Auburn University Health Plan. In addition, part-time employees who are reasonably expected to work 30 hours a week for the first 90 days will be ACA-eligible for the Auburn University Health Plan.
  • Participation in the program is optional.
  • There is no waiting period for pre-existing conditions.

Enrollment

  • New employees must enroll within the first 30 days of employment.
  • Others may apply for enrollment during the annual open enrollment period in the month of November.

Key Documents

Premium Costs

Auburn University contributes a portion of the bi-weekly or monthly premium. The employee's share is deducted from his/her paycheck and is exempt from Federal, State, and FICA/Medicare taxes.

Salary Under $27,300 (Effective Jan. 1, 2019)

Pay ID Self EE+Sp EE+Ch Family
Biweekly $51.45 $107.49 $97.75 $122.39
Monthly $111.49 $232.88 $211.81 $265.17
18-Pay $74.31 $155.26 $141.21 $176.77

Salary Under $27,300 to $40,799 (Effective Jan. 1, 2019)

Pay ID Self EE+Sp EE+Ch Family
Biweekly $77.17 $161.24 $146.63 $183.58
Monthly $167.21 $349.32 $317.71 $397.75
18-Pay $111.49 $232.88 $211.82 $265.15

Salary Equal to/Above $40,800 (Effective Jan. 1, 2019)

Pay ID Self EE+Sp EE+Ch Family
Biweekly $102.89 $214.96 $195.51 $244.76
Monthly $222.95 $465.76 $423.60 $530.32
18-Pay $148.65 $310.52 $282.42 $353.54
  • Self = Employee Only
  • EE + Sp = Employee plus Spouse (or Sponsored Adult Dependent)
  • EE + Ch = Employee plus Child(ren) (including Sponsored Child Dependents)
  • Family = Employee plus Spouse (or Sponsored Adult Dependent) and any enrolled Child(ren) (including Sponsored Child Dependents). 

All premium deductions are on a pre-tax basis except where not permitted by State and/or Federal regulations for Sponsored Adult and/or Sponsored Child Dependents.

Mental Health/Employee Assistance

Mental Health and Substance Abuse Handbook

Summary of Mental Health and Substance Abuse Benefits

Employee Assistance Program

Auburn University's Employee Assistance Program is administered through American Behavioral and is available to all benefit-eligible employees with up to three free visits per year.

An EAP program is a confidential assessment, counseling, and referral service for all regular employees and their eligible dependents who need help with:

  • marital and family issues; 
  • alcohol and other drug dependency; 
  • stress-related issues; 
  • financial/legal referrals; and
  • emotional problems.

An EAP counselor can help identify problems and assist in working through them. The counselor can also determine the best alternatives and, if necessary, make appropriate referrals to other professionals who specialize in particular areas. The program is:

  • Confidential: All information is kept strictly between the individual and the counselor.
  • Informal: A simple phone call starts the process.
  • Free: All counseling offered within the EAP is provided as a benefit by Auburn University.

For additional information, call 1 (800) 925-5EAP (5327).

Mental Health and Substance Abuse Treatment

Mental health and substance abuse treatment are available only to employees, dependents, and retirees covered under the Auburn Medical Plan. For more information, call (800) 925-5EAP (5327)

Inpatient

  • Number of days determined by medical necessity
  • Co-pay same as medical plan

Outpatient

  • Number of visits determined by medical necessity
  • Co-pay same as medical plan 

Summary of Mental Health and Substance Abuse Benefits

Effective January 1, 2019

Summary Document #: 277507868429

Important Information: All benefits are based on the appropriate level of care and medical necessity guidelines. Provider/facility licensure by the state to provide covered services and facility accreditation by The Joint Commission or CARF is required.

Calendar Year Deductible: $250 per person per year With a three-member family maximum

Calendar Year Out-of-Pocket Maximum: $7,900 individual/$15,800 aggregate family maximum

In-Patient Hospital Facility Services

Service In-Network Out-of-Network
  • Acute Inpatient Hospitalization
  • Inpatient Electroconvulsive Therapy (ECT)
  • Partial Hospitalization/Day Treatment (PHP) - Two PHP days equal one inpatient day
  • Intensive Outpatient Program (IOP) - Two IOP days equal one inpatient day
  • Pre-admission certification required; Call 800-677-4544
  • Up to 30 days total for inpatient care (mental health and substance abuse treatment) each 12 consecutive months
  • Covered at 100 percent of allowed amount after copay, subject to calendar year deductible
  • Patient Responsibility: $200 copay per admission subject to calendar year deductible
  • Pre-admission certification required; Call 800-677-4544
  • Up to 30 days total for inpatient care (mental health and substance abuse treatment) each 12 consecutive months
  • Covered at 80 percent of allowed amount subject to calendar year deductible
  • Patient Responsibility: 20 percent of the allowed amount subject to calendar year deductible and all billed charges not covered by the Plan

Substance abuse program including:

  • Detoxification
  • Rehabilitation
  • PHP

Treatment applies to inpatient hospital services; Substance abuse treatment = once per lifetime
  • Pre-admission certification required; Call 800-677-4544
  • Up to 30 days total for inpatient care (mental health and substance abuse treatment) each 12 consecutive months
  • Covered at 100 percent of allowed amount after copay, subject to calendar year deductible
  • Patient Responsibility: $200 copay per admission subject to calendar year deductible
 No Out-of-Network Benefit

Professional Services

Service In-Network Out-of-Network
Outpatient office visits or ambulatory detoxification
  • Up to 30 visits/ sessions/ group therapy sessions (or any combination thereof) total for outpatient care (mental health and substance abuse treatment) per member per calendar year
  • Covered at 100 percent of allowed amount after copay
  • Patient Responsibility is $30 copay per visit/session/group therapy session
  • Up to 30 visits/ sessions/ group therapy sessions (or any combination thereof) total for outpatient care (mental health and substance abuse treatment) per member per calendar year
  • Covered at 80 percent of allowed amount
  • Patient responsibility: 20 percent of the allowed amount and all billed charges not covered by the Plan

Psychological/ Neuropsychological
testing
  • Pre-admission certification required; Call 800-677-4544
  • Limited to five (5) hours of psychological/neuropsychological testing per member per calendar year
  • Covered at 100 percent of allowed amount after copay
  • Patient Responsibility: $30 copay per hour
  • Pre-admission certification required; Call 800-677-4544
  • Limited to five (5) hours of psychological/neuropsychological testing per member per calendar year
  • Covered at 80 percent of allowed amount
  • Patient responsibility: 20 percent of the allowed amount and all billed charges not covered by the Plan

Applied Behavior Analysis (ABA) for the treatment of Autism Spectrum Disorders

Based on eligibility and clinical criteria being met
  • Pre-admission certification required; Call 800-677-4544
  • Ages 0-9: Up to $20,000 per child per calendar year
  • Ages 10-13: Up to $15,000 per child per calendar year
  • Ages 14-18: Up to $10,000 per child per calendar year

 No Out-of-Network Benefit

Inpatient physician services in conjunction with approved inpatient services
  • Up to 30 days total For inpatient care (mental health and substance abuse treatment) each 12 consecutive months
  • Covered at 100 percent of allowed amount
  • Patient responsibility: None
  • Up to 30 days total For inpatient care (mental health) each 12 consecutive months
  • Covered at 80 percent of allowed amount
  • Patient responsibility: 20 percent of the allowed amount and all billed charges not covered by the plan

Anesthesia in conjunction with approved ECT treatment
  • Covered at 100 percent of allowed amount subject to the inpatient copay amount
  • Patient responsibility: None
  • Covered at 80 percent of allowed amount
  • Patient responsibility: 20 percent of the allowed amount and all billed charges not covered by the plan

Covered by Medical Plan

Service In-Network Out-of-Network
  • Ambulance
  • Emergency Department
  • Imaging
  • Lab Work
 Covered by the Auburn University Medical Plan through Blue Cross Blue Shield of Alabama Covered by the Auburn University Medical Plan through Blue Cross Blue Shield of Alabama

Behavioral Health Care Management

Care management is a service offered by the Plan to assist you with difficult behavioral health care needs. You have a personal care manager who acts as your advocate, assisting you whenever you have questions or concerns. Call American Behavioral at 800-677-4544 to talk to your personal care manager.

Transition of Care

Printable version and Provider Nomination/Addition Form

For transition of care, American Behavioral offers one to three visits based on the intensity of services and the severity of the patient’s illness for those individuals currently receiving clinical behavioral healthcare treatment. Please assist American Behavioral in easing transition of care for you or your family members by doing the following:

  • Have your current providers direct all requests for inpatient partial hospitalization and intensive outpatient reviews to American Behavioral.These requests should be directed to case management prior to the organization’s termination date. Any facility-based admissions will be covered and managed by American Behavioral upon the effective date of your contract with American Behavioral.
  • The Provider Nomination/Addition Form that is referenced above is important, even for those not currently receiving services, as American Behavioral uses the completed forms in an effort to create a personalized provider network for the University. Fax or mail completed forms to the number or address that is listed on the form.
  • Outpatient visits require an authorization. Please contact American Behavioral via the telephone numbers on the form.
  • If you see a primary care physician with a behavioral health diagnosis and have the claim denied by Blue Cross Blue Shield, a Behavioral Health Reimbursement Form may be submitted to American Behavioral for payment. At that time, you will be offered the opportunity to schedule an appointment with an in-network provider.

Tobacco Discount

  • All Auburn University employees who are enrolled in the health insurance plan receive a $20 per month tobacco discount by certifying that they (and their spouse/sponsored adult dependent, if applicable) are not tobacco users.
  • Employees must certify their tobacco use status to Human Resources to qualify for the discount. (An employee only has to certify once. He or she does not have to recertify every year.)
  • As an alternative, the employee and/or spouse/sponsored adult dependent may complete the Pack It Up program, which is available through the Auburn University Pharmaceutical Care Center, to qualify for the discount. Contact the AUPCC for more information.

Baby Yourself Program

If you or your spouse are pregnant, Baby Yourself offers individual care by a registered nurse. Please call BCBS nurses at 1-800-222-4379 (or 733-7065 in Birmingham) as soon as you find out you are pregnant. Begin care for you and your baby as early as possible and continue throughout your pregnancy. Your baby has the best chance for a healthy start by early, thorough care while you are pregnant. If you fall into one of the following risk categories, please tell your doctor and your Baby Yourself nurse:
  • Ages 35 or older;
  • High blood pressure;
  • Diabetes;
  • History of previous premature births; or
  • Multiple births (twins, triplets, etc.)

If you enroll in the Baby Yourself Program during the first 16 weeks of your pregnancy your employer will waive the inpatient deductible of $200 for the delivery of your baby.

International Travel

If you are traveling outside of the United States and are a participant in the Auburn University Health Plan, you carry your healthcare benefits with you through Blue Cross and Blue Shield Global. Blue Cross and Blue Shield of Alabama partners with the other Blues to provide this service for you and the covered members of your family at no additional charge.

International Travel - University Business

If you are traveling outside the United States on University business you will need to coordinate that travel with the Office of International Programs. Please review the section on Travel Requests (RAT-50) for information on International Travel Request Policy and Procedure. Upon completion of the RAT-50 you will be enrolled in MEDEX International Travel Insurance program. Please contact the OIP office at (334) 844-5001 for more information.

Travel Assistance (Domestic and International)

Standard Insurance, our provider for Group Life Insurance and Optional Voluntary Life and Accidental Death & Dismemberment (AD&D), also provides Travel Assistance to all employees who are covered by the Group Life Insurance. If you, or any member of your immediate family (including children up to age 26), are travelling more than 100 miles from home, including internationally, then FrontierMEDEX can help you with any problems you may encounter. Please see the MedEx Employee Brochure for details of the services provided and print the card from page seven to carry with you when you travel.

Continuation of Coverage

COBRA
Continuation of your group health benefits as provided by the Consolidated Omnibus Budget Reconciliation Act of 1986 is available for employees, spouses, and dependents after certain qualifying events occur. Additional information including cost and application for applying for coverage is available online.
Family Medical Leave Act

Employees approved for leave under the Family Medical Leave Act will be permitted to continue their group health insurance coverage with no change in premium in accordance with the University's policy and procedures.

Termination of Coverage

  1. Upon termination of employment an employee and his/her dependents will be covered for the time period for which his/her last premium was deducted. Coverage shall cease automatically and without notice unless coverage is continued under COBRA.
  2. The coverage of the spouse of an employee shall terminate automatically and without notice as of the date of divorce or other termination of the marriage, and on such date the spouse shall cease to be a member unless coverage is continued under COBRA.
  3. The coverage of a child as a member shall terminate automatically and without notice as of the date such child ceases to be dependent unless coverage is continued under COBRA. 
Last updated: 04/15/2019