2025 Open Enrollment

AmeriHealth Administrators/BlueCross BlueShield (AHA/BCBS) Health Insurance Carrier

AHA process all medical claims for both the Blue and Maize plans. The provider network is through BCBS.

• Insurance Cards: New cards will be issued by AHA/BCBS which will work for both your health care and SmithRx pharmacy benefit needs.
• Provider Network: All the major healthcare systems are covered by AHA/BCBS. The AHA/BCBS network covers over 98% of the providers that are currently covered. The providers that are not currently covered by AHA/BCBS will be invited to join AHA/BCBS’s network.
• Plan designs: Mimic our 2024 plans with the exception of the deductibles which has a small increase for both Blue and Maize.
• Summary Plan Descriptions:
  • Blue HDHP
  • Maize PPO

AHA/BCBS Resources:

• Example Insurance Cards
• Provider Search: Find Care – Blue Cross Blue Shield Association
  • Enter City Location of Provider(s) You’re Searching For.
  • Click the “Browse a list of plans” link at the bottom of the screen, then select BlueCard PPO Basic Network.
• Member portal will be available on 1/1/2025 (Link will be added at that time.

SmithRx Pharmacy Discount Programs

SmithRx is our new Pharmacy Benefit Manager (PBM). They utilize the Pareto Drug Formularies to optimize your prescription benefits. SmithRx is committed to providing you with the best service and resources to make informed healthcare decisions.

SmithRx Resources:

• Example Insurance Cards
• SmithRx Introduction video (6:23 minutes)
  • Member Portal referenced in the video will become available 1/1/2025 (link will be added at that time).
• Check Prescription coverage: Pareto Low Global Formulary Look Up Tool
• If your drug is not on the formulary list, you will have a grace period for the first 90 days of the plan year.
  • Make certain you speak with your pharmacist or provider to find alternative before the end of the grace period.
• There are 5 tiers in the Formulary, they are as follows:
  • Tier 1 Generics 
  • Tier 2 Preferred Brands
  • Tier 3 Non Preferred Brands
  • Tier 4 Specialty Preferred
  • Tier 5 Specialty Non Preferred 

SmithRx has several cost savings programs including but not limited to:

• SmithRx Assist
  • Simplified Medication Purchasing: Expanded coverage that applies cash prices and discount card programs, ensuring the lowest net cost.
  • Automatic Best Price: Your insurance card will automatically apply the best available price at the pharmacy.
  • Deductible and Out-of-Pocket Maximum Credit: All payments contribute towards your plan limits.
  • NOTE: SmithRx integrates many discount card programs, however, certain discount programs will not apply due to restricted access such as discount card programs that require membership fees and use pricing as a loss-leader for other product offerings they make available.
• SmithRx Connect 360: A representative may reach out to let you know about ways to save money and help you enroll into the savings programs.
  • Access
    • Utilizes Drug Manufacturer Coupons: Reduces costs on both traditional and specialty medications.
    • Proactive Identification and Enrollment: SmithRx Connect 360 streamlines the process.
    • Significant Savings: Low or $0 copays on brand-name medications through Walmart Mail Order.
  • Access Plus
    • Leverages Advocacy Foundations and Grants: Reduces costs for eligible high-cost specialty medications.
    • Proactive Identification: SmithRx Connect 360 identifies eligible medications and assists with program enrollment.
    • Significant Savings: Low or $0 copays on brand-name medications.
  • Mark Cuban Cost Plus Drugs
    • Transparent Pricing: A pharmacy model that delivers medications at cost, plus a straightforward 15% markup, along with a $5 dispensing fee and shipping. 
    • Expanding Drug List: Over 1,000 medications and growing.
    • Proactive Identification and Enrollment: SmithRx Connect 360 assists with the process.
    • Significant Savings: Low or $0 copays on brand-name or generic medications.

Optum Health is the provider.

• HSA allows you to make pre-tax contributions into the account to help cover the costs for medical, dental or visions expenses.
• Any balance in the account at the end of the year will rollover into the next year.
• IRS HSA contribution limits increased, see the chart below.
• Carleton’s HSA contribution is based on tier of coverage and remains the same.

^{Catch up contribution for those age 55 or older is $1,000.}

For those nearing age 65 or contemplating retirement, learn more about HSAs and Medicare. More information on this is available HERE.

Optum Bank is the provider. FSA accounts allow you to set aside pre-tax dollars on an annual basis to reimburse yourself for Medical or Dependent care expenses. If you don’t use the the funds you set aside you will loose them. There are two types of FSA accounts.

Medical FSA: IRS limit is $3,300. Eligible expenses include:

• Medical
• Dental
• Vision

Dependent Care FSA: IRS limit is $5,000 (limit is $2,500 if married/filing jointly). Eligible expenses include:

• Child care for children under the age of 13.
• Aging adults in your life who need care in order for you to come to work.

IMPORTANT: 2024 enrolled in Maize, 2025 change to Blue – Must have a ZERO balance in your FSA by 12/31/2024.

• If you do not have a $0.00 balance by 12/31/2024, contributions into your HSA will be delayed until 4/1/2025.

Delta Dental is the provider, we offer two plans Value & Comprehensive

• No plan design changes.
• Premiums stayed flat.

VSP is the provider.

• No plan design changes.
• Premiums stayed flat.
• VSP – provides access to discounts when purchasing eyewear (glasses, contacts, sun glasses ect..).

Please Note: Health Insurance covers your annual eye exam as a preventative service which is covered at 100%

Unum is the provider for all the policies listed below:

Employee Assistance Program (EAP): Effective 1/1/2025 Unum will be our provider for EAP, they have a national Network of over 60,000 providers. EAP is confidential, safe, and easy to use. A few of the services they offer are:

• Counseling/therapy (individual & family): six visits per family member/year
• Financial and Legal assistance
  • Financial & Legal Resources Support for families needing help during a terminal illness.
• Travel Assistance
• Work Life balance resources
• Emotional support resources

Life and Disability Policies: Unum became the provider on 2/1/2024. We will be offering open enrollment for the voluntary life and long term disability policies.

NOTE: Evidence of Insurability (EOI), if triggered you will be provided a link to complete the questionnaire in the Announcement Widget in Workday

• Voluntary Life Insurance for employee, spouse/domestic partner and child(ren): Employees will be able to elect up to the Guarantee Issue (GI) amounts during open enrollment, which means you will not need to complete the (EOI) for amounts up to the GI.
  • Employee GI: $250,000
  • Spouse/Domestic Partner GI: $40,000
  • Child(ren) GI: $5,000 or $10,000
• LTD (Voluntary Long-Term Disability): Can elect the policy without having to complete the EOI questionnaire.
  • No plan design changes.
  • Premiums stayed flat.
• Accidental Death and Dismemberment AD&D: The tiers (Employee, Spouse/Domestic Partner and Child(ren)) now align with the tiers for voluntary life policies. You will still be able to elect Voluntary Life and AD&D independent of each other. No EOI will be required for elections.
  • Rates per $1,000 of coverage remained flat
  • Premium may be different depending on your elections due to the new tiers.

Employees who have specific questions or requests for individual support can schedule a virtual appointment (via Google Meets or Zoom), call or request an in-person appointment with:

• Andrea Zunkel, Benefits Coordinator (azunkel@carleton.edu / x5989
• Kirsten Budin, Benefits Manager (kbudin@carleton.edu / x 4831

• TIAA DC (Defined Contribution Plan): All benefit eligible non-union employees are required to contribute. Contributions are pre-tax and employees are 100% vested upon enrollment.
  • Employee contributes 2% of their base salary each pay period.
  • Carleton contributes 10% of their base salary each pay period.
• IUOE Central Pension Fund – Union employees participate in this after completing their probationary period and achieving seniority.  Carleton contributes 10% of the employee’s base wage each pay period.
• TIAA SRA (Supplemental Retirement Account): All employees (Non-Union and Union) over the age of 21 are eligible to participate in this plan – regardless of your benefit eligibility status. Account information and resources:
  • SRA Account (Pre-Tax Contribution): Lowers your taxable earnings; taxable when drafted in retirement.
  • Roth 403b (Post-Tax Contribution): Taxes paid up front; tax-free when drafted in retirement.
  • IRS 2025 Annual Contribution limits: See the chart below.

Employees can contribute pre-tax, post-tax or both as long as you remain within the IRS annual limits.

TIAA Webinar Lounge – On Demand Webinars