Understanding Your Health Plan

Cost of Your Benefit Plans

Calculating your monthly benefit costs

The Benefit Plan cost estimator tool is available for you to use at any time to determine your monthly costs/rates.

Medical Plan Costs

Health care is a shared expense between the College and employees. On average, Dartmouth pays 75% of the cost of the health insurance premium, while employees pay 25%. Our contribution schedule is determined by annual base salary (does not inlcude bonuses, shift differentials or overtime pay), so some employees will pay more than 25% and some pay less than 25%. Employees also pay out-of-pocket costs in the form of deductibles, coinsurance, and copayments. 

If you enroll in a health plan, you will receive a medical credit each pay period toward the cost of your health coverage.  The amount you receive is determined by your annual salary, your full time equivalency, your employment category and the family members that you are covering. Your share of the plan cost/rate is deducted from your paycheck on a pre-tax basis (Research Fellows pay post-tax).

When monthly benefit costs can change

It is important to understand how a change in your position or in your family coverage could impact the cost of your benefit premiums.  If you have one of the following changes during the calendar year, the bi-weekly or monthly cost of your medical, supplemental life, and LTD benefit plans may also change:

• A change in employment category: Exempt, non-exempt, SEIU, Research Associate B or Research Fellow.  A change in employment category could impact the benefits that you are eligible for, and in some cases could change the amount you pay each pay period for medical, supplemental life and long-term disability coverage.
• A change in pay frequency: When transitioning from monthly paid to biweekly paid or from biweekly paid to monthly change, a change in pay frequency will cause a recalculation of all benefits.  If the transition also includes a change in annual base salary, then your medical, supplemental life and LTD benefit plans will also adjust.
• A change in Full Time Equivalency (FTE): Benefit eligible FTE’s can range from 0.5 to 1.0. A change in FTE will usually result in a change in base annual salary and a recalculation of medical, supplemental life and long-term disability premiums.  A reduction in FTE could increase the cost of your medical plan while an increase in FTE could decrease the cost of your medical plan.  This is important when using the benefit cost estimator to check new monthly costs.
• Qualified Life Event:  When adding or removing dependents from your plan(s) outside of open enrollment, or when adding or removing coverage all together, your benefit costs will be recalculated and could change if your base annual salary has changed since January 1st.

If you have one of the above changes in the middle of a calendar year, please make sure that you understand how your eligibility and monthly plan costs will be impacted.  Use the Benefit Cost Estimator or reach out to the Benefits Office if you have questions.

Copays, Deductibles and Coinsurance

Understanding health care can be confusing. That's why it's helpful to know the meaning of commonly used terms such as copays, deductibles, and coinsurance. Knowing these important terms may help you understand when and how much you need to pay for your health care.

For full definitions of each of these terms and an explanation on how out-of-pocket costs work, please click here.

In-Network vs. Out-of-Network

You can avoid unexpected medical bills by knowing how your plan works. Certain choices you make can affect what you'll pay out-of-pocket. Know the difference between in-network and out-of-network care to help save on health care expenses.

To better understand the difference between in- and out-of network costs, and why out-of-network services cost more, please click here.

Filing Out-of-Network Claims

• In-Network - When using Cigna's in-network providers, these providers are required to file your medical claims directly with Cigna on your behalf.  The provider will submit the claim to Cigna, Cigna will process the claim and pay the provider.  The provider will then send you a bill for the remaining portion of deductible, coinsurance or copay that is your responsibility.
• Out-of-Network – Your health plan provides coverage for services from doctors and facilities that are not in your plan’s network.  But if you do receive covered out-of-network care, your share of the costs (i.e. deductibles, copays or coinsurance) will usually be higher than if you receive those services in-network.  There is a limit to the amount your plan will pay for covered out-of-network services called the maximum reimbursable charge (MRC).  An out-of-network doctor or facility can bill you directly for any amount above your plan’s MRC.  This is often referred to as “balance billing.” You will be responsible for paying that amount and these payments do not apply to your deductible or out-of-pocket maximum.
  
  

Medical Claim Form
Behavioral Health Claim Form

Provider Lookup

Use the links below to find local medical and behavioral heal care providers within Cigna's national network.  Look for the "Open Access Plus/Carelink" network.

Medical Providers
Behavioral Health Providers

Preventive Care

Preventive care services are provided when you don't have any symptoms and haven't been diagnosed with a health issue connected with the preventive service.

Using these services at the right time can help you stay healthier by:

• Preventing certain illnesses and health conditions from happening.
• Detecting health problems at early stages, when  they may be easier to treat.

Preventive care services are typically covered by your plan at 100% with no cost to you.  View more information and a list of covered services.

Urgent Care

For time sensitive but non-emergent services, you can often avoid costly and time consuming emergency room visits by seeking treatment at one of the Upper Valley's available urgent care clinics.

Pharmacy Coverage

All three of Dartmouth's medical plans include prescription drug coverage through Express Scripts.  Your out-of-pocket costs are determined by the medical plan that you choose.

Note: You will receive separate ID cards from Express Scripts, for each of your covered family members.  You will need to show these ID cards at your pharmacy when filling prescriptions or receiving vaccines.

For more information about Dartmouth's pharmacy benefits, please click here.

Vision Coverage

As part of the preventive care services under your Dartmouth College medical plan, you and your covered family members are eligible for one free eye exam when using an in-network EyeMed provider.  EyeMed is Cigna's vision partner.

Those who need to purchase contacts or eyeglasses during the calendar year, can elect a stand-alone vision plan through VSP at a monthly cost.

For more information about how your vision benefits work, please click here.

Behavioral & Mental Health

Traditional Behavioral Health counseling is available through your Cigna health plan at the cost of a PCP copay on the Open Acess Plus (OAP) and Cigna Choice Fund (CCF) medical plans. Costs are subject to annual plan deductibles and coinsurance when enrolled in the High Deductible Health (HDHP) plans.

Mental Health Exception Benefits:  Dartmouth College also recognizes that there are a limited number of mental health providers in the Upper Valley who participate with health insuance carriers. To improve access to behavioral health care for Dartmouth employees and their families, Dartmouth has worked closely with Cigna to increase the number of Cigna participating providers in the Upper Valley, and to develop a behavioral health exception benefit program for those using out-of-network providers.

For additional emotional support tools and resources, like the Faculty/Employee Assistance Program, virtual behavioral care options, free apps, videos and other helpful resources, please visit Wellness at Dartmouth.

EMMA Can Help

Emma is an online assistance tool that is built into the FlexOnline benefits enrollment system, and can help you with the medical plan decision making process.  The Emma tool calculates the annual cost to have a medical plan through Dartmouth and adds the estimated cost of what she thinks you might spend each year, to use your medical and pharmacy plans (based on how you answer certain questions).  She then makes a medical plan recommendation by listing in order which medical plan she believes would be the most cost effective for you.  Please note:  Emma is not the ultimate decision maker, you are. So please feel free to try various scenarios and see if Emma changes her selection, but remember, ultimately, the final decision is yours.

Tax Advantage Plans

Tax advantage plans are special IRS governed accounts that allow you to receive money from Dartmouth or put aside your own money on a pre-tax basis, that will later be used to pay for eligible medical or child care expenses. Your employment category, your FTE, your annual salary the health plan that you choose, and the age of your dependent children, determine which tax advantage plan(s) you are eligible to participate in and how much money you are eligible to receive from Dartmouth each calendar year.   The IRS determines the annual limit of each tax advantage account each fall for the coming calendar year.  Examples of Tax advantage plans are Health Care FSA's, Health Savings Accounts, Health Reimbursement Accounts, Dependent Care FSAs and the Child Care Subsidy. 

For more Information on Dartmouth's Tax Advantage programs, go to dartgo.org/fsa and dartgo.hsa

Transparency In Coverage Rule

In response to the federal Transparency in Coverage Rule, the link provided below, leads to the machine readable files that have been made available, and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers.

The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data. 

Access the Machine Readable Files.