Premiums

Premiums

Frequently Asked Questions

Premiums

The following frequently asked questions about premiums are not meant to be exhaustive. Refer to your health benefits plan book or contact the SEIB for more information.

How is the State Employees’ Health Insurance Plan funded?

The State Employees’ Health Insurance Plan (SEHIP) is funded by contributions from the state and through employee premiums, deductibles, and copays.

What is the state funding rate?

The state funding rate is a funding mechanism established by the Alabama Legislature to help fund the state health plan. The rate is a dollar amount paid monthly by state agencies for each active employee. For FY2020, the state funding rate is $930 per employee per month.

Is the state funding rate equivalent to an employee premium?

No, it is not the equivalent of an employee premium. The state funding rate is paid by the employer to cover the cost of an active employee and subsidizes retiree and dependent coverage.

What is the employer contribution?

The employer contribution is the amount state agencies pay for each active employee based on the state funding rate. The employer contribution can be broken down into an equation: the state funding rate x number of active employees x 12 months = annual employer contribution.

What is the employee premium?

The employee premium is the amount the SEIB establishes for employees and retirees to contribute to the cost of their coverage. The 2020 single employee premium is $115 per month. This can be reduced by participating in the wellness program ($25 discount per participant per month) and refraining from using tobacco products ($60 discount per member per month), which brings the total single employee premium to $30 per month when all of the discounts are applied. For a complete listing of the employee premium rates visit rates for 2020.

How are premiums determined?
The SEIB establishes premiums for each class of employees and retirees. There are eight premium classes:
  • active employe, single
  • active employee, family
  • non-Medicare retiree, single
  • non-Medicare retiree, family
  • Medicare retiree, single
  • Medicare retiree, dependent
  • non-Medicare retiree with Medicare dependent
  • Medicare retiree with non-Medicare dependent(s)
Are employees responsible for any other costs?

In addition to the employee premium, members are also responsible for out-of-pocket expenses such as copays and deductibles. Members should refer to the employees’ health benefits plan book to determine what your out-of-pocket expenses will be prior to receiving services from your health care provider.

Is there an additional employee surcharge if I cover my spouse?

Yes. Employees and retirees whose spouse is enrolled in the SEHIP will be charged a $50.00 per month surcharge if that spouse is eligible for other group health benefits through his/her employer.

Can the spousal surcharge be waived?
Yes. The spousal surcharge can be waived if one of the following conditions is met:
  • The covered spouse is eligible for other group health benefits through his/her employer, but the premium for single coverage under the lowest cost option offered by the spouse’s employer is more than $255 per month. (Note: the Marketplace, Medicare, Medicaid and Tricare are not considered other employer group health benefits.) Documentation required: A letter from the covered spouse’s employer verifying that the monthly premium for the lowest cost single coverage option is more than $255.
  • The covered spouse is employed, but is not eligible, or not offered, group health benefits through his/her employer. Documentation required: A letter from the covered spouse’s employer verifying that the spouse is not offered group health benefits.
  • The covered spouse is unemployed or retired and not covered nor is eligible for any other employer group health benefits. Documentation required: A copy of the most recent federal or state tax return listing the covered spouse’s employment status. Only the first two pages of the return that shows the name of employee and spouse and the spouse’s occupation need to be provided. All other information on the tax return can be blacked out. On State Form 40 and Federal Form 1040, that information is found on the top of page 1 (your name and your spouse’s name) and the bottom of page 2 (your spouse’s signature and occupation). If you file a Federal Form 1040EZ, that information is found on the top of page 1 (your name and your spouse’s name) and the bottom of page 1 (your spouse’s signature and occupation). If your unemployed spouse files a separate tax return, he/she must submit his/her return showing the same information. Note: If your spouse became unemployed or retired after the most recent federal or state tax return was filed, you must submit an Unemployed or Retired Spouse Verification form (IB27) verifying that your spouse is currently unemployed or retired and not covered or eligible under any other employer group health benefits.
  • For new employees only – the spouse’s current or former employer offers group health benefits, but the enrollment rules of your spouse’s health plan do not allow your spouse to enroll for coverage at the time of your employment. A waiver is available until the earliest date that your spouse can enroll. Documentation required: A letter from your spouse’s current or former employer verifying its enrollment rules.
How do I apply for the spousal surcharge waiver?

To apply for a spousal surcharge waiver you must submit a Spousal Surcharge Waiver Application (Form IB25) to the SEIB. The waiver is on a prospective basis only and the SEIB will not make refunds for previous health premiums. The effective date of the waiver of the spousal surcharge will be the first day of the month following approval of the waiver. The waiver will be effective for 12 months. Thereafter, re-certification must be made annually.

New employees have 60 days from their date of hire to apply for the spousal surcharge waiver. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 60 days from their initial effective date of coverage to apply for the spousal surcharge waiver. There is no grace period to submit the spousal surcharge waiver application if you or your spouse re-enroll in the SEHIP during the year or if you have ever been covered as a state employee.

Premium Discounts

The following frequently asked questions about premium discounts are not meant to be exhaustive. Refer to your health benefits plan book or contact the SEIB for more information.

Non-Tobacco User Premium Discount

What is the Non-Tobacco User Premium Discount?

The non-tobacco user premium discount is a deduction from your monthly health insurance premium available to subscribers and/or their covered spouses who have not used tobacco products in the last 12 consecutive months.

Who is eligible for the Non-Tobacco User Premium Discount?
The following individuals who are non-tobacco users are eligible for the premium discount:
  • All active employees;
  • spouses of active employees;
  • Medicare retirees;
  • spouses of Medicare retirees;
  • non-Medicare retirees; and
  • non-Medicare spouses of retirees.
Is a Non-Tobacco User Premium Discount available to both the subscriber and the covered spouse separately?

Yes. A separate non-tobacco user premium discount is available to both the subscriber and the covered spouse. If you and your covered spouse both use tobacco products, you and your covered spouse will each be subject to a separate tobacco user premium of $60.

Here’s how the premium structure will be applied:

  • If only you or your covered spouse uses tobacco products, your monthly tobacco user premium will be $60.
  • If both you and your covered spouse use tobacco products, your monthly tobacco user premium will be $120 ($60 for you and $60 for your covered spouse).
How do I apply for the Non-Tobacco User Premium Discount?

To obtain the discount, you and/or your covered spouse must complete and submit a non-tobacco user premium discount application to the SEIB verifying that the applicant has not used tobacco products in the last 12 consecutive months. Applications are available from the SEIB or the website. No refunds are allowed for failure to submit an application.

Is it possible to obtain the Non-Tobacco User Premium Discount even if I have used tobacco products in the last 12 months?
Yes, but you and/or your covered spouse must submit acceptable documentation to the SEIB each year verifying that the applicant:
  • has completed a SEIB-approved tobacco-usage cessation program; or
  • cannot stop using tobacco products as advised by your physician because it is unreasonably difficult due to a medical condition.
When should I apply for the Non-Tobacco User Premium Discount?

New employees have 60 days from their date of hire to apply for the non-tobacco user premium discount. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 60 days from their initial effective date of coverage to apply for the non-tobacco user discount. There is no grace period to submit the non-tobacco user premium discount application if you or your spouse re-enroll in the SEHIP during the year or if you have ever been covered as a state employee.

For those who were not eligible for the premium discount at the date of hire, you or your spouse may apply for the discount when the applicant has not used tobacco products in the last 12 consecutive months.

What should I do if my covered spouse or I start using tobacco products while the premium discount is in place?

It is your responsibility to notify the SEIB immediately if you or your covered spouse starts using tobacco products while the premium discount is in place. If you fail to notify the SEIB, you could be subject to disciplinary action and be required to repay all discounts, claims, and expenses related to the tobacco usage by you and/or your covered spouse, plus interest.

Wellness Premium Discount

What is the Wellness Premium Discount?

The wellness premium discount is a deduction from your monthly health insurance premium available to those individuals who complete the wellness requirements established under the SEIB’s Wellness Program.

What is the SEIB Wellness Program?

The SEIB Wellness Program is voluntary and you are not required to participate in the wellness program or any components of the biometric screening. If you choose to participate, you will be asked to complete a biometric screening, which includes measuring your height, weight, and waist size, taking your blood pressure and a blood sample. The blood sample checks your cholesterol (total, HDL (good), LDL (bad), and triglycerides) and glucose. You will be asked if you have or have had high cholesterol, high blood pressure, or diabetes and if you take medicine for those conditions. The screening intends to let you know if you are at risk for certain medical conditions resulting from obesity, high blood pressure, high cholesterol, or diabetes.

Who is eligible for the Wellness Premium Discount?
The following individuals covered by the SEHIP (Group 13000) and who participated in the SEIB wellness program are eligible for the wellness premium discount:
  • All active employees;
  • spouses of active employees;
  • non-Medicare retirees; and
  • non-Medicare spouses of retirees.
Is a Wellness Premium Discount available to both the eligible subscriber and the eligible covered spouse separately?

Yes. A separate wellness premium discount is available to both the eligible subscriber and the eligible covered spouse. If you and your covered spouse both fail to meet the SEIB’s Wellness Program requirements, you and your covered spouse will each be subject to a separate premium of $25.

Here’s how the premium structure will be applied:

  • for those with single coverage or family coverage without a spouse:
    • your monthly wellness premium will be $0 if you complete your wellness program requirements
    • your monthly wellness premium will be $25 if you do not complete your wellness program requirements.
  • for those with family coverage and the spouse is covered:
    • If you and your covered spouse both complete the wellness program requirements, your wellness premium will be $0.
    • If you or your covered spouse complete the wellness program requirements, but not both, your monthly wellness premium will be $25.
    • If neither you nor your covered spouse complete the wellness program requirements, your monthly wellness premium will be $50.
What risk factors are screened for during the wellness screening?
Each plan year every eligible individual must be screened for the following health risk factors:
  • blood pressure;
  • cholesterol;
  • glucose; and
  • body mass index.
Where do I go to get a wellness screening?
You can be screened for these risk factors in one of several ways:
  • through the SEIB’s Worksite Wellness Screening Program;
  • through a local Health Department;
  • through a SEIB certified Pharmacy location; or
  • through your healthcare provider.
How am I determined to be at risk for one of the health risk factors?
You will be deemed at risk for one or more of these health risk factors if your:
  • Blood pressure systolic reading is 160 or above or your diastolic reading is 100 or above;
  • Cholesterol reading is 250 or above;
  • Glucose reading is 200 or above; or
  • Body mass index is 40 or above.

Eligible individuals who are deemed by the SEIB to be at risk for any of the above health risk factors are eligible for an office visit referral with no office visit copay.

If I am deemed at risk for one or more of the health risk factors, can I still receive the premium discount?
Yes. If your screening values show that you are at risk, you will be asked to complete one of the following to receive the premium discount:
  • Submit a provider screening form completed by your health care provider, i.e., your doctor, physician assistant, or nurse practitioner. This form indicates that you consulted with your provider about the identified risk. The form does not have to indicate any improvement in the identified risk for you to receive the premium discount. It is a good idea to have your provider complete and sign your form while you are in for an office visit;
  • Submit a completed and signed office referral form indicating that you have been counseled by a healthcare provider for your identified risk(s);
  • Submit proof of participation in a SEIB approved exercise or weight management program. You must provide the SEIB with the name of the program, dates, and location of participation, and a phone number for verification of your participation; or
  • Provide valid proof that you are self-managing and have made an improvement in your identified risk(s). You must provide documentation of your improvement.
When will my Wellness Premium Discount be effective?

The effective date of the wellness premium discount depends on when the screening results and/or other documentation is submitted to the SEIB. However, for the wellness premium discount to be effective on January 1 of a succeeding year, you must qualify no later than October 31 of the preceding year.

New employees will have 60 days from their date of hire to apply for the wellness premium discount. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 60 days from their initial effective date of coverage to apply for the wellness premium discount. There is no grace period to submit the wellness premium discount application if you or your spouse re-enroll in the SEHIP during the year or if you have ever been covered as a state employee.

Federal Poverty Level Premium Discount

What is the Federal Poverty Level Premium Discount?

The Federal Poverty Level (FPL) Premium Discount is a percentage discount off your monthly health insurance premium based on your total household income and household size.

Who is eligible for Federal Poverty Level Premium Discount?

Active and retired employees whose combined family income is less than or equal to 300% of the FPL, as defined by federal law, may be eligible for a percentage discount off the approved premium.

How do I obtain the Federal Poverty Level Premium Discount?

To obtain the discount, you and your spouse must submit a completed FPL Premium Discount Application to the SEIB and furnish acceptable proof of total annual household income by providing your current (i.e. immediately preceding year) federal income tax return transcript. The discount will be effective on the first day of the second month after SEIB’s receipt and approval of the application and transcript. The discount will expire on June 30th. You must reapply every year. No refunds will be allowed for late or incomplete applications. No refunds will be allowed for failure to submit an application.

The discount does not apply to members on Leave of Absence, COBRA, or surviving dependent coverage.

How is my income level determined?

You must provide a copy of your current (i.e. immediately preceding year) federal income tax return transcript when you send the application to the SEIB. If you are married and file taxes separately, you must also include a copy of your spouses’ current (i.e. immediately preceding year) federal income tax return transcript. Include all pages of the transcript(s). There is no charge to get your transcript from the Internal Revenue Service (IRS). To receive your free federal income tax return transcript, visit IRS Get Transcript or call 800-908-9946. You should receive your transcript within 7-10 business days.

How is my household size determined?

The SEIB will use the number of dependents shown on your federal income tax return transcript to determine your household size for purposes of calculating your potential premium discount.

How much is the premium discount if I qualify for the Federal Poverty Level Discount?
The premium discount will be applied as follows:
  • Over 300% of the FPL – employee pays 100% of the employee premium
  • 251%-300% of the FPL – employee premium reduced 10%
  • 201%-250% of the FPL – employee premium reduced 20%
  • 151%-200% of the FPL – employee premium reduced 30%
  • 101%-150% of the FPL – employee premium reduced 40%
  • 100% or less of the FPL – employee premium reduced 50%

Gaps in Care Program

What is the Gaps in Care Program and to whom does it apply?

SEIB is offering, through BCBS, a gap in care premium discount program that encourages healthy habits to support and improve your overall health. You might ask, “What is a gap in care?” National guidelines for managing certain disease processes are recommended to better manage your health. If you are identified as having a “gap in care”, it simply means that you are missing one or more of the recommended guidelines, such as a lab test, examination, or prescription medication, necessary to manage your health. The program focuses on the following five healthcare standards:

  • Diabetes-, Hemoglobin A1C test at least once a year;
  • Diabetes- eye exam at least once a year;
  • Cervical Cancer Screening- Pap test only;
  • Breast Cancer Screening;
  • Colon Cancer Screening.

This program applies to all active employees, covered spouses of active employees, non-Medicare retirees, and non-Medicare spouses of retirees enrolled in the SEHIP (Group 13000)

What happens if you have a Gap in Care?

If previous claims reveal that you have not met the required guidelines for any of the healthcare standards listed above, you will receive a letter from BCBS outlining the necessary steps required to close your identified gap(s) in care. Members will have until October 31st to close their identified gap(s) in care. If you do not meet the requirements, your monthly premium will increase by $25 per month beginning January 1st of the following year. However, you are not required to pay the $25 per month premium for the entire year if you take the necessary actions to close the gap(s) anytime during the year.