USA VIVA Health

Frequently Asked Questions

▼   Is the USA VIVA Health & Dental Plan right for me?

The University of South Alabama offers a limited network plan option with the USA VIVA Health & Dental Plan during open enrollment for coverage beginning effective January 1, 2018.

Narrow or limited network health plans restrict benefits to specific hospitals, physicians and other medical providers. A narrow network design offers value to consumers through a lower premium, enhanced benefits and access to select medical providers concentrating on improved medical outcomes and preventive health.

The plan is administered by VIVA Health, Inc. VIVA was selected for its ability and experience; and is associated with the University of Alabama at Birmingham (UAB).

The USA VIVA Health & Dental Plan is not for everyone:

  1. The employee and dependents must reside in the state of Alabama to join this Plan.
  2. The employee needs to understand the limited network design.
  3. The employee should be satisfied with the medical providers offered by this Plan.
  4. Employees who select this Plan during open enrollment for the 2017 benefit year will be required to remain in the Plan until the next benefit year.
  5. Employee who joins the USA VIVA Health & Dental Plan and then later elects to change plans may only change to the Standard Plan even if previously enrolled in the Base Plan.
▼   How much will USA VIVA cost me? NEW!!!

USA VIVA Health & Dental Plan is a limited network design based on USA Health medical providers and select providers from the VIVA network.  VIVA, working with USA Health, has reviewed the provider network to ensure adequate access to primary and specialty care physicians.  To supplement primary care, a Telehealth program will be included, providing telephone and internet access to a physician for minor medical concerns, resulting in less cost for the employee, time saved, and convenience. Urgent care services are available with Greater Mobile Urgent Care and American Family Care in Mobile and Baldwin counties. Out-of-network services will be available when approved by VIVA’s medical director.  The limited network providers have agreed to reduce their fee making this a cost effective plan.  The employee monthly cost sharing will be the lowest of the plans offered: 

USA Base Plan $ 108.00 $ 354.00  
USA Standard Plan $ 128.00 $ 418.00  
USA VIVA $ 90.00 $ 300.00 ←Lowest Cost

 

USA VIVA Health & Dental Plan will save the employee $456 for single and $1416 for family coverage annually as compared to the Standard Plan.  In addition, the benefit design has no deductibles or copay amounts required for hospital and physician services as well as several other services. The pharmacy benefit will be administered by Express Scripts, Inc., the dental benefit will be administered by Southland Benefit Solutions, Inc.; and the health and dependent care flexible spending accounts will be administered by Discovery Benefits, Inc. The pharmacy benefit and dental benefit are the same as those provided with the USA Health & Dental Plan’s Standard Plan.   

▼   Why enroll in the USA VIVA Health & Dental plan?

Enrollment in the USA VIVA Health & Dental Plan is on a voluntary basis to all benefits-eligible employees. 

  • Lowest cost program for the employee.
  • Enhanced benefit design with no deductible or copays for hospital and physician services as long as services are within the network.
  • Select providers concentrating on better medical outcomes.
  • Preventive health for early detection and treatment of illness and chronic conditions.
  • Telehealth to improve access and convenience for treatment of minor medical conditions.
  • A voluntary offering for those employees who elect to participate.
▼   Who is eligible for coverage with the USA VIVA Health and Dental Plan?

Employees are eligible for participation in the USA Health & Dental Plan or USA VIVA Health & Dental Plan based solely on hours of service. The Affordable Care Act requires an offer of coverage to employees credited with 30 hours of service per week or 130 hours of service per month on average. The Plans may defer the offer of coverage if the employee is determined as having “variable hours” in which case benefits-eligible status will be determined using a 12-month measurement period with a corresponding 12-month coverage period in compliance with the Affordable Care Act.

Eligible Employees include:

An employee with an employment start date prior to January 1, 2013, and a specific appointment with no termination date, occupying a permanently budgeted position, and working a minimum of 20 hours per week on a regular basis.
An employee with an employment start date on or after January 1, 2013, who is credited with 30 hours of service per week or 130 hours of service per month on average.
Eligible Employees may also enroll their legal spouse, as recognized by the state of Alabama, and children under age 26. Coverage with the selected Plan will begin on the first day of the month following the first day of employment, contingent upon timely application to the Human Resources department and payment of any required employee contribution.

▼   What is premium conversion?

USA Health & Dental Plan and USA VIVA Health & Dental Plan premiums are deducted before any Federal, State or Social Security taxes are withheld. Your gross income is reduced by the amount of your premiums and therefore, you pay fewer taxes. New employees are automatically enrolled in Premium Conversion. However, Premium Conversion is optional for employees. Contact the Human Resources department for information regarding opting out of Premium Conversion.

▼   What is USA VIVA Health & Dental Plan, and what are the premiums?

USA VIVA Health & Dental Plan will be a limited network design based on the USA Health medical providers and select providers from the VIVA network. VIVA working with USA Health has reviewed the provider network to ensure adequate access to primary and specialty care physicians. To supplement primary care a Telehealth program will be included providing telephone and internet access to a physician for minor medical problems resulting in less cost for the employee, time saved, and convenience. Out-of-network services will be available for urgent care and when approved by VIVA’s medical director. The limited network providers have agreed to reduce their fee making this a cost effective plan. The employee monthly cost sharing will be the lowest of the plans offered:

  Single Family
USA VIVA $ 90.00 $ 300.00

USA VIVA Health & Dental will save the employee $456 for single and $1416 for family coverage annually as compared to the Standard Plan. In addition, the benefit design has no deductibles or copay amounts required for hospital and physician services as well as some other services. The pharmacy benefit and dental benefit will be the same as provided under the Standard Plan. USA VIVA Health & Dental Plan will be available on a voluntary basis to all employees.

  • Lowest cost program for the employee.
  • Select providers concentrating on better medical outcomes.
  • Preventive health for early detection and treatment of illness and chronic conditions.
  • Telehealth to improve access and convenience for treatment of minor medical conditions.
  • A voluntary offering for those employees who elect to participate.
▼   How does the Tobacco Cessation program/wellness incentive work?

The University of South Alabama encourages all employees to adopt healthy lifestyle choices. That effort will benefit you, your family and your fellow employees. The University’s Fringe Benefits Committee recommended, and the University adopted, a tobacco cessation program which is intended to help employees stop using tobacco products. Tobacco use and especially smoking will increase your risk of heart disease, stroke, respiratory diseases such as emphysema and bronchitis, as well as cancer including: lung, throat, mouth, esophagus, pancreas, bladder, and leukemia. The benefits from stopping the use of tobacco are almost immediate regardless of how long you have been smoking or using tobacco.

For new employees the Tobacco Declaration information/election is provided within the USA VIVA Health & Dental insurance enrollment form.

Existing employees that do not currently participate in this wellness incentive may begin participation by completing the Tobacco Declaration form .On this form employees will declare that they and their covered spouse do not use tobacco products; and have not used tobacco products within six months prior to the date on the form. This will qualify for a wellness incentive of $50 per month (one per family). The wellness incentive will be applied to the monthly insurance premium effective the pay period following the date on the Tobacco Declaration form (payroll deadlines can affect when this discount will be applied).

For employees enrolled in the USA VIVA Health & Dental plan seeking assistance with tobacco cessation please call VIVA Health Customer Service at 1-800-294-7780 to obtain information on the Plan’s smoking cessation program. The program is provided at no cost to employees and covered dependents who want to stop using tobacco products and offers two visits per year with a $0 copay with a PCP or specialist. The pharmacy benefit provides tobacco cessation products for up to 12 weeks without prior authorization for generic Zyban, generic nicotine patch, gum and lozenges; and nicotine inhaler or nasal spray; up to 24 weeks without prior authorization for varenicline tartrate (Chantix), Tamoxifen and raloxifene (generic only).

For additional tobacco cessation resources you may also contact the Employee Assistance Program office at 461-1346.

▼   When will my medical/dental coverage be effective if I am a new employee?
Coverage with the selected Plan will begin on the first day of the month following the first day of employment, contingent upon timely application to the Human Resources department and payment of any required employee contribution.
▼   May I join any of the three plans offered by the University: Base Plan, Standard Plan, USA VIVA Plan?
No, if you are a new employee you may select between the Standard Plan and the USA-VIVA Plan. Only employees hired before January 1, 2013 are eligible for the Base Plan.
▼   Does the USA VIVA Health & Dental Plan offer dental benefits?

Yes, the dental benefits are administered by Southland Dental which has an extensive network of dental providers.

▼   If I join the USA VIVA Health & Dental Plan can I switch back to the Base Plan or Standard Plan?

No, you may only switch back to the Standard Plan and then only during the annual open enrollment month for coverage starting January 1st of the following benefit year. You may not switch coverage during the year unless you have a change in your residence and you reside outside the state of Alabama. If you decide to change from the USA VIVA Plan you may only enroll in the Standard Plan; you may not enroll in the Base Plan even if you were previously in the Base Plan.

▼   Will my doctor be covered under the USA VIVA Health & Dental Plan?

The USA VIVA Plan is a limited network of medical providers. You will need to look at the provider directory to determine if your physician(s) are in the network or call VIVA at (205) 558-7474 or 1-800-294-7780 or go to the web site for the provider listing at www.viva-usa.com to verify your physician’s status. Remember, medical providers that are not Network Providers are not eligible for benefits and any charges will be the responsibility of the member.

▼   Under the USA VIVA Health & Dental Plan, if my Network Physician refers me to a Non-Network medical provider will that be covered by the Plan?

No, generally no out-of-network medical provider will qualify for benefits. The only time a Non-Network medical provider will qualify for benefits is when the VIVA medical director has approved the medical expense or service for payment of benefits in advance of the medical procedure or expense.

▼   What should I consider when deciding whether or not to join the USA VIVA Health & Dental Plan?
You should consider that only a limited network of medical providers will qualify for coverage. This may not be the best plan if you have a chronic illness and receiving medical care at this time. In that case you will want to verify that the medical providers you use are Network Providers and listed in the provider directory. If they are not Network Providers you should elect the Standard Plan option. You and your dependents must reside in the state of Alabama.
▼   Why are the benefits better and the cost less for the USA VIVA Health & Dental Plan

This is due to the fact that the medical providers have agreed to accept a lower fee. It is also due to medical providers working to achieve better medical outcomes through quality of care thereby reducing the cost of complications. The USA VIVA Plan benefits are better for medical services and the pharmacy and dental benefits are the same as the Standard Plan benefit.

▼   Who selects the medical providers for the USA VIVA Health & Dental Plan?

VIVA Health, Inc. has the sole responsibility for selecting providers to be included as Network Providers. VIVA Health, Inc. monitors providers for access and quality of care as well as medical outcomes to ensure the highest level of medical care. VIVA Health, Inc. has the sole authority to add and remove providers from the listing of Network Providers.

▼   How do I join the USA VIVA Health & Dental Plan?
You must complete an enrollment form and file it with the University’s Human Resources Department and by filing that form you will attest to the fact that you understand: 1) that the USA VIVA Health & Dental Plan is a limited network plan that does not provide benefits for out-of-network medical providers except in the case of emergency medical care and then only after proper notification; 2) that it is your responsibility to ensure that medical care is provided by a Network Provider; 3) that you may not change from the USA VIVA Health & Dental Plan except during open enrollment for coverage effective January 1st of the following year except if you have a change of residence and reside outside the state of Alabama (see the change-in-status event rule described in your Member Handbook).

 

General Information

USA VIVA Health & Dental Plan - Certificate of Coverage / Member Handbook
USA VIVA Wellness Benefits
USA VIVA Schedule of Benefits
VIVA Health: Certificate of Coverage and Summary Plan Description