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2011 Editio
Health Care Plans, Dental Plans, FSA, HSA,Personal Health Management and WellU
HealthProgram
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1........ Health Program Benefts
2........ Your Guide to MakingEnrollment Decisions
3........ Who is Eligible or Benefts
5........ How to Enroll: New Hires &Newly Eligible Faculty & Sta
6........ Changing Your Benefts
8........ Health & Wellness at the
University o Rochester9........Programs & Services to Help You
Get Healthy and Stay Healthy
18 ...... Your Health Care PlanChoices or 2011
20...... University Health CarePlansAn Overview
22...... Comparing the UniversityHealth Care Plans
24...... Comparing the TPAs
26...... Choosing the Right HealthCare Plan
28...... Understanding the Featureso Your Health Care Plan
30...... Flexible Spending Accounts andHealth Savings Account
31...... A Closer Look at theHealth Care FSA
33...... A Closer Look at the HSA
36...... HSA or Health Care FSAWhats Right or You?
37...... Tax Savings Beyond HealthCare: Dependent Care FSA
38...... Choose Your Dental Benefts
40 ..... Schedule o Covered DentalServices and Supplies
41 ...... Dental Services and SuppliesNot Covered
42...... Important Inormation to Know
52...... How Your Coverage Is Aected
54...... ERISA (Employee RetirementIncome Security Act)
56......Terms to Know
58...... Appendix A: When You Can MakeBeneft Changes Outside oOpen Enrollment
62 ...... Appendix B: Diabetic Supplies
and Equipment
Contents
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Promoting wellness and healthy living continues to be an important
focus for the University of Rochester. To support our ongoing com-
mitment, the University offers a benets package designed to help
faculty and staff make good health care decisions that not only help you live
better, but also help you better manage health care costs.
Health Program Benefts
Te University o Rochester is committed to
providing you and your amily with a compre-
hensive and competitive benefts package. In or-
der to meet this commitment and our business
goals, we developed this Health Program Deci-
sion Guide to highlight the benefts, programs,
and services available to you.
Outlined in this Guide are the health
program options available during the January
1 through December 31, 2011 plan year* that
include:
Health care (includes prescription drug
benefts)
Dental
Flexible Spending Accounts
Health Savings Account
Personal Health and Wellness Programs
WellU
Te health care choices you makewhether
selecting health care coverage or you and your
amily or the coming year or deciding when
and how to use health care services on a day-to-
day basishave a direct impact on the health
care costs you and the University pay.
o help you maximize your health care oer-
ings, the University oers health and wellness
programs through Yourhealth and WellU,
which provide programs, tools, resources, and
education necessary to support healthy living.
We encourage you to become involved with our
I you have questions about Contact
Health Care Plans Aetna
1-877-864-4583www.aetna.com
Excellus BlueCross BlueShield
1-800-659-2808 or 1-585-232-2632www.excellusbcbs.com
Dental Plans Excellus BlueCross BlueShield1-800-724-1675www.rochester.edu/benets/dental
Flexible Spending Accounts (FSAs) Health Care FSA Limited Purpose Health Care FSA Dependent Care FSA
Aetna1-888-238-6226www.aetnafsa.com
EBS-RMSCO, Inc.(FSA Administrator for Excellus BCBS)1-800-327-7130 or 1-585-232-2632Fax (for claims): 1-877-256-7228www.myebsaccount.com
Health Savings Account (HSA) Aetna1-877-864-4583
HSA Bank(Excellus HSA Partner)1-800-357-6246www.hsabank.com
General Benefts UR Benefts Ofce275-2084
Facsimile 273-1054
www.rochester.edu/benets
Updating your personal data orusing HRMS to enroll online as a new hire
ASK-URHR (275-8747)
www.rochester.edu/people
WellU Program University WellU Ofce273-5240
www.rochester.edu/well-u
Personal Health and Wellness Programs Carewise Health1-877-598-3967
Your Health or Health Concerns Nurse Line (speak with a Registered Nurse)1-877-598-3967
*Te health care plan year for Strong Memorial Hospital Residents and Fellows is July 1 through June 30.
Health Program Resources
health and wellness oerings, including
taking the Personal Health Assessment
and completing a biometric screening. See
pages 9-13 or more inormation.
ake the time to explore this Guide to
learn more about the benefts and services
that may help you change your behavior to
become more involved in your health and
use your benefts as wisely as possible.
PUT YOUR HEALTH FIRSTTake a more active role in your health.
Take a Personal Health Assessment,
enroll in a Personal Wellness or
Personal Health Program, and you may
be eligible for incentives! For more
information, contact Carewise Health
at 1-877-598-3967.
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Choose and Use Benefts WiselyYou make choices each day that are unique to
your work, amily needs and personal interests.
Be sure to take time to careully consider your
beneft needs and options beore making your
elections. Consider the types o service and
beneft eatures you need or want and the
amount you can reasonably aord to pay out-o-pocket or the coverage.
Remember that your role as a responsible
health care consumer does not end once you
enroll or benefts. Troughout the year, you
should take an active role in managing your
health by maintaining a healthy liestyle, choosing
in-network providers when appropriate,
evaluating your health care choices when care
is needed and using available resources wisely.
Your OptionsYou may have the opportunity to choose rom
the options outlined in the chart below or
your Health Program benefts.
Note: You may elect to waive your health
care plan coverage but still enroll in Dental
Plan coverage, a Health Care FSA, and/ora Dependent Care FSA. I you elect to waive
coverage, you may have to wait until the next
open enrollment period or until you experience
a qualiying event to enroll. See Appendix A or
more inormation.
Your Guide to Making Enrollment DecisionsHealth Care Plans, Dental Plans, FSA and HSA
Benefts Available To You Additional Inormation
Health Care OptionsUniversity High Deductible PlanUniversity Low Deductible PlanUniversity HSA-Eligible PlanUniversity Copay Plan
Dental OptionsTraditional Dental Assistance Plan
Medallion Dental Plan
Modied plan design for 2011.
Modied plan design for 2011.
Accounts to Help You Save on TaxesHealth Care Flexible Spending Account (FSA)
Health Saving Account (HSA)
Limited Purpose Health CareFlexible Spending Account (FSA)
Dependent Care Flexible Spending Account (FSA)
Health Care FSA is not available if you elect to makecontributions to a Health Savings Account (HSA).
You can contribute only if you enroll in theUniversity HSA-Eligible Plan.
You can contribute only if you enroll in theUniversity HSA-Eligible Plan and contribute to aHealth Savings Account (HSA).
Dependent Care FSA is for day care expenses (notmedical expenses) for your qualifying dependents.See page 37.
AvailableCoverage Levels
The coverage levels
available to you or
health care are:
Single
Employee and Child(ren)
Employee and Spouse/
Domestic Partner
Family
The coverage levels
available to you or
dental are:
Single
Family
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Who is Eligible or BeneftsHealth Care Plans, Dental Plans, FSA and HSA
You are eligible ifyou are a regular ull-time
or part-time member o the aculty or sta at the
University o Rochester as defned in the erms
to Know section o this Guide.
Visiting aculty members, part-time
assistant coaches, in-house agency nurses and
in-house operating room technicians are not
eligible or dental plan coverage.Dependents eligible to be covered
under your health care plan and/or dental plan
include:
Your spouse.
Your domestic partner/same-sex legal spouse
and his or her eligible children only i you
cannot become legally married in New York
State.
Your children up to age 26, provided they
have no access to other employer coverage
(through their own employment), regardless
o marital status or student status.
Your children who are handicapped prior to
age 26 and are dependent on you or support.
Dependent children include:
Biological children,
Legally adopted children,
Stepchildren who are chiey dependent upon
your support, and
Recognized children (grandchild, niece,
nephew or other child or whom you are the
legal guardian), i they:
- Are unmarried
- Are under age 24
- Live with you in a parent/child relationship
and are supported by you
- Can be claimed as your ederal tax
dependent, and
- Do not have access to other coverage.
You will be required to complete a
verifcation orm to certiy ederal tax
dependency in order to cover any eligible
dependent children as recognized children.
Forms are available online or rom the Benefts
Oce.
Retirees of the Universityare eligible or
health care and dental coverage. (A separatebrochure explains the health care plans
available to Medicare-eligible retirees. Tis
brochure can be viewed at www.rochester.edu/
benefts. Select Employment Changes, then
select Retirement.)
Your widow/widower and unmarried
surviving dependents are eligible for
coverage under a University Health Care
Plan if:
You had met the age and service requirements
to retire, or
You were retired, or
You had fve or more years o service but had
not met the criteria to retire. (In this instance,
your surviving spouse and eligible dependent
children remain eligible or a period o one
year ollowing your death.)
Individuals represented by collective
bargaining agreements receive benefts in
accordance with those agreements. Copies
o those agreements are available upon
DEPENDENT ELIGIBILITYYou may be contacted to provide
required documentation to
conrm the members of your
family who are eligible for
benets under a University
Health Care Plan. This is to make
sure that we are keeping trackof dependents who may have
reached the age maximum for
plan eligibility, spouses who
are divorced and are no longer
eligible, or dependents who are
deceased or otherwise ineligible
for benets. Please contact the
UR Benets Ofce if there is a
change in eligibility status for
any of your dependents covered
under the plan.
NEW EXPANDED DEPENDENTCOVERAGEUnder the Patient Protection and
Affordable Care Act (PPACA) signed
into law on March 23, 2010 to bring
about health care reform, dependent
coverage has been expanded to include
adult children up to age 26 provided
they have no access to other employer
coverage (based on their own
employment), regardless of marital
status or student status. This change is
effective January 1, 2011.
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written request.
University Married CouplesI you are married to a University aculty
or sta member who also is eligible or
University beneits, both you and your
spouse may enroll or coverage. However,
you and your dependents will not be allowed
to be covered under two University HealthCare or two Dental Plans at the same time.
When I Reach Age 65I you continue to work ull-time or part-time,
your University Health Care Plan remains
the primary coverage, with Medicare as the
secondary payer.
When you retire, transer to an ineligible
status, or terminate your University
employment, your primary coverage
will become Medicare (Parts A and B).
At retirement, you will need to enroll in
Medicare Parts A and B and complete orms
to change your University Health Care Plan
to a Medicare-eligible retiree plan i youwish to continue coverage as a University o
Rochester retiree. (See the separate brochure
that explains health care plans available to
Medicare-eligible retirees.)
If you enroll in the HSA-Eligible Plan and haveMedicare coverage (Parts A, B, C, or D), you cannotcontribute to a Health Savings Account (HSA).If you are contributing to an HSA, please refer topages 3335 for important information.
SPECIAL NOTE REGARDINGDOMESTIC PARTNER ANDSAMESEX LEGAL SPOUSECOVERAGE:The premiums for domesticpartners/same-sex legal
spouses, and any childrenthey bring to the partnership,are paid with after-tax dollars,while the premiums you payfor health care plan coverage
are paid with tax-free dollars.This means you will haveimputed income equal to thevalue of the benet providedby the University for thesedependents. Only non-qualied domestic partners/same-sex legal spouses aresubject to this provision.
Imputed income is theaddition of the value of cash/non-cash compensation to anemployees taxable wagesin order to properly withholdincome and employmenttaxes from the wages. TheInternal Revenue Serviceconsiders medical and dentalinsurance coverage fordomestic partners/same-sex legal spouses and their
dependents as income forthe purposes of calculating
federal taxes. Affectedemployees must report thisimputed income on their
Form W-2.
Who is Eligible or Benefts Continued
Health Care Plans, Dental Plans, FSA and HSA
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Enrolling or benefts is easy. Te ollowing
checklist takes you through the steps you need
to complete to elect your health program op-
tions or 2011.
1. REVIEW THIS GUIDE.Careully read this Decision Guide to under-
stand all o the Health Program options avail-able to you and your dependents.
2. USE THE HEALTH PLAN COST ESTIMATOR.Consider your health care needs by using the
Health Plan Cost Estimator (see page 26).
Tis online tool can assist you in determining the
right Health Program option(s) or your needs.
3. CHOOSE A TPA.I you enroll or health care coverage, you
will need to select a third-party administrator
(PA). (I you elect to contribute to an FSA but
waive your health care plan coverage, EBS-
RMSCO, Inc. will be the administrator o your
FSA.) urn to pages 24 and 25 or inormation
about the two PAs.
4. ENROLL FOR BENEFITS.If you are a new hire and are enrolling for
the rst time, you can enroll or benefts
online using HRMS within 30 days o your
hire date.
o enroll online, log on to HRMS at
www.rochester.edu/people. Select Sel-
Service, then Benefts, and then Benefts
Enrollment.
If you do not wish to enroll online:
Download the enrollment orm at
www.rochester.edu/benefts/health (go toQuick Links section and selectMost Request-
ed Forms), or
Contact the UR Benefts Oce or the enroll-
ment orm by:
- Calling 275-2084,
- Emailing [email protected], or
- Visiting the UR Benefts Oce in the
Medical Center, Room G-8011.
Submit a completed enrollment orm to:
University o RochesterBenefts Oce
260 Crittenden BoulevardBox 636Medical Center, G-8011Rochester, NY 14642
Your health care and dental coverage will
be eective the frst o the month ollowing
the date o the appointment or on the date o
the appointment i that occurs on the frst o
a month. Your FSA and HSA wi ll be eective
the date o appointment or date the orm is
completed, whichever is later.
How to Enroll:New Hires & Newly Eligible Faculty & StaHealth Care Plans, Dental Plans, FSA and HSA
If you do not enroll during the initialenrollment period, your Health Programcoverage will be defaulted to:
Waived (No coverage) for Health Care Plan
Newly Eligible: Waived (No coverage) for Dental Plan
Current Employees: Equivalent new 2011 Dental Plan at the same coverage level
Waived (No contributions) for Health Care and Dependent Care FSA
QuestionsCall ASK-URHR 275-8747 if you
have questions about enrolling
through HRMS.
Call the UR Benets Ofce at
275-2084 if you have questionsabout your benet plans.
ENROLLMENT FORMYour enrollment form must be
received by the Benets Ofce
within 30 days of when you
become benets-eligible. Enroll-
ment forms received after 30days may result in no coverage
until the next open enroll-
ment, or until you experience a
qualifying event. (Please refer
to Appendix A for when you can
make benet changes outside
of open enrollment.)
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Can I Enroll at Another Time?Annual open enrollment is the primary time you
can enroll or make changes to your health care
plan options and FSA contributions. Outside
o open enrollment, you can only enroll in or
change your health care plan options, dental
plan options and FSA contributions, or add/
remove eligible dependents to your health careplan and/or dental plan, i you have a qualiying
event, or a HIPAA special enrollment period.
Qualiying Event EnrollmentPeriod ChangesQualiying events include:
Change in legal marital status (marriage,
divorce, death o spouse, or annulment).
Change in number o tax dependents (birth,
adoption, placement or adoption, or death).
Change in your employment status (that
aects your beneft eligibility) or that o your
spouse or dependent.
Dependent satisying (or ceasing to satisy)
eligibility requirements or coverage (reach
the age at which coverage is no longer
available, etc.).
Change in cost o coverage, such as a
signifcant increase charged by your current
day care provider, or a change in your
provider. (Tis applies to the Dependent
Care FSA only.)
Any changes you make must be due to
and consistent with your qualiying event.
o satisy this ederally required consistency
rule, your qualifed change in status and
corresponding change in coverage must meet
both o the ollowing requirements:
Eect on eligibility. Except or the
Dependent Care FSA, the qualifed change
in status must aect eligibility or coverage
under the plan or under a plan sponsored
by the employer o your spouse or other
dependent. For this purpose, eligibility or
coverage is aected i you become eligible
(or ineligible) or coverage or i the qualifed
change in status results in an increase or
decrease in the number o your dependents
who may beneft rom coverage under the
plan.
For the Dependent Care FSA, thequalifed change in status must aect the
amount o dependent care expenses eligible
or reimbursement. For example, i your
child reaches age 13, his or her dependent
care expenses are no longer eligible or
reimbursement. (Please note, i your child
turns 13 during the year, you cannot stop or
change your contribution at that time.)
Corresponding election change. Te
election change must correspond with the
qualifed change in status. For example, i
your dependent loses eligibility or coverage
under the terms o the University Health
Care Plan, you may cancel health care
plan coverage only or that dependent.
Additionally, you may change or begin
contributions to your Health Care or
Dependent Care FSA i you have or adopt
a child or a child is placed with you or
adoption. Te Plan Administrator will
determine whether a requested change is due
to and consistent with a qualifed change in
status.
Note: When changing due to a qualiying
event, your FSA annual election cannot
be reduced below the amount o payroll
contributions already deducted or the
calendar year, and the change must be
consistent with the qualiying event.
Changing Your BeneftsHealth Care Plans, Dental Plans, FSA and HSA
HOW TO CHANGE YOURCOVERAGEIf you need to change your
coverage because of a qualifyingevent, you will need to completean enrollment/change form andreturn the completed form to the
UR Benets Ofce within 30 daysof the qualifying event (or within60 days for Medicaid or CHIPeligibility events). Coverage willbe effective on the date of eventor date the form is completed,whichever is later. Coveragechanges due to birth, adoption,or placement for adoption will beeffective on the date of the event.
QUALIFYING EVENTSFor more information, please
see Appendix A.
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NOTE:If you terminate coverage under theUniversity HSA-Eligible Plan as the resultof a qualifying event, any contributionsto your HSA via payroll deduction will
stop on the effective date (see If youterminate or change to an ineligible
status, on page 53).If you enroll for coverage under theUniversity HSA-Eligible Plan as theresult of a qualifying event, you maybe eligible to contribute to a LimitedPurpose Health Care FSA and anHSA; however, the HSA contributionmaximums (see page 33) are pro-ratedif you will be covered by the UniversityHSA-Eligible Plan for less than 12 monthswithin the 2011 calendar year.
Depending on the circumstances, you may
also be able to make changes throughout the
year or the ollowing reasons:
Court judgment, decree, or order to provide
coverage to a dependent.
COBRA events.
An eligible dependent drops his or her
coverage rom another employers planduring an open enrollment period which is
dierent than that o the Universitys.
Commencement or return rom FMLA leave.
Medicaid entitlement by you, your spouse or
dependent.
HIPAA Special EnrollmentPeriod ChangesYou can request (within 30 days) to enroll in the
plan or enroll your amily members i:
You or your amily members lose other group
health plan coverage,
You marry, or
You gain a new dependent because o birth,
adoption or placement or adoption.
You can request (within 60 days) to enroll in
the plan or enroll your amily members i you or
your amily member:
Lose Medicaid or Childrens Health Insurance
Program (CHIP) coverage because you are no
longer eligible, or
Become eligible or a states premium
assistance program under Medicaid or CHIP.
Unlike qualiying event changes, the
consistency rule described on page 6 o this
guide does not apply to your HIPAA special
enrollment periods. You can make changes in
your health care plan enrollment, but not your
Health Care FSA elections (unless a qualiying
event would allow Health Care FSA election
changes).
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At the University o Rochester, we believe that we all have the
power to improve our lives by investing in our health and
wellness. Becoming healthier not only reduces risk or disease and
helps us live longer, it also helps us live better.
The University is committed to promoting a culture of wellness. We have
already taken steps to offer opportunities to improve your health. We have
added Personal Health and Wellness Programs, tobacco dependence and other
lifestyle management programs through the Healthy Living Center, onsite
programs for stress management and weight management, indoor walking
routes, and more choices for faculty and staff to eat healthy.
We encourage you to make a commitment to yourself and your family to
become healthier. You can become a WellU champion and promote wellnesswithin your department. The University also encourages you to participate in
educational awareness campaigns throughout the year, including Go Red Day,
National Health Care Directives Day, National Trails Day, Eat Well Live Well and
National Start! Walking Day.
It is up to you to take the steps to better health, but you do not have to do
it alone. The University provides the support, tools and resources to help you
achieve your health goals.
Health & Wellness at theUniversity o Rochester
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Te University o Rochester oers a variety o programs and services that can help you maintain
a healthy liestyle or manage a health care condition. You can use these programs and services to:
Programs & Services to Help YouGet Healthy and Stay Healthy
PERSONAL SUPPORT FORYOU AND YOUR FAMILYCal l 1-877-598-3967 to speak
with a Wellness Coach about
the programs and services
listed here.
Preventive Care
Biometric Screening
PersonalHealthAssessment
Wellness Coach
Onsite Wellness Programs
Employee AssistanceProgram
Personal Health andWellness Programs
Nurse Line
Case Management
Healthy Living Center
Health ProgramDecision Guide
Health Plan Cost Estimator
Educational Sessionsand Workshops
Employee PharmacyDiscounts
Generic PrescriptionDrug Savings
Copay Waiver for Switchingto Generic PrescriptionDrugs
Mail Order forMaintenance PrescriptionDrugs
Discounts on PrescriptionDrugs for CertainDiagnoses
TPA Online Services
TPA Member Discounts
Personal Health Record
Use your health caredollars effectively andmake informed decisionsabout what care you need.
USE YOUR HEALTHCARE DOLLARSEFFECTIVELY
EDUCATEYOURSELF
Educate yourself aboutavailable health programsand become a condent,active consumer.
TAKE CHARGEOF YOUR HEALTH
Take charge of yourhealth and achievea healthier lifestyle.
THE WELLU MISSIONWellU, our award winning
wellness program, can
help improve the health
and wellness of Universityemployees by promoting
a work environment that
encourages healthy behaviors
and by providing the tools,
resources, and education
necessary to support
healthy living.
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Take charge o your health
and achieve a healthier liestyle.
Know Your Numbers: Get a Free Biometric ScreeningWellU sponsors biometric screenings or University aculty and sta, as well as eligible depen-
dents. Individuals will be required to show their University ID in order to receive services.
Screening appointments can be scheduled by contacting the School o Nursing, located at Helen
Wood Hall. o make your appointment, contact Christine Withers by calling 1-585-273-2360 or
emailing [email protected]. Specifc biometric screening services pro-
vided are:
Blood pressure
Heart rate
WeightBMI
otal cholesterol, HDL, triglycerides and glucose
Waist circumerence
You will receive your results immediately, along with educational materials and the opportu-
nity or brie health counseling, i appropriate. You will also receive an individual recording card
to document your screening results. Use your screening results to complete your Personal Health
Assessment and see what areas o your health you may need to improve. Share the results with
your doctor and talk to him or her about the next steps to take.
Take the Personal Health AssessmentTe University invites you to stay healthy and ft with the help o a ree oeringthe Personal
Health Assessment. Te Personal Health Assessment is a ast and easy online tool that helps you
gauge your current level o health and wellness through a series o questions about your liestyle.
Your answers help to identiy potential risks or health conditions and the areas where you can
make healthy improvements. Upon completion, you will receive a comprehensive, personalized,
and confdential Personal Health Assessment Report that oers suggestions on how to achieve
a healthier liestyle. You can share the results o your Personal Health Assessment with your
physician and communicate about your personal health goals. You also will have access to
Personal Wellness Programs and resources recommended just or you.
YOUR PRIVACY IS PROTECTEDThe Personal Health Assessment is administered by Carewise Health, an independent third-party
administrator. The personal health information you supply is completely condential, protected byfederal law, and cannot be divulged to anyone without your permission. The University will only
be provided with aggregate data for the University population as a whole, for the sole purpose of
performing program analysis.
COVERAGE FOR PREVENTIVE SERVICESYour plan covers the preventive services listed in our Preventive Services Guide at 100% as part of
preventive care that includes routine screenings and regular checkups, routine gynecological visits
and well-child exams. You wont have to pay out-of-pocket for these preventive visits unless you
get services not listed at the same time. But, these services are not preventive if you get them
as part of a visit to diagnose, monitor or treat an illness or injury. Then, copays, coinsurance and
deductibles apply.
GET REWARDED FOR TAKINGTHE PERSONAL HEALTHASSESSMENTTo help encourage you to make
an important investment in your
health, the University offers a
$100 incentive if you complete
the Personal Health Assessment.
You and your spouse/domestic
partner (if enrolled in a UniversityHealth Care Plan) may receive this
incentive. In order to be eligible,
you must make sure you enter
your biometric numbers in the
appropriate section of the PHA.
As an added incentive,
employees that complete the
PHA by March 31, 2011 will
receive an additional $25.
NOTE:
The monetary incentiveis considered taxable and will
be subject to normal wage with-
holding. Employees, as well as
spouses/domestic partners, are
eligible for the incentive only
once during the plan year that
runs from January 1 to December
31. SEIU members may take the
Personal Health Assessment,
but are not eligible to receive
the incentive.
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Work with a Wellness CoachWhen you have a health question and you are not sure what to do, you can ask a Wellness Coach.
Wellness Coaches can answer your questions, discuss your options, and empower you to make
inormed decisions. For more inormation, questions, or i you would like to speak to a health
coach, call 1-877-598-3967.
Participate in WellU ProgramsTrough WellU, the Universitys employee wellness program, you have the opportunity to
participate in valuable onsite programs including:
Fitness challengesFlu shots
Lunch and learns
Stress management workshops
Walking clubs
Weight Watchers
Weigh-Well
Yoga
Tese programs are available at numerous locations throughout the University and at o-site
locations, making it convenient or you to participate. For more inormation about WellU, visit
www.rochester.edu/well-u.
Use the Employee Assistance ProgramUse the Employee Assistance Program (EAP) to manage issues that aect your health and
well-being. Strong EAP provides confdential and immediate help with marital and relationship
issues, amily problems, drug and alcohol addictions, stress, fnancial and legal concerns, and
many other issues that can impact the ability o you and your amily members to cope eectively
at home or at work.
You can speak confdentially with experienced counselors who will help you understand your
options. When appropriate, a counselor will reer you to outside resources, such as a community
support group or a licensed behavioral health proessional. Best o all, Strong EAP services
are ree o charge. For more inormation about the EAP, visit www.urmc.rochester.edu/eap/
or call 1-585-475-0432.
Call the Nurse Line or Health Care AssistanceWhen you have a health question and youre not sure what to do, you can call the Nurse Line at
1-877-598-3967, 24 hours a day, seven days a week. Te Nurse Line provides direct access to registered,
specially trained nurses who can help answer your questions, discuss your options, answer beneft
and claims questions, and empower you to make inormed decisions. A nurse can also help
prepare you or your next doctors oce visit by providing you with meaningul questions to discuss
with your doctor. You can also call the Nurse Line or general health inormation, wellness and
prevention education, tips and advice on nutrition, exercise and weight loss, and chronic condition
support.
LEARN ABOUT THE UNIVERSITYS WELLNESS PROGRAMSCheck out the Universitysemployee wellness initiative,
WellU. For more information,go to www.rochester.edu/well-u,call 273-5240, or email well-u-
UNIVERSITY OF ROCHESTERSHEALTHY LIVING CENTERYou may be able to par ticipatein a coaching program throughin-person, one-on-one sessions,small groups, or over the phonefor help with: Quitting tobacco Diabetes prevention Controlling cholesterol
Managing stress
Carewise Health and the HealthyLiving Center will work togetherto help determine the programthat best ts your needs. Formore information, call1-877-598-3967.
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Take charge o your healthand achieve a healthier liestyle Continued
Take Advantage o a Personal Health Management ProgramI you need some guidance to make healthy changes or to help manage a chronic condition, the
University has partnered with Carewise Health to oer you Personal Wellness and Personal Health
Programs to help. Tese programs give you the tools and inormation you need to achieve more
optimal health and better manage chronic conditions. You will learn how to make appropriate
liestyle choices and changes and reduce symptoms related to chronic conditions. When you learn
how to improve and manage your health, you will fnd yoursel leading a happier, healthier lie.
Te Personal Health Programs can help you manage:Asthma
Chronic obstructive pulmonary disease (COPD)
Diabetes
Low back pain
Heart disease
And more
Note: Select individuals managing a chronic condition through the Personal Health Management
program may qualiy or reduced copays or their medications.
Te Personal Wellness Programs can help you manage:
Stress
Physical Inactivity
Weight
Nutrition
And more
Additionally, you can receive guidance on and learn how to:
Get the treatment and preventive care you need
Understand and ollow your doctors treatment plan
Better manage your ongoing conditions
Make changes to reach your personal health goals
Identiy and manage your risks or other conditions
You may qualiy or a $100 cash incentive i you successully complete a Personal Health and/
or Wellness Program. Tis means you can earn up to $200 i you participate in both programs.
o be eligible, you must be a regular ull-time or part-time aculty or sta member enrolled in a
University Health Care Plan. You will also be required to complete the biometric results section o
the PHA in order to receive the incentive. I this section is not flled in with your results, you can
not receive the incentive. Spouses/domestic partners who are enrolled in a University Health Care
Plan also qualiy or the incentive.
Note: SEIU members may participate in a Personal Wellness Program, but are not eligible or
the incentive or a Personal Health Program. Te cash incentive is considered taxable and will be
subject to normal wage withholding. Faculty and sta, as well as spouses/domestic partners, are
eligible or the incentive only once during the plan year that runs rom January 1 to December 31.
A WELLNESS COACH ORNURSE ADVOCATEWellness coaches and nurse advo-
cates are available for you when-
ever you need health information
or decision support. Coaches also
may reach out to you by phone
to introduce a health care plan
service and offer information and
support if you or a covered de-
pendent has an illness or ongoing
medical condition.
The Personal Health and Personal
Wellness programs are adminis-
tered by Carewise Health, an inde-
pendent third-party administrator.
The personal health information
you provide and any conversations
you have with a coach or nurse
are completely condential, pro-
tected by federal law, and cannot
be divulged to anyone without
your permission.
JUST FOR YOUParticipate in the Personal
Health and Wellness Programs.
You can call Carewise Health at
1-877-598-3967 to get star ted or
get your questions answered.
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Educate yoursel about available health programsand become a confdent, active consumer.
Use your health care dollars eectively and make
inormed decisions about what kind o care you need.
Review Your 2011 Health Program Decision GuideTis Decision Guide outlines your Health Program beneft options and highlights other
programs and services that are available to you. Review the Guide to fnd out how you can use
your beneft plans and programs to achieve better health and to help control health care costs.
Use the Health Plan Cost Estimator to Choose a Health Care PlanTe University Health Plan Cost Estimator (HPCE) is designed to give you a general idea o what
your health care costs may be under each o the University Health Care Plans. Te tool helps
you determine the coverage option that may provide the best value or your money, actoring
in payroll deductions and the cost o your anticipated health care needs or the year. For more
inormation about the HPCE, see page 26.
Attend Educational SessionsAttend the University Health Care Plan educational sessions sponsored by the UR Benefts Oce
to help you better understand and learn how to get the most out o your health care plan. Check
the UR Benefts website at www.rochester.edu/benefts/health or dates and times.
Take Advantage o Discounts at the URMC Employee PharmacyIf you are enrolled in the University High Deductible, Low Deductible, and Copay Plans ,
you will receive a 25% reduction in copays, or coinsurance or prescription diabetic supplies.
If you are enrolled in the University HSA-Eligible Plan, you will receive a discount o the
usual out-o-pocket cost o each medicine prior to reaching your deductible, and then the 25%
reduction in copays once your deductible has been met.
Under all of the University Health Care Plans, the URMC Employee Pharmacy can fll 90-day
supplies o maintenance drugs (normally, these are only flled by mail order) at a 25% reduction
in copays. Note: I you are enrolled in the University HSA-Eligible Plan, you will receive the
25% reduction in copays aer the plan deductible has been met. Beore reaching the deductible,
you will receive an applicable discount on your out-o-pocket prescription drug costs.
I you work in an o-campus location, you may be able to have your prescriptions delivered to
your workplace. Eective January 1, 2011, the URMC Employee Pharmacy will oer this ree
service to University employees working in the ollowing o-campus locations: River Campus,
Corporate Woods, Clinton Crossings, Brooks Landing, Eastman School o Music, and Red
Creek. Tese are initial o-campus locations with delivery service. Delivery services will be
expanded to other University o-campus locations at a later date. Also, you do not need to be
enrolled in one o the Universitys Health Care Plans to take advantage o this great service.
Payment will be limited to credit cards only and will be processed through an online system.
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Use your health care dollars eectivelyContinued
More inormation will be coming soon!
Switch to GenericsGeneric drugs are identical to brand name drugs in dosage, saety, strength, quality, and
intended use. Since generics use the same active ingredients and are shown to work the same way
in the body as their brand name counterparts, they have the same benefts and risks.
When you receive generic drugs instead o preerred brand or non-preerred brand drugs,
you will see signifcant savings in your prescription drug copays. In act, under some University
Health Care Plans, a generic drug will cost you less than hal the price o a preerred brand
drug. Additionally, i you choose a brand name drug when a generic equivalent exists, you
will be responsible or the copay plus the cost dierence between the brand name and genericequivalent, even i your doctor prescribes a brand name drug.
Take Advantage o the Generic Drug Copay Waiver ProgramsGeneric Drug Copay Waiver Programs, oered through your PA, provide a waiver or
prescription drug copays or up to six months i you switch to certain generic medications
rom selected brand name drugs. You can call your PA to fnd out i your current medications
are eligible or this beneft. Your PA also may contact you about any prescription drugs you
currently take that may be eligible.
Use the Mail Order ProgramFor prescriptions greater than a 30-day supply, you will need to use your PAs mail order
program, unless you use the URMC Employee Pharmacy. Trough the mail order program, you
can receive a 90-day supply o your prescription or two-and-a-hal times the retail price. Tat is
three times the supply or only two-and-a-hal times the price. (You can receive a 90-day supply
o your prescription at a 25% reduction in copays i you use the URMC Employee Pharmacy.
I you are enrolled in the University HSA-Eligible Plan, you will receive the 25% reduction in
copays aer the plan deductible has been met.) Te mail order program is convenient to use, and
is an easy way to save money on your prescription drugs. Please note, when using mail order or
prescriptions greater than a 30-day supply, you should inorm your physician to write a mail
order prescription or a 90-day supply.
Receive Prescription Drug Discounts or Certain DiagnosesI you have asthma, diabetes, hypertension, coronary heart disease or congestive heart ailure,
you have an opportunity to receive a $10 discount o o your prescription drugs, or a 25%
discount on coinsurance or prescription diabetic supplies to treat these conditions under the
University Health Care Plans. All you need to do is enroll and complete the Personal Health
Program or asthma, diabetes, hypertension, or heart disease. You can call Carewise Health at
1-877-598-3967 or more inormation. Note: I you are enrolled in the University HSA-Eligible
Plan, you must pay the ull cost o prescriptions until you meet the deductible. Once met, you
will then qualiy or the discounted prescription drug program.
NEW PHARMACY BENEFITS
MANAGER FOR 2011Effective April 1, 2011, Excellus
will be the Pharmacy Benets
Manager (PBM) for the
prescription drug coverage under
each of the Universitys four
health care plans, regardless
of the TPA (Aetna or Excellus)
you select. You will receive a
separate Pharmacy Benets
card prior to April 1. If you are
enrolled with Aetna as your
TPA, your health care coverage
will not be impacted, and you
will be transitioned to the new
PBM with no gap in care. Details
about the transition to the new
PBM and how it may affect
things like FSA reimbursement,
maintenance medications and
mail order, will be available
shortly, and will be sent to you
in a separate communication as
soon as possible.
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Access Online Services rom the TPAsAetna and Excellus both provide an array o online services, programs, and member discounts.
Here are a ew o the available benefts under each third-party administrator (PA).
AETNA WWW.AETNA.COM
Research over 6,000 health topics using Healthwise Knowledgebase.
Get inormation on health and wellness, diseases and conditions and much more through Aetna
InteliHealth.
Download a Health History Report that will list your claims history.
Call Aetnas Inormed Health Line or access to registered nurses 24 hours a day, 7 days a week.
Nurses provide inormation about health issues, medical procedures and treatment options, andhelp you communicate more eectively with your doctor.
Use Aetna Pharmacy to fnd a pharmacy, look up your claim status, learn about a drug and drug
saety, order prescriptions, and more.
Locate doctors and other health care proessionals in your area who participate in your plan
through DocFind.
Use the Cost o Care calculator to estimate the cost o your next medical visit.
Print temporary ID cards.
EXCELLUS WWW.EXCELLUSBCBS.COM
Research over 6,000 health topics using Healthwise Knowledgebase.
Learn to live a healthier liestyle with Health Improvement Programs to help you
change your habits.
Use the Personal Health Record to store your health inormation online or easy access.
Use the Healthcare Advisor to estimate treatment costs, evaluate treatment options, compare
drugs, and more.
Have un and learn something new with weekly Health Quizzes.
Locate doctors and other health care proessionals in your area who participate in your plan
through Find a Doctor.
Print temporary ID cards.
Use Member Discounts rom the TPAsAetna eatures discounts on health and wellness programs and products.
Excellus oers discounts on health and wellness, amily care, fnancial well-being, and travel
services through Blue365.
Use your Personal Health Record to Make Smart Health Care DecisionsI you are enrolled in a University Health Care Plan through Aetna, you can download a Health
History Report rom Aetna Navigator. Te Health History Report will include details regard-
ing any claims that you and your covered dependents have incurred under your plan and can be
exported to an Excel spreadsheet or sorting and printing.
I you are enrolled in a University Health Care Plan through Excellus, you and your covered
dependents each have access to your own online Personal Health Record. Tis confdential
resource will store any claims inormation you enter and provide you with convenient access to a
range o health data. You can store your amilys health inormation online or easy access. And,
you can print a report to take to your next doctors appointment or when you travel.
Use your health care dollars eectivelyContinued
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The plans available through the University Health Program can help
you be a better health care consumer. The key is to use these plans
to change your behaviorby becoming more involved in your health,
taking more responsibility or making smart health care decisions, making
healthy liestyle choices, and using your benefts wisely.
The choices you make todaywhether selecting health care coverage for you
and your family for the upcoming year, or deciding when and how to use healthcare services on a day-to-day basishave a direct impact on the health care costs
you and the University pay tomorrow.
Health ProgramHealth Care Plans, Dental Plans, FSA and HSA
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Te University o Rochester oers our health
care plans that ocus on eatures that support the
Universitys goals o ostering a culture o well-
ness, reducing health care expenses, and having
aculty and sta take an active role in managing
personal health. ake some time to understand
the our dierent plan options available to you, so
you select the plan that is cost-eective and appro-priate or your needsand those o your amily.
Your Health Care Plan OptionsYou can choose rom the ollowing options:
University High Deductible Plan
University Low Deductible Plan
University HSA-Eligible Plan
University Copay Plan
You also may choose to waive health
care coverage.
How the Health Care PlansAre AlikeAll four plans:
Are PPOsPreerred Provider Organiza-
tions. By enrolling in a PPO, you get access
to a nationwide network o doctors, hospitals
and treatment acilities that have agreed to
charge lower, negotiated rates or care. You
can choose to receive care in or outside o the
PAs network.
Cover the same types o services and supplies.
Have a broad choice o networks o doctors,
hospitals and service providers oered by
each o two dierent PAs.
A Primary Care Physician (PCP) is not
required, but it is recommended that you
select one, and reerrals are not required or
specialists or other necessary health care
services.
Emphasize preventive care with 100%
in-network coverage to encourage regular
check-ups and wellness services. o learn
more about preventive care, see Manage Your
Health with Well Visits and Screeningson
page 13 and the 2011 Preventive Care Services
document online at www.rochester.edu/
benefts/health. Note: All care is subject to
meeting the clinical policies established by the
PA who administers your University Health
Care Plan.Require you to pay more i you choose a brand
name drug when a generic equivalent exists.*
You will be responsible or the copay plus
the cost dierence between the brand name
and generic equivalent, even i your doctor
prescribes a brand name drug.
Provide similar discounts or a 90-day supply
o prescription drugs through the Employee
Pharmacy and mail order program.
Require you to purchase specialty drugs rom
selected PA specialty vendors.
Will decrease your copays or the out-o-
pocket cost or prescription drugs that are
flled at the Employee Pharmacy.
How the Health Care Plans DierTe health care plan options vary when it
comes to what you pay or:
Your monthly employee contributions or
the plan option you choose, and
Your deductibles, coinsurance, copays and out-
o-pocket maximums when you receive care.
Additionally, the options oer dierent pre-
tax accountsthe University HSA-Eligible Plan
includes the option to contribute to a Health
Savings Account (HSA) and a Limited Purpose
Health Care Flexible Spending Account (FSA),
while the other three plans allow you to con-
tribute to a Health Care FSA.
*Tis provision will not apply if a generic drug is considered to beineective, not available through a retail pharmacy or consideredto cause dangerous side eects.
Your Health Care Plan Choices or 2011
Choosing a PAWhen you elect a health care
plan, you get to choose which
third-party administrator (TPA)
will administer your plan
either Aetna or Excellus BlueCrossBlueShield.
You may want to consider thenetwork availability when choos-ing your TPA. The TPAs haveeach contracted with in-networkproviders to offer health careservices at negotiated, discountedfees. To nd out if your physician,or other providers and facilitiesare members of either the Aetnaor Excellus network, visit theirnetwork directories online at:
AETNAwww.aetna.comSelect Find a Doctor. Completethe information. Note: Underthe Select a Plan drop-downmenu, choose the AetnaChoice POS II (Open Access)option that appears underthe Aetna Open Access Plansblue bar.
EXCELLUSwww.excellusbcbs.comSelect Find a Doctor(located
at the bottom of the page),then click on NationwideProvider Search-BlueCard.
TO LEARN MORE ABOUTTHE DIFFERENCES BETWEENEACH TPA, TURN TO PAGES24 AND 25.
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I you enroll in the University HSA-Eligible
Plan, but do not elect to have an HSA, you
can elect to contribute to a Health Care FSA.
You can only contribute to a Limited Purpose
Health Care FSA i you elect to contribute to an
HSA.
Deductibles/Out-o-Pocket MaximumsTe University High Deductible, Low
Deductible, and Copay (or out-o-network care
only) Plans include embedded single and amily
deductibles and out-o-pocket maximums.
I you are enrolled in any o these plans or
Employee and Child(ren), Employee and
Spouse/Domestic Partner or Family coverage,
once one amily member satisfes the single
deductible, the plan will begin to reimburse
eligible health care expenses or that amily
member. Te same rule applies to the out-o-
pocket maximum. Any combination o eligible
expenses or covered amily members can be
used to meet the amily annual deductible/out-
o-pocket maximum at which point all amily
members will have met the deductible/out-o-
pocket maximum requirements.
Te University HSA-Eligible Plan requires
that the amily deductible be met or any
coverage level other than Single, beore plan
payments will begin.
Similarly, the University HSA-Eligible Plan
requires that the out-o-pocket maximum be
met or any coverage level other than Single,
beore the plan will cover expenses at 100%.
How the Plans WorkWhen you visit a network provider, the plans pay
more o your expenses. Plus, under all our plans,
you do not need to select a primary care physician
or secure reerrals to see a specialist or obtain
other medically necessary health care services.
Each time you receive care, you select a
provider o your choice. Te provider can be in-network or out-o-network based on the PAs
network. I you select an in-network provider,
the money you pay out-o-pocket is less. Please
reer to page 28 or more inormation.
What the Plans Cost YouYou pay or health care coverage with pre-tax
dollars through automatic payroll deductions
(please reer to the Special Note regarding
Domestic Partner and Same-Sex Legal Spouse
Coverage on page 4). Te amount o your
payroll deductions depends on whether you
are paid bi-weekly, semi-monthly or monthly.
o view the costs or each plan, visit
www.rochester.edu/benefts/health.
Your employee contributions depend on
whether you are ull-time or part-time and
vary by salary and coverage level. I your salary
changes mid-year, you will not move to a new
salary band (your employee contributions will
not change). I you switch rom ull-time to
part-time or vice versa, you will move to a new
salary band (your contributions will change).
For University o Rochester retirees, health
care and dental premiums vary depending on
the post-retirement level o the aculty or sta
member. o view costs or each plan, visit
www.rochester.edu/benefts. Select Employment
Changes, then select Retirement.
Note: For University o Rochester retirees, the
Universitys share, i any, o the health care and
dental premiums varies depending on the post-
retirement level o the aculty or sta member.
EXAMPLE OF EMBEDDEDFAMILY DEDUCTIBLEFor example, if you are a family
of four (yourself, your spouse/
domestic partner, and two
children), and you are enrolled
in the University Low Deductible
Plan, the deductible would workas follows:
If you receive in-networkcare and satisfy the singledeductible of $200, the planwill begin to pay coinsurancefor you.If your spouse/domesticpartner receives health careservices and satises hisor her single deductible of$200, the plan will begin topay coinsurance for him orher. So far, you have applied
$400 to the $500 familydeductible, because the single
deductibles count towards thefamily deductible.This means that when thenext person in your familyreceives health care services,he or she only has to pay $100before the plan begins to paycoinsurance, because yourfamily will have met the $500deductible.Once the $500 familydeductible is satised, allmembers will be subject tocoinsurance with no furtherdeductible requirements,assuming care is received
in-network.
The out-of-pocket maximums
follow the same pattern as the
deductibles.
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Tese charts provide a high level overview
o the main eatures o each plan.
University High Deductible PlanI you choose the University High
Deductible Plan, you will be subject to
a higher deductible and out-o-pocket
maximum than the University Low
Deductible Plan and the University Copay
Plan; however, you will have lower payroll
deductions or coverage. As a member othis plan, you may also contribute to a
Flexible Spending Account (FSA).
University Low Deductible PlanI you elect the University Low Deductible
Plan, you will have a lower deductible
and out-o-pocket maximum than the
University High Deductible Plan and the
University HSA-Eligible Plan; however,
you will have higher payroll deductions
or coverage. As a member o this plan,you may also contribute to a Flexible
Spending Account (FSA).
University Health Care PlansAn Overview
University High Deductible Plan
Preventive Care1 not covered out-of-network 100%, No deductible
Deductible2
Rx not includedSingle Family6
In-Network $500 $1,250
Out-of-Network $1,000 $2,500
Coinsurance (Plan pays)
In-Network 80%
Out-of-Network 60%
Out-o-Pocket Maximum3 Single Family6
In-Network $2,000 $5,000
Out-of-Network $4,000 $10,000
Full-time Faculty and Staff Earning Less than $44,100
In-Network $1,500 $3,750
Out-of-Network $4,000 $10,000
Lietime Maximum Unlimited
Prescription Drugs4Not subject to d eductible or out-of-pocket maximum/Not covered out-of-network
Retail (up to 30-days supply) $10/$25/$40
Mail Order (90-days supply)5 2.5 times retail ($25/$62.50/$100)
Health Care FSA $6,500 limit
1 See page 13 for more information. 2 Deductible cross applies in- and out-of-network. 3 Eligible expenses crossapply in- and out-of-network.4 If you are prescribed a brand name drug when a generic equivalent exists, youwill be responsible for the copay plus the cost difference between the brand name and generic equivalent.Specialty drugs must be lled at your TPAs designated pharmacy. Specialty drugs do not qualify for the pricingdiscount available through mail order prescriptions. 5 90-day supplies of maintenance drugs lled at URMCEmployee Pharmacy are eligible for a 25% reduction in copays. 6 For Family coverage, individual deductiblesand out-of-pocket maximums apply to any individuals claims. However, when the sum of any combination ofindividual deductibles or out-of-pocket maximums reaches the family level, the family deductible or out-of-pocket maximum will be met for all family members.
University Low Deductible Plan
Preventive Care1 not covered out-of-network 100%, No deductible
Deductible2
Rx not includedSingle Family6
In-Network $200 $500
Out-of-Network $400 $1,000
Coinsurance (Plan pays)
In-Network 90%
Out-of-Network 70%
Out-o-Pocket Maximum3 Single Family6
In-Network $1,500 $3,750
Out-of-Network $3,000 $7,500
Full-time Faculty and Staff Earning Less than $44,100
In-Network $1,000 $2,500
Out-of-Network $3,000 $7,500
Lietime Maximum Unlimited
Prescription Drugs4Not subject to deductible or out-of-pocket maximum/Not covered out-of-network
Retail (up to 30-days supply) $10/$20/$35
Mail Order (90-days supply)5 2.5 times retail ($25/$50/$87.50)
Health Care FSA $6,500 limit
1 See page 13 for more information. 2 Deductible cross applies in- and out-of-network. 3 Eligible expenses crossapply in- and out-of-network.4 If you are prescribed a brand name drug when a generic equivalent exists, youwill be responsible for the copay plus the cost difference between the brand name and generic equivalent.Specialty drugs must be lled at your TPAs designated pharmacy. Specialty drugs do not qualify for the pricingdiscount available through mail order prescriptions. 5 90-day supplies of maintenance drugs lled at URMCEmployee Pharmacy are eligible for a 25% reduction in copays. 6 For Family coverage, individual deductiblesand out-of-pocket maximums apply to any individuals claims. However, when the sum of any combination ofindividual deductibles or out-of-pocket maximums reaches the family level, the family deductible or out-of-pocket maximum will be met for all family members.
REMINDEREffective April 1, 2011, Excellus will be
the Pharmacy Benets Manager (PBM)
for all prescription drug plans, and
the Excellus formulary will be used todetermine the level of copay(s).
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University HSA-Eligible PlanTe University HSA-Eligible Plan diers
rom the other three plan options in that
it has:
Te highest deductible levels,
Te option to contribute to a Health
Savings Account (HSA), a tax-ree
savings account or health care, andTe lowest payroll deductions.
See A Closer Look at the HSA on page
33 or how this plan works.
University Copay PlanI you select the University Copay Plan, you
will have the highest payroll deductions,
but you will generally pay the lowest cost
or services when you receive care. As
a member o this plan, you may also
contribute to a Flexible Spending Account
(FSA).
For a more detailed look at the our
plans, turn to pages 22 and 23.
University HSA-Eligible Plan
Preventive Care1 not covered out-of-network 100%, No deductible
Deductible2
Rx includedSingle Family7
In-Network $1,200 $2,400
Out-of-Network $1,200 $2,400
Coinsurance (Plan pays)
In-Network 80%
Out-of-Network 80%
Out-o-Pocket Maximum3
Rx included/Includes deductibleSingle Family7
In-Network $2,400 $4,800
Out-of-Network $2,400 $4,800
Lietime Maximum Unlimited
Prescription Drugs4Subject to deductible and out-of-pocket maximum/Not covered out-of-network
Retail (up to 30-days supply) $10/$30/$50
Mail Order (90-days supply)5 2.5 times retail ($25/$75/$125)
Health Savings Account6 Single Family
$3,050 $6,150
Limited Purpose Health Care FSA $6,500 limit
1 See page 13 for more information. 2 Deductible cross applies in- and out-of-network. Family deductible doesnot contain embedded individual deductible. 3 Eligible expenses cross apply in- and out-of-network. 4 If you areprescribed a brand name drug when a generic equivalent exists, you will be responsible for the copay plus the costdifference between the brand name and generic equivalent. Specialty drugs must be lled at your TPAs designatedpharmacy. Specialty drugs do not qualify for the pricing discount available through mail order prescription. 5 90-daysupplies of maintenance drugs lled at URMC Employee Pharmacy are eligible for a 25% reduction in copays. 6 Themaximum HSA contribution amount is pro-rated if you are not covered by the plan for the full year. 7 Plan requiresthat the family deductible be met for any coverage level other than Single, before plan payments will begin, andsimilarly, out-of-pocket maximum must be met before the plan covers expenses at 100%.
University Copay Plan
Preventive Care1 not covered out-of-network 100%, No copay
DeductibleRx not included
Single Family
In-Network None
Out-of-Network $400 $1,000
Coinsurance (Plan pays)
In-Network 100%
Out-of-Network 70%
Out-o-Pocket Maximum2
Rx not included/Includes deductibleSingle Family
In-Network None
Out-of-Network $3,000 $7,500
Copay PCP Specialist
In-Network $20 $30
$250 inpatient admission copay
Out-of-Network Subject to deductible and coinsurance
Lietime Maximum Unlimited
Prescription Drugs3Not subject to deductible or out-of-pocket maximum/Not covered out-of-network
Retail (up to 30-days supply) $10/$20/$35
Mail Order (90-days supply)4 2.5 times retail ($25/$50/$87.50)
Health Care FSA $6,500 limit
1 See page 13 for more information. 2 Eligible expenses cross apply in- and out-of-network. 3 If you areprescribed a brand name drug when a generic equivalent exists, you will be responsible for the copayplus the cost difference between the brand name and generic equivalent. Specialty drugs must be lled atyour TPAs designated pharmacy. Specialty drugs do not qualify for the pricing discount available throughmail order prescription. 4 90-day supplies of maintenance drugs lled at URMC Employee Pharmacy also areeligible for a 25% reduction in copays after the plan deductible has been met. Before reaching the deductible, adiscount on out-of-pocket prescription drug costs applies.
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University High Deductible Plan University Low Deductible Plan
In-Network Out-of-Network In-Network Out-of-Network
COVERAGE
Deductible (single/family) $500/$1,250 $1,000/$2,500 $200/$500 $400/$1,000
Coinsurance Plan pays 80% Plan pays 60% Plan pays 90% Plan pays 70%
Out-of-Pocket Maximum1(single/family)
$2,000/$5,000$1,500/$3,7502
$4,000/$10,000$1,500/$3,750$1,000/$2,5002
$3,000/$7,500
Lifetime Maximum Unlimited Unlimited
FSA/HSA FSA maximum: $6,500 FSA maximum: $6,500
PREVENTIVE CARE SERVICESNOTE: CHECK WITH YOUR TPA BEFORE SEEKING PREVENTIVE CARE TO ENSURE THE SERVICE IS CONSIDERED PREVENTIVE.
Physicals, Well-Baby/Well-Child Exams, Etc.
In-network: Plan pays 100%, no deductible or copay Out-of-network: Not covered
PRESCRIPTION DRUGS3 GENERIC/PREFERRED BRAND/NONPREFERRED BRANDNOTE: RECEIVE A URMC EMPLOYEE PHARMACY DISCOUNT. SEE PAGE 15.
Retail (up to 30-days supply) $10/$25/$40 copay Not covered $10/$20/$35 copay Not covered
Mail Order (up to 90-days supply)5 2.5 times 30-day retail copay N/A 2.5 times 30-day retail copay N/A
Prescription Diabetic Supplies Plan pays 80% (nodeductible) Not covered Plan pays 90% (no deductible) Not covered
OTHER SERVICES
Ofce Visit/Ofce Care
Plan pays 80% aterdeductible
Plan pays 60% (up to R&C)ater deductible
Plan pays 90% aterdeductible
Plan pays 70% (up to R&C)ater deductible
Specialist Visit/Specialist Care
Inpatient Admission (facility)
Diagnostic X-ray
Lab & Pathology;Chemotherapy/Radiation Therapy
Auditory Exam (limit 1 per year)
Physical, Speech, andOccupational Therapy(combined limit 45 visits per year)
Inpatient Physician and SurgeryServices
Outpatient (facility)
Emergency Room Care5
Ambulance
Maternity: Hospital
Maternity: Prenataland Postnatal Care
Mental Health Inpatient
Mental Health Outpatient
Substance Abuse Detoxication
Substance Abuse Outpatient
Skilled Nursing Facility Care(limit of 120 days per year)
Home Health Care
Hospice Care
Durable Medical Equipment (DME)
Allergy Tests and Injections
Chiropractic Care
Acupuncture (limit 10 per year)
Vision Exam (limit 1 per year)
Diabetic Supplies and Equipment6(non-pharmacy purchase)
Diabetic Supplies and Equipment6(pharmacy purchase)
Vision Lenses & Frames (limit 1per year)
$60 maximum allowance once every year (20%-50% discounts on lenses and frames at participating optical providers)
1 Includes deductible. 2 Full-time earning less than $44,100.3 If you are prescribed a brand name drug when a generic equivalent exists, you will be responsible for the copay plus the cost difference between the brand name and genericequivalent. Specialty drugs must be lled at your TPAs designated pharmacy. Specialty drugs do not qualify for the pricing discount available through mail order prescription (see page 15). 4 90-day supplies of maintenance drugs lled at theURMC Employee Pharmacy are eligible for a 25% reduction in copays. 5 Covered at in-network levels. 6 Covered under Durable Medical Equipment (DME). For a list of qualied diabetic supplies, see Appendix B.
Comparing the University Health Care Plans
Plan pays 80% Plan pays 90%
Plan pays 80% ater deductible Plan pays 90% ater deductible
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University HSA-Eligible Plan University Copay Plan
In-Network Out-of-Network In-Network Out-of-Network
COVERAGE
Deductible (single/family) $1,200/$2,400 $1,200/$2,400 None $400/$1,000
Coinsurance Plan Pays 80% Plan pays 80% Plan pays 100% Plan pays 70%
Out-of-Pocket Maximum1(single/family)
$2,400/$4,800 $2,400/$4,800 None $3,000/$7,500
Lifetime Maximum Unlimited Unlimited
FSA/HSAHSA maximum: single $3,050/family $6,150; Health Care FSA
and Limited FSA maximum: $6,5007FSA maximum: $6,500
PREVENTIVE CARE SERVICESNOTE: CHECK WITH YOUR TPA BEFORE SEEKING PREVENTIVE CARE TO ENSURE THE SERVICE IS CONSIDERED PREVENTIVE.
Physicals, Well-Baby/Well-Child Exams, Etc.
In-network: Plan pays 100%, no deductible or copay Out-of-network: Not covered
PRESCRIPTION DRUGS2 GENERIC/PREFERRED BRAND/NONPREFERRED BRANDNOTE: RECEIVE A URMC EMPLOYEE PHARMACY DISCOUNT. SEE PAGE 15.
Retail (up to 30-days supply) $10/$30/$50 copay after deductible Not covered $10/$20/$35 copay4 Not covered
Mail Order (up to-90 days supply)42.5 times retail 30-daycopay after deductible
N/A 2.5 times 30-day retail copay4 N/A
Prescription Diabetic Supplies Plan pays 80% afterdeductible7 Not covered Plan pays 80%4
($20 copay maximum)Not covered
OTHER SERVICESOfce Visit/Ofce Care
Plan pays 80% aterdeductible
Plan pays 80% (up to R&C)ater deductible
$20 copay
Plan pays 70% (up to R&C)ater deductible
Specialist Visit/Specialist Care $30 copay
Inpatient Admission (facility) $250 copay
Diagnostic X-ray $30 copay
Lab & Pathology; Chemotherapy/Radiation Therapy
Plan pays 100%
Auditory Exam (limit 1 per year) $30 copay
Physical, Speech, andOccupational Therapy(combined limit 45 visits per year)
$30 copay
Inpatient Physician and SurgeryServices
Plan pays 100%
Outpatient (facility) Plan pays 100%
Emergency Room Care5 $50 copay
Ambulance $30 copay
Maternity: Hospital $250 copay
Maternity: Prenataland Postnatal Care
$20 one-time copay at initial visit
Mental Health Inpatient $250 copay
Mental Health Outpatient $20 copay
Substance Abuse Detoxication $250 copay
Substance Abuse Outpatient $20 copay
Skilled Nursing Facility Care(limit of 120 days per year)
$250 copay
Home Health Care Plan pays 100%
Hospice Care Plan pays 100%Durable Medical Equipment (DME) Plan pays 80%
Allergy Tests and Injections $20 PCP copay; $30 specialist copay
Chiropractic Care $30 copay
Acupuncture (limit 10 per year) $30 copay
Vision Exam (limit 1 per year) $30 copay
Diabetic Supplies and Equipment6(non-pharmacy purchase)
Plan pays 80%
Diabetic Supplies and Equipment6(pharmacy purchase)
Vision Lenses & Frames(limit 1 per year)
$60 maximum allowance once every year (20%-50% discounts on lenses and frames at participating optical providers)
1 Includes deductible.2 If you are prescribed a brand name drug when a generic equivalent exists, you will be responsible for the copay plus the cost difference between the brand name and generic equivalent. Specialty drugs must be lledat your TPAs designated pharmacy. Specialty drugs do not qualify for the pricing discount available through mail order prescription (see page 15). 3 Prescription drugs do not count toward the deductible, and out-of-pocket maximum. 4 90-daysupplies of maintenance drugs lled at the URMC Employee Pharmacy are eligible for a 25% reduction in copays. Those enrolled in the University HSA-Eligible Plan receive the 25% reduction in copays after the plan deductible has been met.
Before reaching the deductible, a discount on out-of-pocket prescription drug costs applies. 5 Covered at in-network levels. 6 Covered under Durable Medical Equipment (DME). For a list of qualied diabetic supplies, see Appendix B. 7 If you electthe University HSA-Eligible Plan, you have the option to contribute to an HSA and Limited Purpose FSA. You cannot elect a Limited Purpose FSA if you do not contribute to an HSA. If you enroll in this plan, but do not elect to contribute to an HSA,you may contribute to a Health Care FSA.
Comparing the University Health Care Plans
Plan pays 80% ater deductiblePlan pays 80%
Plan pays 80% ($20 copay maximum)
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Comparing the TPAsI you enroll or coverage under the University Health Care Plans, you will need to select a third-party administrator (PA). Listed below is inormationabout the services oered by each PA to help you choose which is right or you.
Aetna Excellus BCBS
Provider Networks Each TPA maintains their own network of providers and reimburses them at d ifferent levels. You may want to conrm if the providers you and your family use areparticipating providers.
To locate a network provider To locate an Aetna network provider or facility, refer to the Aetna NationalProvider Directory, which can be viewed at www.aetna.com (go to Shortcutsand
select Find a Doctor).
Select Aetna Choice POS II under the Aetna Open Access Plans
(second plan listed).
To locate an Excellus BCBS provider, refer to Find a Doctor, Nationwide
BlueCard Provider Network, at www.excellusbcbs.com.
Preventive Services Coverage Preventive services are covered at 100% if you use an in-network provider. To ensure 100% coverage, you should conrm that the service you are seeking ispreventive, as determined by your third-party administrator (TPA), and that your doctor will bill your TPA appropriately. All care is subject to meeting the clinical
policies established by the TPA who administers your University Health Care Plan.
Prescription DrugsPlease note: Effective April 1, 2011, Excellus will administer all prescription drugs, and the Excellus formulary will be used to determine the level of copay(s).While the administrator may be different for your prescription drug plan, the plan design will remain the same.
Drug formularies/copays Each TPA maintains a separate formulary, or preferred drug list. This list is used to determine the level of copay(s) you will be responsible for depending on the
medication prescribed. Please refer to the websites listed below to identify the copay(s) that applies to your and/or your dependents medications.
www.aetna.com (up to March 31, 2011) www.excellusbcbs.com
Mail order Aetna Rx Home Delivery provides mail order services for maintenance medications.
When rst utilizing this service, you must obtain a new prescription from your
doctor. Thereafter, you may go online to order rells or check your order status.
www.aetnarxhomedelivery.com
PrimeMail provides mail order services for maintenance medications. When rst
utilizing this service, you must obtain a new prescription from your doctor for
your rst ll. Thereafter, you may go online to order rells or check your order
status.
www.myprimemail.com
Pre-Authorizations If you change your TPA, you will need to update existing pre-authorizations with the new TPA.
Health Savings Account (HSA) When you elect a TPA for the University HSA-Eligible Plan, that TPA will administer your HSA.
Investing Your funds are held by JP Morgan Chase Bank, N.A. in an interest-bearing
account. Current account interest rates are available online at the website listed
below. There is no minimum balance required and the monthly administrative
fee is $2.25.
Alternate investment options are available through JP Morgan
Institutional Investments once your account reaches $2,000.
Trading fees may apply and are available in the investment prospectus.
Log on to your Aetna NavigatorTM website at www.aetna.com.
Your funds are held by HSA Bank in an interest-bearing account. Current account
interest rates are available online at the website listed below. There is no
minimum balance required and the monthly administrative fee is $2.25.
Alternate investment options are available through a self-directed investment
option with TD Ameritrade. No minimum account balance is required. Trading
fees may apply and are available in the investment prospectus.
In addition to TD Ameritrade, HSA Bank offers Devenir Investment Advisors
as an option. There is a $24 annual fee charged by the Mutual Fund Selection
vendor; however, no trading fees apply.
www.hsabank.com
Automatic payment/debit You will automatical ly receive a debit card that you can use to pay for out-of-
pocket expenses. Until March 31, 2011, you may also elect Auto-Debit and have
eligible out-of-pocket expenses automatically deducted from your HSA at no
extra fee.
As a result of health care reform, over-the-counter medications will not be
considered qualied expenses under the HSA in 2011, unless you have a
prescription from your doctor. If you do not have a prescription and you pay
for over-the-counter medications with HSA funds, it is your responsibility to
properly report the expenses on your federal tax return.
With the new Prescription Benets Manager, Excellus, as of April 1, 2011, prescription
drug expenses will no longer be automatically deducted from your HSA.
Fees will apply to ATM withdrawals and other services.
You will automatically receive a debit card that you can use to pay for out-of-
pocket expenses.
As a result of health care reform, over-the-counter medications will not be
considered qualied expenses under the HSA in 2011, unless you have aprescription from your doctor. If you do not have a prescription and you pay
for over-the-counter medications with HSA funds, it is your responsibility to
properly report the expenses on your federal tax return.
Fees will apply to ATM withdrawals and other services.
Withdrawing funds manually You can withdraw your funds by HSA checks, for a fee.
Checkbook fee is $10.65 plus tax for 25 checks. Deposit slips are provided in the
Welcome Package and online. Fee comes out of your HSA account.
You can withdraw your funds by check or, for a fee, by written
withdrawal forms.
Checkbook fee is $7.95 plus tax for 50 checks and 10 deposit tickets.
Fee comes out of your HSA account.
Account access You can manage your Aetna HSA account activity online anytime, day or night .
Log on to Aetna NavigatorTM at www.aetna.com to view your HSA account
balance, account summary and account ac tivity.
You can manage your HSA account activity online anytime, day or night.
Log on to http://hsabank.com to view your HSA account balance, account
summary and account activity.
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Aetna Excellus BCBS
Flexible Spending Accounts(FSAs)
When you elect a TPA for your University Health Care Plan, that TPA will administer your FSAs, if elected. EBS-RMSCO is the FSA Administrator for Excellus BCBS.
Note: If you waive health care coverage, EBS-RMSCO will administer your FSAs.
Automatic payment/debit Health Care: Out-of-pocket expenses will be automatically reimbursed fromyour FSA if a University Health Care Plan is your primary plan. Until March 31, 2011,
you can also use the Auto-Debit feature at participating pharmacies (including mail
order through Aetna Rx Home Delivery) to have charges automatically deducted
from your FSA. Note: The Limited Purpose Health Care FSA does not include
automatic payments and debits. You will need to le your expenses manually.
You may opt out of automatic reimbursement. Claims not paid through
automatic reimbursement will need to be led manually.
Health Care and Dental: Out-of-pocket health care and dental expenses willbe automatically reimbursed from your FSA through Automatic Claims Transfer
(ACT) including mail order through PrimeMail, if a University Plan is your
primary plan. Note: The Limited Purpose Health Care FSA does not include
automatic payments and debits. You will need to le your expenses manually.
You may opt out of ACT. Claims not paid through ACT will need to be led
manually.
If the University Health Care Plan is not the primary plan for your dependents,
you will need to le claims manually.
If the University Health Care Plan is not t he primary plan for your dependents,
you will need to le claims manually.
Prescription Drugs: With the new Prescription Benets Manager, Excellus, asof April 1, 2011, prescription drug expenses will no longer be automatically
reimbursed from your FSA.
Over-the-Counter Medications: As a result of health care reform, you will not be able to pay for over-the-counter medications using FSA dollars, unless you havea prescription from your doctor. You will not be able to use the Auto-Debit feature for any over-the-counter medication purchases. If you have a prescription, you
must le a manual claim for reimbursement.
Dental and Dependent Care: You will need to le your out-of-pocketexpenses manually.
Dependent Care: You will need to le your out-of-pocket expenses manually.
Submitting claims manually Reimbursement forms are available from the UR Benets Ofce or can be
printed from www.rochester.edu/benets/fsa.
Claims can be faxed directly to 1-888-AETFLEX (238-3539).
Claims are paid on a weekly basis and can be reimbursed to you by check or
direct deposit.
Reimbursement forms are available from the UR Benets Ofce or can be
printed from www.rochester.edu/benets/fsa. Claims can also be submitted
online at www.myebsaccount.com. After submitting claims online, all receipts
and supporting documentation must be faxed to EBS-RMSCO, Inc. at
1-877-256-7228.
Claims are paid on a weekly basis and can be reimbursed to you by check
or direct deposit.
Minimum reimbursement A $25 minimum must be claimed before reimbursement is made, except for
the Auto-Debit feature for prescription drugs.
A $30 minimum must be claimed before reimbursement is made.
Note: Over-the-counter medications cannot be paid for using FSA dollars unless a prescription is provided by your doctor. The Auto-Debit feature cannot be used forover-the-counter medications.
Account access To check FSA balances, view payment information including amounts awaiting
payment, next payment date and minimum payment amounts, log on to Aetna
NavigatorTM at www.aetna.com. Or, call Member Services at 1-888-238-6226.
You can also browse a list of eligible FSA expenses on Aetna Navigator.
To submit claims, check FSA balances, view payment information including
pending claims and reimbursements paid, log on to www.myebsaccount.com.
Or, call customer service at 1-585-232-2632 or 1-800-327-7130.
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o help you select the plan that may best meet
your health care needs and to ensure you are
taking advantage o tax-savings opportunities,
the University o Rochester oers the
ollowing online tool.
The HPCE is an Online Health CarePlan Decision Tool that Helps:
Give you a general idea o what your
health care costs may be under each o the
University Health Care Plans.
You determine the coverage option that may
provide the best value or your money,
actoring in payroll deductions and the cost o
your anticipated health care needs or the year.
Estimate how much you potentially can save
on taxes by paying health care expenses with
a Health Care Flexible Spending Account
(FSA), or Health Savings Account (HSA)1 and
Limited Purpose Health Care FSA1 (LFSA)
Choosing the Right Health Care Plan
Use theHEALTH PLAN COSTESTIMATOR HPCE
1. Go to https://yourhealth.
rochester.edu to access the
Health Plan Cost Estimator.
2. You will be asked to select
the health care usage (as low,
medium, or high) of you and
your family.
3. Using this information, the
tool will calculate your total
estimated out-of-pocket costs
for each of your plan options,
to help you determine which
plan may provide you with
the best overall value and
potential tax savings. You willalso be able to estimate how
much you can save in taxes
by contributing to the Health
Care Flexible Spending Account
(FSA) or the Health Savings
Account (HSA).
After you review your HPCE
results, you should carefully
review each plan, keeping in
mind your unique experience
and tolerance for risk.
1 Only available if you are enrolled in the University HSA-Eligible Plan.
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Go to https://yourhealth.rochester.edu
You can use the... I you want to know... How it works...
Health Plan Cost Estimator An estimate of what your total cost islikely to be under each health care plan
The tool estimates out-of-pocket costsfor health care services based on thehealth care status that you select foryou and your family and adds yourout-of-pocket costs for each plan to thepayroll deductions you would makefor the year to give you an estimatedcombined cost for each of the plans.
Health Care FSA Estimator
Health Savings Account Estimator
Limited Purpose Health Care FSA Estimator