2022 Health Program Guide - A General Overview of the University's Health Care Plan, Prescription Drug Plan, Dental Plans, FSA, HSA, Personal ...
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2022 Health Program Guide A General Overview of the University’s Health Care Plan, Prescription Drug Plan, Dental Plans, FSA, HSA, Personal Health Management, and Well-U
UNIVERSITY OF ROCHESTER 2022 Health Program Guide A General Overview of the University’s Health Care Plan, Prescription Drug Plan, Dental Plans, FSA, HSA, Personal Health Management, and Well-U
2 2022 Health Program Guide Table of Contents
Contents
Health Program Benefits · · · · · · · · · · · · · · · · · · · · · · · · 3
Official Plan Information · · · · · · · · · · · · · · · · · · · · · · · 5
Your Guide to Making Enrollment Decisions · · · · · · · · · · · · · 5
How to Enroll: New Hires and Newly Eligible Faculty and Staff · · · 10
Changing Your Benefits · · · · · · · · · · · · · · · · · · · · · · · 11
An Integrated Approach · · · · · · · · · · · · · · · · · · · · · · · · 13
Use your health care dollars effectively and make
informed decisions about what kind of care you need · · · · · · ·15
Health Program · · · · · · · · · · · · · · · · · · · · · · · · · · · · · 17
Health Care Plans, Vision Benefits, Prescription Drug Plan,
Dental Plans, FSAs, and HSA · · · · · · · · · · · · · · · · · · · · · 17
Your Health Care Plan Choices for 2022 · · · · · · · · · · · · · · 17
University Health Care Plans—An Overview · · · · · · · · · · · · 19
Excellus as Your TPA · · · · · · · · · · · · · · · · · · · · · · · · ·21
Health Plan Resources Available to You · · · · · · · · · · · · · · ·23
Flexible Spending Accounts and Health Savings Account · · · · · 24
HSA or Health Care FSA—What Is Right for You? · · · · · · · · · ·25
Tax Savings Beyond Health Care: Dependent Care FSA · · · · · · 26
Choose Your Dental Benefits · · · · · · · · · · · · · · · · · · · · 27
Choose Your Vision Benefits · · · · · · · · · · · · · · · · · · · · 29
Non-Discrimination and Accessibility Notice · · · · · · · · · · · ·31
Appendix A · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·32
When You Can Make Benefit Changes Outside
of Open Enrollment · · · · · · · · · · · · · · · · · · · · · · · · · 32
Appendix B · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·39
Coverage During Leave of Absence · · · · · · · · · · · · · · · · ·39Health Program Benefits 2022 Health Program Guide 3
Health Program Benefits
Promoting wellness and healthy living developed this Health Program Guide
continues to be an important focus for to highlight the benefits, programs, and Put Your Health First
the University of Rochester. To support services available to you. Take a more active role in your
health. Eligible individuals can take
our ongoing commitment, the University Take the time to explore this Guide
the Personal Health Assessment
offers a benefits package designed to help to learn more about the benefits and ser-
(PHA) and enroll in a lifestyle/
faculty and staff and Strong Memorial vices that may help you change your be-
condition management program
Hospital residents and fellows make good havior to become more involved in your and earn incentives! For more
health care decisions that not only help health and use your benefits as wisely as information, contact the Center for
you live better, but also help you better possible. View the Summary Plan De- Employee Wellness at (585) 275-
manage health care costs. scription (SPD) for additional plan and 6810 or by email at urcew@urmc.
The University of Rochester is com- benefit information; a copy of the SPD rochester.edu.
mitted to providing you and your family and benefit summaries are available on-
with a comprehensive and competitive line at the Office of Total Rewards website
benefits package. In order to meet this and will be provided free of charge upon
commitment and our business goals, we request.
If you have questions about . . . Contact Your Plan Administrator . . .
Excellus BlueCross Gallagher Benefit Services*
BlueShield
Health Care Plans 1-800-659-2808 or 1-844-243-0027
(585) 232-2632 https://clients.garnett-powers.com/pd/rochester/
www.excellusbcbs.com/ur
Vision Benefit N/A 1-844-243-0027
https://clients.garnett-powers.com/pd/rochester/
Supplemental Vision Benefit 800-877-7195 N/A
www.VSP.com
Accountable Health Partners 1-888-457-7463 N/A
Direct: (585) 758-7823
www.ahpnetwork.com
Prescription Drug Plan 1-800-499-2838 1-844-243-0027
www.excellusbcbs.com/ur https://clients.garnett-powers.com/pd/rochester/
Dental Plans Excellus BlueCross BlueShield 1-844-243-0027
1-800-724-1675 https://clients.garnett-powers.com/pd/rochester/
www.excellusbcbs.com
Flexible Spending Accounts (FSAs) Lifetime Benefits Solutions, Inc. N/A
• Health Care FSA 1-800-327-7130 or
• Limited Purpose Health Care FSA (585) 232-2632
• Dependent Care FSA Fax (for claims): 1-877-256-7228
www.lifetimebenefitsolutions.com
Health Savings Account (HSA) HSA Bank N/A
1-866-471-5940
www.hsabank.com
General Benefits Office of Total Rewards
(585) 275-2084
totalrewards@rochester.edu
www.rochester.edu/totalrewards4 2022 Health Program Guide Health Program Benefits
If you have questions about . . . Contact Your Plan Administrator . . .
Excellus BlueCross Gallagher Benefit Services*
BlueShield
Updating your personal data or using ASK-URHR (585) 275-8747
HRMS to enroll online as a new hire or ask-urhr@rochester.edu
www.rochester.edu/people
Well-U Program University Well-U Office
(585) 273-5240
www.rochester.edu/well-u
• Condition Management Coaching (585) 275-6810
• Biometric Screenings www.urwell.rochester.edu
• PHA
Lifestyle Management Programs (585) 602-0720
www.urwell.rochester.edu
Behavioral Health Partners (BHP) (585) 276-6900
www.bhp.urmc.edu
UR Medicine EAP UR Medicine EAP
(585) 276-9110
www.urmc.rochester.edu/life-work-eap
eap@urmc.rochester.edu
Long-Term Care (LTC) Insurance For legacy participants enrolled in the CNA group LTC plan:
CNA
1-877-430-5824
www.cna.com/portal/site/groupLTC/
For participants with individual LTC policies through Legacy Services:
Legacy Services
1-800-230-3398
custsvc@4groupltci.com
http://main.legacyltci.com/
* Gallagher Benefit Services administers coverage for Postdocs only.Official Plan Information 2022 Health Program Guide 5
Official Plan Information
This Health Program Guide, along with the enrollment materials that you receive every year, are intended to supplement the SPD for
the following plans:
Plan Name Plan # Plan Year Type of Plan
Health Care Options 517 1/1 to 12/31 Group Health Plan providing medical benefits, vision
Health Care Plans for Faculty and Staff of the benefits, Health Care FSA, Limited Purpose FSA, Prescription
University of Rochester and SMH residents and Drug benefits, Condition Management, Personal Health
fellows* Assessment (PHA), Lifestyle Management, Behavioral Health
Partners, biometric screenings, and flu shots
Dental Care Options 518 1/1 to 12/31 Group Health Plan providing dental benefits
Dental Plans for Faculty and Staff of the
University of Rochester†
Employee Assistance Program 515 1/1 to 12/31 Group Health Plan providing employee assistance plan
Employee Assistance Plan for Faculty and Staff of benefits
the University of Rochester
Long-Term Care 519 1/1 to 12/31 Group Long-Term Care benefits
Long-Term Care Plan for Faculty and Staff of the
University of Rochester‡
* Postdocs will receive Health and Vision coverage from Garnett-Powers & Associates; they are not eligible for a Flexible Spending Account or to receive services through
Behavioral Health Partners. Vision requires a separate election and is provided through a separate insurance policy.
† Postdocs will receive Dental coverage through Gallagher Benefit Services.
‡ The details of the Long-Term Care plan coverage are not described in this booklet, but rather, in the separate certificate of coverage. Please note that individual LTC
policies purchased through Legacy Services are not part of Plan 519 or any other employee benefit plan sponsored by the University.
Your Guide to Making Enrollment Decisions
Health Care Plans, Prescription Drug Plan, Dental Plans, FSAs, and HSA
Choose and Use Benefits once you enroll for benefits. Throughout when appropriate, evaluating your health
Wisely the year, you should take an active role care choices when care is needed, and
You make choices each day that are in managing your health by maintaining using available resources wisely.
unique to your work, family needs, and a healthy lifestyle, choosing Accountable
personal interests. Be sure to take time Health Partners or in-network1 providers Who Is Eligible for Benefits
to carefully consider your benefit needs Please refer to the SPD and the charts on
and options before making your elec- the following pages outlining your and
1 Doctors, hospitals, or other health care facilities
tions. Consider the types of services and that are affiliated with Excellus Blue Cross Blue
your dependents’ eligibility for the Plans
benefit features you need or want and the Shield. When you use a doctor, hospital, or other included within this Guide and Appendix
amount you can reasonably afford to pay health care facility that is in-network, your out- B for coverage during leaves of absence.
of-pocket costs are lower, because these providers
out of pocket for the coverage.
have agreed to accept discounted rates in return
Remember that your role as a respon- for your use of their services and because the
sible health care consumer does not end benefit coinsurance is higher.6 2022 Health Program Guide Health Program Benefits
Employee Eligibility
Active Full-
Active 1199 LTD
Active Time or Part- Active Active
SEIU & SEIU (Union/
Program Options Union (IUOE Time Non- Residents/ Post- Retirees
Local 200 non-
URPSOA)* SEIU Union Fellows Docs
Union* Union)
Faculty/Staff
EAP for Faculty and Staff of the University of Rochester
N/A Yes Yes Yes Yes Yes Yes Yes†
Health Care Plans for Faculty and Staff of the University of Rochester
YOUR PPO Plan Yes with Non-
Yes‡ Yes‡ Medicare Yes No Medicare-
YOUR HSA-Eligible Plan carve-out§ eligible only
Gallagher Excellus BluePPO
No
Signature Hybrid Plan for
medical No No No Yes No
Gallagher Aetna Vision
Preferred PPO for vision
No
VSP Vision Care Plan Yes Yes Yes Yes Yes¶
No Yes, if
Via Benefits Medicare
No No No Medicare-
Marketplace Access
eligible
Yes, if
enrolled
Condition Management
No in Non-
Yes, if Yes, if medical Medicare-
Yes if enrolled Yes if enrolled in
Behavioral Health Partners enrolled in enrolled in No eligible
in medical medical
medical medical Yes, if enrolled in
enrolled Medical only
Lifestyle Management
in
medical
Flexible Spending Accounts Yes Yes Yes No Yes No No
Dental Plans for Faculty and Staff of the University of Rochester
Traditional Dental Assistance Yes, if Yes, if
Plan Yes Yes non-SEIU Yes No non-SEIU
Medallion Dental Plan No member member
Gallagher MetLife dental PPO
No No No No Yes No
for dental
* Individuals covered by collective bargaining agreements receive benefits in accordance with those agreements. Copies of those agreements are available upon written
request.
† Retirees are eligible for the EAP for only the first 18 months following termination of active employment.
‡ Time-As-Reported (TAR), Agency Nurses with Medical and retirees who return to active employment may also be eligible for medical if they satisfy the criteria in the
University’s Look-Back Measurement Period Guidelines.
§ LTD recipients must enroll in Medicare when eligible.
¶ Retirees and their dependents are eligible to enroll in plans offered through VSP Direct. These plans are not considered University of Rochester group plans.Your Guide to Making Enrollment Decisions 2022 Health Program Guide 7
Dependent Eligibility
If you are eligible for coverage for the plan benefits, your dependents will be eligible as follows:
Program Options Spouse Domestic Children*
Domestic Retiree Retiree Retiree
Partner Partner Spouse‡ Domestic Children¶
Children† Partner§
Employee Assistance Plan for Faculty and Staff of the University of Rochester
Yes, for the first 18 months following the
N/A Yes
employee’s retirement
Health Care Plans for Faculty and Staff of the University of Rochester
YOUR PPO Plan
Yes (Non-Medicare-eligible only)
YOUR HSA-Eligible Plan
Gallagher Excellus BluePPO
No
Signature Hybrid Yes
VSP Vision Care Plan# Yes**
Gallagher Aetna Vision Preferred
No
PPO
Via Benefits Medicare
No Yes, if Medicare-eligible
Marketplace Access
Yes, if enrolled in
Condition Management No
medical
Non-Medicare-eligible
Behavioral Health Partners Yes, if enrolled in medical No
enrolled in medical only
Yes, if enrolled in
Lifestyle Management No
medical
Flexible Spending Accounts No
Dental Plans for Faculty and Staff of the University of Rochester#
Traditional Dental Assistance Plan Yes
Medallion Dental Plan Yes Yes
Gallagher MetLife Dental PPO No
* Children are eligible for medical, dental, and vision coverage through the end of the month in which they turn 26, regardless of access to other health care coverage
through their own or a spouse’s employment, marital status, or student status. Children who became handicapped prior to age 26 and are dependent on the employee
for support are eligible for coverage beyond age 26. Eligibility for Behavioral Health Partners (BHP) includes dependent children of active employees or non-Medicare-
eligible retirees who are 18 or older and are enrolled in a University Health Care Plan.
† Domestic partner children are eligible for medical, dental, and vision coverage through the end of the month in which they turn 26, regardless of access to other health
care coverage through their own or a spouse’s employment, marital status, or student status. Children who became handicapped prior to age 26 and are dependent on
the employee for support are eligible for coverage beyond age 26. Eligibility for Behavioral Health Partners (BHP) includes dependent children of active employees or
non-Medicare-eligible retirees who are 18 or older and are enrolled in a University Health Care Plan.
‡ Surviving spouses of retirees are eligible for medical coverage if, at the time of the participant’s death, (A) the participant had met the age and service requirements to retire,
(B) the participant was retired, and (C) the participant had five or more years of service but had not met the criteria to retire (in which case, the surviving spouse/domestic
partner and eligible children remain eligible to continue coverage under a health care plan for one year following the participant’s death. Following the one year of coverage,
these individuals may be offered COBRA for up to 36 months). Surviving spouses are eligible for dental continuation coverage under COBRA following the retiree's death.
§ Surviving domestic partners of retirees are eligible for medical coverage if, at the time of the participant’s death, (A) the participant had met the age and service
requirements to retire, (B) the participant was retired, and (C) the participant had five or more years of service but had not met the criteria to retire (in which case, the
surviving spouse/domestic partner and eligible children remain eligible to continue coverage under a health care plan for one year following the participant’s death.
Following the one year of coverage, these individuals may be offered COBRA for up to 36 months). Surviving spouses are eligible for dental continuation coverage under
COBRA following the retiree's death.
¶ Surviving children of retirees are eligible for medical coverage if, at the time of the participant’s death, (A) the participant had met the age and service requirements to
retire, (B) the participant was retired, and (C) the participant had five or more years of service but had not met the criteria to retire (in which case, the surviving spouse/
domestic partner and eligible children remain eligible to continue coverage under a health care plan for one year following the participant’s death. Following the one
year of coverage, these individuals may be offered COBRA for up to 36 months.) Children are eligible for medical, dental, and vision coverage through the end of the
month in which they turn 26, regardless of access to other health care coverage through their own or a spouse’s employment, marital status, or student status. Children
who became handicapped prior to age 26 and are dependent on the employee for support are eligible for coverage beyond age 26. Eligibility for Behavioral Health
Partners (BHP) includes dependent children of active employees or non-Medicare-eligible retirees who are 18 or older and are enrolled in a University Health Care Plan.
# Dental and VSP vision plan coverage ends upon the death of the active employee/retiree. Eligible surviving dependents will be offered 36 months of COBRA continuation
coverage in the Dental and Vision Plans.
** Retirees and their dependents are eligible to enroll in plans offered through VSP Direct. These plans are not considered University of Rochester group plans8 2022 Health Program Guide Health Program Benefits
Eligibility Definitions and/or research career. The appointee is household for at least six consecutive
Active Union (1199 SEIU, SEIU Local200, not part of a clinical training program. months and intend to reside together
IUOE, URPSOA)—means an employee The appointee was recently awarded the indefinitely;
of the University whose employment and PhD or equivalent doctorate, works under • At least six months have elapsed
benefit eligibility is governed by the terms the supervision of a faculty member, since the Office of Total Rewards has
of a collective bargaining agreement entered and has the freedom and is expected to received a Statement of Termination
into between the University and a bargaining publish the results of his/her research of Domestic Partnership from either
unit. or scholarship during the period of the partner; and
appointment.
Active Full-Time—means, for hourly staff • Share joint responsibility for the
(excluding those professional, administra- Appointment—means the action which partners’ common welfare and
tive, and supervisory paid hourly): a regular2 begins a relationship with the University financial obligations demonstrated
weekly work schedule of at least 35 hours; in a specific position, such as member of by: (a) the existence of a domestic
for all professional, administrative, and the faculty; the period during which such partner agreement filed through the
supervisory staff: a weekly work schedule of a relationship is in effect. City of Rochester or another local
40 hours or more; for faculty: a normal full Children—means an employee’s biological or municipality (a qualifying domestic
teaching and research load as defined for the legally adopted children, in addition to step- partnership agreement is a legally
faculty by the college or school concerned. children and children who are placed with binding agreement between two indi-
Active Part-Time—means a regular2 the employee by an authorized placement viduals creating personal and financial
weekly or monthly schedule which is less agency or by judgement, decree, or other interdependence, i.e., joint and several
than that required for full-time status but order of any court of competent jurisdiction. liability for each other’s debts and ex-
not less than 17.5 hours per week in the Continuous Employment—means actively penses, responsibility for mutual care,
case of hourly and professional, adminis- at work in a position eligible for the etc.); and (b) at least two other items
trative, and supervisory staff. For faculty full range of University Benefit Plans. showing joint responsibility, such as
it indicates that the individual carries at Absences due to leave of absence or layoff joint bank accounts, joint deed, mort-
least half the normal (full) teaching and would be included in determining contin- gage agreement or lease, joint credit
research load as defined for faculty by the uous employment. account or other liability, joint owner-
college or school concerned. ship of a motor vehicle, designation of
Domestic Partner—means the same or domestic partner as primary benefi-
Active Residents/Fellows—means an opposite gender partner of an employee, ciary for life insurance or retirement
individual who is classified as a full-time who, together with the employee, satisfies contract(s), designation of domestic
resident or fellow through the University, all of the following criteria: partner as primary beneficiary of will,
holds a degree of Doctor of Medicine,
• Have an exclusive mutual commit- durable property or health care power
and is a member or eligible for member-
ment, similar to that of marriage; of attorney, co-parenting agreement,
ship of the AMA.
• Are each other’s sole domestic partner or an adoption agreement.
Active Post-Docs—means an individual
and intend to remain so indefinitely;
with a Postdoctoral Appointment involv- Please note: You will have imputed
ing substantial full-time research or schol- • Are not legally married to each other
income and be taxed on the value of your
arship. It is a transitional position and is or to anyone else in a marriage recog-
domestic partner’s and/or your domestic
viewed as preparatory for an academic nized by state or federal law;
partner’s children’s health/dental coverage
• Are not related by blood to a degree of paid by the University if they do not qual-
2 “Regular” means a period of appointment in closeness which would prohibit legal ify as your federal tax dependents. Addi-
hourly and professional, administrative, and su- marriage in the state in which the tionally, you will need to pay for premi-
pervisory positions that is expected to exceed four partners legally reside; ums for these individuals on an after-tax
months, unless otherwise defined in collective
bargaining agreements; period of appointment for • Are at least 18 years of age and are basis. If your domestic partner and/or his/
faculty-instructional staff that is at least one year legally competent to contract; her dependent children qualify as your
(or one academic year) or, if shorter, is expected tax dependents under federal tax law, you
to be renewed. Appointments primarily for • Are currently residing together and
should complete the Affidavit of Domestic
furthering education (for example, graduate assis- have resided together in a common
tant) are not considered “regular” appointments. Partner’s Federal Tax Dependent StatusYour Guide to Making Enrollment Decisions 2022 Health Program Guide 9
for University Health Benefit Plans. The and (1) who have reached age 60, and period (1/1/2021–12/31/2023), will have
University encourages you to get advice (2) who have met the 15-year service the opportunity to secure benefits
from a tax professional regarding whether requirement. (The 15-year service under the new model.
your domestic partner and/or his/her chil- requirement may be met by cumula- Once retired, Post-Retirement
dren are your tax dependents and qualify tive employment at the University or Benefits continue to be based on status
for pre-tax benefits prior to completing another higher education institution, and years of service at the time of initial
this affidavit. If they do not qualify, you do as long as there is continuous employ- retirement, even if the Retiree returns to
not need to complete the form. ment at the University for the imme- work. Retirees will receive the full Uni-
Hired—means, for purposes of determin- diate five years prior to retirement. versity subsidy contribution at 15 years
ing post-retirement benefits, an appoint- An employee approaching retirement versus previous prorated contributions
ment to a position that is eligible for the who meets previous service require- based on years of service. Employees can
full range of University Benefit Plans. ments, during a transition period retire at a part-time status and receive
(1/1/2021–12/31/2023), will have the the full-time contribution if they cumu-
LTD Employee—means an eligible faculty opportunity to secure benefits under latively meet the full-time equivalent ser-
or staff employee who (1) is receiving the new model. vice requirement. There is no adjustment
long-term disability benefits from the
Retirement—means an employee has to the Grandparent Level, years of service,
University, (2) is Medicare-eligible, and
ended employment or an appointment or age calculation to determine the level
(3) has enrolled in Medicare Parts A
(whether voluntary or involuntary) at of Post-Retirement benefits based upon
and B as of his/her Medicare-eligibility
normal retirement age or beyond after Post-Retirement Rehire and employment.
effective date. For purposes of University
having met the 15-year service require- However, in the event a Retiree returns
medical benefits, Medicare will be the
ment, or: to work and becomes eligible for Health
primary payer. Care Plan coverage, Dental Plan coverage,
Rehired—means, for purposes of deter- • For regular full-time and part-time and/or University-paid Basic Term Life
mining post-retirement benefits, “an faculty and staff hired or rehired prior insurance coverage because the Retiree
appointment to a position that is eligible to 1/1/96 at an earlier age if the indi- has satisfied the eligibility criteria for ac-
for the full-range of University Benefit vidual has reached age 55 and has met tive employees to participate, the Retiree
Plans from an appointment that was not the 15-year service requirement and will be limited to the active employee
eligible for the full range of University maintained continuous benefits-eligible options and will become ineligible for the
Benefit Plans or following termination or service since. (The 15-year service post-retirement benefit options.
requirement may be met by cumula-
retirement. TAR (Time-As-Reported)—means an
tive employment at the University or
Retiree—means, for University retired appointment with (1) no regular schedule,
another higher education institution.) or (2) in which the individual is expected
faculty and staff members:
• For regular full-time and part-time to work fewer than 17.5 hours per week in
• Regular full-time and part-time faculty and staff hired or rehired 1/1/96 the case of hourly and professional, ad-
faculty and staff who were hired or and thereafter at an earlier age if the ministrative, and supervisory staff, unless
rehired prior to 1/1/96 and who have individual has reached age 60 and has otherwise defined in collective bargaining
retired with University consent and met the 15-year service requirement. agreements. For faculty it indicates that
(1) who have reached age 55 and (2) (The 15-year service requirement may the individual carries less than half the
who have met the 15-year service be met by cumulative employment at normal (full) teaching and research load
requirement. (The 15-year service the University or another higher educa- as defined for faculty by the college or
requirement may be met by cumula- tion institution, as long as there is con- school concerned.
tive employment at the University or tinuous employment at the University
another higher education institution.) Termination—means an ending of appoint-
for the immediate five years prior to ment for reason other than retirement.
• Regular full-time and part-time retirement. An employee approaching
faculty and staff who were hired or retirement who meets previous service Spouse—means the employee’s current
rehired 1/1/96 and thereafter and who requirements, during a transition spouse, if the marriage was valid in the
have retired with University consent state or country where it was performed.10 2022 Health Program Guide Health Program Benefits
How to Enroll: New Hires and
Newly Eligible Faculty and Staff
Health Care Plans, Prescription Drug Plan, Dental Plans, Vision Plan, FSAs, and HSA
Enrolling for benefits is easy. The follow- 3. Learn about the Plans.
ing checklist takes you through the steps Read the benefit booklet from Excellus Understanding your Benefit
you need to complete to elect your Health BlueCross BlueShield to understand how Administrators
Program options for 2022. the Plans work. Read the Summaries of The University of Rochester has
partnered with Excellus BlueCross
All required forms are available at the Benefits and Coverage for additional infor-
BlueShield to be the third-party
Office of Total Rewards or online at www. mation. These can be obtained by contact-
administrator (TPA) for our health
rochester.edu/totalrewards/forms. ing the Office of Total Rewards or online on
care plans. TPAs are responsible
Individuals covered by collective the Office of Human Resources website. for processing medical insurance
bargaining agreements receive benefits claims from doctors, hospitals, and
in accordance with those agreements. 4. Utilize the Online Benefits pharmacies, in addition to helping
Copies of those agreements are available Decision Tool. your health plan stay in compliance
upon written request. ALEX is an online benefits decision tool with federal regulations.
that will help you understand the various Additionally, your Health Savings
1. Review this Guide. benefit options and empower you to Account (HSA) administrator is HSA
Carefully read this Guide and the other make informed decisions when it comes Bank, and your Flexible Spending
information provided to you to under- to making your benefit elections. Account (FSA) and COBRA adminis-
stand all of the Health Program option(s) trator is Lifetime Benefits Solutions.
available to you and your dependents. 5. Enroll for Benefits.
If you are a new hire and are enrolling for If you do not wish to enroll online,
2. Review the Health Plans the first time, you can enroll for benefits • download the enrollment form at
Comparison Chart. online using HRMS within 30 days of www.rochester.edu/totalrewards/
The chart compares the YOUR PPO Plan your hire date. To enroll online, log on health (go to Forms and resources), or
and the YOUR HSA-Eligible Plan. It also to HRMS at www.rochester.edu/people. • contact the Office of Total Rewards for
shows how services are covered under Select Main Menu, Self-Service, then the enrollment form by calling (585)
each of the Plans. Benefits, and then Benefits Enrollment. 275-2084 or emailing totalrewards@
rochester.edu.
• Submit the completed form via email to
totalrewards@rochester.edu
Retiree health coverage is maintained through University health plans until age 65. At that time, it is your responsibility to enroll in
Medicare. You will be contacted in advance of your 65th birthday by ViaBenefits to discuss transition of plans.Changing Your Benefits 2022 Health Program Guide 11
Changing Your Benefits
Health Care Plans, Prescription Drug Plan, Dental Plans, FSAs, and HSA
Can I Enroll at Another Time? Any changes you make must be “due the University Health Care Plan, you
Annual Open Enrollment is the primary to and consistent with” your qualifying may cancel Health Care Plan coverage
time you can enroll or make changes to event. The Plan Administrator will deter- only for the dependent that lost eligi-
your Health Care Plan options, Dental mine whether a requested change is due bility. Additionally, you may change
Plan, and FSA contributions. Outside of to and consistent with a qualified change or begin contributions to your Health
Open Enrollment, you can only enroll in in status. Care or Dependent Care FSA if you
or change your Health Care Plan options, The consistency requirements vary have or adopt a child.
Dental Plan options, Vision Plan options, depending on the type of qualifying Note: When changing due to a qual-
and FSA contributions or add/remove event. To satisfy the “consistency rule” for ifying event, your FSA annual election
eligible dependents to/from your Health certain qualifying events, including those cannot be reduced below the amount of
Care Plan and/or Dental Plan, if you have events listed above, your qualified change payroll contributions already deducted or
a corresponding qualifying event or a in status and corresponding change in claims already submitted for the calendar
HIPAA special enrollment period. coverage also must meet both of the year if it would result in a negative bal-
following requirements: ance and the change must be consistent
Qualifying Event Enrollment • Effect on eligibility. Except for the with the qualifying event.
Period Changes Dependent Care FSA, the qualified Depending on the circumstances,
Additional qualifying events are provided change in status must affect eligibility you may also be able to make changes
in Appendix A, but common qualifying for coverage under the Plan or under throughout the year for the following
events include: a plan sponsored by the employer of reasons:
• Change in legal marital status (mar- your spouse or other dependent. For • Court judgment, decree, or order to
riage, divorce, death of spouse, or this purpose, eligibility for coverage provide coverage to a dependent
annulment) is affected if you become eligible
• COBRA events
• Change in number of dependents (or ineligible) for coverage, or if the
qualified change in status results in • An eligible dependent drops his or
(birth, adoption, placement for adop-
an increase or decrease in the number her coverage from another employ-
tion, or death)
of your dependents who may benefit er’s plan during an open enrollment
• Change in your employment status period which is different than that of
from coverage under the plan.
(that affects your benefit eligibility) or the University’s
For the Dependent Care FSA, the
that of your spouse or dependent qualified change in status must affect • Commencement or return from
• Dependent satisfying (or ceasing to the amount of dependent care ex- FMLA leave
satisfy) eligibility requirements for penses eligible for reimbursement. For
• Loss of Medicaid entitlement by you,
coverage (reaching the age at which example, if your child reaches age 13,
your spouse, or dependent
coverage is no longer available, etc.) his or her dependent care expenses are
no longer eligible for reimbursement. As noted, additional qualifying events
• Change in cost of day care cover-
are provided in Appendix A, but you
age, such as a significant increase or • Corresponding election change. The
should contact the Office of Total Re-
decrease in costs charged by your election change must correspond with
wards if you have any questions regarding
current day care provider or a change the qualified change in status. For
qualifying events.
in your provider (this applies to the example, if your dependent loses eligi-
Dependent Care FSA only). bility for coverage under the terms of12 2022 Health Program Guide Health Program Benefits
HIPAA Special Enrollment In addition, you can request (within
Period Changes 60 days) to enroll in the plan or enroll
Failure to Enroll
If you are declining enrollment in the your eligible dependents if:
If you do not enroll during the initial
plan for yourself or your dependents • you marry, or enrollment period, your Health Pro-
(including your spouse) because of other • you gain a new dependent because gram coverage will be defaulted to:
health insurance or group health plan of birth, adoption or placement for • Waived (No coverage) for Health
coverage, you may be able to enroll your- adoption. Care Plan
self and your dependents in this plan if:
You can also request (within 60 days) to • Waived (No coverage) for Dental
• you or your dependents lose eligibility
enroll in the plan or enroll your eligible de- Plan
for that other coverage, or
pendents if you or your eligible dependent: • Waived (No coverage) for VSP
• an employer stops contributing to- • loses Medicaid or Children’s Health Vision Care
ward the cost of your or your depen- Insurance Program (CHIP) coverage
• Waived (No contributions) for
dents’ other coverage; or because you are no longer eligible, or Health Care, Limited Purpose and
• you or your eligible dependents ex- • become eligible for a state’s premium Dependent Care FSA
haust COBRA coverage. assistance program under Medicaid or If you do not make coverage
However, you must request enroll- CHIP. changes during the annual open
ment within 60 days after your or your To request special enrollment or ob- enrollment period:
dependents’ other coverage or COBRA tain more information, contact the Office • Medical, Dental, and Vision Plan
ends (or after the employer stops contrib- of Total Rewards at (585) 275-2084 or elections will continue
uting toward the other coverage). email totalrewards@rochester.edu. • Enrollment in Health Care, Lim-
ited Purpose, and/or Dependent
Care FSAs will be discontinued as
of the first of the year
Questions
• Call Ask-URHR at (585) 275-8747 or email ask-urhr@UR.Rochester.edu if you
have questions about enrolling through HRMS.
Limitations
• Call the Office of Total Rewards at (585) 275-2084 or email totalrewards@ • If you terminate coverage under
rochester.edu if you have questions about your benefit plans. the YOUR HSA-Eligible Plan as
the result of a qualifying event,
Enrollment Form
any contributions to your HSA via
Your enrollment form must be received by the Office of Total Rewards within 30
payroll deduction will stop on the
days of when you are hired or becoming newly eligible for benefits. Benefit enroll-
effective date.
ment forms received after 30 days may result in no coverage until the next Open
Enrollment or until you experience a qualifying event. (Please refer to Appendix A • If you enroll for coverage under
for when you can make benefit changes outside of Open Enrollment. All qualifying the YOUR HSA-Eligible Plan as the
events require supporting documentation and a filled out enrollment form to the result of a qualifying event, you
Office of Total Rewards within 60 days of the event.) may be eligible to contribute to
a Limited Purpose Health Care
How to Change Your Coverage
FSA and an HSA; however, the
If you need to change your coverage because of a qualifying event, you will need
HSA contribution maximums are
to complete a Qualifying Event Change form and return the completed form along
prorated if you will be covered by
with documentation to support your qualifying event to the Office of Total Rewards
the YOUR HSA-Eligible Plan for
within 60 days of the event. Effective date of coverage will generally coincide with
less than 12 months within the
the qualifying event date. Employees are responsible for any missed deductions
calendar year.
due to their qualifying event date, in the next available payroll. If you are currently
covering a domestic partner and get married, within 60 days of the date of the • If you are already enrolled in
marriage you must submit the Personal Data Change Form and the Qualifying Event the Health Care FSA, you cannot
Form to update your spouse’s relationship designation and avoid taxation issues enroll in a Limited Purpose FSA
related to health and/or dental premium deductions. See Appendix A for more and HSA until the next Open
information regarding permitted election changes and when they are effective. Enrollment.An Integrated Approach 2022 Health Program Guide 13
An Integrated Approach
When it comes to the health and wellness 4. Participate in Well-U programs and
of our employees and their families, we events Learn about the University’s
offer a wide array of programs and services Wellness Programs
5. Utilize UR Medicine EAP and Check out the University’s em-
to help you prevent or manage health is- Behavioral Health Partners ployee wellness program, Well-U.
sues affecting your life. Becoming healthier
6. Review your Health Care Plan and Participate in Well-U
not only reduces risk for disease and helps
Prescription drug options Programs
us live longer, it also helps us live better.
The University is committed to 7. Review your annual wellness catalog Through Well-U, you may have the
promoting a culture of wellness. We offer opportunity to participate in valu-
opportunities for you to improve your able programs, including:
Behavioral Health Partners
health, ranging from on-site biometric (BHP)3 • Departmental wellness challenges
screenings, a Personal Health Assessment BHP offers a range of outpatient men- • University-wide fitness challenges
(PHA), lifestyle and condition manage- tal health services, including individual • Wellness workshops
ment programs, indoor walking routes, therapies and medication consultation and
a program to reward healthy eating, and • Learn to run
management. Regular full-time and part-
more choices for faculty and staff to lead time faculty and staff and SMH residents • Stress management workshops
happier, healthier lives. and fellows age 18 and older enrolled in • Fitness classes
Make a commitment to yourself and a University Health Care Plan, as well as These programs are available
your family to become healthier. You can non-Medicare-eligible retirees enrolled virtually and at numerous locations
become a Well-U champion and promote in a University Health Care Plan, may be throughout the University and at off-
wellness within your department. eligible. Spouses, domestic partners, and site locations, making it convenient
It is up to you to take the steps to dependent children of active employees for you to participate.
better health, but you do not have to or non-Medicare-eligible retirees who are The Well-U Mission
do it alone. The University provides the age 18 and older and enrolled in a Univer- Well-U, our award-winning wellness
support, tools, and resources to help you sity Health Care Plan may also be eligible. program, can help improve the
achieve your health goals. BHP does not provide pediatric services, health and wellness of University
and, therefore, enrolled individuals under faculty and staff and SMH resi-
Steps to Take Charge of Your age 18 are not eligible for BHP benefits. dents and fellows by promoting a
Health The cost of BHP services for Univer- work environment that encourages
Educate yourself about available health sity employees and dependents (age 18 healthy behaviors and by providing
programs and become a confident, active and older) enrolled in a University health the tools, resources, and education
consumer. Use your health care dollars necessary to support healthy living.
care plan:
effectively and make informed decisions • YOUR PPO Plan: Services received For more information, go to www.
about what care you need. through BHP are not subject to the rochester.edu/well-u, call (585)
1. Complete your biometric screening annual deductible and are covered at 273-5240, or email well-u-info@
and online health survey 100% by the Plan (i.e., there is no out- rochester.edu.
2. Enroll in a lifestyle management of-pocket cost).
program
3. Enroll in condition management
coaching (if eligible) 3 Postdocs are not eligible14 2022 Health Program Guide An Integrated Approach
• YOUR HSA-Eligible Plan: Per IRS
regulations, services received through How Does That Make You Feel?
BHP are subject to the annual deduct- For more information about University emotional and mental health resources,
visit www.rochester.edu/well-u/emotional.
ible and are covered at 100% after the
annual deductible is met.
subspecialty services that are not available consent prior to the telehealth services
BHP mental health professionals include through BHP. BHP does not offer treat- being rendered, acknowledging that the
psychologists, social workers, mental health ment for the following: service will be considered an evaluation
therapists, psychiatrists, and psychiatric • A primary diagnosis of impulse and management service by the practi-
nurse practitioners who work together in a control disorders such as pathological tioner. Telehealth therapy procedures are
multidisciplinary team. BHP providers also gambling, kleptomania, pedophilia, as follows:
work closely with primary care providers caffeine, or nicotine use • The initial service, if appropriate, will
to understand and treat the mental health be provided in a face-to-face visit,
• Detoxification, chemical dependency,
needs of those served. following which telehealth-delivered
and/or rehabilitation services for
BHP is a general psychiatry outpatient services may occur.
alcoholism or substance dependence
practice providing outpatient psycho-
disorders • The length, format, and treatment
therapy and pharmacotherapy services
• Conditions for which subspecialty care goals of telehealth sessions will be
for persons with a primary mental health
is indicated due to the severity of the identical to those of face-to-face visits.
condition such as:
• Stress mental health symptoms or the need • Telehealth-delivered services will be
for an alternative treatment setting documented in the electronic medical
• Depression
Other psychotic diagnosis not listed record in accordance with the stan-
• Anxiety dards that regulate face-to-face visits.
above and psychiatric emergency, inpa-
Not all types of behavioral health tient treatment, or suicide attempt in the Patients who cannot be managed
services are covered through BHP. An past six months. safely in an outpatient setting will be eval-
initial appointment with a BHP clinician BHP offers telehealth therapy ser- uated for hospitalization, per standard
will help determine if services through vices. To qualify for telehealth therapy, care protocol.
BHP are right for you. Some individu- recipients must be registered patients in
als are better served with acute care or BHP. The patient must provide written
For more information about BHP
visit www.bhp.urmc.edu or call (585) 276-6900.Effective Health Care Dollars 2022 Health Program Guide 15
Use your health care dollars effectively and make
informed decisions about what kind of care you need.
Access Online Services Use Member Discounts multiple specialists and is responsible for
Excellus BlueCross BlueShield Excellus BlueCross BlueShield offers keeping a record of your medical history.
(www.excellusbcbs.com/ur) discounts on health and wellness, family Therefore, it’s important to always let your
Excellus BlueCross BlueShield provides care, financial well-being, and travel ser- PCP know if something has changed with
an array of online services, programs, and vices through Blue365. regards to your health. For example, if
member discounts. Here are a few of the you’ve been prescribed medication by two
available benefits. Use Your Personal Health different specialists, your PCP will be able
• Research over 6,000 health topics Record to Make Smart Health to help you understand if there is any risk
using Healthwise Knowledgebase. Care Decisions to taking both medications.
• Learn to live a healthier lifestyle with When enrolled in a University Health
Health Improvement Programs to Care Plan through Excellus BlueCross Peace of mind. Advice from someone you
help you change your habits. BlueShield, you and your covered depen- trust is important when you’re healthy, but
dents each have access to your own online it’s even more important when you’re sick.
• Use the Personal Health Record to Personal Health Record. This confidential Your PCP is familiar with your health his-
store your health information online resource will store any claims information tory as well as your family’s health history:
for easy access. you enter and provide you with conve- this in-depth knowledge allows your PCP
• Use the Healthcare Advisor to nient access to a range of health data. You to be better able to determine the signs
estimate treatment costs, evaluate can store your family’s health information and symptoms they need to be aware of,
treatment options, and more. online for easy access. And, you can print especially if you or your family members
• Have fun and learn something new a report to take to your next doctor’s are at risk for certain conditions. Although
with weekly Health Quizzes. appointment or when you travel. visiting a PCP prior to scheduling an
appointment with a specialist or receiving
• Locate doctors and other health care
Don’t Have a Personal other medical services is not required by
professionals in your area who par-
Physician? You Should. the University’s Health Care Plans, it’s rec-
ticipate in your plan through “Find a
Here’s Why. ommended to keep your PCP informed of
Doctor.”
Better health. Establishing a relationship your health concerns so they can help you
• Print temporary ID cards. with a primary care physician (PCP) is and your family efficiently and effectively
very important when it comes to staying manage your health.
Excellus BlueCross BlueShield Pharmacy healthy. Visiting the same physician for
(www.excellusbcbs.com/ur) preventive and regular health care is one A healthier wallet. Being able to call or
• Use the Pharmacy Locator to identify way that you and your family can be smart visit your PCP when you are sick or need
participating pharmacies in your local health care consumers and potentially save medical advice helps you avoid costly and
area. money. Getting the right health screenings possibly unnecessary trips to an Urgent
each year can reduce your risk for many Care facility or the emergency room
• Use the Mail Order Pharmacy,
serious conditions. Not only will your PCP (non-emergency visits to the emergency
Wegmans Home Delivery or Express
help you take advantage of preventive care room are not covered by your Health
Scripts Home Delivery, and pay less
covered at 100% by the University’s Health Care Plan). If you do not have a PCP and
for a 90-day prescription.
Care Plans, a PCP is familiar with your are interested in establishing this rela-
• View and print your claims history. health history and can help you determine tionship, please visit Excellus BlueCross
• View a list of specialty medications. what medical services are necessary. He/she BlueShield (www.excellusbcbs.com/ur)
is one of the few health care providers you’ll for information on in-network PCPs.
• Search for and compare prices on
see both when you’re healthy and when You also have access to Accountable
lower cost drug options.
you’re ill. Health Partner providers, a panel of
• Ask a licensed, clinical pharmacist Your PCP can also help coordinate any University of Rochester Medical Faculty
your questions. additional care you may need to seek from Group providers and carefully selected16 2022 Health Program Guide An Integrated Approach
community partners created to improve • You can also save money by asking
the health of our employees and their de- your doctor if there are generic equiv-
pendents. When you visit an Accountable alents available for brand name drugs
Health Partner provider, you’ll receive a you may be prescribed.
higher level of coverage on your out-of- • Use the mail order program for a 90-
pocket medical costs, plus you will have day supply prescription to get three
a lower deductible4, copay5, coinsurance6, times the supply for two and a half
and out-of-pocket maximum7. times the price.
To find Accountable Health Partners
• You may be eligible for discounts on
providers in your area, visit http://
prescriptions drugs used to treat a
ahpnetwork.com/search-provider/.
chronic condition or to save on dia-
betic supplies.
Take Advantage of
Prescription Drug Discounts • Your copay for your first six months
• You can receive discounts on your for a new generic drug will be waived
prescriptions and free delivery to most when changing from a brand name to
off-site University locations with daily a generic drug.
courier service through the URMC • Employees on the PPO Plan have a fea-
Employee Pharmacy. ture added on their plan called SaveOn.
The program offers savings for certain
specialty prescription medications. 8
4 The amount of out-of-pocket expenses that you
must pay for health services before the Plan
begins to pay benefits for many covered services
5 A fixed dollar amount you must pay to a provider
at the time services are received
6 The percentage of the fee that the Plan pays for
certain covered expenses once you have met your
deductible
7 The maximum amount you pay each Plan Year to
receive covered services after you meet your de-
ductible. Once you meet your out-of-pocket max- 8 Employees are only eligible while enrolled in the
imum, the Plan pays 100% of covered services you PPO Plan due to rules and regulations surround-
receive. In-network and out-of-network services ing High Deductible Health Care Plans (HSA-
are subject to separate out-of-pocket maximums. Eligible Plan).Health Program 2022 Health Program Guide 17
Health Program
Health Care Plans, Vision Benefits, Prescription Drug
Plan, Dental Plans, FSAs, and HSA
The Plans available through the Univer- making smart health care decisions, mak- deciding when and how to use health care
sity Health Program can help you be a ing healthy lifestyle choices, and using services on a day-to-day basis—have a
better health care consumer. The key is to your benefits wisely. direct impact on the health care costs you
use these Plans to change your behav- The choices you make today—whether and the University pay tomorrow.
ior—by becoming more involved in your selecting health care coverage for you and
health, taking more responsibility for your family for the upcoming year, or
Your Health Care Plan Choices for 2022
The University of Rochester offers two • You can choose to receive care from: ductible, copay, coinsurance, and out-
Health Care Plans that focus on features • Accountable Health Partners (Tier 1) of-pocket maximum than using a TPA
that support the University’s goals of provider who isn’t part of Accountable
• Providers within the Excellus na-
fostering a culture of wellness, reducing Health Partners.
tional network (Tier 2)
health care expenses, and encouraging • Do not require that you have a PCP,
faculty and staff and SMH residents and • Out-of-network10 (Tier 3) but it is recommended that you select
fellows to take an active role in manag- • Note: You may pay more for ser- one, and referrals are not required for
ing personal health. Take some time to vices received within the Excellus specialists or other necessary health
understand the different Plan options national network (Tier 2) or out-of- care services.
available to you, so you select the Plan network (Tier 3). • Emphasize preventive care with 100%
that is cost effective and appropriate for
• G
ive you access to a nationwide in-network coverage to encourage reg-
your needs—and those of your family.
network of doctors, hospitals, and ular check-ups and wellness services.
treatment facilities that have agreed to Note: All care is subject to meeting
Your Health Care Plan Options9
charge lower, negotiated rates for care. the clinical policies established by
You can choose from the following options:
You can choose to receive care in or Excellus.
• YOUR HSA-Eligible Plan
outside of the TPA’s network, but you • Require you to pay more if you choose
• YOUR PPO Plan may pay more for care outside of the a brand name drug when a generic
You also may choose to waive health TPA’s network. equivalent exists. You will be responsi-
care coverage. • Allow you to visit Accountable Health ble for the copay plus the cost differ-
Partners providers, which provide a ence between the brand name and
How the Health Care Plans Are higher benefits level with a lower de- generic equivalent, even if your doctor
Alike prescribes a brand name drug unless
Both plans: the generic is medically inappropriate
• Are a PPO (Preferred Provider Orga- 10 Doctors, hospitals, or other health care facilities
that are not affiliated with the third-party
in accordance with Excellus’s medical
nization) management guidelines such as if it is
administrator you have selected. When you use a
doctor, hospital, or other health care facility that ineffective, not available at retail loca-
does not participate in the network, your out-of-
tions, or has dangerous side effects.
9 Health care plan options for Postdocs are not de- pocket costs are higher because these providers
scribed in this booklet, but rather in the separate have not agreed to accept discounted rates and
certificate of coverage. because the benefit coverage is generally lower.You can also read
