1 Your complete Guide to the University s Health Care Plans, Prescription Drug Plan, Dental Plans, FSA, HSA, Personal Health Management, and Well-U University OF Rochester 2018 Health Program Guide4 Health Program Benefits6 Your Guide to Making Enrollment Decisions7 Who Is Eligible for Benefits11 How to Enroll: New Hires and Newly Eligible Faculty and Staff12 Changing Your Benefits14 YOUR Health : An Integrated Approach 16 Take Charge of Your Health24 Health Program : Your Plan Choices for 201828 University Health Care Plans An Overview31 Comparing the TPAs33 Choose the Health Plan That s Right for You34 Understanding the Features of Your Health Care Plan36 Your Prescription Drug Plan37 Prescription Drug Discount Programs 39 Flexible Spending Accounts and Health Savings Account40 HSA or Health Care FSA What Is Right for You?
2 41A Closer Look at the Health Care FSA45A Closer Look at the HSA47 Tax Savings beyond Health Care: Dependent Care FSA48 Choose Your Dental Benefits48 Schedule of Covered Dental Services and Supplies51 Choose Your Vision Benefits52 Important Things to Know61 How Your Coverage Is Affected64 Employee Retirement Income Security Act (ERISA)66 Terms to Know68 Appendix A: When You Can Make Benefit Changes Outside of Open Enrollment73 Appendix B: Eligible Dependents for the FSAs and HSA75 Appendix C: Diabetic Supplies and Equipment76 Appendix D: Claims and Appeals ProceduresContents4 2018 Health Program GuidePromoting wellness and healthy living continues to be an important focus for the University of Rochester . To support our ongoing commitment, the University offers a benefits package designed to help faculty and staff and Strong Memorial Hospital residents and fellows make good Health care decisions that not only help you live better, but also help you better manage Health care University of Rochester is commit-ted to providing you and your family with a comprehensive and competitive benefits package.
3 In order to meet this commitment and our business goals, we developed this Health Program Guide to highlight the bene-fits, programs, and services available to you. Outlined in this Guide are the Health Program options available during the January 1 through December 31, 2018, Plan Year that include: Health Care Prescription Drugs Dental Vision Flexible Spending Accounts (FSAs) Health Savings Account (HSA) Biometric screening Personal Health Assessment (PHA) Condition management programs Lifestyle management programs Well-U Life-Work Connections/EAP Behavioral Health PartnersThe Health care choices you make whether selecting Health care coverage for you and your family for the coming year or deciding when and how to use Health care services on a day-to-day basis have a direct impact on the Health care costs you and the University pay.
4 To help you maximize your Health care offerings, the University offers lifestyle/condition management programs through YOUR Health and Well-U, which provide programs, tools, resources, and education necessary to support healthy living. We encourage you to become involved with our Health and wellness offerings, including taking your Personal Health Assessment (PHA) and completing a bio-metric screening. See pages 16 17 for more the time to explore this Guide to learn more about the benefits and services that may help you change your behavior to become more involved in your Health and use your benefits as wisely as Your Health FirstTake a more active role in your Health . Eligible individuals can take the Per-sonal Health Assessment (PHA) and enroll in a lifestyle/condition manage-ment Program and earn incentives!
5 For more information, see page 16 or contact the Center for Employee Wellness at (585) you have questions about ..Contact Your Plan Administrator ..AetnaExcellus BlueCross BlueShieldGarnett-Powers & Associates1 Health Care or (585) or (585) Vision Health Partners1-888-457-7463 Direct: (585) Drug PlansExcellus BlueCross Program BenefitsHealth Program benefits 5 Health Program BenefitsIf you have questions about ..Contact Your Plan Administrator ..AetnaExcellus BlueCross BlueShieldGarnett-Powers & Associates1 Flexible Spending Accounts (FSAs) Health Care FSA Limited Purpose Health Care FSA Dependent Care , aetna Navigator or directly at benefits Solutions, Inc. (FSA Administrator for Excellus BlueCross BlueShield)1-800-327-7130 or (585) 232-2632 Fax (for claims): Savings Account (HSA)Aetna1-888-678-8242 , aetna Navigator or directly at Bank (Excellus BlueCross BlueShield s HSA Partner) BenefitsUR benefits Office(585) 275-2084 Fax: (585) your personal data or using HRMS to enroll online as a new hire(585) ASK-URHR ((585) ProgramUniversity Well-U Office(585) Condition Management Programs Biometric Screenings PHA(585) Management Programs(585) Health Partners (BHP)(585) Connections/EAPLife-Work Connections/EAP(585) Care (LTC) InsuranceFor participants grandfathered and enrolled in the CNA group LTC plan:CNA1-877-430-5824 participants with individual LTC policies through Legacy Services.)
6 Legacy Services1-800-230-3398, ext. 101 Garnett-Powers & Associates administers coverage for Postdocs only. All plans described in this chart are self-funded, and benefits are paid from the University s general assets, with the exception of the Garnett-Powers options, which are insurer-funded and 2018 Health Program GuideOfficial Plan InformationThis Health Program Guide , along with the enrollment materials that you receive every year, are intended to constitute the Summary Plan Description (SPD) for the following plans:Plan NamePlan #Plan YearType of PlanHealth Care OptionsHealth Care Plans for Faculty and Staff of the University of Rochester and SMH residents and fellows15171/1 to 12/31 Group Health Plan providing medical benefits , vision benefits , Health Care FSA, Limited Purpose FSA, Prescription Drug bene-fits, Condition Management, Personal Health Assessment (PHA)
7 , Lifestyle Management, Behavioral Health Partners, biometric screenings, and flu shotsDental Care OptionsDental Plans for Faculty and Staff of the University of Rochester25181/1 to 12/31 Group Health Plan providing dental benefitsEmployee Assistance ProgramEmployee Assistance Plan for Faculty and Staff of the University of Rochester5151/1 to 12/31 Group Health Plan providing employee assistance plan benefitsLong-Term Care Long-Term Care Plan for Faculty and Staff of the University of Rochester35191/1 to 12/31 Group Long-Term Care benefits1. Postdocs will receive Health and Vision coverage from Garnett-Powers & Associates; they are not eligible for a Flexible Spending Account or to recieve services through Behavioral Health Partners. For Postdocs only, vision requires a separate election and is provided through a separate insurance Postdocs will receive Dental coverage through Garnett-Powers & Associates.
8 3. The details of the Long-Term Care plan coverage are not described in this booklet, but rather, in the separate certificate of coverage, which is hereby incorporated by reference. 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 Guide to Making Enrollment DecisionsHealth Care Plans, Prescription Drug Plan, Dental Plans, FSAs, and HSAC hoose and Use benefits WiselyYou make choices each day that are unique to your work, family needs, and personal in-terests. Be sure to take time to carefully con-sider your benefit needs and options before making your elections. Consider the types of services and benefit features you need or want and the amount you can reasonably afford to pay out of pocket for the coverage.
9 Remember that your role as a responsible Health care consumer does not end once you enroll for benefits . Throughout the year, you should take an active role in managing your Health by maintaining a healthy lifestyle, choosing AHP or in-network providers when appropriate, evaluating your Health care choices when care is needed, and using available resources OptionsYou may have the opportunity to choose from the options outlined in the chart on the next page for your Health Program : You may elect to waive your Health Care Plan coverage but still enroll in Dental Plan coverage, a Health Care FSA, and/or a Dependent Care FSA. If you elect to waive coverage for any benefit option, you must wait until the next Open Enrollment period or un-til you experience a qualifying event to enroll. See Appendix A for more Coverage LevelsThe coverage levels available to you for Health care and VSP vision benefits are: Single Employee and Child(ren) Employee and Spouse or Domestic Partner FamilyThe coverage levels available to you for dental are.
10 Single FamilyPostdocs have the same four tier cov-erage levels for dental as they do for Health care and Program benefits 7 Who Is Eligible for BenefitsHealth Care Plans, Prescription Drug Plan, Dental Plans, FSAs, and HSAB enefits Available to YouAdditional InformationHealth Care OptionsYOUR HSA-Eligible PlanAll full-time and part-time faculty and staff and Residents and Fellows are eligible for Health coverage1, 2, 5 YOUR PPO PlanGarnett-Powers & AssociatesCoverage through Garnett-Powers & Associates is limited to PostdocsDental OptionsTraditional Dental Assistance PlanAll full-time and part-time faculty and staff and Residents and Fellows are eligible for dental Dental PlanGarnett-Powers & AssociatesCoverage through Garnett-Powers & Associates is limited to PostdocsVision OptionsVSP Supplemental Vision BenefitsAll full-time and part-time faculty and staff and Residents and Fellows are eligible2.