UVA Health Plan/Pharmacy

The first time you use Aetna Navigator, you must register your account to access resources and view your usage information.

• Go to www.aetna.com 
• Click “Register.”
• Follow the prompts to register your account. You must provide your Member ID (found on your Aetna card) or social security number, so have that information handy.
• Start using Aetna Navigator.

When you first sign up for the UVA Health Plan or switch between options, you will receive a card by mail to your home address. Instructions to get a digital copy or print a replacement card are below.

To view or print your own or a covered dependent’s card, use the following steps:

• Go to www.aetna.com, click “Login” and enter your username and password.
• Click on the down arrow next to your name in the top menu.
• Select "ID Card” option
• Once viewing the ID Card, you may choose to print, download, or share the ID Card via email.

Use Aetna Navigator tools to find in-network providers for the kind of care you or your covered dependent need. Remember in-network providers are less expensive, as they have agreed to Aetna’s allowable amount for their services.

• Go to www.aetna.com
• Log onto your Aetna member portal
• Go to "Find Care & Pricing" within top toolbar
  • Scroll down to "Go Find Care"
• Follow the prompts within search bar to locate the provider or service you seek

DocFind is a custom website for University of Virginia Health Plan members. It provides real-time resources to find core and/or Aetna in-network (national) doctors and facilities. Always use network providers and facilities for the highest level of benefits coverage under the University of Virginia Health Plan.

To start using DocFind today, go to www.aetna.com/docfind/custom/uva. Registration is not required.

Aetna has a number of resources that enable you to be a well-informed benefits consumer. Here are a few of the resources available:

• Find Care & Pricing Tool - compares costs to give you real-time, personalized estimates and provides average in-network and out-of-network costs. Sign onto the Aetna member website for access to this tool.
• Aetna Institute of Quality List: Lists IOQ facilities
• Aetna Digital Care Tool- provides drug cost estimates based on the selected UVA Health Plan option. Use the links below to compare drug prices for the UVA Health Plan options.
  1. Enter the name of the drug
  2. Click "search" to view the estimate and plan details.
     • Health Savings
     • UVA PPO
     • Choice Health 
• When using the Digital Care Tool, review the Aetna formulary list, as your drug may be listed as the generic name within the tool. The Digital Care Tool results are cost estimates and based on Aetna's 2024 formulary and pricing. 

To access these and other coverage and cost resources, follow these steps:

• Go to www.aetna.com, click “Login” and enter your username and password.
• Click on “Find Care & Pricing”

The facility can also provide a cost estimate for your procedure. Obtain your diagnosis and procedure codes from your provider. Call the facility, they will run a test claim for the best estimate. 

To access these and other coverage and cost resources, follow these steps:

• Go to www.aetna.com, click on “Login” and enter your username a and password.
• Click on "Manage Claims."
• Follow the prompts to find the claim or EOB you want to review.

To help you get the most out of your money for medical, pharmacy, dental, vision, and dependent-care expenses, the University offers different benefits-related savings and spending accounts to meet your needs. These accounts enable you to put pre-taxed money aside, by payroll deduction, for eligible expenses.

Visit the Health Savings with Health Savings Account (HSA) page to learn more about the HSA that can be used for dental and other allowable expenses.

For information about UVA’s medical and dependent daycare flexible spending accounts, visit the Flexible Spending Account (FSA) page.

You can submit an out-of-network expense by completing the Claim Reimbursement form and sending directly to Aetna. You can submit this form and all necessary documents through Aetna fax 859-455-8650 or on the Aetna member portal through messaging.

Leaving the Country Less Than 90 Days

If you or your covered UVA Health Plan family member will be out of the United States for less than 90 days, you are eligible for only emergency or urgent care, at in-network benefits, while traveling out of the U.S. 

Emergency Room Visits:

For an emergency room visit, the emergency must be a sudden, unexpected onset of a medical or psychological condition with severe symptoms that could result in serious harm to you if left untreated. 

Examples of conditions that require emergency room treatment include, but are not limited to:

• Severe or unusual bleeding
• Trouble breathing
• Suspected poisoning
• Prolonged or repeated seizures
• Unconsciousness
• Severe burns

Urgent Care Visits:

If you get sick while traveling but do not need to visit the emergency room, you may visit any Urgent care center for treatment and be eligible for in-network coverage. In order for the Claims Administrator to approve your visit, you cannot receive care considered “routine or non-urgent.” 

Contacting Aetna:

Foreign travelers can:

• Call Aetna at 800.987.9072, member services
• Call Aetna, Special Case Pre-certification Unit at 855.888.9046 or 215.775.6445 

This is a Monday – Friday line. Even if you were in the US, Aetna customer service /authorization department is not available 24/7.

• Call the Aetna National Medical Excellence Program NME and After-Hours Pre-certification number: 215.775.6445

There will be an Aetna resource on call to assist with urgent or acute care needs. 

• Contact Aetna online through the secure email via Aetna navigator at www.aetna.com

What You Need to Do:

1. If you have a medical emergency, go immediately to the nearest participating or non-participating Urgent Care facility or Emergency Room, if appropriate for your condition. You may also call the Aetna Informed Health Line at 1.800.556.1555, which is available 24 hours a day, 365 days a year to participants.
2. If you are admitted to the hospital, or need outpatient surgery to resolve the emergency, contact the Claims Administrator at Aetna, to notify them of your admission. If you are unable to make the call, have a family member, friend or the hospital call for you. If you are admitted emergently to an out-of-network hospital, be sure the out-of-network provider requests and receives “In-Network” authorization for any “follow up” outpatient services, including surgery, by contacting Aetna at 800.987.9072 if you are medically unable to return home.
3. If you visit an Urgent Care Center for urgent care, contact the Claims Administrator within 48 hours or the next business day.
4. Remember that any “follow up” care must be obtained in network or must be pre-authorized by Aetna at “in-network benefits”. Follow up care is defined as treatment occurring after discharge from the emergency or urgent care medical facility, or hospital admission through the emergency room. This can include outpatient surgery following an Emergency room visit, such as for surgical repair of a fracture.
5. Pay the foreign provider and submit claims for reimbursement to the claims Administrator within 90 days of the date of service to the health insurance for review for possible reimbursement. The UVA Health Plan Ombuds can assist with submission of foreign claims.

Leaving the Country 90 Days or More

If you or your covered UVA Health Plan family member will be out of the United States for 90 days or more, you should enroll in the foreign country enrollment program by completing a Foreign Enrollment form and sending the completed form back to the UVA Health Plan Ombuds before you leave the U.S.

With this foreign country enrollment, you will be covered for eligible routine and emergency services but will need to pay the foreign providers directly and then you should submit your foreign claims to the Claims Administrator within 90 days for reimbursement. Please be sure that you contact Aetna customer service for pre-authorization of scheduled inpatient admissions/surgery or as soon as possible following emergency admissions. 

Contact the UVA Health Plan Ombuds for a prescription medication vacation override with AetnaRx if you need any prescriptions beyond a 90-day supply or an early “vacation” override refill.

Contact Aetna for any foreign inpatient admissions, surgery, emergency room services or complex radiology situations as soon as possible. 

Pay the foreign provider and submit claims for reimbursement to the claims Administrator within 90 days. The UVA Health Plan Ombuds can assist with submission of foreign claims.

Contacting Aetna:

Foreign travelers can:

• Call Aetna at 1.800.987.9072, member services
• Call Aetna, Special Case Pre-certification Unit at 855.888.9046 or 215.775.6445 

This is a Monday – Friday line. Even if you were in the U.S., Aetna customer service /authorization department is not available 24/7.

• Call the Aetna National Medical Excellence Program NME and After-Hours Pre-certification number: 215.775.6445

There will be an Aetna resource on call to assist with urgent or acute care needs. 

• Contact Aetna online through the secure email via Aetna navigator at www.aetna.com

• They cover the same ranges of services, including prescription drugs
• Preventive care services (in-network only) are covered at 100%, with no deductible
• You must satisfy your annual deductible before coverage begins for most services; then you and your health plan option share the cost of covered services (co-insurance), up to the out-of-pocket maximum
• Once you reach the out-of-pocket maximum, your health plan option pays for in-network covered services at 100% for the rest of the year
• You can elect coverage for you and your eligible dependents
• Aetna is the plan administrator for medical services and prescription drug benefits

The services are the same for all three health plan options. It's how you pay for them that is different: 

• Would you want to pay more in premiums up front (UVA PPO or Choice Health) and pay less out of pocket for using health care services throughout the year?
• Or pay less in premiums (Health Savings) and pay more out of pocket as you use the services?

Compare the three health plan options using the resources and tools below.

• Maximum Out-of-Pocket Comparison - The "UVA Health Plan Options at a Glance" tables below show your potential maximum annual out-of-pocket costs (premiums, deductibles, out-of-pocket max) for in-network services, for Health Savings, UVA PPO, and Choice Health options. Each table represents one employee group (individual, + spouse, + child, family). The tables include the UVA employer contribution to HSA for Health Savings participants. Each table is to scale, relative to its out-of-pocket maximum.
• UVA Health Plan Services Comparison - The UVA Health Plan Schedule of Benefits Comparison compares various health services (professional services, preventive services, urgent care, etc.) for the Health Savings, UVA PPO, and Choice Health options, and shows deductibles, coinsurance, and co-pay amounts for each option
• UVA Health Plan Comparison Tools

  • Summary Plan Description (clickable)

  • Summary Plan Description (printable) 

  • Summary Plan Description Spanish Version 2024 Plan de salud de la Universidad de Virginia Descripción resumida del plan 

• Comparison of Benefits

  • UVA Health Plan Options at a Glance
  • UVA Health Plan Schedule of Benefits Comparison
  • Summary of Coverage and Benefits Glossary - English
  • Summary of Coverage and Benefits Glossary - Spanish
  • Preventative Care Services

• Health Savings

  • Health Savings schedule of benefits
  • Health Savings summary of benefits and coverage

• UVA PPO

  • UVA PPO schedule of benefits
  • UVA PPO Out of Area (OOA) schedule of benefits (If your work location zip code in Workday is more than 50 miles from Charlottesville, you will automatically be covered under this option if you enroll in UVA PPO)
  • UVA PPO summary of benefits and coverage
  • UVA PPO OOA summary of benefits and coverage

• Choice Health (closed to new enrolling starting 1/1/2026)

  • Choice Health schedule of benefits
  • Choice Health summary of benefits and coverage
• Aetna Tools: Visit the Aetna website and click on “Log in/Register” to access these resources:​​​​​  
  • Find Care & Pricing Tool - compares costs to give you real-time, personalized estimates and provides average in-network and out-of-network costs 
  • Aetna Institute of Quality List: Lists IOQ facilities
  • Aetna Digital Care Tool- provides drug cost estimates based on the selected UVA Health Plan option. Use the links below to compare drug prices for the UVA Health Plan options.
    1. Enter the name of the drug
    2. Click "search" to view the estimate and plan details.
       • Health Savings
       • UVA PPO
       • Choice Health 
• Still Need Help? Contact the UVA HR Solution Center, by email  at AskHR@virginia.edu or by phone at 434.243.3344

In general, to be eligible for a UVA Health Plan, you must be a full- or part-time UVA employee, and regularly scheduled to work at least 20 hours per week. To be eligible for the UVA Health Plan, you must be:

• Faculty
• Classified Staff
• Medical Center Team Member
• Postdoctoral Research Associate
• Senior Professional Research Staff
• University Staff
• Grant-funded Postdoctoral Fellow (UVA PPO or Choice Health only)
• Housestaff (UVA PPO or Choice Health only)
• Academic Division and Medical Center Temporary or Wage Employee (if eligible under ACA)

J Visa Holders: J visa holders are only eligible for the UVA J Visa Health Plan option. Federal government regulations prohibit J visa holders from enrolling in the Health Savings, UVA PPO, or Choice Health options. Please visit the J Visa Health Plan page for detailed information about the J Visa Health Plan.

To be added to your UVA Health Plan, spouses must be legally recognized as spouses in the Commonwealth of Virginia and have no access to Affordable Healthcare Coverage of minimum value (as defined by the Affordable Care Act) through their non-UVA employers. 

To be added to your UVA Health Plan, children must be your biological, step, adopted, or foster child, or any child declared a dependent on your federal tax return for whom you are the legal guardian with permanent custody. Children are eligible to the end of the birth month in which they turn 26.

If children are incapable of self-support due to mental or physical disability, they can remain on your UVA health plan beyond age 26 as long as the following requirements are met:

• Required documentation is approved in advance by the Aetna Claims Administrator before the dependent’s 26th birthday
• They are unmarried
• They live with you 100% of the time
• They are declared a dependent on your federal tax return

For further details and additional assistance, contact Aetna Member Services at 800.987.9072 or askhr@virginia.edu

In order to enroll in the Health Savings option, you must:

• Be eligible for UVA’s Health Savings Account (HSA) program

  • To view a list of IRS eligibility rules, review the HSA Eligibility document

• Be enrolled in a high deductible health plan (HDHP) if you are covered by another health care plan

• Not be covered by any part of Medicaid or Tricare

• Not be enrolled in Medicare Part A or Part B in the same calendar year in which you are enrolled in the Health Savings option

• Not be a J Visa holder (federal government regulations prohibit J Visa holders from enrolling in the Health Savings option)

The monthly premiums below apply to both part-time and full-time employees.

2025 Monthly Premiums

2025 Monthly Premiums

2025 Monthly Premiums - Choice Health

2025 Monthly Premiums - UVA PPO

*In the case of external fellowships that are provided directly to postdoctoral fellows, fellowship allowances may be used to support the full cost of postdoctoral fellow health insurance.  In all cases, departments and postdoctoral fellows must account for the full costs provided above.

2025 Monthly Premiums

Benefits-eligible Academic Division and Medical Center wage employees may only enroll in Wage plan option. 

*Those on Health Savings Employee + Child/Children, Employee + Spouse, and Family coverage have the family deductible only.

*Those on Health Savings with Employee + Child/Children, Employee + Spouse, and Family coverage have the family deductible only.

To find out if benefits under this Plan will be reduced, Aetna must first use the rules listed below, in the order shown, to determine which plan is primary (pays its benefits first). The first rule that applies in the chart below will determine which plan pays first:

When the other plan pays first, the benefits paid under this Plan are reduced as shown here:

• The amount this Plan would pay if it were the only coverage in place, minus
• Benefits paid by the other plan(s)

This prevents the sum of your benefits from being more than you would receive from just this Plan. If your other plan(s) pays benefits in the form of services rather than cash payments, the Plan uses the cash value of those services in the calculation.

You are eligible for Medicare if you are:

• Eligible for, and covered by, Medicare
• Eligible for, but not covered by Medicare because you:
  • Refused Medicare coverage
  • Dropped Medicare coverage
  • Did not make a proper request for Medicare coverage

When you are eligible for Medicare, Aetna must determine whether this Plan or Medicare is the primary plan.

When This Plan is Primary

This Plan is primary, and Medicare is secondary, if a covered person is eligible for Medicare and falls into one of the following categories unless eligible for Medicare due to End Stage Renal Disease (ESRD):

• An active employee, regardless of age
• A totally disabled employee who is:
  • Not terminated or retired
  • Not receiving Social Security retirement or Social Security disability benefits
• A Medicare-eligible dependent spouse of:
  • An active employee
  • A totally disabled employee who is not terminated or retired
• Any other person for whom this Plan’s benefits are payable to comply with federal law

When this Plan is the primary plan, Aetna will not take Medicare benefits into consideration when determining the benefits payable by the Plan.

End-Stage Renal Disease

This Plan is primary for the first 30 months after any covered person becomes eligible for Medicare due to End-Stage Renal Disease (ESRD). The Plan will pay benefits for a covered expense first, before Medicare benefits are available.

Medicare becomes the primary plan, and this Plan is secondary, beginning with the 31st month of Medicare eligibility due to ESRD. If you’re eligible for Medicare only because of permanent kidney failure, your Medicare coverage will end 12 months after the month in which you stop dialysis treatments or 36 months after the month in which you have a kidney transplant.

When Medicare is Primary

Medicare is the primary plan, and this Plan is secondary, if a covered person is eligible for Medicare and does not fall into one of the categories above or is in their 31st month or later of Medicare eligibility due to ESRD.

These rules are based on regulations issued by the Centers for Medicare and Medicaid Services (CMS), and may be amended or changed at any time. It is the intent of the Plan to abide by the Medicare Secondary Payer Rules. If the Plan in any way conflicts with regulations issued by CMS, the Plan will pay Benefits in accordance with CMS regulations.

• Navigate to Workday.
• Click on the Benefits "tile," the click on Change Benefits or View Benefit Elections.
• Following the instructions on screen. Changes to benefits outside of the Open Enrollment period in October can only be made when a Qualified Life Event occurs. Click within the Workday Instructions on the right side of the screen for details and instructions.

The following Workday Job Aids and training video offer additional detailed instructions:

Yes, two UVA spouses may choose who covers and who waives, or they may have separate plans.

Employee's non-UVA spouses who have access to health benefits that meet affordability and minimum value standards as defined by the Affordable Care Act are not eligible for enrollment in UVA's health plans, UNLESS ALL of their health options are HMOs and the spouse lives outside the HMOs' defined service areas. In this case, the spouse would be eligible to be a dependent on the UVA employee's health coverage. 

Here are helpful questions to ask yourself. Do you have: 

• Any medical or dental procedures planned? 
• Any upcoming glasses or contact lens needs?
• Any changes in dependent care ?
• A need for replacements to medical or assistive devices?
• Potential life events — for example, new marriage, new children, or children after age 13 no longer eligible for Dependent Care FSA funds?
• Dependents' social security numbers listed correctly in Workday?​

Remember that choosing a health plan option is a personal choice about how you pay for health care services. The services are the same for all three health plan options. It's how you pay for them that is different. Would you want to pay more in premiums up front and pay less out of pocket for using health care services throughout the year? Or pay less in premiums and pay more out of pocket as you use the services?

Preventive care services (in-network only) are the same for all three health plan options, and are covered at 100%, with no deductible.

Visit the Preventive Information webpage for additional resources. 

This brochure provides an overview of the telehealth/virtual mental well-being programs and providers that are within our network and available for you.

The Affordable Care Act Employer mandates that large employers (50+ employees) must offer health insurance that is affordable and provides minimum value to 95% of their full-time employees (or FTE equivalent) and their children up to age 26, or be subject to penalties.

What are the requirements for Academic Wage employees?

The Commonwealth has specific guidelines built within the Manpower Control Program that UVA is required to follow regarding working hour limitation for wage employees. This is a budgeting requirement, and we are mandated by the guidelines as a state institution of higher education.

Are there limitations regarding hours worked for Academic Wage employees?

Wage employees cannot work more than an average of 29 hours per week in a 12-month measurement. All wage employees are monitored through weekly reporting, and terminated prior to reaching 1500 hours.

What are the requirements for University Medical Center Wage team members?

The University Medical Center is not mandated by the Commonwealth, and as such they do offer benefits to wage team members who meet the ACA mandate.

Wage team members who average 30 hours per week in the 12-month measurement period are eligible for Wage Health (no HSA).

Academic Division and University Medical Center FT/PT employees who transfer to a wage position within the plan year may also qualify based on their hours.

What time frame are wage employees' hours monitored?

October to October. The plan is effective 1/1 through 12/31 of the current plan year.

A dependent is a person who is eligible to be covered by you under the health, dental and vision plans. A beneficiary can be a person or a legal entity that is designated by you to receive a benefit, such as life insurance.

A spouse included in your medical coverage and designated as a recipient of your life insurance is both a dependent and a beneficiary.

For another example, a parent is not an eligible dependent for medical coverage but could be designated as a beneficiary.

For additional details about required documentation for eligible dependents, visit the Health Plan Eligibility webpage.

Detailed information about eligibility for the UVA Health, Dental, and Vision Plans can be found on the Health Plan Eligibility webpage. In a nutshell, the Plans are open to:

• UVA Academic and Health System salaried employees, full-time or part-time working at least 20 hours/week, except J visa holders, who are eligible for the UVA J Visa Health Plan
• Spouses of eligible UVA employees (some exception noted on the Eligibility webpage)
• Children of eligible UVA employees - children (as defined on the Eligibility webpage) are eligible through their birthday at age 26, or longer if documented to have mental or physical disabilities (see the Eligibility webpage for more details)

The Health Savings option has some additional requirements; please visit the Eligibility webpage for those details.

Below is a simple illustration of how deductibles, coinsurance, and out-of-pocket maximums work for a single employee on the Health Savings option. For additional examples, please call Aetna for customized scenarios based on your preferred health plan option and potential future health care expenses.

UVA employees and their dependents, covered by the UVA Health Plan may obtain a flu shot through their Primary Care Physician, or at a pharmacy in Aetna's National Pharmacy Network, if you present your Aetna ID card at the pharmacy.

Flu vaccines are covered at no cost, as a preventive service through the UVA Aetna Health Plan. When obtained through an in-network Primary Care Physician, or at a pharmacy in  Aetna's National Pharmacy Network. 

Here is a list of vaccine providers within the Aetna network.  

If you went to a participating pharmacy and were charged for your flu vaccine, you can submit a reimbursement to Aetna. Complete steps 1-25 in the reimbursement form, and attach your receipt and other supporting documentation.

The UVA PPO option has an individual deductible of $800, and family deductible of $1,600. These are applied separately but accumulate together towards the family deductible.

Within an Employee + Spouse plan, if one individual meets the $800 deductible, then the $800 deductible applies towards the individual and family deductible. That individual's deductible is now met, and any additional expenses for that individual would be covered by Aetna as coinsurance (Aetna pays 80%, Employee pays 20%), and this coinsurance goes towards the individual's out-of-pocket maximum of $5,500.

The family deductible has $800 applied towards the total of $1,600. This leaves $800 for the second individual to meet their individual and family deductible totals.

UVA Health Plans provide coverage for comprehensive infertility and advanced reproductive technology. There is a lifetime maximum of $15,000 for medical and Rx services per subscriber and their covered spouse; no coverage for dependent children. 

Aetna's Infertility Clinical Policy Bulletin shares details of Aetna's medical necessity policies for covered services. 

The UVA Health Plan has waived some of the medical requirements for infertility eligibility, specifically, removing Aetna's infertility definition for UVA Health Plan participants (what has been removed is all of the 2nd bullet point in the definition). 

No. If you plan to enroll in Medicare, you are not eligible to sign up for Health Savings and are not eligible for a Health Savings HSA. The UVA Health Plan does not allow movement from one health plan option to another during the year for any reason. Therefore, you cannot move from Health Savings to UVA PPO or Choice Health or vice versa anytime during 2025 if you are thinking about enrolling in Medicare for the same year. You will be out of compliance with IRS which may incur a penalty and will have to address this when you complete your 2025 tax returns.

When considering health plan options during Open Enrollment, make sure your choices for the following calendar year are appropriate for the entire year.

Yes. You may use HSA funds for your spouse even if your spouse is on Medicare. The spouse must be declared on your federal income taxes as a dependent (i.e. filing jointly), and the expense in question is not already covered by Medicare. Otherwise, if the expense is eligible, not already covered by the health plan, and your spouse is a tax dependent, then you may use HSA funds to pay for it.

You and your Medicare-eligible dependent will still receive $1,500 seed money for your Health Savings HSA.

You do not have to enroll in Medicare until you end your employment with UVA. Your benefits counselor will provide you with the form CMS-L564 to negate the late enrollment penalty. 

You can choose to enroll in part A, and waive part B, but this will terminate your eligibility for the HDHP (Health Savings). 

Creditable Coverage information is located within Annual Notices pages 5-7. Share this document when requested by Medicare. 

If you have been newly granted a J Visa during the year, you must move from the UVA Health Plan to the UVA J Visa Health Plan. These are two entirely different health plans, and moving from one to the other is allowed throughout the year in order to comply with federal health coverage requirements.

If you have been on the UVA J Visa Health Plan and are newly granted a different type of visa, you must stay on the UVA J Visa Plan for the rest of the calendar year.

Health Savings participants have a deductible that applies to both medical and prescription costs. You must pay for covered health care services and prescriptions up to your deductible amount before the UVA Health Plan begins to pay. 

UVA PPO and Choice Health participants have a deductible that applies to both medical and prescription costs for tier 2 and tier 3 retail drugs. You must pay for covered prescriptions up to your deductible amount before the UVA Health Plan begins to pay for tier 2 and tier 3 retail prescriptions. Tier 1 medications and specialty prescriptions are not subject to the deductible.

The table below shows costs for retail pharmacy outside of UVA pharmacies (such as CVS, Kroger, etc.); excludes specialty prescriptions and mail order prescriptions.

You can find information on our Prescription Drug Program webpage.

If you need additional details, contact Aetna for assistance.

To get specialty prescription drugs, you must use the UVA Specialty Pharmacy, which can be reached at 434.297.5500 or by email at specialtymedsrx@virginia.edu.