UVA Health Plan 2021

Choose the Right Health Plan Option For You


2020 is a year like no other. Many have suffered loss of income, loss of loved ones, and debilitating illness from the coronavirus. Our goal this year with benefits Open Enrollment is to make the benefits review process for you as positive an experience as possible. Knowing your needs and understanding the different health plan options will help you make informed choices during Open Enrollment. Benefits options change year to year.

Changes

For the 2021 plan year, there are no changes to premiums, coinsurance, copays, or deductibles for the Basic, Value, and Choice Health options for full-time employees. However, there are action items for you to take.

Ensure you're aware of all UVA health plan changes for this year. For the 2021 Plan year, these include:

  • 2020 elections for FSAs and HSAs will NOT automatically carry over to 2021. Even if you do not want to make any changes to your health, dental, or vision plan options, you still need to re-enroll in the FSA and HSA programs for 2021 during Open Enrollment. 
  • Aetna will replace OptumRx as the prescription drug administrator. This means you have one insurance provider to go to for questions or support; one insurance card to show for both health expenses and prescription drugs; and one place to locate all your medical and prescription drug expenses when evaluating your future health care needs.
  • Part-time classification: Beginning January 1, 2021, benefits eligibility for health and dental premiums for UVA Health team members will be defined as part-time if working at least 20 but less than 30 hours per week, and full-time if working 30 hours per week or more. Reflected by employee Workday position status. 
    • Team members currently working 30-36 hours will be eligible in 2021 for full-time rates for health and dental benefits
  • Part-time health and dental premiums: Beginning January 1, 2021, premiums for part-time Academic and Medical Center employees in 2021 will be the same.
    • Most part-time employees will see a reduction in the part-time premiums
    • Harmonizing part-time rates and eligibility removes some of the economic barriers in electing a part-time position, and levels the health and dental premiums for part-time employees throughout the University

Action Items

Just like getting an annual physical, it is a good idea to also check your benefits annually. You can do this by navigating to Workday and checking to make sure the benefits you previously selected continue to meet the needs of you and/or your family.

If you would like to change your benefits, review the sections below or navigate to the Open Enrollment pages on the right sidebar for additional details. When you're ready, make your changes in Workday October 5 - 16 (see instructions below). Here are things to review and/or change during Open Enrollment:

  • Modify medical, dental, vision benefits, if desired
  • Add or drop dependents, if applicable
    • Adding a spouse or dependent requires documentation confirming their relationship to you, to be submitted in order for your change request to be approved
    • Adding a spouse also requires spousal affidavit to be completed before finalizing your benefits elections
  • Confirm social security numbers for dependents
  • Elect/waive Health Savings Account and Flexible Spending Account - 2020 elections for FSAs and HSAs will NOT carryover to 2021. You must re-enroll in the FSA and HSA programs for 2021 during Open Enrollment
  • Confirm or change beneficiaries for life insurance

UVA Health Plan Options

UVA offers 3 health plan options: Choice, Value, and Basic Health. All three health plan options offer the same services but different ways of paying for these services. These options apply to full- and part-time benefits-eligible employees:

  1. Basic Health - least expensive option with highest deductible, lowest premium, and a Health Savings Account with UVA contribution of $1,000 (employee only) or $1,500 (employee + spouse, child, or family) to offset the high deductible
  2. Value Health - mid-range option with medium deductible, higher premium
  3. Choice Health - most expensive option with lowest deductible, highest premium

When researching which option fits your needs, consider not only your health care needs, but your comfort with how you pay for your medical costs. If you prefer the less expensive option, are you financially prepared to cover 100% of your medical expenses up to your deductible?

If you are on a J1 Visa, or have been newly granted a J1 Visa during the year, you must move from the UVA Health Plan to the UVA J1 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.

UVA Health Plan Eligibility

  • Eligibility Requirements for any of the UVA Health Plan Options

    Requirements for eligibility for any of the UVA Health Plan options:

    • Employee: Must be an Academic or Medical Center salaried employee of UVA, full- or part-time, and regularly scheduled to work at least 20 hours/week

      • J1 visa holders are only eligible for the UVA J1 Visa Health option. Federal government regulations prohibit J1 visa holders from enrolling in the Basic, Value or Choice Health options.
    • Spouse:
      • For the UVA Health Plan: Must be legally recognized as spouse 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

      • For UVA Dental and Davis Vision: Must be legally recognized as spouse in the Commonwealth of Virginia

    • 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.

    • Children With Disabilities: Must be incapable of self-support due to a mental or physical disability. May continue beyond age 26, as long as:

      • Required documentation is approved in advance by the Aetna Claims Administrator prior to 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 Eligibility 2021800.987.9072 and the UVA Health Plan Ombudsman.
  • Basic Health Eligibility

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

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

    • 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, or be enrolled in Medicare Part A or Part B in the year 2020

    • Not be a J1 Visa holder (federal government regulations prohibit J1 Visa holders from enrolling in the Basic Health option)

UVA Health Plan Comparison

The UVA Basic, Value, and Choice Health options offer the same benefits but with different pay structures.

  • HOW THEY ARE THE SAME

    • 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 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
  • HOW THEY ARE DIFFERENT

    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 (Value or Choice) and pay less out of pocket for using health care services throughout the year?
    • Or pay less in premiums (Basic) and pay more out of pocket as you use the services?
  • Comparison tools

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

    • Medical Scenarios webpage - You told us you wanted to know the costs for common medical procedures and how they play out across the three health plan options, in order to help you better compare values. We heard you! Go to the new UVA Health Plan Medical Scenarios webpage to see six common medical scenarios. Each scenario offers estimates for what each service could potentially cost you. While we cannot guarantee the accuracy of any cost estimate, these scenarios should give you a good understanding of how your premiums, deductibles, co-pays, co-insurance, and out-of-pocket threshold factor together to impact your total cost.
    • 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 Basic, Value and Choice Health options. Each table represents one employee group (individual, + spouse, + child, family). The tables include the UVA employer contribution to HSA for Basic Health 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 Basic, Value, and Choice Health options, and shows deductibles, coinsurance, and copay amounts for each option
    • UVA Health Plan Comparison Tools
    • Aetna Tools: Visit the Aetna website and click on “Log in/Register” to access these resources:​​​​​  
    • Picwell - an online personalized tool that uses big data to compare information you input with millions of other Americans to determine the best fit. Previously just available for health plan options, Picwell now includes details about health, dental, vision, and benefits savings accounts, including how much you should save in your Basic Health HSA for anticipated medical bills.
    • ALEX - a step-by-step virtual assistant who helps you choose benefits. Enter basic information and ALEX responds with what’s available and how to get the best value for your investment. 
    • Podcasts - short podcasts deliver topic-specific information in an informal way, including:
    • 2021 Open Enrollment Overview Video – This new video provides a high-level summary of benefits changes, action items, and resources to help you select your benefits
    • 2021 Open Enrollment Powerpoint – This PowerPoint presentation reports on 2021 benefits changes, resources, premiums, and keys dates to remember
    • 2021 Benefits and Wellness Expo – The Expo is virtual this year, and running during Open Enrollment hours October 5 -16. See the Benefits and Wellness Expo 2021 webpage for more details.
    • OE Presentations: Virtual Open Enrollment presentations are available to assist you with your benefits choices. You can see the schedule for them here.
    • Personalized Assistance - If, after reviewing materials and resources on the Open Enrollment website, you would like additional 1:1 personalized assistance, please call 434.243.3344 to schedule a 20-minute Zoom appointment with one of our HR professionals. HR is offering a limited number of benefits appointments from now until Wednesday, October 14, with appointment start times from 8:00 am to 4:00 pm.
    • Still Need Help? Contact the UVA HR Solution Center, by email  at AskHR@virginia.edu or by phone at 434.243.3344

    When you are ready to enroll, log in to Workday and follow the instructions in your inbox for Open Enrollment.

     

2021 UVA Health Plan Premiums

Select your employee category to see 2021 UVA Health Plan premiums. The tables for 2021 will show both the Employee Premium (what you contribute each month) and the Employer Premium (what UVA contributes toward your health plan option each month).

For the 2021 plan year, there are no changes to premiums, coinsurance, copays, or deductibles for the Basic, Value, and Choice Health options for full-time employees.

Beginning January 1, 2021, premiums for part-time Academic and Medical Center employees in 2021 have been harmonized so they are the same.

  • Most part-time employees will see a reduction in the part-time premiums
  • Harmonizing part-time rates and eligibility removes some of the economic barriers in electing a part-time position, and levels the health and dental premiums for part-time employees throughout the University

  • Full-Time Faculty, Classified Staff, Medical Center Team Members, Research Associates, Senior Professional Research Staff, and University Staff

    For the 2021 plan year, there are no changes to premiums, coinsurance, copays, or deductibles for the Basic, Value, and Choice Health options for full-time employees.

    2021 Monthly Premiums

    Monthly Rate - BASIC Employee Rate Employer Rate Total Rate
    Employee $20.00 $464.25 $484.25
    Employee + Child(ren) $25.25 $821.75 $847.00
    Employee + Spouse $33.25 $1,055.50 $1,088.75
    Family $63.00 $1,510.50 $1,573.50
    Monthly Rate - VALUE Employee Rate Employer Rate Total Rate
    Employee $87.50 $470.00 $557.50
    Employee + Child(ren) $140.25 $833.25 $973.50
    Employee + Spouse $176.25 $1,075.00 $1,251.25
    Family $282.25 $1,528.75 $1,811.00
    Monthly Rate - CHOICE Employee Rate Employer Rate Total Rate
    Employee $183.00 $493.25 $676.25
    Employee + Child(ren) $370.25 $821.75 $1,192.00
    Employee + Spouse $477.00 $1,055.50 $1,532.50
    Family $706.00 $1,510.50 $2,216.50
  • Housestaff

    For the 2021 plan year, there are no changes to premiums, coinsurance, copays, or deductibles for the Basic, Value, and Choice Health options for full-time employees.

    2021 Monthly Premiums

    Monthly Rate - VALUE Employee Rate Employer Rate Total Rate
    Employee $62.75 $494.75 $557.50
    Employee + Child(ren) $63.00 $910.50 $973.50
    Employee + Spouse $64.25 $1,187.00 $1,251.25
    Family $64.50 $1,746.50 $1,811.00
    Monthly Rate - CHOICE Employee Rate Employer Rate Total Rate
    Employee $78.00 $598.25 $676.25
    Employee + Child(ren) $89.25 $1,102.75 $1,192.00
    Employee + Spouse $91.50 $1,441.00 $1,532.50
    Family $101.50 $2,115.00 $2,216.50
  • Postdoctoral Fellows

    For the 2021 plan year, there are no changes to premiums, coinsurance, copays, or deductibles for the Value and Choice Health options for postdoctoral fellows. 

    2021 Monthly Premiums

    Monthly Rate - VALUE Total Rate
    Single $501.50
    Postdoc + Child(ren) $743.75
    Postdoc + Spouse $1,028.50
    Family $1,481.75
    Monthly Rate - CHOICE Total Rate
    Single $559.00
    Postdoc + Child(ren) $848.75
    Postdoc + Spouse $1,163.00
    Family $1,678.00
  • Retirees

    For the 2021 plan year, there are no changes to premiums, coinsurance, copays, or deductibles for the Basic, Value, and Choice Health options for full-time employees.

    Non-Medicare eligible plans through UVA

    2021 Monthly Premiums BASIC VALUE CHOICE
    Retiree $756.75 $1,109.00 $1,194.25
    Retiree + Child/Children $1,424.25 $2,086.75 $2,354.00
    Retiree + Spouse $1,523.00 $2,230.75 $2,545.75
    Family $2,288.50 $3,352.00 $3,894.75

    Medicare-Supplement Plans

    See Medicare-Supplement Plans through Anthem Blue Cross/Blue Shield.

  • Temporary and Wage Employees

    For the 2021 plan year, there are no changes to premiums, coinsurance, copays, or deductibles for the Basic, Value, and Choice Health options for full-time employees.

    2021 Monthly Premiums

    2021 Monthly Premiums - BASIC Employee Rate Employer Rate Total Rate
    Employee $181.50 $234.75 $416.25
    Employee + Child/Children $503.00 $234.75 $737.75
    Employee + Spouse $717.50 $234.75 $952.25
    Family $1,146.25 $234.75 $1,381.00
  • Part-Time Employees

    Beginning January 1, 2021, premiums for part-time Academic and Medical Center employees in 2021 will be the same. 

    2021 Monthly Premiums

    Monthly Rate - BASIC Employee Rate Employer Rate Total Rate
    Employee $154.96 $329.29 $484.25
    Employee + Child(ren) $271.04 $575.96 $847.00
    Employee + Spouse $348.40 $740.35 $1,088.75
    Family $503.52 $1,069.98 $1,573.50
    Monthly Rate - VALUE Employee Rate Employer Rate Total Rate
    Employee $178.40 $379.10 $557.50
    Employee + Child(ren) $311.52 $661.98 $973.50
    Employee + Spouse $400.40 $850.85 $1,251.25
    Family $579.52 $1,231.48 $1,811.00
    Monthly Rate - CHOICE Employee Rate Employer Rate Total Rate
    Employee $216.40 $459.85 $676.25
    Employee + Child(ren) $381.44 $810.56 $1,192.00
    Employee + Spouse $490.40 $1,042.10 $1,532.50
    Family $709.28 $1,507.22 $2,216.50

COBRA Premiums

As a COBRA participant, you can choose enrollment only in the same option in which you were enrolled on your last day of coverage as an active employee, Postdoc Fellow, or Housestaff. Monthly COBRA premiums are listed below. 

COBRA participants: Visit Chard Snyder COBRA Customer Service on the web or call 888.878.6175.

  • ACTIVE EMPLOYEES AND RESEARCH ASSOCIATES

    2021 Active Employees and Research Associates Cobra BASIC Cobra VALUE Cobra CHOICE
    Employee $493.94 $568.65 $689.78
    Employee + Child/Children $863.94 $992.97 $1,215.84
    Employee + Spouse $1,110.53 $1,276.28 $1,563.15
    Family $1,604.97 $1,847.22 $2,260.83
  • Active Wage Employees

    2021 Active Wage Employees  Cobra BASIC
    Employee $424.58
    Employee + Child/Children $752.51
    Employee + Spouse $971.30
    Family $1,408.62
  • Postdoctoral Fellows

    2021 Postdoctoral Fellows  Cobra Value Cobra Choice
    Postdoc $511.53 $570.18
    Postdoc + Child/Children $758.63 $865.73
    Postdoc + Spouse $1,049.07 $1,186.26
    Family $1,511.39 $1,711.56
  • Housestaff

    2021 Housestaff  Cobra VALUE Cobra CHOICE
    Employee $568.65 $689.78
    Employee + Child/Children $992.97 $1,215.84
    Employee + Spouse $1,276.28 $1,563.15
    Family $1,847.22 $2,260.83

UVA Health Plan Coordination With Medicare and Other Plans

If you have coverage under other group or individual plans or receive payments for an illness or injury caused by another person, the benefits you receive from this Plan may be adjusted. This may reduce the benefits you receive from this Plan. The adjustment is known as coordination of benefits (COB).

Benefits available through other groups or individual plans, contracts or other arrangements, are coordinated with this Plan. This includes automobile insurance coverage, where a health benefit is to be provided, arranged, or paid for, on an insured or uninsured basis. Members involved in an automobile accident should contact Aetna regarding COB.

“Other plans” include any other plan of dental or medical coverage provided by:

  • Group insurance or any other arrangement of group coverage for individuals, regardless of whether that plan is insured
  • Motor vehicle personal injury protection benefit (PIP) or optional motor vehicle insurance, to the extent of applicable law. Whenever legally possible, this Plan will be secondary.

  • Which Plan Pays First?

    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:

      IF:  THEN:
    1. One plan has a COB provision and the other plan does not The plan without a COB provision determines its benefits and pays first
    2. One plan covers you as a dependent and the other covers you as an employee or retiree

    The plan that covers you as an employee or retiree determines its benefits and pays first. Note: If you are Medicare-eligible, this rule may be reversed. Please see rule 3, below.

    3. You are eligible for Medicare and not actively working These Medicare Secondary Payer rules apply:

    - The plan that covers you as a dependent of a working spouse determines its benefits and pays first

    - Medicare pays second

    - The plan that covers you as a retired employee pays third

    4. A child’s parents are married or living together (whether or not married) The plan of the parent whose birthday occurs earlier in the calendar year determines its benefits and pays first. If both parents have the same birthday, the plan that has covered the parent the longest determines its benefits and pays first. But if the other plan does not have this “parent birthday” rule, the other plan’s COB rule applies.
    5. A child’s parents are separated or divorced with joint custody, and a court decree does not assign responsibility for the child’s health expenses to either parent, or states that both parents are responsible for the child’s health coverage The “birthday rule” described in rule 4 applies
    6. A child’s parents are separated or divorced, and a court decree assigns responsibility for the child’s health expenses to one parent The plan covering the child as the assigned parent’s dependent determines its benefits and pays first
    7. A child’s parents are separated, divorced or not living together (whether or not they have ever been married) and there is no court decree assigning responsibilities for the child’s health expenses to either parent Benefits are determined and paid in this order:

    - The plan of the custodial parent pays, then

    - The plan of the spouse of the custodial parent pays, then

    - The plan of the non-custodial parent pays, then

    - The plan of the spouse of the non-custodial parent pays.

    8. You have coverage as an active employee (that is, not as a retiree or laid off employee) and coverage as a retired or laid off employee. Or you have coverage as the dependent of an active employee and coverage as the dependent of a retired or laid off employee The plan that covers you as an active employee or as the dependent of an active employee determines its benefits and pays first. This rule is ignored if the other plan does not contain the same rule. Note: this rule does not apply if the rule 2 (above) has already determined the order of payment.
    9. You are covered under a federal or state right of continuation law (such as COBRA) The plan other than the one that covers you under a right of continuation law will determine its benefits and pay first. This rule is ignored if the other plan does not contain the same rule. Note: this rule does not apply if rule 2 (above) has already determined the order of payment.
    10. The above rules do not establish an order of payment The plan that has covered you for the longest time will determine its benefits and pay 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.

  • Coordination with Medicare

    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.

Additional Information

  • Dependents: While reviewing your benefit elections, be sure to check any dependent information listed and confirm that each dependent’s social security number, birth date, and continued eligibility for coverage is accurate. Now is the time to drop ineligible dependents.
  • FAMIS Virginia’s Affordable Health Care for Children: To see if you qualify for FAMIS, go to Cover Virginia and call 1.855.242.8282, Option 8 to apply.

Resources

Enroll in Workday

  • To review and elect your benefits in Workday

    • Navigate to Workday
    • In your Workday Inbox, click on the message titled "Open Enrollment Change: [Your Name] on 01/01/2021"
    • Follow the instructions to navigate through each part of the Workday Open Enrollment screens:
      1. Modify medical, dental, vision benefits, if desired
      2. Add or drop dependents, if applicable (adding a spouse requires spousal affidavit to be completed before finalizing your benefits elections). Confirm social security numbers for dependents.
      3. Elect/waive Health Savings Account and Flexible Spending Account
      4. View insurances and long-term disability
      5. Confirm or change beneficiaries for life insurance
      6. If you are not ready to submit, back up one page using your "back" arrow in your browser, and select "Save for Later"
      7. When you are ready to submit, electronically sign at the bottom of the last page and press the SUBMIT button
      8. Workday does not currently offer the option to confirm your elections in writing, so after you submit your elections, it is a good idea to print a copy of your elections confirmation for your records. This will save a PDF of the document, which you can print or save.
      9. Watch for additional emails in your Workday Inbox related to post-Open Enrollment action items you made need to take
    • The following Workday Job Aids and training video offer additional detailed instructions:

     

  • If you Change Your Mind on an Open Enrollment Choice You Made and Open Enrollment Has Not Closed

    You can make changes to your elections as long as the Open Enrollment period is open, even after you have submitted your elections.

    1. From the Benefits app in Workday, click on "Change Open Enrollment"
    2. You will be making changes to what has been previously submitted. Any changes made will need to be resubmitted. If you do not resubmit, the changes will be deleted and the previous submission will remain in effect.
    3. Move through the same screens to elect or waive coverage
    4. Once changes are complete, electronically sign at the bottom of the last page and press the SUBMIT button
    5. Print the new confirmation of benefits elections
  • Open Enrollment Workday System Walk-Through

    Watch this short video that gives step-by-step instructions for navigating the Open Enrollment screens in Workday.

I appreciated the fact that there were multiple resources/tools/measures to use to assess what plan was best for my family. This allowed me to see the question from multiple perspectives. Catarina Krizancic, PhD, International Health, Safety, and Security Manager

FAQs - UVA Health Plan

  • Can married UVA employees share a UVA health plan?

    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.

  • How do I decide what health plan option is best for me?

    Try our health care analytical tools, Picwell or ALEX, to help you choose.

    Look at the new Medical Scenarios webpage to learn how the deductible, coinsurance, copayment, and out-of-pocket maximum affect your cost across the 3 health plan options.

    You can map out what you’ll need from your benefits in 2021 by reviewing how you’ve used them in 2020 and thinking about anything new you might need next year. Reviewing how you’ve spent funds and used benefits over the last year can be a huge help when selecting a plan. The following resources can help you look back, in order to take care of yourself in 2021:

    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?

  • How do preventive care services compare between the three health plan options?

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

  • Wage Employees and the Affordable Care Act

    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 Medical Center Wage employees?

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

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

    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.

  • What's the difference between a beneficiary and a dependent?

    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 Open Enrollment Eligibility 2021 webpage.

  • Who is eligible for the UVA Health, Dental, and Vision Plans?

    Detailed information about eligibility for the UVA Health, Dental, and Vision Plans can be found on the Eligibility 2021 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 J1 visa holders, who are eligible for the UVA J1 Visa Health Plan
    • Spouses of eligible UVA employees (some exception noted on the Eligibility 2021 webpage)
    • Children of eligible UVA employees - children (as defined on the Eligibility 2021 webpage) are eligible through their birthday at age 26, or longer if documented to have mental or physical disabilities (see the Eligibility 2021 webpage for more details)

    The Basic Health option has some additional requirements; please visit the Eligibility 2021 webpage for those details.

  • How does cost-sharing work between me and Aetna?

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

  • Where can I obtain a flu vaccine? What is the cost?

    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.

    Flu Shot Updates

FAQs - UVA Health Plan and Medicare

  • Can I sign up for the Basic Health or the Basic Health HSA if I’m enrolling in Medicare?

    No. If you plan to enroll in Medicare, you are not eligible to sign up for Basic Health and are not eligible for a Basic Health 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 Basic Health to Value Health or Choice Health or vice versa anytime during 2021 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 2021 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.

  • Can I sign up for Basic Health or the Basic Health HSA if my spouse on my UVA Health Plan is enrolled in Medicare?

    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 insurance, 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 Basic Plan HSA.

  • Do I (or my spouse) have to enroll in Medicare once I turn 65? I am already enrolled in the UVA Health Plan.

    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 (Basic Health). 

FAQs - UVA Health Plan and J1 Visa

FAQs - Prescription Drug Program

  • How do my deductible, coinsurance, and min/max tiers work with prescription drugs?

    Basic Health 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. 

    Value 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.

    Tier Choice Value Basic

    Tier 1

    Generic, low cost

    $6 co-pay

    30-day supply

    $6 co-pay

    30-day supply

    Deductible + 20% for up to 90-day supply

    Tier 2

    Brand, Preferred

    Deductible + 20%

    $34 min/$150 max

    30-day supply

    Deductible + 20%

    $34 min/$150 max

    30-day supply

    Deductible + 20% for up to 90-day supply

    Tier 3

    Brand, Non-Preferred

    Deductible + 20%

    $68 min/$225 max

    30-day supply

    Deductible + 20%

    $68 min/$225 max

    30-day supply

    Deductible + 20% for up to 90-day supply

     

  • Where can I find more information about prescription coverage?

    You can find information on our Prescription Drug Program 2021 webpage.

    If you need additional details, contact Aetna for assistance.

  • Where can I obtain my specialty medication?

    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.

Having trouble finding what you’re looking for?

We strive to make the information on every webpage clear and easy to find. Please let the HR Communications team know if you're having trouble finding what you're looking for, so we can improve your experience on this page in the future. 

For non-website questions or concerns about benefits and Open Enrollment, please contact the HR Solution Center by phone at 434.243.3344, or by email at AskHR@virginia.edu.

For previous Open Enrollment email communications, visit the Open Enrollment Communications Archive webpage.