How Your UVA Health Plan Works for You

Medical Scenarios 2021


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 have heard you! This year, you can see six common medical scenarios that UVA employees experience, according to Aetna. Each situation provides estimates for what you would pay for each service (keep in mind that the real costs depend on the services you receive and how the doctor or health care facility bills Aetna). The scenarios use different tiers: employee only, employee + spouse, employee + child, and family.

Annual Premiums Included

To see the bigger picture, you'll also want to consider your annual premium. If each scenario was the ONLY medical event you had in a year, you can see what your total estimated out-of-pocket cost would be for the year. The premiums used in these scenarios apply to full-time faculty, classified staff, Medical Center team members, post-doctoral research associates, senior professional research staff, and University staff. 

Create Your Own Scenarios

Of course, most people will touch the health care system more than once in a year. To find out what multiple medical events would cost you in a year for each of the three health plan options, the Aetna One Advocate team can provide you with specific cost estimates based on your own circumstances. See their contact information at the bottom of this page and also on the right sidebar.

Aetna Tools: Visit the Aetna website and click on “Log in/Register” to access these resources:​​​​​  

How You Share Costs With Aetna

The below illustration explains how your health care out-of-pocket costs change as you reach your deductible and your out-of-pocket limit:

health plan cost share illustration

Common Medical Scenarios

  • Inpatient Hospital Services - Traditional Delivery of Baby

    Emily is having a baby.  The estimates below include an uncomplicated vaginal delivery without sterilization, and a hospital stay of three nights for Emily and her baby. Emily and her newborn are the only people covered by her health plan option. 

    These estimates include the deductible and coinsurance limits for Emily and baby. With the inclusion of the baby's estimated costs and associated deductible and coinsurance limits, the estimate you see here may appear higher than the deductible and coinsurance limits listed in the medical plan details. Check your plan benefits for specific details.

    Here are Emily's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

        Basic Health  Value Health Choice Health
    DEDUCTIBLE - Employee Only: $2,000   DEDUCTIBLE - Employee Only: $800 DEDUCTIBLE - Employee Only: $500
    DEDUCTIBLE - Employee + Dependent: $4,000   DEDUCTIBLE - Family: $1,600 DEDUCTIBLE - Family: $1,000
    COINSURANCE: 20% COINSURANCE: 20% COINSURANCE: 15%
    MAXIMUM OUT-OF-POCKET - Employee Only: $4,000   MAXIMUM OUT-OF-POCKET - Employee Only: $5,500 MAXIMUM OUT-OF-POCKET - Employee Only: $5,500
    MAXIMUM OUT-OF-POCKET - Family: $8,000   MAXIMUM OUT-OF-POCKET - Family: $11,000 MAXIMUM OUT-OF-POCKET - Family: $11,000

    ANNUAL PREMIUM - Employee Only (before birth): $240

    ANNUAL PREMIUM - Employee + Child (after birth): $303

    HSA Offset - Employee Only: -$1,000

    ANNUAL PREMIUM - Employee Only (before birth): $1,050

    ANNUAL PREMIUM - Employee + Child (after birth): $1,683

    ANNUAL PREMIUM - Employee Only (before birth): $2,196

    ANNUAL PREMIUM - Employee + Child (after birth): $4,443

    Here are cost estimates for Emily's delivery.

    • These estimates below presume no prior deductible was met
    • The estimates are for in-network providers only
    • The estimates are for inpatient hospital service
    • Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
    • We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
    • This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
    • Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

    Emily's Costs:

      Basic Health Value Health Choice Health
    Cost of Service for Emily $16,045.09 $16,045.09 $16,045.09
    Aetna member rate $10,527.11 $10,527.11 $10,527.11
    Emily's deductible $4,000.00 $800.00 $500.00
    Emily's coinsurance $0.00* $1,945.42 $1,504.07
    Total cost for Emily $4,000.00 $2,745.42 $2,004.07

    * No coinsurance cost; Emily has met her family deductible and individual out-of-pocket threshold.

    Newborn's Costs:

      Basic Health Value Health Choice Health
    Cost of Service for Newborn $8,346.74 $8,346.74 $8,346.74
    Aetna member rate $7,690.00 $7,690.00 $7,690.00
    Newborn's deductible $0.00** $800.00 $500.00
    Newborn's coinsurance $1,538.00 $1,378.00 $1,078.50
    Total cost for Newborn $1,538.00 $2,178.00 $1,578.50
    Total Cost for Emily and Newborn $5,538.00 $4,923.42 $3,582.57

    ** No deductible for newborn; Emily has already met the family deductible.

    Total Costs and Annual Premiums: Factoring in annual premiums, Emily's projected costs for the year she delivers a new baby would be:

      Basic Health Value Health Choice Health
    Total Cost for Emily + Newborn $5,538.00 $4,923.42 $3,582.57
    Annual Premium, Employee + Child 303.00 $1,683.00 $4,443.00
    HSA (Basic Health only)*** ($1,000.00) $0.00 $0.00
    Emily and Newborn's Total Cost + Premium*** $4,341.00 $6,606.42 $8,025.57

    *** Emily was Employee Only prior to her baby being born; her HSA employer contribution would be for Employee Only as of the beginning of the year, and her premiums would change to Employee + Child level with her Qualifying Life Event.

    These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

  • Imaging Services - Foot X-ray

    Bella lives by herself, and recently injured her foot and needs help figuring out what to do about it. The estimates below include a complete foot x-ray, with a minimum of three views. Some facilities may charge an additional fee for the radiologist to read the x-ray. Check your plan benefits for more details.

    Here are Bella's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

    Basic Health Value Health Choice Health
    DEDUCTIBLE - Employee Only: $2,000   DEDUCTIBLE - Employee Only: $800 DEDUCTIBLE - Employee Only: $500
    COINSURANCE: 20% COINSURANCE: 20% COINSURANCE: 15%
    MAXIMUM OUT-OF-POCKET - Employee Only: $4,000   MAXIMUM OUT-OF-POCKET - Employee Only: $5,500 MAXIMUM OUT-OF-POCKET - Employee Only: $5,500

    ANNUAL PREMIUM - Employee Only: $240

    HSA Offset - Employee Only: -$1,000

    ANNUAL PREMIUM - Employee Only: $1,050

    ANNUAL PREMIUM - Employee Only: $2,196

    Here are cost estimates for Bella's foot x-rays.

    • These estimates below presume no prior deductible was met
    • The estimates are for in-network providers only
    • The estimates are for non-preventive x-ray procedure
    • Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
    • We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
    • This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
    • Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

    Bella's Costs:

      Basic Health Employee Only Basic Health Employee + Dependent(s) Value Health Choice Health
    Cost of Service for Bella $725.00 $725.00 $725.00 $725.00
    Aetna member rate $564.78 $564.78 $564.78 $564.78
    Bella's deductible $564.78 $564.78 $564.78 $500.00
    Bella's coinsurance $0.00 $0.00 $0.00 $9.72
    Total cost for Bella $564.78 $564.78 $564.78 $509.72

    Total Costs and Annual Premiums: Factoring in annual premiums, Bella's projected costs for the year she injures her foot would be:

      Basic Health Value Health Choice Health
    Total Cost for Bella $564.78 $564.78 $564.78
    Annual Premium, Employee Only $240.00 $1,050.00 $2,196.00
    HSA (Basic Health only) ($1,000.00) $0.00 $0.00
    Bella's Total Cost + Premium $0.00 $1,614.78 $2,760.78

    These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

  • Type 1 Diabetes Continuous Glucose Monitor

    Mark's family is very concerned for him, as he just found out he has Type 1 diabetes. His doctor has prescribed a continuous glucose monitor for him. The estimates below include a continuous glucose monitor, receive, transmitter, and sensor, purchased through an in-network Durable Medical Equipment supplier. Check your plan benefits for more details.

    Here are Mark's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

    Basic Health Value Health Choice Health
    DEDUCTIBLE - Employee Only: $2,000   DEDUCTIBLE - Employee Only: $800 DEDUCTIBLE - Employee Only: $500
    DEDUCTIBLE - Employee + Dependent: $4,000   DEDUCTIBLE - Family: $1,600 DEDUCTIBLE - Family: $1,000
    COINSURANCE: 20% COINSURANCE: 20% COINSURANCE: 15%
    MAXIMUM OUT-OF-POCKET - Employee Only: $4,000   MAXIMUM OUT-OF-POCKET - Employee Only: $5,500 MAXIMUM OUT-OF-POCKET - Employee Only: $5,500
    MAXIMUM OUT-OF-POCKET - Family: $8,000   MAXIMUM OUT-OF-POCKET - Family: $11,000 MAXIMUM OUT-OF-POCKET - Family: $11,000

    ANNUAL PREMIUM - Family: $756

    HSA Offset - Family: -$1,500

    ANNUAL PREMIUM - Family: $3,387

    ANNUAL PREMIUM - Family: $8,472

    Here are cost estimates for Mark's continuous glucose monitor, receive, transmitter, and sensor.

    • These estimates below presume no prior deductible was met
    • The estimates are for in-network providers only
    • The estimates are for Durable Medical Equipment service
    • Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
    • We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
    • This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
    • Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

    Mark's Costs:

      Basic Health Employee Only Basic Health Employee + Dependent(s) Value Health Choice Health
    Cost of Service for Mark $3,522.67 $3,522.67 $3,522.67 $3,522.67
    Aetna member rate $1,700.00 $1,700.00 $1,700.00 $1,700.00
    Mark's deductible $1,700.00 $1,700.00 $800.00 $500.00
    Mark's coinsurance $0.00 $0.00 $180.00 $180.00
    Total cost for Mark $1,700.00 $1,700.00 $980.00 $680.00

    Total Costs and Annual Premiums: Factoring in annual premiums, Mark's projected costs for the year he is diagnosed with Type 1 diabetes would be:

      Basic Health Value Health Choice Health
    Total Cost for Mark $1,700.00 $980.00 $680.00
    Annual Premium, Family $756.00 $3,387.00 $8,472
    HSA (Basic Health only) ($1,500.00) $0.00 $0.00
    Mark's Total Cost + Premium $956.00 $4,367.00 $9,152.00

    These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

  • Physical Therapy Services - Back Pain

    Robert and his wife Claire are on the UVA Health Plan, and Claire encouraged Robert to seek medical advice for a nagging back pain he hasn't been able to heal. His primary care physician recommends that Robert start physical therapy on his back immediately.

    The estimates below are for physical therapy, therapeutic procedure, one or more areas. Check your plan benefits for more details.

    Here are Robert's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

    Basic Health Value Health Choice Health
    DEDUCTIBLE - Employee Only: $2,000   DEDUCTIBLE - Employee Only: $800 DEDUCTIBLE - Employee Only: $500
    DEDUCTIBLE - Employee + Dependent: $4,000   DEDUCTIBLE - Family: $1,600 DEDUCTIBLE - Family: $1,000
    COINSURANCE: 20% COINSURANCE: 20% COINSURANCE: 15%
    MAXIMUM OUT-OF-POCKET - Employee Only: $4,000   MAXIMUM OUT-OF-POCKET - Employee Only: $5,500 MAXIMUM OUT-OF-POCKET - Employee Only: $5,500
    MAXIMUM OUT-OF-POCKET - Family: $8,000   MAXIMUM OUT-OF-POCKET - Family: $11,000 MAXIMUM OUT-OF-POCKET - Family: $11,000

    ANNUAL PREMIUM - Employee + Spouse: $399

    HSA Offset - Employee + Spouse: -$1,500

    ANNUAL PREMIUM - Employee + Spouse: $2,115

    ANNUAL PREMIUM - Employee + Spouse: $5,724

    Here are cost estimates for Robert's physical therapy on his back; this is a per visit estimate.

    • These estimates below presume no prior deductible was met
    • The estimates are for in-network providers only
    • The estimates are for physical therapy, therapeutic procedure, one or more areas
    • Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
    • We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
    • This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
    • Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

    Robert's Costs:

      Basic Health Employee Only Basic Health Employee + Dependent(s) Value Health Choice Health
    Cost of Service for Robert $281.48 $281.48 $281.48 $281.48
    Aetna member rate $88.48 $88.48 $88.48 $88.48
    Robert's deductible $88.48 $88.48 $0.00 $88.48
    Robert's coinsurance $0.00 $0.00 $0.00 $0.00
    Robert's copayment N/A N/A $40.00 N/A
    Total cost for Robert $88.48 $88.48 $40.00 $88.48

    Total Costs and Annual Premiums: Factoring in annual premiums, Robert's projected costs for the year he has back pain and seeks physical therapy would be:

      Basic Health Value Health Choice Health
    Total Cost for Robert $88.48 $40.00 $88.48
    Annual Premium, Employee + Spouse $399.00 $2,115.00 $5,724.00
    HSA (Basic Health only) ($1,500.00) $0.00 $0.00
    Robert's Total Cost + Premium $0.00 $2,155.00 $5,812.48

    These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

  • Professional Services In office -Medical Visit

    Ken hasn't been feeling well lately, and decides to visit his primary care physician to discover what is troubling his body.

    The estimates below are for a typical primary care established patient office visit. A typical office visit at your primary care physician's office would entail just the cost of the visit itself for low to moderate severity problems. Check your plan benefits for more details.

    Here are Ken's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

    *Mental Health outpatient treatment office visit offer the same member cost-share as Primary Care provider office visits.  

    Basic Health Value Health Choice Health
    DEDUCTIBLE - Employee Only: $2,000   DEDUCTIBLE - Employee Only: $800 DEDUCTIBLE - Employee Only: $500
    COINSURANCE: 20% COINSURANCE: 20% COINSURANCE: 15%
    MAXIMUM OUT-OF-POCKET - Employee Only: $4,000   MAXIMUM OUT-OF-POCKET - Employee Only: $5,500 MAXIMUM OUT-OF-POCKET - Employee Only: $5,500

    ANNUAL PREMIUM - Employee Only: $240

    HSA Offset - Employee Only: -$1,000

    ANNUAL PREMIUM - Employee Only: $1,050

    ANNUAL PREMIUM - Employee Only: $2,196

    Here are cost estimates for Ken's primary care physician office visit.

    • These estimates below presume no prior deductible was met
    • The estimates are for in-network providers only
    • The estimates are for a typical primary care established patient office visit
    • Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
    • We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
    • This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
    • Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

    Ken's Costs:

      Basic Health Employee Only Basic Health Employee + Dependent(s) Value Health Choice Health
    Cost of Service for Robert $195.00 $195.00 $195.00 $195.00
    Aetna member rate $165.91 $165.91 $165.91 $165.91
    Ken's deductible $165.91 $165.91 $0.00 $165.91
    Ken's coinsurance $0.00 $0.00 $0.00 $0.00
    Ken's copayment N/A N/A $40.00 N/A
    Total cost for Ken $165.91 $165.91 $40.00 $165.91

    Total Costs and Annual Premiums: Factoring in annual premiums, Ken's projected costs for the year he visits his primary care physician would be:

      Basic Health Value Health Choice Health
    Total Cost for Ken $165.91 $40.00 $165.91
    Annual Premium, Employee Only $240.00 $1,050.00 $2,196.00
    HSA (Basic Health only) ($1,000.00) $0.00 $0.00
    Ken's Total Cost + Premium $0.00 $1,090.00 $2,361.91

    These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

  • Total Knee Replacement

    Tim's right knee had been bothering him for a long time, and he finally decided to have it replaced. His total knee replacement includes most typical services, from admission to discharge, but does not include physical therapy after his knee replacement. Charges may vary greatly depending on the type of implant Tim receives.

    Here are Tim's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

    Basic Health Value Health Choice Health
    DEDUCTIBLE - Employee Only: $2,000   DEDUCTIBLE - Employee Only: $800 DEDUCTIBLE - Employee Only: $500
    COINSURANCE: 20% COINSURANCE: 20% COINSURANCE: 15%
    MAXIMUM OUT-OF-POCKET - Employee Only: $4,000   MAXIMUM OUT-OF-POCKET - Employee Only: $5,500 MAXIMUM OUT-OF-POCKET - Employee Only: $5,500

    ANNUAL PREMIUM - Employee Only: $240

    HSA Offset - Employee Only: -$1,000

    ANNUAL PREMIUM - Employee Only: $1,050

    ANNUAL PREMIUM - Employee Only: $2,196

    Here are cost estimates for Tim's total knee replacement.

    • These estimates below presume no prior deductible was met
    • The estimates are for in-network providers only
    • The estimates are for in-patient hospital services
    • The estimates are for a typical primary care established patient office visit
    • Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
    • We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
    • This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
    • Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted. 

    Tim's Costs:

      Basic Health Employee Only Value Health Choice Health
    Cost of Service for Tim $77,011.11 $77,011.11 $77,011.11
    Aetna member rate $17,717.77 $17,717.77 $17,717.77
    Tim's deductible $2,000.00 $800.00 $500.00
    Tim's coinsurance $2,000.00 $3,383.55 $2,582.67
    Tim's copayment N/A $40.00 N/A
    Total cost for Tim $4,000.00 $4,183.55 $3,082.67

    Total Costs and Annual Premiums: Factoring in annual premiums, Tim's projected costs for the year he has a total knee replacement would be:

      Basic Health Value Health Choice Health
    Total Cost for Tim $4,000.00 $4,183.55 $3,082.67
    Annual Premium, Employee Only $240.00 $1,050.00 $2,196.00
    HSA (Basic Health only) ($1,000.00) $0.00 $0.00
    Tim's Total Cost + Premium $3,240.00 $5,233.55 $5,278.67

    These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:​​​​​  

Contact Aetna

If you have further questions regarding cost estimates, please reach out to the Aetna Customer Service: 

AETNA CUSTOMER SERVICE

Phone: 800.987.9072

Hours of Operation:

  • Monday through Friday: 9 am - 9 pm, EST
  • Saturday: 8 am - 4:30 pm, EST

Claims Mailing Address: P.O. Box 981106, El Paso, TX 79998-1106

AETNA MEDICAL/PHARMACY PRE-CERTIFICATION DEPARTMENT

Phone: 855.240.0535

Hours of Operation:

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 really appreciated the resources provided for Open Enrollment this year. I have worked at UVA for 10 years now, this is the first year I felt competent and comfortable with the selection process. Thank you so much for spending time to provide all great resources. Ashley Viars, AGACNP-BC, PCCN, Department of Cardiology

Having trouble finding what you’re looking for?

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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.