Health Coverage for You and Your Family

UVA Health Plan


Every UVA employee has different benefits needs, so we offer 3 health plan options to enable you to choose the right coverage. Select from Basic, Value, or Choice Health. All options are administered by Aetna.

To enroll in your health plan as a new employee, navigate to Workday>Inbox and follow the instructions for the new hire enrollment action.

Changes can be made during an Annual Enrollment period each October or after a major life change, like a change in marital status, an addition to the family, or a leave of absence. Visit the Life Changes pages to learn more about making changes to your health plan outside of Annual Enrollment. 

Who is eligible?

The following information is the general eligibility for the UVA Health Plan. Basic Health is UVA’s high deductible health plan (HDHP) option. You must be eligible for a Health Savings Account (HSA) in order to enroll in Basic Health. Visit the HSA page to learn more about those additional requirements.

  • Employees

    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 (Value or Choice Health only)
    • Housestaff (Value or Choice Health only)
    • Retiree
    • Temporary or Wage Employee (if eligible under ACA)

    J-1 Visa Holders: You are eligible for Choice Health only, due to federal government regulations.

  • Spouses

    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. 

  • Children

    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 through December 31 of the year they turn age 26. Starting January 1, 2019, children are eligible to the end of the birth month in which they turn 26 rather than the birth year.

  • Adult Children with Disabilities

    If children are incapable of self-support, due to mental or physical disability, they can remain on your 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.

What are the costs?

When choosing the right health option for you and your family member covered on your plan, costs are one of the many things to consider. Look at the premiums, deductible, and out-of-pocket maximum for each plan and select the best option based on your health care use. Basic Health, UVA’s High Deductible Health Plan (HDHP) has an accompanying Health Savings Account (HSA) into which the University may contribute annually. For more information about the HSA, visit the Health Savings Account page.

For a quick sense of how the costs compare between the UVA Health Plans, see the UVA Health Plan Cost Comparison At a Glance. (For 2020 rates, visit the Open Enrollment webpages.)

Premiums

The UVA Health Plan is self-insured. This means that the employee and employer premiums must be at the appropriate level to cover all services provided to all UVA Health Plan participants including but not limited to visits, surgeries, therapy, drugs, xrays, diagnostic tests, immunizations, etc.  

Your premiums are the amount you spend on the UVA Health Plan each paycheck. Premiums are not included as contributions toward your deductible or out-of-pocket maximum. They are money you spend on health coverage, regardless of whether you use it. As an HDHP, Basic Health has lower premiums than other plans but has a higher deductible.

Note: Premium amounts below are monthly. Family coverage includes the employee, spouse, and child/children.

COBRA Rates

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. 

  • Active Employees and Research Associates

     

    2019 Active Employees and Research Associates Cobra Basic  Cobra Value  Cobra Choice 
    Employee $492.92 $556.92 $658.67
    Employee + Child/Children $862.67 $974.36 $1,152.86
    Employee + Spouse $1,109 $1,252.82 $1,482.06
    Family $1,601.91 $1,809.74 $2,140.73
  • Active Wage Employees

    2019 Active Wage Employees Cobra Basic 
    Employee $416.67
    Employee + Child/Children $729.05
    Employee + Spouse $937.38
    Family $1,353.80
  • Postdoctoral Fellows

    2019 Postdoctoral Fellows  Cobra Value  Cobra Choice 
    Employee $393.47 $438.60
    Employee + Child/Children $583.44 $665.81
    Employee + Spouse $806.82 $912.39
    Family $1,162.55 $1,316.57
  • Housestaff

    2019 Housestaff  Cobra Value Cobra Choice
    Employee $556.92 $658.67
    Employee + Child/Children $974.36 $1,152.86
    Employee + Spouse $1,252.82 $1,482.06
    Family $1,809.74 $2,140.73


     

Deductible

Your deductible is the amount you pay for covered health care services before the UVA Health Plan starts to pay. Since Basic Health is a High Deductible Health Plan, its deductible is higher than those for other UVA Health Plan options, but the premiums are lower. UVA helps offset this higher deductible by contributing to Basic Health participants’ Health Savings Accounts each year.

  • In-Network Deductibles

     

     

    Individual

    Family

    Basic

    $2,000

    $4,000

    Value

    $1,000

    $2,000

    Choice

    $400

    $800

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

     

  • Out-of-Network Deductibles

     

    Individual

    Family

    Basic

    $6,000

    $12,000

    Value

    $3,000

    $6,000

    Choice

    $1,200

    $2,400

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

Out-of-Pocket Maximum

The out-of-pocket maximum is the most you will spend for covered services in a year for health care, and it includes the deductible, co-payments, and co-insurance. It does not include amounts above the allowable amount nor does it include the brand name prescription cost-sharing and the difference in the cost between the brand name drug and the generic drug when a generic equivalent exists for a brand name prescription and you select the brand name drug. If this maximum is reached during the year, the UVA Health Plan would pay 100% of additional covered expenses. The out-of-pocket maximums are the same for all three UVA Health Plan options.

How do I use the UVA Health Plan?

UVA Health Plan coverage varies between the Basic, Value, and Choice Health options. With all three options, preventive care is covered at 100%. For specific information about coverage and costs for each option, please use the following resources:

  • Register at www.aetna.com

    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 and click “Login”.
    • 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.
  • Get a health insurance card

    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 “ID Card” in the top menu.
    • On the ID Card page, select the member name for the card you want to view and click the “View ID Card” button.
    • Once viewing the ID Card, you may choose to print, download, or share the ID Card via fax to a provider.
  • Find a provider

    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.

  • Price a service

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

    • Member Payment Estimator: Estimates costs for over 650 medical tests, services, and procedures based on your plan details, and provides real-time, personalized estimates.
    • Estimate Cost of Care: Provides the average in-network and out-of-network costs for tests, office visits, selected surgeries/procedures, routine physicals, and emergency room visits.
    • Hospital Comparison Tool: Gives you an independent comparison of quality of outcomes for hospitals by procedures or diagnosis.

    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 “See Coverage & Costs.”
    • Follow the prompts to find a provider for the care you need.
  • Review a claim or explanation of benefits (EOB)

    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.
  • How do I prepare for out-of-pocket expenses?

    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 Basic Health 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.

  • Foreign Travel Coverage with the UVA Health Plan

    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 US. 

    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 1.800.987.9072, member services.
    • Call Aetna, Special Case Precertification Unit at 1.855.888.9046 or 1.215.775.6445. 

    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 Precertification 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 1.800.987.9072 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 preauthorized 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 12 months of the date of service to the health insurance for review for possible reimbursement. The UVA Health Plan Ombudsman 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 Country Enrollment Form and sending the completed form back to the UVA Health Plan Ombudsman before you leave the US.

    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 12 months for reimbursement. Please be sure that you contact Aetna customer service for preauthorization of scheduled inpatient admissions/surgery or as soon as possible following emergency admissions. 

    Contact the Benefits office for a prescription medication vacation override with Catamaran (or Aetna for Basic plan) 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 12 months. The UVA Health Plan Ombudsman 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 Precertification Unit at 1.855.888.9046 or 1.215.775.6445. 

    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 Precertification 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

Get More Information

  • UVA Health Concepts and Terms

    This short video explains the main ideas and terms we use to talk about health care insurance coverage.

    Watch video
  • Get help selecting benefits: Ask ALEX

    Our interactive virtual benefits counselor, ALEX, helps to evaluate the different UVA Health Plan options, as well as other benefits. See which one best meets your needs.

    Learn more about Ask ALEX
  • UVA Health Plan: Know Your Options

    This presentation from Annual Enrollment explains 2019 UVA health plan options, an overview of health premiums, health savings options, and more.

  • Understand the 1095-C Form

    The Affordable Care Act (ACA) requires UVA to send a new tax document to employees detailing their health plan coverage. The University will send out this new form, the 1095-C, to employees who were full-time (30 or more hours/week) and part-time employees enrolled in the UVA Health Plan in the previous calendar year.

    Learn More About the 1095-C Form