Health Coverage for You and Your Family

UVA Health Plan


Health Plan Communications:

Consolidated Appropriations Act (CAA) / No Surprises Act (NSA)

Signed into law on December 27, 2020, the $900 billion COVID-19 stimulus package provides funding for COVID-19 testing and tracing, vaccine distribution, and temporarily increases unemployment benefits. The package also includes "Transparency in Coverage" machine-readable file requirements for in-network negotiated rates and out-of-network allowed amounts and billed charges. The link to the machine-readable file will by posted by July 1, 2022 to the UVA Health Plan’s Aetna microsite.


  • UVA Health Plan participants can request a new physical ID card from Aetna with the deductible and out-of-pocket maximums included on the card by calling the Aetna One Advocate Customer Service phone number 800.987.9072. 

    • COVID-19 Test Kit Update: Effective January 15, 2022, the UVA Health Plan will cover up to eight FDA approved at-home COVID-19 diagnosis tests or over-the-counter (OTC) COVID-19 tests per 30 days (or per month) for plan members absent involvement of a health care provider and without cost sharing. Read coverage details.

    • Every home in the U.S. is eligible to order 4 free at-⁠home COVID-⁠19 tests. The tests are completely free through USPS website

    • Please visit the HR COVID-19 webpages for HR information related to the coronavirus and your health, health benefits, and leave.


    Every UVA employee has different benefits needs, and you have 3 health plan options to choose from to meet your needs. All options are administered by Aetna: 

    1. Basic Health (high deductible)
    2. Value Health
    3. Choice Health

    NEW for 2022:

    NEW Spouse Eligibility - Spouses whose remote employer offers affordable health care that provides minimum value, but ALL of their health options are HMOs and the spouse lives outside the HMOs' defined service areas, are eligible to be a dependent on the UVA employee's health coverage.

    New Hearing Benefit - One annual hearing exam is covered, performed by an audiologist as a cost-share benefit.​ Medically necessary hearing aids are covered, up to $1,200 every 48 months.​ Learn more about hearing benefit and discount offerings here.

    Expanded Infertility Benefit - Waives some of the medical requirements for infertility eligibility, specifically, removing Aetna's infertility definition for UVA Health Plan participants. This makes the infertility benefit more widely available. Consult an A1A team member or view the revised Clinical Policy Bulletin with the definition removed on page 2.​

    Part-Time Employees - Part-time employees will receive the same employer contribution to their premium as full-time employees. There will be one premium rate for all benefits-eligible employees within each employee category, resulting in much lower premiums for part-time employees.

    How to Enroll

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

    Changes can be made during the Open Enrollment period each October or after a qualified life event like a change in marital status, an addition to the family, or a leave of absence.

    • Review the Qualified Life Events and Required Documentation resource document for a list of life events and required documentation needed to request a change. Qualified life event change requests along with appropriate documentation must be submitted within 30 days of the life event and must be consistent with the life event.
    • Visit the Life Changes pages for additional information and to learn how to enter these requests in Workday. 

    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:

    Summary Plan Description

    Summary Plan Description -Spanish Version 2021

    Comparison of Benefits

    Basic Health

    Value Health

    Choice Health

    • 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 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.
    • 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.

      • Go to www.aetna.com/docfind/custom/uva.
      • Follow the prompts to find a provider for the care you need. When prompted to select a plan:
        • Choose The University of Virginia - Aetna National Network, if you want to locate all in-network providers
        • Choose The University of Virginia - UVA Provider Network, if you want to locate UVA providers only
    • 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 “Find Care & Pricing”
      • Follow the prompts to find a provider for the care you need.

      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. 

    • 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.

      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.

    • 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 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 Country 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

    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 co-pay 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. 
      • Benefits and Wellness Expo Presentations - review recorded presentations from Open Enrollment 2022 Expo presentations on topics such as UVA Benefits, retirement, and financial well-being.
      • Still Need Help? Contact the UVA HR Solution Center, by email  at AskHR@virginia.edu or by phone at 434.243.3344

      2022 Open Enrollment Comparison Table, Employee Only

      2022 Open Enrollment Comparison Table, Employee + Child

      2022 Open Enrollment Comparison Table, Employee + Spouse

      2022 Open Enrollment Comparison Table, Family

    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; see section below for details. Visit the HSA page to learn more about those additional requirements and a list of IRS eligibility rules.

    • 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)
      • 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 Basic, Value or Choice Health options. Please visit the J Visa Health Plan page for detailed information about the J Visa Health Plan.

    • 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 to the end of the birth month in which they turn 26.

    • Adult Children with Disabilities

      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 the UVA Health Plan Ombuds.

    • Basic Health Eligibility

      In order to enroll in the Basic Health 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 Basic Health

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

    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 for 2022, see the UVA Health Plan Cost Comparison at a Glance. 

    Premiums

    For the 2022 plan year, there are no changes from 2021 to premiums, coinsurance, co-pays, or deductibles for the Basic, Value, and Choice Health options for full-time employees. Part-time employees will receive the same employer contribution to their premium as full-time employees, resulting in much lower employee 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, x-rays, 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.

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

      2022 Monthly Premiums by Plan

      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

      2022 Monthly Premiums by Plan

      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

      2022 Monthly Premiums by Plan

      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
    • Temporary and Wage Employees

      2022 Monthly Premiums

      Monthly Rate - BASIC Employee Rate Employer Rate Total Rate
      Employee $181.50 $234.75 $416.25
      Employee + Child(ren) $503.00 $234.75 $737.75
      Employee + Spouse $717.50 $234.75 $952.25
      Family $1,146.25 $234.75 $1,381.00

      Benefits-eligible temporary and wage employees may only enroll in Basic Health.

    • Part-Time Employees

      Beginning January 1, 2022, premiums for part-time employees are the same as for full-time employees. 

      2022 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

    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. 

    2022 monthly COBRA premiums remain unchanged from 2021.

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

    • Active Employees and Research Associates

      2022 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

      2022 Active Wage Employees  Cobra Basic
      Employee $424.58
      Employee + Child/Children $752.51
      Employee + Spouse $971.30
      Family $1,408.62
    • Postdoctoral Fellows

      2022 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

      2022 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

    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 option, its deductible is higher than those for other UVA Health 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

      $800

      $1,600

      Choice

      $500

      $1,000

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

    • Out-of-Network Deductibles

       

      Individual

      Family

      Basic

      $6,000

      $12,000*

      Value

      $2,400

      $4,800

      Choice

      $1,500

      $3,000

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

    Co-Insurance

    You must satisfy an annual deductible before coverage begins for most services. Then, you and the UVA Health Plan share the cost of covered services (co-insurance), up to the out-of-pocket maximum.

    Co-Pay

    Co-pay amounts only apply to participants in the Value Health plan option. A co-pay is a fixed amount (for example, $25) you pay for a covered health care service, usually when you receive the service (sometimes called “co-pay”). The amount can vary by the type of covered health care service.

    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, co-insurance and covered prescriptions. It does not include amounts above the allowable amount and penalties. If this maximum is reached during the year, the UVA Health Plan would pay 100% of additional covered expenses.

    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.

    Enroll in Workday

    Get More Information

    • Picwell

      Picwell is an online personalized health option selection tool. This is an interactive tool that helps you determine which health option is the best fit for you and your family. You answer a few questions to determine which plans you are eligible for, what medical expenses you anticipate (like having a new baby), and how you prefer to pay for medical expenses (more each month or more out-of-pocket). In a few minutes, you have a recommendation for the best fitting health option for you.

      Visit Picwell
    • Understand the 1095-C Form

      The Affordable Care Act (ACA) requires UVA to send a new tax document to employees detailing their health 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
    • Get help selecting benefits: ALEX

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

      Learn more about ALEX
    • Open Enrollment Overview Video

      This video from Open Enrollment for the 2022 plan year period offers a brief, high-level summary of 2022 changes and available benefits.

      Watch the Video

    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, 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. 

    • 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 Medical Scenarios webpage to learn how the deductible, coinsurance, co-payment, and out-of-pocket maximum affect your cost across the 3 health plan options.

      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.

      Visit the Preventive Information website for additional resources. 

    • 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 Health Plan Eligibility 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 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 Basic Health option has some additional requirements; please visit the Eligibility 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.

      Health plan cost share illustration

    • 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

    • How is the deductible calculated for the Value plan, employee plus spouse. Can one individual meet the deductible of $1600 or does each individual have to independently meet $800?

      The Value Health plan 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.

    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 2022 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 2022 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 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 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 J 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 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.