UVA Health Plan/Pharmacy

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

• Go to www.aetna.com 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.

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

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

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

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

• Go to www.aetna.com/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

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. 

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

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

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

Visit the 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.

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.

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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

• 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

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?

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
  • Summary of Coverage and Benefits Glossary
  • Basic Health
    • Basic Health schedule of benefits
    • Basic Health summary of benefits and coverage
  • Value Health
    • Value Health schedule of benefits
    • Value Health Out of Area (OOA) schedule of benefits (If your work location zip code in Workday is more than 50 miles from Charlottesville, you will automatically be covered under this option if you enroll in Value Health)
    • Value Health summary of benefits and coverage
    • Value Health OOA summary of benefits and coverage
  • Choice Health
    • Choice Health schedule of benefits
    • Choice Health summary of benefits and coverage
• Aetna Tools: Visit the Aetna website and click on “Log in/Register” to access these resources:​​​​​  
  • Find Care and Pricing: Compares costs to give you real-time, personalized estimate
  • Custom Doctor Find: Confirms whether providers are in-network
  • Aetna Institute of Quality List: Lists IOQ facilities
• 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.
• 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

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.

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

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

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

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

For further details and additional assistance, contact Aetna Member Services at 800.987.9072 or the UVA Health Plan Ombuds.

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)

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

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

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

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.

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

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

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

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

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

	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.

	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.

	Individual	Family
Basic	$5,500	$11,000
Value	$5,500	$11,000
Choice	$5,500	$11,000

 

	Individual	Family
Basic	$11,000	$22,000
Value	$11,000	$22,000
Choice	$11,000	$22,000

 

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.

You are eligible for Medicare if you are:

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

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

When This Plan is Primary

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

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

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

End-Stage Renal Disease

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

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

When Medicare is Primary

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

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

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

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

View Job Aids in the "My Benefits" Section of the Workday Training webpage

Workday Benefits Video

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. 

Try our health care analytical tool Picwell 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?

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. 

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

UVA Behavioral Health providers and services

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.

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

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

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

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

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

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

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

Below is a simple illustration of how deductibles, coinsurance, and out-of-pocket maximums work for a single employee on 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.

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

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.

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.

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.

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). 

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

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

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

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

You can find information on our Prescription Drug Program webpage.

If you need additional details, contact Aetna for assistance.

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