Open Enrollment for First-Time Enrollees

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

When UVA Health Plan is Primary

The UVA Health Plan is primary, and Medicare is secondary, if a covered person is eligible for and covered by Medicare and falls into one of the following categories:

• 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.

Exception: 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.

Both health plan options:

• Cover the same range of healthcare services
• Include prescription drug coverage
• Cover in-network preventive care at 100%
• Allow you to enroll eligible dependents
• Use Aetna as the plan administrator

With either plan:

• you pay monthly premiums through payroll deductions
• you must meet a deductible before most coverage begins
• you share costs through copays or coinsurance until you reach your out-of-pocket maximum
• once you reach your out-of-pocket maximum, the plan pays 100% of covered in-network services for the rest of the year

The main difference between the two plans is how you pay for healthcare services throughout the year.

UVA PPO

• Higher paycheck premiums
• Lower deductible and out-of-pocket maximum
• You generally pay less when receiving care

Health Savings

• Lower paycheck premiums
• Higher deductible and out-of-pocket maximum
• You may pay more out of pocket when receiving care
• Includes access to a Health Savings Account (HSA), with employer contributions from UVA for eligible employees
  • A Health Savings Account (HSA) is a tax-advantaged personal savings account used to pay for qualified medical expenses, available only to those enrolled in a High Deductible Health Plan (HDHP). It offers a "triple tax benefit": contributions are tax-deductible, growth is tax-free, and withdrawals for medical expenses are tax-free. Funds roll over annually and are portable.

• How often you visit doctors or specialists
• Whether you cover dependents
• Prescription medication costs
• Whether you want access to an HSA
• Your expected healthcare needs for the year

Understanding Health Care Costs by ced6bn@virginia.edu