Understanding the UVA Health Plan

The High Deductible UVA Health Plan option offers lower monthly premiums and a higher deductible. This means higher upfront costs for health care services before the plan begins sharing covered in-network costs, but payroll deductions are lower throughout the year.

The Health Savings option also qualifies members to contribute to a Health Savings Account (HSA).

The Preferred Provider Organization (PPO) UVA health plan option offers a higher monthly premium (payroll deduction) but lower deductibles. This means lower upfront costs before the plan begins sharing the cost of covered in-network care, but higher payroll deductions throughout the year.

This health plan option is only available to current Choice members. Employees may no longer newly enroll in Choice, which was designed with the highest premiums and lowest deductible.

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.