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Health Insurance

The UVa Health Plan offers two different types of health programs for participants, the High Premium Program and the Low Premium Program. Both programs are administered by Aetna and provide a broad scope of hospital and medical services offered by a carefully selected network of hospital and professional providers, including primary care physicians (PCP). Both the High and Low Premium Programs allow you direct access to physicians and specialists. In other words, it is not necessary for UVa Health Plan members to have a referral from their PCP to see a specialist. In fact, you do not have to select a PCP, although a relationship with a PCP is encouraged. To receive the maximum benefits available, all hospital and medical care must be performed by participating network providers. It is the member’s responsibility to be sure that all preauthorizations are in place before receiving medical services. Contact Aetna's Member Service at 1.800.987.9072 to check on the status of an authorization or claim.

  • Contact Aetna: Aetna Member Service is available Monday through Friday, 8am – 6pm Eastern Time at 1.800.987.9072. Aetna Voice Advantage, Aetna’s interactive telephone system, is available 24 hours a day, 365 days a year at 1.800.987.9072. Aetna Navigator provides access to coverage, claims, costs, and more. Please note that this cost estimator does not include the costs of potential facility charges associated with physician visits, such as from UVa Health System. Aetna Navigator complies with HIPAA regulations and allows the health policy subscriber to access basic claims payment information for each covered dependent. Dependents age 18 and over can request that the subscriber be restricted from seeing their claims on Aetna Navigator. This request for a restriction of confidential communications can be made by contacting Aetna Member Service at 1.800.987.9072.

  • ID Cards: Participants who have a covered spouse and/or dependent will receive two family ID after joining the UVa Health Plan. The card will contain the names of all covered family members. Families with more than five covered members will receive a second set of cards that contain the participant’s name and any dependent that didn’t fit on the first set of cards. Participants with single employee coverage will receive one card. Additional cards can be requested by calling Aetna Member Service or visiting Aetna Navigator online.

  • Provider Network: Aetna has an extensive national provider network and continues to recruit additional providers. All UVa Health Plan participants living in the United States will have access to the entire Aetna provider network. Participants using the UVa Provider Network will receive decreased costsharing. Use UVa’s custom docfind to identify Aetna participating providers and providers participating in the UVa Provider Network. Participants who temporarily live outside the United States for at least 90 days or permanently move outside the United States should contact the UVA Benefits Division for international coverage. Contact Aetna Member Service if you would like to nominate a provider for acceptance into the Aetna provider network.

  • Medical and Behavioral Health: Aetna provides medical and behavioral health management, coverage policies, claims processing, the provider network,and appeals processing. Aetna’s medical policies are available online.

  • Precertification Lists: Precertification for services performed by participating providers is the responsibility of the provider. See Aetna Precertification List and Behavioral Health Precertification List for details on these services. High tech radiology services including MRI/MRA, CT/CCTA, PET, and Nuclear Cardiology procedures also require precertification. MedSolutions is Aetna’s precertification vendor and reviews requests for highly complex radiology procedures. Your provider should contact MedSolutions at 1.888.693.3211 to verify if precertification is required. Precertification for services performed by non-participating providers is the responsibility of the participant.

  • Informed Health Line: The Informed Health Line at 1.800.556.1555 is available 24 hours a day, 365 days a year to participants. Speak with a registered nurse anytime to ask health questions or learn more about health conditions.

  • Beginning Right Maternity Program: Aetna offers Beginning Right, a maternity program for use during your pregnancy and after your baby is born, providing special attention when you need it most. Enrollment and continued participation in the program waives the inpatient copayment for your baby. Enrollment in the program must occur within the first 16 weeks of pregnancy to receive the co-payment waiver.

  • Disease Management: Aetna provides Disease Management Programs for over 35 conditions that coordinate education, counseling, patient self-care, and physician support to help you manage your condition. By identifying and managing your condition early, you can help avoid complications and improve your quality of life. Aetna may identify you for program participation through your doctor, Aetna patient management staff, or medical and pharmacy claims data. You may also self-refer into the program. If you are an Aetna member and have one of the 35 conditions covered by disease management, call Aetna at 1.866.269.4500 to get started. You may also call this telephone number to “opt out” of the Disease Management Program.

  • HealthyRx The HealthyRx program is designed to help manage chronic conditions by offering education, counseling, patient self-care and nurse/physician support. Under the voluntary HealthyRx program, member drug cost sharing will be reduced for a list of Tier 1 and Tier 2 drugs used to treat nine specific conditions when the member fully participates in Aetna’s disease management (DM) program for nine conditions.

  • Hoo's Well: The wellness program for UVa Health Plan participants, Hoo's Well, has many offerings including Hoo's Fit walking program, Quit For Life Tobacco Cessation Program, special pricing for Weight Watchers, on-grounds classes and seminars, and online resources for healthy eating and exercise. More information on the offerings and rewards of Hoo's Well are available at www.hooswell.com. See Simple Steps and Personal Health Record for Aetna's personalized online health and wellness program.

Eligibility

In order to be covered under the UVa Health Plan, an employee must be a salaried employee of the University of Virginia who is either regularly scheduled to work at least twenty hours per week (50% effort), or a Health System employee who works 40 hours a week or who has signed a Medical Center Flexible Staffing Contract. Part-time salaried classified employees who work at least 20 hours per week (50% effort) but less than 32 hours a week (80% effort) are eligible to be covered under the Plan but are required to pay both the employer and employee portion of the health plan premium. Part-time salaried Faculty and University Staff who participate in the UVa Health Insurance Program are entitled to receive a 50% subsidy toward the cost of the employer portion of the health insurance premium.

Those persons eligible to be dependents on the plan are legally recognized spouses and children under the age of twenty-six. Children include biological children, step children, adopted children, and foster children. Children can remain on the health plan through December 31st of the year in which they turn 26. Other children for whom you are the legal guardian with permanent custody who are unmarried, live with you 100% of the time in a parent-child relationship, and are declared as a dependent on your federal tax return can remain on the health plan through December 31st of the year in which they turn 26.

Coverage for dependent children who are incapable of self-support due to a mental or physical handicap may continue beyond age 26 if proof of the handicap is furnished to and approved by the Claims Administrator PRIOR to the dependent's 26th birthday and they are unmarried, live with you 100% in a parent-child relationship, and are declared as a dependent on your federal tax return. Contact Aetna Member Service at 1.800.987.9072 for more information and forms.

Enrollment Rules and Coverage Effective Date

Coverage begins on the first day of the first full month of employment, if an enrollment is submitted within 60 days of employment. If an employee's first day of work is the first working day of the month, coverage begins on that day when the employee's application is submitted within 60 days of employment. Changes in membership may only be made at the annual Open Enrollment, or subsequent to a valid mid-year qualifying event. Events that constitute a mid-year qualifying event include:

  • marriage, divorce, or annulment

  • birth or adoption/placement for adoption

  • loss of dependent eligibility (only acceptable reason is when employee loses permanent custody of "other child")

  • employment status of Employee, dependent, or spouse which affects eligibility to participate in the employer’s health plan

  • commencement of or returning from an unpaid leave of absence

  • judgment, decree, or order changing legal custody

  • cost and/or coverage changes in employee’s, dependent’s or spouse’s health plan

  • entitlement to or loss of eligibility for Government-sponsored programs ;or

  • death of spouse or dependent

Any coverage changes you make must be consistent with the Mid-Year Qualifying Event. For example, if you get married, you may change your Employee Only coverage level to Employee Plus Spouse or Family, but you may not switch your coverage to the High Premium Program from the Low Premium Program.

Changes in membership must be received in the University Human Resources Benefits Division within 60 days of the qualifying event or within the same plan year as the mid-year qualifying event and are effective the first of the month following receipt of the form (on-line or paper) unless they are terminating due to ineligibility. Those enrollment changes are effective the first of the month following the qualifying event. Premium changes due to ineligibility are effective the first of the month following receipt of the form if the form is received within the same plan year as the qualifying event or within days of the qualifying event. Applications for changes due to birth or adoption of a child that are received within sixty days of the event are applicable on the date the birth or adoption occurs. If you submit an application more than 60 days after the date of birth or adoption but within the same plan year, the coverage will be effective the first of the month following receipt of the application.

Any ineligible dependents found on the UVa Health Plan will be terminated on the last day of the month in which they became ineligible. Changes in the employee's coverage category to match this termination of dependent's coverage are subject to IRS Section 125 Regulations. Employee-participants with ineligible dependents enrolled on their policy will be responsible for the costs of incurred claims and may be suspended from the Plan for up to three (3) years.

Extended Coverage

Terminating employees and dependents who lose eligibility for coverage may have the option to extend continuous health care coverage through enrollment in Extended Coverage under the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA). See COBRA Eligibility, Rates and Enrollment

UVa Health Plan Monthly Rates - High Premium 2013
  Employee Rate Employer Rate Total Rate
Single $51 $409 $460
Employee and Child $177 $733 $910
Employee and Spouse $205 $735 $940
Family $394 $1,077 $1,471
Double State $357 $1,114 $1,471
UVa Health Plan Monthly Rates - Low Premium 2013
  Employee Rate Employer Rate Total Rate
Single $12 $409 $421
Employee and Child $47 $733 $780
Employee and Spouse $54 $735 $789
Family $116 $1,077 $1,193
Double State $80 $1,114 $1,194

Part-time salaried Faculty and University Staff who participate in the Health Insurance Program are entitled to receive a 50% subsidy toward the cost of the employer portion of the health insurance premium.

UVa Health Plan Summary Information

Web Site - Aetna

Aetna - 1.800.987.9072

Links and Forms