UVa Health Plan Ombudsman

Joanne R. Hayden
Telephone Number: (434) 924.4346
Fax Number: (434) 924.4486
E-mail: healthplanombuds@virginia.edu

Note: When writing an email to the UVa Health Plan Ombudsman, please do NOT include your Social Security Number or sensitive information, as email is not considered secure. Please leave a telephone number for the Ombudsman to contact you for further information.

The position of UVa Health Plan Ombudsman was established at the University of Virginia in 1999. The role of the Ombudsman is to help employees fully utilize their health care benefits, particularly employees or dependents with serious health conditions.

The UVa Health Plan Ombudsman will:

• Explain the UVa Health Plan policies and benefit coverage

• Provide answers to questions regarding the UVa Health Plan

• Listen to complaints and concerns regarding the UVa Health Plan

• Make UVa Health Plan information available to UVa employees

• Provide information concerning complaint and appeal procedures and advise employees which review level is appropriate

• Investigate payment problems for claims submitted to the UVa Health Plan that employees have been unable to resolve themselves

• Refer issues to other university offices or committees as appropriate

All encounters with the UVa Health Plan Ombudsman are treated with confidentiality. Information retained by the UVa Health Plan Ombudsman is kept secure. However, with the verbal or written request of the employee, the Ombudsman may carry such information forward.

University of Virginia Health Plan

The University of Virginia is self-funded, meaning the University pays claims to physicians, hospitals, and other providers directly from the premiums collected from employees and from the University itself, as the employer. Aetna is the third-party medical claims administrator for the UVa Health Plan and processes claims for enrollees in the UVa Health Plan. In addition, the UVa Health Plan uses the Aetna Open Choice PPO Network as its network. All UVa Health Plan participants living in the United States will have access to the entire Aetna open choice PPO provider network. UVa members can go to the UVa Aetna custom provider search for assistance. Participants should use Aetna open choice PPO network providers for claims to be processed at the in network benefit level.

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. A special foreign country enrollment form needs to be completed to be eligible for in network benefits when living outside of the US for 90 days or more. It is the health plan member’s responsibility to submit a completed special foreign enrollment form, when planning on living outside of the US for 90 days or more to the University Benefits office before the desired effective date.

UVa designed its health plan and provides a detailed description of coverage in the Summary Plan Description. The Medical Schedule of Benefits for Low Premium, High Premium and Dental Schedule of Benefits, can be viewed for a more concise outline of the benefits.