(Teaching and Administrative/Professional "General" Faculty)
Effective January 1, 2006
Full-time salaried faculty members with a term of six months or more are eligible for retirement, life insurance, disability insurance and health care benefit programs. Effective July 1, 1999, part-time salaried faculty with a term of six months or more who currently work at least 50 percent effort (a minimum 20 hours per week) are eligible for retirement, life insurance and disability insurance. Wage faculty are not eligible for benefits. Visiting faculty members who are employed for six months or more and are full-time are eligible for health care benefits only. For additional information, please contact the Benefits Office at (434) 924-4392, e-mail benefits@virginia.edu.
I. Health Insurance
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. An employee who is a member of the faculty must have a University appointment of at least six months in order to be covered. Part-time salaried 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.
The third party administrator for UVa Health Plan dental claims is United Concordia. The Pharmacy Benefit Manager that administers Pharmacy claims is Pharmacare. Southern Health Services, Inc. administers all other claims. Mental Health and Substance Abuse services are also covered. Southern Health is contracted with United Behavioral Health to manage behavioral health claims.
Here is the contact information for UVa Health Plan Third Party Administrators
The UVa Health Plan offers two different types of health programs for participants, the High Premium Program and the Low Premium Program. Both programs 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, you do not have to select a Primary Care Physician (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. You may call the Customer Service desk at 1-888-975-9557 to check on the status of an authorization or claim.
Coverage begins on the first day of the first full month of employment if the employee's application for coverage is received within 60 days of employment. If an employee's first day of work is the first working day of the month, coverage begins on the first day of that month when the employee's application is received within 60 days of employment. Employees may change type of membership only during the annual Open Enrollment Period or within the same plan year as a valid mid-year qualifying event. Employees may change health program type only during the annual Open Enrollment Period. Changes made during Open Enrollment are effective January 1st of the following year. Applications for changes in membership must be accompanied by documentation and received in the University Human Resources Benefits Division within the same plan year as the mid-year qualifying event and are effective the first of the month following receipt of the form or that day if the form is received on the first of the month 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. All employees are automatically enrolled in Premium Conversion, allowing employees to pay health care premiums on a pre-tax dollar basis, unless otherwise requested. Extended coverage is available to terminating employees, dependent children or spouses losing coverage.
Enrollment form: UVA Health Plan Application
Summary Information of Coverage and Copays
Following are descriptions of covered benefits:
A detailed description of coverage through the UVa Health Plan is available in the Description of Benefits and 2006 Amendments.
Hospital and Medical Services
The UVa Health Plan provides a broad scope of hospital and medical services offered by a carefully selected network of hospitals and professional providers, including primary care physicians. A current listing of network providers can be found at the website of Southern Health Services. At the welcome page, choose Members (top left box), Provider Search (in left column), enter provider search, and choose POS as the product. To receive the maximum benefits available, all services must be received from network providers.
Out-of-Area (OOA) Policies/Enrollment information
Participants in the UVa Health Plan who live outside areas serviced by the Southern Health Services Provider Network are required to use participating providers with Private Healthcare Systems, Inc. (PHCS), a national Preferred Provider Organization (PPO) network, in order to receive the highest level of benefits and pay the lowest cost-sharing amounts. This applies to all High and Low Premium Program out-of-area participants, including retirees, COBRA enrollees, and dependents who are at school. Members who are living outside of the Southern Health network at the time of initial enrollment will automatically be enrolled in the PHCS plan. Members who move away or leave the area for more than 90 days must contact UHR and complete an OOA enrollment form to prospectively enroll in the PHCS or OOA plan.
When participants choose to receive care through PHCS PPO physicians and facilities, they receive in-network benefits, the highest available. Members may choose to see health care providers not in the network, but will receive out-of-network benefits with higher cost-sharing and must file their own claims. Members may be billed for the amount above the allowable if nonparticipating providers are used. Referrals are not required to see specialists in the PHCS network. Participants are required to obtain any necessary preauthorization for in-network and out-of-network services. Members may call Southern Health Service's Plan Services Department at (888) 975-9557 prior to accessing services to determine whether preauthorization is necessary for that particular service.
Participating providers can be found on the PHCS web page at www.phcs.com or by calling PHCS at (866) 243-7427 to ensure the provider is participating at the address where the member will receive services. Many providers in the Southern Health Services Provider Network do not participate in the PHCS Network.
UVa Health Plan participants who live outside the United States will remain in Out-of-Area Groups and will not be required to use the PHCS network. In addition, a few participants in the U.S. with limited provider access will also remain in Out-of-Area groups and will continue to use the out-of-area benefits. If a High or Low Premium Program participant qualifies for the Out-of-Area Plan addendum, they will not be required to access care from in-network providers in order to obtain the highest level of benefits. They will be responsible for obtaining all required preauthorization for services provided by non-network providers.
Dental Services
The UVa Health Plan provides $1,000 per person each calendar year for dental benefits. Coverage is 100 percent of the allowable charge for diagnostic and preventative services including two cleanings annually. After a $50 deductible is satisfied, coverage for primary and periodontal services is 80 percent of the allowable charge and 50 percent for complex restorative services. Coverage for orthodontia services is 50 percent of the allowable charge. The lifetime orthodontia maximum is $1000 per person. This benefit is separate from the annual maximum dental benefit. When United Concordia participating dentists are used, participants receive the maximum benefits available. Members may be balance-billed and incur more expenses if non-participating dentists are used. A current listing of network dental providers can be found at United Concordia's website.
Mental Health and Substance Abuse Services
This important feature of the UVa Health Plan provides quality benefits for inpatient and outpatient services for care of mental illness and substance abuse. Care is provided by a carefully selected network of hospitals, substance abuse treatment facilities and professional providers. http://www.southernhealth.com/content/items/4172/UVA.MH.05-06.pdf
When treatment is needed, the participant is encouraged to see their PCP or the UVA Faculty and Employee Assistance Program. This will put the participant in touch with a professional who will help them choose the appropriate type of network provider and level of care they need. Providers must receive preauthorization from Sentara Mental Health Services prior to providing services.
Outpatient Prescription Drug Program
The Outpatient Prescription Drug program is administered by Pharmacare (http://www.pharmacare.com/) and covers certain medically necessary prescription drugs dispensed by licensed pharmacies with mandatory generic substitution. For enrollees with diabetes, the program also covers insulin, syringes, and lancets. For all prescriptions, if a generic drug is available, only the allowance for the generic is covered. If the physician prescribes a brand name drug, you must pay the copayment as well as the difference between the price of the generic and the cost of the brand name drug.
PharmaCare Specialty Pharmacy provides injectable and/or biotechnology medications for participants with complex medical issues. UVa Health Plan members will be required to obtain all specialty and injectable medications through Pharmacare Specialty Pharmacy or through a participating retail Pharmacy if available. This means that the UVA Health Plan participants can not purchase specialty drugs directly from their physician, and charges for these drugs cannot be billed as medical claims.
Copayments for a 30-day supply are $9 for formulary generic drugs, $18 for formulary brand name drugs when no generic is available, and $36 for non-formulary brand name drugs when no generic is available. When a generic is available, your cost-sharing amount is higher since you must pay the copayment as well as the difference between the price of the generic and the cost of the brand name drug. The Formulary List identifies all drugs that are considered non-formulary. Any brand name drug not included on this non-formulary list is a formulary drug.
Mail order service through Pharmacare is available for drugs up to a 90-day supply at the following copayments: generic at $21, Formulary Brand at $41 when no generic is available, and Non-Formulary Brand at $81 when no generic is available. Those employees using the Pharmacare website for the first time to refill mail order prescriptions should call Pharmacare at 1-800-581-5300 after enrolling on-line to ensure you are properly registered.
Prescriptions for a 31-90 day supply are also available at retail pharmacies. The UVa Health Plan does not offer discounted copayments for 31-90 day prescriptions filled at maintenance pharmacies.
Drugs needing prior authorization, requiring Contingent Therapy Protocol (CTP) or having quantity limits are included at the end of the Formulary List. The Prescription Drug Plan has been enhanced by the addition of a fourth tier for a number of prescription drugs that are not available through the UVA Health Plan. With the enhanced benefit, when you use your card to purchase these drugs, you will pay the discounted price negotiated by UVA’s Pharmacy Benefit Manager instead of the full retail price. Although you will still pay 100% of the cost rather than a copayment, the cost will be less than the retail cost in most cases. They include non-sedating antihistamines, vitamins and diet pills, drugs not considered medically necessary such as cosmetic drugs, nicotine gum, infertility medication, and travel-related drugs. Experimental or investigational drugs and other standard exclusions will not be included in the fourth tier.
Premium Conversion
Premium Conversion is a program that allows an employee to enjoy tax savings by having health insurance premiums deducted from salary before taxes are calculated. New employees who do not want this benefit must "opt out of" premium conversion. It is important to note that participation in Premium Conversion places additional restrictions on changing health benefit coverage.
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. An employee who is a member of the faculty must have a University appointment of at least six months in order to be covered. Part-time salaried 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.
Those persons eligible to be dependents on the plan are legally recognized spouses and unmarried children who are less than twenty-three years old. Children include:
- natural children who live at home with the employee-participant, live with the other biological parent if the parents are divorced, or live at college or boarding school and are eligible to be declared as dependents on the employee-participant’s income tax return
- legally adopted children if they are eligible to be declared as dependents on the employee-participant’s income tax return and live with the employee-participant
- children for whom the employee is the legal guardian with sole permanent custody and who live with the employee-participant in a regular parent-child relationship and are declared as dependents on the employee-participant’s most recent income tax return There is one exception to sole custody if the employee or spouse shares custody with a minor child who is the parent of the “other child” living in the home of the employee. The other child, the parent of the other child, and the spouse who has custody must be living in the same household as the employee
- stepchildren who live with the employee-participant full time in a regular parent-child relationship and are declared as dependents on the employee-participant’s most recent income tax return
- children for whom the employee-participant is the proposed adoptive parent, if they are eligible to be declared as dependents on the employee-participant’s income tax return.
A dependent child will no longer be eligible for coverage as of the last day of the calendar year in which an unmarried dependent reaches age twenty-three or the last day of the calendar month in which a dependent marries or otherwise loses eligibility as described above. Even if the dependent is eligible by age to be covered, eligibility as a dependent ends due to marriage, ineligibility to be declared on the employee’s income tax return, and residency in a place other than the employee-participant’s home/school.
Coverage for dependent children who are incapable of self-support due to mental retardation or physical handicap may continue beyond age twenty-three if proof of the handicap is furnished to and approved by the Claims Administrator PRIOR to the dependent's 23rd birthday, they meet all other eligibility requirements for dependents, and are declared on the employee’s federal 1040 income tax form.
Enrollment Rules and Coverage Effective Date
Coverage begins on the first day of the first full month of employment, if an enrollment form is filed within 60 days of employment. If an employee's first day of work is the first working day of the month, coverage begins on the first day of that month when the employee's application is received 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 (child marries or leaves home and cannot be declared as a dependent on the employee’s federal income tax return)
- 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
Applications for changes in membership must be accompanied by documentation and 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 or that day if the form is received on the first of the month 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. Applications for changes due to birth or adoption of a child that are received within sixty days of the event are applicable the first of the month in which 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. Applications not submitted on a timely basis will be processed when the next open enrollment period occurs.
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.
Claims Inquiries
All medical claims should be submitted to Southern Health Services, Inc. at P.O. Box 7704, London, Kentucky 40742. Questions regarding claims should be directed to Southern Health Services' toll-free line at (888) 975-9557. Claim forms may be downloaded from the UHR website at http://www.hrs.virginia.edu/forms.html. You may also contact the UVA Benefits Division at (434) 924-4392 and request that a claim form be faxed or mailed to you.
All dental claims should be sent to United Concordia, Dental Claims, P.O. Box 69421, Harrisburg, PA 17106-9421. Claim forms may be downloaded from the UHR website at http://www.hrs.virginia.edu/forms.html
All mental health claims submitted by members should be sent to Sentara Behavioral Health, 4417 Corporation Lane, Suite 250, Virginia Beach, Va. 23462. Claims submitted by providers should be sent to Vetri Systems, P.O. Box 1440, Troy, Michigan 48099-1440. Claim forms and instructions for submission may be downloaded from the UHR website at http://www.hrs.virginia.edu/forms.html
The pharmacy network is national and includes hundreds of participating pharmacies. Note that prescriptions filled at non-participating pharmacies or at participating pharmacies when no valid ID card is presented must be paid in full at the time the prescription is filled. You may then submit a paper claim to the Pharmacare for reimbursement up to the allowable charge less the applicable copayment. You will pay the difference between the allowable charge and the billed amount as well as the applicable drug copayment. Claim forms may be downloaded from the UHR website at http://www.hrs.virginia.edu/forms.html
Discount Vision Plan
Participants in the active employee and COBRA groups of the UVa Health Plan are automatically enrolled in a national discount vision program. Retirees have the option of enrolling in this program. Enrollees have access to Eye Benefits, a national network of vision care professionals comprised of optometrists, opticians, and refractive surgeons. Discounted prices are charged to participants when they use providers in the Eye Benefits network. See: Listing of network providers and outlining of process to use Plan.
Southern Health WellBeing Program
UVA Health Plan members can participate in Southern Health’s WellBeing program by logging in at www.myephit.com/wellbeing. Utilizing cutting-edge technology and proven techniques, My ePHIT engages individuals in activities promoting physical fitness, good eating habits and behavioral management. With the help of accredited doctors, psychologists, dieticians, and personal trainers, the health improvement program provides customized wellness plans based on individuals' personal fitness goals and current state of health.
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).
For more information and to apply for COBRA coverage, contact the UHR Benefits Division at (434) 924-4392.
Retiree Coverage
For information regarding retiree health insurance, see the Retiree Health Benefits Program.
II. Retirement Programs
All full-time and part-time salaried University faculty not restricted by a temporary appointment must participate in either the Faculty Optional Retirement Plan or the Virginia Retirement System. Part-time faculty are defined as those who work at least 20 hours, but less than 40 hours per week or who work the equivalent of one half of a faculty position and are engaged in teaching, research or administrative duties. The retirement program selected effects the life and disability insurance benefits, so careful consideration should be given to this decision. Once a retirement program is elected, the decision is irreversible. Effective July 1, 1999 all part-time salaried University faculty not restricted by a temporary appointment with a term of six months or more and working at least 50 percent effort (at least 20 hours per week) became eligible to participate in the Faculty Retirement Plan and effective July 1, 2005 they became eligible to participate in VRS.
A. Faculty Retirement Plan (FRP)
The FRP is a "defined contribution" plan in which retirement benefits are based on employer contributions plus earnings of the account balance over the course of the participant's working years. In a defined contribution plan, the value of the retirement benefits may change, depending on investment gains or losses. On behalf of participants hired on or after January 1, 1991, the University contributes 10.4 percent of salary. The University contributes 10.4 percent of salary to the Plan. If you were hired prior to January 1, 1991, click here for additional contribution information.
Participants may invest employer contributions in one of the following companies: TIAA/CREF, Fidelity Investments or Vanguard. Faculty members have 60 days from their date of hire to elect a retirement program. Changes in vendor selection may be made at any time of year, up to three times per year. NOTE: If no program is selected during the 60 days, state policy requires the full-time faculty member to be enrolled in VRS.
B. Virginia Retirement System (VRS)
The Commonwealth of Virginia requires all full-time State employees to participate in VRS, unless they are faculty participating in the FRP. VRS is a "defined benefit" plan that provides benefits based on years of service, age, and average annual salary, paid during the highest 36 consecutive months of credited service. VRS provides retirement benefits, calculated at retirement, as early as age 50 with ten years of service. There is an annual cost-of-living increase for retirees, beginning in the second calendar year after retirement. The contribution needed to fund the system is actuarially determined and adjusted every two years. Full retirement benefits are available for employees with 30 years of service and at least age 50. The total contribution is paid by the University. To contact VRS call toll free (888) 827-3847 or visit their website at http://www.varetire.org. Please Note: An individual may not receive a retirement annuity from the Virginia Retirement System (VRS) or one of the Faculty Retirement Plans while the University of Virginia is making contributions to a regular retirement program. An individual who is receiving a retirement annuity from an account to which any Commonwealth of Virginia agency contributed should contact the UHR Benefits Division.
III. Life Insurance
A. The Standard Group Term Life Insurance
Faculty who enroll in the FRP must also participate in The Standard Group Term Life Insurance Plan. The Plan provides $75,000 of coverage for each participant age 54 or under. The coverage declines in varying increments beginning at age 55 until age 70 when it levels at $22,000. The plan also provides $5,000 of life insurance for each participant who retires at age 55 or over with five or more years of service to the University, provided the sum of age and service is 70 or greater. The University pays the total cost of the insurance. In addition, participants may purchase supplemental insurance in increments from $50,000 to $200,000 of coverage. Premiums vary according to age.
Since The Standard Life Insurance program is a group term plan, insurance coverage stops the day you terminate employment for reasons other than retirement. The insurance may be converted to an individual policy with The Standard if application is made within 31 days of coverage termination.
B. VRS Group Life Insurance
VRS Group Life Insurance provides the following: (a) a natural death benefit in the amount of double the annual salary rounded to the next highest thousand; (b) a benefit of twice the salary for accidental loss of one or more limbs or of eyesight; and (c) coverage at the level of four times the salary for accidental death. For service retirees, the plan also provides 25 percent of the original value of insurance at the time of retirement for each service retiree. VRS members may also purchase additional life insurance for themselves or coverage for their spouse or dependents. Click here for rate and coverage information. In some cases, "Evidence of Insurability" will be required. The cost of the benefit is paid entirely by the University. Since the Life Insurance program is a group term plan, insurance coverage stops 31 days after termination for reasons other than service or disability retirement. The insurance may be converted to an individual policy with Minnesota Life Insurance Company if application is made within 31 days after termination of employment.
IV. Group Accident Insurance
All full-time, non-visiting faculty members with appointments of six months or more are eligible to purchase Cigna Accident Insurance. The Cigna plan provides coverage for death or dismemberment for accidental causes if permanent total disability or death results within one year of the accident.
Participants may select benefits, in multiples of $5,000, between the minimum of $25,000 and the maximum of $200,000. The amount may not exceed ten times the participant's annual salary. Faculty members also may select coverage for a spouse and dependent children at a reduced benefit level. Coverage under the Cigna plan terminates on the last day of the month in which active service terminates.
V. Disability Insurance
A. The Standard Total Disability Benefits Plan
Faculty who participate in the FRP are eligible to receive income replacement benefits in the event they become totally disabled from The Standard Disability Benefit Plan. Total disability is defined by The Standard as the "inability of the employee, by reason of sickness or bodily injury, to engage in any occupation for which the employee is reasonably fitted by education, training or experience." The benefit begins the month following six consecutive months of total disability and continues for the duration of the disability or until one of the following age limits is attained:
| Age When Total Disability Starts |
Maximum Duration of Benefits |
| Less than 60 |
to age 65 |
| 60 but less than 65 |
5 years |
| 65 but less than 68-1/2 |
to age 70 |
| 68-1/2 and over |
1 year |
The plan provides a Monthly Income Benefit that is equal to 66-2/3percent (offset by any social security or workers' compensation benefits) of the covered member's monthly salary, but not to exceed $20,000 monthly. The plan also includes n annual 3 percent cost-of-living increment and continued contributions to the Faculty Retirement Plan.
The University pays the total cost of this insurance. Since the program is a group term plan, insurance terminates on the day on which active service terminates. The insurance may be converted to an individual policy with reduced benefits if application is made within 31 days of coverage termination.
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Forms:
- Claims: Contact the Benefits Division at (434) 924-4392
Disability benefits for VRS participants are provided through the Virginia Sickness and Disability Program for VRS participants hired after January 1, 1999 who elected VSDP during the Spring of 1999, or the VRS Disability Insurance Program. All benefits are reduced by Social Security or Workers' Compensation.
B. Virginia Sickness And Disability Program
An employee covered by the Virginia Retirement System and hired after January 1, 1999 will have sick leave and short and long term disability benefits provided by the Virginia Sickness and Disability Program. The number of sick leave days and percentage of income replacement is defined by the number of months of State service. The short-term disability income replacement benefit starts at 100 percent of pay, and subsequently reduces to 60 percent based on years of service. The long-term disability income replacement benefit is 60 percent regardless of months of State service. There is no cost to the employee for this disability benefit.
C. Disability Insurance for VRS Participants
The Virginia Retirement System provides income replacement benefits through disability retirement.VRS members are eligible for disability retirement if the following conditions apply: the member becomes mentally or physically unable to perform present duties and the disability is likely to be permanent. Regular disability benefits are based upon the average annual salary paid during the highest 36 consecutive months of credited service.
VI. Long-term Care Insurance
A. TIAA Long-term Care Insurance
Faculty members previously had access to a long term care plan provided through TIAA-CREF. Recently, TIAA-CREF sold this line of business to Metropolitan Life Insurance Company (MetLife). MetLife is in the process of filing all of the required paperwork with the state Bureau of Insurance in order to continue to provide this product. At this time, no new policies can be issued. More information should be available in the near future.
B. Aetna Long-Term Care Insurance
Long-term care insurance through Aetna U.S. Healthcare is available to full-time salaried classified staff and faculty in agencies 207 and 246. Their spouses, parents, and parents-in-law can also enroll in the insurance plan. New employees not already eligible to file a claim are guaranteed acceptance into the plan provided they are actively at work and apply within 60 days of their hire date. All other enrollees will be required to complete a medical questionnaire and must be approved by Aetna. An individual employee, retiree or eligible family member's individual coverage will take effect at a time determined by Aetna after a completed application is received and processed. Participants in the program are responsible for all premiums.
To receive benefits, the participant must be unable to substantially perform two of six activities of daily living such as eating, dressing, toileting, continence, and getting in and out of bed, or the participant must have a severe cognitive impairment.
The program pays for actual expenses up to a specified daily limit at a specific reimbursement level. Daily benefit options range from $75 to $200. Benefit levels will vary according to whether the services are performed at a nursing home, assisted living facility, hospice facility (all 100 percent of the daily benefit amount), at home or in adult day care (both at 50 percent). There is a 90-day waiting period.
Should you have questions, need further information or an enrollment kit, contact Aetna to speak with a long-term care specialist toll-free at 1-877-894-2470. The Aetna web site at www.aetna.com/group/commonwealthva/ also has the same information contained in the enrollment kit.
This long-term care insurance plan is overseen by the state's Department of Human Resource Management.
VII. Flexible Reimbursement Accounts
The Flexible Spending Account Program allows you to pay for certain expenses on a pre-tax basis. This means that your money goes farther. For example, if you put aside $5,000 for day care expenses in a Dependent Care account, you get to spend the whole $5,000 on day care. If you take the $5,000 in pay, you will only have roughly $3,500 left after taxes to spend on day care! For most individuals whose adjusted gross income is greater than $25,000, this program may be more beneficial than the federal dependent care tax credit – consult a tax professional for an assessment of your personal situation. The FSA Medical Reimbursement account can also help offset the cost of out-of-pocket health care expenses such as copayments, deductibles, coinsurance, and over-the-counter medications.
The University is pleased to announce Chard Snyder as our new administrator for your Flexible Spending Account program. With this change, there are numerous new features available including:
- A pre-paid benefits debit card that will provide you an easy, automatic way to pay for qualified health care/benefit expenses. The pre-paid card lets you electronically access the pre-tax amounts set aside in your accounts.
- Full array of web services including on-line enrollment, claims submission, account balances, and claims history and detail.
- Tri-weekly reimbursement of approved claims.
To learn more about Chard Snyder and your Flexible Sending Account program, you can watch a short 3 minute video at www.chard-snyder.com/video. For reimbursement questions, call toll-free (800) 982-7715 or visit Chard Snyder’s website at www.chard-snyder.com. Request forms from the UHR Benefits Division at (434) 924-4392 or e-mail benefits@virginia.edu.
Medical Reimbursement
Full-time and part-time salaried employees working at least 20 hours per week are eligible to participate in the medical reimbursement program. You must submit an application within 60 days of your hire date or during open enrollment. This account allows the participant to set aside pretax dollars to pay for medical, dental, and vision care, or other eligible expenses that are not covered by the health insurance plan. In addition to claiming out-of-pocket expenses for the participant, expenses for eligible dependents such as spouses, dependent children and other persons considered to be an eligible dependent for Federal income tax purposes may be included. The maximum amount that you may place in this account is $5,000 per plan year. The minimum contribution is $240 per year.
Dependent Care
Full-time and part-time salaried employees are eligible to enroll in the dependent care reimbursement account, as of the first day of the month following the date of hire or during a subsequent open enrollment period. This account allows the participant to set aside pretax dollars to pay for eligible dependent care expenses, such as childcare. In order to participate in a Dependent Care FSA, you must meet at least one of the following qualifications:
- Single parent who works full-time
- You and your spouse both work, and your spouse's annual income is greater than the amount you are claiming for dependent care
- Your spouse is enrolled full-time at an institution of higher learning (If your spouse is a full-time student at least five months a year or is disabled, federal law limits the maximum amount you may contribute on a pretax basis to $3,000 for one dependent and $5,000 for two or more dependents)
- Your spouse is medically disabled and cannot care for your dependents (If your spouse is a full-time student at least five months a year or is disabled, federal law limits the maximum amount you may contribute on a pretax basis to $3,000 for one dependent and $5,000 for two or more dependents)
- If divorced, you must have custody and be claiming the child as a dependent on your tax return
Money must be in the account before you can be reimbursed. The maximum amount you may place in your account is $2,500 during a plan year if you are married and filing tax returns separately from your spouse. If you are single, or married and filing jointly, the maximum is $5,000. The minimum contribution is $240 per year. Forms:
Enrollment Rules
Participation in FSA Accounts must be renewed every year during the annual open enrollment period. Generally, you may not change the amount of money set aside until the next annual enrollment period. However, the IRS will allow you to make changes during the Plan Year due to a qualifying event. Qualifying events (or family status changes) include:
- a marital status change due to marriage, divorce, or death of a spouse
- birth, adoption, or death of a child
- employee obtaining permanent custody of a child
- termination or commencement of employment by the employee, spouse, or dependent
- employee or employee's spouse taking or returning from an unpaid leave of absence
- change in employment status for employee or spouse
- dependent satisfying or ceasing to satisfy the requirements for unmarried dependents
- and significant change in coverage or costs or a change in daycare provider
Applications for change must be accompanied by documentation and received in the UHR Benefits Division within sixty (60) days of the family status change.
The Summary Plan Description for UVA’s Flexible Spending Account Program details the plan benefits and rules.
VIII. Tax-Deferred Savings Program
The University of Virginia offers an optional savings program that allow employees to tax-defer income and invest for the future. The plans are available through TIAA/CREF, The Vanguard Group, and Fidelity Investments, and are open to all employees who can contribute the monthly minimum of $20. The maximum amount that can be contributed on a tax-deferred basis in 2008 is $15,500 with an additional age catch-up of $5,000. Employees who have been employed with the University for at least 15 consecutive years may be eligible for an additional catch-up of up to $3,000. The University calculates this maximum amount and the employee signs a Tax Deferred Savings Program Authorization Form (Salaried Employees) or Tax Deferred Savings Program Authorization Form (Wage Employees) which specifies the authorized amount of the salary reduction. These forms were previously referred to as the Salary Reduction Agreement (for salaried employees), and the Wage Reduction Agreement (for wage employees).
Employees may participate in both the 403(b) and Commonwealth 457(b) and can contribute the maximum to both.
Beginning January 1, 2008, all eligible newly hired or re-hired salaried state employees will have $40 per month automatically deferred to the 403(b) Plan with Fidelity Investments unless you actively enroll in a 403(b) or 457 plan within 60 days of your date of hire or opt out of participation. Employees who are enrolled automatically will receive a $20 per month match to the Cash Match Plan with Fidelity Investments.
For more information contact the Benefits Division at (434) 924-4392 or email benefits@virginia.edu.
| For Plan Details: |
| TIAA-CREF |
(800) 842-2733 |
|
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| Fidelity |
(800) 343-0860 |
|
|
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| Vanguard |
(800) 523-1188 |
|
|
|
Forms:
Commonwealth Deferred Compensation Plan (457b)
The Commonwealth of Virginia offers for employees an optional savings program that allow employees to tax-defer income and invest for the future. The plan is available through the Commonwealth’s vendor Great-West and is open to all employees who can contribute a monthly minimum of $20 per month. The maximum amount that can be contributed on a tax-deferred basis in 2008 is $15,500 with an additional age catch-up of $5,000. In addition there is a standard catch-up that employees may be eligible for during the three calendar years prior to the designated normal retirement age. Great-West will determine eligibility for this catch-up.
To enroll in the Commonwealth’s plan employees need to complete the Participant Enrollment Form and Beneficiary Designation Form and submit to the Benefits Division.
For more information contact the Benefits Division at (434) 924-4392 or email benefits@virginia.edu.
Forms:
IX. The Matching Contribution Retirement Plan
The University of Virginia offers an employer-paid match to employee contributions to tax-deferred savings programs. To be eligible, employees must be participating in the Virginia Retirement System and the Faculty Retirement Plan. Employee contributions will be matched at 50 percent up to a maximum of $40.00 per month. To enroll, employees must meet the eligibility requirement, participate in a tax-deferred savings account and open a Match Plan account with TIAA-CREF, Fidelity and Vanguard. For more information and account enrollment instructions contact:
| TIAA-CREF |
(800) 842-2733 |
|
|
|
| Fidelity |
(800) 343-0860 |
|
|
|
| Vanguard |
(800) 523-1188 |
|
|
|
X. Miscellaneous Benefits
Social Security
All employees of the University must pay Social Security taxes, except regularly enrolled students and exchange visitors with an F-1 or J-1 Visa. The employee’s share of the cost of Social Security is withheld from each paycheck until the employee’s gross salary reaches the Social Security earnings base. The University matches the contribution to the program.
Faculty and Employee Assistance Program
The University also offers employees confidential counseling and referral services for emotional and financial problems. Please call the Faculty and Employee Assistance Program at 243-2643 to speak with a counselor or visit their website at http://www.healthsystem.virginia.edu/internet/feap/.
Intramural-Recreational Sports Facilities
Full-time and part-time salaried employees may purchase an annual recreation pass which entitles the employee to use the University’s swimming pools, handball, tennis, squash, and racquetball courts, weight rooms, indoor track, boxing rooms, saunas, and several other athletic facilities. The University will subsidize a portion of the annual cost for full-time employees. Employees may purchase a pass at the Intramural and Recreational Sports Office in the Aquatic and Fitness Center. For more information call 924-3791 or visit their website at http://www.virginia.edu/ims/.
Savings Bonds
Any salaried employee, full-time or part-time, may purchase U.S. Savings Bonds through payroll deduction. Please contact the UHR Benefits Division to purchase bonds. The website http://www.savingsbonds.gov.
Pre-Tax Parking
Salaried employees who use payroll deduction to purchase parking permits from University Parking and Transportation services may do so on a pre-tax basis. The program is similar to the pre-tax deduction for health care premiums in that taxable pay is reduced and participants benefit by an increase in take-home or net pay.
Employees who participate in the pre-tax parking benefit will reduce the amount of pay subject to federal income, state income and FICA tax withholdings annually. An employee's gross pay will not change but his or her net pay will increase due tot he lesser amount of pay subject to tax withholding.
All eligible employees are automatically enrolled in the plan.
XI. Termination Information
FULL TIME FACULTY
Health Insurance: If you have been enrolled in the UVa health insurance plan, your coverage will continue until the end of the month in which you terminate employment. According to federal law (COBRA), you have the option to extend continuous coverage for as long as 18 months at your own expense and without Medical Center contribution. Premiums are 102 percent of the premiums for regular coverage, and are required 45 days after the election of Extended Coverage. If you want to elect Extended Coverage, please complete the COBRA enrollment forms that will be sent to your home address under separate cover after termination. These forms must be returned within 60 days of termination of employment or receipt of the enrollment forms, whichever is later.
Note: If you have had the reduced Family Health Care Premium offered to two active state employees, your termination of employment requires a change in membership. Please contact the UHR Benefits Division at 924-4392 for assistance.
Flexible Spending Accounts: If you participate in the Dependent Care or Medical Flexible Spending Accounts, you have three options when you terminate your employment with the University; (1) deduct the remaining contributions from your last paycheck and continue participation until the end of the month in which you terminate employment, (2) deduct your regular monthly contribution from your last paycheck and continue participation until the date on which you terminate employment, or (3) continue participation until the end of the Plan Year as a COBRA participant. If you choose option 3, you will be responsible for paying your current election, your current account administrative fee, and the COBRA administrative fee of 2 percent on a monthly basis. This monthly payment will be due on or before the first of each month through the end of the current Plan Year. Please contact the UHR Benefits Division at 924-4392 for more information about each of these options.
Note: Claims for expenses incurred while participating in these programs must be filed within 90 days of the date of termination from the plan. Funds remaining after the 90-day grace period will be forfeited.
Faculty Retirement Plan
Your options may vary with the retirement plan you have chosen. Generally, you may leave your contributions with your designated retirement plan until you wish to transfer funds to another similar qualified plan, or withdraw funds based on the rules of the retirement fund vendor. If you elect to withdraw funds, tax penalties may be imposed. For more information on specific rules or to initiate a withdrawal/transfer, please contact your optional retirement plan at the toll-free number listed above.
Virginia Retirement System (VRS) (888) 827-3847: You must decide whether to leave your member contributions in place, thus retaining the service credit you have earned or take a refund of your member contribution account, thereby canceling your service credit. There is no time limit on making this choice. Contributions left with VRS earn 4 percent per year. If you do not take a refund and later return to a VRS covered position, the service you earn in your second period of employment will be added to that already in your records. Contact the UHR Benefits Division at 924-4392 and request an "Address Declaration for Inactive Members" (Form VRS3-A). Complete the form and return it to VRS. If you decide to take a refund of your VRS member contribution account, please contact the UHR Benefits Division for information on options, as well as taxes and penalties that apply.
Tax-deferred Savings Program
These contributions cease with termination of employment from the Medical Center. You may leave your accumulated contributions with your designated plan(s) until you wish to initiate a withdrawal or transfer to another 403(b) program or to an IRA. Taxes and penalties may apply on withdrawal of these funds. Please contact your supplemental retirement vendor(s) for more information, as well as withdrawal and transfer forms.
Life Insurance: You have 31 days from the date of your termination of employment with the Medical Center to convert your life insurance coverage to an individual policy. A medical examination is not required. The life insurance carrier determines the cost of your converted policy. If you wish to convert your life insurance, please contact the UHR Benefits Division at 924-4392 for the appropriate conversion form.
Disability Insurance. TIAA disability policy can be converted within 31 days of your termination date by those who meet certain criteria. Nine-month faculty completing the full nine-month contract period have coverage through August 31st or until the start of full-time, permanent employment with another employer, whichever is earlier. Otherwise, coverage ends the day you stop active work. If you wish to convert your disability policy, please contact the UHR Benefits Division at 924-4392. If you participate in the Virginia Sickness and Disability Plan (VSDP), your coverage ends on the date of termination.
Accidental Death and Dismemberment Insurance. This optional policy can be converted to individual coverage. For more information contact the UHR Benefits Division. Nine-month faculty completing the full nine-month contract period have coverage through August 31. Otherwise, coverage ends the last day of the last month of employment.
Other Payroll Related Information
Address Change: To receive a Form W-2 and other necessary payroll-related information, it is necessary for your correct address to be on file. Please submit in writing your name, social security number and new address to the UHR Management Systems Division, University Human Resources, P. O. Box 400127, Charlottesville, VA 22904-4127 (fax (434) 982-2632).
Direct Deposit: If you had your paycheck directly deposited into your bank account, you must notify Medical Center Payroll in writing and give your name and social security number to authorize Payroll to terminate your direct deposit (fax (434) 243-6095). Please call the Medical Center Payroll Division at (434) 924-9842 if you have any questions.
Other Payroll Deductions: If you have authorized payroll deductions for the University of Virginia Community Credit Union and/or parking, you must contact these departments to cancel your deductions.
VISITING FACULTY
Health Insurance: If you have been enrolled in the UVa health insurance plan, your coverage will continue until the end of the month in which you terminate employment. According to federal law (COBRA), you have the option to extend continuous coverage for as long as 18 months at your own expense and without Medical Center contribution. Premiums are 102 percent of the premiums for regular coverage, and are required 45 days after the election of Extended Coverage. If you want to elect Extended Coverage, please complete the COBRA enrollment forms that will be sent to your home address under separate cover after termination. These forms must be returned within 60 days of termination of employment or receipt of the enrollment forms, whichever is later.
Note: If you have had the reduced Family Health Care Premium offered to two active state employees, your termination of employment requires a change in membership. Please contact the UHR Benefits Division at 924-4392 for assistance.
Flexible Spending Accounts: If you participate in the Dependent Care or Medical Flexible Spending Accounts, you have three options when you terminate your employment with the University; (1) deduct the remaining contributions from your last paycheck and continue participation until the end of the month in which you terminate employment, (2) deduct your regular monthly contribution from your last paycheck and continue participation until the date on which you terminate employment, or (3) continue participation until the end of the Plan Year as a COBRA participant. If you choose option 3, you will be responsible for paying your current election, your current account administrative fee, and the COBRA administrative fee of 2 percent on a monthly basis. This monthly payment will be due on or before the first of each month through the end of the current Plan Year. Please contact the UHR Benefits Division at 924-4392 for more information about each of these options.
Note: Claims for expenses incurred while participating in these programs must be filed within 90 days of the date of termination from the plan. Funds remaining after the 90-day grace period will be forfeited.
Tax-deferred Savings Program
These contributions cease with termination of employment from the Medical Center. You may leave your accumulated contributions with your designated plan(s) until you wish to initiate a withdrawal or transfer to another 403(b) program or to an IRA. Taxes and penalties may apply on withdrawal of these funds. Please contact your supplemental retirement vendor(s) for more information, as well as withdrawal and transfer forms.
Other Payroll Related Information
Address Change: To receive a Form W-2 and other necessary payroll-related information, it is necessary for your correct address to be on file. Please submit in writing your name, social security number and new address to the UHR Management Systems Division, University Human Resources, P. O. Box 400127, Charlottesville, VA 22904-4127 (fax (434) 982-2632).
Direct Deposit: If you had your paycheck directly deposited into your bank account, you must notify Medical Center Payroll in writing and give your name and social security number to authorize Payroll to terminate your direct deposit (fax (434) 243-6095). Please call the Medical Center Payroll Division at (434) 924-9842 if you have any questions.
Other Payroll Deductions: If you have authorized payroll deductions for the University of Virginia Community Credit Union and/or parking, you must contact these departments to cancel your deductions.
PART-TIME FACULTY
Faculty Retirement Plan
Your options may vary with the retirement plan you have chosen. Generally, you may leave your contributions with your designated retirement plan until you wish to transfer funds to another similar qualified plan, or withdraw funds based on the rules of the retirement fund vendor. If you elect to withdraw funds, tax penalties may be imposed. For more information on specific rules or to initiate a withdrawal/transfer, please contact your optional retirement plan at the toll-free number listed above.
Flexible Spending Accounts: If you participate in the Dependent Care or Medical Flexible Spending Accounts, you have three options when you terminate your employment with the University; (1) deduct the remaining contributions from your last paycheck and continue participation until the end of the month in which you terminate employment, (2) deduct your regular monthly contribution from your last paycheck and continue participation until the date on which you terminate employment, or (3) continue participation until the end of the Plan Year as a COBRA participant. If you choose option 3, you will be responsible for paying your current election, your current account administrative fee, and the COBRA administrative fee of 2 percent on a monthly basis. This monthly payment will be due on or before the first of each month through the end of the current Plan Year. Please contact the UHR Benefits Division at 924-4392 for more information about each of these options.
Note: Claims for expenses incurred while participating in these programs must be filed within 90 days of the date of termination from the plan. Funds remaining after the 90-day grace period will be forfeited.
Tax-deferred Savings Program
These contributions cease with termination of employment from the Medical Center. You may leave your accumulated contributions with your designated plan(s) until you wish to initiate a withdrawal or transfer to another 403(b) program or to an IRA. Taxes and penalties may apply on withdrawal of these funds. Please contact your supplemental retirement vendor(s) for more information, as well as withdrawal and transfer forms.
Other Payroll Related Information
Address Change: To receive a Form W-2 and other necessary payroll-related information, it is necessary for your correct address to be on file. Please submit in writing your name, social security number and new address to the UHR Management Systems Division, University Human Resources, P. O. Box 400127, Charlottesville, VA 22904-4127 (fax (434) 982-2632).
Direct Deposit: If you had your paycheck directly deposited into your bank account, you must notify Medical Center Payroll in writing and give your name and social security number to authorize Payroll to terminate your direct deposit (fax (434) 243-6095). Please call the Medical Center Payroll Division at (434) 924-9842 if you have any questions.
Other Payroll Deductions: If you have authorized payroll deductions for the University of Virginia Community Credit Union and/or parking, you must contact these departments to cancel your deductions.
XII. Privacy Notice
Notice of University of Virginia Health Plan's and the University of Virginia Flexible Spending Account Plan's (Medical Reimbursement Account Portion) Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. |
UNIVERSITY OF VIRGINIA'S PLANS' COMMITMENT TO PRIVACY
The University of Virginia Health Plan, and the medical reimbursement account portion of the University of Virginia Flexible Spending Account Plan (jointly referred to as the "Plan") are committed to protecting the privacy of your protected health information. Protected health information, which is referred to as "health information" in this Notice, is information that identifies you and relates to your physical or mental health, or to the provision or payment of health services for you. The Plan creates, receives, and maintains your health information when it provides health, dental, prescription drug, and medical flexible spending account benefits to you and your eligible dependents. The Plan also pledges to provide you with certain rights related to your health information.
By this Notice of Privacy Practices ("Notice"), the Plan informs you that it has the following legal obligations under the federal health privacy provisions contained in the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the related regulations ("federal health privacy law"):
- to maintain the privacy of your health information;
- to provide you with this Notice of its legal duties and privacy practices with respect to your health information; and
- to abide by the terms of this Notice currently in effect.
This Notice also informs you how the Plan uses and discloses your health information and explains the rights that you have with regard to your health information maintained by the Plan. For purposes of this Notice, "you" or "yours" refers to insured participants and eligible dependents.
This Notice is effective as of April 14, 2003, and will remain in effect unless and until the Plan issues a revised Notice.
INFORMATION SUBJECT TO THIS NOTICE
The Plan creates, receives, and maintains certain health information about you to help provide health benefits to you, as well as to fulfill legal and regulatory requirements. The Plan obtains this health information, which identifies you, from applications and other forms that you complete, through conversations you may have with the Plan's administrative staff and health care professionals, and from reports and data provided to the Plan by health care service providers, insurance companies, and other third parties. The health information the Plan has about you includes, among other things, your name, address, phone number, birthdate, social security number, and medical and health claims information. This is the information that is subject to the privacy practices described in this Notice.
This Notice does not apply to health information created, received, or maintained by the University of Virginia on behalf of the non-health employee benefits that it sponsors, such as disability benefits and life insurance benefits. This Notice also does not apply to health information that the University of Virginia requests, receives, and maintains about you for employment purposes, such as employment testing, or determining your eligibility for medical leave benefits or disability accommodations.
SUMMARY OF THE PLAN'S PRIVACY PRACTICES
The Plan's Uses and Disclosures of Your Health Information
Generally, you must provide a written authorization to the Plan for it to use or disclose your health information. However, the Plan may use and disclose your health information without your authorization for the administration of the Plan and for processing claims. The Plan also may use and disclose your health information without your authorization for other purposes as permitted by the federal health privacy law, such as health and safety, law enforcement or emergency purposes. The details of the Plan's uses and disclosures of your health information are described below.
Your Rights Related to Your Health Information
The federal health privacy law provides you with certain rights related to your health information. Specifically, you have the right to:
- Inspect and/or copy your health information;
- Request that your health information be amended;
- Request an accounting of certain disclosures of your health information;
- Request certain restrictions related to the use and disclosure of your health information;
- Request to receive your health information through confidential communications;
- File a complaint with the Plan or the Secretary of the Department of Health and
- Human Services if you believe that your privacy rights have been violated; and
- Receive a paper copy of this Notice.
These rights and how you may exercise them are detailed below.
Changes in the Plan's Privacy Practices
The Plan reserves its right to change its privacy practices and revise this Notice as described below.
Contact Information
If you have any questions or concerns about the Plan's privacy practices or about this Notice, if you wish to obtain additional information about the Plan's privacy practices, or if you wish to submit a complaint, please contact:
Joanne Hayden
UVa Health Plan Ombudsman
914 Emmet Street
P.O. Box 400127
Charlottesville, VA 22904-4127
(434) 924-4346
DETAILED NOTICE OF THE PLAN'S PRIVACY POLICIES THE PLAN'S USES AND DISCLOSURES
Except as described in this section, as provided for by federal health privacy law, or as you have otherwise authorized, the Plan only uses and discloses your health information for the administration of the Plan and the processing of health claims. The uses and disclosures that do not require your written authorization are described below.
Uses and Disclosures for Treatment, Payment, and Health Care Operations
- For Treatment. The Plan may disclose your health information to a health care provider, such as a hospital or physician, to assist the provider in treating you. The Plan does not anticipate making disclosures "for treatment" purposes. However, if necessary, the Plan may make such disclosures without your authorization.
- For Payment. The Plan may use and disclose your health information without your authorization so that your claims for health care services can be paid according to the Plan's terms. For example, the Plan may use and disclose your health information to determine whether certain health care services that you seek are covered by the Plan or to process your health care claims. The Plan also may disclose your health information to coordinate payment of your health care with others who may be responsible for certain costs.
- For Health Care Operations. The Plan may use and disclose your health information without your authorization so that it can operate efficiently and in the best interests of its participants. For example, the Plan may disclose your health information for underwriting purposes, for business planning purposes, or to attorneys who are providing legal services to the Plan.
Uses and Disclosures to Business Associates
The Plan may disclose certain of your health information without your authorization to its "business associates," which are third parties that assist the Plan in its operations. For example, the Plan may share your claims information with a business associate that provides claims processing services to the Plan, and the Plan may disclose your health information to its business associates for actuarial projection and audit purposes, and legal services. The Plan enters contracts with its business associates to ensure that the privacy your health information is protected.
Uses and Disclosures to the Plan Sponsor
The Plan may disclose your health information, without your authorization, to the Plan Sponsor, which is the University of Virginia, for plan administration purposes, such as performing quality assurance functions, and for monitoring and auditing functions. The Plan Sponsor will certify to the Plan that it will protect the privacy of your health information and that it has amended the plan documents to reflect its obligation to protect the privacy of your health information.
Other Uses and Disclosures That May Be Made Without Your Authorization
The federal health privacy law provides for specific uses or disclosures of your health information that the Plan may make without your authorization, which are described below.
- Required By Law. The Plan may use and disclose health information about you as required by the law. For example, the Plan may disclose your health information for the following purposes: for judicial and administrative proceedings pursuant to legal process and authority; to report information related to victims of abuse, neglect, or domestic violence; or to assist law enforcement officials in their law enforcement duties.
- Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law. Your health information also may be disclosed for public health activities, such as preventing or controlling disease, injury, or disability.
- Government Functions. Your health information may be disclosed to the government for specialized government functions, such as intelligence, national security activities, and protection of public officials. Your health information also may be disclosed to health oversight agencies that monitor the health care system for audits, investigations licensure, and other oversight activities.
- Active Members of the Military and Veterans. Your health information may be used or disclosed in order to comply with laws and regulations related to military service or veterans' affairs.
- Workers' Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers' Compensation benefits.
- Emergency Situations. Your health information may be used or disclosed to a family member or close personal friend involved in your care in the event of an emergency, or to a disaster relief entity in the event of a disaster.
- Others Involved In Your Care. In limited circumstances, your health information may be used or disclosed to a family member, close personal friend, or others who the Plan has verified are involved in your care or payment of your care. For example, your health information may be so disclosed if you are seriously injured and unable to discuss your case with the Plan. Also, in certain instances, the Plan may advise a family member or close personal friend about your general condition, location (such as in the hospital), or death. If you do not want this information to be shared, you may request that these disclosures be restricted as outlined later in this Notice.
- Personal Representatives. Your health information may be disclosed to people that you have authorized to act on your behalf, or people who have a relationship with you that gives them the right to act on your behalf. Examples of personal representatives are parents for minors and those who have Power of Attorney for adults.
- Treatment and Health-Related Benefits Information. The Plan and its business associates may contact you to provide information about treatment alternatives or other health-related benefits and services that may interest you, including, for example, alternative treatment, services, and medication.
- Research. Under certain circumstances, the Plan may use or disclose your health information for research purposes as long as the procedures required by law to protect the privacy of the research data are followed.
- Organ and Tissue Donation. If you are an organ donor, the Plan may use or disclose your health information to an organ donor or procurement organization to facilitate an organ or tissue donation transplantation.
- Deceased Individuals. The health information of a deceased individual may be disclosed to coroners, medical examiners, and funeral directors so that those professionals can perform their duties.
Uses and Disclosures for Fundraising and Marketing Purposes.
The Plan does not use your health information for fundraising or marketing purposes.
Any Other Uses and Disclosures Require Your Express Written Authorization
Uses and disclosures of your health information other than those described above will be made only with your express written authorization. You may revoke your authorization in writing. If you do so, the Plan will not use or disclose your health information authorized by the revoked authorization, except to the extent that the Plan already has relied on your authorization.
Once your health information has been disclosed pursuant to your authorization, the federal health privacy law protections may no longer apply to the disclosed health information, and that information may be re-disclosed by the recipient without your or the Plan's knowledge or authorization.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights regarding your health information that the Plan creates, receives and maintains. If you are required to submit a written request related to these rights, as described below, you should address such requests to:
Joanne Hayden
UVa Health Plan Ombudsman
914 Emmet Street
P.O. Box 400127
Charlottesville, VA 22904-4127
(434) 924-4346
Right to Inspect and Copy Health Information
You have the right to inspect and obtain a copy of your health information that is maintained by the Plan. This includes, among other things, health information about your plan eligibility, plan coverages, claim records, and billing records.
To inspect and copy health information maintained by the Plan, submit a written request to the UVa Health Plan Ombudsman. The Plan may charge a fee for the cost of copying and/or mailing the health information that you have requested. In limited instances, the Plan may deny your request to inspect and copy your health information. If that occurs, the Plan will inform you in writing. In addition, in certain circumstances, if you are denied access to your health information, you may request a review of the denial.
Right to Request That Your Health Information Be Amended
You have the right to request that the Plan amend your health information if you believe the information is incorrect or incomplete.
To request an amendment, submit a written request to the UVa Health Plan Ombudsman. This request must provide the reason(s) that support your request. The Plan may deny your request if you have asked to amend information that:
- Was not created by or for the Plan, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of your heath information maintained by or for the Plan;
- Is not part of the health information that you would be permitted to inspect and copy; or
- Is accurate and complete.
The Plan will notify you in writing as to whether it accepts or denies your request for an amendment to your health information. If the Plan denies your request, it will explain how you can continue to pursue the denied amendment.
Right to an Accounting of Disclosures
You have the right to receive a written accounting of disclosures, which is a list of disclosures of your health information by the Plan to others. Generally, the following disclosures are not part of an accounting: disclosures that occur before April 14, 2003; disclosures for treatment, payment, or health care operations; disclosures made to or authorized by you; and certain other disclosures. The accounting covers up to six years prior to the date of your request (but not disclosures made before April 14, 2003).
To request an accounting of disclosures, submit a written request to the UVa Health Plan Ombudsman. If you want an accounting that covers a time period of less than six years, please state that in your written request for an accounting. The first accounting that you request within a twelve month period will be free. For additional accountings in a twelve month period, the Plan may charge you for the cost of providing the accounting. But, the Plan will notify you of the cost involved before processing the accounting so that you can decide whether to withdraw or modify your request before any costs are incurred.
Right to Request Restrictions
You have the right to request restrictions on your health care information that the Plan uses or discloses about you to carry out treatment, payment, or health care operations. You also have the right to request restrictions on your health information that the Plan discloses to someone who is involved in your care or the payment for your care, such as a family member or friend. The Plan is not required to agree to your request for such restrictions, and the Plan may terminate its agreement to the restrictions you requested.
To request restrictions, submit a written request to the UVa Health Plan Ombudsman that explains what information you wish to limit, and how and/or to whom you would like the limits to apply. The Plan will notify you in writing as to whether it agrees to your request for restrictions.
Right to Request Confidential Communications, or Communications by Alternative Means or at an Alternative Location
You have the right to request that the Plan communicate your health information to you in confidence by alternative means or in an alternative location. For example, you can ask that the Plan only contact you at work or by mail, or that the Plan provide you with access to your health information at a specific, reasonable location.
To request confidential communications by alternative means or at an alternative location, submit a written request to the UVa Health Plan Ombudsman. Your written request should state the reason(s) for your request, and the alternative means by or location at which you would like to receive your health information. If appropriate, your request should state that the disclosure of all or part of your health information by non-confidential communications could endanger you. The Plan will accommodate reasonable requests and notify you appropriately.
Right to File a Complaint
You have the right to complain to the Plan and/or to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint with the Plan, submit a written complaint to the UVa Health Plan Ombudsman named above.
You will not be retaliated or discriminated against and no services, payment, benefits, or privileges will be withheld from you because you file a complaint with the Plan or with the Secretary of the Department of Health and Human Services.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice. To make such a request, submit a written request to the UVa Health Plan Ombudsman named above. You may also obtain a copy of this Notice at the Plan's website, www.hrs.virginia.edu/forms/uvahealthplanprivacy.pdf.
CHANGES IN THE PLAN'S PRIVACY POLICIES
The Plan reserves the right to change its privacy practices and make the new practices effective for all protected health information that it maintains, including your protected health information that it created or received prior to the effective date of the change and protected health information it may receive in the future. If the Plan materially changes any of its privacy practices that are covered by this Notice, it will revise its Notice and provide you with the revised Notice within 60 days of the revision. In addition, copies of the revised Notice will be made available to you upon your written request, and any revised notice will be available at the Plan's website, www.hrs.virginia.edu.
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