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Mailing Address:
U.Va. Human Resources
914 Emmet Street
P.O. Box 400127
Charlottesville, VA
22904
Phone: (434) 924-4598
Email: hrdept@virginia.edu
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| Benefits Summary for Medical Center Salaried Employees |
Effective January 1, 2008
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. Here is a link to 2008 Medical Services requiring preauthorization: http://www.hrs.virginia.edu/forms/preauthlist.pdf 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 or within 60 days of 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.
Health Plan Premium Rates: U.Va. Health Plan Rates for Active Employees
Enrollment form: http://www.hrs.virginia.edu/forms/uvaenrollmentapplication.pdf
Summary Information of Coverage and Copays
These links provide a description of covered benefits:
A detailed description of coverage through the UVa Health Plan is available in the Description of Benefits.
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 "self funded" 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 (SHS) Provider Network need to elect enrollment in the National Network and are required to use National Network or SHS providers in order to receive the highest level of benefit 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 National Network Plan. Members who move away or leave the area for more than 90 days must contact UHR and complete an OOA enrollment form, available at www.hrs.virginia.edu/forms/ooaenrollmentform.pdf, to enroll in the National Network or OOA plan.
The National Network is the national network of medical providers available for use by UVa Health Plan participants enrolled in the National Network. You may receive medical care from any National Network or SHS physician or hospital. A list of participating providers can be found on the ‘Provider Search’ section of the SHS website www.southernhealth.com at the National Network link. You are not required to select a Network Primary Care Physician (PCP) to receive your benefits. However, a relationship with a PCP is important for wellness and general coordination of health care. Therefore, you are encouraged to establish a PCP relationship. You do not need a referral to see a participating medical specialist in the National Network. You are required to obtain any necessary preauthorization for services. Call SHS’s Plan Services Department at 1-888-975-9557 prior to accessing services to determine whether preauthorization is necessary for that particular service. When National Network participants choose to receive care through the National Network 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. If you have questions or need assistance, call Southern Health Services (SHS) Plan Services Department at 1-888-975-9557, Monday through Friday, 8:30 a.m. - 5:30 p.m. Remember to inform your health care providers of your coverage in the UVa Health Plan’s National 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 National 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.
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 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 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.
Southern Health WellBeing Program
Southern Health has a program called Coventry Wellbeing that offers free or discounted services to UVA Health Plan members and is available through the Southern Health member website, by clicking on “Coventry Well Being and Health Programs” http://www.southernhealth.com/framesetdef.asp?Community=Member You must login to My Online Services and click on the View WellBeing Programs link to access My ePHIT and the Health Risk Assessment. Utilizing cutting-edge technology and proven techniques, MyePHIT 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). See COBRA Eligibility, Rates and Enrollment: http://www.hrs.virginia.edu/forms/cobraexplanation2008.pdf
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.
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