SMH 2011 guide

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2011 Editio

Health Care Plans, Dental Plans, FSA, HSA,Personal Health Management and WellU

HealthProgram

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1........ Health Program Benefts

2........ Your Guide to MakingEnrollment Decisions

3........ Who is Eligible or Benefts

5........ How to Enroll: New Hires &Newly Eligible Faculty & Sta

6........ Changing Your Benefts

8........ Health & Wellness at the

University o Rochester9........Programs & Services to Help You

Get Healthy and Stay Healthy

18 ...... Your Health Care PlanChoices or 2011

20...... University Health CarePlansAn Overview

22...... Comparing the UniversityHealth Care Plans

24...... Comparing the TPAs

26...... Choosing the Right HealthCare Plan

28...... Understanding the Featureso Your Health Care Plan

30...... Flexible Spending Accounts andHealth Savings Account

31...... A Closer Look at theHealth Care FSA

33...... A Closer Look at the HSA

36...... HSA or Health Care FSAWhats Right or You?

37...... Tax Savings Beyond HealthCare: Dependent Care FSA

38...... Choose Your Dental Benefts

40 ..... Schedule o Covered DentalServices and Supplies

41 ...... Dental Services and SuppliesNot Covered

42...... Important Inormation to Know

52...... How Your Coverage Is Aected

54...... ERISA (Employee RetirementIncome Security Act)

56......Terms to Know

58...... Appendix A: When You Can MakeBeneft Changes Outside oOpen Enrollment

62 ...... Appendix B: Diabetic Supplies

and Equipment

Contents

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Promoting wellness and healthy living continues to be an important

focus for the University of Rochester. To support our ongoing com-

mitment, the University offers a benets package designed to help

faculty and staff make good health care decisions that not only help you live

better, but also help you better manage health care costs.

Health Program Benefts

Te University o Rochester is committed to

providing you and your amily with a compre-

hensive and competitive benefts package. In or-

der to meet this commitment and our business

goals, we developed this Health Program Deci-

sion Guide to highlight the benefts, programs,

and services available to you.

Outlined in this Guide are the health

program options available during the January

1 through December 31, 2011 plan year* that

include:

Health care (includes prescription drug

benefts)

Dental

Flexible Spending Accounts

Health Savings Account

Personal Health and Wellness Programs

WellU

Te health care choices you makewhether

selecting health care coverage or you and your

amily or the coming year or deciding when

and how to use health care services on a day-to-

day basishave a direct impact on the health

care costs you and the University pay.

o help you maximize your health care oer-

ings, the University oers health and wellness

programs through Yourhealth and WellU,

which provide programs, tools, resources, and

education necessary to support healthy living.

We encourage you to become involved with our

I you have questions about Contact

Health Care Plans Aetna

1-877-864-4583www.aetna.com

Excellus BlueCross BlueShield

1-800-659-2808 or 1-585-232-2632www.excellusbcbs.com

Dental Plans Excellus BlueCross BlueShield1-800-724-1675www.rochester.edu/benets/dental

Flexible Spending Accounts (FSAs) Health Care FSA Limited Purpose Health Care FSA Dependent Care FSA

Aetna1-888-238-6226www.aetnafsa.com

EBS-RMSCO, Inc.(FSA Administrator for Excellus BCBS)1-800-327-7130 or 1-585-232-2632Fax (for claims): 1-877-256-7228www.myebsaccount.com

Health Savings Account (HSA) Aetna1-877-864-4583

HSA Bank(Excellus HSA Partner)1-800-357-6246www.hsabank.com

General Benefts UR Benefts Ofce275-2084

Facsimile 273-1054

[email protected]

www.rochester.edu/benets

Updating your personal data orusing HRMS to enroll online as a new hire

ASK-URHR (275-8747)

[email protected]

www.rochester.edu/people

WellU Program University WellU Ofce273-5240

www.rochester.edu/well-u

Personal Health and Wellness Programs Carewise Health1-877-598-3967

Your Health or Health Concerns Nurse Line (speak with a Registered Nurse)1-877-598-3967

*Te health care plan year for Strong Memorial Hospital Residents and Fellows is July 1 through June 30.

Health Program Resources

health and wellness oerings, including

taking the Personal Health Assessment

and completing a biometric screening. See

pages 9-13 or more inormation.

ake the time to explore this Guide to

learn more about the benefts and services

that may help you change your behavior to

become more involved in your health and

use your benefts as wisely as possible.

PUT YOUR HEALTH FIRSTTake a more active role in your health.

Take a Personal Health Assessment,

enroll in a Personal Wellness or

Personal Health Program, and you may

be eligible for incentives! For more

information, contact Carewise Health

at 1-877-598-3967.

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Choose and Use Benefts WiselyYou make choices each day that are unique to

your work, amily needs and personal interests.

Be sure to take time to careully consider your

beneft needs and options beore making your

elections. Consider the types o service and

beneft eatures you need or want and the

amount you can reasonably aord to pay out-o-pocket or the coverage.

Remember that your role as a responsible

health care consumer does not end once you

enroll or benefts. Troughout the year, you

should take an active role in managing your

health by maintaining a healthy liestyle, choosing

in-network providers when appropriate,

evaluating your health care choices when care

is needed and using available resources wisely.

Your OptionsYou may have the opportunity to choose rom

the options outlined in the chart below or

your Health Program benefts.

Note: You may elect to waive your health

care plan coverage but still enroll in Dental

Plan coverage, a Health Care FSA, and/ora Dependent Care FSA. I you elect to waive

coverage, you may have to wait until the next

open enrollment period or until you experience

a qualiying event to enroll. See Appendix A or

more inormation.

Your Guide to Making Enrollment DecisionsHealth Care Plans, Dental Plans, FSA and HSA

Benefts Available To You Additional Inormation

Health Care OptionsUniversity High Deductible PlanUniversity Low Deductible PlanUniversity HSA-Eligible PlanUniversity Copay Plan

Dental OptionsTraditional Dental Assistance Plan

Medallion Dental Plan

Modied plan design for 2011.

Modied plan design for 2011.

Accounts to Help You Save on TaxesHealth Care Flexible Spending Account (FSA)

Health Saving Account (HSA)

Limited Purpose Health CareFlexible Spending Account (FSA)

Dependent Care Flexible Spending Account (FSA)

Health Care FSA is not available if you elect to makecontributions to a Health Savings Account (HSA).

You can contribute only if you enroll in theUniversity HSA-Eligible Plan.

You can contribute only if you enroll in theUniversity HSA-Eligible Plan and contribute to aHealth Savings Account (HSA).

Dependent Care FSA is for day care expenses (notmedical expenses) for your qualifying dependents.See page 37.

AvailableCoverage Levels

The coverage levels

available to you or

health care are:

Single

Employee and Child(ren)

Employee and Spouse/

Domestic Partner

Family

The coverage levels

available to you or

dental are:

Single

Family

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Who is Eligible or BeneftsHealth Care Plans, Dental Plans, FSA and HSA

You are eligible ifyou are a regular ull-time

or part-time member o the aculty or sta at the

University o Rochester as defned in the erms

to Know section o this Guide.

Visiting aculty members, part-time

assistant coaches, in-house agency nurses and

in-house operating room technicians are not

eligible or dental plan coverage.Dependents eligible to be covered

under your health care plan and/or dental plan

include:

Your spouse.

Your domestic partner/same-sex legal spouse

and his or her eligible children only i you

cannot become legally married in New York

State.

Your children up to age 26, provided they

have no access to other employer coverage

(through their own employment), regardless

o marital status or student status.

Your children who are handicapped prior to

age 26 and are dependent on you or support.

Dependent children include:

Biological children,

Legally adopted children,

Stepchildren who are chiey dependent upon

your support, and

Recognized children (grandchild, niece,

nephew or other child or whom you are the

legal guardian), i they:

- Are unmarried

- Are under age 24

- Live with you in a parent/child relationship

and are supported by you

- Can be claimed as your ederal tax

dependent, and

- Do not have access to other coverage.

You will be required to complete a

verifcation orm to certiy ederal tax

dependency in order to cover any eligible

dependent children as recognized children.

Forms are available online or rom the Benefts

Oce.

Retirees of the Universityare eligible or

health care and dental coverage. (A separatebrochure explains the health care plans

available to Medicare-eligible retirees. Tis

brochure can be viewed at www.rochester.edu/

benefts. Select Employment Changes, then

select Retirement.)

Your widow/widower and unmarried

surviving dependents are eligible for

coverage under a University Health Care

Plan if:

You had met the age and service requirements

to retire, or

You were retired, or

You had fve or more years o service but had

not met the criteria to retire. (In this instance,

your surviving spouse and eligible dependent

children remain eligible or a period o one

year ollowing your death.)

Individuals represented by collective

bargaining agreements receive benefts in

accordance with those agreements. Copies

o those agreements are available upon

DEPENDENT ELIGIBILITYYou may be contacted to provide

required documentation to

conrm the members of your

family who are eligible for

benets under a University

Health Care Plan. This is to make

sure that we are keeping trackof dependents who may have

reached the age maximum for

plan eligibility, spouses who

are divorced and are no longer

eligible, or dependents who are

deceased or otherwise ineligible

for benets. Please contact the

UR Benets Ofce if there is a

change in eligibility status for

any of your dependents covered

under the plan.

NEW EXPANDED DEPENDENTCOVERAGEUnder the Patient Protection and

Affordable Care Act (PPACA) signed

into law on March 23, 2010 to bring

about health care reform, dependent

coverage has been expanded to include

adult children up to age 26 provided

they have no access to other employer

coverage (based on their own

employment), regardless of marital

status or student status. This change is

effective January 1, 2011.

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written request.

University Married CouplesI you are married to a University aculty

or sta member who also is eligible or

University beneits, both you and your

spouse may enroll or coverage. However,

you and your dependents will not be allowed

to be covered under two University HealthCare or two Dental Plans at the same time.

When I Reach Age 65I you continue to work ull-time or part-time,

your University Health Care Plan remains

the primary coverage, with Medicare as the

secondary payer.

When you retire, transer to an ineligible

status, or terminate your University

employment, your primary coverage

will become Medicare (Parts A and B).

At retirement, you will need to enroll in

Medicare Parts A and B and complete orms

to change your University Health Care Plan

to a Medicare-eligible retiree plan i youwish to continue coverage as a University o

Rochester retiree. (See the separate brochure

that explains health care plans available to

Medicare-eligible retirees.)

If you enroll in the HSA-Eligible Plan and haveMedicare coverage (Parts A, B, C, or D), you cannotcontribute to a Health Savings Account (HSA).If you are contributing to an HSA, please refer topages 3335 for important information.

SPECIAL NOTE REGARDINGDOMESTIC PARTNER ANDSAMESEX LEGAL SPOUSECOVERAGE:The premiums for domesticpartners/same-sex legal

spouses, and any childrenthey bring to the partnership,are paid with after-tax dollars,while the premiums you payfor health care plan coverage

are paid with tax-free dollars.This means you will haveimputed income equal to thevalue of the benet providedby the University for thesedependents. Only non-qualied domestic partners/same-sex legal spouses aresubject to this provision.

Imputed income is theaddition of the value of cash/non-cash compensation to anemployees taxable wagesin order to properly withholdincome and employmenttaxes from the wages. TheInternal Revenue Serviceconsiders medical and dentalinsurance coverage fordomestic partners/same-sex legal spouses and their

dependents as income forthe purposes of calculating

federal taxes. Affectedemployees must report thisimputed income on their

Form W-2.

Who is Eligible or Benefts Continued

Health Care Plans, Dental Plans, FSA and HSA

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Enrolling or benefts is easy. Te ollowing

checklist takes you through the steps you need

to complete to elect your health program op-

tions or 2011.

1. REVIEW THIS GUIDE.Careully read this Decision Guide to under-

stand all o the Health Program options avail-able to you and your dependents.

2. USE THE HEALTH PLAN COST ESTIMATOR.Consider your health care needs by using the

Health Plan Cost Estimator (see page 26).

Tis online tool can assist you in determining the

right Health Program option(s) or your needs.

3. CHOOSE A TPA.I you enroll or health care coverage, you

will need to select a third-party administrator

(PA). (I you elect to contribute to an FSA but

waive your health care plan coverage, EBS-

RMSCO, Inc. will be the administrator o your

FSA.) urn to pages 24 and 25 or inormation

about the two PAs.

4. ENROLL FOR BENEFITS.If you are a new hire and are enrolling for

the rst time, you can enroll or benefts

online using HRMS within 30 days o your

hire date.

o enroll online, log on to HRMS at

www.rochester.edu/people. Select Sel-

Service, then Benefts, and then Benefts

Enrollment.

If you do not wish to enroll online:

Download the enrollment orm at

www.rochester.edu/benefts/health (go toQuick Links section and selectMost Request-

ed Forms), or

Contact the UR Benefts Oce or the enroll-

ment orm by:

- Calling 275-2084,

- Emailing [email protected], or

- Visiting the UR Benefts Oce in the

Medical Center, Room G-8011.

Submit a completed enrollment orm to:

University o RochesterBenefts Oce

260 Crittenden BoulevardBox 636Medical Center, G-8011Rochester, NY 14642

Your health care and dental coverage will

be eective the frst o the month ollowing

the date o the appointment or on the date o

the appointment i that occurs on the frst o

a month. Your FSA and HSA wi ll be eective

the date o appointment or date the orm is

completed, whichever is later.

How to Enroll:New Hires & Newly Eligible Faculty & StaHealth Care Plans, Dental Plans, FSA and HSA

If you do not enroll during the initialenrollment period, your Health Programcoverage will be defaulted to:

Waived (No coverage) for Health Care Plan

Newly Eligible: Waived (No coverage) for Dental Plan

Current Employees: Equivalent new 2011 Dental Plan at the same coverage level

Waived (No contributions) for Health Care and Dependent Care FSA

QuestionsCall ASK-URHR 275-8747 if you

have questions about enrolling

through HRMS.

Call the UR Benets Ofce at

275-2084 if you have questionsabout your benet plans.

ENROLLMENT FORMYour enrollment form must be

received by the Benets Ofce

within 30 days of when you

become benets-eligible. Enroll-

ment forms received after 30days may result in no coverage

until the next open enroll-

ment, or until you experience a

qualifying event. (Please refer

to Appendix A for when you can

make benet changes outside

of open enrollment.)

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Can I Enroll at Another Time?Annual open enrollment is the primary time you

can enroll or make changes to your health care

plan options and FSA contributions. Outside

o open enrollment, you can only enroll in or

change your health care plan options, dental

plan options and FSA contributions, or add/

remove eligible dependents to your health careplan and/or dental plan, i you have a qualiying

event, or a HIPAA special enrollment period.

Qualiying Event EnrollmentPeriod ChangesQualiying events include:

Change in legal marital status (marriage,

divorce, death o spouse, or annulment).

Change in number o tax dependents (birth,

adoption, placement or adoption, or death).

Change in your employment status (that

aects your beneft eligibility) or that o your

spouse or dependent.

Dependent satisying (or ceasing to satisy)

eligibility requirements or coverage (reach

the age at which coverage is no longer

available, etc.).

Change in cost o coverage, such as a

signifcant increase charged by your current

day care provider, or a change in your

provider. (Tis applies to the Dependent

Care FSA only.)

Any changes you make must be due to

and consistent with your qualiying event.

o satisy this ederally required consistency

rule, your qualifed change in status and

corresponding change in coverage must meet

both o the ollowing requirements:

Eect on eligibility. Except or the

Dependent Care FSA, the qualifed change

in status must aect eligibility or coverage

under the plan or under a plan sponsored

by the employer o your spouse or other

dependent. For this purpose, eligibility or

coverage is aected i you become eligible

(or ineligible) or coverage or i the qualifed

change in status results in an increase or

decrease in the number o your dependents

who may beneft rom coverage under the

plan.

For the Dependent Care FSA, thequalifed change in status must aect the

amount o dependent care expenses eligible

or reimbursement. For example, i your

child reaches age 13, his or her dependent

care expenses are no longer eligible or

reimbursement. (Please note, i your child

turns 13 during the year, you cannot stop or

change your contribution at that time.)

Corresponding election change. Te

election change must correspond with the

qualifed change in status. For example, i

your dependent loses eligibility or coverage

under the terms o the University Health

Care Plan, you may cancel health care

plan coverage only or that dependent.

Additionally, you may change or begin

contributions to your Health Care or

Dependent Care FSA i you have or adopt

a child or a child is placed with you or

adoption. Te Plan Administrator will

determine whether a requested change is due

to and consistent with a qualifed change in

status.

Note: When changing due to a qualiying

event, your FSA annual election cannot

be reduced below the amount o payroll

contributions already deducted or the

calendar year, and the change must be

consistent with the qualiying event.

Changing Your BeneftsHealth Care Plans, Dental Plans, FSA and HSA

HOW TO CHANGE YOURCOVERAGEIf you need to change your

coverage because of a qualifyingevent, you will need to completean enrollment/change form andreturn the completed form to the

UR Benets Ofce within 30 daysof the qualifying event (or within60 days for Medicaid or CHIPeligibility events). Coverage willbe effective on the date of eventor date the form is completed,whichever is later. Coveragechanges due to birth, adoption,or placement for adoption will beeffective on the date of the event.

QUALIFYING EVENTSFor more information, please

see Appendix A.

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NOTE:If you terminate coverage under theUniversity HSA-Eligible Plan as the resultof a qualifying event, any contributionsto your HSA via payroll deduction will

stop on the effective date (see If youterminate or change to an ineligible

status, on page 53).If you enroll for coverage under theUniversity HSA-Eligible Plan as theresult of a qualifying event, you maybe eligible to contribute to a LimitedPurpose Health Care FSA and anHSA; however, the HSA contributionmaximums (see page 33) are pro-ratedif you will be covered by the UniversityHSA-Eligible Plan for less than 12 monthswithin the 2011 calendar year.

Depending on the circumstances, you may

also be able to make changes throughout the

year or the ollowing reasons:

Court judgment, decree, or order to provide

coverage to a dependent.

COBRA events.

An eligible dependent drops his or her

coverage rom another employers planduring an open enrollment period which is

dierent than that o the Universitys.

Commencement or return rom FMLA leave.

Medicaid entitlement by you, your spouse or

dependent.

HIPAA Special EnrollmentPeriod ChangesYou can request (within 30 days) to enroll in the

plan or enroll your amily members i:

You or your amily members lose other group

health plan coverage,

You marry, or

You gain a new dependent because o birth,

adoption or placement or adoption.

You can request (within 60 days) to enroll in

the plan or enroll your amily members i you or

your amily member:

Lose Medicaid or Childrens Health Insurance

Program (CHIP) coverage because you are no

longer eligible, or

Become eligible or a states premium

assistance program under Medicaid or CHIP.

Unlike qualiying event changes, the

consistency rule described on page 6 o this

guide does not apply to your HIPAA special

enrollment periods. You can make changes in

your health care plan enrollment, but not your

Health Care FSA elections (unless a qualiying

event would allow Health Care FSA election

changes).

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At the University o Rochester, we believe that we all have the

power to improve our lives by investing in our health and

wellness. Becoming healthier not only reduces risk or disease and

helps us live longer, it also helps us live better.

The University is committed to promoting a culture of wellness. We have

already taken steps to offer opportunities to improve your health. We have

added Personal Health and Wellness Programs, tobacco dependence and other

lifestyle management programs through the Healthy Living Center, onsite

programs for stress management and weight management, indoor walking

routes, and more choices for faculty and staff to eat healthy.

We encourage you to make a commitment to yourself and your family to

become healthier. You can become a WellU champion and promote wellnesswithin your department. The University also encourages you to participate in

educational awareness campaigns throughout the year, including Go Red Day,

National Health Care Directives Day, National Trails Day, Eat Well Live Well and

National Start! Walking Day.

It is up to you to take the steps to better health, but you do not have to do

it alone. The University provides the support, tools and resources to help you

achieve your health goals.

Health & Wellness at theUniversity o Rochester

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Te University o Rochester oers a variety o programs and services that can help you maintain

a healthy liestyle or manage a health care condition. You can use these programs and services to:

Programs & Services to Help YouGet Healthy and Stay Healthy

PERSONAL SUPPORT FORYOU AND YOUR FAMILYCal l 1-877-598-3967 to speak

with a Wellness Coach about

the programs and services

listed here.

Preventive Care

Biometric Screening

PersonalHealthAssessment

Wellness Coach

Onsite Wellness Programs

Employee AssistanceProgram

Personal Health andWellness Programs

Nurse Line

Case Management

Healthy Living Center

Health ProgramDecision Guide

Health Plan Cost Estimator

Educational Sessionsand Workshops

Employee PharmacyDiscounts

Generic PrescriptionDrug Savings

Copay Waiver for Switchingto Generic PrescriptionDrugs

Mail Order forMaintenance PrescriptionDrugs

Discounts on PrescriptionDrugs for CertainDiagnoses

TPA Online Services

TPA Member Discounts

Personal Health Record

Use your health caredollars effectively andmake informed decisionsabout what care you need.

USE YOUR HEALTHCARE DOLLARSEFFECTIVELY

EDUCATEYOURSELF

Educate yourself aboutavailable health programsand become a condent,active consumer.

TAKE CHARGEOF YOUR HEALTH

Take charge of yourhealth and achievea healthier lifestyle.

THE WELLU MISSIONWellU, our award winning

wellness program, can

help improve the health

and wellness of Universityemployees by promoting

a work environment that

encourages healthy behaviors

and by providing the tools,

resources, and education

necessary to support

healthy living.

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Take charge o your health

and achieve a healthier liestyle.

Know Your Numbers: Get a Free Biometric ScreeningWellU sponsors biometric screenings or University aculty and sta, as well as eligible depen-

dents. Individuals will be required to show their University ID in order to receive services.

Screening appointments can be scheduled by contacting the School o Nursing, located at Helen

Wood Hall. o make your appointment, contact Christine Withers by calling 1-585-273-2360 or

emailing [email protected]. Specifc biometric screening services pro-

vided are:

Blood pressure

Heart rate

WeightBMI

otal cholesterol, HDL, triglycerides and glucose

Waist circumerence

You will receive your results immediately, along with educational materials and the opportu-

nity or brie health counseling, i appropriate. You will also receive an individual recording card

to document your screening results. Use your screening results to complete your Personal Health

Assessment and see what areas o your health you may need to improve. Share the results with

your doctor and talk to him or her about the next steps to take.

Take the Personal Health AssessmentTe University invites you to stay healthy and ft with the help o a ree oeringthe Personal

Health Assessment. Te Personal Health Assessment is a ast and easy online tool that helps you

gauge your current level o health and wellness through a series o questions about your liestyle.

Your answers help to identiy potential risks or health conditions and the areas where you can

make healthy improvements. Upon completion, you will receive a comprehensive, personalized,

and confdential Personal Health Assessment Report that oers suggestions on how to achieve

a healthier liestyle. You can share the results o your Personal Health Assessment with your

physician and communicate about your personal health goals. You also will have access to

Personal Wellness Programs and resources recommended just or you.

YOUR PRIVACY IS PROTECTEDThe Personal Health Assessment is administered by Carewise Health, an independent third-party

administrator. The personal health information you supply is completely condential, protected byfederal law, and cannot be divulged to anyone without your permission. The University will only

be provided with aggregate data for the University population as a whole, for the sole purpose of

performing program analysis.

COVERAGE FOR PREVENTIVE SERVICESYour plan covers the preventive services listed in our Preventive Services Guide at 100% as part of

preventive care that includes routine screenings and regular checkups, routine gynecological visits

and well-child exams. You wont have to pay out-of-pocket for these preventive visits unless you

get services not listed at the same time. But, these services are not preventive if you get them

as part of a visit to diagnose, monitor or treat an illness or injury. Then, copays, coinsurance and

deductibles apply.

GET REWARDED FOR TAKINGTHE PERSONAL HEALTHASSESSMENTTo help encourage you to make

an important investment in your

health, the University offers a

$100 incentive if you complete

the Personal Health Assessment.

You and your spouse/domestic

partner (if enrolled in a UniversityHealth Care Plan) may receive this

incentive. In order to be eligible,

you must make sure you enter

your biometric numbers in the

appropriate section of the PHA.

As an added incentive,

employees that complete the

PHA by March 31, 2011 will

receive an additional $25.

NOTE:

The monetary incentiveis considered taxable and will

be subject to normal wage with-

holding. Employees, as well as

spouses/domestic partners, are

eligible for the incentive only

once during the plan year that

runs from January 1 to December

31. SEIU members may take the

Personal Health Assessment,

but are not eligible to receive

the incentive.

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Work with a Wellness CoachWhen you have a health question and you are not sure what to do, you can ask a Wellness Coach.

Wellness Coaches can answer your questions, discuss your options, and empower you to make

inormed decisions. For more inormation, questions, or i you would like to speak to a health

coach, call 1-877-598-3967.

Participate in WellU ProgramsTrough WellU, the Universitys employee wellness program, you have the opportunity to

participate in valuable onsite programs including:

Fitness challengesFlu shots

Lunch and learns

Stress management workshops

Walking clubs

Weight Watchers

Weigh-Well

Yoga

Tese programs are available at numerous locations throughout the University and at o-site

locations, making it convenient or you to participate. For more inormation about WellU, visit

www.rochester.edu/well-u.

Use the Employee Assistance ProgramUse the Employee Assistance Program (EAP) to manage issues that aect your health and

well-being. Strong EAP provides confdential and immediate help with marital and relationship

issues, amily problems, drug and alcohol addictions, stress, fnancial and legal concerns, and

many other issues that can impact the ability o you and your amily members to cope eectively

at home or at work.

You can speak confdentially with experienced counselors who will help you understand your

options. When appropriate, a counselor will reer you to outside resources, such as a community

support group or a licensed behavioral health proessional. Best o all, Strong EAP services

are ree o charge. For more inormation about the EAP, visit www.urmc.rochester.edu/eap/

or call 1-585-475-0432.

Call the Nurse Line or Health Care AssistanceWhen you have a health question and youre not sure what to do, you can call the Nurse Line at

1-877-598-3967, 24 hours a day, seven days a week. Te Nurse Line provides direct access to registered,

specially trained nurses who can help answer your questions, discuss your options, answer beneft

and claims questions, and empower you to make inormed decisions. A nurse can also help

prepare you or your next doctors oce visit by providing you with meaningul questions to discuss

with your doctor. You can also call the Nurse Line or general health inormation, wellness and

prevention education, tips and advice on nutrition, exercise and weight loss, and chronic condition

support.

LEARN ABOUT THE UNIVERSITYS WELLNESS PROGRAMSCheck out the Universitysemployee wellness initiative,

WellU. For more information,go to www.rochester.edu/well-u,call 273-5240, or email well-u-

[email protected].

UNIVERSITY OF ROCHESTERSHEALTHY LIVING CENTERYou may be able to par ticipatein a coaching program throughin-person, one-on-one sessions,small groups, or over the phonefor help with: Quitting tobacco Diabetes prevention Controlling cholesterol

Managing stress

Carewise Health and the HealthyLiving Center will work togetherto help determine the programthat best ts your needs. Formore information, call1-877-598-3967.

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Take charge o your healthand achieve a healthier liestyle Continued

Take Advantage o a Personal Health Management ProgramI you need some guidance to make healthy changes or to help manage a chronic condition, the

University has partnered with Carewise Health to oer you Personal Wellness and Personal Health

Programs to help. Tese programs give you the tools and inormation you need to achieve more

optimal health and better manage chronic conditions. You will learn how to make appropriate

liestyle choices and changes and reduce symptoms related to chronic conditions. When you learn

how to improve and manage your health, you will fnd yoursel leading a happier, healthier lie.

Te Personal Health Programs can help you manage:Asthma

Chronic obstructive pulmonary disease (COPD)

Diabetes

Low back pain

Heart disease

And more

Note: Select individuals managing a chronic condition through the Personal Health Management

program may qualiy or reduced copays or their medications.

Te Personal Wellness Programs can help you manage:

Stress

Physical Inactivity

Weight

Nutrition

And more

Additionally, you can receive guidance on and learn how to:

Get the treatment and preventive care you need

Understand and ollow your doctors treatment plan

Better manage your ongoing conditions

Make changes to reach your personal health goals

Identiy and manage your risks or other conditions

You may qualiy or a $100 cash incentive i you successully complete a Personal Health and/

or Wellness Program. Tis means you can earn up to $200 i you participate in both programs.

o be eligible, you must be a regular ull-time or part-time aculty or sta member enrolled in a

University Health Care Plan. You will also be required to complete the biometric results section o

the PHA in order to receive the incentive. I this section is not flled in with your results, you can

not receive the incentive. Spouses/domestic partners who are enrolled in a University Health Care

Plan also qualiy or the incentive.

Note: SEIU members may participate in a Personal Wellness Program, but are not eligible or

the incentive or a Personal Health Program. Te cash incentive is considered taxable and will be

subject to normal wage withholding. Faculty and sta, as well as spouses/domestic partners, are

eligible or the incentive only once during the plan year that runs rom January 1 to December 31.

A WELLNESS COACH ORNURSE ADVOCATEWellness coaches and nurse advo-

cates are available for you when-

ever you need health information

or decision support. Coaches also

may reach out to you by phone

to introduce a health care plan

service and offer information and

support if you or a covered de-

pendent has an illness or ongoing

medical condition.

The Personal Health and Personal

Wellness programs are adminis-

tered by Carewise Health, an inde-

pendent third-party administrator.

The personal health information

you provide and any conversations

you have with a coach or nurse

are completely condential, pro-

tected by federal law, and cannot

be divulged to anyone without

your permission.

JUST FOR YOUParticipate in the Personal

Health and Wellness Programs.

You can call Carewise Health at

1-877-598-3967 to get star ted or

get your questions answered.

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Educate yoursel about available health programsand become a confdent, active consumer.

Use your health care dollars eectively and make

inormed decisions about what kind o care you need.

Review Your 2011 Health Program Decision GuideTis Decision Guide outlines your Health Program beneft options and highlights other

programs and services that are available to you. Review the Guide to fnd out how you can use

your beneft plans and programs to achieve better health and to help control health care costs.

Use the Health Plan Cost Estimator to Choose a Health Care PlanTe University Health Plan Cost Estimator (HPCE) is designed to give you a general idea o what

your health care costs may be under each o the University Health Care Plans. Te tool helps

you determine the coverage option that may provide the best value or your money, actoring

in payroll deductions and the cost o your anticipated health care needs or the year. For more

inormation about the HPCE, see page 26.

Attend Educational SessionsAttend the University Health Care Plan educational sessions sponsored by the UR Benefts Oce

to help you better understand and learn how to get the most out o your health care plan. Check

the UR Benefts website at www.rochester.edu/benefts/health or dates and times.

Take Advantage o Discounts at the URMC Employee PharmacyIf you are enrolled in the University High Deductible, Low Deductible, and Copay Plans ,

you will receive a 25% reduction in copays, or coinsurance or prescription diabetic supplies.

If you are enrolled in the University HSA-Eligible Plan, you will receive a discount o the

usual out-o-pocket cost o each medicine prior to reaching your deductible, and then the 25%

reduction in copays once your deductible has been met.

Under all of the University Health Care Plans, the URMC Employee Pharmacy can fll 90-day

supplies o maintenance drugs (normally, these are only flled by mail order) at a 25% reduction

in copays. Note: I you are enrolled in the University HSA-Eligible Plan, you will receive the

25% reduction in copays aer the plan deductible has been met. Beore reaching the deductible,

you will receive an applicable discount on your out-o-pocket prescription drug costs.

I you work in an o-campus location, you may be able to have your prescriptions delivered to

your workplace. Eective January 1, 2011, the URMC Employee Pharmacy will oer this ree

service to University employees working in the ollowing o-campus locations: River Campus,

Corporate Woods, Clinton Crossings, Brooks Landing, Eastman School o Music, and Red

Creek. Tese are initial o-campus locations with delivery service. Delivery services will be

expanded to other University o-campus locations at a later date. Also, you do not need to be

enrolled in one o the Universitys Health Care Plans to take advantage o this great service.

Payment will be limited to credit cards only and will be processed through an online system.

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Use your health care dollars eectivelyContinued

More inormation will be coming soon!

Switch to GenericsGeneric drugs are identical to brand name drugs in dosage, saety, strength, quality, and

intended use. Since generics use the same active ingredients and are shown to work the same way

in the body as their brand name counterparts, they have the same benefts and risks.

When you receive generic drugs instead o preerred brand or non-preerred brand drugs,

you will see signifcant savings in your prescription drug copays. In act, under some University

Health Care Plans, a generic drug will cost you less than hal the price o a preerred brand

drug. Additionally, i you choose a brand name drug when a generic equivalent exists, you

will be responsible or the copay plus the cost dierence between the brand name and genericequivalent, even i your doctor prescribes a brand name drug.

Take Advantage o the Generic Drug Copay Waiver ProgramsGeneric Drug Copay Waiver Programs, oered through your PA, provide a waiver or

prescription drug copays or up to six months i you switch to certain generic medications

rom selected brand name drugs. You can call your PA to fnd out i your current medications

are eligible or this beneft. Your PA also may contact you about any prescription drugs you

currently take that may be eligible.

Use the Mail Order ProgramFor prescriptions greater than a 30-day supply, you will need to use your PAs mail order

program, unless you use the URMC Employee Pharmacy. Trough the mail order program, you

can receive a 90-day supply o your prescription or two-and-a-hal times the retail price. Tat is

three times the supply or only two-and-a-hal times the price. (You can receive a 90-day supply

o your prescription at a 25% reduction in copays i you use the URMC Employee Pharmacy.

I you are enrolled in the University HSA-Eligible Plan, you will receive the 25% reduction in

copays aer the plan deductible has been met.) Te mail order program is convenient to use, and

is an easy way to save money on your prescription drugs. Please note, when using mail order or

prescriptions greater than a 30-day supply, you should inorm your physician to write a mail

order prescription or a 90-day supply.

Receive Prescription Drug Discounts or Certain DiagnosesI you have asthma, diabetes, hypertension, coronary heart disease or congestive heart ailure,

you have an opportunity to receive a $10 discount o o your prescription drugs, or a 25%

discount on coinsurance or prescription diabetic supplies to treat these conditions under the

University Health Care Plans. All you need to do is enroll and complete the Personal Health

Program or asthma, diabetes, hypertension, or heart disease. You can call Carewise Health at

1-877-598-3967 or more inormation. Note: I you are enrolled in the University HSA-Eligible

Plan, you must pay the ull cost o prescriptions until you meet the deductible. Once met, you

will then qualiy or the discounted prescription drug program.

NEW PHARMACY BENEFITS

MANAGER FOR 2011Effective April 1, 2011, Excellus

will be the Pharmacy Benets

Manager (PBM) for the

prescription drug coverage under

each of the Universitys four

health care plans, regardless

of the TPA (Aetna or Excellus)

you select. You will receive a

separate Pharmacy Benets

card prior to April 1. If you are

enrolled with Aetna as your

TPA, your health care coverage

will not be impacted, and you

will be transitioned to the new

PBM with no gap in care. Details

about the transition to the new

PBM and how it may affect

things like FSA reimbursement,

maintenance medications and

mail order, will be available

shortly, and will be sent to you

in a separate communication as

soon as possible.

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Access Online Services rom the TPAsAetna and Excellus both provide an array o online services, programs, and member discounts.

Here are a ew o the available benefts under each third-party administrator (PA).

AETNA WWW.AETNA.COM

Research over 6,000 health topics using Healthwise Knowledgebase.

Get inormation on health and wellness, diseases and conditions and much more through Aetna

InteliHealth.

Download a Health History Report that will list your claims history.

Call Aetnas Inormed Health Line or access to registered nurses 24 hours a day, 7 days a week.

Nurses provide inormation about health issues, medical procedures and treatment options, andhelp you communicate more eectively with your doctor.

Use Aetna Pharmacy to fnd a pharmacy, look up your claim status, learn about a drug and drug

saety, order prescriptions, and more.

Locate doctors and other health care proessionals in your area who participate in your plan

through DocFind.

Use the Cost o Care calculator to estimate the cost o your next medical visit.

Print temporary ID cards.

EXCELLUS WWW.EXCELLUSBCBS.COM

Research over 6,000 health topics using Healthwise Knowledgebase.

Learn to live a healthier liestyle with Health Improvement Programs to help you

change your habits.

Use the Personal Health Record to store your health inormation online or easy access.

Use the Healthcare Advisor to estimate treatment costs, evaluate treatment options, compare

drugs, and more.

Have un and learn something new with weekly Health Quizzes.

Locate doctors and other health care proessionals in your area who participate in your plan

through Find a Doctor.

Print temporary ID cards.

Use Member Discounts rom the TPAsAetna eatures discounts on health and wellness programs and products.

Excellus oers discounts on health and wellness, amily care, fnancial well-being, and travel

services through Blue365.

Use your Personal Health Record to Make Smart Health Care DecisionsI you are enrolled in a University Health Care Plan through Aetna, you can download a Health

History Report rom Aetna Navigator. Te Health History Report will include details regard-

ing any claims that you and your covered dependents have incurred under your plan and can be

exported to an Excel spreadsheet or sorting and printing.

I you are enrolled in a University Health Care Plan through Excellus, you and your covered

dependents each have access to your own online Personal Health Record. Tis confdential

resource will store any claims inormation you enter and provide you with convenient access to a

range o health data. You can store your amilys health inormation online or easy access. And,

you can print a report to take to your next doctors appointment or when you travel.

Use your health care dollars eectivelyContinued

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The plans available through the University Health Program can help

you be a better health care consumer. The key is to use these plans

to change your behaviorby becoming more involved in your health,

taking more responsibility or making smart health care decisions, making

healthy liestyle choices, and using your benefts wisely.

The choices you make todaywhether selecting health care coverage for you

and your family for the upcoming year, or deciding when and how to use healthcare services on a day-to-day basishave a direct impact on the health care costs

you and the University pay tomorrow.

Health ProgramHealth Care Plans, Dental Plans, FSA and HSA

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Te University o Rochester oers our health

care plans that ocus on eatures that support the

Universitys goals o ostering a culture o well-

ness, reducing health care expenses, and having

aculty and sta take an active role in managing

personal health. ake some time to understand

the our dierent plan options available to you, so

you select the plan that is cost-eective and appro-priate or your needsand those o your amily.

Your Health Care Plan OptionsYou can choose rom the ollowing options:

University High Deductible Plan

University Low Deductible Plan

University HSA-Eligible Plan

University Copay Plan

You also may choose to waive health

care coverage.

How the Health Care PlansAre AlikeAll four plans:

Are PPOsPreerred Provider Organiza-

tions. By enrolling in a PPO, you get access

to a nationwide network o doctors, hospitals

and treatment acilities that have agreed to

charge lower, negotiated rates or care. You

can choose to receive care in or outside o the

PAs network.

Cover the same types o services and supplies.

Have a broad choice o networks o doctors,

hospitals and service providers oered by

each o two dierent PAs.

A Primary Care Physician (PCP) is not

required, but it is recommended that you

select one, and reerrals are not required or

specialists or other necessary health care

services.

Emphasize preventive care with 100%

in-network coverage to encourage regular

check-ups and wellness services. o learn

more about preventive care, see Manage Your

Health with Well Visits and Screeningson

page 13 and the 2011 Preventive Care Services

document online at www.rochester.edu/

benefts/health. Note: All care is subject to

meeting the clinical policies established by the

PA who administers your University Health

Care Plan.Require you to pay more i you choose a brand

name drug when a generic equivalent exists.*

You will be responsible or the copay plus

the cost dierence between the brand name

and generic equivalent, even i your doctor

prescribes a brand name drug.

Provide similar discounts or a 90-day supply

o prescription drugs through the Employee

Pharmacy and mail order program.

Require you to purchase specialty drugs rom

selected PA specialty vendors.

Will decrease your copays or the out-o-

pocket cost or prescription drugs that are

flled at the Employee Pharmacy.

How the Health Care Plans DierTe health care plan options vary when it

comes to what you pay or:

Your monthly employee contributions or

the plan option you choose, and

Your deductibles, coinsurance, copays and out-

o-pocket maximums when you receive care.

Additionally, the options oer dierent pre-

tax accountsthe University HSA-Eligible Plan

includes the option to contribute to a Health

Savings Account (HSA) and a Limited Purpose

Health Care Flexible Spending Account (FSA),

while the other three plans allow you to con-

tribute to a Health Care FSA.

*Tis provision will not apply if a generic drug is considered to beineective, not available through a retail pharmacy or consideredto cause dangerous side eects.

Your Health Care Plan Choices or 2011

Choosing a PAWhen you elect a health care

plan, you get to choose which

third-party administrator (TPA)

will administer your plan

either Aetna or Excellus BlueCrossBlueShield.

You may want to consider thenetwork availability when choos-ing your TPA. The TPAs haveeach contracted with in-networkproviders to offer health careservices at negotiated, discountedfees. To nd out if your physician,or other providers and facilitiesare members of either the Aetnaor Excellus network, visit theirnetwork directories online at:

AETNAwww.aetna.comSelect Find a Doctor. Completethe information. Note: Underthe Select a Plan drop-downmenu, choose the AetnaChoice POS II (Open Access)option that appears underthe Aetna Open Access Plansblue bar.

EXCELLUSwww.excellusbcbs.comSelect Find a Doctor(located

at the bottom of the page),then click on NationwideProvider Search-BlueCard.

TO LEARN MORE ABOUTTHE DIFFERENCES BETWEENEACH TPA, TURN TO PAGES24 AND 25.

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I you enroll in the University HSA-Eligible

Plan, but do not elect to have an HSA, you

can elect to contribute to a Health Care FSA.

You can only contribute to a Limited Purpose

Health Care FSA i you elect to contribute to an

HSA.

Deductibles/Out-o-Pocket MaximumsTe University High Deductible, Low

Deductible, and Copay (or out-o-network care

only) Plans include embedded single and amily

deductibles and out-o-pocket maximums.

I you are enrolled in any o these plans or

Employee and Child(ren), Employee and

Spouse/Domestic Partner or Family coverage,

once one amily member satisfes the single

deductible, the plan will begin to reimburse

eligible health care expenses or that amily

member. Te same rule applies to the out-o-

pocket maximum. Any combination o eligible

expenses or covered amily members can be

used to meet the amily annual deductible/out-

o-pocket maximum at which point all amily

members will have met the deductible/out-o-

pocket maximum requirements.

Te University HSA-Eligible Plan requires

that the amily deductible be met or any

coverage level other than Single, beore plan

payments will begin.

Similarly, the University HSA-Eligible Plan

requires that the out-o-pocket maximum be

met or any coverage level other than Single,

beore the plan will cover expenses at 100%.

How the Plans WorkWhen you visit a network provider, the plans pay

more o your expenses. Plus, under all our plans,

you do not need to select a primary care physician

or secure reerrals to see a specialist or obtain

other medically necessary health care services.

Each time you receive care, you select a

provider o your choice. Te provider can be in-network or out-o-network based on the PAs

network. I you select an in-network provider,

the money you pay out-o-pocket is less. Please

reer to page 28 or more inormation.

What the Plans Cost YouYou pay or health care coverage with pre-tax

dollars through automatic payroll deductions

(please reer to the Special Note regarding

Domestic Partner and Same-Sex Legal Spouse

Coverage on page 4). Te amount o your

payroll deductions depends on whether you

are paid bi-weekly, semi-monthly or monthly.

o view the costs or each plan, visit

www.rochester.edu/benefts/health.

Your employee contributions depend on

whether you are ull-time or part-time and

vary by salary and coverage level. I your salary

changes mid-year, you will not move to a new

salary band (your employee contributions will

not change). I you switch rom ull-time to

part-time or vice versa, you will move to a new

salary band (your contributions will change).

For University o Rochester retirees, health

care and dental premiums vary depending on

the post-retirement level o the aculty or sta

member. o view costs or each plan, visit

www.rochester.edu/benefts. Select Employment

Changes, then select Retirement.

Note: For University o Rochester retirees, the

Universitys share, i any, o the health care and

dental premiums varies depending on the post-

retirement level o the aculty or sta member.

EXAMPLE OF EMBEDDEDFAMILY DEDUCTIBLEFor example, if you are a family

of four (yourself, your spouse/

domestic partner, and two

children), and you are enrolled

in the University Low Deductible

Plan, the deductible would workas follows:

If you receive in-networkcare and satisfy the singledeductible of $200, the planwill begin to pay coinsurancefor you.If your spouse/domesticpartner receives health careservices and satises hisor her single deductible of$200, the plan will begin topay coinsurance for him orher. So far, you have applied

$400 to the $500 familydeductible, because the single

deductibles count towards thefamily deductible.This means that when thenext person in your familyreceives health care services,he or she only has to pay $100before the plan begins to paycoinsurance, because yourfamily will have met the $500deductible.Once the $500 familydeductible is satised, allmembers will be subject tocoinsurance with no furtherdeductible requirements,assuming care is received

in-network.

The out-of-pocket maximums

follow the same pattern as the

deductibles.

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Tese charts provide a high level overview

o the main eatures o each plan.

University High Deductible PlanI you choose the University High

Deductible Plan, you will be subject to

a higher deductible and out-o-pocket

maximum than the University Low

Deductible Plan and the University Copay

Plan; however, you will have lower payroll

deductions or coverage. As a member othis plan, you may also contribute to a

Flexible Spending Account (FSA).

University Low Deductible PlanI you elect the University Low Deductible

Plan, you will have a lower deductible

and out-o-pocket maximum than the

University High Deductible Plan and the

University HSA-Eligible Plan; however,

you will have higher payroll deductions

or coverage. As a member o this plan,you may also contribute to a Flexible

Spending Account (FSA).

University Health Care PlansAn Overview

University High Deductible Plan

Preventive Care1 not covered out-of-network 100%, No deductible

Deductible2

Rx not includedSingle Family6

In-Network $500 $1,250

Out-of-Network $1,000 $2,500

Coinsurance (Plan pays)

In-Network 80%

Out-of-Network 60%

Out-o-Pocket Maximum3 Single Family6

In-Network $2,000 $5,000


Full-time Faculty and Staff Earning Less than $44,100

In-Network $1,500 $3,750


Lietime Maximum Unlimited

Prescription Drugs4Not subject to d eductible or out-of-pocket maximum/Not covered out-of-network

Retail (up to 30-days supply) $10/$25/$40

Mail Order (90-days supply)5 2.5 times retail ($25/$62.50/$100)

Health Care FSA $6,500 limit

1 See page 13 for more information. 2 Deductible cross applies in- and out-of-network. 3 Eligible expenses crossapply in- and out-of-network.4 If you are prescribed a brand name drug when a generic equivalent exists, youwill be responsible for the copay plus the cost difference between the brand name and generic equivalent.Specialty drugs must be lled at your TPAs designated pharmacy. Specialty drugs do not qualify for the pricingdiscount available through mail order prescriptions. 5 90-day supplies of maintenance drugs lled at URMCEmployee Pharmacy are eligible for a 25% reduction in copays. 6 For Family coverage, individual deductiblesand out-of-pocket maximums apply to any individuals claims. However, when the sum of any combination ofindividual deductibles or out-of-pocket maximums reaches the family level, the family deductible or out-of-pocket maximum will be met for all family members.

University Low Deductible Plan


Deductible2

Rx not includedSingle Family6

In-Network $200 $500

Out-of-Network $400 $1,000


In-Network 90%

Out-of-Network 70%

Out-o-Pocket Maximum3 Single Family6

In-Network $1,500 $3,750


Full-time Faculty and Staff Earning Less than $44,100

In-Network $1,000 $2,500



Prescription Drugs4Not subject to deductible or out-of-pocket maximum/Not covered out-of-network


Mail Order (90-days supply)5 2.5 times retail ($25/$50/$87.50)


1 See page 13 for more information. 2 Deductible cross applies in- and out-of-network. 3 Eligible expenses crossapply in- and out-of-network.4 If you are prescribed a brand name drug when a generic equivalent exists, youwill be responsible for the copay plus the cost difference between the brand name and generic equivalent.Specialty drugs must be lled at your TPAs designated pharmacy. Specialty drugs do not qualify for the pricingdiscount available through mail order prescriptions. 5 90-day supplies of maintenance drugs lled at URMCEmployee Pharmacy are eligible for a 25% reduction in copays. 6 For Family coverage, individual deductiblesand out-of-pocket maximums apply to any individuals claims. However, when the sum of any combination ofindividual deductibles or out-of-pocket maximums reaches the family level, the family deductible or out-of-pocket maximum will be met for all family members.

REMINDEREffective April 1, 2011, Excellus will be

the Pharmacy Benets Manager (PBM)

for all prescription drug plans, and

the Excellus formulary will be used todetermine the level of copay(s).

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University HSA-Eligible PlanTe University HSA-Eligible Plan diers

rom the other three plan options in that

it has:

Te highest deductible levels,

Te option to contribute to a Health

Savings Account (HSA), a tax-ree

savings account or health care, andTe lowest payroll deductions.

See A Closer Look at the HSA on page

33 or how this plan works.

University Copay PlanI you select the University Copay Plan, you

will have the highest payroll deductions,

but you will generally pay the lowest cost

or services when you receive care. As

a member o this plan, you may also

contribute to a Flexible Spending Account

(FSA).

For a more detailed look at the our

plans, turn to pages 22 and 23.

University HSA-Eligible Plan


Deductible2

Rx includedSingle Family7

In-Network $1,200 $2,400



In-Network 80%

Out-of-Network 80%

Out-o-Pocket Maximum3

Rx included/Includes deductibleSingle Family7

In-Network $2,400 $4,800



Prescription Drugs4Subject to deductible and out-of-pocket maximum/Not covered out-of-network


Mail Order (90-days supply)5 2.5 times retail ($25/$75/$125)

Health Savings Account6 Single Family

$3,050 $6,150

Limited Purpose Health Care FSA $6,500 limit

1 See page 13 for more information. 2 Deductible cross applies in- and out-of-network. Family deductible doesnot contain embedded individual deductible. 3 Eligible expenses cross apply in- and out-of-network. 4 If you areprescribed a brand name drug when a generic equivalent exists, you will be responsible for the copay plus the costdifference between the brand name and generic equivalent. Specialty drugs must be lled at your TPAs designatedpharmacy. Specialty drugs do not qualify for the pricing discount available through mail order prescription. 5 90-daysupplies of maintenance drugs lled at URMC Employee Pharmacy are eligible for a 25% reduction in copays. 6 Themaximum HSA contribution amount is pro-rated if you are not covered by the plan for the full year. 7 Plan requiresthat the family deductible be met for any coverage level other than Single, before plan payments will begin, andsimilarly, out-of-pocket maximum must be met before the plan covers expenses at 100%.

University Copay Plan

Preventive Care1 not covered out-of-network 100%, No copay

DeductibleRx not included

Single Family

In-Network None

Out-of-Network $400 $1,000


In-Network 100%

Out-of-Network 70%

Out-o-Pocket Maximum2

Rx not included/Includes deductibleSingle Family

In-Network None


Copay PCP Specialist

In-Network $20 $30

$250 inpatient admission copay

Out-of-Network Subject to deductible and coinsurance


Prescription Drugs3Not subject to deductible or out-of-pocket maximum/Not covered out-of-network


Mail Order (90-days supply)4 2.5 times retail ($25/$50/$87.50)


1 See page 13 for more information. 2 Eligible expenses cross apply in- and out-of-network. 3 If you areprescribed a brand name drug when a generic equivalent exists, you will be responsible for the copayplus the cost difference between the brand name and generic equivalent. Specialty drugs must be lled atyour TPAs designated pharmacy. Specialty drugs do not qualify for the pricing discount available throughmail order prescription. 4 90-day supplies of maintenance drugs lled at URMC Employee Pharmacy also areeligible for a 25% reduction in copays after the plan deductible has been met. Before reaching the deductible, adiscount on out-of-pocket prescription drug costs applies.

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University High Deductible Plan University Low Deductible Plan

In-Network Out-of-Network In-Network Out-of-Network

COVERAGE

Deductible (single/family) $500/$1,250 $1,000/$2,500 $200/$500 $400/$1,000

Coinsurance Plan pays 80% Plan pays 60% Plan pays 90% Plan pays 70%

Out-of-Pocket Maximum1(single/family)

$2,000/$5,000$1,500/$3,7502

$4,000/$10,000$1,500/$3,750$1,000/$2,5002

$3,000/$7,500

Lifetime Maximum Unlimited Unlimited

FSA/HSA FSA maximum: $6,500 FSA maximum: $6,500

PREVENTIVE CARE SERVICESNOTE: CHECK WITH YOUR TPA BEFORE SEEKING PREVENTIVE CARE TO ENSURE THE SERVICE IS CONSIDERED PREVENTIVE.

Physicals, Well-Baby/Well-Child Exams, Etc.

In-network: Plan pays 100%, no deductible or copay Out-of-network: Not covered

PRESCRIPTION DRUGS3 GENERIC/PREFERRED BRAND/NONPREFERRED BRANDNOTE: RECEIVE A URMC EMPLOYEE PHARMACY DISCOUNT. SEE PAGE 15.

Retail (up to 30-days supply) $10/$25/$40 copay Not covered $10/$20/$35 copay Not covered

Mail Order (up to 90-days supply)5 2.5 times 30-day retail copay N/A 2.5 times 30-day retail copay N/A

Prescription Diabetic Supplies Plan pays 80% (nodeductible) Not covered Plan pays 90% (no deductible) Not covered

OTHER SERVICES

Ofce Visit/Ofce Care

Plan pays 80% aterdeductible

Plan pays 60% (up to R&C)ater deductible



Specialist Visit/Specialist Care

Inpatient Admission (facility)

Diagnostic X-ray

Lab & Pathology;Chemotherapy/Radiation Therapy

Auditory Exam (limit 1 per year)

Physical, Speech, andOccupational Therapy(combined limit 45 visits per year)

Inpatient Physician and SurgeryServices

Outpatient (facility)

Emergency Room Care5

Ambulance

Maternity: Hospital

Maternity: Prenataland Postnatal Care

Mental Health Inpatient

Mental Health Outpatient

Substance Abuse Detoxication

Substance Abuse Outpatient

Skilled Nursing Facility Care(limit of 120 days per year)

Home Health Care

Hospice Care

Durable Medical Equipment (DME)

Allergy Tests and Injections

Chiropractic Care

Acupuncture (limit 10 per year)

Vision Exam (limit 1 per year)

Diabetic Supplies and Equipment6(non-pharmacy purchase)

Diabetic Supplies and Equipment6(pharmacy purchase)

Vision Lenses & Frames (limit 1per year)

$60 maximum allowance once every year (20%-50% discounts on lenses and frames at participating optical providers)

1 Includes deductible. 2 Full-time earning less than $44,100.3 If you are prescribed a brand name drug when a generic equivalent exists, you will be responsible for the copay plus the cost difference between the brand name and genericequivalent. Specialty drugs must be lled at your TPAs designated pharmacy. Specialty drugs do not qualify for the pricing discount available through mail order prescription (see page 15). 4 90-day supplies of maintenance drugs lled at theURMC Employee Pharmacy are eligible for a 25% reduction in copays. 5 Covered at in-network levels. 6 Covered under Durable Medical Equipment (DME). For a list of qualied diabetic supplies, see Appendix B.

Comparing the University Health Care Plans

Plan pays 80% Plan pays 90%

Plan pays 80% ater deductible Plan pays 90% ater deductible

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University HSA-Eligible Plan University Copay Plan

In-Network Out-of-Network In-Network Out-of-Network

COVERAGE

Deductible (single/family) $1,200/$2,400 $1,200/$2,400 None $400/$1,000

Coinsurance Plan Pays 80% Plan pays 80% Plan pays 100% Plan pays 70%

Out-of-Pocket Maximum1(single/family)

$2,400/$4,800 $2,400/$4,800 None $3,000/$7,500

Lifetime Maximum Unlimited Unlimited

FSA/HSAHSA maximum: single $3,050/family $6,150; Health Care FSA

and Limited FSA maximum: $6,5007FSA maximum: $6,500

PREVENTIVE CARE SERVICESNOTE: CHECK WITH YOUR TPA BEFORE SEEKING PREVENTIVE CARE TO ENSURE THE SERVICE IS CONSIDERED PREVENTIVE.

Physicals, Well-Baby/Well-Child Exams, Etc.

In-network: Plan pays 100%, no deductible or copay Out-of-network: Not covered

PRESCRIPTION DRUGS2 GENERIC/PREFERRED BRAND/NONPREFERRED BRANDNOTE: RECEIVE A URMC EMPLOYEE PHARMACY DISCOUNT. SEE PAGE 15.

Retail (up to 30-days supply) $10/$30/$50 copay after deductible Not covered $10/$20/$35 copay4 Not covered

Mail Order (up to-90 days supply)42.5 times retail 30-daycopay after deductible

N/A 2.5 times 30-day retail copay4 N/A

Prescription Diabetic Supplies Plan pays 80% afterdeductible7 Not covered Plan pays 80%4

($20 copay maximum)Not covered

OTHER SERVICESOfce Visit/Ofce Care



$20 copay


Specialist Visit/Specialist Care $30 copay

Inpatient Admission (facility) $250 copay

Diagnostic X-ray $30 copay

Lab & Pathology; Chemotherapy/Radiation Therapy

Plan pays 100%

Auditory Exam (limit 1 per year) $30 copay

Physical, Speech, andOccupational Therapy(combined limit 45 visits per year)

$30 copay

Inpatient Physician and SurgeryServices

Plan pays 100%

Outpatient (facility) Plan pays 100%

Emergency Room Care5 $50 copay

Ambulance $30 copay

Maternity: Hospital $250 copay

Maternity: Prenataland Postnatal Care

$20 one-time copay at initial visit

Mental Health Inpatient $250 copay

Mental Health Outpatient $20 copay

Substance Abuse Detoxication $250 copay

Substance Abuse Outpatient $20 copay

Skilled Nursing Facility Care(limit of 120 days per year)

$250 copay

Home Health Care Plan pays 100%

Hospice Care Plan pays 100%Durable Medical Equipment (DME) Plan pays 80%

Allergy Tests and Injections $20 PCP copay; $30 specialist copay

Chiropractic Care $30 copay

Acupuncture (limit 10 per year) $30 copay

Vision Exam (limit 1 per year) $30 copay

Diabetic Supplies and Equipment6(non-pharmacy purchase)

Plan pays 80%

Diabetic Supplies and Equipment6(pharmacy purchase)

Vision Lenses & Frames(limit 1 per year)

$60 maximum allowance once every year (20%-50% discounts on lenses and frames at participating optical providers)

1 Includes deductible.2 If you are prescribed a brand name drug when a generic equivalent exists, you will be responsible for the copay plus the cost difference between the brand name and generic equivalent. Specialty drugs must be lledat your TPAs designated pharmacy. Specialty drugs do not qualify for the pricing discount available through mail order prescription (see page 15). 3 Prescription drugs do not count toward the deductible, and out-of-pocket maximum. 4 90-daysupplies of maintenance drugs lled at the URMC Employee Pharmacy are eligible for a 25% reduction in copays. Those enrolled in the University HSA-Eligible Plan receive the 25% reduction in copays after the plan deductible has been met.

Before reaching the deductible, a discount on out-of-pocket prescription drug costs applies. 5 Covered at in-network levels. 6 Covered under Durable Medical Equipment (DME). For a list of qualied diabetic supplies, see Appendix B. 7 If you electthe University HSA-Eligible Plan, you have the option to contribute to an HSA and Limited Purpose FSA. You cannot elect a Limited Purpose FSA if you do not contribute to an HSA. If you enroll in this plan, but do not elect to contribute to an HSA,you may contribute to a Health Care FSA.

Comparing the University Health Care Plans

Plan pays 80% ater deductiblePlan pays 80%

Plan pays 80% ($20 copay maximum)

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Comparing the TPAsI you enroll or coverage under the University Health Care Plans, you will need to select a third-party administrator (PA). Listed below is inormationabout the services oered by each PA to help you choose which is right or you.

Aetna Excellus BCBS

Provider Networks Each TPA maintains their own network of providers and reimburses them at d ifferent levels. You may want to conrm if the providers you and your family use areparticipating providers.

To locate a network provider To locate an Aetna network provider or facility, refer to the Aetna NationalProvider Directory, which can be viewed at www.aetna.com (go to Shortcutsand

select Find a Doctor).

Select Aetna Choice POS II under the Aetna Open Access Plans

(second plan listed).

To locate an Excellus BCBS provider, refer to Find a Doctor, Nationwide

BlueCard Provider Network, at www.excellusbcbs.com.

Preventive Services Coverage Preventive services are covered at 100% if you use an in-network provider. To ensure 100% coverage, you should conrm that the service you are seeking ispreventive, as determined by your third-party administrator (TPA), and that your doctor will bill your TPA appropriately. All care is subject to meeting the clinical

policies established by the TPA who administers your University Health Care Plan.

Prescription DrugsPlease note: Effective April 1, 2011, Excellus will administer all prescription drugs, and the Excellus formulary will be used to determine the level of copay(s).While the administrator may be different for your prescription drug plan, the plan design will remain the same.

Drug formularies/copays Each TPA maintains a separate formulary, or preferred drug list. This list is used to determine the level of copay(s) you will be responsible for depending on the

medication prescribed. Please refer to the websites listed below to identify the copay(s) that applies to your and/or your dependents medications.

www.aetna.com (up to March 31, 2011) www.excellusbcbs.com

Mail order Aetna Rx Home Delivery provides mail order services for maintenance medications.

When rst utilizing this service, you must obtain a new prescription from your

doctor. Thereafter, you may go online to order rells or check your order status.

www.aetnarxhomedelivery.com

PrimeMail provides mail order services for maintenance medications. When rst

utilizing this service, you must obtain a new prescription from your doctor for

your rst ll. Thereafter, you may go online to order rells or check your order

status.

www.myprimemail.com

Pre-Authorizations If you change your TPA, you will need to update existing pre-authorizations with the new TPA.

Health Savings Account (HSA) When you elect a TPA for the University HSA-Eligible Plan, that TPA will administer your HSA.

Investing Your funds are held by JP Morgan Chase Bank, N.A. in an interest-bearing

account. Current account interest rates are available online at the website listed

below. There is no minimum balance required and the monthly administrative

fee is $2.25.

Alternate investment options are available through JP Morgan

Institutional Investments once your account reaches $2,000.

Trading fees may apply and are available in the investment prospectus.

Log on to your Aetna NavigatorTM website at www.aetna.com.

Your funds are held by HSA Bank in an interest-bearing account. Current account

interest rates are available online at the website listed below. There is no

minimum balance required and the monthly administrative fee is $2.25.

Alternate investment options are available through a self-directed investment

option with TD Ameritrade. No minimum account balance is required. Trading

fees may apply and are available in the investment prospectus.

In addition to TD Ameritrade, HSA Bank offers Devenir Investment Advisors

as an option. There is a $24 annual fee charged by the Mutual Fund Selection

vendor; however, no trading fees apply.

www.hsabank.com

Automatic payment/debit You will automatical ly receive a debit card that you can use to pay for out-of-

pocket expenses. Until March 31, 2011, you may also elect Auto-Debit and have

eligible out-of-pocket expenses automatically deducted from your HSA at no

extra fee.

As a result of health care reform, over-the-counter medications will not be

considered qualied expenses under the HSA in 2011, unless you have a

prescription from your doctor. If you do not have a prescription and you pay

for over-the-counter medications with HSA funds, it is your responsibility to

properly report the expenses on your federal tax return.

With the new Prescription Benets Manager, Excellus, as of April 1, 2011, prescription

drug expenses will no longer be automatically deducted from your HSA.

Fees will apply to ATM withdrawals and other services.

You will automatically receive a debit card that you can use to pay for out-of-

pocket expenses.

As a result of health care reform, over-the-counter medications will not be

considered qualied expenses under the HSA in 2011, unless you have aprescription from your doctor. If you do not have a prescription and you pay

for over-the-counter medications with HSA funds, it is your responsibility to

properly report the expenses on your federal tax return.

Fees will apply to ATM withdrawals and other services.

Withdrawing funds manually You can withdraw your funds by HSA checks, for a fee.

Checkbook fee is $10.65 plus tax for 25 checks. Deposit slips are provided in the

Welcome Package and online. Fee comes out of your HSA account.

You can withdraw your funds by check or, for a fee, by written

withdrawal forms.

Checkbook fee is $7.95 plus tax for 50 checks and 10 deposit tickets.

Fee comes out of your HSA account.

Account access You can manage your Aetna HSA account activity online anytime, day or night .

Log on to Aetna NavigatorTM at www.aetna.com to view your HSA account

balance, account summary and account ac tivity.

You can manage your HSA account activity online anytime, day or night.

Log on to http://hsabank.com to view your HSA account balance, account

summary and account activity.

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Aetna Excellus BCBS

Flexible Spending Accounts(FSAs)

When you elect a TPA for your University Health Care Plan, that TPA will administer your FSAs, if elected. EBS-RMSCO is the FSA Administrator for Excellus BCBS.

Note: If you waive health care coverage, EBS-RMSCO will administer your FSAs.

Automatic payment/debit Health Care: Out-of-pocket expenses will be automatically reimbursed fromyour FSA if a University Health Care Plan is your primary plan. Until March 31, 2011,

you can also use the Auto-Debit feature at participating pharmacies (including mail

order through Aetna Rx Home Delivery) to have charges automatically deducted

from your FSA. Note: The Limited Purpose Health Care FSA does not include

automatic payments and debits. You will need to le your expenses manually.

You may opt out of automatic reimbursement. Claims not paid through

automatic reimbursement will need to be led manually.

Health Care and Dental: Out-of-pocket health care and dental expenses willbe automatically reimbursed from your FSA through Automatic Claims Transfer

(ACT) including mail order through PrimeMail, if a University Plan is your

primary plan. Note: The Limited Purpose Health Care FSA does not include

automatic payments and debits. You will need to le your expenses manually.

You may opt out of ACT. Claims not paid through ACT will need to be led

manually.

If the University Health Care Plan is not the primary plan for your dependents,

you will need to le claims manually.

If the University Health Care Plan is not t he primary plan for your dependents,

you will need to le claims manually.

Prescription Drugs: With the new Prescription Benets Manager, Excellus, asof April 1, 2011, prescription drug expenses will no longer be automatically

reimbursed from your FSA.

Over-the-Counter Medications: As a result of health care reform, you will not be able to pay for over-the-counter medications using FSA dollars, unless you havea prescription from your doctor. You will not be able to use the Auto-Debit feature for any over-the-counter medication purchases. If you have a prescription, you

must le a manual claim for reimbursement.

Dental and Dependent Care: You will need to le your out-of-pocketexpenses manually.

Dependent Care: You will need to le your out-of-pocket expenses manually.

Submitting claims manually Reimbursement forms are available from the UR Benets Ofce or can be

printed from www.rochester.edu/benets/fsa.

Claims can be faxed directly to 1-888-AETFLEX (238-3539).

Claims are paid on a weekly basis and can be reimbursed to you by check or

direct deposit.

Reimbursement forms are available from the UR Benets Ofce or can be

printed from www.rochester.edu/benets/fsa. Claims can also be submitted

online at www.myebsaccount.com. After submitting claims online, all receipts

and supporting documentation must be faxed to EBS-RMSCO, Inc. at

1-877-256-7228.

Claims are paid on a weekly basis and can be reimbursed to you by check

or direct deposit.

Minimum reimbursement A $25 minimum must be claimed before reimbursement is made, except for

the Auto-Debit feature for prescription drugs.

A $30 minimum must be claimed before reimbursement is made.

Note: Over-the-counter medications cannot be paid for using FSA dollars unless a prescription is provided by your doctor. The Auto-Debit feature cannot be used forover-the-counter medications.

Account access To check FSA balances, view payment information including amounts awaiting

payment, next payment date and minimum payment amounts, log on to Aetna

NavigatorTM at www.aetna.com. Or, call Member Services at 1-888-238-6226.

You can also browse a list of eligible FSA expenses on Aetna Navigator.

To submit claims, check FSA balances, view payment information including

pending claims and reimbursements paid, log on to www.myebsaccount.com.

Or, call customer service at 1-585-232-2632 or 1-800-327-7130.

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o help you select the plan that may best meet

your health care needs and to ensure you are

taking advantage o tax-savings opportunities,

the University o Rochester oers the

ollowing online tool.

The HPCE is an Online Health CarePlan Decision Tool that Helps:

Give you a general idea o what your

health care costs may be under each o the

University Health Care Plans.

You determine the coverage option that may

provide the best value or your money,

actoring in payroll deductions and the cost o

your anticipated health care needs or the year.

Estimate how much you potentially can save

on taxes by paying health care expenses with

a Health Care Flexible Spending Account

(FSA), or Health Savings Account (HSA)1 and

Limited Purpose Health Care FSA1 (LFSA)

Choosing the Right Health Care Plan

Use theHEALTH PLAN COSTESTIMATOR HPCE

1. Go to https://yourhealth.

rochester.edu to access the

Health Plan Cost Estimator.

2. You will be asked to select

the health care usage (as low,

medium, or high) of you and

your family.

3. Using this information, the

tool will calculate your total

estimated out-of-pocket costs

for each of your plan options,

to help you determine which

plan may provide you with

the best overall value and

potential tax savings. You willalso be able to estimate how

much you can save in taxes

by contributing to the Health

Care Flexible Spending Account

(FSA) or the Health Savings

Account (HSA).

After you review your HPCE

results, you should carefully

review each plan, keeping in

mind your unique experience

and tolerance for risk.

1 Only available if you are enrolled in the University HSA-Eligible Plan.

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Go to https://yourhealth.rochester.edu

You can use the... I you want to know... How it works...

Health Plan Cost Estimator An estimate of what your total cost islikely to be under each health care plan

The tool estimates out-of-pocket costsfor health care services based on thehealth care status that you select foryou and your family and adds yourout-of-pocket costs for each plan to thepayroll deductions you would makefor the year to give you an estimatedcombined cost for each of the plans.

Health Care FSA Estimator

Health Savings Account Estimator

Limited Purpose Health Care FSA Estimator

SMH 2011 guide

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