{"id":2696,"date":"2019-11-04T23:20:29","date_gmt":"2019-11-05T04:20:29","guid":{"rendered":"https:\/\/www.rochester.edu\/human-resources\/?page_id=2696"},"modified":"2026-01-02T09:23:40","modified_gmt":"2026-01-02T14:23:40","slug":"health-care-plans","status":"publish","type":"page","link":"https:\/\/www.rochester.edu\/human-resources\/benefits\/health-care\/health-care-plans\/","title":{"rendered":"Health Care Plans"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":6,"featured_media":0,"parent":256,"menu_order":1000,"comment_status":"closed","ping_status":"closed","template":"page-templates\/one-column.php","meta":{"_acf_changed":false,"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-2696","page","type-page","status-publish","hentry"],"acf":{"lead_in":"","display_title":"","subtitle":"","call_to_action":"","hero_image_placement":"no_image","hero_media":"images","hero_pattern_option":"","hero_video":"","hero_image_landing":"","hero_image_landing_two":"","hero_image_landing_three":"","content_modules_above":[{"acf_fc_layout":"text","anchor":"","css_class":"","title":"","content":"As part of your Total Rewards package, the University of Rochester offers two health care plans: the YOUR HSA-Eligible Plan<\/strong>\u00a0and the\u00a0YOUR PPO Plan<\/strong>. These plans are administered through Excellus BlueCross BlueShield<\/a>.\r\n\r\nThis page explains the differences between the two plans, and includes helpful forms and information if you're already on one of our plans.\r\n

Comparing your options<\/h2>\r\nThe chart below goes through key differences between the two health care plan options. In addition, you can find more specific details, like deductibles, in our\u00a02026 Health Program Guide<\/a>\u00a0and 2026 Health Plans Comparison Chart<\/strong><\/a>.\u00a0<\/span>You can also explore rate information<\/a> for these plans.\r\n\r\nNeed help choosing a health plan? Use the ALEX tool<\/a>, an interactive online benefits decision tool that will assist you in understanding your benefit options and enable you to make an informed decision when making your benefit elections.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/td>\r\nYOUR PPO Plan<\/strong><\/td>\r\nYOUR HSA-Eligible Plan<\/strong><\/td>\r\n<\/tr>\r\n
Premiums<\/strong><\/td>\r\nHigher premiums<\/td>\r\nLower premiums<\/td>\r\n<\/tr>\r\n
Plan deductible<\/strong><\/td>\r\nDeductible applies to some services for example Inpatient, Outpatient, Emergency Room, Urgent Care, see comparison chart for more details<\/td>\r\nDeductible applies to all medical and pharmacy services except for preventive care services<\/td>\r\n<\/tr>\r\n
Preventive care services<\/strong><\/td>\r\nPreventive care services are covered at 100% for Tier 1 and Tier 2 providers. Deductible does not apply<\/td>\r\n<\/tr>\r\n
Out-of-pocket maximum<\/strong><\/td>\r\nAfter meeting out-of-pocket maximum, plan covers services at 100%<\/td>\r\n<\/tr>\r\n
Prescription drug coverage<\/strong><\/td>\r\nYou pay your share of the copay or coinsurance until you reach the out-of-pocket maximum<\/td>\r\nAfter meeting the deductible, you pay your share of the copay or coinsurance until you reach the out-of-pocket maximum<\/td>\r\n<\/tr>\r\n
Health Savings Account (HSA) or Flexible Spending Account (FSA)\r\n<\/strong><\/td>\r\nYou will have the option to contribute to a\u00a0Flexible Spending Account (FSA)<\/a><\/td>\r\nYou will have the option to contribute to a\u00a0Health Saving Account (HSA)<\/a>,\u00a0Limited Purpose FSA<\/a>, or\u00a0Health Care FSA<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n ","background_color":"#ffffff","width":"width-medium"},{"acf_fc_layout":"accordion_new","anchor_id":"","classes":"","title":"

Additional support<\/h2>","description":"Explore additional resources, and find links and forms that could be relevant to you.","background":"plain","background_color":"#ffffff","style":"row_blank","expand":"yes","accordions":[{"acf_fc_layout":"accordion","accordion_title":"Forms and resources","icon":"","row_content":"Employee benefit forms<\/a>\r\nFind forms relevant to your health care plan.\r\n\r\nGlossary of terms<\/a>\r\nAs you read through your benefit materials, refer back to this list for the definitions of terms that are commonly unknown or misunderstood.\r\n\r\nALEX tool<\/a>\r\nAn interactive online benefits decision tool that will assist you in understanding your benefit options.\r\n\r\n2026 Health Program Guide<\/a>\r\nAn in-depth PDF brochure detailing University\u2019s Health Care Plan, Prescription Drug Plan, Dental Plans, FSA, HSA, Personal Health Management, and Well-U benefits.\r\n\r\nMedical plan basics<\/a>\r\nReview the medical plan basics with this webpage and video.\r\n\r\nHSA vs. FSA<\/a>\r\nA video helping explain the important distinctions between a Health Savings Account (HSA) and a Flexible Spending Account (FSA)\r\n\r\nHealth Care FSA video overview<\/a>\r\n\r\nLimited Purpose FSA video overview<\/a>\r\n\r\nDependent Care FSA video overview<\/a>","accordion_anchor":""},{"acf_fc_layout":"accordion","accordion_title":"Pharmacy Coverage","icon":"","row_content":"Navitus will be the administrator of the University pharmacy benefits that are included in the health plan enrollment.\r\n\r\nIf you enroll in one of the University of Rochester Health Care Plans, you will automatically receive prescription drug benefits in conjunction with your plan. The Navitus drug formulary<\/a> is used to determine the level of copay(s) or coinsurance you will be responsible for depending on the medication prescribed.\r\n\r\nThrough Navitus, you have the opportunity to utilize a mail-order pharmacy \u2013 Costco. You can conveniently fill your prescriptions via phone or online and have them delivered to your home. Visit pharmacy.costco.com<\/a> for additional information.\r\n\r\nThe UR Employee Pharmacy offers a discount to all employees and their eligible dependents enrolled in a 糖心传媒 Health Care Plan. The pharmacy is located in the Medical Center, though they do offer courier services for employees located in off-site locations. Visit the\u00a0UR Employee Pharmacy website<\/a>\u00a0for additional information.\r\n\r\nEmployees on the PPO Plan will have a plan feature called Access Guidance Services through the University\u2019s partnership with Navitus. The program offers savings for certain specialty prescription medications. Employees are only eligible while enrolled on the PPO Plan due to rules and regulations surrounding High Deductible Health Care Plans (HSA-Eligible Plan).\r\n\r\nFor additional information on Navitus, please refer to our frequently asked questions<\/a>.","accordion_anchor":"2024-pharmacy-coverage"},{"acf_fc_layout":"accordion","accordion_title":"Accountable Health Partners (AHP)","icon":"","row_content":"AHP is a clinically integrated network of hospitals and physicians with a proven record of improving quality outcomes and delivering value. When visiting an AHP provider, also referred to as a Tier 1 provider, you will have a lower deductible, copay, and out-of-pocket maximum than Tier 2 or Tier 3 providers. To find Accountable Health Partners providers in your area or learn more about the AHP network, visit the AHP provider search website<\/a>.\r\n\r\nWhile you receive the highest level of benefits when you visit AHP providers, you can receive care through a combination of AHP, Tier 2 and Tier 3 providers. You do not need to choose a tier when enrolling, your level of savings will vary as you visit providers in different tiers throughout the Plan year.\r\n\r\nThe out of area payment program is available for University employees who, due to the business need of their position, must work and live outside of the AHP network area<\/a> and therefore cannot participate with Tier 1 health care providers. As a result, these employee will receive a stipend to assist with their health care costs. If you believe you are eligible for this program, please have your supervisor or manager contact the Office of Total Rewards<\/a>. View the\u00a02026 Health Program Guide<\/a> for more information.<\/span>","accordion_anchor":""},{"acf_fc_layout":"accordion","accordion_title":"Find providers and estimate costs","icon":"","row_content":"To find providers in the Excellus National Network, use their Doctor Search\u00a0tool<\/a>. When prompted, select \u201cChoose a location and plan\u201d. Enter your address, city, or zip code. Enter your plan prefix as \u201cURL\u201d and select \u201cContinue\u201d.\r\n\r\nExcellus also offers treatment cost advisor and provider selection advisor tools. To access, log in to\u00a0Excellus BCBS<\/a> and select \u201cExcellus BCBS administers my UR Health Care Plan.\u201d","accordion_anchor":""},{"acf_fc_layout":"accordion","accordion_title":"Health care when traveling","icon":"","row_content":"You take your healthcare coverage with you wherever you travel. Excellus has nationwide networks and offer international coverage which means you have access to medical assistance services, doctors and hospitals around the world. Review important coverage information available online:\r\n