Health Care FAQs

The University Health Care Plans offer three tiers of providers with different levels of coverage. You do not choose a tier when electing a Health Care Plan. The tier is determined based on the network in which your provider/facility participates. Your deductible and out-of-pocket maximums for tier 1 and tier 2 accrue together; tier 3 services are subject to their own separate deductible/out-of-pocket maximum. Your tier is determined by the providers you receive service from. The insurance card you receive in the mail with your member ID is the ID you will give your provider regardless of the tier they are in.

• Tier 1 – Accountable Health Partners (AHP) Providers: AHP is a panel of University of Rochester Medical Faculty Group providers and carefully selected community partners. You will have a lower deductible, copay, coinsurance, and out-of-pocket maximum than tier 2 and tier 3 providers. Please note, all AHP providers are also in the Excellus national networks.
• Tier 2 – Third-Party Administrator (TPA) Network: You may seek providers within the Excellus national network. Services provided at the tier 2 benefit level will be subject to higher deductibles, coinsurance, copays and out-of-pocket maximums than tier 1 providers, but lower than tier 3 providers.
• Tier 3 – Out-Of-Network: This includes any providers who do not participate in AHP and the Excellus network. Services provided at the tier 3 benefit level will be subject to higher deductibles, coinsurance, and out-of-pocket maximums than tier 1 and 2 providers and will be capped at the reasonable and customary levels; you may be subject to balance billing.

The Out of Area program is for University employees who, due to the business need of their position, are required by the University to work and live outside of the AHP network area and therefore cannot participate with Tier 1 health care providers. As a result, these employees 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. View the 2024 Health Program Guide for more information.

A premium is the cost of your Health Care Plan that is automatically deducted from your paycheck, typically before taxes.

免赔额是指在计划开始支付许多承保服务的福利之前，你必须为健康服务支付的自付费用.

共同保险是指在你达到年度免赔额后，你的医疗保健计划为某些承保费用支付的费用百分比.

Use the AHP Provider Search to determine whether your providers are in AHP. To view a list of providers accepting new patients, 访问并点击AHP提供者搜索页面右上角的“查看初级保健医生接受新患者”按钮.

View the Rate Information page to determine what the premium is for each plan. Premiums are automatically deducted from your paychecks, typically via pre-tax payroll deductions. If you have a domestic partner as a dependent on your coverage that is not your tax-dependent, their portion is taken as after-tax deductions.

The coverage levels available to you for health care are:

1. Single
2. Employee and Child(ren)
3. Employee and Spouse or Domestic Partner
4. Family

For a list of benefit eligible dependents, view the definition of benefit eligible dependents.

The domestic partner’s portion of the premium is taken as an after-tax deduction. In addition, the employer paid portion of your domestic partner’s coverage would be taxed as income.

You may want to consult a tax advisor for more information on how adding a Domestic Partner to your health care coverage will affect you.

You will need to provide a Certification of Domestic Partner Status form with a copy of your Certificate of Domestic Partnership, which is granted by the City of Rochester or your local municipality.

If your Domestic Partner is considered a taxable dependent, you will also need to complete and return the Tax Affidavit form .

If your Domestic Partner is turning age 65 and covered under your University Health Care Plan, Medicare requires Domestic Partners to enroll in Medicare A and B during their Initial Enrollment Period for Medicare. 您的同居伴侣仍然有资格享受大学医疗保健计划，但也必须参加医疗保险A和B，以避免将来的医疗保险处罚.

For more information on Medicare rules, please contact Medicare at 1-800-MEDICARE (1-800-633-4227).

Your domestic partner can stay on coverage, though it is still subject to taxes. Once they turn 65 they will need to sign up for Medicare A and B.

Below is a list of qualifying events that allow corresponding changes to your coverage:

• Legal marriage/domestic partnership
• Legal separation or divorce
• Termination of domestic partnership
• Birth/adoption of a child
• Gain eligibility of Medicaid/Medicare
• Loss eligibility of Medicaid/Medicare
• Approved leave (i.e. FMLA, Military Leave, layoff)
• Return from leave (i.e. FMLA, Military Leave, Layoff)
• Retirement
• Loss of coverage
• Spouse/domestic partner or parent/dependent child open enrollment period
• Dependents gains eligibility through their own employer or parent’s coverage
• Change in cost of care for dependent care FSA
• Significant increase in the employee’s share of health care premiums
• Significant decrease in the employee’s share of health care premiums

Please view the Matrix for more details on a list of qualifying events.

View the Excellus when traveling document for more information. Also view the Travel-Accident Insurance Policy and the Travel Assistance Service Identification Card.

If you are actively working and are becoming Medicare-Eligible, you will not need to enroll in Medicare. 由于你的保险是通过一个大型雇主团体健康计划支付的，你在澳门威尼斯人网上赌场的健康计划将继续是主要付款人. If you enroll in any parts of Medicare, Medicare will be the secondary payer.

If you have an HSA and you would like to continue to contribute to your HSA, you should not enroll in any part of Medicare. If you are enrolled in any parts of Medicare, you cannot contribute pre-tax dollars to your HSA.

To learn more about Medicare, please visit www.medicare.gov.

If you are actively working and your spouse is becoming Medicare-Eligible, he/she does not need to enroll in Medicare. 你通过澳门威尼斯人网上赌场获得的医疗保险将继续是你和你配偶的主要支付人，因为你的保险是通过一个大型雇主团体健康计划获得的. If your spouse enrolls in any parts of Medicare, Medicare will be the secondary payer for your spouse.

Special Extended Health Coverage is available for adult children, who are not otherwise eligible for coverage under his or her parent’s University Health Care Plan due to age, student status, or federal income tax dependence. Certain adult children may be eligible to elect continuation coverage through age 29 under the University Health Care Plan. For more details, please see our Health Care Plans page for specific details regarding Special Extended Health Coverage for Certain Adult Children through Age 29.

Your last day on coverage will be the last day of the pay period in which you terminate. When your coverage ends, you will be sent a separate document that explains your rights under COBRA continuation coverage.

No, an eligible employee may be covered under the Plan as an employee or dependent of an employee, but may not be covered as both.

For example, if you and your spouse are both eligible for coverage under the Plan, you and your spouse may both elect employee only coverage or you or your spouse may elect Employee and Spouse or Family coverage and add the other as a dependent under that coverage; however, if your spouse elects Employee and Spouse or family coverage and covers you as a dependent under that coverage, you may not also elect employee coverage.

A Health Savings Account (HSA) is available to eligible individuals who meet all of the following criteria:

• Employee has elected coverage under the University’s YOUR HSA-Eligible Plan for the Plan Year.
• Employee is not covered by any other health plan, including spousal health insurance, except for those that the IRS permits.
• Employee cannot be enrolled in any part of Medicare, Tricare, Medicaid, or state health care programs.
• 雇员不能选择或被另一个人的医疗保健灵活支出帐户或计划年度的医疗报销安排覆盖.
• Employee will not be claimed as a dependent on another person’s tax return for the Plan Year.
• Employee has not received Veteran’s Administration health benefits in the past 90 days. Only preventative, dental, and vision are permitted.
• Please Note: Unless your domestic partner qualifies as your tax dependent, you’re not eligible to withdraw funds tax-free for their qualified health care expenses. However, if you’re enrolled in a family HDHP covering your domestic partner and they meet the other HSA eligibility requirements, they may establish and contribute to their own HSA outside of the University.

For 2024 the HSA maximum election amount for employees with single coverage is $4,150. Employees covering one or more dependents on their plan may contribute up to $8,300. Employees who are 55 or older may contribute an additional $1,000 per year to an HSA through pre-tax deductions as a “catch-up” contribution.

Changes to your HSA annual contribution amount can be made at any time during the year.

All funds contributed to your HSA rollover from one year to the next.

You can make pre-tax payroll contributions each pay period by electing an annual contribution amount. This amount can be changed at any time throughout the year.

Employees may also make after-tax direct contributions to their HSA and claim the contribution on their annual tax return. These contributions still have to comply with the IRS’ maximum election for the tax year.

If you have an HSA elsewhere, you can transfer those funds to your new HSA through the University. Contact your HSA administrator for details.

If you start your employment at the University after the first month of the tax year, 如果:(a)你在12月1日参加了学校的你的hsa合格计划，(b)你在计划年仍然参加了合格的高免赔额健康计划，你可以在一年的剩余时间里贡献最大的选举. Contact your HSA administrator for details.

In 2024, the University will provide a one-time HSA contribution of $200 individual/$400 family for full-time employees earning less than $68,900名居民和澳门威尼斯人网上赌场员在开放注册期间参加了您的hsa合格计划，并满足国税局的资格要求. We will also provide a prorated contribution to full-time employees earning less than $68,900 and Residents and Fellows if they are: new hires, rehires, newly eligible employees as well as employees or Residents and Fellows experiencing a qualifying event during the 2024 calendar year.

Please note that the employer contribution counts toward your annual HSA maximum. If you elect to contribute the maximum and receive the UR HSA contribution, 你每年的HSA工资扣除额将自动减少，以考虑雇主的贡献，以确保你不会超过国税局的最高限额.

You can use your HSA to pay for qualified medical expenses including out-of-pocket costs counting towards your deductible, coinsurance, copays and out-of-pocket maximum.

The qualified medical expenses must be incurred on or after the effective date of your HSA and can be for you, your spouse, and your tax dependents, even if you have single coverage under the YOUR HSA-Eligible Plan.

For a complete list of eligible health care expenses, consult IRS Publication 502. Please note that you generally cannot use the HSA to pay insurance premiums even though they appear in Publication 502. Exceptions would be for COBRA, long-term care, insurance while you are unemployed, retiree health insurance, or Medicare Part A,B,C, or D premiums.

You only have access to the funds currently in your account, not the full annual election.

There are three ways you can use your HSA funds:

1. Swipe your card at the point of service to pay for qualified medical expenses. You will receive this card in the mail from your HSA administrator once you pass the Customer Identification Program (CIP).
2. Use online bill payment to pay your provider directly from your HSA.
3. Pay for a qualified medical expense out-of-pocket, then reimburse yourself from your HSA.

Unused funds in an HSA continue to roll over in the account each year and collect tax-free interest. An HSA is portable, so employees can keep their HSA when they retire, leave the University, or change health care plans.

If you would like to continue to contribute to your HSA, you should not enroll in any part of Medicare. If you are enrolled in any parts of Medicare, you cannot contribute pre-tax dollars to your HSA. Additionally, if you are collecting Social Security Benefits, you will be automatically enrolled in Medicare Part A. Since you are covered on a large employer group plan, you can contact Social Security to waive Medicare Part B but will not be able to waive Medicare Part A. Therefore, you will not be able to contribute to your HSA.

If you do enroll in Medicare Part A, your coverage start date may go back (retroactively) six months from when you sign up, and as a result you may need to stop contributing to your HSA up to six months in advance of enrolling. For more information, contact Social Security.

As the employee, you may continue to contribute to your HSA as long as you are not enrolled in any parts of Medicare. You can continue to use your HSA as reimbursements for any eligible expenses your spouse incurs.

HSA Bank administers HSAs.

Coverage for VSP Vision Care will be continued during a Leave of Absence, Long-Term Disability, Layoff, Worker’s Compensation or NYS Paid Family Leave for up to 90 days from the start of your unpaid leave. If you return to work in an active, benefit-eligible position within 90 days from the start of your unpaid leave, Corestream will recoup any missed premiums by double deducting your premium in your paycheck(s) until the deficit has been recouped. If you do not return to an active, benefits-eligible position within 90 days from the start of your unpaid leave, you may, if you wish, continue coverage under VSP Vision Care under the COBRA Policy.

Yes, you can elect vision coverage through VSP regardless of your healthcare enrollment.

New hires and newly eligible faculty and staff have 30 days to enroll. You can also enroll in VSP when you have a qualifying event or on an annual basis during Open Enrollment. See the Changing My Benefits page for information regarding making benefit changes outside the enrollment period.

You can visit the VSP website at www.vsp.com.

You can also contact VSP directly at (800) 877-7195 during the following hours:

• Monday–Friday: 8 a.m–9 p.m.
• Saturday: 10 a.m–8 p.m.
• Sunday: 10 a.m–8 p.m.

Note: The VSP vision plan does offer out-of-network coverage. Visit the VSP website for details on the differences between in-network and out-of-network coverage.

Yes, your premium for vision coverage will be a pre-tax payroll deduction.

You received a welcome letter in the mail, 其中包括您的VSP卡，确认您的会员身份号码(您的六位数员工身份号码，ID号码前面有三个零). When you go to your provider, you will let them know you have VSP and they will be able to apply the discounts.

Visit the VSP site at www.vsp.com.

• Select “Members”
• 用你的六位数的员工ID号创建一个账户，ID号前面加三个零(你的员工ID号在你的工资单或工资单上), or contact your HR Business Partner if you need your employee ID number)
• Once you have logged in, you will be able to view information about your vision benefit

Note: You can also print a Member Vision Card to keep in your wallet. Click on the link in the left toolbar called Member Vision Card.

Contact Corestream at (888) 935-9595 or customerservice@corestream.com.