Plan Information for the Health Care Plans and FSAs:
Choose the Medical Plan that’s Right for You
The University Plan Administrator for Health Care Plans Coverage is:
A variety of resources are available to help guide your decision about which medical plan may provide the best coverage and value
Associate Vice President of Human Resources
University of Rochester (ID No. 16-0743209)
Office of Human Resources Benefits Office
260 Crittenden Boulevard
Rochester, NY 14642
Telephone: 585-275-2084
The Associate Vice President of Human Resources is the agent for legal process in any action involving the University of
Rochester Health Care Plans:
The Plan Year is from January 1 to December 31
The Plan Number is 517
For Strong Memorial Hospital Residents and Fellows, the Health Care Plan Year is from July 1 to June 30 and the Plan Number
is 509.
The University of Rochester medical plans will no longer be considered “grandfathered health plans” under the Patient
Protection and Affordable Care Act (the Affordable Care Act or health care reform) effective January 1, 2013.
The University reserves the right to modify, amend or terminate the Plans at any time, including actions that may affect
coverage, cost-sharing or covered benefits, as well as benefits that are provided to current and future retirees.
for your money.
Health Plan Cost Estimator
The Health Plan Cost Estimator is an online tool that will
estimate how much you’ll pay in out-of-pocket expenses under
each of the plans available to you based on your health care
profile. You can also use this tool to determine how much you
could potentially save on taxes by paying your eligible expenses
with a Health Care Flexible Spending Account or a Health
Savings Account.
To use the Health Plan Cost Estimator, simply go to the
University of Rochester Benefits home page at
www.rochester.edu/benefits/health and select the Health Plan
Cost Estimator link.
Third–Party Administrator (TPA) Plan Specific Cost of Care Estimating Tools
2013 Medical Plans At-a-Glance
Both Aetna and Excellus offer personalized cost estimator tools to facilitate plan selection and other resources to help take the
challenge out of benefits selection, make informed health care decisions and know what you may pay out-of-pocket before ever
making an appointment.
The University of Rochester Medical Plans offer coverage to help
meet the health care needs of you and your family. This chart is
Aetna
To access the Plan Selection and Cost Estimator tool:
• Login to Aetna Navigator at www.aetna.com (first time users will
have to register and create an account).
• Select Cost of Care from the left navigation bar
• Select a condition from the drop-down menu to see both
in- and out-of-network costs specific to your geographical area
Excellus
To access the Treatment Cost Advisor and Provider Selection
Advisor tools:
• Go to www.excellusbcbs.com/ur and click on Excellus BCBS
administers my UR Health Care Plan.
• Type in your login and password (first time users will have to
register and create an account).
• Click on For Your Health from the top navigation bar, then
Decision Support Tools.
designed to help you compare the features of each medical plan
so that you can make informed decisions.
Comparing the University Health Care Plans
University High
Deductible Plan
University Low
Deductible Plan
University
HSA-Eligible Plan
University
Copay Plan
In-Network
Out-ofNetwork
In-Network
Out-ofNetwork
In-Network
Out-ofNetwork
In-Network
Out-ofNetwork
$600/$1,500
$1,200/$3,000
$300/$750
$600/$1,500
$1,250/$2,500
$2,500/$5,000
$200/$500
$600/$1,500
Plan pays 80%
Plan pays 50%
Plan pays 90%
Plan pays 60%
Plan Pays 80%
Plan Pays 50%
Plan pays 90%8
Plan pays 60%
$3,000/$7,500
$2,500/$5,000
$3,750/$7,500
$1,000/$2,5008
$3,000/$7,500
COVERAGE
Deductible
(single/family)
Coinsurance
Out-of-Pocket
Maximum
(single/family)1
$2,000/$5,000
$1,500/$3,7502
$4,000/$10,000
$1,500/$3,750
$1,000/$2,5002
Lifetime Maximum
Unlimited
FSA/HSA
FSA maximum: $2,500
FSA maximum: $2,500
HSA maximum: single $3,250/
family $6,450; Health Care FSA and
Limited FSA maximum: $2,5007
FSA maximum: $2,500
PREVENTIVE CARE SERVICES
Note: Check with your TPA before seeking preventive care to ensure the service is considered preventive.
Physicals, Well-Baby/
Well-Child Exams, etc.9
In-network: Plan pays 100%, no deductible or copay.
Out-of-network: Not covered
PRESCRIPTION DRUGS (Generic/Preferred Brand/Non-Preferred Brand)
Retail
(up to 30 days’
supply)3,4
$10/$25/$40
copay
Not covered
$10/$20/$35
copay
Not covered
$10/$30/$50
copay
after deductible
Not covered
$10/$20/$35
copay
Not covered
Mail Order
(up to 90 days’ supply)3,4
2.5 times
30-day retail
copay
N/A
2.5 times
30-day retail
copay
N/A
2.5 times
30-day copay
after deductible
N/A
2.5 times
30-day retail
copay
N/A
Plan pays 80%
(no deductible)
Not covered
Plan pays 90%
(no deductible)
Not covered
Plan pays 80%
after deductible
Not covered
Plan pays 90%
(no deductible)
($20 maximum)
Not covered
Prescription Diabetic
Supplies3
Physician Office and Diagnostic/Lab Services
Office Visit/Office Care
Specialist Visit/
Specialist Care
Diagnostic X-ray
$20 copay
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Lab & Pathology,
Chemotherapy/
Radiation Therapy
$40 copay
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
MATERNITY SERVICES
Prenatal
Plan pays 100%,
no deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 100%,
no deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 100%,
no deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 100%,
no deductible or
copay
Plan pays 60%
(up to R&C) after
deductible
Postnatal
Plan pays 100%,
no deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 100%,
no deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 100%,
no deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 100%,
no deductible or
copay
Plan pays 60%
(up to R&C) after
deductible
Hospital Care for
Mother
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
INPATIENT HOSPITAL SERVICES
Inpatient Admission
(facility)
Inpatient Physician and
Surgery Services
Plan pays 80%
after deductible
OUTPATIENT HOSPITAL SERVICES
Outpatient (facility)
Plan pays 80%
after deductible
EMERGENCY CARE
Emergency Room Care5
Ambulance
Urgent Care
Plan pays 80% after deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90% after deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80% after deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90% after deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
MENTAL HEALTH & CHEMICAL DEPENDENCE SERVICES
Mental Health –
Inpatient
Mental Health –
Outpatient
Substance Abuse –
Detoxification
Plan pays 90%
after deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Substance Abuse –
Outpatient
$20 copay
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
$20 copay
OTHER SERVICES
Auditory Exam
(limit 1 per year)
Chiropractic Care
Acupuncture
(limit 10 per year)
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
$40 copay
Plan pays 60%
(up to R&C) after
deductible
Vision – Exam
(limit 1 per year)
Vision – Lenses &
Frames
(limit 1 per year)
$60 maximum allowance once every year (20%-50% discounts on lenses and frames at participating optical providers)
Diabetic Supplies and
Equipment6 (nonpharmacy purchase)
Plan pays 80%
after deductible
Diabetic Supplies
and Equipment
(pharmacy purchase)
Plan pays 80%
(no deductible)
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Not covered
Plan pays 90%
(no deductible)
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Not covered
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Not covered
Plan pays 90%
(no deductible)
($20 copay
maximum)
Not covered
Durable Medical
Equipment (DME)
Physical, Speech and
Occupation Therapy
(combined limit
45 visits per year)
Plan pays 90%
after deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
$40 copay
Plan pays 60%
(up to R&C) after
deductible
$20 PCP copay;
$40 specialist
copay
Allergy Tests and
Injections
SKILLED NURSING
Skilled Nursing
Facility Care (limit of
120 days per year)
Home Health Care
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Plan pays 80%
after deductible
Plan pays 50%
(up to R&C) after
deductible
Plan pays 90%
after deductible
Plan pays 60%
(up to R&C) after
deductible
Hospice Care
Includes deductible.
Full-time earning less that $45,100.
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 generic equivalent.
Specialty drugs filled at URMC Employee Pharmacy qualify for the 25% reduction in copay under the High Deductible, Low Deductible and Copay Plans, and the HSA-Eligible Plan after
deductible is met.
4
90-day supplies of maintenance drugs filled at the URMC Employee Pharmacy are eligible for a 25% reduction in copays for each 30-day supply.
5
Non-Emergency Care in a Hospital Emergency Room is not covered.
6
Covered under Durable Medical Equipment (DME). For a list of qualified diabetic supplies, see Appendix C of the 2013 Decision Guide.
7
If you elect the 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.
8
Applies to all inpatient, outpatient and emergency care services.
9
Includes women’s health screenings; breast feeding support, supplies and counseling; contraceptive methods; patient education and counseling.
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