Medical and Prescription Plans
Faculty members and their eligible family members may select health care plan coverage under the Preferred Provider Organization (PPO) Plan, the Point of Service (POS) Plan, or a Health Maintenance Organization (HMO) Plan. Employee-only coverage is available under the Catastrophic Plan. There is no pre-existing condition exclusion in any plan offered by the University.
The Preferred Provider Organization (PPO) Plan, administered by United HealthCare, features both an In-Network and an Out-of-Network component. The In-Network approach allows members to seek care without having to designate a primary care physician. As a result, it is not necessary to obtain a referral before visiting another physician or specialist who participates in the provider network. Other features of the In-Network portion of the plan include a co-pay for office visits and a deductible and coinsurance for most other services. The Out-of-Network portion of the plan provides the participant with the ability to see any physician, but at a greater cost. There is a deductible and coinsurance requirement for Out-of-Network services.
The Point of Service (POS) Plan, administered by Oxford Health Plans, features both an In-Network and Out-of-Network component. The In-Network approach requires that members seek care through a primary care physician and features no deductible, no claim forms, and a copay for office visits. Under the Out-of-Network portion of the plan, members may see a physician who is not a part of the network, but at a greater cost. There is a deductible and coinsurance requirement for Out-of-Network services.
The Catastrophic Plan is an indemnity plan that is available to employees only at no charge. (No coverage is available for spouses and/or children.) This plan is designed to provide coverage in the event of a catastrophic illness or injury. Reimbursement through this plan will not begin until an annual deductible of $4,000 is reached.
There is no separate prescription drug program with this plan. If you are enrolled in this plan and also have medical coverage elsewhere, your coverage in the Catastrophic Plan will be primary. You will be required to submit all claims through this plan first.
Several HMO plans are also available. Brochures and application forms are available through the Office of Human Resources, 1 New South Building.
In addition, information in chart form highlighting the expenses covered under each plan and the monthly cost of each plan is available through the Office of Human Resources, 1 New South Building, and on the Benefits website.
The faculty member's contributions toward the cost of the health care plan, if any, are reduced from the faculty member's pay on a pretax basis (salary reduction).
Members of the faculty (excluding visitors) whose duty time is 50 percent or greater for appointments of five months or more are eligible to participate in the benefit described above. These summaries are for general information only. The University intends to continue each of the benefit plans but reserves the right to terminate or amend any plan at any time and for any reason. Any inquiries concerning details of the benefit plans listed here should be addressed to the Office of Human Resources, 1 New South Building, (609) 258-3300. More detailed information can also be found on the HR website.