Health Care Plans
There will now be 10% co-insurance
when using an in-network provider when the service isn’t for a routine office visit.
For example, tests such as MRI’s, will require a deductible and 10%
co-insurance. These changes are similar to plan designs at several local
colleges and Universities and allow for the continuance of these type of plans,
despite rising medical costs.
Review the Summary of Benefits and Coverage for the Choice EPO Plan for more details about this plan. Paper copies are also available by
contacting Human Resources.
Finding Participating (In-Network) Providers
Enrollees in the Aetna Open Access-
Aetna Select EPO plan must obtain health care services from in-network
providers. To find in-network providers go to www.aetna.com.
Prescription Drug Coverage
Beginning 1/1/2021 prescription drug coverage will be administered by Express Scripts (ESI). Visit www.express-scripts.com to
determine the cost of the most common medications, Step Therapy Rules
and to receive info for specialty medication (we will update info for
ESI as it’s made available).
The university’s prescription drug plan with OptumRx will remain
active through the end of the 2020 calendar year (OptumRx info below).
- View the 2020 Advantage Prescription Drug List to determine the cost of a the most common medications.
- Under
the Optum Rx Progression Rx program, some prescriptions require that
you try a "Step 1" medication before a "Step 2" medication will be
covered. Refer to Progression Rx – Step Therapy Program list to view the names of these medications and details about this plan feature.
- The Specialty Pharmacy Program must
be used by members with rare or complex medical conditions who require
specialty medications (described in flyer). If you have an existing
(active) specialty medication prescription with Optum Rx it will remain
on file and you will not need to obtain a new one.
Vision Plan Coverage
As a reminder, Aetna enrollees will automatically be enrolled in the
Vision Plan at no additional cost. You must be enrolled in the health
care plan to receive vision plan benefits; there is no option to enroll
separately. The plan allows you to receive routine vision services
either from participating (in-network) vision providers or from
providers who do not participate in the Aetna vision network
(out-of-network). To search for in-network providers, go to www.aetnavision.com You
should also print your vision care member ID card once you're logged
in; you will present the card at the time you receive routine vision
services.
The Vision Care Plan covers an examination and new lenses (contact
and glasses) every 12 months and new frames every 24 months. Review the Plan Summary for coverage details. Call Aetna at 877-973-3238 for additional information. Visit their website to locate a provider.
Dental Plan Coverage
The
University Dental Plan will now be administered through Aetna. If you
wish to newly enroll or make a change to your current dental elections,
you must do so via the MyDay system. For additional information please go to the dental care page of the New School's benefits website.