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October 08, 2014

FAQs: Health Care Changes

bullseye graphic showing options

Q: What do I need to do as an employee?
A: The most important step you need to take is to select a plan option for 2015. In past open enrollment periods, if you didn’t make a selection for the coming year you were automatically re-enrolled in their previous year’s plan. Because the plans are significantly different from last year, you must actively make an election. If you don’t make a selection, you will be enrolled in the PPO plan with single coverage. You can also elect to waive coverage, but you must make that preference know during the open enrollment period.

Q: How are the plans changing?
A: There are two important differences for 2015. First, the number of plan options is being simplified from four plans to two plans. Second, both plans take advantage of a tiered network, in which you will see differences in the pricing of deductible, copay, coinsurance, and out-of-pocket expenses, based on the tiers you and your family use to access health care.

Q: How do the tiers work?
A: Think of the tiers as three concentric circles. In the inner-most circle is a network of providers known as Accountable Health Partners (AHP). That’s a network established nearly two years ago and includes UR Medicine faculty physicians as well as community and regional doctors and health care providers. The goal of the community-wide network is to better coordinate care among practices and to better control costs by focusing on keeping patients healthy. In addition to more than 1,600 faculty and community physicians, AHP also includes Strong Memorial Hospital, Highland Hospital, F.F. Thompson Hospital, Noyes Memorial Hospital, Jones Memorial Hospital, and Arnot Ogden Medical Center. The next tier includes physicians, providers, and services within the Excellus and Aetna networks, but who have chosen not to be part of AHP. The third tier includes “out of network” providers: those who are not part of AHP or in the networks of Excellus or Aetna.

Q: How do the tiers make a difference for me?
A: The 2015 plans are structured so that you may see considerable savings in copays, deductibles, and coinsurance by choosing to get health care for you and your covered dependents from providers in the AHP network.

Q: Do I have to use AHP providers?
A: No. You and your family are free to choose the providers whom you think best serve your health care needs.

Q: How do I find out more about AHP?
A: The best way is to visit the network’s website at There, you can search for physicians and other services and get contact information. You can also call AHP’s call center at (585) 784-8855.

Q: Why are the options being reduced to two health care plans?
A: When the four current plans were set up, the University wanted to make sure there was plenty of flexibility for you to choose a plan that would work well for you and your family. Particularly important was the introduction of health savings accounts, which were new to the benefits program at the time. With a couple years’ experience in seeing how the plans have been used, most employees choose one of the two configurations that are being offered for 2015. In effect, the new plans are based on the two most popular options from the past couple years, but they also are designed to offer you a range of choices while ensuring access to high-quality providers, as well as health and wellness offerings.

Q: What are the two plans?
A: The two plans are a PPO plan, which is much like the current copay plan, and a health savings account (HSA)–eligible plan, similar to one currently offered. Under the PPO plan, you contribute a set amount from each paycheck. For most non-preventive services, you are expected to pay a portion of the cost—the copay amount—and you are expected to meet required deductible and coinsurance costs as part of your coverage. In an HSA–eligible plan, you contribute less money from each paycheck but you have the opportunity to put money into an account—the HSA—that you can use to pay for eligible health care costs. You also have to meet copay, coinsurance, and deductible requirements. One difference is that the yearly deductible under and HSA plan is higher than under a PPO plan.

Q: What about prescription, dental, mental health, life insurance, and other programs?
A: To get the most up-to-date information about those important programs, watch for your open enrollment materials. If you have questions, please contact the Benefits Office at ASK-URHR (275-8747).

Q: Where can I find the pricing information for the 2015 plans?
A: The pricing structures for the new plans will be included in the open enrollment materials that are mailed to the homes of each benefits-eligible employee. As with the current plans, all employees will contribute to the cost of their plan in 2015 through payroll deductions. The amount of the deduction is based on the plan—PPO or HSA–eligible—and level of coverage— single or family—as well as contributions to dental, life insurance, and other programs.

Q: What do I need to do to enroll?
A: During open enrollment (Oct. 20 through Nov. 10), you need to log in to HRMS ( with your NetID—you may need to connect to the VPN if you are off the University network. Once logged in, go through the online steps to select a plan (PPO or HSA–eligible) and the administrator (Aetna or Excellus). You may also call ASK-URHR (275-8747) to enroll.

Q: Where can I get more information?
A: The Benefits Office website at will be updated throughout the open enrollment period. Enrollment information will be sent to your home if you are benefits-eligible. There are several in-person and online educational sessions scheduled during the open enrollment period— see the list in this issue of Currents, watch for reminders in @Rochester and other electronic vehicles, or refer to the Benefits site. The Benefits Office also offers the ASK-URHR (275-8747) help center that is available from 8 a.m. to 5 p.m. Monday through Friday, or via e-mail to

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