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October 08, 2014

University health care plans to change in 2015

New this year: employees must select from one of two plans during the open enrollment period of Oct. 20 to Nov. 10.

Health Care Special Edition

The University’s employee health care plans are changing for the 2015 plan year, and all benefit-eligible employees must make an election during the 2015 open enrollment period, Oct. 20 to Nov. 10.

Designed to be simpler, and to provide the potential to lower out-of-pocket costs, while offering high-quality providers and health and wellness programs, the University’s employee health plans have two fundamental changes.

First, the plans have been simplified from four options to two. One, known as YOUR PPO Plan, is much like the current copay plan; the other, known as YOUR HSA–Eligible Plan, is similar to one of the HSA–eligible plans currently offered. The new plans are designed around the fact that 70 percent of employees covered under a current University health plan are enrolled in either the copay plan or the HSA–eligible plan.

Second, both Aetna and Excellus will continue to serve as the University’s third-party administrators (TPA), and employees will continue to have access to Aetna’s and Excellus’s national “in-network” and “out-of-network” tiers.

New this year is the addition of Accountable Health Partners (AHP) as a subset of Aetna’s and Excellus’s “in-network” providers, making AHP the first tier of a three-tier network.

AHP is a growing health provider network that now includes more than 1,600 physicians from the Rochester region, including those in UR Medicine’s clinical network and a growing number of community physician practices, as well as six hospitals. The providers will interact closely with the University’s existing health and wellness programs to improve care coordination while helping employees to take charge of their health.

Faculty and staff will still have the choice to see health providers within the broader Aetna and Excellus national networks— and outside them, as well—but anytime they receive care from AHP providers, they will enjoy lower copays, deductibles, and coinsurance.

“The University has built the region’s best health care network that encompasses faculty and community clinicians, and one that is driven by care management systems that improve the health of patients,” says Ron Paprocki, senior vice president for administration and finance and CFO. Paprocki led the University’s Health Plan Committee, which worked for more than a year with input from Faculty Senate Executive, Benefits, and Budget committees to address the health care challenges facing the University as an employer. Those challenges include the rising cost of insurance and new federal requirements for health care coverage.

“The cost of health care continues to rise, making tiered network options more attractive to many employers,” Paprocki says. “Through these changes, we can provide higher quality health care for our employees while lowering our costs and theirs.”

Because this will be an entirely new University health plan lineup, all benefit-eligible employees will be required to actively review their current benefits and either elect coverage under the new plans or waive coverage through the University.

In addition to health care plan choices, open enrollment is also the period when dental plan coverage, flexible spending accounts (FSAs), health savings accounts (HSAs), and life insurance coverage and beneficiaries can be changed or elected.

Additionally, all employees enrolled in a health or dental plan are required annually during open enrollment to certify that each dependent on the plan meets the University’s health program eligibility requirements.

Open enrollment is conducted online through the HRMS website ( with a NetID, or over the phone with ASK-URHR (275-8747). After open enrollment ends, employees cannot make changes to benefit elections (except HSA contribution amounts), unless they experience a qualifying event.

Full enrollment packages have been mailed to the homes of each eligible employee, and the expectation is that employees and their families will have the resources and support they need to make the most optimal and informed choices about their health care.