Health Care Plans

Employee benefit forms
Find forms relevant to your health care plan.

Glossary of terms
As you read through your benefit materials, refer back to this list for the definitions of terms that are commonly unknown or misunderstood.

ALEX tool
An interactive online benefits decision tool that will assist you in understanding your benefit options.

2025 Health Program Guide
An in-depth PDF brochure detailing University’s Health Care Plan, Prescription Drug Plan, Dental Plans, FSA, HSA, Personal Health Management, and Well-U benefits.

Medical plan basics
Review the medical plan basics with this webpage and video.

HSA vs. FSA
A video helping explain the important distinctions between a Health Savings Account (HSA) and a Flexible Spending Account (FSA)

Health Care FSA video overview

Limited Purpose FSA video overview

Dependent Care FSA video overview

Navitus will be the administrator of the University pharmacy benefits that are included in the health plan enrollment.

If you enroll in one of the University of Rochester Health Care Plans, you will automatically receive prescription drug benefits in conjunction with your plan. The Navitus drug formulary is used to determine the level of copay(s) or coinsurance you will be responsible for depending on the medication prescribed.

Through Navitus, you have the opportunity to utilize a mail-order pharmacy – Costco. You can conveniently fill your prescriptions via phone or online and have them delivered to your home. Visit pharmacy.costco.com for additional information.

The UR Employee Pharmacy offers a discount to all employees and their eligible dependents enrolled in a University of Rochester Health Care Plan. The pharmacy is located in the Medical Center, though they do offer courier services for employees located in off-site locations. Visit the UR Employee Pharmacy website for additional information.

Employees on the PPO Plan will have a plan feature called Access Guidance Services through the University’s partnership with Navitus. The program offers savings for certain specialty prescription medications. Employees are only eligible while enrolled on the PPO Plan due to rules and regulations surrounding High Deductible Health Care Plans (HSA-Eligible Plan).

For additional information on Navitus, please refer to our frequently asked questions.

AHP is a clinically integrated network of hospitals and physicians with a proven record of improving quality outcomes and delivering value. When visiting an AHP provider, also referred to as a Tier 1 provider, you will have a lower deductible, copay, and out-of-pocket maximum than Tier 2 or Tier 3 providers. To find Accountable Health Partners providers in your area or learn more about the AHP network, visit the AHP provider search website.

While you receive the highest level of benefits when you visit AHP providers, you can receive care through a combination of AHP, Tier 2 and Tier 3 providers. You do not need to choose a tier when enrolling, your level of savings will vary as you visit providers in different tiers throughout the Plan year.

The out of area payment program is available for University employees who, due to the business need of their position, must work and live outside of the AHP network area and therefore cannot participate with Tier 1 health care providers. As a result, these employee will receive a stipend to assist with their health care costs. If you believe you are eligible for this program, please have your supervisor or manager contact the Office of Total Rewards. View the 2025 Health Program Guide for more information.

To find providers in the Excellus National Network, use their Doctor Search tool. When prompted, select “Choose a location and plan”. Enter your address, city, or zip code. Enter your plan prefix as “URL” and select “Continue”.

Excellus also offers treatment cost advisor and provider selection advisor tools. To access, log in to Excellus BCBS and select “Excellus BCBS administers my UR Health Care Plan.”

You take your healthcare coverage with you wherever you travel. Excellus has nationwide networks and offer international coverage which means you have access to medical assistance services, doctors and hospitals around the world. Review important coverage information available online:

• Excellus when traveling
• Travel-accident insurance policy
• Travel assistance card

Special extended health coverage is available for adult children, who are not otherwise eligible for coverage under his or her parent’s University Health Care Plan due to age, student status, or federal income tax dependent may be eligible to elect continuation coverage through age 29 under the University Health Care Plan. Eligible adult children are those who:

• Are under age 30;
• Are unmarried;
• Live, work or reside in the state of New York or the service area of the insurer;
• Are not covered by Medicare; and
• Are not covered by or eligible for health insurance coverage through another employer’s group health plan (e.g. their own employer’s plan, or the plan of their other parent’s employer).

To enroll for coverage, the employee and/or the employee’s child will need to complete an Excellus enrollment form and may be asked to verify the child’s state of residency or other requirements for this coverage. Rate information is available through the providers. Enrollment opportunities are available at the following times:

• Within 60 days prior to or following the date the child’s coverage under the University Health Care Plan ends due to age, student status, or federal income tax dependent status
• Within 60 days of meeting the eligibility criteria for adult child status, when coverage for the child under the University Health Care Plan had previously terminated (e.g., within 60 days of moving back into New York State, losing employer coverage, becoming unmarried, etc.)
• During the University’s annual open enrollment period

If you or a covered dependent lose coverage through the University Health and/or Dental Plans, COBRA coverage may be available. View the COBRA notice for additional information.

If you’re unable to visit your primary care physician, MDLive provides 24/7 access to US board-certified doctors for non-emergency medical services. For more information, please contact Excellus at (800) 659-2808 or visit excellusbcbs.com/find-a-doctor/telemedicine.

The Transparency in Coverage Final Rules require certain group health plans to disclose on a public website information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services in two separate machine-readable files (MRFs).  The MRFs for the benefit package options under the Health Care Plans for Faculty & Staff of the University of Rochester can be found here.

If you’re not able to be seen at your primary care provider’s office, Virtual Urgent Care is a quick and convenient way to get telemedicine care from anywhere. For more information, please visit www.urmc.rochester.edu/get-care-now/virtual-urgent-care