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Find answers to frequently asked questions related to health care plans and other health-related coverage options offered by the University of Rochester’s Total Rewards package. Visit our Health Care Benefits page to learn more.

Health Care Plans

For more information, visit our Health Care Plans page.

The University Health Care Plans offer three tiers of providers with different levels of coverage. You do not choose a tier when electing a Health Care Plan. The tier is determined based on the network in which your provider/facility participates. Your deductible and out-of-pocket maximums cross apply between all tiers. The insurance card you receive in the mail with your member ID is the ID you will give your provider regardless of the tier they are in.

  • Tier 1 – Accountable Health Partners (AHP) Providers: AHP is a panel of University of Rochester Medical Faculty Group providers and carefully selected community partners. You will have a lower deductible, copay, coinsurance, and out-of-pocket maximum than tier 2 and tier 3 providers. Please note, all AHP providers are also in the Excellus national networks.
  • Tier 2 – Third-Party Administrator (TPA) Network: You may seek providers within the Excellus national network. Services provided at the tier 2 benefit level will be subject to higher deductibles, coinsurance, copays and out-of-pocket maximums than tier 1 providers, but lower than tier 3 providers.
  • Tier 3 – Out-Of-Network: This includes any providers who do not participate in AHP and the Excellus network. Services provided at the tier 3 benefit level will be subject to higher deductibles, coinsurance, and out-of-pocket maximums than tier 1 and 2 providers and will be capped at the reasonable and customary levels; you may be subject to balance billing.

This program is directed at University employees who, due to the business need of their position, must work outside of the Rochester area and therefore cannot participate with Tier 1 health care providers. As a result, these employees will receive a stipend to assist with health care costs. To confirm your eligibility, reach out to your department.

A premium is the cost of your Health Care Plan that is automatically deducted from your paycheck, before taxes.

A deductible is the amount of out-of-pocket expenses that you must pay for health services before the plan begins to pay benefits for many covered services.

Coinsurance is the percentage of the fee that your health care plan pays for certain covered expenses once you have met your annual deductible.

This is the maximum amount you would need to pay each plan year to receive covered services after you meet your annual deductible. This amount includes your deductible, copays and coinsurance payments. If you reach the out-of-pocket maximum, the plan pays 100% of covered health care and prescription drug expenses for the remainder of the plan year.

Use the AHP Provider Search to determine whether your providers are in AHP. To view a list of providers accepting new patients, visit and click on the “View Primary Care Physicians Accepting New Patients” button in the upper right-hand corner of the AHP Provider Search page.

View the Rate Information page to determine what the premium is for each plan. Premiums are automatically deducted from your paychecks via pre-tax payroll deductions.

The coverage levels available to you for health care are:

  1. Single
  2. Employee and Child(ren)
  3. Employee and Spouse or Domestic Partner
  4. Family

For a list of benefit eligible dependents, view the definition of benefit eligible dependents.

Yes. You will need to complete the certification of domestic partner status form certifying that you and your domestic partner meet the criteria as domestic partners for the purpose of being eligible for certain benefits offered under the University of Rochester’s benefits program; you will need to also submit a copy of your legal domestic partner certificate/agreement that was filed with the City of Rochester or your local municipality. You may also submit the tax affidavit, if applicable.

Please note that if your domestic partner is not your tax dependent, the domestic partner’s portion of the premium will be taken as after-tax deductions and the employer paid portion of your domestic partner’s coverage is considered taxable income.

Below are qualifying events:

  • Legal marriage/domestic partnership
  • Legal separation or divorce
  • Termination of domestic partnership
  • Birth/adoption of a child
  • Gain eligibility of Medicaid/Medicare
  • Loss eligibility of Medicaid/Medicare
  • Approved leave (i.e. FMLA, Military Leave, layoff)
  • Return from leave (i.e. FMLA, Military Leave, Layoff)
  • Retirement
  • Loss of coverage
  • Spouse/domestic partner or parent/dependent child open enrollment period
  • Dependents gains eligibility through their own employer or parent’s coverage
  • Change in cost of care for dependent care FSA
  • Significant increase in the employee’s share of health care premiums
  • Significant decrease in the employee’s share of health care premiums

See full details in the qualifying event matrix.

If you are actively working and are becoming Medicare-Eligible, you will not need to enroll in Medicare. Your health plan through the University of Rochester will continue to be the primary payer since your insurance is through a large employer group health plan. If you enroll in any parts of Medicare, Medicare will be the secondary payer.

If you have an HSA and you would like to continue to contribute to your HSA, you should not enroll in any part of Medicare. If you are enrolled in any parts of Medicare, you cannot contribute pre-tax dollars to your HSA.

To learn more about Medicare, please visit www.medicare.gov.

If you are actively working and your spouse is becoming Medicare-Eligible, he/she does not need to enroll in Medicare. Your health insurance through the University of Rochester will continue to be the primary payer for both you and your spouse since your insurance is through a large employer group health plan. If your spouse enrolls in any parts of Medicare, Medicare will be the secondary payer for your spouse.

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. For more details, please see our Health Care Plans page for specific details regarding Special Extended Health Coverage for Certain Adult Children through Age 29.

Coverage will be cancelled effective on the last day of the pay period in which you terminate. When coverage stops, you will be sent a separate document that explains your rights under COBRA continuation coverage.

Dental Plans

For more information, visit our Dental Plans page.

No, both University Dental Plans are administered by Excellus BlueCross BlueShield.

View the Rate Information page to determine what the premium is for each plan. Premiums are automatically deducted from your paychecks via pre-tax payroll deductions.

The two dental plans differ in the following areas:

  • Maximum Benefit Per Calendar Year per participant for classes II, IIA and III
  • Major Restorative Services (Class III) coverage
  • Orthodontia (Class IV) coverage

For details on these differences, view the Dental Plans page.

The Medallion Plan offers Orthodontia coverage for dependents up to age 19, covered at 50% up to the lifetime maximum of $1,500 per person for Orthodontia. No more than one half of the orthodontia lifetime maximum will be paid in any calendar year.

Yes, both plans pay 100% of the in-network negotiated rates. Preventative Services are not subject to a deductible. Out-of-network claims are subject to balance billing. See the Health Program Guide for details.

The dental plans allow you the freedom to see any dentist you choose. Dental Blue Options (in-network) gives you access to a range of participating dental providers to choose from, who have agreed to a discounted set of fees for covered services and accept these amounts as payment in full. To find a dentist in this network, use the Excellus BCBS “Find a Dentist” tool and choose “Dental Blue Options” for Step 1. If your dentist does not fall within the Dental Blue Options network, you may be required to pay at time of service. Then, you can submit a claim to Excellus BCBS for reimbursement for the out of pocket costs you paid at the time of service.

Health Savings Account (HSA)

For more information, visit our HSA page.

A Health Savings Account (HSA) is available to eligible individuals who meet all of the following criteria:

  • Employee has elected coverage under the University’s YOUR HSA-Eligible Plan for the Plan Year.
  • Employee is not covered by any other health plan, including spousal health insurance, except for that the IRS permits.
  • Employee cannot be enrolled in any part of Medicare, Tricare, Medicaid or state health care programs.
  • Employee cannot elect or be covered by another person’s Health Care Flexible Spending Account or Health Reimbursements Arrangement for the Plan Year.
  • Employee will not be claimed as a dependent on another person’s tax return for the Plan Year.
  • Employee has not received Veteran’s Administration health benefits in the past 90 days. Only preventative, dental and vision is permitted.

The HSA maximum election amount for employees with single coverage is $3,600. Employees covering one or more dependents on their plan may contribute up to $7,200. Employees who are 55 or older may contribute an additional $1,000 per year to a HSA through pre-tax deductions as a “catch-up” contribution. Changes to an HSA annual contribution amount can be made at any time in the year.

All funds in contributed to your HSA roll over from one year to the next.

You can make pre-tax payroll contributions each pay period by electing an annual contribution amount. This amount can be changed at any time throughout the year.

Employees may also make after-tax direct contributions to their HSA and claim the contribution on their annual tax return. These contributions still have to comply with the IRS’ maximum election for the tax year.

If you have an HSA elsewhere, you can transfer those funds to your new HSA through the University. Contact your HSA administrator for details.

If you start your employment at the University after the first month of the tax year, you may contribute the maximum election throughout the remainder of the year if: (a) you are in the University’s YOUR HSA-Eligible Plan as of December 1 and (b) you remain in a qualifying High Deductible Health Plan for the plan year. Contact your HSA administrator for details.

In 2021, the University will provide a one-time HSA contribution of $200 individual/$400 family for full-time employees earning less than $62,100 and Residents and Fellows who enroll in the YOUR HSA-Eligible Plan during the Open Enrollment and satisfy the IRS eligibility requirements. We will also provide a prorated contribution to full-time employees earning less than $62,100 and Residents and Fellows if they are: new hires, rehires, newly eligible employees as well as employees or Residents and Fellows experiencing a qualifying event.

You can use your HSA to pay for qualified medical expenses including out-of-pocket costs counting towards your deductible, coinsurance, copays and out-of-pocket maximum.

The qualified medical expenses must be incurred on or after the effective date of your HSA and can be for you, your spouse, and your tax dependents, even if you have single coverage under the YOUR HSA-Eligible Plan.

For a complete list of eligible health care expenses, consult IRS Publication 502. Please note that you generally cannot use the HSA to pay insurance premiums even though they appear in Publication 502. Exceptions would be for COBRA, long-term care, insurance while you are unemployed, retiree health insurance, or Medicare Part A,B,C, or D premiums.

You only have access to the funds currently in your account, not the full annual election.

There are three ways you can use your HSA funds:

  1. Swipe your card at the point of service to pay for qualified medical expenses. You will receive this card in the mail from your HSA administrator once you pass the Customer Identification Program (CIP).
  2. Use online bill payment to pay your provider directly from your HSA.
  3. Pay for a qualified medical expense out-of-pocket, then reimburse yourself from your HSA.

Unused funds in an HSA continue to roll over in the account each year and collect tax-free interest. An HSA is portable, so employees can keep their HSA when they retire, leave the University, or change health care plans.

If you would like to continue to contribute to your HSA, you should not enroll in any part of Medicare. If you are enrolled in any parts of Medicare, you cannot contribute pre-tax dollars to your HSA. Additionally, if you are collecting Social Security Benefits, you will be automatically enrolled in Medicare Parts A and B. Since you are covered on a large employer group plan, you can contact Social Security to waive Medicare Part B but will not be able to waive Medicare Part A. Therefore, you will not be able to contribute to your HSA.

If you do enroll in Medicare Part A, your coverage start date may go back (retroactively) six months from when you sign up, and as a result you may need to stop contributing to your HSA up to six months in advance of enrolling. For more information, contact Social Security.

As the employee, you may continue to contribute to your HSA as long as you are not enrolled in any parts of Medicare. You can continue to use your HSA as reimbursements for any eligible expenses your spouse incurs.

HSA Bank administers HSAs.

Flexible Spending Account (FSA)

See separate FAQs below for each of the different types of FSAs. For more information, visit our FSA page.

Health Care Flexible Spending Account (FSA)

A Health Care Flexible Spending Account (FSA) is a tax-advantage reimbursement account that allows you to set aside money for eligible expenses on a pre-tax basis. This account reimburses you for qualified out-of-pocket medical, dental, prescription, or vision services including expenses applied towards your deductible, copays and coinsurance.

Full-time and part-time faculty and staff, including members of 1199 SEIU, who are enrolled in the YOUR PPO Plan or YOUR HSA-Eligible Plan or who have waived University Health Care coverage are eligible to contribute to a Health Care FSA.

The Health Care FSA maximum election amount for the 2021 Plan Year is $2,750. You may not change your annual contribution amount outside of Open Enrollment unless you experience a qualifying event.

Employees are eligible to roll over up to $550 of their unused balances from one plan year to the next if they elect to contribute to their FSA for the upcoming plan year during Open Enrollment. If no election is made during Open Enrollment, unused funds will be forfeited per IRS “use it or lose it” guidelines with FSA’s. This eligibility pertains to Health Care and Limited Purpose FSA’s only.

Your annual Health Care FSA contribution amount will be split evenly between the numbers of pay periods you have each calendar year. Each pay period, your contribution will be automatically deducted from your paycheck—before taxes—and deposited into your FSA.

You will have immediate access to your full annual FSA election even if you have not yet placed all of the funds in your Health Care FSA.

You can be reimbursed from your Health Care FSA for qualified medical expenses including out-of-pocket costs counting towards your deducible, coinsurance, and copays. The qualified medical expenses must be incurred on or after the effective date of your Health Care FSA.

For a complete list of eligible health care expenses, consult IRS Publication 502. Please note that you generally cannot use the Health Care FSA to pay insurance premiums or for long-term care expenses, even though they appear in IRS Publication 502.

You can set up your reimbursements to be directly deposited into your personal banking account; otherwise, you will be reimbursed with a check from your Health Care FSA administrator. Expenses processed as part of your University Health or Dental coverage will be automatically reimbursed through your Health Care FSA unless otherwise requested. If you or your eligible dependents incur qualified expenses not covered by the University Health or Dental Plans, or if you did not elect coverage through the University, you must submit a manual request for reimbursement for your Health Care FSA administrator.

Limited Purpose Flexible Spending Account (FSA)

A Limited Purpose Flexible Spending Account (FSA) is a tax-advantage reimbursement account that allows you to set aside money for eligible expenses on a pre-tax basis. This account can provide reimbursement for qualified dental or vision expenses but cannot reimburse any out-of-pocket health care expenses until the plan deductible has been satisfied; otherwise, the Limited Purpose FSA works like a Health Care FSA.

Employees enrolled in the YOUR HSA-Eligible Plan and are contributing to a Health Savings Account (HSA), are also able to contribute to a Limited Purpose FSA.

The Limited Purpose FSA maximum election amount for the 2021 Plan Year is $2,750. You may not change your annual contribution amount outside of Open Enrollment unless you experience a qualifying event.

Employees are eligible to roll over up to $550 of their unused balances from one plan year to the next if they elect to contribute to their FSA for the upcoming plan year during Open Enrollment. If no election is made during Open Enrollment, unused funds will be forfeited per IRS “use it or lose it” guidelines with FSA’s. This eligibility pertains to Health Care and Limited Purpose FSA’s only.

Your annual Limited Purpose FSA contribution amount will be split evenly between the number of pay periods you have each calendar year. Each pay period, your contribution will be automatically deducted from your paycheck—before taxes—and deposited into your Limited Purpose FSA.

You will have immediate access to your full annual Limited Purpose FSA election even if you have not yet placed all of the funds in your Limited Purpose FSA.

You can be reimbursed from your Limited Purpose FSA for qualified dental or vision expenses. You may not be reimbursed for qualified medical expenses until your plan deductible has been met. The qualified expenses must be incurred on or after the effective date of your FSA.

For a complete list of eligible health care expenses, consult IRS Publication 502.

You must submit a manual request for reimbursement for your FSA administrator.

Dependent Care Flexible Spending Account (FSA)

A Dependent Care FSA is a tax-advantaged savings account designed to help you save money on expenses to provide care for qualified dependents.

Qualified dependents include children under age 13, whom you claim as a tax dependent on your federal income tax return (special rules apply for divorced parents) or a disabled spouse or any other dependent on your tax return who resides with you and is physically or mentally disabled.

The maximum contribution amount set by the IRS for 2021 is $5,000 for individuals or married couples filing jointly, or $2,500 for a married person filing separately. You may not change your annual contribution amount outside of Open Enrollment unless you experience a qualifying event.

Your annual Dependent Care FSA contribution amount will be split evenly between the number of pay periods you have each calendar year. Each pay period, your contribution will be automatically deducted from your paycheck—before taxes—and deposited into your Dependent Care FSA.

Qualified expenses eligible for reimbursements from your Dependent Care FSA include Child Care Centers, Nursery School, and before and after school care. The qualified expenses must be incurred on or after the effective date of your Dependent Care FSA. See IRS Publication 503 for a complete list of eligible expenses.

You only have access to the funds currently in your account, not the full annual election.

You must submit a manual request for reimbursement for your Dependent Care FSA administrator.

Funds in a Dependent Care FSA cannot be rolled over into the next Plan Year.

Vision Care (VSP)

For more information, visit our Vision Care page.

Yes, you can elect vision coverage through VSP regardless of your healthcare enrollment.

Dependents eligible to be covered on your vision plan include:

  • Your current spouse or domestic partner and their children up to age 26
  • Your children up to age 26

See the definition of benefit eligible dependents for additional information regarding eligible dependents.

New hires and newly eligible faculty and staff have 30 days to enroll. You can also enroll in VSP when you have a qualifying event or on an annual basis during Open Enrollment. See the Changing My Benefits page for information regarding making benefit changes outside the enrollment period.

You can visit the VSP website at www.vsp.com.

You can also contact VSP directly at (800) 877-7195 during the following hours:

  • Monday–Friday: 8 a.m–9 p.m.
  • Saturday: 10 a.m–8 p.m.
  • Sunday: 10 a.m–8 p.m.

Note: The VSP vision plan does offer out-of-network coverage. Visit the VSP website for details on the differences between in-network and out-of-network coverage.

Yes, your premium for vision coverage will be a pre-tax payroll deduction.

You received a welcome letter in the mail, which included your VSP card that confirms your Member ID number (your six-digit employee ID number with three zeroes in front of your ID number). When you go to your provider, you will let them know you have VSP and they will be able to apply the discounts.

Visit the VSP site at www.vsp.com.

  • Select “Members”
  • Create an account using your six-digit employee ID number with three zeroes in front of your ID number (your employee ID number is located on your paycheck or paystub, or contact your HR Business Partner if you need your employee ID number)
  • Once you have logged in, you will be able to view information about your vision benefit

Note: You can also print a Member Vision Card to keep in your wallet. Click on the link in the left toolbar called Member Vision Card.

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