UPHS_Enrollment_Guide_FINAL

UPHSflex Enrollment
2010 Open Enrollment Guide
Click
Here
See What’s
New for
2010-2011!
OPEN ENROLLMENT Monday, April 19, 2010 – Sunday, May 2, 2010

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Open Enrollment Guide
UPHSflex Benefits
It’s time to enroll in UPHSflex benefits for the benefits that will cover you and
your family beginning July 1, 2010 through June 30, 2011. This enrollment guide
provides a brief summary of your UPHSflex benefit options and an overview of
the enrollment process.
Use the navigation bars at the top and left of the page to access information
about your benefits. You’ll also be able to download forms and additional
information. To learn more about the benefits available to you:
1. See What’s New in 2010-2011
2. See the Cost of Coverage in 2010-2011
3. Review the Plan Highlights
4. Select your benefits on EnrollOne
(If you are not currently logged on to EnrollOne, log on to
www.enrollone.com/uphs.)
When is Open
Enrollment?
Monday, April 19 –
Sunday, May 2
Enrollment Deadline:
11:59 p.m., May 2, 2010
All Open Enrollment
elections become effective
on July 1, 2010

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Welcome > What’s New
What’s New for 2010-2011
New for 2010-2011
UPHS continues to review the competitiveness of our benefit programs through
market surveys of local and regional health care providers and we are pleased to
say that the our benefits remain one of the most generous in the region. In
addition, UPHS Corporate Benefits aggressively negotiates, on your behalf, with
medical, dental, vision and life and disability insurance vendors to continue to
give you the best available rates. As a result, we are pleased to announce the
following for this upcoming plan year.
Plan Designs
Our medical, dental and vision plan designs will remain the same for the 2010-
2011 plan year.
Mental Health Parity
There is a change in the Penn Behavioral Health Plan design due to the Mental
Health Parity and Addiction Act of 2008. As a result of this change, all limits on
mental health and substance abuse days and visits will be removed for inpatient
and outpatient care. Also, all co-pays and co-insurance will be removed for PBH
providers (except for emergency services) while the co-pays and co-insurance
will match those of the out-of-network medical/surgical benefits. For more
information about the new Act, please refer to these questions and answers, as
well as the updated benefit chart.
Prescription Drug Coverage
Due to increasing utilization and the cost of prescription drugs, UPHS has
increased some of the copays under the prescription drug plan. This is the first
time UPHS has raised copays since the 2006-2007 plan year. Remember, you
will always save money when you use an in-house UPHS pharmacy, along with
generic drugs. For more information, please see the prescription drug section.
More >
Monday, April 19 –
Sunday, May 2
Please review your current
benefit elections. If you want
to continue with the same
benefit elections and
coverage levels, you do not
have to re-enroll. However, if
you participated in the
Health Care FSA and/or
Dependent Care FSA plans
for the 2009-2010 plan
year and you want to
continue to participate for the
2010-2011 plan year, you
must re-enroll.
You can enroll 24-hours a
day during Open Enrollment.
Any elections you make
during Open Enrollment are
effective July 1, 2010
through June 30, 2011.

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Welcome > What’s New
Self- Injectable Drugs
Beginning July 1, most self-injectable drug coverage will go through CVS
Caremark instead of your medical plan. If you are currently taking a selfinjectable
drug (delivered into the muscle or under the skin with a syringe and
needle) and it’s being covered through your medical plan, you’ll receive
information about the change from your medical plan carrier.
Health Care Reform
By now, you are aware that in late March President Obama signed into law the
Patient Protection and Affordable Care Act of 2010. There is no immediate
impact on either our programs or your coverage; however, there is one provision
that is scheduled to take effect in 2011 that may impact you.
• Health Care FSA – Over-the-counter medications will only be reimbursable
until December 31, 2010 without a prescription. Beginning January 1, 2011,
over-the-counter medications will no longer be reimbursable unless you have
a prescription from your doctor.
UPHS will continue to evaluate the new health care reform provisions and remain
compliant with all mandatory regulations.
Please note: The provision that states that all dependents must be covered until
age 26, regardless of student status, is not required until July 1, 2011.
Flexible Spending Accounts (FSA) Cards
If you currently participate in the Health Care Flexible Spending Account (FSA)
and the expiration date on your FSA card is 06/10; you will receive a new card in
the mail if you re-enroll for the upcoming plan year (July 1, 2010-June 30, 2011).
New Benefits Coming
Adoption Policy
UPHS is pleased to
announce the new Adoption
Policy that will go into effect
July 01, 2010. This policy
provides financial assistance
for eligible adoption
expenses for employees
who are building their family
through adoption. For more
information, click here.
Long-Term Care Coverage
In the upcoming months,
look for more information
about the Long Term Care
benefit that will be effective
January 1, 2011.

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > What’s New
Employee Contributions
We are pleased to announce that employee contribution rates for the
Supplemental Life and Dependent Life insurance plans will be reduced; however,
please keep in mind that the premiums are based on your age and salary.
Employee contribution rates for Short-Term Disability will remain the same, but
may change due to a change in your age and/or salary.
New employee contribution rates for medical, dental and vision can be found in
the Cost of Coverage section.
Social Security Numbers Updates for Eligible Dependents
Open Enrollment is a good time for you to validate that the dependents you have
listed on your benefits are eligible dependents as outlined in the UPHS Summary
Plan Description. In addition, the Centers for Medicare & Medicaid Services
(CMS) is requiring all medical carriers (IBC and Aetna) to obtain the Social
Security information for covered dependents. Therefore, we’re encouraging you
to make sure your covered dependents’ Social Security numbers are updated
and correct in the system.
Beneficiary Updates
As we’re getting ready to go through Open Enrollment, now is the time to review
your beneficiary information. Even if you are not making any changes, the
Benefits Department is asking that everyone log on to www.enrollone.com/uphs
to update their beneficiary information. Please keep in mind that you can
update/change your beneficiary anytime throughout the year.
< Back

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Cost of Coverage
Cost for Coverage
To see a chart with your 2010-2011 rates, please select from the two choices
below:
Full-Time Employees
Part-Time Employees

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Welcome > Making Changes During the Year
Making Changes During the Year
Confirmation Statement
After Open Enrollment, you will receive a confirmation statement reflecting your
benefit elections for the 2010-2011 plan year (July 1, 2010 – June 30, 2011). If
any information on this confirmation statement is incorrect, you can access
EnrollOne to make corrections by the deadline noted on your confirmation
statement.
Life Event Changes
After the Open Enrollment correction deadline has passed, you may not make
changes to your benefit elections until the next Open Enrollment — unless you
experience a qualified Life Event during the year. A Life Event may include, but is
not limited to:
• Marriage or divorce,
• Birth or adoption of a child, or
• A change in your or your spouse’s employment resulting in the gain or loss of
health care coverage.
You have 30 days from the date of your Life Event to make a change by
submitting a Life Event Change form (also available at your local Human
Resources office or on the UPHS Human Resources Intranet site), along with
any required documentation.
Please remember you must notify the UPHS Benefits Office of any changes
in family status that affect your covered dependents.
Life Events Related to
Medicaid or CHIP
If your Life Event is related
to Medicaid or CHIP, you
have 60 days from the date
of your Life Event to make a
change to your coverage.
Click here for more
information.

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Contact Information
Benefit Plan Contact Information
Plan Name Phone Number Website
Medical Plans PENNCare PPO 215-241-2990 www.ibx.com
800-841-1992
Keystone Health Plan POS 215-241-2273 www.ibx.com
800-227-3114
Aetna QPOS 888-287-4296 www.aetna.com
To make an appointment with a PENNCare provider, call 877-354-4999 or visit
http://www.pennmedicine.org/penncarenetwork/.
CVS Caremark Prescription
Drug Program
800-777-1023 www.caremark.com
PENN Behavioral Health 888-321-4433 www.pennbehavioralhealth.org
Program
• Behavioral Health
• EAP
• Work/Life Program
Health Program Carewise Health 800-615-0194
Dental Plans PENN Faculty Practice (PFP) 215-898-4615 www.dental.upenn.edu/patients/pfp/pfp.
html
Delta Dental 800-932-0783 www.midatlanticdeltadental.com
Aetna DMO 877-238-6200 www.aetna.com
Vision Plans Davis Vision Standard Plans
Davis Vision Premium Plans
888-393-2583 www.davisvision.com
Vision Benefits of America 800-432-4966 www.visionbenefits.com
(VBA)
FSA
Administrator
SHPS 800-678-6684 www.enrollone.com/uphs, click on “FSA
Detail”
TRIP WageWorks 877-924-3967 www.enrollone.com/uphs, click on
“Transportation”

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Human Resources/Benefits Locations
Human Resources/Benefits Locations
UPHS Entity Office Address Phone Number
All UPHS Entities UPHS Benefits Office 3001 Market Street
Suite 320
Philadelphia, PA
19104
Clinical Care Associates
(CCA), Clinical Health Care
Associates of New Jersey
(CHCANJ)
Human Resources Office
250 King of Prussia
Road
4th Floor
Radnor, PA 19087
Pennsylvania Hospital (PAH) Human Resources Office Harte Memorial
Building
723 Delancey Street
Philadelphia, PA
19107
PENN Presbyterian
Medical Center (PPMC)
PENN Home Care and
Hospice Services
Human Resources Office
Human Resources Office
186 Wright-
Saunders
39th and Market
Streets
Philadelphia, PA
19104
150 Monument
Road, Suite 300
Bala Cynwyd, PA
19004
215-615-2675 or
215-615-2277 and
select the option
for Benefits
610-902-1710
215-829-3341
215-662-8450
610-747-3431

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Plan Highlights
Plan Highlights
We continue to design our health plans to encourage employees to use UPHS
facilities and services so we all can receive the highest quality of care in a costeffective
manner. Employees pay less out-of-pocket when using UPHS facilities.
We all benefit when we use the health system for our health care.
• Medical — Three choices of medical coverage are offered to provide you
with broad health insurance options; all three plans include prescription drug
coverage.
• Vision — Three choices of coverage for your routine and enhanced vision
care.
• Dental — Three choices of coverage for many preventive, basic, and major
dental treatments, including orthodontia.
• Flexible Spending Accounts — Pay for eligible health care and/or dependent
care expenses with tax-free money.
• Life Insurance — UPHS provides you with Core Coverage. You may also
purchase additional life insurance for yourself. In addition, you have life
insurance options for your spouse and dependent children.
• AD&D Coverage — You may purchase AD&D coverage for you and your
family.
• Disability Protection — Short-Term Disability (STD) and Long-Term Disability
(LTD) coverage are provided based on your eligibility. STD has to be elected
and paid for by the employee and full-time employees are eligible for LTD
coverage after one full year of continuous service.
The descriptions in this document are not intended to be complete statements
about each benefit plan. There may be differences between these descriptions
and the actual plan documents. Where details differ, the plan documents shall
apply. Employees are advised that plans are amended from time-to-time. Itis the
employee’s responsibility to inquire about the effect of such changes with their
plan.

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Carewise Health Programs
Carewise Health Programs
The decisions we make today can have a lasting effect on our health and
happiness tomorrow. In today’s complex world, sometimes it’s hard to know what
the right decisions are – not only for yourself, but for your loved ones as well.
That’s where Carewise Health Personal Health Management can help. Carewise
is a free program that helps you understand your benefits and make the best
possible health choices – for today and tomorrow. No matter what your health
concerns, or your current condition, Carewise can make a real difference.
Through the program, you have access to specially trained registered nurses –
experienced caregivers, who can provide all the in-depth, up-to-date medical
information you need to make wise decisions and see those decisions through to
successful conclusions.With Carewise, you don’t have to go it alone.
The program includes:
• 24 hour Nurse Line – A direct, toll-free, connection to real, live, registered nurses.
• Health Notes – Postcards and newsletters with award-winning features on a variety
of timely health and wellness topics.
• Personal Health Programs – Custom-tailored services that enable those with chronic
conditions (such as asthma, diabetes, coronary artery disease, etc.) to work one-onone
with a personal Nurse Advocate.
• High Risk Disease Management – A service that, in the event of accident, sudden
illness, or ongoing health condition, provides a specially trained Nurse Advocate to
help you navigate the health care system.
• Maternity Management – A service designed to identify high-risk pregnancies,
prevent pre-term deliveries and offer ongoing, support to expectant mothers and
families during pregnancy.
Maximize Your Benefits
Carewise Health nurses can
review your health
insurance to answer
questions about your
coverage. They also can
help you clarify careprovider
and treatment
options to make sure you
are getting the best possible
care you’re eligible to
receive.
To take advantage of these valuable resources, call Carewise Health at 800-615-0194.

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Carewise Health
Programs
Medical
PENNCare PPO
Keystone Point-of-
Service (POS) Plan
Aetna Quality
Point-of-Service
(QPOS) Plan
Behavioral Health
Prescription Drug
Vision
Dental
Flexible Spending
Accounts (FSAs)
Life Insurance
AD&D Coverage
Disability
Legal Notices
Welcome > Medical
Medical Benefits
You can elect the PENNCare PPO, Keystone Point-of-Service (KPOS) or the
Aetna Quality Point-of-Service (QPOS) Plans. Your out-of-pocket expenses will
be lower when you use a UPHS provider or facility, including CHOP. However,
the PPO, KPOS and QPOS plans have large carrier networks.
Keep in mind that in the KPOS and QPOS plans, your Primary Care Physician
manages all of your in-network care, including referring you to specialists and
network facilities (for example, laboratory testing).
Click on the boxes to learn more about each plan:
PENNCare PPO
Plan
Keystone Pointof-Service
Plan
Aetna Quality
Point-of-Service
Plan
Provider Directory
PENNCare provider
directories and carrier
network listings are
available online. Click here
to access the PENN
Provider Directory.
• PENNCare PPO
• Keystone POS
• Aetna QPOS

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Medical > PENNCare PPO
PENNCare PPO
Below is a summary of the PENNCare PPO plan. For a more detailed list of
coverage, click here.
How to Access Care
PENNCare PPO
PENNCare Network Personal Choice Out-of-Network
Go to any PENNCare
provider
Go to any Personal
Choice provider
Referrals Needed No No No
Annual Deductible and
Coinsurance
Outpatient Office Visit
Hospital Inpatient
For all plans, Pavilion is
covered for an additional
fee.
Annual Out-of-Pocket
Limit
None None; 80%
coinsurance for other
services as noted
$10 Primary Care or
specialist visit
Covered at 100%
N/A
$20 Primary Care or
specialist visit
Covered at 100% after
copayment ($375
maximum per
admission)
$2,000/person
$4,000/family
(coinsurance only)
Go to any qualified
provider
$300/person
$600/family
Plan pays 70% UCR
after deductible
Deductibles and
coinsurance apply
Covered at 70% after
deductible
$2,500/person
$5,000/family
More Information
Review the PENNCare PPO Chart
Contact Provider
PENNCare PPO at 215-241-2990 or 800-841-1992

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PENNCare PPO
Keystone POS and
Aetna QPOS
Behavioral Health
Prescription Drug
Vision
Dental
Flexible Spending
Accounts (FSAs)
Life Insurance
AD&D Coverage
Disability
Legal Notices
Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Medical > Keystone POS and Aetna QPOS
Keystone POS and Aetna QPOS
Below is a summary of the POS plans. For a more detailed list of coverage, click here.
Point-of-Service Plan (Keystone POS and Aetna QPOS)
PENNCare Network
Carrier Network Out-of-Network/Self-
(Keystone or Aetna) Referred
How to Access Care Select a UPHS Primary
Care provider
Select a carrier network
Primary Care provider
Go to any qualified
provider
Referrals Needed Yes Yes No
Annual Deductible and
Coinsurance
None None $300/person
$600/family
Outpatient Office Visit
Hospital Inpatient
For all plans, Pavilion is
covered for an additional
fee.
Annual Out-of-Pocket
Limit
$10 Primary Care or
specialist visit
Covered at 100%
N/A
$15 Primary Care or
$20 specialist visit
Covered at 100% after
$120 copayment per
admission
Keystone only
$1,500/person
$3,000/family
Plan pays 70% UCR
after deductible
Deductibles and
coinsurance apply
Covered at 70% after
deductible
$2,500/person
$5,000/family
More Information
Review the POS Chart
Contact Provider
• Keystone POS at 215-241-2273 or 800-227-3114
• Aetna QPOS at 888-287-4296

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Welcome > Medical > Behavioral Health
Behavioral Health Coverage
The University of Pennsylvania Health System Mental Health and Chemical
Dependency Benefits have changed in response to the Mental Health Parity and
Addiction Equity Act of 2008. To learn more about Parity and how it may affect
your coverage, please click here.
Behavioral health coverage for all of the medical plans is provided by PENN
Behavioral Health. They can be reached by at 888-321-4433.
More Information
Review the Behavioral Health Chart.
Contact Provider
PENN Behavioral Health at
888-321-4433

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Using a UPHS
Pharmacy
Retail/Mail-Order
Vision
Dental
Flexible Spending
Accounts (FSAs)
Life Insurance
AD&D Coverage
Disability
Legal Notices
Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Prescription Drug
Prescription Drug
All employees enrolled in any of the UPHSflex medical options are automatically
enrolled in prescription drug coverage through CVS Caremark.
Three-Tier Prescription Drug Approach
When you have a prescription to fill, you have a choice among:
• Generic (copay is the lowest)
• Preferred (copay is higher than for generic drugs, but less than for nonpreferred
drugs)
• Non-preferred (highest copay)
If you must have a particular medication that is not on the preferred list, out of
preference or necessity, you will pay the highest copay.
Remember, your out-of-pocket costs will be lower if you use an in-house
UPHS pharmacy.
Copays
UPHS
(30-Day
Supply)
Retail
Pharmacy
(30-Day
Supply)
PENN
Medicine
at Radnor
(90-Day
Supply)*
CVS Caremark
Mail-Order
Program
(90-Day
Supply)
Generic $5 $15 $10 $30
Preferred $15 $30 $30 $60
Non-Preferred $25 $45 $60 $90
* You may access a 90-day supply through the outpatient pharmacies at UPHS
locations.
Contact Provider
Contact CVS Caremark at
800-777-1023
Prescription Drug Card
You will receive a separate
prescription drug card for
your benefits. Your medical
card is not your prescription
drug card. Contact CVS
Caremark at 800-777-1023
if you need a replacement
card.

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Prescription Drug > Using a UPHS Pharmacy
Using a UPHS Pharmacy
This is the most cost-effective way for you to fill your prescriptions.
You can fill any of your prescriptions for a 30-day or 90-day supply at any of the
UPHS pharmacies for a lower copay.
Filling a 30-day or 90-day supply is very convenient — drop off your prescription
on your way to work and pick up your medication the next day.
Have prescriptions filled for you and your family members at the following inhouse
UPHS pharmacies:
Hospital of the
University of
Pennsylvania
3400 Spruce Street
1 Ravdin
215-662-2920
Pennsylvania
Hospital
Outpatient
Pharmacy
800 Spruce Street
Spruce Building
First Floor
215-829-5873
PENN
Presbyterian
Medical Center
Outpatient
Pharmacy
39th & Market
Streets
Medical Office
Building (MOB)
215-662-9494
PENN Medicine
at Radnor
Outpatient
Pharmacy and
Mail Order
Services
250 King of
Prussia Road
2nd Floor
Radnor
610-902-1700

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Prescription Drug > Retail/Mail-Order
Using a Retail Pharmacy
You can also fill a 30-day supply of your prescription at any of the CVS
Caremark national network pharmacies. To find a pharmacy near you, visit
www.caremark.com or call CVS Caremark at 800-777-1023.
Using the Mail-Order Program
The mail-order benefit plan allows you to receive a 90-day supply of your
maintenance medication for one copay. Your prescription is mailed to the
address of your choice.
Mail-order is available through CVS Caremark and PENN Medicine at Radnor.
Contact your local HR Office or call UPHS Benefits at 215-615-2277 for more
information.

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Behavioral Health
Prescription Drug
Vision
IBC Davis Vision
Premium Plan
IBC Davis Vision
Standard Plan
Vision Benefits of
America (VBA)
Plan
Dental
Flexible Spending
Accounts (FSAs)
Life Insurance
AD&D Coverage
Disability
Legal Notices
Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Vision
Vision
The UPHSflex vision benefit options are:
• IBC Davis Vision Premium Plan
• IBC Davis Vision Standard Plan
• Vision Benefits of America (VBA) Plan
Scheie Eye is a participating provider with both IBC Vision Plans and VBA for
your routine vision care. However, if you elect the IBC Davis Vision Premium
Plan and use Scheie providers, you will receive some enhanced vision care
benefits at a reduced cost for services.
All vision services are covered once every contract year (July 1 through
June 30).
You will save money if you receive eye care from these UPHS Eye Care Centers:
PENN
Presbyterian
Medical Center
Scheie Eye
Institute
51 N. 39th Street
Philadelphia, PA
19104
Hospital of the
University of
Pennsylvania
2 Gates
3400 Spruce
Street
Philadelphia, PA
19104
PENN Medicine
at Radnor
250 King of
Prussia Road
Radnor, PA
19087
Mercy Fitzgerald
Medical Office
Building
Suite 2058
1501 Lansdowne
Avenue
Darby, PA 19023
Call 215-662-8100 or 800-789-PENN to make an appointment at any location.
PENN Eye Care
at Media
601 West
State Street
Media, PA 19063
Contact Providers
• Davis Vision at
888-393-2583
• Vision Benefits of
America at
800-432-4966
Low Vision
Research and
Rehabilitation
Center at
Ralston House
3615 Chestnut
Street
Philadelphia, PA
19104

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IBC Davis Vision
Premium Plan
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Standard Plan
Vision Benefits of
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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Vision > IBC Davis Vision Premium Plan
IBC Davis Vision Premium Plan
IBC Davis Vision Premium Plan
How to Access Care Scheie Provider All Other Participating
Providers
Non-Participating
Providers
Eye Exam (once per Covered at 100% Covered after $10 copay Reimbursement of up to $32
contract year)
Standard Lenses
(once per contract
year)
Covered at 100% for all
ranges of prescriptions
Covered at 100% for all
ranges of prescriptions
Reimbursement of up to:
• Single vision: $30
• Bifocal: $36
• Trifocal: $50
• Lenticular: $72
Frames
Medically necessary
contact lenses (in lieu
of eyeglasses) and
evaluation and fitting,
with prior approval
Contact lenses (in lieu
of eyeglasses)
including standard,
specialty and
disposable lenses
Participating provider's
frame collection:
• $100 allowance
OR
• Davis' Fashion selection:
100%
• Designer selection:
100%
• Premier selection: $20
Participating provider's
frame collection:
• $65 allowance
OR
• Davis' Fashion
selection: 100%
• Designer selection:
100%
• Premier selection: $20
Reimbursement of up to $30
Covered up to $200 Covered up to $200 Reimbursement of up to
$200
Allowance of up to:
• Standard/Specialty:
$110
• Disposable: $80
Allowance of up to $75
Reimbursement of up to:
• Standard/Specialty: $60
• Disposable: $75
This chart does not provide a complete description of the plans. For more details,
please contact the UPHS Benefits Office at 215-615-2277.

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IBC Davis Vision
Premium Plan
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Standard Plan
Vision Benefits of
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Dental
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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Vision > IBC Davis Vision Standard Plan
IBC Davis Vision Standard Plan
IBC Davis Vision Standard Plan
How to Access Care Participating Providers Non-Participating Providers
Eye Exam (once per contract year) Covered after $10 copay Reimbursement of up to $30
Standard Lenses (once per
contract year)
Frames
Medically necessary contact
lenses (in lieu of eyeglasses) and
evaluation and fitting, with prior
approval
Contact lenses (in lieu of
eyeglasses) including standard,
specialty and disposable lenses
Covered at 100% for all ranges of
prescriptions
Participating provider's frame
collection:
• Single vision: $20
• Bifocal: $20
• Trifocal: $30
• Lenticular: $50
Participating provider's frame collection: Reimbursement of up to $15
• $15 allowance
OR
• Davis' Fashion selection: 100%
• Designer selection: $16
• Premier selection: $35
Allowance of up to $100 Reimbursement of up to $200
Not Covered
This chart does not provide a complete description of the plans. For more details,
please contact the UPHS Benefits Office at 215-615-2277.
Not Covered

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IBC Davis Vision
Premium Plan
IBC Davis Vision
Standard Plan
Vision Benefits of
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Plan
Dental
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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Vision > Vision Benefits of Amercia (VBA) Plan
Vision Benefits of America (VBA) Plan
Vision Benefits of America (VBA) Plan
How to Access Care VBA Provider Non-VBA Provider
Eye Exam (once per contract Covered at 100% Reimbursed up to $40
year)
Standard Lenses (once per Covered at 100% Reimbursed up to $30-$80
contract year)
Frames Reimbursed up to $100 Reimbursed up to $30
Medically necessary contact Based on UCR Reimbursed up to $200
lenses (in lieu of eyeglasses)
and evaluation and fitting,
with prior approval
Contact lenses (in lieu of
eyeglasses) including
standard, specialty and
disposable lenses
$140 max paid in lieu of
exam and glasses
$140 max paid in lieu of exam
and glasses
This chart does not provide a complete description of the plans. For more details,
please contact the UPHS Benefits Office at 215-615-2277.
Receiving Benefits
You must request a claim form before your appointment. The claim is good for
60 days. To obtain a claim form, please contact VBA at 800-432-4966 or log on
to their website at www.visionbenefits.com. Along with the claim form, you will
also receive a list of participating providers in your area.
Please note: There is no vision card associated with this plan.

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Penn Faculty
Practice
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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Dental
Dental
PENN Faculty Practice
(PFP)*
Delta Dental*
Aetna DMO
How to Access Care Go to any PFP network
provider
Go to any dental care
provider (benefits may be
greater with a Delta
Care must be coordinated
by your Primary Care
dentist
Dental provider)
Referrals Needed No No Yes
Annual Deductible $50/person, $150/family (on
basic, major and ortho)
$50/person, $150/family
(on basic, major and
None
Coinsurance
• Preventive
• Basic
• Major
• Orthodontic
Plan pays:
• 100%
• 80%
• 50%
• 50% up to $2,000 lifetime
orthodontic maximum (for
dependent children to age
19 only)
ortho)
Plan pays:
• 100% of Delta’s
allowance
• 80% of Delta’s
allowance
• 50% of Delta’s
allowance
• 50% of Delta’s
allowance up to
$1,500 lifetime
orthodontic maximum
(for dependent
children to age 19
only)
Plan pays:
• 100%
• 100%
• 50%
• 50% (for adults and
dependent children); no
lifetime orthodontic
maximum
Annual Maximum $3,000/person
Premier – $1,500/person None
Benefit
PPO – $2,000/person
*The Dental Plan contains a provision that coordinates the benefits it pays on behalf of an individual with
payments that may be made under other plans covering the individual, so that the total benefits available will not
exceed 100% of the allowable expenses. Please see your Summary Plan Description for more information.
This chart does not provide a complete description of the plans. For more details, please contact the
UPHS Benefits Office at 215-615-2277.

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Welcome > Dental > Penn Faculty Practice
Penn Faculty Practice
There are three Penn Faculty Plan locations you can go to for dental services.
The Dental Care
Center
4003 Locust Street
Philadelphia
215-898-4615
PENN Dental
3401 Market Street
Philadelphia
215-573-8400
Please note: There is no dental card associated with this plan.
PENN Dental Center At Bryn
Mawr
711 Lancaster Avenue
Bryn Mawr
610-520-4600
Contact Providers
• PENN Faculty Practice
at 215-898-4615
• Delta Dental at
800-932-0783
• Aetna DMO at
877-238-6200

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Carewise Health
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Flexible Spending
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Health Care FSA
Dependent Care
FSA
Life Insurance
AD&D Coverage
Disability
Legal Notices
Welcome > Flexible Spending Accounts
Flexible Spending Accounts
Flexible Spending Accounts (FSAs) allow you to pay for eligible health care
and/or dependent care expenses with tax-free money. You pay no federal or
Social Security taxes on money in these accounts. When you enroll in a Health
Care and/or Dependent Care FSA, the dollars you designate will be deducted
from your paycheck on a before-tax basis and credited to your FSA. For a
complete list of eligible expenses, visit www.enrollone.com/uphs.
Reimbursements
You can use your Health Care Flexible Spending Account Card to pay for eligible
health care expenses. When you first enroll for the FSA, SHPS will mail your
card. Once you activate the card, you can use it to pay for your eligible health
care expenses. If you are currently enrolled in an FSA, you will receive a new
card when your current card expires (the expiration date is listed on your card).
You can still choose to submit paper claims instead of using the Flexible
Spending Account Card. Reimbursement checks will either be mailed directly to
your home or wire-transferred to an account you designate via Electronic Funds
Transfer (EFT).
When submitting a claim, remember to include your Explanation of Benefits
(EOB) if you are filing a claim for health care expenses partially covered by an
insurance plan.
Please keep your receipts until your claim is validated by SHPS.
Use It or Lose It!
According to IRS
regulations, you must
forfeit any unused funds
left in your Flexible
Spending Account after
the applicable deadline:
• Health Care FSA: Any
unused funds left after
September 15, 2011, will
be forfeited. You can
submit expenses until
December 31 after the
plan year.
• Dependent Care FSA:
Any unused funds left
after June 30, 2011, will
be forfeited. You can
submit expenses until
September 30 after the
plan year.
Forms
Health Care FSA Claim Form
Dependent Care FSA Claim Form
Electronic Funds Transfer
Eligible Expenses
Health Care FSA
Dependent Care FSA
Contact Your Provider
SHPS at 800-678-6684

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Welcome What’s New Cost for Coverage Plan Highlights
Welcome > Flexible Spending Accounts > Health Care FSA
Health Care FSA
You can use this account to pay for certain health care expenses not covered by
your benefit plans. For the 2010 – 2011 plan year, you can contribute from $60
up to $3,000 to a Health Care FSA.
Expenses that are reimbursable
• Medical and dental deductibles and
copays;
• Out-of-pocket costs for hospital or
physician care;
• Non-reimbursed prescriptions and
copays;
• Over-the-counter medications and
drugs (such as pain relievers,
antacids and allergy and cold
medicines);
• Dental care, including orthodontia;
• Vision care, including exams,
eyeglasses and contact lenses;
• Hearing aids; and
• Other expenses considered eligible
by the IRS.
Expenses that are NOT reimbursable
• Health insurance contributions;
• Health insurance premiums under your
spouse’s plan;
• Most cosmetic surgery procedures;
and
• Dietary supplements/vitamins,
cosmetics, toiletries and sundry items.
Over-the-counter medications will only be reimbursable without a
prescription until December 31, 2010. Beginning January 1, 2011, over-thecounter
medications will no longer be reimbursable unless you have a
prescription from your doctor.
You must re-enroll for the Health Care FSA if you would like to
participate in the plan for the 2010-2011 plan year.

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Welcome > Flexible Spending Accounts > Dependent Care FSA
Dependent Care FSA
You can use this account to pay for some of the expenses you incur for certain
dependent care services. Dependent care may also include costs you incur for
child care for dependent children under age 13 and/or an adult living with you
whom you claim as a tax dependent and who is physically or mentally incapable
of self-care (e.g., disabled spouse, elderly parent).
For the 2010 – 2011 plan year, you can contribute from $260 up to $5,000 to a
Dependent Care FSA. For the Dependent Care FSA, pre-paid expenses are not
eligible for reimbursement until the service is actually received.
If you are married and filing a joint tax return, your contributions combined with
your spouse’s contributions to a Dependent Care FSA, cannot exceed $5,000 for
the calendar year (January 1 through December 31), regardless of your or your
spouse’s plan year.
Remember, your Dependent Care FSA election is reported on your W-2 form for
the current calendar year (January 1 through December 31); however, your
election is on a fiscal year basis (July 1 through June 30). As such, be mindful of
the amount you elect for the Dependent Care FSA.
You must re-enroll for the Dependent Care FSA if you would like
to participate in the plan for the 2010-2011 plan year.
Eligible Dependent Care
Expenses
Please note, this benefit is
not for health care
expenses such as copays,
braces, eyeglasses, and
prescriptions. For
information on health care
expenses, click here.

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Welcome > Life Insurance
Life Insurance
The cost for life insurance is based on your coverage option, base pay and your
age. If you leave UPHS, you may convert your coverage to an individual policy
within 30 days of your termination date.
Your Coverage Options:
Core Coverage
• All benefit-eligible employees may elect UPHS-provided Core Coverage of 1x
your base pay at no cost to employees.
• You can elect to opt out of Core Coverage.
Supplemental Coverage
• You can also choose employee-paid Supplemental Coverage of 1x, 2x, or 3x
your base pay. However, you must elect Core Coverage to elect
Supplemental Coverage.
• Premiums for Supplemental Coverage will be deducted from your paycheck
on an after-tax basis.
Combined maximum employee life insurance coverage amount (UPHS-provided
Core Coverage plus Supplemental Coverage) is $1,000,000.
Imputed Income for
Core Coverage
Under IRS rules, you must
pay taxes on the premium
value of UPHS-paid Core
Coverage over $50,000.
This is called imputed
income and will be shown
on your pay stub. The IRS
determines the amount of
this tax. Note that imputed
income rules do not apply
to AD&D, supplemental
and dependent life
insurance benefits.

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Welcome > Life Insurance > Dependent Life Insurance
Dependent Life Insurance
Dependent life insurance provides benefits to you, as the beneficiary, in the
event of the death of your spouse/partner and/or child(ren). If you choose any of
the dependent life insurance options, your deductions for the coverage are made
with after-tax dollars.
Remember, a dependent must meet the requirements under the dependent
eligibility section as defined in the Summary Plan Description (SPD).
Dependent life insurance options for all UPHS employees are as follows:
Spouse/Partner
Child(ren)
$2,000 for your spouse/partner $1,000 for your child(ren)
$5,000 for your spouse/partner $2,000 for your child(ren)
$10,000 for your spouse/partner $5,000 for your child(ren)
Please Note: If your spouse works for UPHS, only one of you can elect
dependent life insurance.

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Welcome > AD&D Coverage
Accidental Death & Dismemberment (AD&D) Coverage
AD&D coverage pays benefits — in addition to any life insurance benefits you
receive — if you die or are dismembered as the result of an accident. You may
also elect family coverage for your spouse/partner and any eligible dependent
children. If you choose any of the family coverage options, your deductions for
the coverage are made with after-tax dollars.
Employee-Paid AD&D Coverage
• Your choices for employee-paid AD&D coverage are 1x, 2x, 3x, 4x base pay,
or no coverage.
• The maximum available AD&D coverage amount is $500,000.
• Required premiums for election amounts will be deducted pre-tax from your
paycheck.
Family AD&D Coverage
• Your spouse’s coverage will equal 50% of the amount you choose for
yourself.
• Coverage for each dependent child will equal 15% of the amount you choose
to a maximum of $25,000.
• If you elect family AD&D coverage, you are automatically the beneficiary for
any benefits that may be payable.
Please Note: A dependent must meet the requirements under the dependent
eligibility section as defined in the Summary Plan Description (SPD). If your
spouse works for UPHS, only one of you can elect family AD&D coverage.
Naming a Beneficiary
• Name a beneficiary
when you first become
insured.
• You may change your
beneficiary at any
time.
• For your life insurance
or AD&D coverage,
you may name anyone
as your beneficiary;
however, minors will
not be entitled to
benefits until they
reach legal adult age.

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Welcome > Disability
Short-Term Disability (STD)
• Provides you with income if you are not able to work due to a non-workrelated
illness or injury.
• For most of the Health System, the waiting period for STD is 30 days or the
end of your accrued sick time, whichever is greater. For CCA, the waiting
period is 14 days.
• The voluntary plan provides 60% of your base pay to a maximum of $1,000
per week for up to 180 days following the start of your disability payments.
• The cost of STD coverage is based on your age and base pay.
Employees who work in New Jersey can elect coverage through the UPHSflex
STD option. However, this coverage will be offset by any STD benefit you receive
from the New Jersey state plan.
You can file a short-term disability claim over the phone by calling
UnumProvident, at which time a representative will begin the claim process. You
will be asked to sign an authorization allowing UnumProvident to obtain
information directly from your medical provider. For more information, call the
Disability Management Office at 215-615-2360.
Long-Term Disability (LTD)
• A non-flex benefit and will not appear as an option for enrollment on the
EnrollOne website.
• Provides you with income if you are not able to work due to a non-workrelated
illness or injury that extends beyond the later of 26 weeks or the
exhaustion of your STD benefit.
• Provides a UPHS-paid core benefit of 60% of base pay to a maximum of
$10,000 per month.
• Full-time employees that have worked one continuous year are eligible for
LTD benefits.

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Welcome > Legal Notices
Legal Notices
The following legal notices are included in this guide to inform you of your rights
under federal law. The chart includes brief descriptions of each notice. You can
click on a notice to learn more.
Notice
Mastectomy Services
Michelle’s Law
Notice of Privacy Practices
Employees Eligible for Medicare
Medicaid and Children’s Health
Insurance (CHIP) Participants
Medicaid CHIP Notice: States
This Notice Describes …
Your right to receive coverage for breast reconstruction and
related services.
Information about Extended dependent coverage for students on
medical leave.
How medical information about you may be used and disclosed
and how you may get access to your medical information.
Information about your current prescription drug coverage with
UPHS and prescription drug coverage if you are enrolled in or
Medicare eligible. It also explains the options you have under
Medicare prescription drug coverage and can help you decide
whether or not you want to enroll.
How to request a special enrollment if you or your family
member(s) lose Medicaid or CHIP coverage.
A list of Medicaid and/or CHIP programs available by state.

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Welcome > Legal Notices
Women’s Health and Cancer Rights Act Notice
The Women’s Health and Cancer Rights Act of 1998 requires that all UPHS
medical plans cover the following medical services in connection with coverage
for a mastectomy: reconstruction of the breast on which the mastectomy has
been performed; surgery and reconstruction of the other breast to produce a
symmetrical appearance; and prostheses and physical complications in all
stages of mastectomy, including lymphedemas.
These services shall be provided in a manner determined in consultation with the
attending physician and the patient. Coverage for these medical services are
subject to applicable deductibles and coinsurance amounts.
Michelle’s Law
Effective January 1, 2010, if your child loses his or her status as a full-time
student (for example, takes a leave of absence or changes to part-time status)
because of a serious illness or injury, he or she may continue to be covered
under the UPHS health care plans. Coverage can continue for up to 12 months
from the date of the change in student status, unless your child loses eligibility for
another reason, such as reaching the plan’s age limit.