UPHS_Enrollment_Flipbook_Print_Version

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Quick Checklist for Enrolling Go through the entire E-Book carefully, including the medical, dental and vision plan charts. Review the 2011-2012 Employee Contributions by visiting EnrollOne atwww.enrollone.com/uphs. Enroll for benefits online by visiting EnrollOne at www.enrollone.com/uphs. Review your confirmation statement which reflects your benefit elections for the 2011-2012plan year. If any information is incorrect, access EnrollOne at www.enrollone.com/uphs tomake corrections by the deadline noted on your confirmation statement. Name a beneficiary for your life insurance benefits. If you are enrolling your dependents, you need to provide their correct Social Security numberat the time of enrollment. If you have any questions, please contact the UPHS Benefits Office at 215-615-2675 andselect the option for Benefits.3
What’s New for 2011-2012UPHS is proud to offer affordable, competitive and flexible benefits for our employees. The goodnews is that most of your benefits are staying the same.Health Plan Changes• Eligibility ─ Dependent children covered up to age 26 (with some restrictions) for the medical,dental and vision plans.• Preventive care services in the medical plans are covered at 100% with no copay. Please seethe Appendix beginning on page for a list of included preventive services.• The lifetime limit on benefits has been eliminated.• Remember, over-the-counter drugs are no longer eligible for reimbursement under the HealthCare Flexible Spending Account, unless you have a prescription from your doctor.• Employees making $110,000 or more will only be able to contribute a maximum of $1,700 thisplan year to a Dependent Care FSA to meet IRS regulations.Medical Plan ChangesWhen you use a UPHS facility or provider you will pay less out of pocket. Therefore we encourageyou to use a UPHS provider. We have changed some of the carrier network copays to support thatgoal.Since there will be some carrier network copay changes, new medical ID cards will be issued to allcovered employeesPENNCare PPOThere are no changes to benefits when you use a PENNCare Network doctor or facility. Thefollowing changes apply when you use a provider from the Personal Choice Network.• Office visit copays; $25 PCP/$35 Specialist• Inpatient services: $500 per admission• Outpatient surgery: $125 copay• Radiology: $30 copay• Emergency room care: $100 copay• Urgent Care Centers: $50 copayKeystone POS (KPOS) and Aetna QPOS (QPOS)There are no changes to benefits when you use a PENNCare Network doctor or facility. Thefollowing changes apply when you use a provider from the Keystone or Aetna network.• Office visit copays: $25 PCP/$35 Specialist• Inpatient services: $500 per admission4
Page 2 and 3: Table of ContentsEnrolling for Bene
Page 6 and 7: • Outpatient surgery: $100 copay
Page 8 and 9: UPHS realizes that certain life eve
Page 10 and 11: Emergency Room$25 (waived ifadmitte
Page 12 and 13: Carewise Health ProgramsCarewise He
Page 14 and 15: Dental BenefitsYou can choose from
Page 16 and 17: IBC Davis Vision Premium PlanHow to
Page 18 and 19: Keep in mind that elections do not
Page 20 and 21: Eligible Dependent Care ExpensesYou
Page 22 and 23: Short-Term DisabilityShort-Term Dis
Page 24 and 25: Adoption ReimbursementThe financial
Page 26 and 27: Prescription Drugs• The U.S. Food
Page 28 and 29: Enrolling OnlineHere are the steps
Page 30 and 31: Coverage forPreventive ServicesAs a
Page 32 and 33: Additional covered preventiveservic
Page 34 and 35: Uses and Disclosures for Health Car
Page 36 and 37: Restrictions on Use and Disclosure
Page 38 and 39: Important Notice from the Universit
Page 40 and 41: Medicaid and the Children’s Healt
Page 42: NORTH DAKOTA - MedicaidWebsite:http

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