UPHS_Enrollment_Flipbook_Print_Version

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UPHS realizes that certain life events may change your need for benefits during the year. Youmust experience one of these events called a Qualified Life Event to change your benefitsafter your initial enrollment or outside of the annual Open Enrollment period.Life Events include but are not limited to a change in:• Legal marital status,• Domestic partnership,• Birth or Adoption,• Employment status; or• Dependent status.If you experience one of these events, you have 30 days from the date of your Life Event to makea change by logging on to the EnrollOne site or by contacting your local Human Resources office.You will also need to provide required documentation. Benefit changes due to a life event areeffective the first day of the month following the date of the life event.Eligible DependentsEligible dependents include:• Your legal spouse or same-sex domestic partner.• Your unmarried or married children until the end of the calendar month of their 26th birthday.• Your dependent disabled children, if disability occurred before age 19.UPHS will extend medical, dental, vision and dependent life insurance coverage to eligiblechildren up to the end of the month in which they turn age 26. If you have a child who previouslyaged out of coverage, or who was not classified as disabled, or a full-time college student, youwill have the opportunity to re-enroll him or her during this year’s Open Enrollment (with properdocumentation).• Children are eligible for medical, dental and vision coverage regardless of their student,marital or IRS dependent status. Employees may buy dependent life insurance for childrenup to age 26, however, the dependent would be not eligible if married.• Children do not have to live with you or depend on you for financial support to be eligible.• Children over age 19 no longer have to be full-time college students to remain on coverage.• The coverage does not extend to your child’s spouse/partner or children.• Eligible expenses incurred by children up to age 26 can be reimbursed from your HealthCare Flexible Spending Account.7
Medical BenefitsYou 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 aUPHS provider or facility, however, the PPO, www.ibx.com,KPOS, www.ibx.com and QPOS, www.aetna.com plans havelarge carrier networks.PENNCare provider directoriesand carrier network listings areavailable online.http://www.pennmedicine.org/penncarenetwork/Keep in mind that in the KPOS and QPOS plans, your Primary Care Physician manages all of yourin-network care, including referring you to specialists and network facilities (for example, laboratorytesting).When you enroll in a medical plan, you will automatically receive behavioral health benefits,provided through PENN Behavioral Health. You do not have to get a referral from your primarycare physician before receiving care.Behavioral Health benefits include:• Individual, group and family therapies,• Medical evaluations,• Crisis intervention, and• Inpatient and outpatient care for the treatment of emergent and acute cases.Treatment facilities are conveniently located throughout the Delaware Valley and your healthinformation is strictly confidential. You may call 888-321-4433 for assistance and a qualifiedcounselor will provide you with all of the options available for you and your dependents.PENNCare PPOHow to Access CarePENNCare PPOContact PENNCare PPO Provider at 215-241-2990 or 800-841-1992PENNCare Network Personal Choice Out-of-NetworkGo to any PENNCareproviderGo to any PersonalChoice providerReferrals Needed No No NoAnnual Deductible and NoneCoinsuranceOutpatient Office VisitHospital InpatientFor all plans, Pavilion iscovered for an additionalfee.$10 Primary Care orSpecialist visitCovered at 100%None; 80% coinsurancefor other services asnoted$25 Primary Care/$35Specialist visitCovered at 100% aftercopayment ($500 peradmission)Go to any qualifiedprovider$300/person$600/familyPlan pays 70% UCRafter deductibleDeductibles andcoinsurance applyCovered at 70% afterdeductible8
Page 2 and 3: Table of ContentsEnrolling for Bene
Page 4 and 5: Quick Checklist for Enrolling Go th
Page 6 and 7: • Outpatient surgery: $100 copay
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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