benefits - yeshiva university 2020 oe... · 4 what benefits are new for 2020? (cont.) •hsa and...

2020BENEFITS

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Welcome to Open Enrollment!

• Open enrollment runs November 6th – November 25th

• During this time you can enroll for benefits effective January 1, 2020

– December 31, 2020.

• This is a passive enrollment – if you take no action, your current

elections and covered dependents will automatically continue in

2020, except for FSA and commuter plans elections which you must

re-enroll in every year.

• Note: you can elect, stop, or change your commuter election at any time.

• Enrollment is completed online in Benefitfocus. Refer to the 2020

Benefits enrollment Guide for instructions.

• After the open enrollment period, you will not be able to make any

changes to your elections until next year’s open enrollment, unless

you experience a qualifying life event during the year (marriage,

birth of a child, etc.).

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What Benefits Are New For 2020?

• Medical coverage with Aetna

• Medical plans are the same as today: EPO with HRA, PPO

with HRA, and HDHP with HSA

• Vision continues to be included as part of the medical plan.

• The HRA accounts can now be used towards deductible

expenses, coinsurance, and copays. It can also now be used

for dental and vision expenses.

• Dental coverage with Aetna

• Dental continuing to offer DPPO, and DHMO (copay plan).

• DPPO has an increased annual maximum & orthodontia

maximum of $2,000

Details can be found in the 2020 Benefits Enrollment Guide

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What Benefits Are New For 2020? (cont.)

• HSA and HRA administration with PayFlex• All employees who enroll in medical will receive a PayFlex debit card,

for easy access to your HRA or HSA funds.

• All funds you have accrued in your current HRA or HSA will

automatically roll over into your new PayFlex account.

• Unused HRA funds with Empire will roll over some time in April 2020.

• If you have an HSA account balance at year end, you can roll over to

your new PayFlex HSA account. More information will be sent by the

Benefits Office to employees who have an active HSA account.

• All base funding amounts remain the same as today.

• If you completed both your annual physical and the Empire BCBS

online health assessment in 2019, you will receive the Healthy

Incentive Contribution into your 2020 PayFlex HRA/HSA account.


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• Life, disability, leave administration, and EAP services

with Lincoln Financial

• Plans offered are the same: employer-paid life, voluntary

life, voluntary short-term disability, long-term disability, EAP.

• During this year’s open enrollment, you can elect voluntary

life coverage up to the guarantee issue amount without

submitting ANY evidence of insurability.

• Your current elections will automatically carry over into

2020, unless you actively elect to increase, decrease, or

cancel your coverage.


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• Two new voluntary benefits:

PrivacyArmor Plus

• Identity protection services, including identity monitoring

and alerts, full-service remediation, and more.

• Enroll during the Open Enrollment period.

StuLo

• Student loan assistance and financial wellness services,

including loan consolidation, loan modification, income-

based repayment, public service loan forgiveness, and credit

repair services.

• Enroll starting January 1, 2020.


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What Benefits Are The Same As Today?

• WageWorks continues to administer the Health

Care FSA, Dependent Care FSA, Commuter/Transit,

and Parking Plans

• Health Advocate employee advocacy services

• Other voluntary benefits

• Aflac accident & critical illness, pet assure (veterinary

discount plan), long-term care, discount auto &

homeowners, retirement plan, tuition remission program


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Do I Need To Take Action During OE?

• If you do not take any action during this OE timeframe, all your

current elections, except FSA and commuter plans, will automatically

roll over into the new plan year.

• FSA and commuter plan(s) enrollees must actively re-enroll in these

benefits every year, even if you want to keep the same contributions.

• If you plan to enroll in any new benefits, or discontinue any benefits,

you must make those changes during OE.

• If you wish to take advantage of the voluntary life open enrollment,

you must do so during this OE period.

9©2019 Aetna Inc.

Your goals lead the wayYeshiva University

Understand your health benefits and take us along for the journey

10©2019 Aetna Inc.

Agenda

• Aetna Concierge

• Your Aetna Medical Networks

• Medical and Pharmacy Plans

• Ensuring a Smooth Transition to Aetna

• CVS minute clinics

• Telemedicine

• Dental

• Website and Mobile app

11©2018 Aetna Inc.

Aetna Concierge: Your personal health care assistant

Your designated Concierge Phone Number is: 855-333-6825

• This number will appear on member’s ID cards. • Your Concierge is available Monday through Friday from: 8am-6pm.

Your concierge will: • Walk you through tools to help you make educated decisions

• Find network providers based on your medical needs • Help you schedule appointments

Getting to know your plans

13©2019 Aetna Inc.

Get the coverage you need with theAetna Choice® POS II health plan

In-network and out-of-network care

No referrals requiredPre-approval for

some servicesLower out-of-pocket

costs forin-network care

100% preventive care

Check the plan design and benefits summary for more information on coverage and costs.

14©2019 Aetna Inc.

Get the coverage you need with theOpen Access Aetna Select health plan

In-network care No referrals requiredPre-approval for

some servicesYou may have lower

out-of-pocket costs when visiting

your PCP

100% preventive care

Check the plan design and benefits summary for more information on coverage and costs.

15©2018 Aetna Inc.

Simplifying your search: Find Medical Provider

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Visit www.aetna.com/docfind1. Enter your zip code, city, state, or

county then click search. 2. Choose the appropriate plan from

the “Select a Plan” drop down menu:

Aetna Open Access Plans: Aetna Choice POS II

Aetna Open Access® Aetna Select

3. Type in what you are looking for. (examples could be primary care physicians or Specialists)

http://www.aetna.com/docfind

16©2019 Aetna Inc.

The 3 Plans Available and Their Accounts

▪ Open Access Aetna Select

▪ In-network care

▪ Tied to a HRA account

EPO Plan

▪ Aetna Choice POS II

▪ Both in-network and out-of-network care

▪ Tied to a HRA account

PPO Plan

▪ Aetna Choice POS II

▪ Both in-network and out-of-network care

▪ Eligible to open a HSAaccount

HDHP Plan

17©2019 Aetna Inc.

EPO Plan: How it works

Plan Features In Network(no out-of-network coverage on this plan)

Deductible $1,500 Individual / $3,750 Family

Co-Insurance 20%

Out of PocketMedical Copays Apply towards the out-of-pocket maximums

$3,500 / $8,750Medical deductibles apply towards the out of pocket maximums

Primary Care Office Visit $25 copay

Specialist Care Office Visit $50 copay

Preventative Care Covered at 100%

Urgent Care $50 copay

Teladoc $25 copay

Emergency Room $250 copay (co-pay waived if admitted)

Inpatient / Hospital 20% After Deductible

Outpatient Surgery 20% After Deductible

Diagnostic Screenings 20% After Deductible

18©2019 Aetna Inc.

PPO Plan: How it works

Plan Features In Network Out of Network

Deductible $1,500 Individual / $3,750 Family $4,500 Individual / $11,250 Family

Co-Insurance 20% 40%



$10,500 / $25,500Pharmacy copays and co-insurance apply towards the out-of-pocket maximums

Primary Care Office Visit $25 copay 40% After Deductible

Specialist Care Office Visit $50 copay 40% After Deductible

Preventative Care Covered at 100% 40% After Deductible

Urgent Care $50 copay 40% After Deductible

Teladoc $25 copay N/A

Emergency Room $250 copay (co-pay waived if admitted) $250 copay (co-pay waived if admitted)

Inpatient / Hospital 20% After Deductible 40% After Deductible

Outpatient Surgery 20% After Deductible 40% After Deductible

Diagnostic Screenings 20% After Deductible 40% After Deductible

19©2019 Aetna Inc.

HDHP Plan: How it works

Plan Features In Network Out of Network

Deductible $2,600 Individual / $6,500 Family $4,500 Individual / $11,250 Family

Co-Insurance 20% 40%



$10,500 / $25,500Pharmacy copays and co-insurance apply towards the out-of-pocket maximums

Primary Care Office Visit 20% after deductible 40% After Deductible

Specialist Care Office Visit 20% after deductible 40% After Deductible

Preventative Care Covered at 100% 40% after deductible

Urgent Care 20% after deductible 20% after deductible

Teladoc 20% after deductible N/A

Emergency Room 20% after deductible 20% after deductible

Inpatient / Hospital 20% After Deductible 40% After Deductible

Outpatient Surgery 20% After Deductible 40% After Deductible

Diagnostic Screenings 20% After Deductible 40% After Deductible

20©2019 Aetna Inc.

Pharmacy Coverage On Each Plan

Plan Features EPO Plan PPO Plan HDHP Plan

RX – Preferred Generic Drugs Retail: $7.50 copayMail Order: $15 copay

Retail: $7.50 copayMail Order: $15 copay

Retail: 20% After DeductibleMail Order: 20% After Deductible

RX – Preferred Brand Name Drugs

Retail: 20% ($60 max)Mail Order: 20% ($120 max)



RX – Non-Preferred Generic & Brand Name




Out-of-Network pharmacy is not covered on any of the medical plans. This is the same set up as today.

21©2019 Aetna Inc.

Routine eye exam

Standard plastic lenses

Standard progressive lenses

In-network Care Out-of-network care

Vision coverage that gives you a better look at health

Standard polycarbonate lenses

Contact lenses allowance*

Frames allowance

Vision Plan

$10 copay $25 allowance

$25 copay

$25 copay

$25 copay

Up to $130 (20% discount on remaining balance)

Up to $130 (15% discount on remaining balance)

[*Medically Necessary contact lenses covered in full in-network, and $200 allowance out-of-network]

$10 allowance

$25 allowance

$55 allowance

$65 allowance

Allowance $90 conventional / $104 disposable

Aetna’s vision network is the same network you have today! The network includes

over 97,000 providers, and national retail chains.

https://www.pearlevision.com/

22©2019 Aetna Inc.

Ensuring a Smooth Transition

Re-submit any approvals / prior authorizations

If you have a scheduled procedure on or after January 1st, 2020 that required prior authorization with your former

carrier (Empire BCBS), you need to work with your provider to have that approval re-submitted and authorized with

Aetna. Engage in this process with Aetna starting any time on or after January 1st, 2020.

This also applies to any medications you take that require prior authorization. If they were previously approved with

Empire BCBS, you need to have these re-authorized with Aetna in 2020.

Show your new Aetna ID Card to your doctor(s) and pharmacist

You will receive a new ID card from Aetna by January 1st. Be sure to throw away your Empire ID card and use your Aetna

ID card for all medical and pharmacy claims.

Make sure you show your new ID card to your pharmacist – they will not typically ask for your new card and this can

lead to your pharmacy claims being incorrectly denied.

Need assistance? Call Aetna Concierge!

855-333-6825

Transition of Care (TOC) available for those in active course of treatment

You can visit your Aetna member website

or call member services to:

• Get a TOC form

• Get help completing and submitting the form

TOC is temporary, usually 90 days, as we

transfer services

from a nonparticipating provider or primary

care physician to

a participating provider.

24©2019 Aetna Inc.

Pharmacy with CVS Caremark®

Your retail pharmacy network is CVS Caremark ®

But you are not restricted to only using CVS as your retail pharmacy. In addition to CVS

Pharmacy, many major pharmacy chains – including Walgreens, Giant, Safeway, Wegmans,

and others – are also considered in-network.

To locate an in-network pharmacy near you, use the “Locate a Pharmacy in Your Area” tool

posted on info.caremark.com/fcps.

Mail order pharmacy with CVS Caremark ®

Receive a 90-day supply of your maintenance medicine(s) sent directly to your home by

using CVS Caremark® Mail Order Pharmacy. Here’s how to get started:

1. Ask your doctor for your prescription. Your doctor can e-prescribe it to us, or we can

call your doctor for you

2. Request home delivery by visiting aetna.com or print an order form and send it to

Aetna (address is on the form)

3. Get refills your way – online, by phone, or by mail.

Change Your Mail Order Service ToCVS Caremark ®

If you currently use a mail-order

medication with a service that is not

CVS Caremark®, call your provider

and request that your mail order

prescription be sent to your new

mail-order pharmacy CVS

Caremark®.

You can also call Aetna and request

Aetna reach out to the provider on

your behalf.

Need assistance?

Call Aetna Concierge!

855-333-6825

Your pharmacy formulary is the Aetna Standard Formulary. Locate the formulary online at aetna.com

25©2019 Aetna Inc.

Care when you need it at MinuteClinic® locations

Wide range of services

Prescriptions

Care when you need it

Family coverage

MinuteClinic® health care providers treat and diagnose a variety of illnesses, injuries and conditions.

The providers in MinuteClinic® can write prescriptions, when medically appropriate.

MinuteClinic® locations are open 7 days a week, including evenings. You can walk in or schedule appointments online beforehand.

Your covered family members can take advantage of this MinuteClinic benefit.

MinuteClinic® is a walk-in clinic inside select CVS Pharmacy and Target stores, and is the largest provider of retail healthcare in the United States, making it easy to access care in your neighborhood. It’s as simple as going to your

local MinuteClinic® and receiving care.

26©2019 Aetna Inc.

24/7 access to a doctor by phone or video Talk to a doctor anytime, anywhere

Download the app: Teladoc.com/aetna

Call 1-855-TELADOC

“Teladoc is a godsend for

anyone who has spent 3 hours in a

waiting room for something that

can be resolved with a simple phone

call in minutes. I love bragging to my

friends that I have Teladoc.”

-Teladoc member

Talk to a doctor

in minutes*

Available anytime,

anywhere*

$40 or less

per visit

27©2018 Aetna Inc. 27

800-556-1555

Informed Health Line

Free as part of your Aetna medical benefits. Our team of nurses will save time and money by answering your health-related questions over the phone and online:

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24/7 registered nurse support via phone or email

Personal database for additional health and wellness information

Video library enables you to learn at your own pace

28©2018 Aetna Inc.©2018 Aetna Inc.

Behavioral Health Telemedicine

Aetna is making it easier to access behavioral health care.

Teladoc

• Comprehensive solution with integrated tele-video services for medical and behavioral health

Tele-video

• National and regional partners which includes Inpathy for the New York tri-state area.

Call Inpathy at 800-442-8938

29©2019 Aetna Inc.

Two Dental Plans

▪ In-network and out-of-network care

▪ Coinsurance Plan

DPPO

▪ In-network care

▪ Copay Plan

DHMO

30©2019 Aetna Inc.

In-networkVisit a dentist in the Aetna Dental PPO network

To find one, use our online directory at aetna.com.

Your options How it works

*State laws vary with regard to out-of-network benefits. In Illinois, DMO plans provide limited out-of-network benefits. In Virginia, the DMO plan is known as the DNO Plan (Dental Network Only). In order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO. The DNO plan in Virginia is not an HMO.

In-network or out – it’s your choice

Out-of-network

Visit any licensed dentist outside the network

• Network dentists offer special rates for covered services. So your share of the cost is usually lower.

• Network dentists file claims for you.

• You may pay more when you get care from dentists who aren’t in the network

• You may have to file your own claims.

Easy-to-use coverage withthe Aetna Dental® PPO* plan

31©2019 Aetna Inc.

Annual deductible

Annual benefits maximum

Preventive services

In-network Care Out-of-network care

Dental benefits you can “sink your teeth” into

Basic services

Orthodontic services*

Major services

Orthodontic lifetime maximum

$100 individual / $300 family

[*Available only for adults and children]

$100 individual / $300 family

$2,000 per person $2,000 per person

100% no deductible 100%

80% 80%

50% 50%

50% 50%

$2,000 per person $2,000 per person

Dental DPPO Plan

32©2019 Aetna Inc.

No deductible, claim forms or yearly dollar limits

What to do

In-network

Pick a primary care dentist (PCD) from the Aetna network.

To find one, use our online directory at aetna.com.

Visit your PCD.

Visit a PCD in the Aetna DMO network*

Note: DMO is not available in the following states: AK, AL, AR, LA, ME, MS, MT, ND, NH, PR, SC, SD, VT, WY.

*State laws vary with regard to out-of-network benefits. In Illinois, DMO plans provide limited out-of-network benefits. In Virginia, the DMO plan is known as the DNO Plan (Dental Network Only). In order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO. The DNO plan in Virginia is not an HMO.

• See your PCD for regular exams and to get referrals if you need specialty care.

• Covered family members can choose their own PCDs.

• You can change your PCD once a month on your member website. Switch by the 15th day of the current month. The change will start the first day of the next month

• Check your benefits summary so you’ll know what to pay.

• Give your personal information at your visit.

• Pay your share of the cost

Easy-to-use coverage withthe Aetna Dental® DMO®* plan

How it works

33©2018 Aetna Inc.

to help our members

achieve their personal

health ambitions on

their terms

We are focused on making

health care easy to

understand and navigate,

leading to a

great experience, improved

health and lower costs

Aetnais on a mission

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Aetna Health is delivering on this mission

Single digital front door with personalized real time information, tools, and guidance helping our members manage their health where, when, and how they want

34©2018 Aetna Inc.

We makeit easy to

keep track of your benefits

With the Aetna HealthSM app,you can manage your benefits all in one place.

Manage benefits, view and pay claims

View progress toward your deductible

Find a doctor or urgent care center

Get cost estimates before you get

care

Schedule doctor appointments

Apple, the Apple logo and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service

mark of Apple Inc. Google Play and the Google Play logo are trademarks of Google LLC.

App screens are a composite of real situations. All names and other identifying information are fictional.

TipYou can access your ID card anytime on your phone using our Aetna Health app.

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