PennCare/Personal Choice Preferred Provider Organization (PPO)

Administered by Independence Blue Cross, this plan doesn’t require a Primary Care Provider (PCP) or referrals. You can go to any provider, but your out-of-pocket costs are based on the type of provider you use:

PennCare Network Providers

When you use health care providers who are part of, or affiliated with, the UPHS network:

• Preventive care services are covered at 100%.
• Most other services are covered at 90% after a deductible; you pay only 10% of the covered charges.

Personal Choice Preferred Providers

When you use health care providers who are part of the Personal Choice network:

• Preventive care services are covered at 100%.
• Provider office visits are covered at 100% after copays.
• Most other services are covered at 80% after a deductible; you pay 20% of the covered charges.

Non-Preferred Providers

When you use health care providers who aren’t part of the PennCare or Personal Choice networks:

• Most services are covered at 60% after a deductible.
• You pay 40% of the covered charges.

Aetna Choice Point-of-Service (POS) II

Administered by Aetna, this plan doesn’t require a Primary Care Provider (PCP) or referrals, even when using in-network providers. You can go to any provider, but your out-of-pocket costs are based on the type of provider you use:

In-Network Providers

When you use health care providers who are part of the Aetna Choice POS II network:

• Preventive care services are covered at 100%.
• Provider office visits are covered at 100% after copays.
• Most other services are covered at 80% after a deductible; you pay 20% of the covered charges.

Out-of-Network Providers

When you use health care providers who aren’t part of the Aetna Choice POS II network:

• Most services, including preventive care, are covered at 60% after a deductible.
• You pay 40% of the covered charges.

Keystone/Amerihealth (HMO)

This is a Health Maintenance Organization HMO administered by Keystone Health Plan East / Amerihealth You must pre-select and coordinate your care through a Primary Care Provider (PCP) and obtain referrals when you go to specialists.  Your providers must be part of the HMO network and you must live in a covered service area to be eligible for this plan.  Most services are covered at 100% after applicable copays:

• You must use providers in the HMO network.
• You must select a PCP and obtain referrals to see other network providers for care.
• Most services are covered at 100% after applicable copays.
• You must live in a covered service area.

Medical Plan Options: Retirees/Dependents Age 65 and Over

The medical plan options available to retirees and dependents age 65 and over are listed below. For detailed information about these plans, please see the Medical Plan Comparison Chart for retirees age 65 and over. Retirees and dependents age 65 and over who elect medical coverage through Penn have options regarding prescription drug coverage.

Aetna Medicare Plan (PPO)

This is a Medicare-Advantage (PPO) plan administered by Aetna. You may use any provider you wish, and you do not need to select a Primary Care Physician (PCP) or obtain referrals. Benefits differ according to the health care provider you use. If you use health care providers who are part of the Aetna Medicare network, most services are covered at 100% after applicable copays. If you use health care providers who are not part of the Aetna Medicare network, most services are covered at 80%.

Independence Blue Cross (IBC) Medigap Security 65: Standard and Premium Plans (Medicare Supplement Plans)

The IBC Medigap Security 65 plans combine the benefits of traditional Medicare and features of a private health plan by helping to pay expenses that Medicare doesn’t fully cover, such as copayments and coinsurance. These plans offer freedom and flexibility with no referrals and virtually no claim forms. They also provide coverage for services when traveling throughout the U.S. and emergency coverage when traveling outside of the U.S. You may choose between the Standard and Premium plans. The Standard plan offers a lower premium, but higher out-of-pocket costs. The Standard plan has a $20 copay for office visits and a $50 copay for the emergency room (waived if admitted), but there are no copays for the Premium plan.

Coordination with Medicare (Medicare-Eligible Retirees/Dependents)

Retirees and dependents who are Medicare-eligible must be enrolled in Medicare Parts A and B in order to enroll in a Penn medical plan for Medicare-eligible retirees/dependents. Penn’s medical plans are secondary to Medicare. You should apply for Medicare at your local Social Security office 90 days prior to reaching age 65 in order to give Social Security time to process the application. Contact the Social Security Office directly for more information.

Retirees age 65 and over with dependents who are not eligible for Medicare should note that your dependents will be enrolled in a pre-65 retiree medical plan until becoming eligible for Medicare. Then the dependents must enroll in Medicare Parts A and B and you must select a Medicare-eligible plan for them. Social Security should be contacted 90 days prior to the dependent’s 65th birthday to avoid coverage delays and late enrollment penalties.

Medicare Part A

Eligibility for premium-free Medicare Part A starts when you are: (1) age 65 or over and (2) eligible for Social Security. If you are receiving Social Security, enrollment in Medicare Part A is automatic. If you are eligible for Social Security but have opted not to start receiving the benefit, perhaps because you have decided to continue working, you may still enroll in Medicare Part A. This enrollment establishes your entitlement with the Social Security Administration (SSA).

Medicare Part B

If you are covered by a group health plan sponsored by your employer or your spouse/partner’s employer while either of you are in active employment, you need not enroll in Medicare Part B. When you enroll in Medicare Part A, you must notify the SSA that you want to decline Part B because of your coverage. When your coverage ends under the group health plan, the SSA will allow you to sign up for Part B during a Special Enrollment Period without any penalty.

As part of the application for enrollment, you will need to complete the Medicare Request for Employment Verification form at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.PDF. You can contact our office at HRBenefits@hr.upenn.edu to request the completion of the employer portion.