IMPORTANT INFORMATION REGARDING
THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA)
Effective January 1, 2014 under the Patient Protection and Affordable Care Act (ACA) all individuals and their family members are required to obtain health insurance or they may be subject to a tax penalty.
The health plan options listed here are provided to you, as an eligible participant in the University of Pennsylvania benefits program, and to your eligible dependents in accordance with Penn’s obligation under Employer Shared Responsibility provisions of the ACA.
It is important to remember that if you waive your University coverage, you are still responsible for obtaining coverage through some other source, such as a spouse or domestic partner’s plan or your parent’s plan (if you are under age 26); or you can obtain coverage via the Health Insurance Marketplace.
Beginning with your 2014 tax filing, you will be required to report to the IRS that you have coverage, whether through the University or some other source. For the 2015 tax year, the University will provide you with the required form (1095-C) in time for your tax filing. The 1095-C form will confirm that you were offered the minimum level of coverage each month and whether you elected the coverage or waived this coverage.
Please take note of the following changes for the 2015–2016 plan year.
Prescription Carrier Change
Penn’s prescription drug carrier will change from Express Scripts to CVS/caremark. You can fill your prescriptions at CVS pharmacies as well as a wide network of non-CVS pharmacies.
You will receive a new ID card and a new member number. Look for your new card in mid-June. To ensure that your claims are processed correctly, it’s very important that you present this new card and ID number to your pharmacy. Please be sure to destroy your old card after June 30, 2015.
Maintenance medication and the 90-day retail pick-up option will only be available at CVS pharmacies. You may also use the CVS/caremark Mail Service pharmacy to receive your maintenance medications at your address of choice.
Effective July 1, 2015, the generic copay minimum and maximum will change from $5 min/$20 max to $7.50 min/$20 max for retail scripts, and from $10 min/$40 max to $15 min/$40 max for mail service scripts. The minimum and maximum copay for brands with no generic equivalent will change from $15 min/$75 max to $15 min/$100 max for retail scripts.
You’ll receive more details about the switch to CVS/caremark in future communications from Penn and CVS/caremark.
Health Care Flexible Spending Account Limit Increase and Rollover
The Health Care Flexible Spending Account (FSA) limit has increased from $2,500 to $2,550. If you want to increase your FSA savings to the new $2,550 limit, you must do so during open enrollment.
Remember, the IRS has relaxed the “use it or lose it” rule. Instead of losing all unspent money in your Health Care FSA at the end of the plan year, you’re able to protect up to $500 by rolling it over to the following year. Note that rolling over funds does not impact your maximum election for the following plan year. Keep in mind that the rollover rule only applies to the Health Care FSA. Participants in the Dependent Care FSA cannot roll over any unused funds.
PennCare Personal Choice
The PennCare/Personal Choice PPO plan deductibles will increase as of July 1, 2015. Under the PennCare tier, the individual deductible will increase from $100 to $125, and the family deductible will increase from $300 to $375. Under the Personal Choice tier, the individual deductible will increase from $250 to $300 and the family deductible will increase from $750 to $900.
As of July 1, 2015, the deductible, copays, and coinsurance will count toward the out-of-pocket maximum. Currently, copays do not count toward the maximum.
As of July 1, 2015, both the copay out-of-pocket maximum and coinsurance/deductible out-of-pocket maximums will combine to a single out-of-pocket maximum of $1,200 individual/$2,400 family.
Aetna POS II
Laboratory/pathology coverage will change from 20% coinsurance after deductible to a $30 copay.
X-rays/radiology coverage will change from 20% coinsurance after deductible to a $40 (routine) copay or $100 (complex) copay.
Effective July 1, 2015, MetLife will provide orthodontic coverage for adults. The out-of-pocket lifetime maximum orthodontia coverage per child and adult will increase from $1,000 to $1,500. Limited dental implant coverage will now be provided at 50% but not to exceed the cost of a bridge.
During Open Enrollment you need to determine if your current benefits still meet your needs or if you need to make a change, such as:
- Enrolling in a health care plan for the first time, or dropping an existing plan.
- Switching to a different medical, dental or vision plan.
- Increasing or decreasing your life insurance coverage.
- Changing how much you contribute to a flexible spending account.
- Adding or dropping a dependent from your benefits coverage*.
* If you add a new dependent, you’ll receive a letter requesting that you provide verification of that dependent’s eligibility under Penn’s plan rules. You’ll also need to provide verification if you re-enroll a spouse/partner who had previously been covered.
You’ll be able to make your Open Enrollment elections from Monday, April 20 through Friday, May 1.
Just visit the online enrollment system and use your PennKey and password to log on. If you don’t have online access, you can contact the Penn Benefits Center at 1-888-PENN-BEN (1-888-736-6236), Monday through Friday, between 8am and 6pm EST and complete your enrollment over the phone.
If you don’t make changes during Open Enrollment, you’ll receive the same coverage you had last year.
Your contributions for medical, dental, vision, and the flexible spending accounts are made with pre-tax dollars. You pay for employee and dependent life insurance with after-tax dollars. All contributions are taken from your paycheck in the month for which your benefits are effective. Your pay must support your contributions for the benefits elected. If that is not the case, then your enrollment cannot be processed.
Any changes made during Open Enrollment will be effective as of July 1, 2015. New rates for all plans will begin with your July 2015 paycheck.
Outside of Open Enrollment, you may only modify your elections when you experience a life event change—such as marriage or the birth of a child—and even then, the IRS limits the types of changes you are allowed to make.
Several Open Enrollment presentations will be held in the spring of 2016 so you can get more information and ask questions.
Download and view the presentation for Open Enrollment 2015-2016.
Attend a Fair
Representatives from Penn’s health care providers and administrators will be onsite to share information and answer questions. Learn about medical plans, prescription drug coverage, dental plans, vision coverage, flexible spending accounts and the Penn Benefits Center. At the Open Enrollment and Wellness Fair, you can also take advantage of free health screenings and wellness information on several topics.
If you don’t have internet access at home or at work, don’t worry—log on to manage your benefits at one of these convenient locations:
Goldstein Undergraduate Study Center
3420 Walnut Street (ground level of Van Pelt Dietrich Library)
Monday–Thursday: 24 hours daily
Friday: closes 12 midnight
Sunday: opens 10am
3401 Walnut Street
3624 Market Street
If you’re newly eligible for benefits or you experience a qualifying life event between now and June 1, 2015, you’ll need to enroll twice: once to elect or change your benefits for the current plan year (through June 30, 2015), and then again to elect your coverage for the 2015-2016 plan year (starting July 1, 2015).
Stay up to date on the latest Open Enrollment information by: