Benefits Human Resources

• Employees enrolled in the Employee Health Care Plan, their enrolled family members, and anyone else residing in the employee’s home may obtain services through the Employee Assistance Program at no cost
• Coverage includes preventive services covered at 100%, services for family members on the autism spectrum, fertility assistance, and coverage for mental health and substance use disorders.
• The Plan is self-funded by the University. This means that the amount employees and departments pay must be enough to cover all claims and administrative expenses.  The University pays approximately 90% of the cost and employees pay approximately 10%.
• Employee rates are paid through pre-tax payroll deductions.
  • Because a domestic partner is not a recognized dependent under current tax law, the portion of premiums an employee pays for a domestic partner and domestic partner’s children will be paid with after-tax dollars.  In addition, the employee will be taxed on the amount the department contributes for the domestic partner and domestic partner’s children.
• Dental Coverage is available for those enrolled in medical coverage.
  • The dental plan has no pre-existing condition waiting period and no deductible.
  • Covered services are paid based on Regence BlueCross BlueShield’s schedule of eligible dental expenses.
  • Dental network includes ValueCare Dental Providers.

Enroll Through UBenefits

• Initial Enrollment Period – newly eligible employees may enroll during the first 90 days following their date of hire (or transfer from a non-benefitted position to a benefit-eligible position) – coverage begins on the date of hire.
• Open Enrollment – employees may enroll, change plan options, and add or drop dependents during open enrollment in May each year – coverage begins (or changes are effective) on July 1st, the first day of the new plan year.
• Life Change Events – employees may enroll, cancel, or add or drop dependents if they experience a life change event during the plan year.  See Events that Allow Changes to Health Plan and FSA Enrollment for additional information.
• ACA Eligibility – employees in positions that are not benefit-eligible may be able to enroll if they meet the eligibility requirements under the Affordable Care Act.  See Affordable Care Act Compliance below for additional information.

Eligible family members include:

• Your spouse or your eligible domestic partner
  • Your legal spouse (in the state of Utah, a common law marriage must be certified by a court of law)
  • An eligible domestic partner is someone with whom the employee has a partnership that meets the following requirements:
    • Both are over the age of eighteen (18)
    • Reside together in a permanent residence and have done so for at least six months and will remain members of the same household for the period of coverage
    • A serious and committed relationship which they intend to continue indefinitely
    • An emotional commitment to one another
    • Joint responsibility for the common welfare and financial obligations of the household or one is chiefly dependent upon the other for financial assistance
    • Not related in any way that would prohibit legal marriage
    • Not legally married to anyone else or the domestic partner of anyone else
  • Children of the employee, spouse or domestic partner who are under age 26
    • Birth
    • Placement for legal adoption
    • Placement for foster care
    • Legal (court-appointed) guardianship granting full guardianship rights (proof of court-appointed guardianship must be provided to Human Resources)
    • Coverage may be available for a dependent child age 26 or older who has a disability. Complete and submit the Incapacitated Dependent Eligibility Form.
    • Coverage may be continued for a child who turns 26 while enrolled in the plan if the child is a full-time student. Complete and submit the Student Verification Form

Please note:  Because a domestic partner is not a recognized dependent under current tax law, the portion of premiums an employee pays for a domestic partner and domestic partner’s children will be paid with after-tax dollars.  In addition, the employee will be taxed on the amount the department contributes for the domestic partner and domestic partner’s children.

Medical Providers:

• RedMed Employee Health Clinic
• Virtual Visits
• University Health Providers
• University Health Urgent Care Centers
• Regence Network Providers
• Preferred ValueCare Network PDF Directory
• Participating Network PDF Directory

Dental Providers:

• University of Utah School of Dentistry Clinics
• Preferred ValueCare Dental Providers
• Preferred ValueCare Dental Network PDF Directory

Pharmacies:

• University Health Pharmacies
• University Health Specialty Pharmacy
• Participating Pharmacies

Mental Health and Substance Use Disorder Providers:

• Huntsman Mental Health Institute Network Providers
• Call the Employee Assistance Program for a referral to a network provider: (801) 587-9319 or (800) 926-9619.

Providers Outside of Utah:

To find a provider outside the state of Utah, go to Regence's website and without logging into your account, click “Find a doctor” on the top green bar.  The website will then ask you to search for a network by name.

• If you are enrolled in the Preferred ValueCare network, use the National BlueCard PPO network to search for providers outside Utah
• If you are enrolled in the Participating network, use the National BlueCard Participating network to search for providers outside Utah
• To find a dental provider outside Utah, use the Regence Dental network

Update your location at the top of the search page if it does not show the area you wish to search.

For information on coinsurance and out-of-pocket maximum amounts, see the Summary Comparison of Medical and Dental Benefits.

Coverage Highlights:

• If a generic prescription drug is available, but the member chooses to purchase the brand name drug, the plan will pay its share of the generic cost.
• Members will generally pay less if they use a University Health Pharmacy.
• Prescription drug coverage under both options of the Employee Health Care Plan is creditable coverage under Medicare D. Employees and their family members who are eligible for Medicare do not need to enroll in Medicare D coverage as long as they remain enrolled in one of the Employee Health Care Plan options.

Coordination Between Two Plans

• The Employee Health Care Plan only allows coordination of prescription drug benefits when two University employees are both enrolled in the Advantage plan and cover each other and all eligible family members.

Complete the Certification of Dual University Coverage

The cost of prescription medications continues to increase. This means health plan members and the University’s health care plan are paying more for medications. To help save costs, Regence and the University have introduced FlexAccess.

What is FlexAccess?
University health plan members who are taking certain specialty medications are automatically enrolled in the FlexAccess program. This program works with the plan members to find the best manufacturer copay assistance (coupon) discounts for members.

Members enrolled in the FlexAccess program, will pay copays between $0-$35 per eligible prescription. Even if you exhaust the funds awarded to you by the manufacturer, you will continue to pay the reduced copay amount until you are eligible to re-enroll with the manufacturer for additional funding (generally, each calendar year).

NOTE: Not all specialty medications are eligible for manufacturer copay assistance through the FlexAccess Program. For specialty medications that are not eligible through the FlexAccess program members will pay their applicable drug tier copay.

Am I eligible for the program?
FlexAccess is only available to Advantage plan members and is not available for those enrolled in the Consumer Directed Health Plan option. However, if you are on the Consumer Directed Health Plan, you may still use manufacturer copay assistance to help cover the cost of your medications on your own (not through the FlexAccess program).

How do I enroll in copay assistance for my Specialty medication?
Call FlexAccess at 1 (888) 302-3618, Monday-Friday 6am to 6pm MT, to see if your medication(s) is on the list of eligible medication(s) for manufacturer assistance. If your medication is eligible, they will provide you with next steps to enroll with the manufacturer to obtain funding.

Will there be any required steps for me to take to acquire copay assistance through the FlexAccess program?
Some manufacturers will allow the FlexAccess agent to complete the enrollment on your behalf. The FlexAccess agent will be able to advise you on next steps. Some manufacturers require the patient to contact them directly to complete enrollment in their copay assistance program. If this is the case, you will be directed by your FlexAccess agent to contact the manufacturer yourself. Once your copay assistance has been approved, provide that information to your pharmacy.

I am eligible for copay assistance via a debit/credit card, but the card will take several days to receive. How can I get my medication while I wait for the card?
Call FlexAccess at 1 (888) 302-3618 Monday-Friday 6am to 6pm MT. Advise them that you are waiting for your debit/credit card, and they can provide your pharmacy with a temporary one-time override/assistance until the card arrives. If you already have a credit/debit card number provided to you verbally, share this with the pharmacy to process payment for your prescription.

• University Health Pharmacies
• University Health Specialty Pharmacy
• Participating Pharmacies

Employee Assistance Program:

• Employees enrolled in the Employee Health Care Plan and their family members may obtain services through the Employee Assistance Program (EAP) at no cost to the employee.
• Schedule an Appointment by calling (801) 587-9319 or (800) 926-9619.
• The EAP is a confidential counseling service that provides assistance with a variety of personal concerns, including stress, anxiety or depression, personal and emotional issues, marital, relationship and family counseling, grief or loss, substance abuse or other addictions.
• EAP counselors are available during regular and extended hours, and Crisis Line support is available 24/7.
• Blomquist Hale Solutions, a professional EAP firm, provides the EAP services. For detailed information, please see the Blomquist Hale Solutions website at blomquisthale.com.
• When needs exceed the scope of what is typically provided by the EAP, individuals are referred to appropriate behavioral health network providers.
• The EAP practices strict adherence to all professional, state and federal privacy guidelines.

Mental Health and Substance Use Disorder Coverage Highlights:

• Mental health and substance use disorder benefits are managed through Huntsman Mental Health and are processed through University of Utah Health Plans.
• See the Summary Comparison of Medical and Dental Benefits for coverage information.
• Find a Network Provider: call the EAP at (801) 587-9319 or (800) 926-9619

Other Available Options:

• Huntsman Mental Health Crisis Line: (801) 587-3000
• Utah Crisis Line in association with National Suicide Prevention Lifeline:  (800) 273-8255
• Huntsman Mental Health Community Resources
• Safe UT App

Adoption Benefits:

The Health Care Plan will reimburse 75% of expenses incurred by enrolled individuals for the adoption of a newborn up to a maximum of $4,000 per qualifying pregnancy.

An adoption benefit is available, when the following conditions have been met:

• The child is placed for the purpose of adoption within 90 days after the child's birth.
• Coverage is in effect on the date the newborn child is placed for adoption.
• The newborn child is enrolled under the health plan.
• The employee submits a written request for the adoption benefit along with proof of placement for adoption.

Additional details can be found in the applicable Summary Plan Description.

Fertility Benefits:

Surgical and nonsurgical reproductive assistance is included in the Health Care Plan.  No finding of infertility is required.  The benefit can be used for:

• Intrauterine insemination (IUI)
• Ovulation induction
• In vitro fertilization (IVF)
• Frozen embryo transfer
• Purchase of donated eggs, sperm or embryos
• Freezing and storage of eggs, sperm or embryos

Fertility clinics may not be contracted with Regence for services.  In that case, you will need to pay out of pocket for services and request reimbursement.

See Fertility Benefits for additional information and answers to frequently asked questions.

The Health Care Plan covers most gender-affirming procedures defined by the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC), as well as medical care for transsexual, transgender, and gender nonconforming people including:

• Primary care
• Gynecological and urologic care
• Mental health services (e.g., assessment, counseling, psychotherapy)
• Crisis response
• Hormonal and surgical treatments

Some providers may be limited in providing hormonal and surgical treatments by state law.

The Health Care Plan does not limit sex-specific recommended preventive services based on your sex assigned at birth, gender identity or recorded gender.  For example, a transgender man who has an intact cervix is covered for a Pap smear.

For additional information, contact Regence BlueCross BlueShield at (800) 262-9712 and ask to speak to a member of their gender-affirming team or visit Regence’s inclusive health care website.

You should apply for leave under the Family and Medical Leave Act (FMLA) if you will be unable to perform the duties of your job during treatment and your treatment involves:

• Inpatient care;
• Treatment two or more times by a health care provider (within 30 days of the first day of being unable to perform your job duties); or
• One-time treatments which result in a regimen of continuing treatment under the supervision of the health care provider.

Visit the Medical Leaves of Absence website for FMLA information and application forms.

Livongo is available for employees and their enrolled family members who have diabetes.  Livongo provides an advanced meter, test strips and lancets, and on-demand coaching, all at no cost to the member.  Join by clicking register below or call (800) 945-4355 and use registration code: UNIVERSITYOFUTAH.

Register

• When you enroll in the health care plan through UBenefits, you agree to have premiums deducted from your pay pre-tax. This means you are not paying federal, state, or FICA taxes on the amount you pay for health coverage for you and your family members (other than a domestic partner and domestic partner’s children).
• The amount you pay for premiums will be reflected on your W-2 in Box 14 with any amounts you elect for a Health FSA.
• If you are paid through a grant or some source other than payroll or if you are on an unpaid leave of absence, you will need to pay premiums through billing. Email hrbilling@utah.edu for information.  Your department can also submit the Post doc/trainee Benefits Billing Form to set you up on billing or cancel billing when you begin receiving pay through payroll.
• If you are on billing, please sign up for automatic withdrawals from your accounts to make your billing payments by completing the ACH Form.

In the event an individual is covered under more than one health plan, the medical benefits of the health plans will be coordinated (prescription drug coverage is only coordinated between two University plans). The primary coverage is identified by using the first of the following rules which applies (the other coverage is the secondary coverage):

• The health plan which covers the person as the policyholder (e.g., the employee).
• For a child of parents living together, the plan of the parent whose birthday falls earlier in the calendar year.
• For a child of parents not living together,
  • The plan of the parent with custody;
  • The plan of the spouse of the parent with custody;
  • The plan of the parent without custody; or
  • The plan of the spouse of the parent without custody.

For additional information on coordination of benefits, see the applicable Summary Plan Description below under “Legal Plan Documents & Notices” or contact the UHRM at AskHR@utah.edu.

The Summary Comparison of Medical and Dental Options gives a brief summary of the network and plan design options in the Employee Health Care Plan, as well as brief information about covered services and eligibility. The summary contains only a general description of some of the features of the Employee Health Care Plan. The exact details of the Plan are included in the Summary Plan Descriptions.

Summary Plan Descriptions:

The Employee Health Care Plan Summary Plan Descriptions (SPDs) provide detailed information about covered services, eligibility, and claims processing. Links to the SPDs are provided below.  Contact Human Resources at (801) 581-7447 if you need a printed copy of a plan document.

• Advantage Medical and Dental - Preferred ValueCare and Participating (PAR) Networks
• Consumer Directed Health Plan - Preferred ValueCare Network

Summaries of Benefits and Coverage:

The Summaries of Benefits and Coverage (SBCs) describe each Network/Plan Design Option in a standard format created by the Department of Labor.  This standard format is designed to allow individuals to compare certain coverage details among a variety of different plans.

• Advantage – Preferred ValueCare
• Advantage – PAR
  
• Consumer Directed Health Plan – Preferred ValueCare
  
• Dental
  

Legal Notices

The University is required by law to provide employees with several different legal notices.  Notices are provided directly to employees at times required by law.

• COBRA Continuation of Coverage Rights
• Marketplace Notice - Non-Benefitted Employees
  
• Marketplace Notice - Benefits-eligible Employees
• HIPAA Opt Out Notice - Children's Health Insurance Program (CHIP)
• HIPAA Privacy Notice
• Medicare Part D Notice

If you paid out of pocket for services, usually required when you use an out-of-network provider, you can obtain reimbursement for the amount the plan would have paid the provider.

• Medical, Dental and Prescription Request for Reimbursement  – BlueCross BlueShield
• Mental Health and Substance Use Disorder Request for Reimbursement - University Health Care Plus

The University fully complies with the Affordable Care Act (ACA), also known as Health Care Reform. The ACA requires employers to offer affordable health coverage that meets minimum requirements to full-time employees.

In accordance with the ACA, the University categorizes employees into three groups.

• Full-time employees – employees expected to work full-time (30 hours per week). Expectations are based on the standard hours in the job posting or as otherwise communicated to the employee.
• Part-time and variable hour employees – employees expected to regularly work less than an average of 30 hours per week.
• Seasonal employees – employees in positions for which the customary annual employment is less than six months. A seasonal position is one that can only be performed each year, beginning and ending in approximately the same part of the year, such as summer or winter.

Employees who are in full-time positions will be offered coverage in the Employee Health Care Plan (the "Plan"), which is compliant with the ACA within three months of their date of hire or transfer into a full-time position.

The University uses a 12-month measurement period to determine if employees who are in part-time, variable hour, or seasonal positions are actually working full-time.  The University's Standard Measurement Period (look back period) begins on May 1st each year and continues through the following April 30th.  New hires have an Initial Measurement Period which begins on the first day of the month on or following their date of hire.

Hours worked include:

• Hours worked in all position with the University, including University Health (hospitals and clinics) positions, student, temporary and seasonal jobs (but does not include hours worked under a Federal or State-sponsored student work study program)
• Vacation, sick and holiday hours paid
• Jury duty
• FMLA and military leave

In addition, because the University is an educational institution, breaks in service of 26 weeks or less will have hours credited.

Employees who work 1,560 or more hours during a Standard or Initial Measurement Period (30 hours per week average), are considered full-time for purposes of health care eligibility and will be eligible to enroll in the Plan as a full-time employee while employed during the following one-year period.  Employees who work full-time during a Standard Measurement Period will be offered coverage effective the following July 1st.  New hires who work full-time during their Initial Measurement Period will be offered coverage within one month following the end of their Initial Measurement Period.

For additional information on the eligibility rules, contact the HR Employment Services Representative for your department.

See the COBRA Continuation Coverage web page for information about health coverage.

See the Leaving the University web page for information and options for continuing other benefit coverage.