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Health Care Plans

The University of Rochester offers two Health Care Plans: the YOUR HSA-Eligible Plan and the YOUR PPO Plan.

Explore the resources below to ensure you choose the plan that is most cost effective and appropriate for you and your family.

The Plans

Both the YOUR HSA-Eligible Plan and the YOUR PPO Plan cover the same services and are designed to help you take control of your health and the dollars you spend on your health care. Below are some key features of the two Plans.



YOUR HSA-Eligible Plan


Higher Premiums

Lower Premiums

Plan Deductible

Deductible only applies to inpatient, outpatient, emergency room and urgent care services.

Deductible applies to all medical and pharmacy services except for preventive care services.

Preventive Care Services

Preventive care services are covered at 100% for Tier 1 and Tier 2 providers. Deductible does not apply.

Out-of-pocket maximum

After meeting out-of-pocket maximum, plan covers services at 100%.

Prescription Drug Coverage

You pay your share of the copay or coinsurance until you reach the out-of-pocket maximum.

After meeting the deductible, you pay your share of the copay or coinsurance until you reach the out-of-pocket maximum.

Health Savings Account or Flexible Spending Account

You will have the option to contribute to a Flexible Spending Account (FSA).

You will have the option to contribute to a Health Saving Account (HSA), Limited Purpose FSA, or Health Care FSA.

Need help choosing a health plan? Use the 2020 ALEX tool, an online benefits decision tool that will assist you in understanding your benefit options and enable you to make an informed decision when making your benefit elections.

  • Picking a Third-Party Administrator (TPA)

    If you enroll in coverage under the University Health Care Plans, you will need to choose which TPA will administer your Plan- either Aetna or Excellus BlueCross BlueShield. Since each TPA has contracted with in-network providers to offer health care services at negotiated fees, it is important to consider the TPA network availability when choosing your TPA. Explore the Aetna Directory of Healthcare Professionals and the Excellus Doctor Search tools to see if your providers and facilities are members of either networks.

  • Pharmacy Coverage

    If you enroll in one of the University of Rochester Health Care Plans, you will automatically receive prescription drug benefits in conjunction with your plan. Your TPA will provide your prescription drug coverage. The Aetna drug formulary and Excellus BlueCross Blue Shield drug formulary are used to determine the level of copay(s) or coinsurance you will be responsible for depending on the medication prescribed.

    The UR Employee Pharmacy offers a discount to all employees and their eligible dependents enrolled in a University of Rochester Health Care Plan. The pharmacy is located in the Medical Center, though they do offer courier services for employees located in off-site locations. Visit the UR Employee Pharmacy website for additional information.

  • Accountable Health Partners (AHP)

    Accountable Health Partners (AHP) is a clinically integrated network of hospitals and physicians with a proven record of improving quality outcomes and delivering value. Both Aetna and Excellus BlueCross BlueShield give you access to AHP providers. When visiting an AHP provider, also referred to as a Tier 1 provider, you will have a lower deductible, copay, and out-of-pocket maximum than Tier 2 or Tier 3 providers. To find Accountable Health Partners providers in your area, visit the AHP Provider Search website.

    While you receive the highest level of benefits when you visit AHP providers, you can receive care through a combination of AHP, Tier 2 and Tier 3 providers. You do not need to choose a tier when enrolling, your level of savings will vary as you visit providers in different tiers throughout the Plan year. The deductible and out-of-pocket maximums cross apply for all three tiers.

  • Useful Tools

    To find providers in the Aetna National Network, use their DocFind tool. To find providers in the Excellus National Network, use their Doctor Search tool. When prompted to “Choose Your Network”, select “BlueCard PPO/EPO”.

    Both Aetna and Excellus also offer cost estimator tools to assist with plan selection process.

    • Aetna Plan Selection and Cost Estimator Tools: Log in to Aetna Navigator and select “Cost of Care” on the navigation bar. Then, select a condition to see both in-network and out-of-network costs specific to your area. 
    • Excellus Treatment Cost Advisor and Provider Selection Advisor Tools: Log in to Excellus BCBS and select “Excellus BCBS administers my UR Health Care Plan”.
  • Health Care When Traveling

    You take your healthcare coverage with you wherever you travel. Aetna and Excellus have nationwide networks and offer international coverage which means you have access to medical assistance services, doctors and hospitals around the world. Review important coverage information available online:

  • Special Extended Health Care Coverage for Certain Adult Children through Age 29

    Special Extended Health Coverage is available for adult children, who are not otherwise eligible for coverage under his or her parent's University Health Care Plan due to age, student status, or federal income tax dependent may be eligible to elect continuation coverage through age 29 under the University Health Care Plan. Eligible adult children are those who:

    • Are under age 30;
    • Are unmarried;
    • Live, work or reside in the state of New York or the service area of the insurer;
    • Are not covered by Medicare; and
    • Are not covered by or eligible for health insurance coverage through another employer’s group health plan (e.g. their own employer’s plan, or the plan of their other parent’s employer).

    To enroll for coverage, the employee and/or the employee’s child will need to complete an enrollment form ( Aetna Excellus ) and may be asked to verify the child’s state of residency or other requirements for this coverage.  Enrollment opportunities are available at the following times:

    • Within 60 days prior to or following the date the child’s coverage under the University Health Care Plan ends due to age, student status, or federal income tax dependent status;
    • Within 60 days of meeting the eligibility criteria for adult child status, when coverage for the child under the University Health Care Plan had previously terminated (e.g., within 60 days of moving back into New York State, losing employer coverage, becoming unmarried, etc.);
    • During the University’s annual open enrollment period.

    If you or a covered dependent lose coverage through the University Health and/or Dental Plans, COBRA coverage may be available. View the COBRA Notice for additional information.