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Health Care FAQs

Find answers to frequently asked questions related to health care plans and other health-related coverage options offered by the University of Rochester’s Total Rewards package. Visit our Health Care Benefits page to learn more.

Health Care Plans

For more information, visit our Health Care Plans page.

What are the tiers? Do I need to choose a tier for my health care plan?

The University Health Care Plans offer three tiers of providers with different levels of coverage. You do not choose a tier when electing a Health Care Plan. The tier is determined based on the network in which your provider/facility participates. Your deductible and out-of-pocket maximums for tier 1 and tier 2 accrue together; tier 3 services are subject to their own separate deductible/out-of-pocket maximum. Your tier is determined by the providers you receive service from. The insurance card you receive in the mail with your member ID is the ID you will give your provider regardless of the tier they are in.

  • Tier 1 – Accountable Health Partners (AHP) Providers: AHP is a panel of University of Rochester Medical Faculty Group providers and carefully selected community partners. You will have a lower deductible, copay, coinsurance, and out-of-pocket maximum than tier 2 and tier 3 providers. Please note, all AHP providers are also in the Excellus national networks.
  • Tier 2 – Third-Party Administrator (TPA) Network: You may seek providers within the Excellus national network. Services provided at the tier 2 benefit level will be subject to higher deductibles, coinsurance, copays and out-of-pocket maximums than tier 1 providers, but lower than tier 3 providers.
  • Tier 3 – Out-Of-Network: This includes any providers who do not participate in AHP and the Excellus network. Services provided at the tier 3 benefit level will be subject to higher deductibles, coinsurance, and out-of-pocket maximums than tier 1 and 2 providers and will be capped at the reasonable and customary levels; you may be subject to balance billing.
What is the out-of-area payment program? Who do I contact with questions about eligibility?

The Out of Area program is for University employees who, due to the business need of their position, are required by the University to work and live outside of the AHP network area and therefore cannot participate with Tier 1 health care providers. As a result, these employees will receive a stipend to assist with their health care costs. If you believe you are eligible for this program, please have your supervisor or manager contact the Office of Total RewardsView the 2024 Health Program Guide or 2025 Health Program Guide for more information.

What is a premium?

A premium is the cost of your Health Care Plan that is automatically deducted from your paycheck, typically before taxes.

What is a deductible?

A deductible is the amount of out-of-pocket expenses that you must pay for health services before the plan begins to pay benefits for many covered services.

What is coinsurance?

Coinsurance is the percentage of the fee that your health care plan pays for certain covered expenses once you have met your annual deductible.

What is an out-of-pocket maximum?

This is the maximum amount you would need to pay each plan year to receive covered services after you meet your annual deductible. This amount includes your deductible, copays and coinsurance payments. If you reach the out-of-pocket maximum, the plan pays 100% of covered health care and prescription drug expenses for the remainder of the plan year.

How can I find out if my doctor is in AHP? Where can I find a list of AHP providers accepting new patients?

Use the AHP Provider Search to determine whether your providers are in AHP. To view a list of providers accepting new patients, visit and click on the “View Primary Care Physicians Accepting New Patients” button in the upper right-hand corner of the AHP Provider Search page.

How much do the plans cost?

View the Rate Information page to determine what the premium is for each plan. Premiums are automatically deducted from your paychecks, typically via pre-tax payroll deductions. If you have a domestic partner as a dependent on your coverage that is not your tax-dependent, their portion is taken as after-tax deductions.

Who can I cover on my plan?

The coverage levels available to you for health care are:

  1. Single
  2. Employee and Child(ren)
  3. Employee and Spouse or Domestic Partner
  4. Family

For a list of benefit eligible dependents, view the definition of benefit eligible dependents.

I have a Domestic Partner on my health care coverage, how will that affect my payroll premium?

The domestic partner’s portion of the premium is taken as an after-tax deduction. In addition, the employer paid portion of your domestic partner’s coverage would be taxed as income.

You may want to consult a tax advisor for more information on how adding a Domestic Partner to your health care coverage will affect you.

What do I need to provide to have my domestic partner on coverage?

You will need to provide a Certification of Domestic Partner Status form  with a copy of your Certificate of Domestic Partnership, which is granted by the City of Rochester  or your local municipality.

If your Domestic Partner is considered a taxable dependent, you will also need to complete and return the Tax Affidavit form .

My domestic partner is turning 65, what actions must take place?

If your Domestic Partner is turning age 65 and covered under your University Health Care Plan, Medicare requires Domestic Partners to enroll in Medicare A and B during their Initial Enrollment Period for Medicare. Your Domestic Partner remains eligible to be covered under the University Health Care Plan but must enroll in Medicare A and B as well in order to avoid Medicare penalties in the future.

For more information on Medicare rules, please contact Medicare at 1-800-MEDICARE (1-800-633-4227).

I am planning on retiring, and my domestic partner is under 65 years old, can they stay on my coverage?

Your domestic partner can stay on coverage, though it is still subject to taxes. Once they turn 65 they will need to sign up for Medicare A and B.

What is a qualifying event?

Below is a list of qualifying events that allow corresponding changes to your coverage:

  • Legal marriage/domestic partnership
  • Legal separation or divorce
  • Termination of domestic partnership
  • Birth/adoption of a child
  • Gain eligibility of Medicaid/Medicare
  • Loss eligibility of Medicaid/Medicare
  • Approved leave (i.e. FMLA, Military Leave, layoff)
  • Return from leave (i.e. FMLA, Military Leave, Layoff)
  • Retirement
  • Loss of coverage
  • Spouse/domestic partner or parent/dependent child open enrollment period
  • Dependents gains eligibility through their own employer or parent’s coverage
  • Change in cost of care for dependent care FSA
  • Significant increase in the employee’s share of health care premiums
  • Significant decrease in the employee’s share of health care premiums

Please view the Matrix for more details on a list of qualifying events.

I am traveling outside of the United States. Am I still covered?

View the Excellus when traveling document for more information. Also view the Travel-Accident Insurance Policy and the Travel Assistance Service Identification Card.

I am an active employee enrolled in health insurance through the University of Rochester and am not collecting Social Security Benefits. Do I need to enroll in Medicare when I turn 65?

If you are actively working and are becoming Medicare-Eligible, you will not need to enroll in Medicare. Your health plan through the University of Rochester will continue to be the primary payer since your insurance is through a large employer group health plan. If you enroll in any parts of Medicare, Medicare will be the secondary payer.

If you have an HSA and you would like to continue to contribute to your HSA, you should not enroll in any part of Medicare. If you are enrolled in any parts of Medicare, you cannot contribute pre-tax dollars to your HSA.

To learn more about Medicare, please visit www.medicare.gov.

I am an active employee at the University of Rochester who is covering my spouse on my health plan, and my spouse is turning 65. Does my spouse need to enroll in Medicare?

If you are actively working and your spouse is becoming Medicare-Eligible, he/she does not need to enroll in Medicare. Your health insurance through the University of Rochester will continue to be the primary payer for both you and your spouse since your insurance is through a large employer group health plan. If your spouse enrolls in any parts of Medicare, Medicare will be the secondary payer for your spouse.

My dependent child is over 26, but still needs benefits, can I still cover them under my plan?

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 dependence. Certain adult children may be eligible to elect continuation coverage through age 29 under the University Health Care Plan. For more details, please see our Health Care Plans page for specific details regarding Special Extended Health Coverage for Certain Adult Children through Age 29.

When does my coverage end when I leave the University? Can I continue Coverage?

Your last day on coverage will be the last day of the pay period in which you terminate. When your coverage ends, you will be sent a separate document that explains your rights under COBRA continuation coverage.

I have my own medical coverage through the University, can I also be covered as a dependent on another University medical plan?

No, an eligible employee may be covered under the Plan as an employee or dependent of an employee, but may not be covered as both.

For example, if you and your spouse are both eligible for coverage under the Plan, you and your spouse may both elect employee only coverage or you or your spouse may elect Employee and Spouse or Family coverage and add the other as a dependent under that coverage; however, if your spouse elects Employee and Spouse or family coverage and covers you as a dependent under that coverage, you may not also elect employee coverage.

Dental Plans

For more information, visit our Dental Plans page.

Do I need to choose a Third Party Administrator (TPA) for my dental plan?

No, both University Dental Plans are administered by Excellus BlueCross BlueShield.

How much do the plans cost?

View the Rate Information page to determine what the premium is for each plan. Premiums are automatically deducted from your paychecks, typically via pre-tax payroll deductions. If you have a domestic partner as a dependent on your coverage that is not your tax-dependent, their portion is taken as after-tax deductions.

What is the difference between the Traditional Plan and Medallion Plan?

The two dental plans differ in the following areas:

  • Maximum Benefit Per Calendar Year per participant for classes II, IIA and III
  • Major Restorative Services (Class III) coverage
  • Orthodontia (Class IV) coverage

For details on these differences, view the Dental Plans page.

Which plan covers Orthodontia?

The Medallion Plan offers Orthodontia coverage for dependents up to age 19, covered at 50% up to the lifetime maximum of $1,500 per person for Orthodontia. No more than one half of the orthodontia lifetime maximum will be paid in any calendar year.

Who can I cover on my plan?

The coverage levels available to you for dental are:

  1. Single
  2. Family

For a list of benefit eligible dependents, view the definition of benefit eligible dependents.

Do both plans cover preventative services (Class I) at the same level?

Yes, both plans pay 100% of the in-network negotiated rates. Preventative Services are not subject to a deductible. Out-of-network claims are subject to balance billing. See the 2024 Health Program Guide or 2025 Health Program Guide for details.

Are all dentists covered under these plans?

The dental plans allow you the freedom to see any dentist you choose. Dental Blue Options (in-network) gives you access to a range of participating dental providers to choose from, who have agreed to a discounted set of fees for covered services and accept these amounts as payment in full. To find a dentist in this network, use the Excellus BCBS “Find a Dentist” tool and choose “Dental Blue Options” for Step 1. If your dentist does not fall within the Dental Blue Options network, you may be required to pay at time of service. Then, you can submit a claim to Excellus BCBS for reimbursement for the out of pocket costs you paid at the time of service.

I have my own dental coverage through the University, can I also be covered as a dependent on another University dental plan?

No, an eligible employee may be covered under the Plan as an employee or dependent of an employee, but may not be covered as both.

For example, if you and your spouse are both eligible for coverage under the Plan, you and your spouse may both elect employee only coverage or you or your spouse may elect Family coverage and add the other as a dependent under that Family coverage; however, if your spouse elects family coverage and covers you as a dependent under that Family coverage, you may not also elect employee coverage.

Health Savings Account (HSA)

For more information, visit our HSA page.

Who is eligible for a HSA?

A Health Savings Account (HSA) is available to eligible individuals who meet all of the following criteria:

  • Employee has elected coverage under the University’s YOUR HSA-Eligible Plan for the Plan Year.
  • Employee is not covered by any other health plan, including spousal health insurance, except for those that the IRS permits.
  • Employee cannot be enrolled in any part of Medicare, Tricare, Medicaid, or state health care programs.
  • Employee cannot elect or be covered by another person’s Health Care Flexible Spending Account or Health Reimbursements Arrangement for the Plan Year.
  • Employee will not be claimed as a dependent on another person’s tax return for the Plan Year.
  • Employee has not received Veteran’s Administration health benefits in the past 90 days. Only preventative, dental, and vision are permitted.
  • Please Note: Unless your domestic partner qualifies as your tax dependent, you’re not eligible to withdraw funds tax-free for their qualified health care expenses. However, if you’re enrolled in a family HDHP covering your domestic partner and they meet the other HSA eligibility requirements, they may establish and contribute to their own HSA outside of the University.
How much can I contribute per year? Does my money roll over to the next year?

For 2024 the HSA maximum election amount for employees with single coverage is $4,150. Employees covering one or more dependents on their plan may contribute up to $8,300. Employees who are 55 or older may contribute an additional $1,000 per year to an HSA through pre-tax deductions as a “catch-up” contribution.

For 2025 the HSA maximum election amount for employees with single coverage is $4,300. Employees covering one or more dependents on their plan may contribute up to $8,550. Employees who are 55 or older may contribute an additional $1,000 per year to an HSA through pre-tax deductions as a “catch-up” contribution.

Changes to your HSA annual contribution amount can be made at any time during the year.

All funds contributed to your HSA rollover from one year to the next.

How do I contribute to the account?

You can make pre-tax payroll contributions each pay period by electing an annual contribution amount. This amount can be changed at any time throughout the year.

Employees may also make after-tax direct contributions to their HSA and claim the contribution on their annual tax return. These contributions still have to comply with the IRS’ maximum election for the tax year.

If you have an HSA elsewhere, you can transfer those funds to your new HSA through the University. Contact your HSA administrator for details.

If you start your employment at the University after the first month of the tax year, you may contribute the maximum election throughout the remainder of the year if: (a) you are in the University’s YOUR HSA-Eligible Plan as of December 1 and (b) you remain in a qualifying High Deductible Health Plan for the plan year. Contact your HSA administrator for details.

Will the University contribute money to my account?

In 2024, the University will provide a one-time HSA contribution of $200 individual/$400 family for full-time employees earning less than $68,900 and Residents and Fellows who enroll in the YOUR HSA-Eligible Plan during the Open Enrollment and satisfy the IRS eligibility requirements. We will also provide a prorated contribution to full-time employees earning less than $68,900 and Residents and Fellows if they are: new hires, rehires, newly eligible employees as well as employees or Residents and Fellows experiencing a qualifying event during the 2024 calendar year.

In 2025, the University will provide a one-time HSA contribution of $200 individual/$400 family for full-time employees earning less than $71,000 and Residents and Fellows who enroll in the YOUR HSA-Eligible Plan during the Open Enrollment and satisfy the IRS eligibility requirements. We will also provide a prorated contribution to full-time employees earning less than $71,000 and Residents and Fellows if they are: new hires, rehires, newly eligible employees as well as employees or Residents and Fellows experiencing a qualifying event during the 2025 calendar year.

Please note that the employer contribution counts toward your annual HSA maximum. If you elect to contribute the maximum and receive the UR HSA contribution, your annual HSA payroll deduction will automatically be reduced to account for the employer contribution to ensure you do not go over the IRS maximum for the year.

What can I use the account for?

You can use your HSA to pay for qualified medical expenses including out-of-pocket costs counting towards your deductible, coinsurance, copays and out-of-pocket maximum.

The qualified medical expenses must be incurred on or after the effective date of your HSA and can be for you, your spouse, and your tax dependents, even if you have single coverage under the YOUR HSA-Eligible Plan.

For a complete list of eligible health care expenses, consult IRS Publication 502. Please note that you generally cannot use the HSA to pay insurance premiums even though they appear in Publication 502. Exceptions would be for COBRA, long-term care, insurance while you are unemployed, retiree health insurance, or Medicare Part A,B,C, or D premiums.

How do I access these funds?

You only have access to the funds currently in your account, not the full annual election.

There are three ways you can use your HSA funds:

  1. Swipe your card at the point of service to pay for qualified medical expenses. You will receive this card in the mail from your HSA administrator once you pass the Customer Identification Program (CIP).
  2. Use online bill payment to pay your provider directly from your HSA.
  3. Pay for a qualified medical expense out-of-pocket, then reimburse yourself from your HSA.
Can I roll money over to the next year?

Unused funds in an HSA continue to roll over in the account each year and collect tax-free interest. An HSA is portable, so employees can keep their HSA when they retire, leave the University, or change health care plans.

I am turning 65 soon and am currently contributing to a Health Savings Account. Should I enroll in Medicare?

If you would like to continue to contribute to your HSA, you should not enroll in any part of Medicare. If you are enrolled in any parts of Medicare, you cannot contribute pre-tax dollars to your HSA. Additionally, if you are collecting Social Security Benefits, you will be automatically enrolled in Medicare Part A. Since you are covered on a large employer group plan, you can contact Social Security to waive Medicare Part B but will not be able to waive Medicare Part A. Therefore, you will not be able to contribute to your HSA.

If you do enroll in Medicare Part A, your coverage start date may go back (retroactively) six months from when you sign up, and as a result you may need to stop contributing to your HSA up to six months in advance of enrolling. For more information, contact Social Security.

I am an active employee at the University of Rochester who is covering my spouse on my health plan, and my spouse is turning 65. Do I, the employee, have to stop contributing to my HSA?

As the employee, you may continue to contribute to your HSA as long as you are not enrolled in any parts of Medicare. You can continue to use your HSA as reimbursements for any eligible expenses your spouse incurs.

Who is my HSA administrator?

HSA Bank administers HSAs.

Flexible Spending Account (FSA)

See separate FAQs below for each of the different types of FSAs.

Health Care Flexible Spending Account (FSA)

What is a Health Care FSA?

A Health Care Flexible Spending Account (FSA) is a tax-advantage reimbursement account that allows you to set aside money for eligible expenses on a pre-tax basis. This account reimburses you for qualified out-of-pocket medical, dental, prescription, or vision services including expenses applied towards your deductible, copays and coinsurance.

Who is eligible for a Health Care FSA?

Full-time and part-time faculty and staff, including members of 1199 SEIU, who are enrolled in the YOUR PPO Plan or YOUR HSA-Eligible Plan or who have waived University Health Care coverage are eligible to contribute to a Health Care FSA.

How much can I contribute per year? Does my money roll over to the next year?

2024 Contributions

The maximum amount you may contribute in 2024 is $3,050 (minimum election is $100). At the end of the year, employees may be able to roll over some eligible funds.

2025 Contributions

The maximum amount you may contribute in 2025 is $3,200 (minimum election is $100). At the end of the year, employees may be able to roll over some eligible funds.

If I have a Health Care FSA this year but do nothing during Open Enrollment, what happens?

Your current FSA election will not automatically roll over to the following year, so you’ll need to elect your annual contribution amount during Open Enrollment. You may not change your annual contribution amount after it has been elected unless you experience a corresponding qualifying event during the year.

If you do not make an active election for a Health Care FSA during Open Enrollment, then any unused funds from the current plan year will be forfeited. You will have 120 days beginning January 1st of the current plan year to submit any remaining claims for qualified services incurred in the previous plan year.

How do I contribute to the account?

Your annual Health Care FSA contribution amount will be split evenly between the numbers of pay periods you have each calendar year. Each pay period, your contribution will be automatically deducted from your paycheck—before taxes—and deposited into your FSA.

You will have immediate access to your full annual FSA election even if you have not yet placed all of the funds in your Health Care FSA.

What can I use the account for?

You can be reimbursed from your Health Care FSA for qualified medical expenses including out-of-pocket costs counting towards your deducible, coinsurance, and copays. The qualified medical expenses must be incurred on or after the effective date of your Health Care FSA.

For a complete list of eligible health care expenses, consult IRS Publication 502. Please note that you generally cannot use the Health Care FSA to pay insurance premiums or for long-term care expenses, even though they appear in IRS Publication 502.

How do I access these funds?

If you are enrolled in a Health Care or Limited Purpose FSA, you can use your FSA Health Spending Card to cover your qualified medical and over-the-counter expenses. If you do not use your FSA Health Spending Card, you must submit a manual claim for each qualified expense that you would like to receive reimbursement for. Please note that the FSA Health Spending Card cannot be used for Dependent Care FSA expenses.

Who is my Health Care FSA administrator?

Lifetime Benefit Solutions administers Health Care FSAs.

Flexible Spending Account (FSA)

See separate FAQs below for each of the different types of FSAs.

Health Care Flexible Spending Account (FSA)

What is a Health Care FSA?

A Health Care Flexible Spending Account (FSA) is a tax-advantage reimbursement account that allows you to set aside money for eligible expenses on a pre-tax basis. This account reimburses you for qualified out-of-pocket medical, dental, prescription, or vision services including expenses applied towards your deductible, copays and coinsurance.

Who is eligible for a Health Care FSA?

Full-time and part-time faculty and staff, including members of 1199 SEIU, who are enrolled in the YOUR PPO Plan or YOUR HSA-Eligible Plan or who have waived University Health Care coverage are eligible to contribute to a Health Care FSA.

How much can I contribute per year? Does my money roll over to the next year?

2024 Contributions

The maximum amount you may contribute in 2024 is $3,050 (minimum election is $100). At the end of the year, employees may be able to roll over some eligible funds. Please refer to 2025 Open Enrollment communications for details.

2025 Contributions

The maximum amount you may contribute in 2025 is $3,200 (minimum election is $100). At the end of the year, employees may be able to roll over some eligible funds. Please refer to 2026 Open Enrollment communications for details.

If I have a Health Care FSA this year but do nothing during Open Enrollment, what happens?

Your current FSA election will not automatically roll over to the following year, so you’ll need to elect your annual contribution amount during Open Enrollment. You may not change your annual contribution amount after it has been elected unless you experience a corresponding qualifying event during the year.

If you do not make an active election for a Health Care FSA during Open Enrollment, then any unused funds from the current plan year will be forfeited. You will have 120 days beginning January 1st of the current plan year to submit any remaining claims for qualified services incurred in the previous plan year.

How do I contribute to the account?

Your annual Health Care FSA contribution amount will be split evenly between the numbers of pay periods you have each calendar year. Each pay period, your contribution will be automatically deducted from your paycheck—before taxes—and deposited into your FSA.

You will have immediate access to your full annual FSA election even if you have not yet placed all of the funds in your Health Care FSA.

What can I use the account for?

You can be reimbursed from your Health Care FSA for qualified medical expenses including out-of-pocket costs counting towards your deducible, coinsurance, and copays. The qualified medical expenses must be incurred on or after the effective date of your Health Care FSA.

For a complete list of eligible health care expenses, consult IRS Publication 502. Please note that you generally cannot use the Health Care FSA to pay insurance premiums or for long-term care expenses, even though they appear in IRS Publication 502.

How do I access these funds?

If you are enrolled in a Health Care or Limited Purpose FSA, you can use your FSA Health Spending Card to cover your qualified medical and over-the-counter expenses. If you do not use your FSA Health Spending Card, you must submit a manual claim for each qualified expense that you would like to receive reimbursement for. Please note that the FSA Health Spending Card cannot be used for Dependent Care FSA expenses.

How does the FSA Health Spending Card work?

You will receive two Health Spending Cards. You can place the extra card in a safe place or provide it to a family member to use. Even though your card is a debit card, you should always select CREDIT when using your card. The Health Spending Card is a VISA card and is accepted at all health-related providers who accept VISA cards as well as grocery stores and pharmacies. You must save the receipt for every card transaction. LBS will occasionally need you to provide a receipt so that the plan can ensure every card transaction is FSA eligible. Your Health Spending Card can only be used to pay for expenses that occurred in the current plan year. Once the plan year has ended, any reimbursement request for prior year expenses should be filed by manual claim submission.

The IRS requires that FSA cards be disabled if a member is not able to provide proper documentation.  Should your card be disabled, you can still submit claims via paper form, member portal, or mobile app. Your card will remain disabled until you provide proper support or pay back the purchase. In a situation where you used your card for a service that was not FSA eligible (i.e. teeth whitening), you can contact LBS customer service and repay the purchase over the phone. You can also mail a check. Any card transactions that remain unsubstantiated at year end and has not been repaid will be added to your taxable income on your W-2 for the year of the transaction.

Please note that with a Limited Purpose FSA, your card is configured to only work at dental and vision providers.  Your card may not work at certain dental and vision providers who do not have their card terminal properly coded. In these instances, you will need to pay using another form of payment and then submit a claim for reimbursement.

Who is my Health Care FSA administrator?

Lifetime Benefit Solutions administers Health Care FSAs.

Limited Purpose Flexible Spending Account (FSA)

What is a Limited Purpose FSA?

A Limited Purpose Flexible Spending Account (FSA) is a tax-advantage reimbursement account that allows you to set aside money for eligible expenses on a pre-tax basis. This account can provide reimbursement for qualified dental or vision expenses but cannot reimburse any out-of-pocket health care expenses until the plan deductible has been satisfied; otherwise, the Limited Purpose FSA works like a Health Care FSA.

Who is eligible for a Limited Purpose FSA?

Employees enrolled in the YOUR HSA-Eligible Plan and are contributing to a Health Savings Account (HSA), are also able to contribute to a Limited Purpose FSA.

How much can I contribute per year? Does my money roll over to the next year?

2024 Contributions

The maximum amount you may contribute in 2024 is $3,050 (minimum election is $100). At the end of the year, employees may be able to roll over some eligible funds.

2025 Contributions

The maximum amount you may contribute in 2025 is $3,200 (minimum election is $100). At the end of the year, employees may be able to roll over some eligible funds.

If I have a Limited Purpose FSA this year but do nothing during Open Enrollment, what happens?

Your current FSA election will not automatically roll over to the following year, so you’ll need to elect your annual contribution amount during Open Enrollment. You may not change your annual contribution amount after it has been elected unless you experience a corresponding qualifying event during the year.

If you do not make an active election for a Limited Purpose FSA during Open Enrollment, then any unused funds from the current plan year will be forfeited. You will have 120 days beginning January 1st of the current plan year to submit any remaining claims for qualified services incurred in the previous plan year.

How do I contribute to the account?

Your annual Limited Purpose FSA contribution amount will be split evenly between the number of pay periods you have each calendar year. Each pay period, your contribution will be automatically deducted from your paycheck—before taxes—and deposited into your Limited Purpose FSA.

You will have immediate access to your full annual Limited Purpose FSA election even if you have not yet placed all of the funds in your Limited Purpose FSA.

What can I use the account for?

You can be reimbursed from your Limited Purpose FSA for qualified dental or vision expenses. You may not be reimbursed for qualified medical expenses until your plan deductible has been met. The qualified expenses must be incurred on or after the effective date of your FSA.

For a complete list of eligible health care expenses, consult IRS Publication 502.

How do I access these funds?

If you are enrolled in a Health Care or Limited Purpose FSA, you can use your FSA Health Spending Card to cover your qualified medical and over-the-counter expenses. If you do not use your FSA Health Spending Card, you must submit a manual claim for each qualified expense that you would like to receive reimbursement for. Please note that the FSA Health Spending Card cannot be used for Dependent Care FSA expenses.

Who is my FSA administrator?

Lifetime Benefit Solutions administers Limited Purpose FSAs.

Dependent Care Flexible Spending Account (FSA)

What is a Dependent Care FSA?

A Dependent Care FSA is a tax-advantaged savings account designed to help you save money on expenses to provide care for qualified dependents.

What are qualified dependents?

Qualified dependents include children under age 13, whom you claim as a tax dependent on your federal income tax return (special rules apply for divorced parents) or a disabled spouse or any other dependent on your tax return who resides with you and is physically or mentally disabled.

How much can I contribute per year?

2024 Contributions

The maximum amount you may contribute in 2024 is $5,000 for individuals or married couples filing jointly, or $2,500 for a married person filing separately. You may not change your annual contribution amount outside of Open Enrollment unless you experience a corresponding qualifying event.

2025 Contributions

The maximum amount you may contribute in 2025 is $5,000 for individuals or married couples filing jointly, or $2,500 for a married person filing separately. You may not change your annual contribution amount outside of Open Enrollment unless you experience a corresponding qualifying event.

If I have a Dependent Care FSA this year but do nothing during Open Enrollment, what happens?

Your current FSA election will not automatically roll over to the following year, so you’ll need to elect your annual contribution amount during Open Enrollment. You may not change your annual contribution amount after it has been elected unless you experience a corresponding qualifying event during the year.

If you do not make an active election for a Dependent Care FSA during Open Enrollment, then any unused funds from the current plan year will be forfeited. You will have 120 days beginning January 1st of the current plan year to submit any remaining claims for qualified services incurred in the previous plan year.

How do I contribute to the account?

Your annual Dependent Care FSA contribution amount will be split evenly between the number of pay periods you have each calendar year. Each pay period, your contribution will be automatically deducted from your paycheck—before taxes—and deposited into your Dependent Care FSA.

What can I use the account for?

Qualified expenses eligible for reimbursements from your Dependent Care FSA include Child Care Centers, Nursery School, and before and after school care. The qualified expenses must be incurred on or after the effective date of your Dependent Care FSA. See IRS Publication 503 for a complete list of eligible expenses.

How do I access these funds?

You only have access to the funds currently in your account, not the full annual election.

You must submit a manual request for reimbursement for your Dependent Care FSA administrator.

Can I roll money over to the next year?

Dependent Care FSA is not eligible to have a rollover.

Who is my Dependent Care FSA administrator?

Lifetime Benefits Solutions is the administrator.

Vision Care (VSP)

For more information, visit our Vision Care page.

Can I access my VSP Vision Care Plan if I am not actively at work (Leave of Absence, Long-Term Disability, Layoff, Worker’s Compensation or NYS Paid Family Leave)?

Coverage for VSP Vision Care will be continued during a Leave of Absence, Long-Term Disability, Layoff, Worker’s Compensation or NYS Paid Family Leave for up to 90 days from the start of your unpaid leave. If you return to work in an active, benefit-eligible position within 90 days from the start of your unpaid leave, Corestream will recoup any missed premiums by double deducting your premium in your paycheck(s) until the deficit has been recouped. If you do not return to an active, benefits-eligible position within 90 days from the start of your unpaid leave, you may, if you wish, continue coverage under VSP Vision Care under the COBRA Policy.

Can I enroll in the vision plan without electing health coverage through the University?

Yes, you can elect vision coverage through VSP regardless of your healthcare enrollment.

Who can I add to my vision plan?

Dependents eligible to be covered on your vision plan include:

  • Your current spouse or domestic partner and their children up to age 26
  • Your children up to age 26

See the definition of benefit eligible dependents for additional information regarding eligible dependents.

When can I enroll in VSP?

New hires and newly eligible faculty and staff have 30 days to enroll. You can also enroll in VSP when you have a qualifying event or on an annual basis during Open Enrollment. See the Changing My Benefits page for information regarding making benefit changes outside the enrollment period.

How can I find an in-network VSP provider?

You can visit the VSP website at www.vsp.com.

You can also contact VSP directly at (800) 877-7195 during the following hours:

  • Monday–Friday: 8 a.m–9 p.m.
  • Saturday: 10 a.m–8 p.m.
  • Sunday: 10 a.m–8 p.m.

Note: The VSP vision plan does offer out-of-network coverage. Visit the VSP website for details on the differences between in-network and out-of-network coverage.

Will the premium for vision coverage be deducted from my paycheck?

Yes, your premium for vision coverage will be a pre-tax payroll deduction.

Where is my VSP card?

You received a welcome letter in the mail, which included your VSP card that confirms your Member ID number (your six-digit employee ID number with three zeroes in front of your ID number). When you go to your provider, you will let them know you have VSP and they will be able to apply the discounts.

How can I view my VSP benefit information?

Visit the VSP site at www.vsp.com.

  • Select “Members”
  • Create an account using your six-digit employee ID number with three zeroes in front of your ID number (your employee ID number is located on your paycheck or paystub, or contact your HR Business Partner if you need your employee ID number)
  • Once you have logged in, you will be able to view information about your vision benefit

Note: You can also print a Member Vision Card to keep in your wallet. Click on the link in the left toolbar called Member Vision Card.

Who do I contact if I have specific plan questions?

Contact Corestream at (888) 935-9595 or customerservice@corestream.com.

Pharmacy

What is a PBM?

A PBM (pharmacy benefit manager) directs prescription drug programs and processes prescription claims by negotiating drug costs with manufacturers, contracting with pharmacies, and building and maintaining drug formularies. These cost-saving strategies will lower drug costs and promote good health. Navitus is the University of Rochester’s PBM.

How do I know if my prescription is covered?

Please view the Navitus drug formulary.

What are my copays/coinsurance?

Please refer to the 2024 and 2025 Health Plans Comparison Chart for more details.

Who will I call with questions?

Navitus Customer Care is available 24 hours a day, 7 days a week and can be reached at 833-210-5965 | 711 (TTY). Closed Thanksgiving and Christmas.

What pharmacy can I use?

You will have access to over 64,000 pharmacies including national chains, such as Costco, CVS, Walgreens, Wegmans, and Walmart, as well as many independent pharmacies. You may use the online pharmacy search tool on the member portal to locate a pharmacy nearest to you. You can also access the UR Employee Pharmacy. As a reminder, employees are eligible for a discount on all prescriptions including specialty drugs filled and 90-day supplies of maintenance drugs at the UR Employee Pharmacy.

Are specialty drugs covered?

Yes, however, certain formulary and network restrictions may apply. Specialty Drugs must be filled at the UR Employee Pharmacy. Access Guidance Services under the YOUR PPO Plan offers savings for certain specialty prescriptions.

View the Navitus drug formulary.

Will I receive a discount at the UR Employee Pharmacy?

All prescription drugs, including Specialty Drugs, filled at the URMC Employee Pharmacy qualify for a discount under the YOUR PPO Plan and the YOUR HSA-Eligible Plan.

Can I use mail order?

Yes. Costco will be your mail order provider. Register online at pharmacy.costco.com.  Costco’s mail order phone number is 800-607-6861. A Costco membership is not required.

Can I know my prescription cost before filling my prescription?

You will be able to see prescription costs using the cost compare tool on the member portal. In addition, you can also contact Navitus Customer Care at 833-210-5965 | 711 (TTY).

Do I need to enroll in prescription coverage separately?

No. Enrollment in the prescription coverage will be automatic when you select a University of Rochester health plan.

Will I pay a separate premium for prescription coverage?

No. Prescription coverage is included as part of your health care premium rates.

How will I submit manual claims if I need to do so?

You may submit manual claim forms to:

CLAIMS: Navitus Health Solutions

ATTN: Claims Department P.O. Box 999 Appleton, WI 54912-0999

TOLL-FREE FAX: 1 (855) 668-8550

WEBSITE: navitus.com/members