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 30 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 Certification Form
    • To notify HR when your child who is age 26 or older loses eligibility for continued coverage, use the Health Care Eligibility Change 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.

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

• • University Health Pharmacies
  • University Health Specialty Pharmacy

Employee Assistance Program:

• Employees and their eligible family members may obtain services through the Employee Assistance Program through SupportLinc, at no cost.
• For a list of SupportLinc services and ways to access care visit the Employee Assistance Program (EAP) webpage.

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:
  • Advantage Plan Members
    • Provider Directory for Huntsman Mental Health Institute
  • Consumer Directed Health Plan Members:
    • Use the Regence ValueCare Provider Directory

Other Available Options:

• 988 - Suicide and Crisis Lifeline - call, text or chat
• Community Crisis Intervention and Support Services through Huntsman Mental Health Institute
• Huntsman Mental Health Institute
• SafeUT 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.

Take Control of Diabetes—At No Cost to You
Employees and covered family members living with Type 1 or Type 2 diabetes can join a special program offering a free advanced glucose meter, test strips, lancets, and unlimited on-demand coaching.

Register now by clicking below or call (800) 835-2362 with 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
• HIPAA Privacy Notice
• Marketplace Notice - Non-Benefitted Employees
  
• Marketplace Notice - Benefits-eligible Employees
• Medicare Part D Notice
• Newborns' and Mothers' Health Protection Act
• Premium Assistance under Medicaid and the Children's Health Insurance Program (CHIP)
• Women's Health and Cancer Rights

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 and Dental Request for Reimbursement  – BlueCross BlueShield
• Community Plan and HMHI Request for Reimbursement - University of  Utah Health Plans

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.

For information about Form 1095-C, click here.

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.