Health Care Plan

Vanderbilt partners with Aetna to offer health coverage to full-time and part-time employees. Health plan option eligibility varies based on your employment status. Please see below for more details.

Vanderbilt Health Plan Options
Premiums
Eligibility
New hires and rehires
Aetna Services
Medicare
Resources

Vanderbilt Health Plan Options

Aetna Choice Plan (CDHP)

Default plan if you do not complete new hire enrollment
Lower monthly premiums
Higher deductibles and out-of-pocket maximums
Health Savings Account with seed money from Vanderbilt*

For fully benefits-eligible employees, Aetna automatically issues health insurance cards for the Choice CDHP health plan option at the employee-only coverage tier. If you enroll in the Select PPO health plan option or waive health plan coverage, you may dispose of the original ID card that was sent to you.

*For fully benefits-eligible employees.

Aetna Select Plan (PPO)

Higher monthly premiums
Lower deductibles and out-of-pocket maximums
Includes copays for many services
Flexible Spending Account available

Both the Choice and Select options:

Allow you to see providers and specialists without a referral.

Provide 100% coverage for preventive care and screenings, with no deductible or co-pay required, as long as the service meets the guidelines for a preventive care service and is not for diagnosis screenings.

Give you a choice of in-network and out-of-network providers:
- In-Network - Aetna National network – A larger national network –(Aetna POS II)
- Out-of-network. These providers may be used, but you will not have the advantage of the network discount. Out-of-network expenses have their own deductible and co-insurance.

Refer to the Benefits Overview or the Summary of Benefits and Coverage (SBC) for each health plan for more details. For an explanation of the terms above, please refer to the glossary of terms.

Aetna International Plan

The Aetna International Plan is for J1T Visa holders only. For more information, please refer to the International Health Plan page.

Premiums

Health care premiums are determined by your Annual Base Benefits Rate (ABBR). For most employees, your ABBR is equal to your annual salary. You can find your ABBR by logging into Oracle, clicking on Personal Information, and then selecting compensation. Health care premiums are broken up into three bands:

Band A: $0-$59,999.99
Band B: $60,000.00 - $149,999.99
Band C: $150,000.00+

Premiums can be found under Quick Links on both the Staff and Faculty new hire pages. Premiums are usually noted as monthly amounts, but if you are paid weekly or biweekly, these amounts will be divided evenly between your paychecks each month. Your personal premiums will also be available in My VU Benefits when you enroll in coverage.

Tobacco Credit

Vanderbilt offers a $20 monthly credit to your health care premiums if you and your covered family members (any dependent covered under your Vanderbilt health care plan) are committed to being tobacco-free. Tobacco-free means that you and your covered family members do not use any form of tobacco, including e-cigarettes. To receive this credit, just indicate your tobacco usage status when completing enrollment in My VU Benefits.

Vanderbilt is committed to a culture of wellness, so if you want to quit using tobacco, there is help available to you. Health & Wellness offers a variety of tobacco cessation resources including self-help, medical and one-on-one coaching services to help support you in becoming tobacco-free. The Quit Rx Smoking Cessation program offers counseling and treatment services, including prescription medication when recommended. More than 500 employees have participated in this program since its launch. Let the program help you begin your plan to quit today. Information can be found on the Health & Wellness Tobacco Cessation Resources website.

Spousal Surcharge

If your spouse has access to health coverage through another employer, including Vanderbilt University Medical Center, but prefers using the Vanderbilt Health Plan, you will be charged a $100 monthly fee. This fee will not apply if you both work for Vanderbilt University. The fee will be added to your health care payroll premiums. Medicare coverage does not count as employer-sponsor coverage, so no fee will apply.

Vanderbilt has a spousal coverage fee to encourage spouses to take the coverage offered by their employers. We recognize there are circumstances where the Vanderbilt University plan is more attractive – whether for family convenience, providers, or cost. In that case, the $100 per month fee would apply.

Spousal coverage fees are common in employer-sponsored plans, and a $100 monthly surcharge is the most prevalent fee. This surcharge keeps the University aligned with similar-sized organizations and is enough to encourage people to consider other available health insurance options with their employer.

Making changes during the year

If you are paying the fee and your spouse loses coverage with their employer, you can declare a life event on My VU Benefits, and the fee will be waived. You may be audited and required to submit documentation proving your qualifying event. See Life/Work Changes for more information.

Health Care Plan Eligibility

For information on general benefits eligibility, please visit the Eligibility page.

Fully benefits-eligible (full-time) employees may choose to enroll in either the Aetna Choice CDHP or Aetna Select PPO health plan option and may cover their spouse and/or eligible child(ren).

Partially benefits-eligible (part-time, see below) employees may choose to enroll in the Aetna Choice CDHP, and may cover their eligible child(ren).

Some part-time and temporary employees are also considered partially benefits-eligible, which means their dependent child(ren) are eligible to be covered by the Vanderbilt health plan. Partial benefits eligibility includes employees who are:

Regular and term exempt faculty and staff working part-time schedules (less than 30 hours per week / less than 75% of full time)
Regular and term non-exempt employees who are regularly scheduled to work at least 20, but less than 30 hours per week (50% time or more)
Temporary employees, such as VTS and flex employees who work 30 hours per week or more on average, for any 3 months within a 12-month period
Student workers, including graduate teaching and research assistants, professional students, and undergraduate student workers, who work 30 hours per week or more on average for any 3 months within a 12-month period (although students need prior approval to work such hours, may already have other coverage, and should consider carefully before electing employee health care, even if eligible).

New Hires and Rehires

If you are a fully benefits-eligible employee, you must complete New Hire Enrollment in My VU Benefits within 30 days of your hire or eligibility date (see "How to Enroll" below). As a fully benefits-eligible employee, you will be automatically enrolled in the Choice CDHP medical plan option at the employee only level effective your hire dare. If you do not want coverage or want to change to the Select PPO plan option, you must take action within 30 days of your hire date.

If you are a J1T Visa holder, you will be automatically enrolled in the Aetna International Plan.

If you are partially benefits-eligible, you have 30 days to enroll in the Choice CDHP medical plan option, but you will not be automatically enrolled.

Behavioral Health and Aetna Services

Vanderbilt partners with Lyra to provide the Employee Assistance Program which provides mental health services to University faculty, staff, postdocs and their families (including spouse and children ages 2 and older). Vanderbilt faculty, staff, postdocs and their families are eligible to receive 12 sessions per household member per year, at no cost to the employee. Please visit https://vanderbilt.lyrahealth.com/ for more information.

Vanderbilt is committed to providing access to behavioral health services that meet the needs of employees and their families. The Vanderbilt health plan provides coverage for behavioral health services, but sometimes it’s not easy to find an in-network provider. To alleviate the uncertainty that comes with visiting an out-of-network provider, the Vanderbilt health plan covers out-of-network providers as in-network.

How does it work?

If you visit an out-of-network provider and you’re in the Select PPO medical option, you’ll have a $50 copay of the reasonable and customary charge, but you would need to pay the entire charged amount up front. If your provider submits claims to Aetna you don’t need to take any action, but if they do not, you will need to submit a claim form directly to Aetna. Once Aetna receives the claim, they will determine the reasonable and customary charge, which is based on typical amount charged by providers in that geographic area and reimburse you for the reasonable and customary charge less the $50 copay that is due. An example of this might look like an out-of-network provider that charges $300 for a service, but Aetna determines that the reasonable and customary charge is $200. In this scenario, Aetna would reimburse you $150 ($200 approved charge - $50 copay), but you would still be responsible for any amount over the reasonable and customary charge.

If you’re in the Choice CDHP, your claims will initially be subject to the out-of-network deductible, but you can contact Aetna or the VU Benefits team at benefits@vanderbilt.edu to have your claims reprocessed as in-network. Once the in-network deductible has been met, you’ll be responsible for 20% coinsurance of the reasonable and customary charge until you reach the out-of-pocket maximum. Just like with the Select PPO, you will need to submit claims directly to Aetna if your provider will not do so, any amount over the reasonable and customary charge will be your responsibility. An example of the reimbursement might look like an out-of-network provider who charges $300 for a service, but Aetna determines the reasonable and customary charge is $200. If you have not met your in-network deductible, after reprocessing your claim, you would be responsible for the full $300 service change and the $200 reasonable and customary charge would be applied to your deductible. If you have met your deductible, you would be reimbursed $160 (80% of $200 approved charge), but you would still be responsible for the $100 that is over the reasonable and customary charge.

For more information or help with reprocessing out-of-network claims, please contact the VU Benefits team at benefits@vanderbilt.edu.

Aetna also offers many services to help employees navigate their healthcare including access to behavioral and mental health care, substance abuse recovery and advocacy services. Here are some examples of the programs and services that are part of your healthcare plan at Vanderbilt University.

Aetna Advocates	Program Summary	Contact Information
Autism Advocate	Autism specialists help pair your child with the right providers, answer questions about benefits, and connect you with resources for support	1-866-724-0604
Infertility Advocate	Infertility care specialists help locate in-network providers and explain benefits	Visit AetnaInfertilityCare.com, or call 1-800-575-5999
Transgender Advocate	Personal navigator who can assist with finding providers and explain your costs and benefits	Contact Member Services at the number of the back of your ID Card; advise the representative you would like to speak with a transgender advocate and provide your contact information. The Personal Navigator will contact you.
Behavioral Health/Mental Wellness	Program Summary	Contact Information
Able To	One-on-one meetings with a coach for an 8-week program to help reduce depression, stress, and anxiety	Visit AbleTo.com/Aetna, or call 1-844-330-3648
Alma	Help finding a mental health provider	Visit www.helloalma.com
Array AtHome Care	Behavioral Health Telehealth service - virtual psychiatry	Visit www.arraybc.com/patients/aetna, or call 1-800-442-8938
Blue Sprig Pediatrics	ABA evaluation and treatment	Visit www.bluesprigautism.com
Brightside	Virtual anxiety and depression treatment for those who are 18+	Visit www.brightside.com/aetna
Charlie Health	Virtual intensive outpatient treatment for teens, young adults, and families.	Visit www.charliehealth.com, or call 1-866-600-9578
CHE Behavioral	Online mental health therapy	Visit www.cheservices.com, or call 1-888-831-2618
Equip Health	Eating Disorder treatment	Visit www.Equip.health, or call 1-855-387-4378
Groups Recover Together	Adult recovery community for opioid use	Visit www.joingroups.com
Headway Health	Assistance finding a mental health provider	Visit www.headway.co
Hopebridge	ABA evaluation and treatment	Visit www.hopebridge.com
Maxim Healthcare	ABA evaluation and treatment	Visit www.maximhealthcare.com
MDLive	Virtual mental heath	Visit www.mdlive.com, or call 1-855-824-2170
Mind Check	Emotional health services	Visit mindchecktoday.com
Meru Health	Virtual care which includes an app-based service offering access to therapy, mindfulness, and exercises	Visit www.meruhealth.com/sign-up/aetna
NOCD	Obsessive Compulsive Disorder therapy	Visit www.treatmyocd.com
Talk Saves Lives	Online therapy	Visit https://www.resourcesforliving.com/talk-saves-lives
Talkspace	Online therapy	Visit www.talkspace.com/aetna
Telemynd	Mental health care for Tricare and Veterans	Visit www.telemynd.com/aetna, or call 1-866-991-2103
Maternity	Program Summary	Contact Information
SimpliFed	Breastfeeding support	Visit www.SimpliFed.com, or call 1-888-458-1364
Menopause	Program Summary	Contact Information
Gennev	Virtual menopause clinic of OB/GYNs and Registered Dietitian Nutritionists apply evidence-based treatments to relieve symptoms in every stage of menopause.	Visit www.gennev.com/aetna
Substance Abuse	Program Summary	Contact Information
Bicycle Health	Virtual treatment for opioid use	Visit www.bicyclehealth.com/aetna
Guardian Angel Opioid Use recovery (GAP)	Opioid support	Call Aetna Behavioral Health at 1-800-424-4047
Weight Management/Fitness	Program Summary	Contact Information
LifeMart (discounts)	Discounts for a variety of products and services	Visit your Aetna Member Website at www.aetna.com. Log in with your user name and password. Click on the Health & Wellness Tab > Health & Wellness Discounts > Click on any of the Health and Wellness tiles to access the LifeMart Discount Website.

*Please note: These services are covered via Aetna® and Vanderbilt, for employees and enrolled dependents. Access to these services are subject to change. For more information, please contact Member Services at the number on the back of your ID card. Participants in the Aetna International Plan are not eligible for these services.

Preventive health

Maintaining your health is important, and staying on top of your preventive care services, which are covered at no charge under the plan, can help you stay health. Aetna provides a preventive health schedule to help you keep track of when certain exams and tests are recommended. To view this schedule, visit the Aetna website and look for Health Programs, then select Preventive Health Schedule. Choose your age and gender to find the guidelines that best fit you.

Preventive Care Program.Both health plan options include a comprehensive Preventive Care Program that covers such things as annual well-checkups and well-baby visits for covered dependents.

Foreign Travel

Aetna provides coverage while traveling internationally. However, it requires you pay the provider and then submit a claim form to Aetna. Foreign emergency/urgent care claims are paid at the Aetna in-network level of coverage. Foreign non-emergency claims are paid at the out-of-network level, as long as they were medically necessary. Also see the AD&D Insurance page.

COVID-19

Effective May 12, 2022, normal copays and co-insurance will apply for all COVID tests and vaccines. The United States government provides four free tests through

TN Resources:

Vanderbilt University Medical Center: If you are a Vanderbilt employee or VUMC patient with fever, cough or shortness of breath and are concerned about the coronavirus, call (888) 312-0847 to be assessed. This line is available daily, 7:00 a.m.- 7:00 p.m.

Visit the Tennessee Department of Health and the Centers for Disease Control and Prevention (CDC) for the latest status and recommendations.

Department of Health website
COVID-19 Public Information Hotline: (877) 857-2945, available daily, 10 a.m.-10 p.m.

Symptoms of COVID-19 include respiratory symptoms, fever, cough, shortness of breath and difficulty breathing.

Learn more on the Aetna website or contact People Experience at human.resources@vanderbilt.edu

CHIPRA

Special Enrollment Rights under CHIPRA. The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) was enacted by the United States federal government on February 4, 2009. CHIPRA created new special enrollment rights effective April 1, 2009. CHIPRA extended the State Children's Health Insurance Program (SCHIP) through 2013 and renamed it the Children's Health Insurance Program (CHIP). Learn more about CHIP. The special enrollment rights under CHIPRA allow the following for qualified Vanderbilt Group Health Plan members:

If you or your dependent become eligible for state-granted premium assistance, or you or your dependent's coverage terminates due to a loss of eligibility (as opposed to termination due to failure to pay premiums) under Medicaid, Tennessee's CoverKids program, or a State Children’s Health Insurance Plan, you may enroll in the Vanderbilt Group Health Plan. You must request coverage within 60 days of this special-enrollment qualifying event by making a Family Status Change.
If your dependent becomes eligible to receive a premium subsidy from the Child Health Insurance Program, you will be allowed under CHIPRA to disenroll (drop) your dependent from the Vanderbilt Group Health Plan. You must request this coverage change within 60 days of this special-enrollment qualifying event by making a Family Status Change.

Medicare

Medicare and You
Medicare.gov
Have more in-depth questions? Visit TN SHIP. SHIP is a national program that provides free and objective one-on-one counseling, information and help to people with Medicare, people who may need Medicare, and people looking into Medicare with someone else in mind.

Resources

Links to Vendors

Aetna
Aetna online provider directory

Phone: 800.743.0910

Capital Rx (prescription benefit)

Phone: 833.599.0942

The Transparency in Coverage final rule, released on 10/29/20, requires health plans and issuers to publicly disclose pricing information via machine-readable files (MRF). Vanderbilt's MRF can be found here.

^{Children up to age 18 under legal guardianship or custody of the employee must meet the definition of dependent under the Federal Tax Code for income tax purposes and be able to show supporting documentation (such as the employee’s claim of dependency for the child on the relevant portion of your most recent IRS Form 1040 federal income tax return) in order to be eligible under the Plan. Children under legal guardianship or custody, who do not meet eligibility requirements above in (a), will lose their coverage eligibility the first day of the month following the month in which they turn 18 years of age (age of majority).}