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Health Care Plan

Please note: cost coverage for copays and co-insurance will end May 11, 2023.  Beginning May 12, normal copays and co-insuranace will apply for all COVID tests and vaccines. 

Effective immediately, Aetna will waive copays and co-insurance costs for all diagnostic testing related to COVID-19.
OTC COVID-19 tests now covered at no cost. Read FAQ.
Members inside the United States can also get four free tests through COVIDTEST.gov. These government provided tests do not count towards the minimum benefit of eight tests per member per 30 days. Read our know your test kit options informational pdf. 

Aetna is taking significant steps in response to COVID-19. Effective immediately, Aetna will waive copays and member cost-share for all diagnostic testing related to COVID-19.  This will cover the test kit for patients who meet CDC guidelines for testing, which can be performed in any approved laboratory location. You can find an approved laboratory location at your state’s Department of Health website.

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.

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

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

We have two health plan options: Aetna Select and Choice CDHP.

We also offer the Aetna International Plan to our J1T Visa holders. 

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.

The Aetna International Plan is for J1T Visa holders only. 

The only differences in the plans are the cost of the premiums, deductibles, copays, 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.

Choosing your health plan is a personal decision. Read the Benefits Overview thoroughly and visit Vanderbilt’s health plan page to help you decide. The Summary of Benefits and Coverage (SBC) for each plan provides an easy-to-understand summary about benefits and coverage. To request a printed copy, call the Human Resources front desk.

To find providers covered on the health plans go to Aetna’s DocFind. You can also call Aetna at 800.743.0910.

Preventive care coverage means you won't have a co-pay for most routine services like cholesterol screenings. The Aetna website has details.

  • Go to the Aetna website.
  • Log in to Aetna Navigator by selecting "Member Log In."
  • Once you log in, look for "Health Programs" and then select "Preventive Health Schedule."
  • Choose your age and gender to find your preventive guidelines.
  • If you have questions, call Aetna Customer Service at 800-743-0910.

Several preventive care drugs will be available without charge. See the Healthcare Reform Contraceptives List in the Formulary section of the Navitus website for details. For questions, contact Navitus at 866-333-2757.

The premiums can be found in three places:

  • In the Benefits Overview
  • In the New Staff Orientation booklet
  • In My VU Benefits, as you enroll

Premiums are based on your Annual Base Benefits Rate (ABBR). For most employees, you ABBR is equal to your annual salary. Premiums are broken up into 3 bands:

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

Yes, monthly premiums will come out of each check. If you are paid weekly or bi-weekly, these amounts will be divided between four or two paychecks of each month.

  • If you are fully benefits-eligible, you will default into the Choice CDHP at the Individual Level, starting on your hire date. If you do not want coverage under the Vanderbilt Health Plan, you must go in to My VU Benefits within 30 days of your hire date and waive coverage.
  • If you are a J1 visa holder, you’ll be defaulted in the Aetna International Plan

Group health plan administrators must give new plan enrollees a general notice describing COBRA rights within 90 days of their coverage effective date.

Some part-time and temporary employees are considered partially benefits-eligible, which means they and their dependent children are eligible for Vanderbilt Health Plan coverage. See the Benefits Eligibility page for full details. 

Summarized partial-benefits eligibility for 2022 includes:

  • 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).

Vanderbilt Health Plan coverage for partially benefits-eligible employees is optional and you must enroll to receive coverage. If you are already covered on someone else’s plan or prefer to purchase a plan from the healthcare.gov marketplace, you do not need to take any action.

Spouses are not eligible for partially benefits-eligible employee coverage. 

Yes. When you enroll, indicate in My VU Benefits that you want to waive health coverage. If you are a fully benefits eligible employee and you don't waive, you will default into coverage. If you are a partially benefits- eligible employee, you will not have coverage unless you enroll.

To find your annual base benefits rates, log into Oracle, click on Personal Information from menu tiles then select compensation to view current salary.

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 FAQs for AD&D coverage.

If you and your covered family members (any dependent covered under your Vanderbilt Health Care Plan) are committed to being tobacco-free you are eligible to receive the $20 per month tobacco credit on your health plan premiums. Tobacco-free means that you and your covered family members do not use any form of tobacco, including e-cigarettes. Just indicate your tobacco usage status when completing enrollment in My VU Benefits. The $20 credit lowers your health care payroll premium.

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 smoke-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. Call the Occupational Health Clinic at 615-936-0955 for an appointment or more information. Licensed counselors at Work/Life Connections-EAP are available to teach relaxation techniques and help you build your stress resilience. Make an appointment by calling 615.936.1327. Contact Health Plus to receive a free tool-kit or to schedule one-on-one coaching. Additional information can be found on the Health & Wellness Tobacco Cessation Resources website.

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 
Learn more.

Medicare coverage does not count as employer-sponsor coverage. If your spouse has Medicare the fee will not apply.

The fee encourages 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. Some organizations do not offer coverage for spouses with other health insurance options. At Vanderbilt University, only spouses with access to health insurance through an outside employer, including Vanderbilt University Medical Center, would pay the fee. We compared this cost with other employers and learned that for the majority, the fee is $100 per month. This amount keeps the University aligned with similar-sized organizations and is enough to encourage people to consider other available health insurance options with their employer.

Yes. Your spouse's loss of coverage would be considered a qualifying life event. You should declare a Life Change in My VU Benefits, and the fee will be waived. You may be audited and required to submit documentation proving your qualifying event– and there are limitations in allowable changes. See Life/Work Changes for more information.

Yes, he or she can remain on your Vanderbilt Health Plan, but you will pay the coverage fee. We generally do not recommend carrying secondary coverage.

If this happens, the unpaid balance will be automatically deducted from your next paycheck. You do not need to take any action.

As of Jan. 1, 2017, unmarried same-sex domestic partners are no longer eligible for benefit programs, including dependent tuition assistance and FMLA.

If you will not be working for a month or more, you should request your department place you on unpaid leave. Once on unpaid leave, you can make payments through direct billing with Vanderbilt’s benefit administrator, Benefit Express. You will pay the same premium amount on leave as you do when you are activity working, even though you will pay through direct billing. If your department keeps you in an active status, but you happen to not work for a month or so, any premiums you missed will be collected through subsequent paychecks until your balance is up-to-date.


 

Aetna Choice Plan (CDHP)

  • Default plan if you do not complete new hire enrollment
  • Lower monthly premiums
  • Higher deductibles
  • Health Savings Account with seed money from Vanderbilt
  •  Aetna automatically issues health insurance cards for the ‘default’ health plan option (Aetna Choice plan at the 'employee-only' coverage tier) to new fully benefits-eligible employees.)

Aetna Select Plan (PPO)

  • Higher monthly premiums
  • Lower deductibles
  • Flexible Spending Account available

Aetna International Plan (J1T Visa holders only) 

See Benefits Eligibility. 

You must complete New Hire Enrollment in My VU Benefits within 30 days of your hire or eligibility date (see "How to Enroll" below). If you elect another health plan option, you may disregard the Aetna Choice card. If you choose the Aetna Choice health plan option, keep the card for your use.

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Prescription Drug Benefit

Both health plan options include Prescription Drug Benefit coverage, but costs apply differently, depending on which plan you choose. The Vanderbilt Health Plan includes a prescription drug benefit managed by Capital Rx for faculty and staff enrolled in either health plan option.

Other Benefits

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.

Tobacco Cessation Benefit. Vanderbilt helps to pay for a tobacco cessation program for employees and their dependents covered on the health plan.

Brightline Mental Health Services for Children. Aetna members have access to mental health support for kids (18 months – 18 years old) with Brightline.  Whether your kid needs help building new skills through personalized coaching, sessions with a therapist or psychiatrist, or you need coaching for challenges with younger kids, our expert care team is here to help.  Plus, your family can take video visits right from home or on-the-go.  Chat with an expert within minutes and schedule a video visit within days. Learn more

*Please note: Brightline’s services are covered benefits via Aetna® and Vanderbilt, for children covered as dependents on your benefits. Brightline will check your eligibility when you sign up. Deductibles and copays apply. Participants in the Aetna International Plan are not eligible. 

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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.

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How to Enroll

To enroll, use My VU Benefits within 30 days of your hire date:

  1. Go to My VU Benefits and log in with your VUnetID and ePassword
  2. Make your benefits selections
  3. Print your benefits enrollment receipt and keep it for your records

Medicare

  • Medicare and You
  • Medicare.gov
  • Have more in depth questions? Visit TN SHIPSHIP 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.

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Resources


Links to Vendors

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).

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