Health Care Plan
Last Modified: 2016-07-07
As a benefits-eligible employee, you may choose between three health options. Click on the links below for details of each options (VUnetID and ePassword are needed), provider directories, evidence of coverage booklets and administrators' Web sites. Also see the Health Care Plan Summary Plan Description.
Aetna Plus - 2016 Evidence of Coverage Booklet(most detailed information)2016 Aetna Plus Summary of Benefits and Coverage (SBC)
Aetna Select - 2016 Evidence of Coverage Booklet(most detailed information)2016 Aetna Select Summary of Benefits and Coverage (SBC)
Aetna HealthFund - 2016 Evidence of Coverage Booklet(most detailed information)2016 Aetna HealthFund Summary of Benefits and Coverage (SBC)
Prescription Drug Benefit
All three health plan options include the same Prescription Drug Benefit. Navitus Health Solutions administers the prescription drug benefit for all Vanderbilt faculty and staff enrolled in one of the three health plan options.
Preventive Care Program. All three health plan options include a comprehensive Preventive Care Program that covers such things as annual well-checkups and well-baby visits for covered dependents.
Applied Behavior Analysis for Autism Spectrum Disorder. Each of the Vanderbilt Health Plan options (Plus, Select and HealthFund) includes coverage for Applied Behavioral Analysis (ABA) therapy for autism spectrum disorder (ASD). Refer to the Evidence of Coverage Booklet for more information.
Tobacco Cessation Benefit. Vanderbilt helps to pay for a tobacco cessation program for employees and their dependents covered on the health plan. Learn more.
Health Care Plan Eligibility
Fully benefits-eligible employees
A fully benefits-eligible employee is a regular or term employee (not temporary) who is regularly scheduled to work 30 hours or more per week.
Fully benefits-eligible employees may also cover the following:
- spouses or same-sex domestic partners*,
- natural, step-, or adopted children up to age 26, and other qualified dependents, such as disabled children over age 26, with required documentation. Coverage beyond the age of 26 may be available if child is disabled. (You must contact Vanderbilt Human Resources prior to the child's 26th birthday. For more information on continuing coverage for disabled children.)
- Refer to the Health Care Plan Summary Plan Description for full details of eligibility.
*Because same-sex marriages are now performed and legal in all U.S. states, married same-sex couples are eligible for the same benefits and tax advantages as other married couples. Vanderbilt will continue to offer unmarried same-sex domestic partners and their children access to Vanderbilt benefit programs, including insurance plans and tuition assistance, in 2016. However, only spouses and natural, step- and adopted children will be eligible in 2017.
Health benefits for staff begin on the hire date.The monthly cost of the health plan is not pro-rated.
Aetna automatically mails insurance cards for the default health plan option (Aetna Plus at the 'employee-only' coverage tier) to new employees. To elect another health plan option and/or coverage tier, you must use My VU Benefits within 30 days of your hire date (see "Benefits Enrollment Tool" below). If you elect another health plan option, you may disregard the Aetna Plus card. If you choose the Plus health plan option, keep the card for your use.
In 2016, a new group of partially benefits-eligible employees and their dependent children will be eligible for Vanderbilt Health Plan coverage. Partially benefits-eligible employees include:
- Monthly paid employees who aren’t already eligible for benefits,
- Weekly and bi-weekly paid employees regularly scheduled to work 20 or more hours per week who aren’t already eligible for benefits, and
- Temporary employees, such as VTS, adjunct, flex and PRN in these roles.
Partially benefits-eligible employees may also cover the following:
- natural, step-, or adopted children up to age 26, and
- other qualified dependents, such as disabled children over age 26, with required documentation. Coverage beyond the age of 26 may be available if child is disabled. (You must contact Vanderbilt Human Resources prior to the child's 26th birthday. For more information on continuing coverage for disabled children, refer to the Health Care Plan Summary Plan Description for full details of eligibility.)
All health plan options include prescription drug coverage. However, this new partial benefits-eligibility does not extend to other benefits, such as flexible spending accounts, dental or vision insurance.
Health benefits for staff begin on the hire date. The monthly cost of the health plan is not pro-rated.
Vanderbilt Health Plan coverage for partially benefits-eligible employees is optional. You will not be automatically enrolled in a default health plan option.
Benefits while on leave
Your benefit deductions will continue while on a paid leave of absence. In some instances and depending on the nature of your role, you may be placed on an unpaid leave of absence for a limited period of time. If you are placed on an unpaid leave of absence, you will receive instructions to pay your health plan premiums directly to Vanderbilt’s benefit administration vendor, Benefit Express. Your premium will remain the same during this time. If your employment later ends, you will be able to continue your coverage through COBRA, but will be charged the full premium (employee plus employer portions), plus a two percent administrative fee.
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.
How to Enroll
To enroll, use My VU Benefits within 30 days of your hire date:
- Go to My VU Benefits and log in with your VUnetID and ePassword
- Make your benefits selections
- Print your benefits enrollment receipt and keep it for your records
- Decision-making tools: choosing a health plan, spouse/same-sex domestic partner coverage fee
- Same-Sex Domestic Partner Benefits
- How to Find a Doctor - Aetna DocFind Instructions
- Health Care Plan Summary Plan Description
- Aetna Claim Form
- Uniform Glossary of Health Coverage and Medical Terms
- Traveling with Vanderbilt Health Care
- Community Pediatricians Approved for In-Network Vanderbilt Employee Co-pay (VUnetID required)
- Program for LGBTI Health
- Form 1095-C Information
Links to Vendors
- Aetna online provider directory
- Phone: 800.743.0910
Navitus (prescription benefit)
- Phone: 866.333.2757
Note: On June 2, 2015, the St. Thomas Medical Group terminated its agreement with Aetna to participate as In-Network providers. Click here to see the list of providers that are no longer in the Aetna network. The Aetna network consists of qualified physicians that can serve your needs. Visit the Aetna website to locate an In-Network provider.
For complete details of the Health Care Plan, refer to the Summary Plan Description.