Health Insurance

Health Insurance

Penn State Health Plans are administered by Aetna. There are two health plan options for eligible employees to choose from; the PPO Plan and the PPO Savings Plan. Please see this Aetna website for a list of in-network providers for the Penn State Health Plans. For additional information, you can contact Aetna at 855-878-4197.

 

2022 Insurance Information

As part of the Federal No Surprises Act, please see details on the Aetna website at: Federal No Surprises Act | Aetna.

Participating plan members may have recently received email notification from Aetna regarding a new ID card format as part of the Federal No Surprises Act. Current members may use their existing ID cards without issue and there is no change to your plan or plan design. If a member would like a new ID card, please contact the Aetna concierge team to request your new card.

In an ongoing effort to expand Americans' access to free COVID-19 testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over the counter (OTC), at-home COVID-19 test kits. 

On Saturday, January 15, individuals with private health coverage were able to begin obtaining OTC COVID-19 at-home test kits for free. Penn State’s CVS Caremark prescription coverage will cover the cost of OTC COVID-19 at-home test kits, for those employees and their families enrolled in a Penn State health plan.  

There is a limit of up to 8 OTC COVID-19 at-home test kits per covered member (meaning each covered family member) per 30 consecutive days. (If the kits contain 2 tests, then no more than 4 kits per 30 consecutive days).

Coverage/Reimbursement Options:

  1. Purchase OTC COVID-19 at-home test kit AT THE PHARMACY COUNTER of a participating pharmacy, with no up-front out of pocket costs. Members will need to present their CVS Caremark ID card at point of sale to the pharmacy. If you encounter an issue at the pharmacy counter processing your claim, please rest assured that you will be reimbursed up to the mandated limit, so please keep your receipt so you can submit a claim to CVS Caremark.

CVS Caremark has confirmed that the issue some are experiencing for option #1 above is not necessarily a systemic issue, as they are seeing adjudication at some pharmacies across the network, however, not consistently. The biggest challenges being experienced are due to capacity contraints and OTC test kit supply limitations. In some cases, pharmacies may be prioritizing dispensing medications that are provided with a valid prescription and administering vaccines over adjudicating OTC tests.

  1. Purchase OTC COVID-19 at-home test kits at a participating pharmacy, however, if purchasing the kits NOT AT THE PHARMACY COUNTER, members will be required to pay for the kit and then must submit a claim for reimbursement, via the CVS Caremark reimbursement page. The reimbursement will be the cost of the test itself, which may not include sales tax.  
  2. Purchase OTC COVID-19 at-home test kits at NON-PARTICIPATING PHARMACIES AND at NON-PHARMACY LOCATIONS, such as Amazon, however, the member will need to pay for the kit at the time of purchase and then must submit a claim for reimbursement. The maximum reimbursement for these tests will be $12.

Health plan enrolled employees needing further assistance in finding a participating pharmacy, reviewing the CVS Caremark COVID-19 Help Center online, or may have questions regarding a claim reimbursement, should visit CVS Caremark or contact them directly at 844-462-0203 for further assistance.

Eligibility

Regular full-time faculty and staff members are eligible to enroll in Penn State’s Health Care Plan. For information about spouse and dependent children eligibility, please see Dependent Eligibility.

Part-time faculty and staff members can become eligible for medical coverage under the Affordable Care Act (ACA) regulations. There is a small group of part-time employee grandfathered under a former policy, for which additional details regarding this plan can be found within the health care premium comparison below. The same dependent eligibility outlined for full-time faculty and staff also applies for part-time faculty and staff.

Postdoctoral appointees: As per postdoctoral eligibility, the per-pay contribution rates follow the same salary-based premium schedule as for faculty and staff. For additional information regarding the benefits available to postdoctoral appointees, please contact or visit the Office of Postdoctoral Affairs. Please note that if you are a Postdoctoral Fellow, or a J1 Visa holder, you are only eligible for the PPO Plan.

Postdoctoral SCHOLARS are ELIGIBLE for the Health Care and Dependent Care Flexible Spending Account (FSA). Postdoctoral FELLOWS are NOT ELIGIBLE for either Flexible Spending Account (FSA). When any Postdoctoral appointment is changing to a full-time Faculty, Staff, or Technical Service position, you will become newly eligible for an FSA. In order to enroll in an FSA after changing from a Postdoctoral appointment to a full-time Faculty, Staff, or Technical Service position, please submit a Workday benefit change request to "Change Flexible Spending" in addition to submitting your Job Change benefit elections.

If you or your dependents are no longer eligible for the health plans, information will be mailed from Lifetime Benefit Solutions regarding continuing coverage under COBRA. Additional information regarding COBRA benefits can be found on our COBRA website.

Becoming Medicare eligible (turning age 65) as an active employee:

As an active employee, your Penn State medical plan is considered primary for you and your eligible dependents; so as an active employee, there is no need to sign up for Medicare Parts A or B. Employees need to make the determination if it makes fiscal sense to enroll in Medicare as a secondary insurance.  

Part A is provided at no cost, so you can either enroll or decline Part A, but only if you are not currently enrolled or want to be enrolled in the future in the PPO Savings Plan.
Since there is a premium associated with Part B and it is secondary coverage, it may not make financial sense to pay for Part B. Please contact your local Social Security Office with any questions regarding Part B.

Upon leaving employment/retirement, if you and/or your spouse are 65 plus, you will want to visit your local Social Security office three months prior to sign up for Medicare upon retirement.

Please be aware that if you are enrolled in the PPO Savings plan, you must decline Parts A and B. Per IRS regulations, you, the employee, cannot be enrolled in Medicare Part A or B and be contributing to a Health Savings Account, which is automatically included with the PPO Savings Plan; however you CAN insure your Medicare eligible dependent under the PPO Savings Plan. It is important to note, upon turning 65, you are automatically enrolled in Part A if you are receiving Social Security benefits.

Healthcare Premiums

Payroll contributions are determined based on an employee's annual base salary (Faculty and Staff, as of October 31, 2021; Technical Service as of September 30, 2021). Your 2022 premium contribution amount is effective January 1, 2022, and will remain constant for the entire year, regardless of salary increases, decreases, position changes, or job transfers throughout the year. Also, appointments of irregular duration will be adjusted as deemed appropriate when the appointment is updated.

Additionally, brand new hires to the University will have benefit elections pro-rated based upon their hire date. If you are a current employee experiencing a job change, or an IRS qualifying life event that causes your existing coverage to change in the middle of a pay period, the regular per pay benefit deductions will occur for the full pay period in which benefit elections or changes were made.

Payroll contributions are deducted based on the year of payroll issuance. For example, the first January bi-weekly payroll will be for hours worked in the prior year, but the deductions will be taken at the new rate since the paycheck is processed in the new year.

If both spouses are employed by Penn State, medical coverage must be carried by the higher-paid employee. For Technical Service employees, this only applies if both employee and spouse are Teamsters members.

Visit health care premium comparison for sample rates.

Dually-Employed at Penn State

In the past, the University permitted employees to both be covered under the same health care plan of the employee with the lower salary. In 2018, this practice changed. When dually-employed Penn State employees would like to be covered under one medical plan (dental and vision plans are not affected). The following changes took effect on January 1, 2018.

Faculty/Staff or Postdoc: If you and your spouse are both employed at Penn State and are currently covered under one spouse’s medical plan, your coverage election must be made by the higher-paid spouse. It is important to note that while you may remain covered under one medical plan of the higher-paid spouse, you do have the option to move to separate plans if you wish.

Technical Service Employees: This applies if BOTH spouses are Technical Service employees; does not apply if the spouse is faculty or staff. It is important to note that while you may remain covered under one medical care plan of the higher-paid spouse, you do have the option to move to separate plan if you wish.

For reference, here are the possible combinations for employees choosing to be covered under one medical plan based on the above changes:

  • Faculty/Staff/Postdoc + Faculty/Staff/Postdoc = Must be covered under the spouse with the higher salary
  • Technical Service Employee + Technical Service Employee = Must be covered under the spouse with the higher salary
  • Technical Service Employee + Faculty/Staff/Postdoc = Employees can choose which spouse will carry the policy

If you experience the following qualifying event changes:

  1. Spouse becomes a new employee at Penn State and is the higher-paid spouse.
  2. You and your spouse are both Penn State employees and a change of position for one of you changes the higher-paid spouse to the one not carrying coverage.

In either of these instances, you will NOT be required to change coverage to the higher-paid spouse mid-year. During the next annual benefits open enrollment period, you will need to make the appropriate changes for the higher-paid spouse to carry coverage if choosing to maintain coverage under only one spouse.

24-Hour Nurse Line

Talk to a registered nurse anytime with the 24-Hour Nurse Line, you can speak to a registered nurse about health issues — whenever you need to.* Available to both PPO and PPO Savings plan members, the 24-Hour Nurse Line is toll-free, you can call as many times as you need, and covered family members can use it, too. Just call 1-800-556-1555 (TTY: 711)* or go to Aetna.com to log in.

Health Care Spending Accounts

Penn Staters have the following options for putting aside pre-tax dollars to help pay for medical expenses:

Health Savings Accounts - For PPO Savings Plan members

Flexible Spending Accounts - For Plan members and for Penn State employees who are not in a Penn State health plan

Additional Resources