Highmark Partnership: Frequently Asked Questions
What is happening with Penn State’s medical and prescription drug benefits?
On January 1, 2023, Highmark Blue Shield partnered with Penn State for employee medical and prescription benefits. Highmark Blue Shield will replace Aetna and CVS Caremark, which has been the third-party administrator (TPA) for both the medical and prescription drug benefit plan for the last five years.
Please contact Highmark directly at 844-945-5509 with any questions regarding benefits, providers, or prescription costs.
Why is Penn State making this change?
Penn State’s contract with Aetna and CVS Caremark ended on December 31, 2022. Penn State continually reviews employee benefits in order to provide faculty and staff with the highest quality and most affordable health care possible. Highmark Blue Shield’s provider partnerships in Pennsylvania and throughout the United States are strong, resulting in the overall lower total cost of care and positive health care experiences.
Will my health care contributions change?
Faculty and staff health care contributions are based on a specific percentage of your annual base salary as of October 31 each year (employees covered by a collective bargaining agreement should refer to their applicable contract). For the fifth year in a row, Penn State’s health care contribution percentages will remain the same for faculty and staff for 2023 (employees covered by a collective bargaining agreement should refer to their applicable contract).
Will my copays, deductibles, or coinsurance amounts change?
No. Plan designs – which include copays, deductibles, and coinsurance – will remain the same. The medical plans have been renamed Lion Traditional (formerly PPO Plan) and Lion Advantage (formerly PPO Savings Plan).
How will Benefits Open Enrollment be impacted by this change?
Benefits Open Enrollment meetings begin on Sept. 20, and employees and/or their partners are encouraged to attend. Employees currently enrolled in a Penn State medical plan will continue to be enrolled in the same plan unless they choose to make changes during Penn State’s annual Benefits Open Enrollment period, which runs from November 1 to November 18.
Employees, along with their eligible dependents, may elect to participate in either medical plan during the Open Enrollment period in November. If not elected during Open Enrollment, an employee may be eligible to elect a medical plan throughout the calendar plan year with an IRS qualifying event (e.g., loss of other coverage, marriage, birth/adoption of a child, etc.).
Will I receive new benefits ID cards?
Yes. New ID cards will be mailed to home addresses by Highmark Blue Shield in December. You will receive one ID card for both medical and prescription benefits.
Will I need to select a new primary care physician, or can I keep my doctor?
While a vast majority of Penn State’s benefits-eligible employees and families already visit physicians and facilities that are in the Highmark Blue Shield network certain providers may not be considered in-network. Employees who have questions about their individual providers can call Highmark Blue Shield at 844-945-5509, or visit the Highmark website www.highmarkblueshield.com and click on Find a Doctor or Pharmacy using more detailed instructions below:
Locate an in-network Provider
- After clicking Find a Doctor or Pharmacy, click on Find a Doctor, Hospital, or other Medical Provider.
- Click No for the question, "Are you looking for Medicare Advantage providers or facilities?"
- A new web page will load. You will need to select Medical, then click on the Continue button within the Sapphire Digital Site pop-up.
- If you receive a new page asking "Just browsing?" or "Are you a member?", select Continue for the just browsing option. Once you select Continue under just browsing, you may be required to enter your location for search parameters. If you do not receive this new page, skip down to the next bullets.
- Narrow Your Search Results by selecting the Enter Card ID option.
- Enter the first 3 characters of the Penn State member ID as P 8 U.
- For the Plan Name Options, use BCBS PPO through 12/31/2022. Starting 01/01/2023, use PPOBlue.
What if I want to change my primary care physician?
You are free to select and visit any health care provider you choose. However, if you choose an in-network provider (one who contracts with Highmark Blue Shield), you will be charged less than if you choose an out-of-network provider.
What if I want to stay with my current doctor and they do not participate with Highmark Blue Shield?
You will still have coverage options available to you at the out-of-network benefit rates. Information regarding out-of-network costs will be available during the Benefits Open Enrollment period.
Will I need to change my pharmacy?
You should not need a new pharmacy in most cases. Highmark Blue Shield partners with Express Scripts to administer our pharmacy benefit. All major chains, except Walgreens, are included in the Express Scripts pharmacy network. As long as your current pharmacy is participating with Express Scripts, you will simply need to present your new Highmark ID card, in order for your prescription to be processed correctly under your medical plan. You can verify your pharmacy by calling Highmark Blue Shield at 844-945-5509, or visit the Highmark website www.highmarkblueshield.com and click on Find a Doctor or Pharmacy using more detailed instructions below:
Locate an in-network Pharmacy
- After clicking Find a Doctor or Pharmacy, click on Find a Pharmacy.
- Next you will need to select Locate a National Network Pharmacy.
- Enter Zip Code and click Search to locate an in-network pharmacy near you.
Find your prescription on the Formulary
- After clicking Find a Doctor or Pharmacy, click on Find a Drug.
- Next you will need to select National Select Formulary.
- Search for your prescription drug name on the list.
Does CVS Pharmacy participate in Express Scripts?
Yes, CVS pharmacies are in-network with Express Scripts so there will be no disruption in service if you are using one of their retail pharmacies.
Can I still use the mail-order prescription benefit?
Yes. Employees using CVS Caremark Mail Order will have any OPEN refills transferred automatically to Express Scripts Mail Order, so you will not need a new prescription to continue your mail order benefit.
Can I still use University Health Services pharmacy?
University Health Services pharmacy will continue to be available for short-term and mail-order/maintenance prescriptions. You will simply need to present your new Highmark ID card in order for your short-term or mail-order prescription to be processed correctly under your medical plan. You will NOT need a new prescription to remain with University Health Services pharmacy.
Please complete the University Health Services Pharmacy Employee/Retiree Enrollment Form if you want to begin utilizing their pharmcy for your mail order prescriptions.
If I’m taking a specialty medication, do I need to use a specific pharmacy?
Yes, Accredo is Highmark’s preferred specialty pharmacy. Your open prescription with CVS Caremark Specialty pharmacy will be automatically transferred to Accredo. You will receive information from Accredo before Jan. 1, 2023, and you can discuss this process with Highmark Blue Shield at 844-945-5509.
What is the status of UPMC providers, primarily those located in western Pennsylvania?
UPMC is currently an in-network provider with Highmark Blue Shield. Their network contract with Highmark for all doctors and hospitals runs through 2029.
Will my prescription (standard or specialty) be covered at the same level in 2023? Is my prescription on the Highmark formulary?
Coverage levels will remain the same; however, Highmark Blue Shield’s prescription formulary may be different than CVS Caremark’s formulary. Highmark Blue Shield may be in contact with you prior to January 1, 2023, regarding potential differences in your prescription drug coverage.
Will the Value-Based Benefit for diabetes, high cholesterol, and high blood pressure continue to be offered through Highmark Blue Shield?
Yes, the Value-Based Benefit will continue and is being renamed to Condition Care Program. Your enrollment with Aetna/CVS Caremark will automatically roll over to Highmark Blue Shield. Additional details on this program will be discussed during Benefits Open Enrollment meetings.
Who do I contact if I have a 2022 medical claim, prescription drug claim, or question prior to Jan. 1, 2023?
You should continue to contact Aetna and CVS Caremark regarding questions for any claims incurred through Dec. 31, 2022, as Aetna and CVS Caremark will manage all 2022 claims. Questions for claims processed for dates of service January 1 forward should be addressed with Highmark.
Does the change impact Medicare-eligible retirees covered under Freedom Blue?
No. The Freedom Blue Medicare Advantage plan through Highmark Blue Shield will continue to be offered to eligible retirees in 2023. Non-Medicare-eligible retirees will also have the option of Lion Traditional (formerly PPO Plan) and Lion Advantage (formerly PPO Savings Plan).
What advantage will we have by partnering with Highmark Blue Shield?
In addition to the community and provider partnerships, Highmark Blue Shield has today, you can access the Penn State concierge customer service team to navigate your entire health care journey and maximize your benefits. Additional services offered by Highmark Blue Shield, such as their concierge benefit and telemedicine, will be announced during Benefits Open Enrollment, which runs from Nov. 1 to Nov. 18.
Is there any impact to other benefit plan vendors (ex. HealthEquity) given the medical and prescription vendor change?
No. Claim information will be transferred from Highmark Blue Shield to HealthEquity, who manages our Health Savings Account (HSA) and Health Care and Dependent Flexible Spending Accounts (FSA) for continued ease of processing HSA or FSA claims. Penn State’s contract with HealthEquity will continue, so you will not experience interruption because of our partnership with Highmark Blue Shield.
You will not receive new cards from HealthEquity unless your current card is set to expire.
If I am retiring on Dec. 31, 2022, what does that mean for my coverage as of Jan. 1, 2023?
If you are retiring on Dec. 31, 2022, you do not need to complete the 2023 Open Enrollment. If you want to change retiree medical plans, you will need to complete a Retiree Request for Change Form, as retirees do not have access to Workday.
If I am considering retiring on Dec. 31, 2022, what does that mean for my coverage as of Jan. 1, 2023?
If you are not certain of a Dec. 31 retirement date, you should complete the 2023 Open Enrollment for any changes you may want in 2023. If you decide to retire as of Dec. 31 after 2023 Open Enrollment has been completed, and you need to make a plan change, you will need to complete a Retiree Request for Change Form.
Is Penn State encouraging me to use Penn State Health physicians and facilities?
No. You will continue to have a wide choice of providers through the Highmark Blue Shield nationwide network.
Will employees still be able to obtain over-the-counter COVID-19 tests that are paid for or reimbursed through health insurance?
Yes, in an ongoing effort to expand Americans' access to free COVID-19 testing, the Biden administration is requiring insurance companies and group health plans to cover the cost of over the counter (OTC), at-home COVID-19 test kits. There is a limit of up to eight OTC COVID-19 at-home test kits per covered member (meaning each covered family member) per 30 consecutive days. (If the kits contain two tests, then no more than four kits per 30 consecutive days).
Does the transition impact Penn State’s partnership with Quest Diagnostics for lab services?
No, Quest Diagnostics (and LabCorp) are the major stand-alone laboratory providers and by utilizing their services, you will save a significant amount of deductible and coinsurance dollars. See more details on the Penn State HR website.
Will my personally identifiable information be transferred from Aetna to Highmark? What kinds of records will be transferred? How will my data be kept safe?
The safeguarding of employee information is of paramount importance, and all such information will be handled securely and in accordance with the federal Health Insurance Portability and Accountability Act (HIPAA). Information will be limited to open authorizations, medication refills, and other records necessary to ensure a smooth transition between carriers. All such information will be shared between Aetna/CVS and Highmark via a secure transfer between the organizations.
Does this impact me if I am on an approved leave of absence?
There will be no impact to an employee on an approved leave of absence throughout this transition. For employees experiencing claims from 2022 to 2023, there will be systems in place to smoothly move claims over to Highmark Blue Shield. We encourage employees on a leave of absence who are interested in changing their coverage for 2023 to complete the Open Enrollment event within Workday to ensure that their desired changes are made.
What about vision, dental, accidental death and dismemberment, and other health-related insurance? Any impacts?
This transition will not impact any other already-existing benefits.
Who was involved in the decision-making process to move to Highmark Blue Shield?
The University continually reviews employee benefits in order to provide faculty and staff with the highest quality and most affordable health care possible. Highmark Blue Shield has expressed their commitment to partnering with us to bring additional savings and long-term, key provider relationships to our employees throughout the next contract. This partnership positions Penn State to continue offering our employees the excellent medical and prescription drug benefits they depend upon now and will offer them positive health care experiences. A core team of leaders at Penn State including key members of the University’s Health Care Advisory Committee (HCAC), Human Resources, and administration collaborated to finalize this new partnership with Highmark Blue Shield. The Faculty Senate Benefits Committee submitted recommendations to the Faculty Senate during the spring 2022 semester relating to health plan management. Two of the recommendations encourage the choice of more than one health plan and affordability, both of which are met going into 2023. (See Appendix K | University Faculty Senate (psu.edu). The new contract with Highmark Blue Shield runs through Dec. 31, 2025.