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VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R O R I E N TAT I O N G U I D E2020 Benefits OverviewAs a Vanderbilt University Medical Center employee, you make a difference to our patientsand their families by bringing compassion and care to those in need of hope and healing.VUMC extends this culture of caring to you and your family by providing a comprehensiveand flexible benefits package to help you lead longer and healthier lives. Read this overviewcarefully and elect the benefits that fit you and your family.OverviewEligibilityVUMC pays the full cost for: Basic life insurance Time off (flexPTO) Tuition reimbursement and adoptionassistance (maximums applied)If you work at least 30 hours a week and area regular, full-time staff or faculty member,then you are eligible for most benefitsbeginning on your hire date (refer to thetable below).VUMC shares the cost of these benefitswith you: Health plan Enhanced short-term disability Long-term disability 403(b) retirement planPartially benefits-eligible employees andtheir dependent children are eligible forVUMC health plan coverage. If you are amonthly paid employee not fully benefitseligible, or a weekly or biweekly paidemployee regularly scheduled to work 20to 29 hours per week, then you are partiallybenefits-eligible. TempForce (temporary),adjunct, flex or PRN employees may alsobe partially benefits-eligible if they arescheduled to work 20 to 29 hours per week.You also may choose to enroll in thefollowing voluntary benefits. You will paythe full cost of: Accidental death & dismemberment Dental and/or vision Flexible spending accounts Supplemental life insurance Traditional short-term disability Auto, home and pet insuranceAbout this bookletThis document providesinformation about your benefitoptions. It is not meant to replacethe summary plan descriptions(SPDs), which are the governingdocuments for VUMC benefits.SPDs are available at hr.vumc.org/benefits/sbc-eoc. Offerings andplans are subject to change. Pricesare valid for the 2020 plan year.Important: You will beautomatically enrolled inthe Aetna Plus employeeonly health plan option andcharged, unless you makechanges or opt-out within 30days of your hire date.Quick reference: Benefits effective dates (example for new full-time regular staff)BenefitTakes EffectHealth, dental and visionYour hire date403(b) Retirement PlanYou can contribute right away. Employer match eligibilityvaries.*Life insuranceYour hire dateLong-term disabilityFirst of the month after 1 year of employment*/eligibilityAccidental Death &Dismemberment(optional)Your hire dateShort-term disabilityTraditional coverage begins the first of the month following 30 days of employment/eligibility; Enhanced coveragebegins automatically after 1 year*Flexible SpendingAccountsFirst of the month following 30 days ofemployment/eligibilityTuition assistance3 months from your hire date**Examples shown are for regular, fulltime staff. Some programs’ guidelinesand eligibility vary for faculty, housestaff and post-docs. Refer to yourfaculty manual for guidance.16
VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R O R I E N TAT I O N G U I D EFamily Member EligibilityUse the information and chart below to determine who is eligible for each type of benefit.If you and your spouse bothFor Fully Benefits-EligibleEmployeesIf you work at least 30 hours a week and area regular, full-time staff or faculty member,then you are eligible for most benefitsbeginning on your hire date. (Refer to thechart on the right.)For Partially BenefitsEligible EmployeesPartially benefits-eligible employees andtheir dependent children are eligible forVUMC health plan coverage. If you are amonthly paid employee not already eligiblefor benefits, or a weekly or biweekly paidemployee regularly scheduled to work 20to 29 hours per week, then you are partiallybenefits-eligible. TempForce (temporary),adjunct, flex or PRN employees are alsopartially benefits-eligible if they work 20 to29 hours per week.work for VUMC, you canRandom AuditsVUMC reserves the right to audit eligibilityand may require copies of any legalpapers issued to establish a person asyour spouse or child. Only copies of actualcourt documents issued by the respectivecourts will be considered as acceptabledocumentation for dependents.Attempting to insure someone whois not eligible may result in disciplinaryaction, up to and including termination ofemployment.each enroll as an employeeor one of you can enroll asa dependent of the other.Dependent children of VUMCcouples can only be enrolledunder one parent’s coverage.Fully Benefits-Eligible EmployeesHealthplanPrescription planDental Auto/homeinsuranceflexPTOGo for theGoldMTAdiscountsChild Eligibility DetailsFully and partially benefits-eligibleemployees may cover natural, step-, oradopted children up to age 26, and otherqualified dependents, such as disabledchildren over age 26, with requireddocumentation.Any child placed in your home for legaladoption or guardianship (pursuant to acourt order) is eligible until age 26.Unmarried children with mental orphysical handicaps who are already enrolledand dependent on you for support areeligible, regardless of age, provided youcontact the Employee Service Center atleast one month before your child’s 26thbirthday for the necessary paperwork toprovide proof of disability. Thereafter, youwill be contacted by Human Resourcesannually to verify eligibility.Partially Benefits-Eligible EmployeesHealthplanPrescription planGo for homeinsuranceflexPTO(except TempForce)17
VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R O R I E N TAT I O N G U I D EVUMC Health PlanHealth Plan OptionsVUMC offers three health plan options: Aetna Plus Aetna Select Health Savers with Health SavingsAccount (HSA)All three are strong, high-quality optionsand provide similar services and networks.The differences come in the cost-sharingamounts — meaning the premiums,deductibles, copayments and out-of-pocketmaximums.VUMC pays a significant part ofthe health expenses you and yourfamily members may incur. You will beautomatically enrolled in the Aetna Plusemployee-only option and charged if youare fully benefits eligible, unless you makechanges or opt-out within 30 days of yourhire date.Preventive CareAll plan options provide 100 percentcoverage for preventive care and screenings,with no deductible or copay required, aslong as the service meets the guidelinesfor a preventive care service, is not forscreening of a diagnosis, and is done at aTier 1 or 2 provider.Please refer to the Evidence of Coveragefor the health plan option of your choicefor more information regarding preventivecare benefits. Information can be found onthe Human Resources website, hr.vumc.org,under Benefits.ID CardsYou will receive two ID cards if you enrollin any health plan option, one from Aetnafor medical and one from Navitus forprescription drugs. If you need a duplicatecard, contact the appropriate vendor tomake the request.Health Plan NetworksA network is a group of physicians,hospitals, and other health care providersthat have agreed to provide medical servicesat pre-negotiated rates. VUMC’s health planoptions have three networks:Tier 1: VUMC/VHAN AffiliatesAs our preferred network, you willusually receive maximum savings usinga Tier 1 provider. We have made severalimprovements in our Tier 1 offeringsto ensure VUMC employees havecomprehensive and readily accessiblecare in all specialties, including behavioralhealth. In addition, we have greatlyexpanded the convenient locations andcare coordination capabilities of the VUMCand VHAN network, including a largenumber of walk-in and after-hours clinics.You can easily find a Tier 1 provider on theAetna DocFind website at aetna.com/dse/custom/vanderbilt.Tier 2: Aetna Preferred ProvidersTier 2 is the Aetna preferred network, whichis largely intended for individuals seekingnon-emergency care when they happen tobe in locations outside VUMC and VHANservice areas (typically, vacation travel).It is important to note that employeesas well as covered dependents livingoutside of the State of Tennessee can usethe Tier 2 network for their care at Tier1 coverage rates. In the rare situationswhere a particular health care service orclinical trial is not available at VUMC or ata VHAN affiliate, Vanderbilt Medical Groupproviders may refer members to a provideroutside of Tennessee which will then becovered at the Tier 1 level.Tier 3: Out-of-NetworkMost other local facilities and providersthat are not VHAN-affiliates, such as HCAand St. Thomas Health, will be Tier 3, withthe exception of OB/GYN services at St.Thomas Midtown and Rutherford whichwill remain a Tier 1 offering in 2020. Tier3 providers and facilities are considered“out-of-network” and will continue to havethe highest deductibles and out-of-pocketmaximums.Provider DirectoriesThe Aetna directory is available to searchfor Tier 1 and 2 doctors and hospitals: www.aetna.com/dse/custom/vanderbilt.Please remember thatyou choose a health planoption when you enroll,not a network.Go for the GoldThe Wellness Credit you earn forparticipating in Go for the Goldwill be placed in your VUMCHealth Plan Account managed byAetna if you are enrolled in theAetna Plus or Aetna Select plans.If you are enrolled in the HealthSavers plan, the Wellness Creditwill be deposited into your HealthSavings Account (HSA). Theannual amount you earn dependson your level of participation(bronze: 120, silver: 180, gold: 240).Evidence of CoverageBookletsFor full details of each health planoption, see each option’s Evidenceof Coverage booklet at hr.vumc.org/benefits/sbc-eoc.Summary of Benefitsand CoverageVUMC provides a Summary ofBenefits and Coverage for eachhealth plan option. Required bylaw, the SBCs provide an easyto-understand summary abouteach health plan’s benefits andcoverage. You can find them athr.vumc.org/benefits/sbc-eoc oryou can request a printed copyby calling the Employee ServiceCenter at 615.343.700018
VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R O R I E N TAT I O N G U I D EUsing Tier 1: VUMC/VHAN AffiliatesAs our preferred network, you will usually receive maximum benefit using a Tier 1 provider. We have made several improvementsin our Tier 1 offerings to ensure VUMC employees have comprehensive and readily accessible care in all specialties, includingbehavioral health. In addition, we have greatly expanded the convenient locations and care coordination capabilities of the VUMCand VHAN network, including a large number of walk-in and after-hours clinics. You can easily find a Tier 1 provider on the AetnaDocFind website at aetna.com/dse/custom/vanderbilt. For full details of each health plan option, see each option’s Evidence ofCoverage booklet. If you participate in Go for the Gold, your Wellness Credit will be applied to your Health Plan Account for AetnaPlus and Aetna Select plans. If you enroll in the Health Savers Plan, the Wellness Credit will be deposited into your Health SavingsAccount (HSA). (see hr.vumc.org/benefits/gftg for details).Aetna PlusAetna SelectHealth Plan OptionHealth Savers Plan1Health Plan OptionHealth Plan OptionAnnual deductible2Individual: 600Family maximum: 1,100Individual: 500Family maximum: 1,000Employee only: 1,800Employee plus:Individual: 2,800, Family: 3,500Coinsurance20% after deductible10% after deductible10% after deductibleOut-of-pocket limitIndividual: 4,000Family maximum: 7,500Individual: 3,500Family maximum: 7,000Individual: 6,500Family maximum: 12,500Preventive visit 0 0 0Sick visit, specialist visit,mental health visit 20 copay 20 copay10% after deductibleUrgent care visit 50 copay, then 20% afterdeductible 50 copay then 10% afterdeductible10% after deductibleEmergency room visit 125 copay then 20% afterdeductible 125 copay then 10% afterdeductible10% after deductibleHospital inpatient, outpatient, diagnostic testing20% after deductible10% after deductible10% after deductibleSkilled nursing, homehealth, hospice, therapy20% after deductible10% after deductible10% after deductible3*The Aetna Health Savers Plan comes with an HSA account. If you elect employee-only coverage, VUMC deposits 750 into the HSA account. If you electspouse,children, or family coverage, VUMC deposits 1,500 into the HSA account. You can use these funds to meet your deductible. Note: The VUMC contributionis prorated based on hire date. January-June: 750 for individual, 1,500 for family. July-September: 375 for individual, 750 for family. October-December: 0.**Certain out-of-network services require prior authorization or else the out-of-pocket limit does not apply.***Aetna Plus and Select plans have a separate out-of-pocket limit for pharmacy expenses.Glossary ofhealth coveragetermsDeductible. The amountyou owe for healthservices before yourhealth insurance beginsto pay.Coinsurance. Yourshare of the costs ofa covered health careservice, calculated as apercent of the allowedamount for the service.Out-of-pocketmaximum. The most youpay during a year beforeyour health insurancebegins to pay 100% ofthe allowed amount.Copay. A fixed amountyou pay for a coveredhealth care service,usually when you receivethe service.19
VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R O R I E N TAT I O N G U I D EUsing the Tier 2: Aetna Preferred NetworkTier 2 is the Aetna preferred network, which is largely intended for individuals seeking non-emergency care when they happen to be inlocations outside VUMC and VHAN service areas (typically, vacation travel). It is important to note that employees as well as covereddependents living outside of the State of Tennessee can use the Tier 2 network for their care at Tier 1 coverage rates. In the rare situationswhere a particular health care service or clinical trial is not available at VUMC or at a VHAN affiliate, Vanderbilt Medical Group providersmay refer members to a provider outside of Tennessee which will then be covered at the Tier 1 level. For full details of each health plan option,see each option’s Evidence of Coverage booklet. If you participate in Go for the Gold, your Wellness Credit will be applied to your Health PlanAccount for Aetna Plus and Aetna Select plans. If you enroll in the Health Savers Plan, the Wellness Credit will be deposited into your HealthSavings Account (HSA). (see hr.vumc.org/benefits/gftg for details).Aetna PlusHealth Plan OptionAetna SelectHealth Plan OptionHealth Savers Plan1Health Plan OptionAnnual deductible2Individual: 2,500Family maximum: 5,000Individual: 2,000Family maximum: 4,000Employee only: 3,000Employee plus:Individual: 3,000, Family: 6,000Coinsurance60% after deductible60% after deductible60% after deductibleOut-of-pocket limitIndividual: 6,000Family maximum: 10,000Individual: 6,000Family maximum: 10,000Individual: 6,500Family maximum: 12,500Preventive visit 0 0 0Sick visit, specialist visit,mental health visit 50 copay 50 copay60% after deductibleUrgent care visit 75 copay then 60% afterdeductible 75 copay then 60% afterdeductible60% after deductibleEmergency room visit 125 copay then 20% afterdeductible 125 copay then 10% afterdeductible10% after deductibleHospital inpatient, outpatient, diagnostic testing60% after deductible60% after deductible60% after deductibleSkilled nursing, homehealth, hospice, therapy60% after deductible60% after deductible60% after deductible3*The Aetna Health Savers Plan comes with an HSA account. If you elect employee-only coverage, VUMC deposits 750 into the HSA account. If you electspouse,children, or family coverage, VUMC deposits 1,500 into the HSA account. You can use these funds to meet your deductible. Note: The VUMC contributionis prorated based on hire date. January-June: 750 for individual, 1,500 for family. July-September: 375 for individual, 750 for family. October-December: 0.**Certain out-of-network services require prior authorization or else the out-of-pocket limit does not apply.***Aetna Plus and Select plans have a separate out-of-pocket limit for pharmacy expenses.Glossary ofhealth coveragetermsDeductible. The amountyou owe for healthservices before yourhealth insurance beginsto pay.Coinsurance. Yourshare of the costs ofa covered health careservice, calculated as apercent of the allowedamount for the service.Out-of-pocketmaximum. The most youpay during a year beforeyour health insurancebegins to pay 100% ofthe allowed amount.Copay. A fixed amountyou pay for a coveredhealth care service,usually when you receivethe service.20
VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R O R I E N TAT I O N G U I D EUsing the Tier 3: Non-Preferred/Out-of-NetworkMost other local facilities and providers that are not VHAN-affiliates, such as HCA and St. Thomas Health, will be Tier 3, with the exceptionof OB/GYN services at St. Thomas Midtown and Rutherford which will remain a Tier 1 offering in 2020. Tier 3 providers and facilities areconsidered “out-of-network” and will continue to have the highest deductibles and out-of-pocket maximums. For full details of each healthplan option, see each option’s Evidence of Coverage booklet. If you participate in Go for the Gold, your Wellness Credit will be applied to yourHealth Plan Account for Aetna Plus and Aetna Select plans. If you enroll in the Health Savers Plan, the Wellness Credit will be deposited intoyour Health Savings Account (HSA). (see hr.vumc.org/benefits/gftg for details).Aetna PlusHealth Plan OptionAetna SelectHealth Plan OptionHealth Savers Plan1Health Plan OptionAnnual deductible2Individual: 5,000Family maximum: 10,000Individual: 5,000Family maximum: 10,000Employee only: 5,000Employee plus:Individual: 5,000, Family: 10,000Coinsurance70% after deductible70% after deductible70% after deductibleOut-of-pocket limitIndividual: 8,500Family maximum: 16,500Individual: 8,500Family maximum: 16,500Individual: 11,000Family maximum: 21,500Preventive visit70% after deductible70% after deductible70% after deductibleSick visit, specialist visit,mental health visit70% after deductible70% after deductible70% after deductibleUrgent care visit 75 copay then 70% afterdeductible 75 copay then 70% afterdeductible70% after deductibleEmergency room visit 125 copay then 20% afterdeductible 125 copay then 10% afterdeductible10% after deductibleHospital inpatient, outpatient, diagnostic testing70% after deductible70% after deductible70% after deductibleSkilled nursing, homehealth, hospice, therapy70% after deductible70% after deductible70% after deductible3*The Aetna Health Savers Plan comes with an HSA account. If you elect employee-only coverage, VUMC deposits 750 into the HSA account. If you electspouse,children, or family coverage, VUMC deposits 1,500 into the HSA account. You can use these funds to meet your deductible. Note: The VUMC contributionis prorated based on hire date. January-June: 750 for individual, 1,500 for family. July-September: 375 for individual, 750 for family. October-December: 0.**Certain out-of-network services require prior authorization or else the out-of-pocket limit does not apply.***Aetna Plus and Select plans have a separate out-of-pocket limit for pharmacy expenses.Glossary ofhealth coveragetermsDeductible. The amountyou owe for healthservices before yourhealth insurance beginsto pay.Coinsurance. Yourshare of the costs ofa covered health careservice, calculated as apercent of the allowedamount for the service.Out-of-pocketmaximum. The most youpay during a year beforeyour health insurancebegins to pay 100% ofthe allowed amount.Copay. A fixed amountyou pay for a coveredhealth care service,usually when you receivethe service.21
VA N D E R B I LT U N I V E R S I T Y M E D I C A L C E N T E R O R I E N TAT I O N G U I D EPrescription Drug Be
health insurance begins to pay. Coinsurance. Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. Out-of-pocket maximum. The most you pay during a year before your health insurance begins to pay 100% of the allowed amount. Co
