Eligibility

Regular full-time faculty and staff members are eligible to enroll in Penn State’s Health Care Plan. Highmark Blue Shield is responsible for administering the health plan.

If you have any children, they are eligible for coverage on your insurance up to the age of 26. Eligibility is regardless of student status, marital status, or ability to have insurance through their employer.

NOTE: If the adult dependent child of the employee is married, only the adult dependent child of the employee is eligible for coverage.

Notification is sent to the employee from the Employee Benefits Division 60 days prior to a dependent turning 26.  This notification includes information concerning a dependent child who may be eligible to continue coverage if that dependent is mentally or physically handicapped, so as to be incapable of earning a living when coverage would normally terminate due to age.  When your child is no longer eligible, please contact the Employee Benefits Division to inquire about continuing benefits under COBRA.

University Health Services Student Health Center Update

As of August 2014, University Health Services (UHS) Student Health Center located at the University Park campus, will accept the following insurances for STUDENTS ONLY:

  • Highmark Blue Shield
  • Aetna
  • Cigna
  • United Health Care
  • UPMC
  • PA Medical Assistance
  • Tri Care

University employees who participate in either the PPO Blue plan or the PPO Savings Plan, who have student dependents attending Penn State, should encourage their children to present their Highmark medical ID card when seeking services at UHS. Please be aware that Penn State FACULTY AND STAFF may continue to use the UHS pharmacy for prescriptions, but they will not have access to MEDICAL services at UHS.  
 
Questions regarding this change should be directed to University Health Services at uhs-info@psu.edu.

Employee Medical Plans Used at Other Penn State Student Health Clinics

All other Penn State campuses also have a student health clinic that is the primary treatment center for its students.  Therefore, it is reasonable to expect that dependent students may try to seek treatment from one of these clinics.  Unfortunately, these student clinics are unable to contract with insurance providers.  The cost of dealing with so many insurance companies for those clinics would drive up the current discounted rate for services provided there.

Therefore, if you have dependents who are also students at Penn State campuses, other than University Park, we suggest that they continue to utilize their family physician or search for a participating provider through the Highmark Provider Directory.  In most cases, the student health clinics available to Penn State students will be considered an out-of-network provider with our Highmark employee health plan.  Should your dependent student decide to visit a student clinic regardless, it is the patient (or employee) responsibility to submit claims to Highmark for reimbursement.

If your dependent student attends University Park campus, please review the information in the section above, “University Health Services Student Health Center Update,” regarding the use of their Highmark health insurance coverage.

Enhanced Prescription Drug Coverage for Contraceptives

The cost sharing structure for contraceptives has changed due to Health Care Reform legislation. All FDA-approved contraceptive methods are included in this enhancement, and will be covered at zero cost share.

Contraceptive Coverage Update:

As of November 1, 2013, Highmark has changed the cost sharing for contraceptives in the Brand Non-Formulary tier of coverage. Now, ALL tiers of contraceptives are covered at 100% under the prescription drug coverage.

Specialty Medications

Specialty medications are typically self-administered injectibles, biological agents, biotechnology medications and other prescriptions that are not available at most pharmacies.

  • Walgreens Specialty Pharmacy is the exclusive provider for certain specialty medications
  • Dispensed in one-month supplies
  • Maximum cost $50/month for formulary drugs and $100/month for non-formulary drugs

If you have any questions, contact Highmark Blue Shield at 1-800-914-4384. This is a dedicated line for Penn State faculty and staff.

Health Care Payroll Contribution

2014 will be the third year of the salary-indexed payroll premium contribution method. A sample of the contribution rates for 2014 is outlined below.

Payroll contributions will be determined on your annual base salary as of October 1, 2013. Your new payroll contribution amount will be effective January 1, 2014 and will remain the same for the entire year (Appointments of irregular duration will be adjusted as deemed appropriate when the appointment is updated). The 2014 contribution rates will be reflected after January 1, 2014.

If both the employee and spouse/same-sex domestic partner are employed at Penn State, they have the ability to choose which employee will carry the health benefits and have the corresponding salary-indexed payroll deduction; changes of this nature must by made in ESSIC during Open Enrollment only.

For postdoctoral scholars interested in participating in the University’s healthcare plan, the rates are shown below. Additional information regarding the benefits for postdoctoral scholars can be found at the Office of Postdoctoral Affairs.

The below grid(s) are sample contribution amounts only. Your own specific, salary-based payroll contribution for 2014 is reflected in ESSIC.

If your base salary is higher than $140K, your contribution will be determined based on $140K, as this is the maximum salary level for the 2014 contribution calculation.

2014 PPO Blue Plan
Plan
Type
25K30K35K45K50K55K60K70K75K85K100K140K
Individual $36.46 $43.75 $51.04 $65.63 $72.92 $80.21 $87.50 $102.08 $109.38 $123.96 $145.83 $204.17
2 Person $88.54 $106.25 $123.96 $159.38 $177.08 $194.79 $212.50 $247.92 $265.63 $301.04 $354.17 $495.83
Parent/Child(ren) $82.08 $98.50 $114.92 $147.75 $164.17 $180.58 $197.00 $229.83 $246.25 $279.08 $328.33 $459.67
Family $113.13 $135.75 $158.38 $203.63 $226.25 $248.88 $271.50 $316.75 $339.38 $384.63 $452.50 $633.50
2014 PPO Savings Plan
Plan
Type
25K30K35K45K50K55K60K70K75K85K100K140K
Individual $10.42 $12.50 $14.58 $18.75 $20.83 $22.92 $25.00 $29.17 $31.25 $35.42 $41.67 $58.33
2 Person $25.21 $30.25 $35.29 $45.38 $50.42 $55.46 $60.50 $70.58 $75.63 $85.71 $100.83 $141.17
Parent/Child(ren) $23.33 $28.00 $32.67 $42.00 $46.67 $51.33 $56.00 $65.33 $70.00 $79.33 $93.33 $130.67
Family $32.29 $38.75 $45.21 $58.13 $64.58 $71.04 $77.50 $90.42 $96.88 $109.79 $129.17 $180.83

Part-Time Health Care Contribution

Healthcare benefits are available for eligible part-time employees. Eligibility rules can be found in HR policy HR05 – “Regular” and “Non-regular” University Employees. For those part-time employees that are notified they are eligible to participate in the healthcare plan, the rates are shown below.

2014 Part-Time Employee Contributions Per Pay
Plan TypeMonthly RateBi-Weekly Rate
Individual $260.55 $120.25
Family $708.56 $327.03

Summary of Benefits and Coverage (SBC)

As part of Health Care Reform, Penn State has made available to you a Summary of Benefits and Coverage (SBC) for each of the plan types available to benefit-eligible employees for review. These documents summarize important information about the healthcare coverage options that are offered under the group PPO Blue Plan, PPO Savings Plan, and Value Based Benefit Design at Penn State. A paper copy is also available, free of charge, by contacting the Employee Benefits Division.

Presentations

Additional Resources

Forms