Health Insurance

Penn State offers two health care options to its employee population:

Both plans:

  • Are administered by Highmark BlueShield
  • Cover the same services
  • Utilize the same provider network
  • Have the same drug formulary
  • Include 100% coverage for preventive care with in-network providers
  • Offer world-wide coverage
  • Treat all emergency care as in-network
  • Have no lifetime maximum
  • Carry a deductible
  • Contain a cost-sharing component called co-insurance
  • Have an out-of-pocket maximum associated with them 

Following are some differences between the two plans:

  • The level of deductible that needs to be satisfied before medical claims begin to be paid at 90%
  • The amount for the out-of-pocket maximum
  • The employee’s payroll contribution for the premium
  • The method by which the employee may put aside pre-tax dollars for use in paying for medical expenses
  • Other differences, such as eligibility criteria, and prescription drug costs as they relate to the deductible

Summary of Benefits and Coverage (SBC)

Summary of Benefits and Coverage (SBC) documents summarize important information about the healthcare coverage options that are offered under the two Penn State health plans:

PPO Savings Plan SBC           PPO Blue Plan SBC

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.

Postdoctoral Scholar Eligibility: For postdoctoral scholars interested in participating in the Penn State employee healthcare plan according to postdoctoral scholar eligibility, the per-pay contribution rates follow the same salary-based schedule as for faculty and staff. For additional information regarding the benefits available to postdoctoral scholars, please contact or visit the Office of Postdoctoral Affairs.

Healthcare Premiums

Payroll contributions will be determined based on the employee's annual base salary as of October 31, 2015. For the 2016 plan year, the new payroll contribution amount is effective January 1, 2016 and will remain the same for the entire year.

If both the employee and spouse 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, and may be made only during the Benefits Open Enrollment period in November.

The below grid(s) are sample contribution amounts only. The employee's specific, salary-based payroll contribution for 2016 is reflected in ESSIC.

2016 Premiums for Faculty and Staff:

2016 PPO Blue Plan (Faculty & Staff)
Plan Type $30,000 $40,000 $50,000 $60,000 $75,000 $85,000 $100,000 $140,000
Individual
(1.81% of Salary)
$45.28 $60.37 $75.47 $90.56 $113.20 $128.30 $150.94 $211.31
2-Person
(4.40% of Salary)
$110.05 $146.74 $183.42 $220.11 $275.13 $311.82 $366.84 $513.58
Parent/Child(ren)
(4.08% of Salary)
$101.98 $135.97 $169.97 $203.96 $254.95 $288.95 $339.94 $475.91
Family
(5.61% of Salary)
$140.37 $187.16 $233.95 $280.74 $350.93 $397.72 $467.91 $655.07
2016 PPO Savings Plan (Faculty & Staff)
Plan Type $30,000 $40,000 $50,000 $60,000 $75,000 $85,000 $100,000 $140,000
Individual
(0.52% of Salary)
$12.94 $17.25 $21.56 $25.87 $32.34 $36.66 $43.12 $60.37
2 Person
(1.25% of Salary)
$31.31 $41.75 $52.18 $62.62 $78.27 $88.71 $104.36 $146.11
Parent/Child(ren)
(1.16% of Salary)
$28.98 $38.64 $48.30 $57.96 $72.45 $82.11 $96.60 $135.24
Family
(1.60% of Salary)
$40.11 $53.47 $66.84 $80.21 $100.27 $113.63 $133.69 $187.16

2016 Bi-Weekly Premiums for Teamsters:

2016 PPO Blue Plan (Teamsters)
Plan Type $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $60,000
Individual
(2.37% of Salary)
$22.79 $27.35 $31.90 $36.46 $41.02 $45.58 $54.69
2-Person
(5.12% of Salary)
$49.23 $59.08 $68.92 $78.77 $88.62 $98.46 $118.15
Parent/Child(ren)
(4.78% of Salary)
$45.96 $55.15 $64.35 $73.54 $82.73 $91.92 $110.31
Family
(6.42% of Salary)
$61.73 $74.08 $86.42 $98.77 $111.12 $123.46 $148.15
2016 PPO Savings Plan (Teamsters)
Plan Type $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $60,000
Individual
(1.04% of Salary)
$10.00 $12.00 $14.00 $16.00 $18.00 $20.00 $24.00
2 Person
(1.81% of Salary)
$17.40 $20.88 $24.37 $27.85 $31.33 $34.81 $41.77
Parent/Child(ren)
(1.71% of Salary)
$16.44 $19.73 $23.02 $26.31 $29.60 $32.88 $39.46
Family
(2.17% of Salary)
$20.87 $25.04 $29.21 $33.38 $37.56 $41.73 $50.08

2016 Premiums for Part-Time Employees:

Individuals who became eligible on or before December 31, 2014, for the part-time health care plan will continue to be eligible for such provisions, provided:

  1. There is no involuntary or voluntary separation from University employment, for example if the employee leaves University employment for any period of time;
  2. The employee continues to be enrolled in the part-time health care plan, with applicable payment of health care plan premiums, with no drop of coverage; or
  3. The employee transfers into a full-time benefits eligible position.

See Policy HR103 Employment Conditions for Part-Time, Intermittent/Short-Term & Full-Time Student Employees for established criteria for those grandfathered under discontinued Policy HR05 prior to December 31, 2014.

2016 Part-Time Employee Contributions Per Pay
Plan Type Monthly Rate Bi-Weekly Rate
Individual $281.66 $130.00
Family $765.97 $353.52

Tools for Decision-Making

Following are tools that will assist Penn State employees in making the health plan selection that is best for themselves and their families:

Healthcare 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 PPO Blue Plan members and for Penn State employees who are not in a Penn State health plan

To see the medical expenses for which these spending accounts may used, please go to Comprehensive List of Qualifying Medical Expenses.

Additional Resources

  1. Visit Highmark Blue Shield and log in at the top of the screen
  2. Click on the Health & Wellness tab at top of webpage under Highmark logo
  3. Click on the Wellness Profile WebMD link from the list on the left-hand side of screen
  4. In the upper right side of the page, click on the triangle to the right of your name
  5. Click on "Settings"
  6. Click "Account Deletion"
  7. Click the checkbox beside "I agree to the deletion of my data as described above."
  8. Click "Delete My Account"
  9. Type "DELETE" in the box, then click "Confirm Deletion"

Upon completing the steps outlined above, the member's WebMD account (and Wellness Profile) will be deleted.

Please note that members cannot "delete" their Wellness Profile from WebMD and still have access to other WebMD functionality. Those wishing to delete their responses to the Wellness Profile will need to delete their WebMD account.

Forms

Please use the following link for the most up-to-date versions of Highmark's medical, prescription, and spending account reimbursement claim forms. For help in locating a Highmark form, please contact Highmark directly at (800) 914-4384.

Medical, Prescription, and Spending Account Forms for Highmark Members: Provides the most recent versions of Highmark's medical, prescription, and spending account reimbursement claim forms. For help in locating a Highmark form, please contact Highmark directly at (800) 914-4384.

University Health Services Prescription Mail Order Form

Highmark website updates

Highmark is making several changes to their website in order to provide member enhancement to their Find a Doctor feature and their health spending account Claims & Spending functions.

Find a Doctor Update – Now you no longer need to log in to your Highmark account in order to search for an in-network physician or hospital. The updated search is also simpler and more efficient. You will be able to use everyday language such as "ear, nose, and throat" or "heart disease" to find in-network specialist in those areas. Please visit Highmark to use the updated Find a Doctor feature.

FSA/HSA Update – Participating members are now being given more options when using their flexible spending account or health savings account to pay claims. New updates allow members to pay a portion or the entire claims with one submission, including the ability to select a precise amount to pay toward a claim. Please visit the Highmark website to log in to your account to utilize the new features.

Equian (formerly Trover Solutions)

Highmark’s subrogation vendor, Trover Solutions, has announced a name change to Equian effective July 1, 2016. Highmark uses Equian to investigate accident and/or injury claims that are submitted for processing. Please note that it is important for members to respond to the information requested by Equian in order for claims to process appropriately.

For PPO Blue members only without a Health Care FSA: 

As Highmark continues to “go green”, effective May 9, they will discontinue printing/mailing paper Explanation of Benefits (EOBs) when there is a $0 balance, or when there is only an office visit or emergency room copayment, due for a medical claim. You will be able to view these EOBs online at www.highmarkblueshield.com or by calling Highmark member services at 800-914-4384.  

All other types of claims will continue to generate paper EOB’s, unless you have chosen to receive EOBs through the Highmark website only.  

This change does NOT apply to those enrolled in the PPO Blue plan with an FSA or the PPO Savings plan with the HSA. Plan Activity Statements will continue to generate as usual.

Highmark Network Rules for Laboratories

Network rules for labs are different than other in-network providers.  Laboratories are considered in-network if they participate in the local Blue Cross and/or Blue Shield network IN THE SERVICE AREA OF THE PHYSICIAN WHO ORDERED THE LAB WORK.  This means that when a physician orders lab work, you need to make sure you are using a laboratory in the same state as the ordering physician.  For example, if you live in Pennsylvania, but see a doctor in New Jersey, you need to make sure the lab work is performed in New Jersey, or the laboratory claim will be processed as out-of-network, and the higher deductible and coinsurance would apply.  Contact Highmark directly at 800-914-4384 if you need help finding network providers. 

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.