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Health Plan Details

2018 Health Plan Rates     • Dental, Vision, FSA, AD&D details

We're offering the same health plan options as we did in 2017 and the key features of our health plan options—such as annual deductibles, coinsurance and prescription coverage—are remaining the same.

Health Plan Options

VUMC offers three health plan options: Aetna Plus, Aetna Select and Aetna HealthFund. All three are strong high-quality options and provide similar services and networks. The three options also include the same prescription coverage with Navitus. The differences come in the cost-sharing amounts — meaning the premiums, deductibles, copayments and out-of-pocket maximums.

How will I know which health plan option to choose?

Here are three tools to help you decide which health plan option is best for you.

In addition, here are three questions to ask yourself:

  1. Did my pay increase and possibly change my salary band? VUMC payroll premiums are based on salary bands. See a chart in the Detailed Guide.
  2. Do I need to update which dependents are covered under my plan?
  3. Do I expect to need more or less medical care in 2018 than I did in 2017?

If you answer "yes" to any of the questions above, you may want to make a change to your health plan option.

Networks

A network is a group of physicians, hospitals, and other health care providers that have agreed to provide medical services at pre-negotiated rates. VUMC's health plan options have three networks:

Vanderbilt Health Affiliated Network (VHAN)

As our preferred network, you will usually receive the most cost-effective services using a VHAN provider. See the chart, below, for details about the VHAN Network (see a larger version of the chart). You can easily find VHAN providers on the Aetna DocFind website

VHAN chart

 

Aetna National Network

If your preferred doctor is not in the VHAN network, you're traveling, or a service you need is not offered, you may not be able to use a VHAN provider. In that case, try to use an Aetna National Network provider. Costs for using an Aetna National Network provider can be higher than using a VHAN provider but provides better value than going out-of-network. See the chart, below, for details about the Aetna National Network (see a larger version of the chart). You can find Aetna National Network providers on the Aetna DocFind website.

Aetna National chart

 

Out-of-Network

These providers have not contracted with Aetna for reimbursement at a negotiated rate. This means this network can be the least cost-effective to use. Don't forget, some non-emergency, out-of-network services will require prior authorization. See the chart, below, for details about out-of-network costs (see a larger version of the chart).

out of network chart

 

Please remember that you choose a health plan option during Open Enrollment, not a network.

Prescription drug benefit

All three health plan options include the same Prescription Drug Benefit. Navitus Health Solutions administers the prescription drug benefit for all VUMC faculty and staff enrolled in one of the three health plan options. The prescription drug benefit is a multi-level formulary (i.e., list of covered drugs) with a recommended generic program.

The VUMC Health Plan encourages faculty and staff to use the Vanderbilt pharmacies, where you will get the $1 maintenance generics and the best price for all other prescriptions. You can also take advantage of the Vanderbilt Mail Order Pharmacy, meaning your medications will be shipped for free. The Navitus pharmacy network is also available and includes most major retail pharmacies.

While Vanderbilt pharmacies give us the best pricing using our employee health plan, we know that sometimes you need to use a non-Vanderbilt pharmacy such as a retail outlet. Starting in 2018, you can fill prescriptions at Walgreens at lower rates than other non-Vanderbilt pharmacies. As our preferred partner, Walgreens offers lower copays and coinsurance rates than other non-preferred pharmacies.

  • As an example, Tier 1 drugs at a Vanderbilt Pharmacy have a $5 copay while Tier 1 drugs at Walgreens have a $12 copay. By contrast, drugs at a non-preferred pharmacy have a $20 copay.
  • The following prescriptions will continue to be offered exclusively through the Vanderbilt Pharmacy and will not be available at Walgreens: 90-day prescriptions, mail-order prescriptions and specialty pharmacy prescriptions.

There is a calendar year prescription coinsurance and copay limit of $2,500 for individuals or $5,000 for families. The cap is the same for each of the health plan options.

Not all prescription drugs are covered by the VUMC Health Plan. Some prescription drugs require prior authorization from Navitus Health Solutions before the prescription can be filled. If you fill a prescription at an out-of-network pharmacy, you won't receive the prescription benefit.

Visit the Navitus website for more information.


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