Medical Insurance

You are eligible to join the University of Miami medical plan if you are a full-time or part-time faculty or staff working at least 50% full-time effort (FTE). For new employees who elect as part of their new hire period, coverage will be retroactive to your start date.

Faculty members who are members of the Associated Faculty (visiting and voluntary faculty) without the title of lecturer are not eligible.The following employee types in Workday are also not eligible for the UM/Aetna plan:

• Faculty-Intermittent (Seasonal)
• Temporary-Intermittent
• Temporary - Charge Back (Fixed Term)
• Student

Your eligible dependents include:

• Your legal spouse
• Your dependent child up to age 26, regardless of student, employment, or marital status (coverage ends at the end of the month in which the dependent child turns 26)

Your dependent children include:

• Your natural child
• Your legal stepchild
• Your legally adopted child (or child placed with you for legal adoption)

If you experience a qualifying status change (life event), HR-Total Rewards must be notified of the change within 30 days of the date of the event via Workday.

Any changes made will be retroactive to the date of the event (such as marriage date) and the employee will be responsible for any owed premiums (if applicable).

The Aetna Select 1 plan offers access to a to a national network (Aetna Select Open Access) of providers and facilities. There are no out-of-network benefits. The Aetna Select 1 plan has a $200 deductible per person, up to $600 per family. Once the deductible is met, participants pay copays for services. Preventive care is free and bypasses the deductible. Prescription drugs also bypass the deductible, but require copays.*

*Note, any prescription NOT covered by AetnaRx is the full responsibility of the member and WILL NOT be applied toward your deductible or out-of-pocket maximum.

The Aetna Select 2 plan offers access to a national network (Aetna Select Open Access) of providers and facilities. There are no out-of-network benefits. The Aetna Select 2 plan has a $300 deductible per person, up to $900 per family. Once the deductible is met, participants pay copays for services. Preventive care is free and bypasses the deductible. Prescription drugs also bypass the deductible, but require copays.*

*Note, any prescription NOT covered by AetnaRx is the full responsibility of the member and WILL NOT be applied toward your deductible or out-of-pocket maximum.

The HRA plan offers access to a national network (Choice POS II Open Access) of providers and facilities and out-of-network benefits (at higher costs). The plan has a $400 per person health fund - paid by UM - to help pay for up front medical and pharmacy expenses, including the $1,500 per person deductible, up to $4,500 per family. The maximum fund a family will receive is $1,200. The unused funds roll over each year as long as you remain in this plan. 

A pharmacy expense is a medication, prescribed by a licensed provider, which requires a prescription to obtain, is run through the Aetna insurance, and is applied to the deductible. Over the counter items are not considered pharmacy expenses.

In-network preventive care is free and bypasses the deductible. However, prescription drugs do not bypass the deductible, which must be met prior to copays.* 

Note, if you participate in both the Aetna HRA medical plan and a health care FSA, you will receive one WageWorks Visa card with both HRA and FSA funds on the card. Aetna medical and pharmacy expenses will pull your HRA dollars first, unless you have FSA funds left over from the previous calendar year to spend down. Click here to view a presentation explaining how the HRA Plan works.

*Note, any prescription NOT covered by AetnaRx is the full responsibility of the member and WILL NOT be applied toward your deductible or out-of-pocket maximum.

Faculty (non-UMMG) and Staff

University of Miami Medical Group (UMMG) - Clinical Faculty & Staff Physicians

Residents (full-time residents at JFK Medical Center and Holy Cross Hospital)

Part-Time Faculty (non-UMMG) and Staff

Part-Time UMMG

Long-Term Disability Faculty (non-UMMG) and Staff

Long-Term Disability UMMG

Early Retirees

COBRA

Review and compare plan details including copays, deductibles and out-of-pocket maximums.

2023 Medical Plan Comparison Chart

2024 Medical Plan Comparison Chart

Review and compare plan details including copays and coinsurance.

Mental and Behavioral Health Charge Schedule

Balance Billing
Out-of-network providers may bill patients for the balances remaining on the charges associated
with services rendered, after the insurance reimbursement amount is paid. You are responsible
for the difference between out-of-network billed charges and Aetna’s maximum allowable fee.

Coinsurance
Your share of the costs of a covered healthcare expense calculated as a percent based on the
contracted Aetna rate you pay for services after your deductible is met

Copayment (Copay)
The fixed dollar amount you pay each time you receive certain types of medical services or prescriptions. Copays vary depending on the service you’re receiving.

Deductible
The dollar amount you must pay for covered health care services before your insurance plan
starts to pay. Copayments do not apply to the deductible.

Family
A family plan consists of an employee, a spouse, and at least one dependent child. In all of our plans, once the deductible is met for three members of a family, it is met for all other members of the same family.

Maximum Allowable Fee
An amount determined by Aetna to be the prevailing charge for the service. This amount is based
on a national database, complexity of services, range of services and prevailing charge in the
geographic area.

In-Network
Physicians, hospitals, and other healthcare providers who are contracted with Aetna. Aetna has a national network with providers all over the country. UHealth providers are all within the Aetna network.

Out-of-Network
Physicians, hospitals, and other healthcare providers who are not contracted with Aetna

Out-of-Pocket Maximum
The maximum dollar amount you are required to pay out of pocket for medical, behavioral health
Rx during the calendar year. When the amount of combined covered expenses paid by you
and/or all your covered dependents (family) satisfies the out-of-pocket maximums, the plan will
pay 100% of covered expenses for the remainder of the calendar year. You are still responsible for premiums.

Premium
The amount you'll be deducted each pay period to remain in the plan.

UHealth Provider
A UHealth physician, a UHealth facility, or a Jackson Health System facility.

Usual, Customary and Reasonable
The usual charge made by a physician or other provider of services that does not exceed the
general level of charges made by other providers for the same care in the same geographic area.

UHealth is pleased to introduce UHealth Virtual Clinics. It is a safe and easy way to access University of Miami Health System providers, in all specialties, on a secure telehealth platform. They use technology to bring the expert care you need, when you need it, from the safety of your own home. UHealth virtual clinics are available for a wide variety of non-emergency conditions and are available by appointment. Your virtual visit will be billed to your UM/Aetna insurance, the same way an in-person visit would be billed. 

Scheduling a UHealth Virtual Clinics appointment is easy.

1. Request your visit by:
   • Calling 305-243-4000. Customer service representatives are available from Monday-Friday, 7:30 a.m. to 6 p.m., EST.
   • Completing an online request form at UMiamiHealth.org/VirtualClinics.
2. Schedule your appointment.
3. Get the care you need.

Schedule* a Rapid Virtual Eye Care appointment for a quick and easy way to connect with one of Bascom Palmer Eye Institute’s expert providers from the comfort of your own home. Use your laptop, smartphone, or tablet to connect. Your eye care provider will evaluate, diagnose, recommend treatment, and prescribe medications when indicated. 

Common concerns include:

• Styes
• Eyelid swelling or tenderness
• Tearing or watery eyes
• Red or pink eyes
• Dry eyes
• Itchy eyes
• Eye pain or discomfort
• Discharge from eyes
• Flashes or floaters
• Change in vision

Click here to learn more.

*Service is limited to persons located in the state of Florida.

Teladoc® is a benefit made available to you through Aetna. As a Teladoc member, you have access to a national network of U.S. board-certified physicians, licensed in your state. With an average of over 20 years of clinical experience, their doctors can diagnose, treat and prescribe medication for 
non-emergency conditions. This includes treatments for the flu, eye infections, bronchitis, and much more. Whenever you need care, they are available within minutes, by phone or video.

Set up your account today at teladoc.com/aetna or call 1-855-TELADOC (835-2362). 

Teladoc Prescription Policy

The Healthy ’Canes Employee Clinic is a Well ’Canes benefit for faculty and staff, offering convenient access to UHealth medical services for common illnesses. Visits to the Healthy ’Canes Clinic are by appointment only and services are provided for the low cost of $5 per visit. Each clinic is staffed by a UHealth nurse practitioner overseen by UHealth physicians.

However, full-time and part-time UM/Aetna benefits eligible University of Miami employees are eligible to receive care at this clinic. Non-UM/Aetna benefits eligible employees, for example, a dependent, a student, a temporary/casual worker or a contract worker, are not eligible to receive care at the clinics.

For location information and operating hours, please visit www.healthycanesclinic.com.

UHealth Clinic at Walgreens provides convenient care from the experts you trust and is operated by the University of Miami Health System. UHealth at Walgreens provides faculty, staff and their dependents, with convenient access to UHealth medical services for common illnesses, seven days a week. Services at UHealth at Walgreens are provided for the low cost of $5 per visit. 

For location information, operating hours, and to make an appointment at one of their 12 locations,  visit uhealthclinics.com.

One Medical has entered into a partnership with UHealth to expand access to UHealth on-site clinics and UHealth Walgreens. In addition to existing access at UHealth, One Medical offers:

• Modern approach to primary care with 24/7 virtual care
• Free annual membership if covered by the UM/Aetna medical plan
• Provider messaging through the app
• Triage common issues like UTIs through "Treat Me Now" in the app
• Prescription renewals through the app
• Convenient in-person care
• Appointments (in-person or remote) are billed through your UM/Aetna insurance with the lower UHealth provider copays (after deductible)

Employees who wish to use the expanded network can register directly with One Medical at no cost.

If you're sick, have a minor injury, or need a sports physical, don’t wait for a doctor appointment or spend the day in the emergency room. Visit your nearby UHealth Jackson Urgent Care center, where we provide care to all ages, without the wait and without an appointment.

• Personalized care approach with access to UHealth’s renowned experts across all disciplines — cardiology, neurology, pulmonology, orthopaedics, geriatrics, surgery and many more
• Staffed 24/7 with emergency medicine board-certified physicians
• Award-winning clinical pathway for immunocompromised oncology patients
• State-of-the-art radiology and imaging technology for rapid diagnoses

Click here to learn more.

If you and/or your spouse is a smoker, your monthly premium will increase by $100. To waive this surcharge, the individual must have been smoke free for 12 months at the time of initial enrollment or annual Open Enrollment, or the individual must have successfully completed the UHealth Clinic at Walgreens smoking cessation services.

The program is delivered by Family Nurse Practitioners which includes:

• One-on-one consultation with a nurse practitioner
• Individualized smoking cessation plan and education
• Treatment

To learn more, click here.

A $350 monthly spousal surcharge will apply to spouses who are eligible to participate in their employer sponsored medical plan (regardless of the cost), but choose to participate in the University’s group medical plan. The surcharge is waived if the spouse:

• does not have access to medical coverage through his/her employer
• is an employee of the University, or
• is on Medicare/Medicaid

After meeting your deductible, pay lower copays by using UHealth providers and facilities. Click here to view a listing of UHealth hospitals, primary, and specialty care locations in Miami-Dade, Broward, Palm Beach, and Collier counties.

Call UHealth Connect at 305-243-CARE (2273) to schedule an appointment with one of our 1,100 UHealth physicians. This employee-dedicated appointment line is staffed to serve you and your family quickly and efficiently. The line is available only to UM employees and their immediate families. UHealth hopes this service will help enhance your UHealth experience. 

You can also search for UHealth providers at www.findaumdoc.com.

Only University employees, who are the primary subscriber on the UM/Aetna plan, are eligible for coverage of bariatric surgery. Additional information on employment, provider and clinical requirements can be found here.

All high end imaging, including PET, CT, and MRI services, are covered exclusively at UHealth (certain exceptions apply). For more information, click here.

In-network labwork is covered at UHealth, Quest Diagnostics and LabCorp.

For more information on Medicare, please click here.

Yes. The pharmacy benefit is administered by Aetna. You are automatically covered when you elect a medical plan. For more information on pharmacy benefits, click here.

The University of Miami medical plan has designated Aetna as its primary behavioral health administrator and Carisk Behavioral Health (Carisk) as a secondary administrator, as part of a pilot program designed to improve access to mental and behavioral health services for employees and their dependents.

For more information, click here.

If you would like to enroll in the UM/Aetna medical plan as a primary insurance and have Medicare as secondary, you may do so. If you are not interested in enrolling in our UM/Aetna medical plan, you do not have to elect a medical plan, but can still take advantage of other voluntary benefits such as a flexible spending account.

If you’d like to remain on the University’s plans, you may continue to do so. You are not required to leave the University’s plans and join Medicare, unless you want to.

For more information on Medicare, click here.

• Learn which medical plan is best for you, ask questions of your doctors, and follow the tips below to save money on health care for you and your family.
• Use your free in-network preventive care benefits including annual physicals, well woman exams, and immunizations.
• Save time and money by using a UHealth Clinic at Walgreens location for minor illnesses. UM/Aetna plan members pay a $5 copayment for visits without having to meet their deductible.
• Pay for your eligible health care expenses using pre-tax dollars by enrolling in a healthcare flexible spending account.
• Use generic drugs whenever possible. If you receive a letter from Aetna regarding brand medications, review it with your doctor to avoid higher costs.
• Save on copayments by using UHealth physicians. Schedule your appointment through UHealth Connect at 305-243-CARE (2273).
• If you are taking a maintenance medication, any medication taken in the same strength and dosage for more than 90 days, you can save money and avoid a penalty by filling your prescription in a 90-day supply at any in-network pharmacies such as Walgreens, Walmart, Publix, CVS retail pharmacy, or CVS Caremark®. You receive three months supply for the cost of 2½ months of copays. If you fill these prescriptions in 30-day supplies, your medications will cost you the same as a 90-day supply, but you only receive the 30-day supply. In the HRA, copayments apply after deductible is met. For more information on pharmacy, click here.

1-800-824-6411
www.aetna.com

1-877-924-3967
www.wageworks.com

305-284-3004
www.miami.edu/benefits/ask