1. Postdoctoral Insurance Plan
“An investment in knowledge pays the best interest”
– Benjamin Franklin
The University of
Pennsylvania
Postdoctoral Insurance Plan
Open Enrollment – Plan Year 2015
November 10th through November 25th, 2014
Effective January 1, 2015

2. AGENDA process Review of benefit plan designs,
rates and changes for 2015
Explanation of the Open Enrollment
process
Q & A

3. The Postdoctoral Insurance Plan
The University of Pennsylvania has partnered with
Garnett-Powers & Associates to provide marketing,
administrative services and customer service for
this program.
The University of Pennsylvania Postdoctoral Insurance
Plan was implemented on March 1st, 2007, and is available
to all Postdoctoral Scholars.
The program offers a package of benefits originally
designed to closely match the benefits offered to the
University of Pennsylvania faculty & staff.

4. Meet Your Postdoctoral Insurance Plan Representative!
Dane Pisano is a graduate of California State University,
Fullerton, with a Bachelor’s degree in Communications,
and a licensed insurance agent.
He has 4 years of experience as a Garnett-Powers &
Associates University Services Account Manager, and is
eager to assist you with any enrollment, benefits or
billing questions you may have regarding the
Postdoctoral Insurance Plan.

5. Benefits Offered Through The Postdoctoral Insurance Plan
Plan Name
Insurance Type
Company
HMO
*new for 2015*
Medical
PPO
DMO
Dental
DPPO
Vision
Life and AD&D
Life

6. Benefit Plan/Rate Changes for 2015
Change from Aetna Medical POS Plan
to Aetna Medical HMO Plan
The Aetna medical POS plan will be changing to the
Aetna Open Access HMO plan.
The HMO plan rates will be a 5% increase from the
current POS plan rates.
If you are currently enrolled in the POS plan, you will be
automatically enrolled in the new Open Access HMO Plan
effective January 1st, 2015.
New ID cards will be sent to your home for all enrolling
family members.

7. Aetna PPO (Current Plan) Aetna PPO - Downgrade Option
Benefit Plan/Rate Changes for 2015, cont. Aetna Medical PPO Plan Benefit Changes
The medical PPO plan’s benefits are being altered
to bring them more in-line with the comparable
faculty/staff plan to reduce the monthly premium
cost.
MEDICAL
Aetna PPO (Current Plan)
Aetna PPO - Downgrade Option
BENEFITS
In-Network
Out-of-Network
Physician Office Visit
$20 Copay
30%
$30 Copay
40%
Specialist Office Visit
$40 Copay
Hospitalization:
Inpatient -
10% after deductible
30% after deductible
20% after deductible
40% after deductible
Outpatient -
Maternity -
Prescription Drugs:
30% Plus
40% Plus
Generic
$10 Copay
Brand Name
$15 Copay
Non Formulary
$50 Copay
Deductible:
Individual -
$200
$500
$300
$800
Family
$600
$1,500
$900
$2,400
There will be an 11.8% increase to the rates.

8. Benefit Plan/Rate Changes for 2015, cont.
The dental DMO rates will be increasing by
4%.
The dental PPO and vision rates will remain
the same with no reduction in benefits.

9. MEDICAL INSURANCE Provided by

10. What is an Open Access HMO plan?
A Health Maintenance Organization (HMO) plan typically
requires the selection of a Primary Care Physician (PCP)
to act as your healthcare “gatekeeper”, referring you to
specialists if necessary.
The ‘Open Access’ component of this HMO plan allows
you to choose a PCP as you seek service, as well as self-
refer to specialists, as long as those providers are in the
HMO network.
The Open Access HMO plan benefits mirror the rich, in-
network benefits of the current POS plan, however there
is no out-of-network benefit.
Unless it is a true emergency, any services rendered by
an out-of-network provider will not be covered under the
plan in any capacity.
There is minimal provider disruption between the POS
and HMO networks.

11. Postdoctoral Insurance Plan
Postdoctoral Insurance Plan AETNA Open Access HMO Medical Plan Medical Benefits In-Network Postdoc Pays   PCP Office Visit $20 Copay (no PCP selection required) Women’s Preventive Health $0 Specialist Office Visit $30 Copay (members can self-refer to specialists) Hospitalization: Inpatient $250 Copay Outpatient $100 Copay Pregnancy $250 Copay Prescription Drugs: Tier $10 Copay Tier $15 Copay Tier $30 Copay Emergency Room Visits $75 Copay Urgent Care $30 Copay Routine Physical Exam $0 Mental Health Office Visit $30 Copay Inpatient $250 Copay Annual Maximum Out of Pocket $1,500 Individual $3,000 Family Deductible: Individual None Family None Lifetime Maximum Unlimited For more detailed plan design information go to:

12. What is a PPO Plan? There is an In-Network and Out-of-Network
The member does not have to choose a PCP.
There is an In-Network and Out-of-Network
component.
The In-Network benefits will be greater than the
Out-of- Network benefits.
At the time of service, the member has the ability to
seek care from a Specialist, without having to
obtain a referral from a PCP.
The contractual agreement between the PPO Plan
and the Provider is on a “discounted fee for
service” basis.

13. Postdoctoral Insurance Plan. AETNA PPO Medical Plan Medical Benefits
Postdoctoral Insurance Plan AETNA PPO Medical Plan Medical Benefits In-Network Out-of-Network Postdoc Pays Postdoc Pays   Non-Specialist/Specialist Office Visit $30 ($20)/$40 ($30) Copay 40% (30%)* Women’s Preventive Health $0 40% (30%)* Hospitalization: Inpatient 20% (10%)* 40% (30%)* Outpatient 20% (10%)* 40% (30%)* Pregnancy 20% (10%)* 40% (30%)* Prescription Drugs: Tier 1 $20 ($10) Copay $20 ($10) Copay + 40% Tier 2 $30 ($15) Copay $30 ($15) Copay + 40% Tier 3 $50 ($30) Copay $50 ($50) Copay + 40% Emergency Room Visits $150 ($50)Copay $150 ($50) Copay* Urgent Care $35 Copay 40% (30%)* Routine Physical Exam $0 40% (30%)* Mental Health: Office Visit $40 ($30) Copay 40% (30%)* Inpatient 20% (10%)* 40% (30%)* Deductible: Individual $300 ($200) $800 ($500) Family $900 ($600) $2,400 ($1,500) Annual Maximum Out-of-Pocket $2,500 Individual** $3,000 Individual **Includes deductible, copays & pharmacy $7,500 Family** $9,000 Family Lifetime Maximum Unlimited Unlimited * Subject to Deductible For more detailed plan design information go to:

14. Summaries of Benefits and Coverage
The PPACA requires that you be notified that the
Summaries of Benefits and Coverage for your
medical plans will be available on our website.
The Summaries of Benefits and Coverage follow
the recommended guidelines of PPACA in a
standardized format to make them easier to read
and comprehend to better serve you in making
your plan selections.
You may request a paper copy at no charge by
calling the toll-free number on your ID card.
You may also print a copy directly off of the GPA
website.

15. Mail Order Pharmacy You may fill your maintenance
prescriptions through mail order, which
offers a savings.
Mail order forms and instructions are
available on Aetna Navigator as well as
the GPA website.
Up to 3 months worth of Rx
Mail Order Copay
(up to 3 month supply)
Regular Rx Co
Copay
(3 month supply)
Generic Formulary
$20
$30
Brand Formulary
$45
Generic or Brand,
Non-Formulary
$60
$90

16. Aetna Wellness Programs
Beginning Right – A program to assist moms-to-be
with materials on prenatal care, labor and delivery, as
well as newborn care and pregnancy risk surveys to
identify any potential problems.
GlobalFit – Save on fitness club memberships and
exercise equipment, with preferred discounts within
the GlobalFit network.
Several programs may be viewed on the website at
To see all programs Aetna offers, visit
and register for Aetna Navigator.
Aetna Navigator’s secure member website provides
numerous services as finding the cost for tests and
procedures, reviewing your claim status details,
ordering ID cards and a myriad of other services that
can assist you in managing your healthcare.

17. Urgent Care if the situation is life or limb threatening.
The hospital emergency room should be used only
if the situation is life or limb threatening.
The Urgent Care Center should be used as often as
possible to avoid additional charges.
Most Urgent Care Centers are open 24 hours and
available to treat most non-life threatening
emergencies, as broken bones (not multiple
fractures), wounds not bleeding profusely, fevers
and flu symptoms.
The copay is significantly less: PPO Plan, $150 copay for emergency room vs $35 for urgent care; HMO Plan, $75 for emergency room, vs $30 for urgent care.
There are 7 Urgent Care Centers within 10 miles of
UPENN.

18. Walk-In Clinics The Walk-In Clinic is an in-network, free-standing
health care facility that is an alternative to a
physician’s office for treatment of unscheduled,
non-emergency illnesses and injuries and
administration of certain immunizations.
They are not an alternative for the emergency room
or the outpatient department of a hospital.
They are generally found in a retail location such as
CVS or Walgreens.
If you use a Walk-In Clinic on the Medical HMO
plan, you will pay $20.
If you use a Walk-In Clinic on the Medical PPO plan,
you will pay $25 in-network.
There are 2 Walk-In Clinics within 5 miles of
campus.

19. Healthcare Reform The Patient Protection and Affordable Care Act
(ACA) was signed into law on March 23, 2010.
The ACA requires that most people that are either
citizens or legal residents to have health insurance
coverage, or to pay a tax beginning in 2014 if they
do not.
The intent of the ACA is to make health care coverage
available to the millions that are uninsured in the U.S.
All states are required to offer a Health Care
Exchange, either through the federal government,
on their own or through a partnership between the
state and the federal government.
Pennsylvania is using the federal exchange.
U.S. citizens and most legal residents are eligible
for plans on the exchange.

20. Healthcare Reform (continued)
There are differing levels of coverage and cost, as well as several insurance carriers offering the plans.
In order to be eligible for the Premium Tax Credit, also known as a subsidy, a person must meet certain eligibility requirements:
The employer offers coverage where the
plan design does not meet the coverage
requirements of the ACA.
Certain poverty-level income conditions
are met.
The cost of the postdoc-only coverage
exceeds 9.5% of the postdoc wage/stipend.

21. Healthcare Reform (continued)
Important ACA Information Specifically for Enrollees in the UPENN-PIP:
All of the UPENN postdoc medical plans meet or exceed the legal requirements of the ACA.
To the best of our knowledge, the cost of single coverage for the POS does not exceed 9.5% of an eligible postdoc’s wage/stipend.
It is highly unlikely that anyone enrolled in the UPENN postdoc plan’s medical coverage will be eligible for a subsidy through the exchange.
For more information, please visit the federal exchange site at

22. DENTAL INSURANCE Provided by

23. Postdoctoral Insurance Plan. AETNA DHMO Dental Plan Dental Benefits
Postdoctoral Insurance Plan AETNA DHMO Dental Plan Dental Benefits Postdoctoral Scholar Pays Deductible None Diagnostic and Preventative Care Routine Oral Exams (2x per year) No charge Routine Teeth Cleanings (2 x per year) No charge Routine X-Rays No charge   Basic Procedures Fillings Varies up to $75 copay Oral Surgery Varies up to $117copay Endodontics Varies up to $380 copay Periodontics Varies up to $300 copay   Major Procedures Crowns Varies up to $275 copay Bridgework Varies up to $275 copay Dentures Varies up to $350 copay   Orthodontics Comprehensive Treatment- Child $1,945 copay plus start-up fees and retention Comprehensive Treatment- Adult $1,945 copay plus start-up fees and retention   Annual Maximum Unlimited
For more detailed plan design information go to:

24. Accessing Care Through The PENN Dental School
The DMO plan requires that you choose or be assigned a
Primary Care Dentist (PCD) and access all care through this
provider unless a specialist referral is necessary.
A vast majority of postdocs are enrolled before they are able to choose a PCD, and if one is not chosen before accessing care for the first time, it can make the claims process difficult.
In order to alleviate this issue, we have begun automatically assigning the PENN dental school as the PCD for all newly enrolled postdocs. Should you want to change to a different PCD, you may do so through Aetna member services.
Accessing care through the PENN Dental School offers a number
of valuable benefits:
Penn Dental Medicine ranks #1 of Top Dental Schools in U.S.A.
for 2014
Direct supervision of care by faculty with national and
international reputation
Convenient on-campus location – all dental specialties under
one roof

25. Accessing Care Through The PENN Dental School, continued
Collaboration with HUP and CHOP – world
renowned medical and pediatric care
Convenient evening clinic sessions – options for
convenient appointments
24/7 access to professional care for dental
emergencies
High quality dental care at a reasonable cost –
maximize use of insurance benefits
Diverse international environment – over 40
languages spoken
State of the art care in a comfortable environment

26. Postdoctoral Insurance Plan AETNA DPPO Dental Plan
Annual Maximum $1,500
In-Network Out-of-Network
Postdoc Pays Postdoc Pays
Calendar Year Deductible $50 Ind/$150 Family $50 Ind/$150 Family
(Applies to Basic and Major only)
Diagnostic and Preventative Care
-Routine Exams No charge 20% of UCR
-Teeth Cleanings
-X-Rays
Basic Procedures
-Fillings 20% 50% of UCR
-Endodontics
-Periodontics
-Oral Surgery
Major Procedures
-Crowns 50% 50% of UCR
-Bridgework
-Dentures
Orthodontia (child only)
-$1,500 Lifetime Maximum 50% 50% of UCR
For more detailed plan design information go to:

27. VISION INSURANCE Provided by

28. Postdoctoral Insurance Plan Aetna Vision Plan
In-Network Out-of-Network
Postdoc Pays Postdoc Allowance
Exam with Dilation (if necessary): $10 Exam Copay Up to $40
Standard Lenses:
-Single Vision $25 Up to $40
-Bifocal Materials Up to $60
-Trifocal Copay Up to $80
-Lenticular Up to $80
Frames: $130 retail allowance for Up to $45
any frame at a retail chain
Lens Options:
-UV Coating N/A
-Tint (solid and gradient) Available N/A
-Standard Polycarbonate at a N/A
-Standard Progressive discount N/A
-Standard Anti-Reflection N/A
*Contact Lenses: $25 (up to 4 boxes) up to $210 Allowance
Frequency: Exam, Lenses, Contact Lenses & Frames – Once every 12 months
*Contact lenses may be chosen in lieu of eyeglasses.
For more detailed plan design information go to:

29. LIFE AND AD&D INSURANCE Provided by

30. Postdoctoral Insurance Plan Life Insurance and Accidental Death & Dismemberment (AD&D) Plan
The plan pays $50,000 in the event of death.
The plan provides postdocs and their dependents
the $10,000 Medical Evacuation and $7,500
Repatriation of Mortal Remains benefits necessary
to satisfy the J1 & J2 Visa requirements for 2014.
The plan already satisfies the new 2015 Department
of State requirements of $50,000 Medical
Evacuation and $25,000 Repatriation of Remains
coverage. These changes take effect on 5/1/15.
Accelerated Benefit Provision – Allows eligible
members who are terminally ill to receive an early
allocation of up to 75% of their group life insurance
benefit.

31. The Open Enrollment Process
All currently enrolled Postdoctoral Scholars have the
option of making changes during the Open Enrollment
Period from November 10th – November 25th, 2014.
If you are currently enrolled in the Medical PPO
you may switch to the Medical HMO as long as you are in
the Medical HMO service area. Please call GPA for
assistance.
If you are currently enrolled in the Medical POS, you may
switch to the Medical PPO.
All changes you make to your enrollment will be effective
as of January 1st, 2015.
If you are currently enrolled in the Dental HMO, you may
switch to the Dental PPO, or vice versa.
If you previously waived either yourself and/or your
family members, you/they may be enrolled at this time.
If you are not changing your current enrollment status,
no action is necessary.

32. The Open Enrollment Process, (continued)
In order to make changes to your enrollment for Plan Year
2015, please follow these steps. Please note that all changes made to your current enrollment will take effect
January 1st, 2015.
First, click on the “Enrollment” section of the website,
then the sub-link “Open Enrollment”.
Click on the “Open Enrollment Instructions” link and
print them out for assistance with completing the Open
Enrollment Form properly.
Once the instructions are in hand, go directly to the
“Open Enrollment Form”. You will need your Penn ID and
previously created unique password to enter the site on
the login page. Once you reach the Postdoc Dashboard,
you may view your current enrollment and make the plan
changes you desire online. Once complete, you may
print a copy for your records.

33. The Open Enrollment Process, (continued)
Once you access your online Open Enrollment Form you may do the following:
If you are currently enrolled, you may view your current
Benefit enrollment.
Make the changes mentioned earlier regarding switching to medical PPO and/or dental PPO if desired. Please
check all plans in which you wish to be enrolled for Plan
Year 2015.
Enroll yourself and/or your eligible dependents if you
previously waived.
Update your Life Insurance beneficiary information. If
nothing has changed, you may leave this section as is.
If you previously waived or are enrolling for the first time,
and choose the dental HMO, you must choose a Primary
Care Dentist for all participating family members.

34. The Open Enrollment Process, (continued)
Provider directory links are available at the GPA website.
All Postdoctoral Scholars making changes to their
enrollment, whose dependent or PPO buy-up premiums
are covered by their department, must complete the
Dependent Contribution Worksheet.
Please have your Business Administrator sign the
form, then either fax or it to Garnett-Powers &
Associates.
To obtain the form, click on “Dependent Contribution
Worksheets” found in the Enrollment section on the
website.

35. The Open Enrollment Process, (continued)
An electronic version of the enrollment form will be
submitted to the Garnett-Powers & Associates’
secure website for data entry.
An will be sent no later than December 22nd
confirming your new enrollment status.
Please make sure the address that appears
on your enrollment form is correct.
ID cards will be mailed to your home.

36. Family Member Eligibility
Family member eligibility requirements are the same as the family member eligibility requirements for the Penn faculty/staff plans.
The major family categories are:
Spouse
Natural or adopted children to age 26 and unmarried
(unless eligible to continue coverage because of
disability).
Stepchildren may be included, if they live with the
Postdoctoral Scholar, are supported by the Postdoctoral
Scholar at more than 50% and claimed as a tax dependent.
Same-sex domestic partner. The required domestic
partner affidavit (located on the GPA website) must be
notarized and forwarded to Garnett-Powers & Associates.

37. Garnett-Powers & Associates
INFORMATION SOURCES
For general inquiries and customer service regarding
enrollment, benefit questions and ID cards, you should
contact:
Garnett-Powers & Associates
Website:
Toll Free Phone:
Fax #:
Address:

38. Data Entry & Premium Payment Process
All UPENN Postdoctoral Scholars will automatically be
enrolled in the Postdoctoral Insurance Plan (Medical, Dental,
Vision and Life Insurance) as a single individual.
To be eligible and automatically enrolled in the program,
Postdoctoral Scholars must be in the payroll system
(minimum record okay) with the following codes to be eligible:
Salary Key “S”
Active Code “A”
Postdoc Indicator of:
PD Researcher
PD Researcher
PD Fellow
PD NRSA Fellow

39. Data Entry & Premium Payment Process, cont.
A Dependent Contribution Worksheet must be submitted to
GPA so the appropriate premium allocation is distributed
between the department, grant and postdoc, ONLY when the
Department or grant is paying for:
The up-charge for medical PPO or dental PPO
The dependent premiums
The worksheet must be submitted, prior to the final payroll for
the month, to avoid charges being assigned to the postdoc
when they should not.
We at GPA do not need the worksheet unless the department
or grant is paying for the up-charge or dependent premiums.
Please attempt to enter a phone number for the postdoc to
assist with their enrollment success. All zeros will work when
a phone number is not available.

40. Current Process to Confirm Appointment End Date/Re-Appointment
When a postdoc transfers to a faculty/staff position, we
receive an ‘A’ for active and an ‘N’ for ineligible from the Penn
eligibility file (for true terms, a ‘T’ is transmitted instead of
the ‘A’).
An is sent to the BA, copying the postdoc, asking for
confirmation of either reappointment or termination, and
requiring the exact term date.
If a response is not received within 2 weeks, the postdoc is
termed from all coverage per the appointment end date in our
system.
If a postdoc is terminated per this process, a certified letter is
mailed to their home address (taken from their Penn payroll
record) advising them of the termination and why it occurred.

41. Thank you for joining us today! Questions?