As a regular full-time Penn State University faculty or staff member, you are eligible to participate in the University-sponsored healthcare plans. Additionally, you may elect to include coverage for:
Penn State health care plans include medical plan coverage, dental coverage (basic or enhanced plan), and vision coverage.
Penn State has employees residing in all 67 Pennsylvania counties as well as outside of the state. The University makes every effort to provide the same health plan coverage opportunities to all faculty and staff. However, because of the availability of plans in certain geographic areas, plan administrators, coverage and the cost of plans will vary and are determined by the county or state in which you reside. It is important that you review the availability of health plans in your area.
Medical plan coverage options are as follows:
Your coverage begins immediately upon date of your appointment (pay status) provided that you enroll yourself and all eligible dependents in coverage within thirty-one days of your appointment date. Enrollment in your University benefits is done n-line through ESSIC, the Employee Self Service Information Center.
Any eligible dependent that is not enrolled during this initial thirty-one day period, cannot be added to your coverage until the next annual open enrollment period. Similarly, if you acquire a dependent during the plan year through marriage, birth or adoption, they must be added within thirty-one days of the date that they became eligible or they also will not be eligible for coverage until the next annual open enrollment period. Newly eligible dependents may be added to your coverage through ESSIC.
NOTE: Special enrollment exceptions exist for dependents who were covered under another employer's plan and who lost that coverage through no fault of their own. Special enrollments must occur within 31 days of the loss of coverage.
Questions regarding eligibility and enrollment should be directed to the Employee Benefits Division at benefits@psu.edu or by phone at (814) 865-1473.
Your coverage and/or that of your dependents will terminate when you cease to be an eligible employee as defined by University policy or if the Benefit Plan is discontinued. Additionally, dependent coverage ceases when the dependent is no longer an eligible dependent as defined by University policy. Coverage ends at the end of the month in which you or your dependent cease to be eligible to participate in the Penn State sponsored plans.
In certain cases, such as the death of a faculty or staff member, termination, divorce, or when dependent children are no longer eligible for coverage, benefits may be continued for a specified period of time under the provisions of COBRA. Further details may be obtained from the Employee Benefits Division.
Health maintenance organizations provide prepaid, managed health care for you and your family. HMOs cover most services at 100% with no "deductibles," "usual and customary" fee schedules, or claim forms. Some services have co-payments. Doctors office visits; for example, have either a $10 to $15 co-pay.
HMO coverage includes preventive services, such as immunizations, routine health assessments, annual gynecological examinations, mammography, and colorectal screenings. Certain procedures require pre-certification through Health America.
When you join an HMO, you must select a primary care physician (PCP) from those providers who are participating with the plan. The PCP (family practitioner, pediatrician or general internist) is your first contact when you need care. Your PCP will evaluate your condition and provide treatment. In the event that you need testing or the services of a specialist, your PCP will coordinate you care with that specialist.
Your relationship with your PCP will be critical to your satisfaction with HMO coverage. Should you choose to change primary care physicians, you may do so at any time by contacting your HMO plan. On line directories of participating providers are available for:
While HMOs generally provide the same types of coverage, certain variations do exist. You should review the HMO summaries below for the specifics of the coverage offered by your HMO.
The Penn State Choice enhanced PPO plan allows you the freedom to choose health care providers both in and out of the network, while providing comprehensive medical services, including preventive care. You do not need to select a primary care physician if you elect the Penn State choice plan nor are referrals required for specialist care. Certain procedures require pre-certification through Health America. No deductible applies if you use network providers. If you reside in Pennsylvania, the Penn State Choice network is administered by HealthAmerica. You can ask your doctor if he or she is a HealthAmerica network provider or you can search the HealthAmerica provider directory. Select HealthAssurance PPO as the plan; contact HealthAmerica at 800-366-6433 if you have any questions or experience difficulty.
If you reside, or if you use providers outside of Pennsylvania, you may access network services from providers who participate with the First Health Network. Please note that to search for First Health participating providers, you will need to include the login ID of CVM. Using network providers prevents additional out-of-network expenses such as deductibles and higher coinsurance payments. The Penn State Choice plan protects you against large out-of-pocket expenses with the use of annual maximums for both medical and drug charges. No deductibles apply for in network services.
The Penn State Choice plan coverage chart provides a summary of information for In-network and Out-of-Network services. The Penn State Choice Certificate of Coverage provides more detailed plan information.
Penn State Choice and HMO comparison
Both the Geisinger and the Aetna Point of Service (POS) plans (see below) are available in select counties. Like HMO members, POS participants must select a primary care physician and will receive HMO-style benefits if they secure a referral from their primary care physician before seeing a specialist. Also, preventive care services are covered only when provided by network physicians. Unlike an HMO, a POS plan provides alternatives to those who seek care outside of the network or who do not receive a referral from their primary care physician.
While there are definite financial incentives to secure a referral from a primary care physician in order to see a specialist or to choose care through physicians that participate in the POS network, participants are not obligated to do so in order to have covered services. In other words, the POS plan combines the low out-of-pocket charges and preventive coverage associated with HMOs while including the complete freedom to choose providers.
The decision to use a network provider or to seek the referral from a primary care physician is made by the participant at the point that the service is rendered. HMOs provide more extensive coverage, including preventive care, but limit a participant's choice of health care providers.
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