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Benefits News
May 2013
For Eligible Non-represented Employees; Faculty; and
Non-faculty Athletic Coaches covered under the PPOBlue or HMO Plans
Pennsylvania State System of Higher Education (PASSHE) Group Health Program
Health Care Plan Open Enrollment is
May 6 to May 17, 2013
Key Points
For the 2013/2014 Plan Year

THE FOLLOWING BENEFIT DESIGN CHANGES WILL BE MADE:
o FOR ALL HEALTH PLANS - OFFICE VISIT CO-PAYMENTS FOR SPECIALISTS WILL INCREASE FROM $15 TO
$25 (INCLUDING URGENT CARE FACILITIES). THE OFFICE VISIT CO-PAYMENT FOR PRIMARY CARE
PROVIDERS REMAINS AT $15
o THE CO-PAYMENT FOR EMERGENCY ROOM VISITS FOR THE PPO BLUE AND MOST HMO PLANS WILL
INCREASE FROM $50 TO $100 (WAIVED IF ADMITTED)
o THE PRESCRIPTION DRUG CO-PAYMENTS WILL INCREASE (SEE PAGE 4 FOR MORE INFORMATION)
o ADULT CHILDREN UP TO THE AGE OF 26 CAN BE COVERED/ENROLLED ON ANY PASSHE HEALTH PLAN
REGARDLESS OF WHETHER THEY HAVE HEALTH PLAN COVERAGE AVAILABLE THROUGH THEIR OWN
EMPLOYER
o WOMEN’S PREVENTIVE HEALTH CARE SERVICES WILL BE EXPANDED
o ALL PASSHE HEALTH PLANS WILL PROVIDE ACCESS TO A WIDE RANGE OF PREVENTIVE HEALTH
SERVICES AT NO MEMBER COST, INCLUDING PREVENTIVE PHYSICAL EXAMS, ANNUAL GYNECOLOGICAL
EXAMS AND WELL BABY/CHILD EXAMS
New Highmark ELITE Dedicated Customer Service Unit
1-(888) 745-3212 (Monday thru Friday, 8:00 am to 5:00 pm)
All Highmark members in our groups will be receiving new identification cards
for July 1, 2013
Plan Costs for the July 1, 2013 Plan Year – SEE PAGES 7 THROUGH 10 FOR BI-WEEKLY CONTRIBUTIONS
EFFECTIVE JULY 1, 2013
DON’T LOSE YOUR DENTAL AND VISION BENEFITS!!
Important information for all non-faculty employees (including coaches, nurses, security/police and nonrepresented employees) - In order to retain your dental and vision benefits, YOU MUST ELECT COVERAGE
through Employee Self-Service (ESS) (https://portal.passhe.edu/irj/portal) during open enrollment which
ends May 17, 2013. You will be receiving additional e-mails which will include more information about this
supplemental plan and the enrollment actions which are required of you.
Benefit News
Page Two
Changing Plans or Adding/Dropping Dependents?






ALL CHANGES MUST BE MADE ONLINE USING EMPLOYEE SELF-SERVICE
GO TO PASSHE’S EMPLOYEE SELF-SERVICE (ESS): https://portal.passhe.edu/irj/portal
INSTRUCTIONS ON EMPLOYEE SELF-SERVICE (ESS) PROCEDURES ARE FOUND BELOW
PLEASE REVIEW AND RETAIN E-MAIL CONFIRMATION AS VERIFICATION OF CHANGES
SUBMIT ANY REQUIRED ELIGIBILITY DOCUMENTATION NO LATER THAN MAY 17, 2013
REMEMBER PLAN CHANGES AND DEPENDENT CHANGES CAN ONLY OCCUR DURING OPEN ENROLLMENT
UNLESS THERE IS A QUALIFYING LIFE EVENT. SEE PAGE 6 FOR DETAILS
For Information on the Various Plans available to you – SEE THE PLAN COMPARISON ON PAGE 11 OR
THE PLAN SERVICE AREAS/CONTACT INFORMATION INCLUDING WEBSITES ON PAGE 12
Attention PASSHE Highmark PPOBlue Members - The participation deadline of the Healthy U
wellness program is May 31, 2013. Don’t wait until the last minute to complete your participation
requirements! Both you and your covered spouse/same-sex domestic partner(if applicable) need to accumulate
a minimum of 70 Healthy U points each by the deadline of May 31, 2013. There are a wide variety of activities
and programs that individuals can choose from to earn Healthy U points. Everyone is REQUIRED to complete the
Wellness Profile (worth 30 points). If you attain 70 points without completing the Wellness Profile, you still must
complete the Wellness Profile to qualify for the premium incentive. You can access Healthy U at
www.highmarkblueshield.com. Log in with your Highmark user name and password, and select the “Rewards
Program” link to get started.
Need More Information or Assistance with Healthy U?



Call Highmark’s Member Services 1-888-745-3212 for general assistance
Call Highmark’s Technical Support 1-877-298-3918 for website or login issues
Contact your university Human Resources office for Healthy U information and resources
INSTRUCTIONS FOR OPEN ENROLLMENT (ENROLL OR MAKE CHANGES)
THROUGH EMPLOYEE SELF-SERVICE (ESS)





Connect
to
the
PASSHE
portal
through
the
internet
at
the
following
link:
https://portal.passhe.edu/irj/portal
Sign in at the Self Service Portal screen.
On the tabs across the top of your page, select Employee Self-Service.
Select “Help Documents” for instructions on how to utilize ESS for Open Enrollment (SSHE Health
Enrollment).
Review and retain the e-mail confirmation to verify open enrollment changes. If you do not receive an email confirmation of open enrollment changes, contact your human resources office no later than May 17,
2013.
Benefit News
Page Three
GRANDFATHERED PLAN STATUS
The Healthcare Reform law places various requirements on group health plans. Certain plans known as “grandfathered
health plans” must comply with some of these requirements, but not all of them.
All of the PASSHE benefit plans are now categorized as Non-grandfathered health plans:
What impact does a health plan’s non-grandfathered status have on you as a participant? :

Your adult children up to the age of 26 are eligible for coverage as your dependent regardless of whether they
have health plan coverage available through their own employer. The Dependent Attestation process for adult
children is no longer necessary.

You will have access to a wide range of preventive health services at no cost to you. This means no co-payments
for services such as preventive physical exams, annual gynecological exams, or well-baby/child exams.

Female participants will have expanded benefits to include the Women’s Preventive Health Services mandates.
Some of the more significant changes included in this benefit expansion are the provision of contraception and
lactation support and supplies at no member cost.
ELIGIBILITY RULES FOR SPOUSE OR SAME-SEX DOMESTIC PARTNER
Date of Employment
Rules for spouse/domestic partner eligibility
Hired Prior to July 1, 2001
No restriction on spouse and their eligibility for PASSHE Health coverage
Hired July 1, 2001 to June 30, 2013
Spouses eligible for fully-paid employer coverage through his/her employer must
be enrolled in their employer’s coverage and PASSHE health coverage will provide
benefits as secondary payer only
Effective July 1, 2007 - Same-sex domestic partners of FACULTY AND COACHES are
eligible for PASSHE benefits. If the spouse/same-sex domestic partner is eligible
for fully-paid employer coverage through his/her employer, they must be enrolled
in their employer’s coverage and PASSHE health coverage will provide benefits as
secondary payer only
Effective November 1, 2007 - Same-sex domestic partners of NON-REPRESENTED
EMPLOYEES are eligible for PASSHE benefits. If the spouse/same-sex domestic
partner is eligible for fully-paid employer coverage through his/her employer, they
must be enrolled in their employer’s coverage and PASSHE health coverage will
provide benefits as secondary payer only
Hired on or after July 1, 2013
If an employee enrolls a spouse or same-sex domestic partner in the PASSHE
health plan and that person is eligible for coverage under their own employer’s
plan, the spouse/same-sex domestic partner shall be required to enroll in their
own employer’s plan for their primary coverage as a condition for eligibility for
secondary coverage under the State System plan regardless of the cost to
spouse/same-sex domestic partner of that coverage.
Benefit News
Page Four
PLAN CHANGES EFFECTIVE JULY 1, 2013
For employees enrolled in the PPO or HMO Plans:
 The office visit co-payment for specialists will increase from $15 to $25 (includes visits to urgent care
facilities)
 Office visit co-payments for primary care providers will remain at $15.
 Office visits to gynecological providers for annual gynecological examinations will have no co-payment
assessed. However, if the office visit is for a medical issue, the specialist co-payment of $25 will be
charged.
 The co-payment for emergency room visits for the PPO Blue and most HMO plans will increase from $50
to $100 (waived if the patient is admitted to the hospital).
The following changes have been made to the prescription drug co-payments:
Retail purchase (30 day supply)  Generic drug co-payment increased from $0 to $5
 Brand name formulary drug co-payment increased from $15 to $18
 Brand name non-formulary drug co-payment increased from $30 to $36
Mail order purchase (90 day supply)  Generic drug co-payment increased from $0 to $10
 Brand name formulary drug co-payment increased from $30 to $36
 Brand name non-formulary drug co-payment increased from $60 to $72
Same-Sex Domestic Partner Eligibility for Annuitants
Upon retirement, faculty, coaches and non-represented employees will be permitted to enroll a same-sex
domestic partner in the Annuitant Health Care Program (AHCP) with approved PASSHE Annuitant Same-Sex
Domestic Partnership Certification. Please note that there may be potential tax ramifications as the result of
adding a domestic partner to the AHCP coverage, and it is recommended that a qualified tax professional be
consulted for guidance regarding the tax issues involved.
PASSHE Supplemental Benefits
The supplemental benefit plan (providing dental and vision coverage to coaches, SPFPA, nurses and nonrepresented employees) will have a nominal annual participant contribution of $5.00 per year assessed ($0.19
per pay) to remain in compliance with health care reform.
MANDATORY INSURER REPORTING LAW
Social Security numbers are required for employees and dependents – effective immediately, PASSHE will not enroll a
dependent without a Social Security Number, except for a newborn. The new Mandatory Insurer Reporting Law (Section
111 of Public Law 110-173) requires all insurers to report the Social Security and Medicare health insurance claims
numbers of its members who meet certain reporting criteria to the Centers for Medicare and Medicaid Services (CMS).
If a dependent is not eligible for a Social Security Number, the employee will be required to provide a letter of
explanation from the Social Security Administration. Employees in this situation or with any questions should contact
their university human resources office.
Benefit News
Page Five
ADDING DEPENDENTS TO YOUR HEALTH CARE COVERAGE
To enroll your dependents, you will need to provide any required DOCUMENTATION (e.g., birth certificate)
to verify their eligibility and provide their SOCIAL SECURITY NUMBER.
 Who Is Eligible for Coverage under the PASSHE Health Plans?
The following categories of individuals may be eligible for coverage under the PASSHE health plan for active
employees:
 Legal Spouse
 Same-sex domestic partner (applicable to Faculty, non-faculty Coaches and non-represented employees)
 Children under 26 years of age who meet the following requirements:
 A natural child of your own
 A legally adopted child (including a child living with the employee during the probation period)
 A stepchild
 A child for whom the employee is the legal guardian
 A foster child, if the employee was the child’s legal guardian or foster parent prior to the child’s 18th birthday
(foster children under age 18 are not eligible dependents)
 A child being supported by the employee under a court order as a result of a divorce decree
 A newborn child of an employee is automatically covered from the moment of birth to 31 days after the date
of birth. To be covered as a Dependent beyond the 31-day period, the employee has 60 days to add the child
as a Dependent through the Human Resources office.
 A child of a Domestic Partner (applicable to Faculty, non-faculty Coaches and non-represented employees)

Unmarried dependent child 26 years of age or older, who is incapable of self-support because of a physical or
mental disability that commenced before the age of 26
 What Do I Need To Do to Add a Dependent During Open Enrollment?
You will need to provide documentation that verifies your dependent’s eligibility for PASSHE coverage, e.g., birth
certificate, marriage certificate, court approved adoption order, etc. Please refer to Documentation Requirements
which can be found at
http://www.passhe.edu/inside/hr/syshr/Additional_Benefits_Docs/Documentation%20Requirements.pdf
 More About Adult Children to Age 26
Health care reform legislation requires group health plans covering active employees and their dependents to make
coverage available to adult children until they turn age 26. During open enrollment, you may enroll your adult
children up to the age of 26. Here are some specifics:
 Student status is not required

Your adult children can be married. If married, the coverage does not extend to your adult children’s spouse, or
to your adult children’s own children

Your adult children do not have to live with you, be financially dependent on you, or be claimed as a dependent
on your tax return
(continued)
Benefit News
Page Six
 PLAN AHEAD!
The eligibility documentation must be provided to your Human Resources office by May 17, 2013, or your dependent(s)
will not be enrolled in the health plan. Take the time now to locate your documentation, or refer to the Documentation
Requirements for resources to contact in replacing lost documents. This document can be found at
http://www.passhe.edu/inside/hr/syshr/Additional_Benefits_Docs/Documentation%20Requirements.pdf
 When Can I Make Changes To My Covered Dependents?
Outside of open enrollment, if you experience a qualifying life event you have the opportunity to add or remove
dependents from your coverage, or make other changes to your benefit elections. You will need to notify your
Human Resources office within 60 days of the event occurring. Below are some of the more common examples.

Removing Dependents
You are required to contact your Human Resources office and remove a dependent that is no longer eligible for
PASSHE coverage under the following situations:
 Covered child attains age 26 (unless disabled)
 Divorce (removal of spouse and stepchildren)
 Termination of a domestic partnership (removal of partner and children of partner)
 Death of a dependent

Adding Eligible Dependents
You may add a dependent for PASSHE health coverage due to a qualifying life event. You must notify your
Human Resources office and submit the enrollment change within 60 days of the qualifying life event.
 You gain a dependent through birth or adoption
 You get married or enter into a qualifying domestic partnership
 Your dependent loses coverage under another employer’s plan
 Your dependent loses eligibility for coverage in a Medicare plan, a Medicaid plan or a state children’s health
insurance program

Other Plan Enrollment Changes
You must notify your Human Resources office and submit the enrollment change within 60 days of the qualifying
life event.
 You lose coverage under your spouse’s plan
 You move, either to an area outside of your current plan’s service area, or to an area where a different plan
option is available
 You are enrolled in a plan option that is no longer available, or is substantially reduced
 Is There Anything Else I Should Know?
 Please note that the PASSHE Highmark PPO Plan does not provide maternity benefits for dependent
daughters.
 The extension of coverage of adult children to age 26 only affects the PASSHE group health plan for active
employees. For individuals enrolled in a PASSHE Annuitant Health Plan, these plans will continue to follow
their current eligibility criteria for dependent children, i.e., coverage to age 19, or coverage to age 25 if a fulltime student.
Benefit News
Page Seven
Employee Contributions (Effective July 1, 2013)
Non-Represented Employees and Faculty – Deductions Based on 26 pays
FULL-TIME EMPLOYEES
Highmark PPO
Blue
HEALTHY U PARTICIPANT
(15% of cost)
Single Contract
Two-Party Contract
Family Contract
NON-PARTICIPANT HEALTHY U
(25% of cost)
Single Contract
Two-Party Contract
Family Contract
$39.51
$87.60
$107.36
Geisinger
Keystone
Keystone
Health Plan
Health Plan
Health Plan
UPMC HMO
HMO
Central HMO
East HMO
PARTICIPATION IN WELLNESS PROGRAM NOT APPLICABLE
$43.07
$94.89
$116.43
$50.89
$103.51
$150.44
$55.02
$113.04
$156.29
Keystone
Health Plan
Central HMO
Keystone
Health Plan
East HMO
$42.24
$93.57
$114.69
$65.86
$146.01
$178.93
PART-TIME EMPLOYEES
Highmark PPO
Blue
HEALTHY U PARTICIPANT
(57.5% of cost)
Single Contract
Two-Party Contract
Family Contract
NON-PARTICIPANT HEALTHY U
(62.5% of cost)
Single Contract
Two-Party Contract
Family Contract
$151.47
$335.81
$411.55
Geisinger
Health Plan
HMO
UPMC
HMO
HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
$164.64
$365.01
$447.33
HIPAA PRIVACY NOTICE
As required by the Health Insurance Portability and
Accountability Act (HIPAA), the Pennsylvania State System of
Higher Education is required to notify employees of the
availability of the HIPAA Privacy Notice. A copy of the HIPAA
Privacy Notice can be obtained from your Human Resources
Office.
Benefit News
Page Eight
Non-Faculty Athletic Coaches Contributions
(Effective July 1, 2013)
Deductions Based on 26 pays
FULL-TIME EMPLOYEES
Highmark PPO
Blue
HEALTHY U PARTICIPANT
Single Contract
Two-Party Contract
Family Contract
NON-PARTICIPANT HEALTHY U
Single Contract
Two-Party Contract
Family Contract
2.0% of salary
Geisinger
Health Plan
HMO
Keystone
Health Plan
Central HMO
Keystone
Health Plan
East HMO
UPMC HMO
2.0% of salary
PARTICIPATION IN WELLNESS PROGRAM NOT APPLICABLE
4.5% of salary
PART-TIME EMPLOYEES
Highmark PPO Blue
HEALTHY U PARTICIPANT
Single Contract
Two-Party Contract
Family Contract
2.0% of salary plus $131.71
2.0% of salary plus $292.01
2.0% of salary plus $357.87
NON-PARTICIPANT HEALTHY U
Single Contract
Two-Party Contract
Family Contract
4.5% of salary plus $131.71
4.5% of salary plus $292.01
4.5% of salary plus $357.87
HMO COVERAGE NOT OFFERED TO PARTTIME EMPLOYEES
Contribution rates for Non-Faculty Athletic Coaches will increase
with the first pay date in 2014 (January 10, 2014)
Please see page 9 for 2014 contribution rates

Benefit News
Page Nine
Non-Faculty Athletic Coaches Contributions
(first pay date in 2014 – January 10, 2014)
Deductions Based on 26 pays
FULL-TIME EMPLOYEES
Highmark PPO
Blue
HEALTHY U PARTICIPANT
Single Contract
Two-Party Contract
Family Contract
NON-PARTICIPANT HEALTHY U
Single Contract
Two-Party Contract
2.5% of salary
Geisinger
Health Plan
HMO
Keystone
Health Plan
Central HMO
Keystone
Health Plan
East HMO
UPMC HMO
2.5% of salary
PARTICIPATION IN WELLNESS PROGRAM NOT APPLICABLE
5.0% of salary
Family Contract
PART-TIME EMPLOYEES
Highmark PPO Blue
HEALTHY U PARTICIPANT
Single Contract
Two-Party Contract
Family Contract
NON-PARTICIPANT HEALTHY U
Single Contract
Two-Party Contract
Family Contract
2.5% of salary plus $131.71
2.5% of salary plus $292.01
2.5% of salary plus $357.87
5.0% of salary plus $131.71
5.0% of salary plus $292.01
5.0% of salary plus $357.87
HMO COVERAGE NOT OFFERED TO PARTTIME EMPLOYEES
Benefit News
Page Ten
Employee Contributions (Effective July 1, 2013)
Faculty (20 pays)
FULL-TIME EMPLOYEES
Highmark PPO
Blue
HEALTHY U PARTICIPANT
(15% of cost)
Single Contract
Two-Party Contract
Family Contract
NON-PARTICIPANT HEALTHY U
(25% of cost)
Single Contract
Two-Party Contract
Family Contract
$51.36
$113.88
$139.57
Geisinger
Keystone
Keystone
Health Plan
Health Plan
Health Plan
UPMC HMO
HMO
Central HMO
East HMO
PARTICIPATION IN WELLNESS PROGRAM NOT APPLICABLE
$55.99
$123.36
$151.36
$66.16
$134.56
$195.57
Two-Party Contract
Family Contract
$54.91
$121.64
$149.10
$85.62
$189.81
$232.61
PART-TIME EMPLOYEES
Geisinger
Keystone
Highmark PPO
Health Plan
Health Plan
Blue
HMO
Central HMO
HEALTHY U PARTICIPANT
(57.5% of cost)
Single Contract
Two-Party Contract
Family Contract
NON-PARTICIPANT HEALTHY U
(62.5% of cost)
Single Contract
$71.53
$146.95
$203.18
Keystone
Health Plan
East HMO
UPMC HMO
$196.91
$436.55
$535.02
HMO COVERAGE NOT OFFERED TO PART-TIME EMPLOYEES
$214.03
$474.51
$581.53
Important Health Care Coverage Notification
The Women’s Health and Cancer Rights Act requires that health care plan members
receive annual notification of the coverage provided for mastectomy patients who elect
reconstructive surgery.
Your PASSHE coverage provides benefits for reconstruction of the breast on which the
mastectomy is performed, surgery and reconstruction of the other breast to produce a
symmetrical appearance, and prostheses and treatment of physical complications for all
states of mastectomy, including lymphedemas. These services are elective and should be
chosen by consulting your physician. Benefits are subject to any deductible and coinsurance provisions.
Benefit News
Page Eleven
Pennsylvania State System of Higher Education Group Health Program
2013 - 2014 Health Plan Comparison
General Features
Deductibles
Co-payments and/or CoInsurance
Lifetime Maximum
Preventive Care
Emergency Room Services
Mental Health-Inpatient
Mental Health-Outpatient
Prescription Drug
Coverage-same for all
plans
Highmark PPOBlue (Preferred Provider Organization)
In-Network
Out-of-Network
In-network providers accept
Services performed by out-ofHighmark allowance as
network providers are paid at
payment in full.
80% of allowance after a
deductible. Providers can bill
employees for charges above
allowances.
Covers medically necessary surgery, diagnostic services, therapy,
inpatient services and preventive benefits. Not necessary to
select a primary care physician.
No deductible.
$250 per person/$500 per family
deductible per year.
$15 for primary care
After deductible, employee pays
physician office visits. $25
20% until $1500 per
for specialist office visits
person/$3000 per family out-of(including urgent care
pocket maximum is paid.
facilities)
Unlimited.
$1,000,000/person.
No member cost. Preventive Employee pays 20% after
care is covered in accordance deductible for adult and
with Highmark’s Preventive
pediatric exams and certain
Schedule based on
preventive care. Deductibles do
age/gender and includes
not apply for gynecological
routine physical exams for
exams, Pap tests, and pediatric
adults and children along
immunizations.
with certain diagnostic
screenings, as well as
pediatric and certain adult
immunizations, gynecological
exams, Pap tests and routine
mammograms. 
$100 co-payment. Co-payment waived if admitted.
In-network providers accept
Highmark allowance as
payment in full.
Health Maintenance Organization (HMO)
Payment in full to participating providers for
medically necessary surgery, diagnostic services and
inpatient services. Services must be authorized by
HMO primary care physician. Covered services vary
by HMO. No payment for services out of the HMO
network. Must select a primary care physician.
No deductible.
$15 for primary care physician visit; $25 for
specialist office visits. Co-payments for other
services vary by HMO.
Unlimited.
No member cost. Preventive care is covered and
includes routine physical examinations for adults
and children, pediatric immunizations,
gynecological exams and Pap test. Diagnostic
screenings vary by HMO.
Co-payment vary by HMO. Covered if considered a
medical emergency as defined by the HMO. Copayment may be waived if admitted.
Coverage varies by HMO. See HMO literature.
Services performed by out-ofnetwork providers are paid at
80% of allowance after a
deductible. Providers can bill
employees for charges above
allowances.
$25 office visit co-payment.
Employee pays 20% after
deductible.
No deductible; $5/$18/$36 co-payment for 30-day supply at retail when using a participating network pharmacy;
$10/$36/$72 co-payment for 90-day supply through mail order.
For more detail on Highmark’s Preventive Schedule, please see
http://www.passhe.edu/inside/hr/syshr/Medical_docs/Preventive%20Schedule.pdf
This summary highlights the Pennsylvania State System of Higher Education Health Program. Information is provided for general purposes
only. Legal plan documents will govern any discrepancies that may arise. For additional information concerning these benefits, contact your
human resource office.
Benefit News
Page Twelve
Plan Service Areas and Contacts
Offered in all geographic areas.
HIGHMARK PPOBLUE
(888) 745-3212
www.highmarkblueshield.com
GEISINGER HEALTH PLAN HMO
(800) 631-1656 Pre-enrollment questions
(800) 447-4000 Current members
www.thehealthplan.com
KEYSTONE HEALTH PLAN CENTRAL
HMO
(800) 669-7061
www.capbluecross.com
KEYSTONE HEALTH PLAN EAST HMO
(800) 275-2583
www.ibx.com
UPMC HMO
(800) 644-1046 Pre-enrollment questions
(888) 876-2756 Current members
www.upmchealthplan.com
HIGHMARK PRESCRIPTION DRUG –
(included with all medical plans)
Offered in the following counties:
Adams, Bedford , Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre,
Clearfield, Clinton, Columbia, Cumberland, Dauphin, Elk , Fulton, Huntingdon,
Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming,
Mifflin, Monroe, Montour, Northampton, Northumberland, Perry, Pike, Potter,
Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming
and York
 DENOTES PARTIAL COUNTY
Offered in the following counties:
Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata,
Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry,
Schuylkill, Snyder, Union and York
Offered in the following counties:
Berks, Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery, Northampton and
Philadelphia
Offered in the following counties:
Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Clarion,
Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana,
Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren,
Washington and Westmoreland
Offered in all geographic areas.
(888) 745-3212 (Highmark Customer Service
number)
www.highmarkblueshield.com
For more detail on the benefit summary of each HMO, please see
http://www.passhe.edu/inside/hr/syshr/Medical_docs/HMO%20List.pdf
INFORMATION ON MEDICARE FOR ACTIVELY EMPLOYED MEMBERS
If you and/or your spouse qualify for and are enrolled in benefits from Social Security, you or your spouse are
automatically enrolled in Medicare Part A and Medicare Part B beginning the first day of the month in which you or
your spouse turn age 65. Because you are an active employee and you are receiving benefits under the PASSHE Group
Health Program, it is not necessary to enroll in Medicare Part B coverage at this time, and you and your spouse can
avoid the monthly Medicare Part B premium until you retire. There will be no penalty for enrolling upon your
retirement since you and your spouse were enrolled in an active employee health coverage program. You (or your
spouse) will need to contact Social Security to advise them that you do not need Medicare Part B at this time.
If covering a domestic partner, please be aware that because the Defense of Marriage Act (DOMA) provides that
domestic partners and same-sex spouses covered as dependents under employer-sponsored plans cannot be
considered “spouses” for purposes of federal law, including Medicare, the waiver of the Part B late-enrollment penalty
does not apply.
(continued on Page 13)
Benefit News
Page Thirteen
Information on Medicare for Actively Employed Members (con’d)
It is critical for you and/or your spouse to contact Social Security about three months prior to retirement to enroll in
Medicare Part B so that this coverage is in place at the time of retirement. Typically the Medicare Part B premium is
deducted from your Social Security check and/or your spouse’s Social Security check, if receiving a monthly benefit from
Social Security.
You may receive numerous mailings from other vendors regarding Medicare Complement plans, which you do not need
while you have coverage as an active employee under the PASSHE Group Health Program.
For more information about Medicare Parts A and B, please contact Medicare at 1-800-633-4227. You can learn more by
visiting the Medicare website at www.Medicare.gov. If you have questions or need further assistance regarding how
your coverage changes upon retirement, please contact your university human resources office.
IF YOU DO NOT ENROLL IN MEDICARE PART B WHEN YOU RETIRE, MOST PHYSICIAN AND
MEDICAL/SURGICAL SERVICES WILL NOT BE COVERED.
IMPORTANT NOTICE
MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
OFFER FREE OR LOW-COST HEALTH COVERAGE TO CHILDREN AND FAMILIES
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium
assistance programs that can help pay for coverage. These States use funds from the Medicaid or CHIP programs to help people
who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP, you can contact your State Medicaid or CHIP office to find out if
premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be
eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or
www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay
the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s
health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible,
but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage
within 60 days of being determined eligible for premium assistance.
For Pennsylvania – Medicaid:
Website: http://www.dpw.state.pa.us/HIPP
Phone: 1-800-644-7730
For more information on special enrollment rights, or for information on other states, you can contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.gov
1-877-267-2323, Ext. 61565