As of Jan. 1, 2020, the University’s health plan will change in the following ways, subject to applicable cost share:
- Infertility coverage will be expanded to include coverage of artificial insemination and prescription drugs with lifetime limits of $20,000.
- Out-of-network coverage will now be provided under SUBlue for routine vision, routine hearing and chiropractic services.
- Eligibility for fully covered prostate screenings will be expanded with a broader definition of “high risk.”
- Partial hospitalization will be reclassified as an outpatient hospitalization rather than inpatient for both in- and out-of-network services. Under SUBlue and SUOrange, the in-network copay for partial hospitalization will be reduced to a $200 copay. Under SUPro, the in-network coinsurance will increase to 20 percent.
- The definition of the types of services that will be covered at an emergency room will be expanded.
- OptumRx regularly evaluates and makes changes to the prescription drug formulary and programs that focus on safety and proper usage of certain prescriptions. If there are changes that may impact you, OptumRx will notify you prior to Jan. 1 with additional information.
Reference the Coverage Examples Guide [PDF] or the Schedule of Benefits documents to see, in general, how the deductible and copay/coinsurance are applied to certain services for SUBlue, SUOrange and SUPro.
The University strives to keep benefit costs affordable for faculty and staff. While national health trends are increasing by 5 to 6 percent for 2020, the University will hold the health plan contribution increase to 1 percent. Additionally, there will be no increase to any other employee benefit contribution in 2020, including dental, vision, life, accidental death & dismemberment and long term disability insurance.
There will be no increase in deductibles, copays and coinsurance, with the exception of a change to partial hospitalization under SUPro. Partial hospitalization will be reclassified as an outpatient hospitalization rather than inpatient for both in- and out-of-network services. Under SUBlue and SUOrange, the in-network copay for partial hospitalization will be reduced to a $200 copay. Under SUPro, the in-network coinsurance will increase to 20 percent.
The following table highlights some key differences among the three plan options:
|Network coverage||Provides in-network and out-of-network coverage||Provides in-network coverage only||Provides in-network and out-of-network coverage|
|Referrals||Not required||Not required||Not required|
|Your cost when you use an in-network provider||Generally deductible and copays||Generally deductible and copays||Generally deductible and coinsurance|
|Schedule of benefits document||SUBlue [PDF]||SUOrange [PDF]||SUPro [PDF]|
A deductible is a dollar amount members pay toward covered medical care each year, before their health plan begins to pay for covered medical expenses. The SUBlue and SUOrange plans have an annual in-network deductible of $100 per person with a maximum of $250 for a family. The SUPro plan has an annual in-network deductible of $200 per person with a maximum of $400 for a family. Once the annual deductible has been met, eligible in-network services for the remainder of the year will be covered at the copay and/or coinsurance percentage that applies to that service.
Employees are encouraged to examine the best benefit plan for their needs. Reference the Coverage Examples Guide [PDF] or the Schedule of Benefits documents to see, in general, how the deductible and copay/coinsurance are applied to certain services for SUBlue, SUOrange and SUPro.
The University offers three health plan options to benefits-eligible employees: SUBlue, SUOrange and SUPro. All three plan options include medical benefits administered by Excellus BCBS. Prescription drug benefits are administered by OptumRx.
The same health care services are covered under SUBlue, SUOrange and SUPro, but your share of the cost will be different. For a high level overview, please review At a Glance: A Comparison of Health Care Plans [PDF] which highlights frequently used services and their associated costs.
Yes, you can access Excellus’ online provider directory to view doctors, hospitals and other facilities that participate with the network. Follow these steps to assist with your search:
On the top blue menu bar, click on Find a Doctor
- Choose Find a Doctor/Provider or
- Find a Hospital, Urgent Care or Other Provider
Select your provider’s location:
- Local Provider (Upstate New York service area)
- National Provider Network
- Global Provider
Based on the location you selected:
- Upstate New York providers:
- Select your health plan: SUBlue, SUOrange or SUPro.
- Complete the remaining steps to narrow your search.
- National Network providers:
- Next to “Your Location”, enter the location of the provider.
- Enter your plan. You will be asked to enter the first three letters of your Member I.D. card. Enter VYK.
- Complete the remaining steps to narrow your search.
- International Network providers:
- Review and accept the terms and conditions for using the website.
- You will be asked to enter the first three letters of your Member I.D. card. Enter VYK.
- Complete the remaining steps to narrow your search.
You will maximize the value of your benefit when your physician or facility participates in the Excellus BCBS network. If your provider does not participate and you would like Excellus BCBS to attempt to recruit the provider, please contact Excellus at 800.493.0318 (TTY: 800.662.1220). Excellus BCBS will reach out to providers who do not participate with their network and are recommended by Syracuse University’s health plan members.
Yes. Excellus BCBS has a local, DeWitt-based dedicated customer service center for Syracuse University. These experienced representatives are well-versed in the University’s plan designs, and are ready to assist you with any health plan questions that you may have. The phone number and hours of operation are 800.493.0318 (TTY: 800.662.1220), Monday–Thursday: 8 a.m.-8 p.m. and Friday: 9 a.m.-8 p.m.
Should you have any questions regarding prescription drug coverage, please contact OptumRx at 866.854.2945 (TTY: 711).
The monthly costs are based on the 12-month calendar year. Actual deductions from each paycheck will vary depending upon your deduction cycle (e.g., weekly vs. semi-monthly, academic year vs. calendar year).
Qualifying for Reduced Medical Contributions: Schedule B
Depending on your household income and size, you may be eligible for lower medical contributions. Certain employees specified by a collective bargaining agreement automatically qualify for Schedule B rates. Please review the chart below. If you think you may qualify, the Schedule B application will need to be completed and returned to HR Shared Services by Dec. 6.
|Household Size||Household Income|
|1||Less than $37,000|
|2||Less than $51,000|
|3||Less than $64,000|
|4 and up||Less than $77,000|
Paycheck deductions for faculty and staff who work during the academic year are taken over nine months rather than twelve months. The accelerated deductions for these individuals cover the summer months when deductions are not taken but benefits continue. The same total dollar amount is charged to all faculty and staff over the course of the year.
Should I expect to receive an Explanation of Benefits (EOB) each time I receive a service from a provider?
Each month, you will receive a Monthly Health Statement, which shows the claims that Excellus BCBS has processed for you and your family for the previous month. Your Explanation of Benefits (EOBs) are available online, unless you specifically request a paper copy from your dedicated customer service representative. As an exception, if you receive care from a non-participating provider, you will automatically receive an EOB at your home address recorded in MySlice.
I will be enrolling in the health plan as a new participant. How can I receive a copy of my member ID card?
You will receive a welcome packet at the permanent address you have on file with the University as recorded in MySlice, which will include two member ID cards with your name on both. In addition, each dependent who is over the age of 18 and is enrolled under your plan will also receive a welcome packet with two member ID cards at their home address as recorded in MySlice. If you cover any dependents under the age of 18, please provide your ID card to their provider when they seek services.
If you wish to obtain additional member ID cards, contact our dedicated Excellus customer service center at 800.493.0318 (TTY: 800.662.1220). Once your coverage is active, you may also view your ID card online on Excellus BCBS's website or by downloading the Excellus BCBS app.
Prescription Drug Plan:
You will receive a welcome packet from OptumRx to your permanent home address you have on file with the University as recorded in MySlice, which will include two member ID cards with only the subscriber’s name on both.
If you wish to obtain additional member ID cards, contact OptumRx at 866.854.2945 (TTY: 711). Once your coverage is active, you may also view your ID card online on OptumRx's website or by downloading the OptumRx app. Also included in the welcome packet will be an enrollment form for OptumRx Home Delivery, which will allow you to receive your medications for up to a 90 day supply.
Prescription Drug Benefits
A formulary is a list of the drugs OptumRx has selected as the preferred medication(s) in each drug class based on their safety, efficacy and cost. A drug can be placed on one of three tiers. A drug that is excluded is not eligible for any plan coverage. Talk with your prescriber about covered alternatives for excluded drugs to avoid paying full retail price.
A formulary can be updated at any time, especially as new drugs are introduced to the market and generic equivalents become available for brand-name drugs. This can affect your share of the cost. You can search OptumRx’s online formulary when you log into the secure member website. You can also call to speak with an OptumRx member services representative, 24 hours a day, seven days a week at 866.854.2945 (TTY: 711).
If you are impacted by any prescription drug formulary change or program that targets safety and proper usage of certain drugs, you will be notified by OptumRx prior to Jan. 1 with additional details.
Generic medications are FDA-approved drugs that contain the identical active ingredient in the same strength as the brand-name drug. Generic drugs must meet the same standards for safety, purity, potency and quality as the branded drug, but are priced lower than the brand-name product. To encourage the use of generics, if a generic is available and you or your doctor choose to get the brand name drug (by checking the “Dispense as Written” box on the prescription), you will pay the generic copay plus the difference between the brand name drug cost and the generic drug cost.
If you take certain medications on a daily basis, you may wish to fill those prescriptions using home delivery, which offers convenient mail order service with free standard shipping. Enroll in home delivery on the OptumRx secure member website. Orders are generally received within 14 days.
When you use home delivery, the mail-order cost sharing applies, which may be a lower cost to you than filling a prescription at a retail pharmacy. Savings vary for each medication and are not guaranteed.
Use the OptumRx Home Delivery Order Form [PDF] to mail in prescriptions and payment to OptumRx. Your health care provider can also e-prescribe or fax prescriptions on your behalf.
NOTE: You can fill up to a 90-day supply of medication either at a retail pharmacy or through OptumRx Home Delivery. When you use home delivery, the mail-order cost sharing applies, which may result in considerable savings over your cost at a retail pharmacy. Savings vary for each medication and savings are not guaranteed. Use the Price and Save tool on the OptumRx website, or call OptumRx Member Services at 866.265.1761 (TTY: 711) to determine which method is best for each drug you take.
Specialty medications are those that treat serious chronic conditions, such as Crohn’s disease, rheumatoid arthritis, and multiple sclerosis. Specialty medications often require special handling or refrigeration, and may be self-injected rather than taken orally. You will need to obtain your specialty drugs through the Optum Specialty Pharmacy which is a mail-order pharmacy that focuses on providing you with the best possible care while you receive treatment with a specialty medication. Please contact Optum at 844.265.1761 (TTY: 711) to set up your account and coordinate delivery of your medication.
Every effort has been made to ensure that the information contained within this website is accurate. However, benefits are governed by legal documents (which, in certain circumstances, may include insurance contracts). If there is any difference between the information on this website and the official documents, the official documents will control. As is the case with all of Syracuse University’s benefit plans, the University reserves the right to modify or terminate these benefits at any time.