Appendix H



2018 Medical and Prescription Drug Plan



The contract with Highmark Blue Shield ends on December 31, 2017 and as a result, Penn State will be changing its third-party medical plan administrator on January 1, 2018 to Aetna. Penn State will also transition to a new pharmacy benefits administrator, CVS/Caremark at this time. In this report we will present some of the differences you will see in healthcare benefits design and delivery. Based on the guiding principle of providing choice, both plans, the PPO plan and the PPO Savings plans will continue to be offered just as before. The spending accounts (FSA/HSA) will be administered by HealthEquity. Unum will be the new Life and Disability insurance carrier, and for the first time, Penn State will also be offering an optional Short Term Disability plan.  This Short Term Disability plan addresses a need for individuals with low accumulations of paid sick time.  There are no changes to the Dental or Vision plans or the administrators of those plans.

Overview of the Changes

Unlike the contract Penn State had with Highmark during the past ten years, the new contract with Aetna is only for three years. It is common for employers to contract with third party vendors for limited periods of time, as the healthcare market continues to rapidly change.  It is a healthy exercise to issue requests for proposals every few years to ensure that employees and the University are benefiting from access to high quality, in-network providers, steeper in-network discounts, and lower administrative fees.  Projected estimates for savings over the duration of the three-year contract are $35M for the university and $5M for insured employees. The estimated savings for the prescription drug plan are $29M over three years.  The majority of these cost savings come from more competitive negotiated rates with providers for what employees and Penn State are charged for each service.

The process describing the selection of the third-party administrators and the types of measures used to guide this selection were presented to the senate on December 6, 2016.

View the December 6, 2016 Report (

If you are a retiree currently utilizing the Freedom Blue Medicare Advantage Plan through Highmark, you can continue to participate in this plan in 2018. If you are an Under-65 retiree, you will have Aetna as your plan administrator. If you have been using the Blue365 benefit, “HealthWays-Fitness Your Way”, you are grandfathered as an existing member of Highmark Blue Shield. As long as you continue to pay your monthly membership and keep your payment information up-to-date you can continue as a Fitness Your Way member. However, if you decide to cancel your membership, you will not be able to rejoin later and take advantage of the program discounts.

Medical Benefits

One of the first questions most of you will be asking is, “can I keep my current doctor(s)?” In most cases you can be assured that Aetna has longstanding provider agreements in Pennsylvania and many doctors, hospitals, and out-patient facilities make it a habit of establishing contractual agreements with most major insurance carriers. One of the easiest ways to determine if your doctor is in network is simply ask your doctor does he/she participate with Aetna? If not, you are encouraged to inform him/her of the opportunity to join their network as a means to retain Penn State employees and families as patients, since in-network charges are much lower than out-of-network. If you don’t have an appointment between now and the end of the year, Aetna has set up a website (|The_PPO_PPO_Savings_Plans) to allow you to check . There is also a link on the benefits open enrollment site (

Aetna also has contracts with many of the other healthcare providers in Pennsylvania ensuring continued access to doctors and facilities, including UPMC, Highmark, Pinnacle, Geisinger, and Mt. Nittany Medical Center.

Decisions were made last spring about changes to the cost structure and plan design of the Penn State medical plan that are unrelated to changes in the third-party administrators.  The changes were presented on the senate floor on April 25, 2017.

View the April 25, 2017 Report (

and also reviewed in the annual report of JCIB.

Changes in the plan design and cost sharing for healthcare benefits are based on Penn State’s annual review of healthcare expenses, projected costs, desired outcomes, guiding principles, and budgetary considerations, which is coordinated with the Senate Committee on Faculty Benefits, the Joint Committee on Insurance and Benefits (JCIB), and the Health Care Advisory Committee (HCAC).  An overview of these committees’ roles in developing recommendations for executive leadership regarding healthcare benefits was prepared by Faculty Benefits and presented to the Senate on January 24, 2017.

View the January 24, 2017 Senate Agenda (

There are decreases in premiums for the PPO plan and increases in premiums for the PPO Savings plan.  Changes for technical service employees are governed by the collective bargaining agreement.

View the Health Insurance Premium Comparison (

Employees can find information about all plan design and cost sharing changes at  These changes were made to align with the guiding principle of (also presented to the Senate) a 75%/25% cost share between the University and employees.

There are several opportunities to determine which plan choice is right for you:

  • An e-Magazine with all this information can be found on the home page (
  • You can download your claims into an Excel spreadsheet from the Highmark Claims page at (– this can be sorted by person, service, plan charges/payments, etc.
  • HealthEquity Comparison Tool: (

(link also found in the E-magazine)

  • Several opportunities for in-person meetings at all campuses, including University Park: (
  • Webinars  (
  • HR, Aetna, and CVS Caremark representatives are present at all campus meetings across the Commonwealth

Your current medical coverage with Highmark will continue through December 31, 2017. If, however you have a claim incurred before the end of 2017 that is not paid you can continue to contact Highmark after December 31, 2017 by calling 1-800-914-4384.

Penn State will continue to offer through Aetna the Value-Based benefits for PPO Plan members who have been diagnosed with diabetes, high blood pressure, and/or high cholesterol. More details on the continuation of the VB plan can be found in the e-magazine.

Prescription Benefits

Penn State has contracted with CVS Caremark to cover your prescription drugs. CVS Caremark is a leading pharmacy benefits manager with nearly 90 million plan members, nearly 9,700 retail locations, and more than 1,100 walk-in medical clinics. CVS Caremark offers a dedicated senior pharmacy care business serving more than one million patients each year.

CVS Caremark can be used for both short-term and long-term prescription refills. You will also have the option of having your mail-order prescriptions shipped to your home, or if they are time or temperature sensitive, you can opt to have your prescriptions shipped to your local CVS pharmacy for pickup. If you are currently using University Health Services for your prescriptions, you may continue to use that facility.

CVS has a different prescription drug formulary than Highmark (although there is much overlap).  If your drug is not covered on this formulary, it is possible to get prior authorization from your doctor; or, request that your doctor write a prescription for one of the formulary alternatives.


HR is endeavoring to make these benefit vendor transitions as seamless as possible. In addition to providing a representative to every unit and campus to personally answer your questions and concerns, HR has setup a website ( to help explain all of the healthcare plan options for the coming year which also includes an FAQ page ( Faculty Benefits, JCIB, and HCAC will continue to monitor these transitions to ensure continuity of care and services for Penn State employees and families.


  • Mary Beahm
  • Renee Borromeo
  • Lonnie Golden
  • Galen A. Grimes, Chair
  • Mark Horn
  • Peter Jurs
  • Cassandra Kitko
  • John Liechty
  • Kathleen Noce
  • David Post
  • Ira Saltz
  • Geoff Scott
  • Erica Smithwick, Vice Chair
  • Gregory Stoner
  • William Wenner