The UM/Aetna Medical plans do not have pre-existing condition limitations, and all of the plans offer the same benefit coverage. The medical plan UM Group ID is 811409.  For a list of general exclusions, click here.  See below links to helpful medical plan information:

medical plan summary
“people like me” medical plan examples
View YouTube Health and Wellness Video
2010 Quick Guide to Benefits

Click here for 2009 medical plans.

2010 Medical Plan Highlights

•  Same four open access plans administered by Aetna - referrals are not required to see specialists.
•  All four medical plans have national networks.
•  All four medical plans have lower copays when you use UHealth providers.
•  Preventive care services continue to be free - paid 100 percent by the University.  To view a summary of the free preventive care benefits click here.
•  Free annual vision exam offered through the preventive care benefits, as well as the Aetna/EyeMed discount plan.  To find a provider, visit www.aetna.com.
•  New autism benefit to include diagnosis and treatment of autism spectrum disorders.  For more information call 305-243-7172.
•  Minimal copay changes and no changes to deductibles or out-of-pocket maximums. To view a summary of the 2010 medical plan click here.
•  Enhanced customer service at the 305-243-CARE (2273) UHealth employee-dedicated appointment and help line.
•  Smokers’ surcharge increased to $40 per pay period for employees and spouses/partners who smoke.  Many programs available through the Be Smoke Free for assistance with quitting, call 305-243-3537.
•  Reward programs including completion of Aetna’s online Health Assessment and “Know Your Numbers” event that can reduce your 2010 average monthly medical premium.  These events begin in January. 

2010 Monthly Medical Premiums (1)

Plan 2009 2010
Monthly Premium

Monthly Premium
  without Incentive Savings (2)

 

Aetna Select 1
Employee Only $117.00 $125.50
Employee + Child $231.00 $248.00
Employee + Children $277.00 $297.00
Employee + Spouse/Partner $360.00 $387.00
Employee + Family $400.00 $430.00
Aetna Select 2
Employee Only $60.00 $64.50
Employee + Child $128.00 $137.00
Employee + Children $189.00 $203.00
Employee + Spouse/Partner $212.00 $228.00
Employee + Family $233.00 $250.00
Choice POSII 600
Employee Only $258.00 $277.00
Employee + Child $452.00 $485.00
Employee + Children $494.00 $530.00
Employee + Spouse/Partner $655.00 $703.00
Employee + Family $721.00 $774.00
Choice POSII HRA
Employee Only $20.00 $21.50
Employee + Child $87.00 $93.00
Employee + Children $129.00 $138.00
Employee + Spouse/Partner $154.00 $165.00
Employee + Family $179.00 $192.00

(1) All premiums shown reflect premiums for non-smokers and for those with spouses/partners who do not have access to employer-sponsored health insurance.

(2) Incentives include a $50 one-time premium credit for the completion of Aetna’s online Simple Steps Health Assessment and a $100 one-time premium credit for participation in the “Know Your Numbers” event from January 1 through March 31, 2010. Actual monthly premiums will vary depending on the timing of completion of the incentive requirements, but total annual amount will equal 12 times the average premium shown if all incentives are completed. Learn more online at www.miami.edu/benefits.

- If you are a smoker, your monthly premium for medical coverage will be increased by $40, and if your spouse/domestic partner is a smoker, your monthly premium will be increased by $40.

- If you and your spouse/domestic partner complete the six-week Be Smoke Free Program held at the UM Wellness Centers, the smokers’ surcharge will be removed for the remainder of the calendar year. For more information about the Be Smoke Free program, visit www.miami.edu/besmokefree or call 305-243-3537.

- A $20 monthly Spousal Surcharge will apply to spouses/partners (partner refers to same sex domestic partner) who are eligible to participate in their employer sponsored medical plan but choose to participate in the University’s group medical plan. The surcharge will be waived if the spouse/partner does NOT have access to medical coverage through his/her employer. To avoid this surcharge, the employee MUST complete the No Access to Employer Sponsored Medical Insurance Certification Form located at www.miami.edu/myUM during Open Enrollment, or via the paper enrollment form (new employees only).

2010 Premiums for Other Employee Groups

UMMG Premiums
UMH Premiums
Retiree Medical Premiums
COBRA Medical Premiums
Long-Term Disability Medical Premiums
Part Time Medical Premiums

2010 Medical Plan Summary

The Medical Plan Summary chart outlines copays and exenses in each plan, for different types of medical services, from office visits to high-end imaging and hospitalization.

2010 Medical Plan Summary

Important Medical Claims Information

If you receive a bill for covered services from an Aetna provider you must do the following:

In-Network:

Make a copy of your Aetna ID card (front and back) and a copy of the bill. Send a copy of both to the provider who is sending you the bill. This will alert the provider to bill the insurance company. Provide an explanation of the issue. Follow the same steps as above, but mail the information to the Aetna claims address below. Provide an explanation of the issue.

Out-of-Network:

Complete the claim form located below. Send Aetna a copy of your Aetna ID card and a copy of the itemized bill. When filing a claim you will need to provide: member ID, billed charges, patient date of birth, procedure code(s), diagnosis code(s), provider name and address or tax ID, and indicate on the bill if the charges were paid.

Note: If you would like assistance with regard to medical claims issues from a University benefits representative, you must first complete the online HIPAA authorization. The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions and prohibit discrimination against employees and dependents based on their health status. To complete the authorization, log on to www.miami.edu/myUM, click, employee, then benefits.

Benefits Administration Contact for Claims:
Jose Candelaria
305-243-8270


Mailing Address for Aetna Claims:
Aetna
P.O. Box 981106
El Paso, TX 79998-1106

Important Medical Forms

Aetna Medical Claim Form
Pharmacy Claim Form
Provider Nomination Form

Locate a Medical Facility

Urgent Care Centers
Walk-in Clinics
Registered Dieticians

CONTACT AETNA
www.aetna.com
1-800-824-6411