Medical Insurance Plans

SPU’s medical plan is self-insured and administered by Aetna. The University pays the full premium for a full-time employee’s coverage. The employee pays premiums for dependents, and part-time employees also share a portion of the employer rate ( see “Cost of Medical Plans").

While you do have the flexibility to see in-network or out-of-network providers, you’ll receive the highest level of benefits by using in-network providers. The network for all SPU medical plans is the Aetna Choice POS II (Open Access) network. This network is searchable using the Aetna DocFind tool. To search the network CLICK HERE

The prescription drug formulary (i.e., the list of approved drugs and coverage level) has also moved to Aetna. To review the formulary or search for medication coverage, CLICK HEREThe name of the prescription drug network is the Aetna/CVS Pharmacy network, formally titled the “Aetna National Pharmacy Network” on the websites. To search the pharmacy network, CLICK HERE and select the “Aetna National Pharmacy Network” in the “Select a Plan” drop-down menu.

For information about Flexible Spending Accounts, please visit the Flexible Spending Accounts page.

High-Deductible Health Plan (HDHP)

SPU offers a comprehensive, (IRS) qualified High Deductible Health Plan (HDHP). This underlying medical insurance is partnered with different tax-advantaged account options to help pay for qualified medical expenses that plan members or their families may incur: your choice of a Health Savings Account (HSA) or a Health Reimbursement Account (HRA).

Preventive Care: no charge when using an in-network provider

Annual Deductible: $2,500 if Individual coverage / $5,000 if Family coverage (resets each January 1)

Plan Co-insurance: You pay 10% of all approved expenses after deductible for in-network providers and 40% of approved out-of-network expenses. If you choose to use an out-of-network provider, the provider is allowed to send the remainder of any bill not paid by the plan to you, the patient. This is called 'balance-billing' and is up to the provider. Balance-billing is not allowed from in-network providers.

Out-of-pocket Maximum: $4,000 if Individual coverage / $8,000 if Family coverage (if Family coverage, there is also a separate $4,000 max per Individual within the Family)

Prescription Drug Coverage: This plan uses the Aetna Nations Standard Prescription Drug List, which is searchable at There is no out-of-network prescription coverage.

  • Preventive Generics: no charge (deductible waived)
  • Generic Drugs: you pay 10% (after deductible)
  • Preferred Brand-name Drugs: you pay 20% (after deductible)
  • Non-Preferred Brand-name Drugs: you pay 30% (after deductible)

2024 Calendar Year HSA / HRA Plan Contributions

Health Savings Accounts (HSA)

If you are enrolled in a Health Savings Account (HSA), SPU will contribute monthly to an HSA setup on your behalf plus a dollar-for-dollar match of your HSA contributions, up to the annual maximum.

HDHP Coverage LevelSPU Monthly ContributionsSPU Match of Employee HSA ContributionsTotal Possible SPU HSA Contributions per Year
Individual$84Up to $600 per plan year*$1,608 in 2024
Family$168Up to $1,000 per plan year**$3,016 in 2024

*If you have Individual coverage and contribute by payroll deduction to your HSA during 2024, SPU will match your HSA contributions dollar-for dollar, up to $600 for the year.

**If you have Family coverage and contribute by payroll deduction to your HSA during 2024, SPU will match your HSA contributions dollar-for-dollar, up to $1,000 for the year.  

Tip: For those who participate in the HSA, with SPU’s additional contributions, be sure to review your contribution plan to ensure that all HSA contributions will not exceed the annual IRS maximums. You may change your HSA pre-tax contribution amounts once per pay period. Please take advantage of your personalized HSA Calculator to help you plan appropriately.

HSA funds belong to the account holder and are portable: unused funds do rollover to the next plan year. If you change coverage to the HRA plan or otherwise lose eligibility to this plan, contributions to the HSA are no longer allowed but you do keep current funds in the HSA to be used for qualifying health expenses in the future.

Health Reimbursement Accounts (HRA)

If you are enrolled in a Health Reimbursement Account (HRA), SPU will fund the below amounts to a HRA setup on your behalf, based on your HDHP enrollment. 

Coverage LevelSPU Contributions for 2024

Eligible reimbursements through the HRA are for the employee and also eligible dependents that are enrolled on the HDHP plan as a dependent under the employee's medical coverage. If an otherwise qualified dependent is not enrolled on the HDHP medical plan, their expenses are not eligible for reimbursement from this HRA plan.

If a participant remain covered on this HRA plan from year-to-year and does not use up all the funds available, the unused HRA funds from the prior year will rollover and be added to the funding available in subsequent plan years.

However, once coverage under this HRA plan is ended, either because of moving over to the HSA plan or because of changing employment or losing benefits eligibility, the funds remaining in the HRA are returned back to the plan at that time. HRA funds are not portable.

HRA contributions are pro-rated on a monthly basis for those with midyear changes.

Frequently Asked Questions

 How much does it cost to be on the plan?

The University pays the full premium for regular full-time employees' high deductible health plan (HDHP) coverage (subject to change each year, based on renewal of program contracts) and also contributes to either a HSA or HRA on the behalf of plan members. 

For regular part-time employees (0.50 FTE through 0.79 FTE for Staff and 0.50 FTE through 0.74 for Faculty), the University pays a prorated portion of the premium for employee coverage, based on the employee's FTE. Employees pay the remainder of the employee premium via payroll deduction. The rates are noted below.

Employees who elect spouse and/or children coverage pay for the cost of their dependents' premiums by payroll deduction as stated below.

All medical insurance premiums deducted from employee earnings are taken on a pretax basis.  


Coverage TierMedical HDHP with HSA/HRA

Employee Only$0$230
Employee + Spouse$475$695
Employee + Child(ren)$155$395
Employee + Family$640$900

 Do I need to report my medical insurance coverage on my taxes?

As part of the Affordable Care Act, institutions that employ more than 50 people became required to report on the health coverage offered to its full-time employees. SPU produces and distributes the 1095-C form each year to employees in order to comply with this requirement. For more information on this, please see the Healthcare Tax Reporting Requirements page.

 How do the Health Savings Account and Health Reimbursement Account work with the plan?

The funds in both the Health Savings Account (HSA) and the Health Reimbursement Account (HRA) can be used to pay for qualified health expenses (i.e. medical bills, prescriptions, dental, vision, etc). For more information on how those accounts are funded, please see the HSA and the HRA pages. Please note that the HSA allows qualified expenses for any tax-dependent while the HRA requires that the dependent actually be enrolled on the SPU medical plan as a dependent in order for their expenses to be reimbursable. 

 When can I make changes to my benefits?

You can make changes to your benefits if you experience any of the following situations:

  1. An Initial Enrollment Period
    1. New Hires: the enrollment period for new hires is 30 days from the date of hire (the first day with official working hours). Coverage will be effective on the first on the month following the date of hire. However, if the date of hire is on the first of a month then coverage will be effective on that date. In the case where the first of the month falls on the weekend and the first day with official working hours is the Monday following the first of the month, coverage will be effective on the first date of that same month.
    2. Newly Eligible Employees: An employee that becomes eligible due to a position change or FTE change will have a date assigned that will function like the date of hire as described above.
    3. Rehires: the first day with official working hours is treated as the date of hire as described above for a rehire. However, if a rehire has a break in coverage of less than 30 days, the prior benefits package will be continued and there is no opportunity to make changes. If the break is equal to or greater than 30 calendar days, then the rehire is treated like a new hire and must actively enroll in all benefits anew.
  2. After a "Qualified Life Event," such as:
    1. Loss of Other Coverage: If you or your dependents lose eligibility for other coverage or if the employer stops contributing towards your or your dependents’ other coverage. Ex., spouse loses a job and the corresponding insurance coverage with that job. Enrollment must be requested within 30 days after your coverage ends (or after the employer stops contributing toward the other coverage).
    2. Family Status Change: If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption; you may be able to enroll yourself and your dependents. Enrollment must be requested in most cases within 31 days after the marriage, and 60 days after the birth/adoption or placement for adoption. Likewise, in the case of a divorce, legal separation, annulment, or dependent becoming independent; you must request changes within 31 days of such an event.
    3. Change in Job Status: In addition to the above special enrollments, you may also enroll if you previously waived benefits when initially eligible because your position was part-time (.50 -.79 FTE for staff, .50 -.74 FTE for faculty) but recently experienced an increase in FTE (expected to continue for three months or longer). Changes must be requested within 30 days of such an event.
  3. During Open Enrollment: SPU's annual Open Enrollment period is generally held in October/November. All changes made during that time will be effective on January 1st. Once the Open Enrollment period is closed, no changes may be made for the purpose of Open Enrollment. 

Plan Documents

Aetna Contact Information

As of January 1, 2021 Aetna is the new administrator of the High Deductible Health Plan (HDHP) medical coverage offered through the University. Along with this goes the provider network, prescription drug coverage, pharmacy network, and wellness program. Whether an eligible employee chooses the HSA or HRA medical plan choice, Aetna provides only the underlying medical plan coverage for all. The actual HSA and HRA accounts are administered by HSA Bank.

Aetna Health Concierge Line: 1 (833) 735-0680
Online Tools: please register online at: