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 HERE. The 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 www.Aetna.com. 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.

*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. 

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.

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: Aetna.com