Adjunct Benefits Information

Adjunct employees are eligible for medical, dental, and vision coverage for themselves and their eligible family members when they are working. Adjunct who are newly eligible for benefits must enroll within 31 days after the first day of classes. If you do not take action by the required due date, you cannot enroll or make changes in health care coverage unless you have a qualifying event - refer to the Mid-Year Benefits Enrollment Change Summary for details.

Within 31 days after the first day of classes, you must submit your enrollment form through the Change Benefits for Adjunct Employees service request. 

If you will be covering eligible family members and you have not submitted proof of their eligibility (e.g., copy of marriage certificate for your spouse, copy of birth certificate for a child), you should submit that proof with the Service Request.   

If you are working continuously, your coverage will remain active.

For example, if you work in the Spring and Summer semesters, your coverage will continue through the Summer semester but will end on August 31 if you are not teaching in the Fall semester. Similarly, if an adjunct works in the Fall and will be working in the Spring, their coverage will continue through the end of the Spring semester. See the section When Coverage Ends for more details about when coverage ends. 

Adjuncts who's coverage is being reinstated will receive an email confirmation. If COBRA coverage was elected, P&A Group (RIT's COBRA administrator) should  be contacted to cancel benefits due to coverage being reinstated through RIT.

If you are enrolled in coverage and will not be working in the next semester, coverage will end the last day of the month in which classes end for that semester.

• Spring (not teaching in the Summer) - benefits end May 31
• Summer (not teaching in the Fall) - benefits end  August 31
• Fall (not teaching in the Spring) - benefits end December 31

You will be eligible to continue coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA); we will notify RIT’s COBRA administrator, P&A Group, to send you the necessary enrollment information.

The Medical and Prescription Drug coverage has two Claims Administrators:

Each person covered by a POS plan (A, B or D) should have a Primary Care Physician (PCP) listed at Excellus. The specialist copay will apply for any visit to a primary care physician who is not listed as the PCP. You can change your PCP at any time by logging into your online account with Excellus or contacting customer service at 1-877-253-4797.

A PCP is not required for those covered by the Blue PPO. 

⁽¹⁾The lower RRH copays do not apply to tests, treatments or any other services (e.g., allergy shots, chiropractic services, physical therapy, etc.).

For a full comparison of the POS plans, please see the current Medical Benefits Comparison Book for specifics. 

Located right on the RIT Henrietta campus, Family Medicine at RIT provides complete medical care in a convenient location. All RIT employees and their family members are welcome at this practice. More information about this location can be found at Rochester Regional Family Medicine at RIT. 

The practice is in the Clinical Health Sciences Center located at the north end of Louise Slaughter Hall. The office hours of operation are Monday through Friday, 8:00AM to 5:00 PM.

Adjacent to the practice is the Rochester Regional Health Outpatient Lab, where you can have blood drawn or provide a urine sample. The hours of operation are Monday through Friday 7:00 AM to 4:00 PM (closed for lunch 12-1 PM). The lab is open to the public and no appointment is required, but you will need to bring a lab request from your medical provider.

In support of the strategic alliance between RIT and Rochester Regional Health (RRH), there are two ways for medical plan participants to save money on their medical care:

• If a POS plan member has an appointment at Rochester Regional Family Medicine at RIT, they will have a lower $20 copay for the PCP 
• There is an “RRH Copay Option” within our point of service medical plans. Under this option, there is a slightly lower copay when you obtain the following medical services from RRH providers:
  • office visit to primary care physician (PCP)
  • office visit to specialists
  • emergency room visits
  • Under POS A only, there is a lower copay for Inpatient Hospitalization and Outpatient Services.
    • The lower copays do not apply to tests, treatments or any other services (e.g., allergy shots, chiropractic services, physical therapy, x-rays, etc.). These lower copays are outlined.

Example of how a deductible and coinsurance works: 

• Sam is enrolled in POS B, individual coverage, which has a deductible and coinsurance for inpatient hospitalization
• In January, Sam has an inpatient hospital stay of 3 days
• The total cost of the stay is $20,000
  • Sam pays the first $250 to meet the deductible
    • This leaves a balance of $19,750
  • Sam pays 10% coinsurance on the remaining $19,750, or $1,975
  • Sam's total cost for the hospitalization is $2,225 ($250 + $1,975)
  • The plan pays $17,775

When choosing which medical plan that is right for you and your family...

• It's not just about the premium you pay out of your paycheck - you need to consider your estimated out of pocket costs as well
• Generally, the higher the premium contribution, the lower the out of pocket cost (will not apply for all services). 
• The plan with the highest premium contribution may not be the best plan for you. If you rarely go to the doctor and you do not take any medications or take only an inexpensive generic medication(s), you might not need to pay for the plan with the richest benefits. 
• The plan with the lowest premium contribution may not be the least expensive plan for you overall - you will likely have higher out of pocket costs.

POS Plans Similarities

• Same doctors and hospitals participate
• Same services are covered
• Routine care is covered in full (e.g., annual physical)
• Copay for telemedicine with MDLIVE is the same
• Copay at Rochester Regional Health on-campus practice is the same
• Prescription drug formulary (i.e., tiers and excluded drugs) is the same for POS A, POS B, and POS D
• POS A and POS B have the same prescription drug coverage
• POS B, POS B No Drug, and POS D have a deductible and coinsurance for Inpatient Hospitalization, Outpatient Services, and Advanced Imaging

POS Plans Differences

• Your payroll contribution amount is different for each plan
  • POS A has the highest contribution and POS D has the lowest (excluding POS B No Drug since it has no Rx coverage)
• Generally, the higher your payroll contribution, the less you will pay for services
• POS A has copays for Inpatient Hospitalization, Outpatient Services, and Advanced Imaging
• POS D has higher out of pocket prescription drug costs than POS A and POS B
• POS B No Drug does not cover prescription drugs

As part of the Federal Consolidated Appropriations Act (CAA), new Transparency in Coverage rules have been established by the Centers for Medicare & Medicaid Services (CMS), including a multi-year initiative that requires health plans to share contracted prices for all health care items and services. The first phase of these requirements begins July 1, 2022.

Excellus BlueCross BlueShield (BCBS) has provided the link below where you can find the following information:

• In-network provider contracted rates for items and services

• Out-of-network allowed amounts and billed charges for items and services

Please note that the link below is to a machine-readable file and is designed for a machine (i.e., computer) to read and will not be user-friendly for members. The best user experience for Excellus BCBS members will be to login to their online account (www.excellusbcbs.com) to access the cost estimation tool where you will be able to see both the cost of services (“contracted rates”) and how your own medical plan benefits will apply to those rates.

Excellus Online Member Link:

https://www.excellusbcbs.com/transparency-coverage-mrf

If you have any questions, please contact Excellus directly at 877-253-4797.

OptumRx is the pharmacy benefit manager (PBM) which administers RIT’s prescription drug coverage. Under the plan, covered medications can be purchased from a participating retail pharmacy or from OptumRx’s mail pharmacy. 
 

IMPORTANT! 

The medical benefit and the prescription drug benefit each have a separate out-of-pocket maximum. This means that medical expenses count only toward the medical plan out-of-pocket maximum, while prescription drug expenses count only toward the prescription drug out-of-pocket maximum.

For POS A, POS B and Blue PPO

For POS D

Wegmans Pharmacies are designated as the “preferred pharmacy” under the plan. Wegmans offers the convenience of a local pharmacy paired with the preferred pricing typically available only at a mail pharmacy. Wegmans also has a free home shipping option available.

Additional Benefits of using Wegmans Pharmacy: 

• Lower copay when you purchase your medications at Wegmans than at other retail pharmacies.
• Ability to purchase up to a 90-day supply of your medications at Wegmans, but only up to a 30-day supply at other retail pharmacies.
  • Your copay for a 90-day supply at Wegmans is equal to your copay at the mail pharmacy, and lower than the total of three 30-day copays that you would pay at another participating retail pharmacy.
• You may choose to purchase 30-day supplies at Wegmans and your copay will not increase after 3 fills; at other retail pharmacies, your copay for a maintenance medication (those drugs you take for an ongoing medical condition) will increase significantly after 3 fills. 

OptumRx has contracted with a broad national network of retail pharmacies. This network includes thousands of pharmacies throughout the United States, including nearly all major retail pharmacy chains, such as CVS and Rite Aid, certain stores containing pharmacies such as Wegmans, Target, Tops, and Wal-Mart, and most smaller, independent pharmacies, including nearly all in the Rochester area. Retail pharmacies in the OptumRx network are referred to as “participating pharmacies.” To locate a participating pharmacy close to your home or other location, you can call OptumRx Member Services or check OptumRx website at www.optumrx.com.

Mail Order Pharmacy

For maintenance medications (prescriptions taken on an ongoing basis), OptumRx’s mail pharmacy offers the convenience of home delivery. Your initial prescription will be delivered within 10 to 14 days of receipt. Refills can be ordered online at OptumRx and are typically delivered within seven to 10 days. Be sure that your physician provides a prescription for a 90-day supply when you are ordering from the mail pharmacy. The mail copay is based upon a 90-day supply, but if your prescription is written for a lesser supply, the same mail copay will apply.

If a particular drug is not available through the mail pharmacy, you will need to fill your prescription at a participating retail pharmacy and pay the applicable retail pharmacy copay.

Optum Rx Specialty Pharmacy

If you are prescribed a specialty medication, you generally must fill it with OptumRx Specialty Pharmacy in order to have coverage. There are a few limited situations in which an exception may be granted in advance by OptumRx and the medication may be purchased at a participating retail pharmacy. Please call OptumRx Customer Service at the dedicated Rochester Institute of Technology toll-free member phone number 1-855-209-1300 (TTY: 711) for more information. 

Nonparticipating Retail Pharmacies

When your prescription is filled at a nonparticipating retail pharmacy, your copays are as indicated in the copay charts, plus you will pay any cost difference between the nonparticipating pharmacy’s prescription price and OptumRx’s discounted network prescription price. You will be required to pay the full cost of the prescription at the time you make your purchase; you must then submit a paper claim to OptumRx to receive reimbursement from the plan.

If you take maintenance medications (those you take for an ongoing medical condition), there is a significant financial incentive to purchase them at Wegmans, our preferred retail pharmacy, or through OptumRx’s mail pharmacy.

On the 4th fill (original plus 3 refills) of a maintenance prescription filled at a retail pharmacy (other than Wegmans), your copay for a 30-day supply will be equal to the copay for a 90-day supply of the medication if you ordered it from OptumRx’s mail pharmacy or purchased it at Wegmans. This will result in greatly increased copays if you continue to fill your maintenance medications at a retail pharmacy other than Wegmans beyond the 3rd fill.

This higher copay does not apply to acute care drugs such as antibiotics – your copays for such medications purchased at a retail pharmacy will not change. Also, certain medications are not available from OptumRx’s mail pharmacy, such as certain controlled substances; the higher copay will also not apply in these situations. The rest of the cost of your drugs will be paid by the prescription drug plan, except as described below:

• In cases of selected brand name drugs where an FDA-approved generic is available, your benefit will be based on the generic drug’s cost. If you or your doctor chooses the brand name drug, regardless of the reason, you will be required to pay the difference in cost between the brand-name drug and the generic, in addition to the applicable copay.
• If you purchase your medication at a nonparticipating pharmacy, you will be required to pay the full cost at the pharmacy. You can then file a claim for reimbursement (described in the section “Claims and Payment of Benefits”) with OptumRx. Your cost will be the retail copay you would have paid at a participating pharmacy (other than Wegmans), plus any additional amount charged by the nonparticipating pharmacy above the amount the drug would have cost at a participating retail pharmacy.

Two dental plan options are offered and administered through Excellus BlueCross BlueShield: the Standard Plan and the Enhanced Plan. Both plans provide 100% preventive coverage; the Enhanced plan providing more coverage for major services with a higher annual maximum.

Employees may cover their spouse/domestic partner and children up to age 26. 

Dental - Standard Plan Summary 2024

Dental - Enhanced Plan Summary 2024

Claims Administrator

Excellus Blue Cross Blue Shield of Rochester member login

Participating Providers

Search for a local participating dentist (select Dental Blue Options) 

Alternative Benefits Allowance

All covered procedures are subject to an alternative benefit allowance.

When there is more than one technique or material type for a dental procedure, the dental plan will reimburse for the procedure that has the lesser allowance. When alternate benefit is enforced, the subscriber’s benefits are not intended to interfere with the treatment plan recommended by the dentist. The subscriber and dentist should discuss which treatment is best suited for the patient, and may proceed with the original treatment plan regardless of the benefit determination. If the more expensive treatment is chosen, the subscriber is liable for the balance up to the billed amount.

Predetermination of Benefits

A Predetermination of Benefits is a written estimate from the insurance company of the amount your dental plan will pay for a specific service based on the treatment plan provided by your dentist.  Predetermination of benefits should be requested when using the Basic Restorative, Major Restorative or Orthodontia benefits,

Out of Network Services

The Dental Plans allow you to see any dentist you choose. However, nonparticipating dentists are not obligated to accept Excellus BCBS’s allowed amounts as payment in full and will balance bill any amount in excess of these allowed amounts. 

Other Important Information

Priced according to the Blue Shield Schedule of Allowances. Dentists who participate with Blue Shield agree to accept the Schedule of Allowances. Subscribers who go to a non-participating dentist will be liable for balances over the Schedule of Allowances.

NOTE: All rules, limits, and exclusions apply regardless of plan (e.g., you would still have a 5-year wait to replace a crown even if you change plans).

(All services subject Blue Shield Schedule of Allowances and to the annual deductible and annual maximum)

Vision coverage is offered through VSP. Well vision exams have a $15 copay and there is a $150 allowance for frames or contacts each calendar year. Employees may cover their spouse/domestic partner and children up to age 26. Vision coverage is fully paid by employee payroll deductions.

Provider Information 

The Vision Care plan is offered through VSP. You can find participating providers at VSP Vision Care or by calling VSP at (800) 877-7195/v and (800) 428-4833/TTY Monday – Friday 8 a.m. to 10 p.m., Eastern Time.

Vision Care along with RIT Medical Insurance

RIT’s medical coverage under POS A, POS B, POS B No Drug, and POS D covers routine eye exams with a copay. If you want to continue using your same eye doctor who is not a VSP provider, use your medical ID card at the eye doctor. Then you can take your prescription for eyeglasses or contacts to a VSP provider.

Online Account with VSP

You can set up an member account on the VSP website to manage your coverage. Click on Members then Member Log In to log in or create an account. Enter you University ID number (UID) for the Member ID along with the other required information. 

Once your account is set up, you will be able to see information about your coverage. From your account, you will also be able to print a Member ID Card to keep in your wallet; the card does not have the VSP ID on it.

Non-Participating Providers

If you or a covered family member receives coverage from a non-VSP provider, you should pay the provider’s full fee at the time of service and then submit an itemized bill to VSP for reimbursement according to the schedule of allowances. Discounts do not apply for vision care benefits obtained from non-VSP Providers, so your cost is likely to be higher if you receive services from a non-VSP Provider.

You can print a Member ID card from the VSP website. You will not receive an ID card from VSP. And, when you go to a VSP provider, you simply let them know you are a VSP member and they will take care of the rest (no claim forms to file). The ID number will be your RIT University ID (UID) number.

Member will receive the below in-network benefits when they go to a participating provider.

Note: RIT’s medical coverage under POS A, POS B, POS B No Drug, and POS D covers routine eye exams with a copay. If you want to continue using your same eye doctor who is not a VSP provider, use your medical ID card at the eye doctor. Then you can take your prescription for eyeglasses or contacts to a VSP provider.

The VSP Diabetic Eyecare Plus Program^SM provides coverage of additional eyecare services specifically for members with diabetic eye disease, glaucoma or age-related macular degeneration (AMD). Eligible members can receive both routine and follow-up medical eyecare from their VSP doctor—the doctor who already knows their eyes best. A summary of the coverage is as follows:

• The VSP Diabetic Eyecare Plus Program^SM provides coverage of additional eyecare services specifically for members with diabetic eye disease, glaucoma or AMD, including:
  • medical follow-up exams,
  • visual field and acuity tests,
  • specialized screenings and diagnostic tests,
  • diagnostic imaging of the retina and optic nerve,
  • retinal screening for eligible members with diabetes.
• The program also provides supplemental¹ coverage for non-surgical medical eye conditions such as diabetic retinopathy, abnormal blood vessel growth on the eye (rubeosis), and diabetic macular edema.
• Members can self-refer², visit their VSP Provider as often as needed, and pay only a copay for services.

_{1 The VSP Diabetic Eyecare Plus Program pays secondary to other medical eye insurance coverage.
2 Unless referral by a primary care physician is required by the health plan.}

Low Vision Services are a plan benefit when specific benefit criteria are satisfied and when prescribed by the covered person’s VSP Preferred Provider. Professional services for severe visual problems not correctable with regular lenses are covered as follows:

• Supplemental Test: Covered in full*
• Supplemental Aids: 75% of VSP Preferred Provider’s fee, up to $1,000*

_{*maximum benefit for all Low Vision services and materials is $1,000 every two (2) years and a maximum of two supplemental tests within a two-year period.}

Some brands of spectacle frames may be unavailable for purchase as Plan Benefits, or may be subject to additional limitations. You may obtain details regarding frame availability from the VSP Member Doctor or by calling VSP’s Customer Care Division at (800) 877-7195.

This Plan is designed to cover visual needs rather than cosmetic materials. If you or a covered family member selects any of the following extras, the Plan will pay the basic cost of the allowed lenses, and you will pay the additional costs for the options.

• Optional cosmetic processes
• Anti-reflective coating
• Color coating
• Mirror coating
• Scratch coating
• Cosmetic lenses
• Laminated lenses
• Oversize lenses
• Photochromic lenses, tinted lenses except Pink #1 and Pink #2
• UV (ultraviolet) protected lenses
• Certain limitations on low vision care

Not Covered
There are no benefits for professional services or materials connected with:

• Orthoptics or vision training and any associated supplemental testing
• Plano lenses (less than a ±.50 diopter power)
• Two pair of glasses in lieu of bifocals
• Replacement of lenses and frames furnished under this plan that are lost or broken, except at the normal intervals when services are otherwise available
• Replacement of lost or damaged contact lenses, except at the normal intervals when services are otherwise available.
• Medical or surgical treatment of the eyes
• Local, state and/or federal taxes, except where VSP is required by law to pay
• Services associated with Corneal Refractive Therapy (CRT) or Orthokeratology
• Corrective vision treatment of an experimental nature, unless approved by an external appeal agent
• Plano contact lenses to change eye color cosmetically
• Artistically-painted contact lenses
• Contact lens insurance policies or service contracts
• Additional office visits associated with contact lens pathology
• Contact lens modification, polishing, or cleaning
• Costs for services and/or materials above Plan Benefit allowances
• Services or materials of a cosmetic nature
• Services and/or materials not indicated on this Schedule as covered Plan Benefits

Liability in Event of Non-Payment
In the event VSP fails to pay a VSP preferred provider, you will not be held liable for any sums owed by VSP other than those not covered by the plan.

Employee Salary Reduction Contributions

All adjunct employees can participate in the salary reduction portion of the Plan beginning on the first day of the month on or after their date of hire. Adjunct employees are NOT eligible for RIT Matching Contributions to their retirement accounts. 

To find details regarding how to enroll in or make changes to the RIT Savings Plan, please see RIT Retirement Savings Plan. 

Adjunct Employee Tuition Waiver

Adjunct employees are immediately eligible for a Tuition Waiver in semesters in which you work as outlined below, on up to 12 credit hours per term, as well as eligible classes you take through RIT’s Academic Success Center and English Language Center. 

Family Member Tuition Waiver

The RIT Tuition Waiver is available to eligible family members of Adjunct Employees, unless noted under exclusions in the Education Benefits summary for Tuition Waiver. The Tuition Waiver is provided for credit-bearing courses as outlined below, based on the employee work classification and your years (or terms) of service with RIT. Family members of adjunct employees are not eligible for the Tuition Waiver for classes through RIT’s Academic Success Center and English Language Center. 

Applying for Tuition Waiver 

You must complete the Tuition Waiver for Adjuncts and their eligible family members Service Request each semester you will use the benefit at RIT.

For eligible courses taken through the Academic Success Center or the English Language Center, complete the Tuition Waiver for classes through ASC or ELC for Regular Employees and eligible family members Service Request. 

As required by law, RIT matches the employee's FICA tax contributions. There are two components of the FICA tax: 1) Social Security, and 2) Medicare. The employee and RIT contributions for Social Security provide retirement, disability and dependent benefits. The employee and RIT contributions for Medicare fund Medicare Part A. The employee Social Security and Medicare deductions are made automatically each pay period and are combined with RIT's contributions and forwarded to the Federal Government for these programs.

Employees who terminate may be eligible for unemployment insurance benefits from their state of residence. Employees should check with their state Department of Labor, Unemployment Insurance Division, to investigate possible eligibility.

NEW YORK STATE RESIDENTS 

Adjunct employees are eligible for only New York State Statutory Disability. After a one-week waiting period of seven consecutive calendar days, New York State disability benefits provide 50% of your pay to a maximum of $170 per week.

NYS Statutory Disability benefits are administered by FutureComp. Adjunct employees who are disabled should notify the RIT leave specialists by emailing fmla@rit.edu. 

NON-NEW YORK STATE RESIDENTS 

If you reside in California, Connecticut, District of Columbia, Hawaii, Massachusetts, New Jersey, Rhode Island or Washington - you may be eligible for state disability leave that you can apply for. 

Non-NY residents and Adjunct employees who are disabled should notify the RIT leave specialists by emailing fmla@rit.edu. 

For full details, see the Workers' Compensation Summary.