Department of Human Resources
Medical, Prescription & Dental Benefits
Summary of Benefits and Coverage: The Federal government required that beginning in 2013 employers provide benefit plan members with a summary of their medical and prescription plans. They mandated the format to be used so the documents would be easy to read and understand. Click on the link below to view the summary for your plan. The summaries provide cost examples however, the examples are for a general cost comparison and do not reflect the specifics of the Jefferson plans.
Jefferson offers eligible employees the choice of three medical plans, all of which use Independence Blue Cross (IBC) provider networks. Each is designed to meet different needs:
- The Consumer Driven Health Plan (CDHP) – this plan offers a Health Reimbursement Account (HRA) funded by Jefferson which members use to pay for health care services. Once the account is exhausted, members must pay for their care to a maximum dollar amount, after which the plan pays 100% of expenses. You can use a Flexible Spending Account to set aside money on a before tax basis (saving on income taxes) to pay for expenses once your HRA is exhausted. If you do not use all of the money in your HRA, it will roll into the next year (up to the allotment for 4 years) building the account balance to cover future health care costs at 100%.
- Personal Choice PPO – The PPO allows complete freedom of choice of providers from three networks: Jefferson, JeffPLUS and IBC’s Personal Choice network, although your costs will be lower at a Jefferson or JeffPLUS facility. The plan also provides coverage at a lower level for providers who do not participate in any of these networks. PPO members share the cost of services through deductible and co-insurance. No referrals are required although some services do require pre-certifications.
- Keystone HMO – You must choose a primary care physician (PCP) in the Keystone network and get referrals from him/her for care provided by other physicians. Co-pays apply for most services although they are lower at a Jefferson or JeffPLUS provider. There is no coverage for services received by providers who are not in the Jefferson networks or IBC’s Keystone network.
Adobe Acrobat Reader is freeware required to view PDF material.
The OPTUMRx prescription drug program is included with each of the above health plans.
If you enroll, you will receive separate ID cards for each plan.
You may review and evaluate the benefits of each plan by selecting the
comparison charts below:
2012 Jefferson HMO Comparison Chart
2012 Jefferson PPO Comparison Chart
2012 Jefferson CDHP Comparison Chart
2013 Jefferson HMO Comparison Chart
2013 Jefferson PPO Comparison Chart
2013 Jefferson CDHP Comparison Chart
You will have the lowest out-of-pocket costs when you use Jefferson facilities.
Consult the web site for an up-to-date listing of participating providers at www.jeffplus.org.
Home Hospitals: out-of-pocket costs are lowest at your home hospital where you work
- Thomas Jefferson University Hospital
- Methodist Hospital Division
- Magee Rehabilitation Hospital
- Bryn Mawr Hospital
- Bryn Mawr Rehab Hospital
- Lankenau Hospital
- Mirmont Treatment Center
- Paoli Memorial Hospital
- Riddle Memorial Hospital
Other Network Hospitals: out-of-pocket costs are higher than your home hospital but lower than if you use a hospital participating in the insurance company’s network
- Nemours/Alfred. I. duPont Hospital for Children
- Aria Hospitals, Frankford, Torresdale and Bucks Campuses
Virtua Hospitals: (For in-patient stays only)
- West Jersey Hospitals at Berlin, Marlton, Memorial and Voorhees
- CHOP and St. Christopher’s Hospital
- Plus other JHS hospitals
To get the best coverage use a JeffPLUS physician. Please be aware that not all physicians who practice at Jefferson facilities are in the JeffPLUS network. In the event that you receive services from a non JeffPLUS doctor your benefits will be paid as follows:
- For physicians who participate in the insurance company’s network benefits are paid at “in-network” levels
- For physicians who do not participate in the insurance company’s network benefits are paid at the “out-of-network” levels
Member Rights – Mandatory Notices
Please click on the documents below to review important information on member rights. These articles include information on selecting primary care providers, women’s and newborn rights, and Premium Assistance for coverage for children and privacy information. Eligible employees may request a paper copy of the posted information by contacting the HR Service Center at (215) 503-8100.
HIPAA Notice of Privacy Practices
Mandated Employer Notices
For more information, please contact the HR Service Center at (215) 503-8100 or HRQuestions@Jefferson.edu.