Annual Benefits Enrollment

Musculoskeletal Program: Beginning Jan. 1, 2025, those enrolled in WFU’s medical plan will have access to a new Musculoskeletal program via the Hinge Health mobile app.

Medical Plan Premiums: There will be a 10% premium increase across all medical plans. Below is an example of the impact of this premium increase per month based on the full-time benefits rate.

• Employee Only Low Plan: $11.79 more per month
• Family Low Plan: $47.77 more per month
• Employee Only High Plan: $24.68 more per month
• Family High Plan: $82.58 more per month

Member Cost Changes: Emergency Room Copays will increase by $100; individual deductible and out-of-pocket maximum will increase by $250 for the Aetna Whole Health Plans.  

Behavioral Health Transition: As previously communicated, the University will transition from Carolina Behavioral Health Alliance (CBHA) to Aetna as our third-party behavioral health plan administrator. Learn more about the transition on the Human Resources website.

Member Cost Changes: With the transition to Aetna, all Behavioral Health copays will be level-set at $15, and the separate $1,000 out-of-pocket maximum for Behavioral Health will be discontinued.  Behavioral health copays will be included in your overall medical out-of-pocket maximum.

Teledoc for Behavioral Health: Effective January 1, 2025, the current Teladoc Health program will include behavioral health support for members 13 years of age and older.

Important: Aetna is available to help WFU members verify whether their current behavioral health provider is in-network with Aetna and/or identify a new in-network provider if needed. Email wfu@aetna.com or call 855.586.6961.

Dental Plan Premiums: Dental premiums will increase by $6.49 or less per month.

The University is moving to a fully-insured dental plan and has updated the cost-share to 15% employer / 85% employee paid. Dental plan benefits will remain the same.

Health Care FSA: The Health Care FSA maximum contribution for 2025 has increased to $3,200 per individual with a $640 carry over limit from 2024 into 2025. 

Dependent Care FSA: The Dependent Care FSA maximum contribution amount for 2025 will remain at $5,000 per household. There is no carry over allowance for Dependent Care.

Important: If you are planning to participate in a Flexible Spending Account in 2025, you must actively enroll in Workday during the annual benefits enrollment period. FSA elections do not carry over each year. 

The Paid Time Off policy will be updated to align the PTO accrual schedules for Reynolda Campus exempt and non-exempt staff, including Reynolda House. Beginning Jan. 1, 2025, non-exempt staff will accrue PTO at the same rate as exempt staff according to the following schedule: 

• Less than 5 years of service: 5 weeks of PTO
• 5 or more years, but less than 10 years: 6 weeks of PTO
• 10 or more years of service: 7 weeks of PTO

New Medical Insurance Cards: All employees enrolled in the University’s medical plan will receive new Aetna insurance card(s) in late December, which will be mailed directly to the home residence. Once the ID card is received, new members may register online at aetna.com or download the Aetna app to access an electronic copy of their ID cards and other resources. Get the Aetna HealthSM app by texting “AETNA” to 90156 for a download link. Message and data rates may apply.

Update Your Address in Workday: The Aetna medical plan has two networks based on your primary home zip code (Aetna Whole Health and Aetna Choice POS). The Aetna Whole Health network offers additional savings when you utilize Atrium and AHWFB providers. You will see the name of your network during the enrollment process in Workday. It is important to ensure your primary home address is up-to-date in Workday before you submit your open enrollment task, as that determines which medical plan network you are eligible for.

CVS ExtraCare Plus: Medical plan members have access to the CVS ExtraCare Plus (formerly CarePass) membership, which offers discounts and a monthly $10 promotional reward, and to CVS Minute Clinics with no copay. The CVS Minute Clinic is a great option when you or a dependent can’t wait to see a primary care physician for medical needs such as a sore throat or a vaccination.

Discontinuation of Genworth Long-Term Care: Effective Nov. 1, 2024, Genworth Life Insurance Company will discontinue offering new and additional coverage under Wake Forest’s policy. Coverage will continue for current policyholders; faculty and staff may apply for coverage through Oct. 31, 2024.

If you would like coverage, you must enroll in the following benefits during open enrollment or following a qualified event: medical plan (includes prescription and behavioral health plans), dental plan, vision plan, legal plan, flexible spending accounts, supplemental health insurance (though Aflac), and whole life insurance (through Unum).

All your current elections, except for Flexible Spending, will carry forward to the next plan year. Flexible Spending doesn’t automatically renew; you must re-enroll each year.

1. Download and open the Workday mobile app on your mobile device.
2. Sign in using wfu as your company ID (only applies to first-time downloads).
3.  Enter the username and password for your work Gmail account.
4. Complete the Google Two-Step Verification.
5. Go to your inbox, click Open Enrollment Change, and Let’s Get Started.
6. To change benefits or dependent(s), click on the appropriate box and follow the prompts.
7. To submit your elections, click View Summary, I accept (checkbox), and Submit.

If you submitted your benefit elections and need to make additional changes during annual benefits enrollment, follow these steps in Workday:

1. Click Menu in the top left corner.
2. Click the Benefits link.
3. In Cost section, click Change Open Enrollment button.
4. Click OK.
5. Make your elections; progress through the screens by clicking Continue.
6. Click Submit.

Verify if a provider or a facility is in-network by following these steps:

• Visit: aetna.com
• Under Already a member: Click Login to Secure Site
• Enter: Username and Password, Click Secure Log In
• Under “Find Care & Pricing,” click Go Find Care
• Search by provider name, specialty, procedure, or medication.

*Members should call Aetna when searching for an in-network provider or facility that is between 70-100 miles from their home zip code to verify network status.

Verify if a prescription is covered by following these steps:

• Visit aetna.com
• Login to the member portal (registration is required; click on Register in the Don’t Have an Account section)
• Under Plan Overview, under Pharmacy, click on What’s Covered
• In the Estimate Medication Costs, enter the name of the prescription and select the correct name/dosage
• Under the Pricing section, click View Price
• If a prescription is not covered, Price Unavailable and Not Covered will be displayed

How to Find Medication Alternatives

• Log into your Aetna account
• Hover over Plan Overview
• Click What’s Covered under Pharmacy
• In the Estimate Medication Costs, enter the medication that is not covered
• Click View Price
• If it is not covered, it will display messaging that says Not Covered & Price Unavailable
• Beneath that message, alternatives will be displayed along with the respective copay(s)

Members may call Rx Member Services at 888-792-3862 to discuss alternatives.

Members enrolled in the Aetna Whole Health network will have higher out-of-pocket costs if they choose to use a Novant provider/facility (Tier III; Standard Savings) instead of choosing an Atrium provider/facility (Tier I; Maximum Savings).

Faculty and staff enrolled in the University’s Aetna medical plan may call 336-702-3322 (DEAC) for personalized assistance finding an in-network Atrium provider(s) and/or an Atrium provider(s) with shorter wait times.

When a member incurs copays, deductibles, and coinsurance costs in the health plan, these amounts will cross accumulate between medical plan tiers within a calendar year. 

For example, if a member sees a Tier III, Standard Savings, provider and incurs $750 towards their individual deductible expenses, the member will have accumulated those deductible expenses across all tiers. Later on, if the member seeks care with a Tier I, Maximum Savings, provider and services are performed that would normally go towards the individual deductible, the member’s individual deductible would already be met based on the prior incurred expenses within the calendar year.

Out-of-pocket expenses work the same way. Out-of-pocket expenses, including deductibles, copays, and coinsurance for the medical, pharmacy, and behavioral health plans cross accumulate between tiers.

When Aetna files their Aetna Whole Health products with the NC Department of Insurance, they are required to show sufficient access to Tier I providers (Atrium) in order for the product to be approved in certain locations. This evaluation is based on zip codes. If Aetna cannot offer sufficient access to Tier I providers within a certain distance of a zip code, they are not permitted to offer the Aetna Whole Health product. Members who do not have sufficient access to Tier I providers are offered Aetna’s national network, Aetna Choice POS II. When employees log into Workday and select the Open Enrollment task in their inbox, and select the medical plan, they will see what network they are in. Workday will be updated annually, if the Aetna Whole Health network is approved to expand access.

Regardless of where the dependent lives, they will be in the same network as the employee. Both networks have a “Standard Savings” tier, which is national and offers in-network providers across the U.S. 

Check your Flexible Spending Account (FSA) balance by either logging into your account at mcgriff.com or downloading the McGriff mobile app. Alternatively, faculty and staff may contact McGriff’s WFU dedicated customer service line by calling 800.930.2417 or emailing wfu_flex_inquiry@mcgriff.com.

Organizations with self-funded plans, like Wake Forest University, assume all financial risk for providing benefits and typically outsource the plan’s administration to a third-party administrator. Large employers generally are self-funded. Self-funded plans are beneficial because they are more flexible in meeting the organization’s specific needs and allow additional savings on premium costs.

A third-party administrator is an organization, like Aetna or MetLife, that administers the benefit plans for a self-funded organization like WFU, which includes handling claims, processing, and reporting. 

A provider network is a list of the doctors, hospitals, and other health care providers with which a third-party administrator (TPA) of a plan contracts with to provide medical care to plan members. These providers are called “network providers” or “in-network providers.” A provider that isn’t contracted is called an “out-of-network provider.” The network is a financial arrangement between the plan TPA and the providers, which is why discounts may be offered by specific providers.

Premiums: This is the pre-tax amount taken directly from your paycheck in exchange for coverage. Your premium will depend on the type of coverage you choose and the number of dependents on your plan.

Copayment: Sometimes referred to as the office copay, the fixed fee you pay at the doctor’s office during each visit.

Deductible: This is the upfront cost of your covered health care before insurance starts to pay. For example, if you have a $1,000 deductible, you will need to pay $1,000 of your health care expenses before your insurance starts to pay for it. Copays are not included in your deductible.

Coinsurance: This is the share (or percentage) of your covered health care costs that you pay after you’ve met your deductible. For example, if your coinsurance is 20%, you would pay 20% of a medical bill and your insurance would pay 80%. This cost is in addition to your copayment, or office copay.

Out-of-Pocket Maximum: This is the total amount you pay annually before your health care insurance starts paying 100% for covered services. You reach your out-of-pocket maximum by combining the money you’ve spent towards covered health care services with copays, deductibles, and coinsurance.