HUMAN RESOURCES

Effective January 1, 2027, Hofstra University will change its health insurance carrier from Anthem BlueCross BlueShield to Aetna. These answers explain what the change means for your coverage and how to prepare.

1. When does Aetna coverage begin?

January 1, 2027. Your Anthem coverage continues through December 31, 2026.

2. Do I need to enroll again to keep my current plan?

No. If you are currently enrolled, you will automatically move to the same type of plan with Aetna unless you make a change during Open Enrollment. For example, an employee currently enrolled in the Hofstra EPO plan with Anthem BlueCross BlueShield will move to the Aetna EPO plan.

3. Will my copays, deductible, or out-of-pocket maximum change?

No. These amounts stay the same for 2027.

4. How do I check whether my doctor is in the Aetna network?

99% of current providers participate in the Aetna network. To confirm whether your doctor participates, visit the Hofstra Aetna website and search for providers in the network associated with your 2027 plan. You can also call Aetna at 877-543-0074 for assistance confirming your doctor’s participation.

5. How do I check whether my doctor is in the Aetna network?

Visit the Hofstra Aetna website and search for participating providers. Check the network for the plan you will have in 2027. You can also ask Aetna for help confirming participation by calling 877-543-0074.

6. Where can I get help during Open Enrollment?

Aetna’s dedicated customer service line for Hofstra is available 24/7 to answer questions and help you find providers. Call 877-543-0074 or visit aetnaresource.com/lg/Hofstra.

7. What if I am currently in treatment and my doctor is not in the Aetna network? How do I request continuity of care?

If you are undergoing an active course of medical treatment with a doctor who does not participate in the Aetna network, you may be eligible for continuity of care, subject to Aetna’s review and approval.

To request consideration, complete the Continuity of Care form, also available in the Forms section of the Hofstra Aetna website. You may prepare the form in advance, but you must wait until your Aetna coverage begins on January 1, 2027, to submit it.

For questions, call Aetna at 877-543-0074. A concierge representative can provide guidance, but eligibility must be determined by Aetna’s clinical team after reviewing your completed form.

8. Will my vision or dental coverage change?

No. EyeMed vision coverage and Delta Dental coverage will remain the same.

9. Can I access my Aetna ID card on my phone?

Yes. Digital ID cards will be available in the Aetna Health app starting in mid-December 2026.

10. Will I need to request a new ID card?

No. Aetna will mail new ID cards to your home before January 1, 2027. Starting January 1, show your Aetna card to your doctors and other providers.

11. What steps should I take before January 1 to prepare for the transition to Aetna?

Attend an Open Enrollment information session, where Aetna will be participating, to learn more about your coverage and ask questions. Review your benefit options during Open Enrollment and watch for your new ID card in December.

Check whether your providers participate in your Aetna plan’s network.

Express Scripts now may require that certain medications be reviewed before they are covered by your prescription plan. These answers explain the most common programs and any steps you may need to take.

1. What is prior authorization, and does it apply to all medications?

Prior authorization applies only to certain medications, not all prescriptions. For medications that require it, your doctor must provide additional information before your plan can approve coverage. This review helps ensure the medication is being used safely, appropriately, and according to your plan’s coverage rules.

Coverage decisions are based on:

• FDA-approved prescribing information
• Clinical guidelines and published research
• Your prescription plan’s coverage rules

If your medication requires prior authorization, your doctor will need to submit the requested information for review. If approved, your prescription will be covered according to your plan.

2. How long does a prior authorization take?

Most reviews are completed within 1–3 business days after all required information is received. Delays can occur if additional information is needed from your doctor.

3. What if my prior authorization request is denied?

You can talk with your doctor about a covered alternative, file an appeal using the instructions in your denial letter.

4. What is electronic prior authorization?

Electronic prior authorization, also called ePA, allows your doctor to submit a prior authorization electronically, which may help speed up the review process.

5. What is step therapy, and does it apply to all medications?

Step therapy applies only to certain medications, not all prescriptions. For medications subject to step therapy, your plan requires you to try safe, effective medications that are typically lower in cost before covering a more expensive alternative. These first-line medications are often FDA-approved generics or preferred brands.

If your medication requires step therapy, talk with your doctor about a preferred medication covered by your plan. If that medication does not work for you, your doctor may request a coverage review for another option.

6. What is Drug Quantity Management?

Drug Quantity Management, also called DQM, sets limits on the amount of medication covered at one time based on FDA recommendations and clinical guidelines. This helps ensure medications are dispensed in amounts considered safe and effective and can help reduce waste and costs.

Your pharmacy will apply the amount covered by your plan when filling your prescription. If needed, talk with your doctor about whether a higher-strength medication is appropriate or whether to request approval for a larger quantity.

7. How will I know if my medication is affected by one of these changes?

Express Scripts will notify you directly if your medication is affected by these changes. These requirements apply only to certain medications, not all prescriptions. If you receive a notification, review it carefully and work with your doctor to complete any required steps.

8. Where can I get help with my prescription coverage?

Call the number on your prescription ID card for questions about your prescription coverage, the status of a coverage review, or covered medication options.