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Cornell Program for Healthy Living (CPHL) plan

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A comprehensive medical insurance PPO plan that encourages your progress toward healthier living through an optional Enhanced Wellness Program and Fitness Benefit discounts (for Ithaca-area members).

The Aetna PPO Cornell Program for Healthy Living (CPHL) plan offers the freedom to choose any doctor — in or out of the Aetna network. Keep in mind, however, that your share of the medical cost is usually lower when you stay in the network. And, with so many doctors and hospitals on the list, that’s not hard to do. Your participation in any of the endowed medical plans, includes prescription drug coverage administered by OptumRx.

You will get the most out of the optional enhanced wellness program if you live in the Ithaca area and are:

  • willing to commit to following a wellness improvement plan
  • willing to choose a participating PCP for your yearly enhanced wellness exam
  • able to encourage your family members to support this plan choice for themselves as well

If you live outside of the Ithaca area or do not receive an enhanced wellness exam, you can receive routine and covered medical services from any participating Aetna provider. You do not need to identify a PCP or obtain a referral to see a specialist.


Tools & Resources

Also see: Covid-19 Benefits Info   


CPHL Health Plan Details

Eligibility

You

Endowed benefits-eligible* faculty and staff members can enroll in the CPHL plan.

*If you are uncertain of your eligibility status for this benefit, please contact your HR representative to review.

Your Dependents

  • The employee must qualify for and be actively enrolled in Cornell’s medical plan for a spouse/domestic partner and child(ren) to be enrolled.  
  • Children are eligible for coverage through December 31st of the year they turn age 26.
  • Children may be eligible to continue coverage beyond 26 years old. Both below “Request for Continuation of Coverage for Disabled Child” forms must be completed and returned to Aetna prior to the child turning age 26.

The above eligibility is a high-level summary. Please review the CPHL Benefit Plan Booklet for details on who is eligible for coverage.

Plan Highlights

In-Network Out-of-Network
Level of Health Plan Support

You pay less out of pocket:

$100 deductible

$20 office visit copay

90% for other services

Pharmacy administered by Optum Rx

You pay more out of pocket:

$400 deductible

80% after deductible

Pharmacy administered by Optum Rx

PCP Requirement Applies to Enhanced Wellness Exam only

N/A

Referral Requirement to a Specialist No referrals needed No referrals needed
Preventive Care Covered at 100%, regardless of where you live and the network PCP you choose.

Covered at 80% after deductible

Broad national network of physicians and hospitals Fully available at discount prices You may use out-of-network providers but it will cost you more
Balance Billing (the amount billed by your provider that is over the insurance company's allowed amount) Providers have agreed not to bill you over allowed amount Providers are free to bill you over the allowed amount
Certification for inpatient hospital and other medical services Participating provider precertifies for you You precertify by calling the toll-free number on your ID card. Failure to precertify may result in substantially reduced benefits
Claim forms to file No. Your provider files claims on your behalf Yes. You are responsible to file claims. Claim forms located at http://www.aetna.com/individuals-families- health-insurance/document-library/medical- claim-form.pdf
Also see:

Rates

For 2023

Coverage Type Hourly/Non-Exempt Salary/Exempt

Individual

$31.50

$34.13

Individual + child(ren)

$142.48

$154.35

Individual + Spouse/Domestic Partner

$157.98

$171.15

Individual + Spouse/Domestic Partner + child(ren)

$213.23

$231.00

Individual + Spouse/Domestic Partner working at Cornell (dual eligibility) + child(ren)

$144.29

$156.31

NOTE: The dual eligibility category is available to an endowed staff or faculty member with dependent children whose spouse or domestic partner is also a benefits-eligible staff or faculty member paid from endowed funds at Cornell University.

Also see: Compare rates across all Endowed Health Plans

Deductibles

For 2023

Type of Coverage

In-Network

Out-of-Network

Individual

$100

$400

Family

$200

$800

Forms

Plan Documentation


While every attempt has been made to ensure the accuracy of this Summary, in the event of any discrepancy the Summary Plan Description and Plan Document will prevail.