Useful Definitions
Dependent Definitions
Who is considered a Dependent for health, dental and life plans?
- Your legal spouse.
- Same-Sex Domestic Partner (SSDP). Another adult of the same sex who is engaged with you in a spouse-like relationship characterized by mutual caring and dependency.
- Same Sex Domestic Partners coverage and coverage for child(ren) of same sex domestic partners requires completion of the Statement of Same-Sex Domestic Partnership
 . To receive the Affidavit and to learn more about the eligibility requirements to add a same sex domestic partner, please call 404-727-7613 to speak to a benefits representative.
- Your legal children. Children include your natural or adopted child(ren) or stepchild(ren) or any child(ren) for whom you have legal custody and who live with you in a parent-child relationship as noted. They are eligible if they are:
- Under age 19, unmarried and financially dependent on you.
- Full-time students ages 19-25 and financially dependent on you.
- Incapacitated and financially dependent on you (must be covered prior to age 19).
Note:
- Parents, grandparents and siblings are NOT eligible dependents under these plans.
- For the Dependent Care (daycare) FSA, a dependent is defined as a legal child under the age of 13, a disabled child or elderly parents that you can claim as a dependent on your tax returns.
Network Definitions
Each medical plan offers three network options – Core Network, In-Network and Out-of-Network. Your cost sharing (co-pays, co-insurance, deductibles, etc.) varies based on which network you use.
- Core Network providers have lower co-pay, co-insurance, and deductibles. The core network includes physicians, hospitals and other health care providers primarily affiliated with Emory HealthCare; however, there may be other providers who are not a part of the Emory Healthcare system but are in the core network.
Core Network hospitals include:
Emory Crawford Long Hospital
Emory University Hospital
Emory Johns Creek Hospital
Emory Eastside Medical Center
Emory Adventist Hospital
Wesley Woods Hospital
Children's Healthcare of Atlanta (Egleston and Scottish Rite)
Northside Hospital (Johnson Ferry Road location only)
Newton Medical Center
Core Network Physicians include:
Emory physicians
Other participating physicians as specified by each plan
- In-Network providers includes physicians, hospitals and other health care providers that are identified as part of a particular medical plan. At Emory, BCBS and Aetna provide our medical plans and each has a defined “network” of providers. If you choose to use an in-network provider instead of a core provider, you still have in-network benefits but the deductibles, coinsurance and co-pays are slightly higher.
Contact the appropriate network to find a participating Core physician or facility:
- Out-of-Network providers are any physicians, hospitals or other health care providers who are not affiliated with either the Emory Core Network or your medical plan in-network providers. If you choose to go to a provider outside the core or in-network, eligible charges will be reimbursed at the usual and customary rate subject to an annual deductible and coinsurance.
Note:
- If you require hospitalization, both the PPO and the POS require you to pre-certify your admission by contacting your plan provider (BCBS or Aetna).
Health Plan Definitions
You can choose medical coverage through Aetna Point of Service (POS) plan or the BCBSGA Preferred Provider Organization (PPO).
What is a Point of Service (POS)?
A POS is a type of managed care group health insurance with characteristics of both an HMO and a PPO. In a POS, you have the ability to see out-of-network providers unlike with an HMO. There is an emphasis on prevention and health education where members are encouraged to participate in programs, which lead them to healthier choices and lifestyles.
Emory offers one POS plan:
- AETNA POS (EmoryChoice)
- Do not need to select a Primary Care Physician (PCP).
- No referral needed for specialist appointments.
- Core network of providers stays the same.
- Able to use out-of-network option.
What is a Preferred Provider Organization (PPO)?
A PPO is a group system of health care organized by an insurance company. Physicians, health care providers, hospitals and clinics sign contracts with the PPO system and accept the PPO’s fee schedule and guidelines for its managed medical care. As with a POS, you have the freedom to see an out-of-network provider but at a higher cost than using the core or provider network.
Emory offers one PPO plan:
- BCBSGA PPO (HealthChoice)
- Do not need to select a PCP.
- No referral needed for specialist appointments.
- Core network of providers stays the same.
- BCBS network of providers is staying the same.
Note:
- Your medical and dental plan contributions and your contributions to flexible spending accounts are deducted from your paycheck on a pre-tax basis. These contributions are deducted before federal and most state and local taxes are calculated. The amount you save in taxes helps offset your contributions to these plans.
Emory University Benefits
Hours of Operation:
Monday through Friday from 8:00 a.m. to 5:00 p.m.
1599 Clifton Road, NE
Atlanta, GA 30322
(404) 727-7613
Disclaimer
Emory reserves the right to terminate, suspend, withdraw, amend or modify the Plan in whole or in part at any time. Further, Emory reserves the right to terminate or modify coverage for any group of employees, active or retired and their dependents or a class of dependents at any time.
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