HUMAN RESOURCES

• For PPO coverage, you can contact your provider and ask if they are in-network for UHC’s Choice Plus network. Or, you can use UHC’s PPO Provider Finder.  

• For HMO coverage, you can contact your provider and ask if they are in-network for UHC’s HMO, Navigate Balanced HMO or Navigate Plus HMO networks. Or you can use UHC’s HMO Provider Finder. 

During the upcoming Open Enrollment period, faculty and staff who want to remain covered under a Northwestern sponsored medical plan will need to take action for coverage in 2026.

All other enrollment, excluding FSA and HSA enrollment, will carry over to 2026, including PPO Dental enrollment.

Enhanced UHC Customer Support: Answer to all Your Questions

The UHC support model will allow faculty and staff to contact UHC directly in three different ways:

1. For general questions about medical coverage, contact UHC at 833-314-1787 for PPO and HSA plans and 855-828-7715 for the HMO plan.
2. For those with questions regarding complex or ongoing conditions, you may schedule a one-on-one meeting with UHC to discuss how your treatment will be covered and transition of care questions. You may also email northwestern@uhc.com your questions to UHC directly.
3. If your provider is not in-network, see the nomination tool on the UHC benefits website to request UHC invite them to join the network.

• If you are unable to obtain information from UHC via the 800-, a 1:1 consultation, and from the email address (after at least 2 business days) you may email benefits@northwestern.edu for additional support. This email should not be used for initial questions or general inquiries as it is meant to help faculty and staff who have not received a timely response from UHC. General questions can be sent to the askHR Service Center at askHR@northwestern.edu or 847-491-4700. 

In addition, for pre-enrollment and during enrollment, UHC has added a Super Advocate and a dedicated Behavioral Health Advocate to the plan’s customer service team. The Super Advocate is specially trained to support complex inquiries. The Behavioral Health Advocate is specially trained in behavioral health matters and can help confirm providers who are in network but have not yet been posted on the public directory.

Prescription Drug Customer Support

• For general questions about prescription drug coverage or to verify your medication is covered, contact CVS at 833-844-5348.
• You may review drugs and how they will be covered online by medical plan.
• CVS will send a letter to all participants in December with information on and let you know if any action is required by you or your provider.

Many of you have reported hearing negative publicity regarding UHC, including reports that a large percentage of UHC claims (up to 32% of claims) are denied. Not only is this denial rate inapplicable with self-insured plans like Northwestern’s, it is also inaccurate for UHC’s fully-insured plans, like its Affordable Care Act Exchange plans.

UHC reports that it approves 90% of claims shortly after they are submitted. While the remaining 10% go through an additional review process, this extra review may happen for a number of reasons, including most commonly:

• To verify eligibility (whether the patient is actually enrolled in the plan);
• To question duplicate claims (which can occur when a provider submits multiple claims for the same treatment or service);
• To request missing information (if the provider failed to submit all necessary information to review the claim);
• To perform a coverage check with the plan sponsor to confirm that the service or procedure is covered under its health plan; and
• To conduct a clinical review to ensure the treatment/service adheres to widely accepted clinical standards (UHC reports that only about 0.5% of claims fall into this category).

After this additional review process is completed, UHC reports that its claims approval rate stands at 98% for claims for eligible members, when submitted in a timely manner with complete information, and after duplicate claims are removed. If a claim is denied, members can file an appeal (see below).

The University will regularly review and audit UHC’s claims administration to ensure that claims are processed accurately and consistently in accordance with Northwestern’s plan.

When changing health plan administrators, some disruption is going to be inevitable, but Northwestern is doing what it can to minimize those disruptions.  Prior to making the decision to switch, our benefits consultant performed an analysis to determine how disruptive the change from BCBSIL to UHC would be for our plan participants in relation to in-network providers. Of the in-network providers used by those individuals covered on Northwestern’s plans in a 12-month period during 2023-2024, 95.8% of the BCBSIL in-network providers were also in-network with UHC, including Northwestern Memorial Healthcare, Northwestern Medical Faculty Foundation, Endeavor Health (Clinical Operations and Medical Group), Ann & Robert H. Lurie Children’s Hospital, Advocate Heath and Hospitals Corp, Northwestern Lake Forest Hospital, Rush University Medical Center, the University of Chicago Medical Center, and Advocate North Side Health Network.

We know there is significant concern regarding behavioral health coverage, and we are also doing what we can to minimize disruption in this area.  For example, we have asked UHC to expand their in-network providers to include additional behavioral health providers who were in-network with BCBSIL and used by Northwestern claimants. Most recently, the Family Institute and several other frequently utilized providers have been added to the UHC network.

If your provider is not in-network, you have the option to fill out the Nominate Your Provider form online which will be routed to UHC who will reach out to your provider with an invitation to join the network.

You can stay with your provider if they are not in the UHC network and the plan will reimburse your covered expenses at the out-of-network rate.

UHC reports that when its members seek care, more than 99% of the time no prior approval is needed, or the approval is obtained quickly (within an average of 2 days or less) so that care is not delayed.   

When the plan requires prior authorization, UHC will conduct a clinical coverage review before the service is performed to determine whether the service is medically necessary based on evidence-based clinical guidelines. Prior authorization must be completed before the service is performed.

Northwestern will map over prior authorization approvals from BlueCross BlueShield of Illinois to UHC where possible. Previously approved PAs will be honored by UHC through the original approval date or 12 months, whichever is less. One will need to follow the UHC prior authorization process and criteria once the BlueCross BlueShield of Illinois authorization expires. Prior authorization is not a guarantee of coverage under BlueCross BlueShield of Illinois or UHC. You should contact UHC at 833-314-1787  for PPO and HSA plans and 855-828-7715 for the HMO plan to discuss your specific circumstances. 

We recognize that for community members going through ongoing treatments, an insurance change can be especially disruptive. More information on timeframes will be forthcoming on prior authorizations for those receiving ongoing care.

For those receiving ongoing care from a provider that is in-network with BCBSIL but will be out-of-network with UHC, transition of care allows new UHC members to temporarily continue seeing an out-of-network provider at in-network rates for certain medical conditions while they transition to an in-network provider. We suggest that faculty and staff contact the UHC NU-dedicated 800 number 833-314-1787 for PPO and HSA plans and 855-828-7715 for the HMO plan to start the process as soon as possible.

If you are enrolled in the HMO plan, you must change to an in-network provider.  For those enrolled in the PPO plans, you have coverage when you see an out-of-network provider.  Your level of coverage will be reduced when services are provided by an out-of-network provider due to higher coinsurance, out-of-pocket maximums, and deductibles.  You will receive the highest level of coverage at an in-network facility.

UHC has provided an online form in which you can nominate your out-of-network provider to be included with UHC.

We expect that some providers who are currently out-of-network will become in-network providers after the change; however, as we do today, we will provide an out-of-network coverage option under the plan for those who do not want to change providers. Please visit this site to search for your provider.

You may also use the UHC pre-enrollment website to nominate an out-of-network provider to join UHC's network.

• Costco Pharmacies
• CVS
• Health Mart Atlas
• Jewel-Osco / Albertsons / Safeway
• Kroger
• Meijer Pharmacy
• Rite Aid
• Sam's Club
• Walgreens
• Walmart

The prescription drug plan has the same formulary of covered drugs regardless of which medical plan you elect.  How much you pay for prescription drugs is based on which medical plan you elect.  See the prescription drug website for information on coverage.

You may review drugs and how they will be covered online by medical plan. You may also call CVS Caremark directly 833-844-5348 to verify coverage.

You may use CVS Caremark's online pharmacy locator or call 833-844-5348 to find an in-network pharmacy near you.

For those taking prescription drugs not included on the formulary, covered faculty and staff member will receive a communication prior to January 1, 2026 from CVS Caremark about next steps. You should contact CVS Caremark directly at 833-844-5348 to request a medical necessity exception.

Northwestern will map over prior authorization approvals from ExpressScripts to CVS Caremark where possible. Previously approved PAs will be honored by CVS Caremark through the original approval date or 6 months, whichever is less. One will need to follow the CVS Caremark prior authorization process and criteria once the ExpressScripts authorization expires. Prior authorization is not a guarantee of coverage under ExpressScripts or CVS Caremark. 

For questions about the PA process, contact CVS Caremark directly at (833) 844-5348.

Delta Dental offers more PPO dentists in-network than our current dental insurance provider. Faculty and staff can verify that their dentists are in-network by doing one of the following: 

• Use Delta’s online provider finder.
• Contact your dentist’s office and ask if they are in-network for Delta's PPO network. 
• Call Delta at 800-323-1743 and ask if your dental provider(s) are in-network for Delta's PPO network.

There are no changes to orthodontics coverage due to the change to Delta Dental as plan administer for the PPO dental plan. The plan will cover 50% of eligible costs, based on whether or not the provider is in- or out-of-network, to a lifetime benefit of $3,000 per eligible dependent. The lifetime benefit is inclusive of what the plan has paid regardless of whether it was paid by BCBSIL or Delta Dental. For example, in 2025, BCBSIL paid $1,500 towards the cost of dependent child orthodontics. When the plan changes administrators, Delta Dental will credit what the plan has already paid of the lifetime maximum and will continue to process orthodontics claims until the remaining $1,500 is met or treatment ends, whichever comes first. Note, it is important to remind your providers that your coverage is changing 1/1/2026 and provide them with an updated Delta Dental insurance card when you receive it in December 2025.

The impact will be on non-credit courses billed through CAESAR that do not earn credit hours toward an undergraduate or graduate degree. They are typically the professional development certificates provided by the School of Professional Studies.

These courses are non-credit courses offered by Northwestern but not billed through CAESAR. They typically include Kellogg Executive Education Certificates, Summer Writers Conference with SPS, and Executive Learning & Organizational Change with SESP; please note this is not an exhaustive list. Certificate programs and professional development certificates provided by School of Professional Studies will remain covered under the Employee Reduced benefit with an annual benefits cap of $5,250.

We will update the Northwestern Programs website closer to January 2026 with changes.

Classes that begin before the Winter 2026 term will follow the terms of the current benefit. 

Classes that start during the Winter 2026 term or after will follow the updated terms of the benefit.

The decision support tool utilizes your salary tier for medical and life insurance, as well as your appointment type, to help you make a more informed decision on benefits elections.  For a more tailored recommendation, you may complete an optional survey that explores your health, wellness, finances and future plans.  Keep in mind the survey is optional.

Personal information is stored in secure operating environments unavailable to the public. The vendor has technical, administrative, and physical security measures in place designed to protect users’ personal information from unauthorized access and improper use.

Each user’s answers are used to personalize their recommendations to facilitate enhanced decision-making. The vendor will not sell, rent, license, or lease personally identifiable user data to any outside third parties.

The use of this tool is of course optional.

Only you can see your Upwise Decision Support Tool.

Upwise Decision Support Tool is available only to Northwestern faculty and staff in a with an FTE of 0.50 or greater. Due to the complicated appointment structures and unique benefit packages, there are a few groups of employees who cannot utilize the decision support tool.  These include Postdoctoral Fellows and employees on the Qatar campus. It was never the intention to purposely exclude these groups, but the nature of these appointments and employment types could not be incorporated into the tool.

• Eligibility rules for employee and dependent coverage
• Life insurance
• Dental HMO plan
• Vision insurance
• Long-term Disability
• Spending account vendor