Health and Welfare Benefits (Faculty Only)
Using Your Health and Welfare Benefits
The Pennsylvania Faculty Health and Welfare Fund administers seven (7) different benefit programs, which may not
be a part of your health plan. The Fund is administered by ACA, Inc. The Fund was established through money
negotiated in the collective bargaining process.
The following is a brief, step-by-step explanation of how to use your APSCUF Health and Welfare (H&W) benefits.
This summary in no fashion replaces the most up-to-date version of the Program of Health and Welfare Benefits and
announcements which can be viewed and downloaded from the Fund’s website at www.pafac.com. PLEASE DO
NOT PROVIDE ANY OF THE FEE SCHEDULES TO YOUR MEDICAL PROVIDERS.
All PA Faculty Health and Welfare information can be viewed 24/7 at www.apscuf.org or www.pafac.com.
Completing a BENEFIT ENROLLMENT CARD is the first step in qualifying for the Dental, Vision, Hearing Exam/Aid,
Mammogram, Wellness, Immunizations (member only) and Educational Leave Without Pay Programs. You may
obtain your enrollment card from your campus APSCUF office or APSCUF Health and Welfare Specialist.
Eligible faculty members include all PERMANENT OR TEMPORARY FULL-TIME FACULTY. Part-time faculty
members are now eligible for certain preventative benefits provided under the Fund.
Eligible dependents include spouse, same-sex domestic partners and any unmarried children (up until the day before
their 19th birthday). If your child(ren) is/are single, full-time student(s) and dependent upon your support, they are
eligible for Fund benefits up until the day before their 25th birthday. If a child has been medically deemed unable to
support him or herself prior to the day before the 19th birthday, Fund benefits will continue contingent on
documentation of the circumstances.
Go to www.pafac.com for eligibility requirements for other dependents such as legal guardian and same-sex
domestic partnership. If both parents are Faculty Members, dependents may only be listed as such on ONE
FACULTY MEMBER'S enrollment card (not both).
IMMUNIZATIONS FOR THE FACULTY PLAN – The faculty only are eligible for annual reimbursement up to
$300.00 for immunizations beginning January 1, 2007. The benefit includes, but is not limited to, foreign travel,
influenza, PPV (pneumonia), MMR (measles/mumps/rubella), tetanus, VZV (chicken pox) and hepatitis A & B
immunizations. The Fund will reimburse up to $30.00 for influenza and up to $45.00 for PPV immunizations.
This Fund benefit is available for the reimbursement of expenses not covered under faculty members’ basic
health care plans. Immunizations covered by PASSHE health plans may not be submitted to the Fund for
reimbursement. The Fund’s benefits should not be considered a substitute for the health plan benefits
provided by the PASSHE.
WELLNESS EXAMINATIONS AND RELATED TESTS PLAN – Faculty and their spouses only are eligible for
annual reimbursement up to $225.00 for out-of-pocket expenses incurred for physician examinations and related
diagnostic tests beginning January 1, 2007. The Fund will reimburse up to $125.00 for physician examinations. In
addition, the Fund will reimburse up to $100.00 for diagnostic tests including, but not limited to, glucose, lipid, pap,
Chlamydia, bone-density, prostate, colorectal, and mammogram tests.
The Fund will not reimburse medical/surgical health plan deductibles and/or co-pays faculty and spouses
may be required to pay. The Fund’s benefit coverage is limited to services not otherwise covered by faculty
and spouses’ basic health care plans.
Hearing Examination and Aid
The Fund will reimburse up to $120.00 once each calendar year for a hearing examination from a physician with a
specialty in otolaryngology or an audiometric specialist. The Fund will reimburse $1000 per appliance per ear. You
may be eligible for this benefit once every 3 years IF a physician or audiometric specialist recommends an aid. To
receive reimbursement, return completed claim form to the Fund office with the itemized bill(s). The bill(s) must
include a description of the examination and/or the hearing appliance, the amount(s) charged for the examination
and/or hearing aid appliance, the name of the person requiring the appliance and the doctor's certification.
Schedule the appointment for you and/or your family with a dentist of your choice. Provide for your dentist a separate
form for each family member receiving services. Have the regular and normal examination and services completed.
Payment may be assigned to the dentist or yourself. Please sign the dental form appropriately. No matter what
method of reimbursement is chosen, the patient/member and dentist signatures must appear on the claim form for
If the dentist is contemplating dental work which exceeds $500.00, the services must be pre-certified by the Fund to
ensure reimbursement. The dental claim form is used as the pre-certification form.
For eligibility rules, fee schedules and claim forms go to www.pafac.com.
The eligibility rules and fee schedules are located under Class IV Services (Dental Benefits) in your Program of
Health and Welfare Benefits Handbook. It is important to have your orthodontist follow the schedule. The lifetime
maximum per family member under the orthodontia services is $3,000.00. To obtain the remainder of the lifetime
maximum, the faculty member must provide the Fund with documentation that shows the patient is in retention and
the total bill has been paid.
The eligibility rules, fee schedules and claim forms are located at www.pafac.com. Schedule an appointment for you
and/or your family members with a professional eye care specialist of your choice. Provide the professional eye care
specialist with a separate claim form for each family member receiving eye care services. Pay for the eye care
services directly. Vision reimbursements cannot be assigned to the provider. Complete the claim form and attach all
necessary receipts and forward it to the Fund for reimbursement. The patient/member and the professional provider
must sign the vision form. For traumatic eye care, please go to pafac.com.
Educational Leave Without Pay Benefits Plan
This plan is designed to assist those eligible faculty members who have elected, and have been approved by the
university president, to go on an educational leave without pay. The faculty member must write a letter to the Fund
stating the term of leave and eligible dependent(s) information. Accompanying this communication must be the letter
received from the university president approving the educational leave. The Fund will provide H&W benefits and
reimburse the COBRASERV and group life insurance premiums. SEPARATELY, the faculty member must apply and
pay for benefits under COBRASERV for Highmark Blue Shield. Please go to pafac.com for more details.
Part-time Faculty Benefits
Part-time faculty who are employed at least 25% of full-time are eligible for the preventative care benefit package as
long as they have satisfied the eligibility criteria of working one (1) semester in the preceding three (3) semesters at
least 25% of full-time. The initial waiting period need only be satisfied once as long as the faculty member works at
least one semester each academic year. Part-time faculty members who are employed for at least 25% to 49% of full-
time are eligible for employee only benefits. Those faculty employed at least 50% to 99% of full-time have employee
and lawful spouse benefits. Preventive benefits covered under this program are vision, wellness, mammography, and
dental examinations (includes cleanings and x-rays). This summary in no fashion replaces the most up-to-date
version of the Part-Time Program of Health and Welfare Benefits and announcements which can be viewed and
downloaded from the Fund’s website at www.pafac.com. PLEASE DO NOT PROVIDE ANY OF THE FEE
SCHEDULES TO YOUR MEDICAL PROVIDERS. This benefit became effective January 1, 1994.
Continuation of Benefits Upon Termination
This program is mandatory under federal law. The government made available continuation of group benefits at
102% of the employer contribution under such circumstances as death, age limitation for eligibility; divorces and
terminations. Faculty members/dependents must pay the stated premium directly to the Fund to retain benefits.
Please go to pafac.com for more details.
Coordination of Benefits
Any faculty member who has a spouse that is employed and covered another group health insurance plan MUST
coordinate both insurance plans for reimbursement. Please go to www.pafac.com for more details on this and the
new policy on subrogation.
All claims forms for the PA Faculty Health and Welfare Fund can be obtained from the local APSCUF office or your
local Health and Welfare Specialist. If you have questions and/or problems, please contact your local Health and
Welfare Specialist. *Before sending any information/documentation to anyone, make copies of all materials
Local APSCUF’s Health & Welfare Specialists - listed below:
These people serve APSCUF members voluntarily. Be sure to thank them for their time and effort on your behalf.