The Cooper Union. Student Health Insurance Plan Underwritten by Tufts Insurance Company. SP Form number:

Transcription

1 The Cooper Union Student Health Insurance Plan Underwritten by Tufts Insurance Company. SP Form number:

2 Health and Counseling: The Office of Student Affairs maintains partnerships with local providers for counseling, mental health and related supportive services. Questions about counseling and mental health services should be addressed to Chris Chamberlin, Dean of Students, at or at edu. On-Site Counseling Our on-site and near-site free counseling is designed to provide students with an opportunity to talk with a counselor and for a counselor to assess their needs. If a student needs continued care, they will be referred to a local off-campus agency, equipped to provide that care. Our counselors will generally meet with a student for 1 or 2 sessions and then provide appropriate referral information. On-site and near-site counseling sessions are free of charge for all Cooper Union students. Anyone interested in an appointment with one of our counselors should the Office of Student Affairs at cusa@cooper.edu, or call the Office of Student Affairs at Nearest Emergency Rooms to Cooper Union: Beth Israel Medical Center First Avenue and 16th Street Bellevue Hospital First Avenue and 27th Street For non-emergency referrals, you may call (877) for assistance. Identify yourself and as a Cooper Union Student and have your Insurance Card ready. Did you know? The cost of the Student Health Insurance Plan may be less expensive than coverage as a dependent under your Parent s Plan. Useful contact info: Christie Student Health Customer Care: USI Affinity Collegiate Insurance Resources: CVS Health (Prescription Drug Information): Hour Nurse Line: Europ Assistance: Mail claims to: Cigna PO Box Chattanooga, TN Search for a provider: *This plan is underwritten by Tufts Insurance Company (TIC), and administered by Christie Student Health Plans LLC (CSHP). Christie Student Health is the brand name for the student health products and services provided by TIC and CSHP. 1

3 Top 5 Things You Need to Know #1 The Student Health Insurance Plan provides coverage for basic care and prescription drugs which includes, but is not limited to the following: Primary Care Care for many specialists Urgent Care Mental and behavioral health care/counseling Lab testing and screenings #2 The Student Health PPO Plan provides nationwide coverage with access to over 840,000 providers and 6,000 hospitals. #3 Your Student Health PPO Plan also includes worldwide travel assistance. For more details, visit: #4 Domestic and international students are automatically enrolled in and billed for the Student Health Insurance Plan. Students who have comparable health insurance can elect to waive the Student Health Insurance Plan. #5 Once registered, you can access all of the tools the Student Portal has to offer, including accessing a copy of your ID card. This way, if necessary, you can go see a doctor or fill a prescription. Online Tools Our Student Portal provides students with one central location for all of your student health insurance needs, including getting a copy of your ID card, viewing claims, searching for a provider or hospital and viewing eligibility details and benefit documents. 2

4 Are you eligible? All matriculated students, while enrolled at The Cooper Union for the Advancement of Science and Art, are eligible for coverage under the Plan. Domestic students will be automatically enrolled in and charged premium for coverage under the Student Health Insurance Plan ( the Plan ) unless they are currently insured under a comparable health insurance plan. Domestic students who are currently insured under a comparable health insurance plan may waive coverage under the Plan by completing the online Student Insurance waiver process. The premium for coverage under the Plan is added to the student s tuition bill and will remain unless a successful waiver is completed by the applicable waiver deadline. International students will be automatically enrolled in and charged premium for coverage under the Plan. International students may not waive coverage. Dependent Coverage Insured students who are enrolled in the Student Health Insurance Plan may also enroll their eligible dependents. Eligible dependents under the plan include the person s spouse or domestic partner and dependent children under age twenty-six (26). Dependent eligibility expires concurrently with that of the insured student. Enrollment and Waiver Details Did you know? Medical Evacuation could cost $10,000 or more and is an included benefit in the Health Insurance Plan. Eligible Domestic students are automatically enrolled in and billed for the Student Health Insurance Plan. Students who have comparable health insurance can elect to waive the Student Health Insurance Plan. International students will be automatically enrolled in and charged premium for coverage under the Plan. International students may not waive coverage. To provide proof of comparable coverage, an online waiver form must be completed and submitted by September 30, To waive the Student Health Insurance Plan, visit Waiver Deadline The deadline for students to complete the waiver form for annual coverage is September 30, Students who waive the Student Health Insurance Plan in the fall, waive coverage for the entire Policy Year. New students enrolling in the spring/summer semesters may waive coverage for those semesters. The deadline for students to complete the waiver form for spring/summer semester coverage is February 15, Students who do not submit an online waiver form by the deadline will be enrolled in and billed for the Student Health Insurance Plan. Cooper Union reserves the right to audit and subsequently reject a waiver request. If it is determined that a student waived coverage with a health insurance plan that was not comparable coverage, the student will be automatically enrolled in the Student Health Insurance Plan. 3

5 What the Cooper Union Student Health Insurance Plan offers: The Cooper Union Health Insurance Plan is a fully insured student health insurance plan underwritten by Tufts Insurance Company ( TIC ) and administered by Christie Student Health. Your Plan is a Preferred Provider Organization or PPO Plan. It provides you with a higher level of coverage when you receive covered medical expenses from physicians who are part of the Plan s network referred to as Participating Providers. The participating providers participate in the Cigna network outside of MA and RI, and in the Tufts Health Plan network in MA and RI. The Plan also provides coverage when you obtain Covered Medical Expenses from Physicians who are not part of the Plan s network, referred to as Non-Participating Providers. Did you know? The Student Health Insurance Plan includes worldwide travel assistance. The Premium Rates and the list of Covered Services are illustrated in the tables below. Please contact our Customer Care Representatives with any questions you may have about the Plan at Rates: Annual 08/15/16 08/14/17 Fall 08/15/16 12/31/16 Spring 01/1/17 08/14/17 Student $1,520 $579 $941 Spouse/ Domestic Partner Per Child $1,520 $1,520 $579 $941 $579 $941 Effective Dates: All Students Effective Date Termination Date Annual 08/15/16 08/14/17 Fall 08/15/16 12/31/16 Spring 01/01/17 08/14/17 4

6 Covered Services: Metallic Level: Platinum / Tested at: 90.19% Annual Deductible Out of Pocket Maximum Plan Maximum Participating Provider: $50 per member; $100 Family Non-Participating Provider: $100 per member; $200 Family Participating Provider: $5,000 per member; $10,000 Family Non-Participating Provider: $6,850 per member; $13,700 Family Unlimited Benefit type Inpatient Hospital Expense (Including Intensive Care Unit) Inpatient Miscellaneous Expense Inpatient Physician or RN Visit Expense Surgical Expense (Inpatient and Outpatient) Anesthesia Expense (Inpatient and Outpatient) Assistant Surgeon Expense (Inpatient and Outpatient) Emergency Room Expense Ambulance Service Expense Physician Office Visit Expense Specialist Office Visit Expense Urgent Care Expense Diagnostic Labs Diagnostic Radiology Physical, Occupational and Speech Therapy Expense Chiropractic Therapy Expense Durable Medical Equipment Expense Routine Pap Smears Expense Mammogram Expense Immunizations Expense Includes travel immunizations Participating Provider Member Responsibility, $50 copay then 10% of allowed amount after $50 copay then 10% of allowed amount after $50 copay then 10% of allowed amount after $50 copay then 10% of allowed amount after Non-Participating Provider Member Responsibility 10% of reasonable charges after 10% of reasonable charges after 10% of reasonable charges after $50 copay then 40% of reasonable charges after $50 copay the 40% of reasonable charges after $50 copay then 40% of reasonable charges after $50 copay then 40% of reasonable charges after 5

7 Covered Services Continued: Benefit Type Routine Physical Exams Expense Routine Colorectal Cancer Screening Expense Routine Prostate Cancer Screening Inpatient Mental Health Care Inpatient Substance Abuse Outpatient Substance Abuse Maternity Expense (including complications of pregnancy) Prescription Drug Expense Diabetic Treatment and Supplies Expense Outpatient Diabetic Self-Management Education Program Expense Hospice Expense Home Healthcare Expense Skilled Nursing Facility Expense Rehabilitation Facility Expense Pediatric Vision Care Expense Exam Pediatric Dental Care Expense Routine/Preventative Care Pediatric Dental Care Expense Major Pediatric Medically Necessary Orthodontia Participating Provider Member Responsibility following: $10 copay for generic; $25 copay for brand name 40% of allowed amount after 40% of allowed amount after Non-Participating Provider Member Responsibility following; $10 copay for generic $25 copay for brand name 10% of reasonable charges after 10% of reasonable charges after 6

8 Commonly Used terms: Claim: A request for payment that is submitted to your health insurance company for services received. Co-insurance: Your share of the costs of covered health care services calculated as a percent (for example, 20%) of the allowed amount for the service. Copayment (copay): The fixed amount you pay for a certain covered health care services, paid at the time of service. Deductible: The amount you pay for Covered Services before any payments will be made by your insurance company. Eligibility: Terms of an insurance policy that define the requirements to become a member on the insurance plan. Exclusions: Expenses for which the plan does not cover nor provide benefits for. In-Network: Refers to a provider or facility that has a contract with your health insurance company or plan to provide services to you at a discount. Inpatient Care: Medical services provided after a patient is admitted to a facility such as a hospital. Out-of-Network: Refers to a provider or facility that does not have a contract with your health insurance company and therefore you may incur higher costs. Out-of-Pocket Maximum: The maximum amount that you pay during your plan s policy period before your health insurance company will pay 100% of the allowed amount. Negotiated Rate: An agreed upon amount between the insurance company and in-network providers and facilities for covered services. The Negotiated Rate is used to determine the allowed amount. Premium: The amount you pay to purchase your health insurance plan. Primary Care Physician (PCP): A general or family practitioner who provides and manages your care and refers you to specialists. Reasonable Charge: The lesser of the amount charged by the Non-Network Provider; or the amount paid for a medical service in a geographic area based on nationally accepted means and amounts of claims payment. The Reasonable Charge amount is used to determine the allowed amount. Waiver: Showing proof of adequate health care coverage in order to opt-out of the student health plan. Exclusions: No Coverage is available under this Certificate for the following: Aviation. We do not Cover services arising out of aviation, other than as a fare-paying passenger on a scheduled or charter flight operated by a scheduled airline. Convalescent and Custodial Care. We do not Cover services related to rest cures, custodial care and transportation. Custodial care means help in transferring, eating, dressing, bathing, toileting and other such related activities. Custodial care does not include Covered services determined to be Medically Necessary. Cosmetic Services. We do not Cover cosmetic services, Prescription Drugs, or surgery except that cosmetic surgery shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly of a covered Child which has resulted in a functional defect. We also Cover services in connection with reconstructive surgery following a mastectomy, as provided elsewhere in this Certificate. Cosmetic surgery does not include surgery determined to be Medically Necessary. If a claim for a procedure listed in 11 NYCRR 56 (for example, certain plastic surgery and dermatology procedures) is submitted retrospectively and without medical information, any denial will not be subject to the Utilization Review process as referred to in your Certificate. 7

9 Exclusions Continued: Dental Services. We do not Cover dental services except for: care or treatment due to accidental injury to sound natural teeth within 12 months of the accident; dental care or treatment necessary due to congenital disease or anomaly; or dental care or treatment specifically stated in the oral surgery or pediatric dental care section of this Certificate. Experimental or Investigational Treatment. We do not Cover any health care service, procedure, treatment, device, or Prescription Drug that is experimental or investigational. However, We will Cover experimental or investigational treatments, including treatment for Your rare disease or patient costs for Your participation in a clinical trial, when Our denial of services is overturned by an External Appeal Agent certified by the State. However, for clinical trials We will not Cover the costs of any investigational drugs or devices, non-health services required for You to receive the treatment, the costs of managing the research, or costs that would not be Covered under this[policy, Contract, Certificate] for non-investigational treatments. See your Certificate for a further explanation of Your Appeal rights. Foot Care. We do not Cover foot care, in connection with corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet, except as specifically listed in your Certificate. However, we will Cover foot care when You have a specific medical condition or disease resulting in circulatory deficits or areas of decreased sensation in Your legs or feet. Government Facility. We do not Cover care or treatment provided in a Hospital that is owned or operated by any federal, state or other governmental entity, except as otherwise required by law. Medically Necessary. In general, We will not Cover any health care service, procedure, treatment, device or Prescription Drug that We determine is not Medically Necessary. If an External Appeal Agent certified by the State overturns Our denial, however, We will Cover the procedure, treatment, service, or Prescription Drug for which Coverage has been denied, to the extent that such procedure, treatment, service, or Prescription Drug is otherwise Covered under the terms of your Certificate. Medicare or Other Governmental Program. We do not Cover services if benefits are provided for such services under the federal Medicare program or other governmental program (except Medicaid). Military Service. We do not Cover an illness, treatment or medical condition due to service in the Armed Forces or auxiliary units. No-Fault Automobile Insurance. We do not Cover any benefits to the extent provided for any loss or portion thereof for which mandatory automobile no-fault benefits are recovered or recoverable. This exclusion applies even if You do not make a proper or timely claim for the benefits available to You under a mandatory no-fault policy. Services Separately Billed by Hospital Employees. We do not Cover services rendered and separately billed by employees of Hospitals, laboratories or other institutions. Services Provided by a Family Member. We do not Cover services performed by a member of the Covered person s immediate family. Immediate family shall mean a child, spouse, mother, father, sister, or brother of You or Your spouse. Services With No Charge. We do not Cover services for which no charge is normally made. Services Not Listed. We do not Cover services that are not listed in your Certificate as being Covered. Vision Services. We do not Cover the examination or fitting of eyeglasses or contact lenses, except as specifically stated in the [Pediatric, Routine] Vision Care section of your Certificate. Workers Compensation. We do not Cover services if benefits for such services are provided under any state or federal Workers Compensation, employers liability or occupational disease law. 8

10 Your plan also includes: 24 Hour Nurse Help Line Nurse24 will provide participants with immediate and reliable health advice and information. Registered nurses are available 24 hours a day, 7 days a week to answer any health questions. Worldwide Assistance This plan includes worldwide travel assistance through Europ Assistance. Whether you are studying abroad or traveling on vacation, you can have the comfort of knowing that help is only a phone call away. Member Perks: Dietary & Nutritional Supplement Discounts You can save 15% or more off of the manufacturers suggested retail price on a wide variety of vitamins, supplements and popular energy and protein bars through ChooseHealthy.com Discount on Glasses & Eye Care You are eligible for discounts on vision correction services and eyewear from participating EyeMed providers. Fitness Rebate You may be eligible for a rebate for the cost of 4 months of fitness club fees for using a qualified fitness club. Discounts at Jenny Craig When you re ready to lose weight, Jenny Craig makes it simple. 50% off Jenny Crag All Access Enrollment plus 5% off All Jenny Craig Food.* *50% discount on $99 enrollment fee. Plus the cost of food. Plus the cost of shipping if applicable. Member is responsible for all payments for the Jenny Craig Program. Careington Dental Discounts Program The Careington dental discounts program is available to you and your eligible dependents on a voluntary basis to provide access to quality dental care at reduced rates. Save 20% to 50% on most dental procedures including routine oral exams, unlimited cleanings and major work such as dentures, root canals and crowns at over 200,000 dental access points through Careington and DenteMax. To enroll in the Careington Dental Discounts Program, please visit christiestudenthealth.com/cooperunion. If you have questions regarding the program, please call Careington Dental Customer Service at (800)