What you need to know about insurance at UC Berkeley

Transcription

1 What you need to know about insurance at UC Berkeley

2 Insurance at UC Berkeley All UC Students are: Required to have major medical health insurance Automa9cally enrolled in SHIP when registered Able to reverse waiver if their current coverage is lost Able to maintain dual coverage Able to waive out of the plan through an online waiver SAVE THE DATE: Spring Waiver Deadline Jan. 10, 2015 Spring Waiver Period: Dec. 1-Jan. 10, late waiver until Feb 5 with $50 late fee. July 15 regular annual waiver deadline.

3 New Waiver Criteria New, streamlined SHIP waiver criteria for Spring Please follow instruc9ons or check our webpage for more details.

4 Administration Medical and mental health plan through Aetna Student Health (ASH) Dental plan through MetLife Vision plan through Vision Service Plan (VSP) Dental & vision plans cannot be purchased separately Student Health

5 Premiums for SHIP is a comprehensive plan that covers medical, mental health, dental and vision services Fall Semester: August 15 thru January 14 Spring Semester: January 15 thru August 14 $1095 per semester/$2190 per academic year

6 Aetna Web + Mobile App

7 Great Plan Benefits 90% Co- Insurance 100% coverage for adult preventa9ve services Generic Prescrip9on copay $5 No maximum visit limits on counseling when referred outside the Tang Center 100% coverage for most immuniza9ons (per policy) In- Network medical and mental health office visits, emergency room and urgent care visits are covered with a co- pay

8 Referrals University Health Services manages the medical and mental health care of registered students with SHIP Except for emergency or urgent care, referrals are required for ALL services received outside the Tang Center

9 Benefits Overview $200 Deduc9ble per plan year (some services outside UHS) Co Payments (in- network rates) $15 co- pay primary care and specialty care visit $100 co- pay Emergency room visit Facility and Professional Services : Plan pays 100% 90% co- insurance other charges $50 Co- pay Urgent Care visit outside of the Tang Center $30 Co- pay for each Urgent Care visit at the Tang Center

10 Benefits Overview 10% Co Insurance 40% Out of network (based on the maximum allowed rate) Out of Pocket Maximum for in network providers $3200 Out of network $6500 per plan year No Life9me Maximum

11 Benefits Overview Prescrip9ons Prescrip9ons are conveniently located at the Tang Center Pharmacy or from an in- network pharmacy when away from Berkeley $5 per generic prescrip9ons $25 per brand prescrip9ons $40 non- formulary prescrip9ons

12 Examples of fees at Tang Services rendered: Office visit, Blood test and X- ray Non SHIP Student Service SHIP Student $15.00 Office Visit $15.00 $17.00 Blood Test $1.70 (10% co ins) $54.00 Chest X- Ray $5.40 (10% co ins) $86.00 $22.10

13 Mental Health Care Students can see mental health care providers in the Tang Center and the first 5 visits are free of charge CPS provides short- term counseling on campus (up to 8 sessions), then we work with students to find the with perfect fit with a community provider for long- term counseling/ psychiatric needs SHIP students pay a $15 co- pay for in- network visits Non- SHIP students can also obtain referrals to outside mental health providers but need to check with their own insurance regarding coverage

14 MetLife Dental MetLife Network more than 100 denjsts within 5 miles of campus Covers up to $1,000 per academic plan year PreventaJve & DiagnosJc Services (100% of nego9ated fees, no deduc9ble) Oral exams, cleanings, fluoride treatment - 2 per plan year X- ray Bitewing (once each year) X- ray Full mouth (once every 5 years) Basic Services (80% of nego9ated fees aier $25 annual deduc9ble) Fillings & extrac9ons Endodon9cs (root canal), Periodon9cs & Oral Surgery Major Services (Pays 70% of nego9ated fees aier $25 annual deduc9ble) Prosthodon9cs, In- Lays/On- Lays, crowns & cast restora9ons

15 Vision Service Plan (VSP) Eye exam $10 co- pay, once every 12 months Frames and lenses OR contact lenses $25 co- payment (only for frames + lenses), once every 12 months, up to a $120 Lens discounts Lasik or PRK Refrac9ve surgeries 15% discount

16 UC Berkeley School of Optometry Two loca9ons on campus, both take Vision Service Plan (VSP) Minor Hall LocaJon Tang Center LocaJon

17 Out of Area Coverage An authoriza9on MUST be obtained through the Student Health Insurance Office PRIOR to receiving services while away from campus (except in emergency or urgent care situa9ons) While away from campus (outside the Bay Area) Call the Student Health Insurance Office for a primary care referral Primary care physician can request referral for specialty services Students can use the Find A Doctor search op9on on the Aetna Student Health Website Claims should be billed to Aetna s local claims department where care was provided

18 Out of Area Coverage While out of the country (Interna9onal Claims) Students would pay for services in the country they are visi9ng and then submit receipts for reimbursement directly to Aetna Student Health Interna9onal reimbursement is usually covered at out of network rates Addi9onal benefits provided through Aetna s On Call Interna9onal program

19 Miscellaneous Advice Nurse Available during UHS regular business hours Staffed by UHS Registered Nurses 24/7 Nurseline available to SHIP students Staffed by Registered Nurses. Urgent & cri9cal care calls are followed closely by nurse line staff and details are provided to Tang Center clinicians. Send secure messages to insurance office via etang

20 Miscellaneous Dual coverage? Yes! SHIP is primary when used in the Tang Center, we do not bill any other insurances outside of SHIP even as a secondary SHIP is secondary to your coverage when used with providers outside the Tang Center. A referral from the Student Health Insurance Office is s9ll required to receive secondary coverage. ID Cards and Eligibility Easy electronic card online any9me

21 Waiving SHIP? Spring 2015 Online Waiver LATE Deadline is January 10 Review waiver criteria carefully Tang Jp: complete the worksheet prior to waiving! New waiver requirements for Spring 2015 Must be completed each academic year Need help deciding? NEW! Insurance Advocate service to assist: or

22 Waiving SHIP? Spring 2015 Online Waiver LATE Deadline is January 10 All registered students can use the Tang Center, regardless of insurance The Tang Center does not accept outside insurance, or submit bills to outside insurance plans. We are considered out- of- network for other plans, including other Aetna plans. Students without SHIP s9ll benefit from the standard co- pays at Tang ($15 Primary Care & Specialty, $30 Urgent Care, 5 free counseling visits) but pay 100% for all other services. Students must work with their own insurance plan on how and if they will be reimbursed.

23 Waiving SHIP? Make sure your student establishes local providers! Tang Tip from our medical staff Please ensure your student understands your insurance plan benefits, costs, and how to access care. One insurance waiver requirement is ensure that your student has a local primary care provider and hospital within 30 minutes of campus. It s important to proac9vely ensure that you establish care with those local providers, taking extra cau9on if you have an HMO.

24 Thank you! Student Insurance Helpline: or