HEALTH INSURANCE PLAN

Transcription

1 SERVICES AT THE HEALTH CENTER AT AURARIA AND THE MSU DENVER STUDENT HEALTH INSURANCE PLAN

2 TABLE OF CONTENTS Introductory Letter Services at the Health Center at Auraria Health and Wellness Programs Student Health Insurance Plan Student Eligibility Late Enrollment University Health Insurance Policy Confirmation of Coverage for Services Outside The Health Center at Auraria UnitedHealthcare Global: Global Emergency Services Important Contact Information Health Center at Auraria Claims Procedures Claims, Eligibility and Benefits Questions Preferred Provider Organizations Health Care Management Program

3 Dear MSU Denver Student: Metropolitan State University of Denver, while primarily concerned with educational pursuits, is aware of the varied needs of its urban student population, one of which is in compliance with the Federal Government s health insurance requirement for all citizens of the United States. To meet these needs, MSU Denver offers a comprehensive Affordable Care Act (ACA) compliant Student Health Insurance Plan. This plan offers students a high quality insurance program, with excellent benefits at a great price, when compared to plans sold on the State Insurance Exchange. There are no plans offered on the State Insurance Exchange that include the highly beneficial Health Center at Auraria benefits that are included in the University sponsored plan. The plan consists of two important components: 1) the Student Injury and Sickness Insurance Plan, underwritten by United Healthcare Insurance Company, and 2) a separate plan with cost saving benefits at the Health Center at Auraria, which includes 100% coverage for covered benefits, no deductible and no co-insurance. Each year the University negotiates a high quality student health insurance plan that is offered exclusively to MSU Denver students. The University s primary goal has been to provide MSU Denver students with an economical health insurance product that includes outstanding benefits which will assist students in keeping their healthcare costs as low as possible. All of us at the Health Center at Auraria wish you academic success and good health during your higher education experience. We want you to know that we are here to meet your medical needs, if and when they arise, and look forward to serving you. SERVICES AT THE HEALTH CENTER AT AURARIA A portion of the student fees collected is retained by Metropolitan State University of Denver to provide certain benefits at the Health Center at Auraria. Accordingly, these benefits are not underwritten or provided by UnitedHealthcare Insurance Company under Policy # For Services Outside the Health Center at Auraria go to under Health Insurance, MSU Denver Insurance, Student Insurance Resources for a copy of the Policy Web Brochure offered through the UnitedHealthcare Insurance Company, Policy # Covered students are not required to submit claims for Health Center at Auraria expenses. Services at the Health Center at Auraria are available to all students regardless of their type of insurance coverage. INSURANCE PLAN Necessary eligible medical expenses incurred for Sickness or Injury will be reimbursed at 100% (following the appropriate prescription copay, if applicable) for care provided at Health Center at Auraria. This includes well care, supplies, in-house testing, X-rays, labs and procedures. In addition, there is no Annual Deductible and coinsurance for services performed at the Health Center at Auraria. No claim forms will be required. Please note that care at the Health Center is not always available due to hours of operation and staffing. Special Health Center at Auraria Benefits! 100% Reimbursement at the Health Center with NO Deductible or Coinsurance (except for Prescriptions). 100% Reimbursement at the Health Center at Auraria No Deductible No Copay No Co-Insurance No Claim Forms $20 Prescription Copays Sincerely, Steve Monaco, Director Health Center at Auraria Page 1 Page 2

4 SERVICES AT THE HEALTH CENTER AT AURARIA (CONT D) Please call ahead to the Health Center at Auraria (303) to determine appointment or walk-in availability. The services covered under this Schedule are not underwritten or provided by UnitedHealthcare Insurance Company. A portion of the school fees is retained by Metropolitan State University of Denver to provide the following benefits at the Health Center at Auraria. For Services Outside the Health Center at Auraria go to under Health Insurance, MSU Denver Insurance for a copy of the Policy Web Brochure offered through the UnitedHealthcare Insurance Company, Policy # SCHEDULE OF MEDICAL AND PRESCRIPTION BENEFITS FOR THE HEALTH CENTER AT AURARIA (HCA) ONLY Benefit Description Annual Deductible Pre-Existing Condition Limitations Preventative Health Services Primary Care/ Urgent Care X-ray Services/ Lab Services Outpatient Mental Health Prescriptions Cost No Deductible None 100% Covered 100% Covered 100% Covered 100% Covered $20 Rx Copay per Prescription per 30 day Supply Additional Limitations & Explanations Limitations may apply Limitations may apply Limitations may apply Limitations may apply Maintenance medications filled at the Health Center of Auraria may be filled up to a 90 day supply. A copay of $20 will apply per prescription up to a 30 day supply. A copay of $40 will apply per prescription for a day supply. A copay of $60 will apply per prescription for a day supply. For maintenance medications filled near the end of the semester, only a 30 day supply will be filled 30 days or less to the end of the semester and only a 60 day supply will be filled 60 to 30 days to the end of the semester. If it is over 60 days to the end of the semester a 90 day prescription can be filled. Contraceptives provided at the Health Center at Auraria have no copay. HEALTH AND WELLNESS PROGRAMS HEALTH EDUCATION The Health Center at Auraria is committed to improving the health knowledge, attitudes, skills and behaviors of the Auraria campus community. The purpose of health and wellness information is to positively influence the health choices of the Auraria Campus Community. The Health Education department offers a variety of educational opportunities throughout the school year including classroom presentations, events, and outreach tables. HEALTHY PURSUITS As part of the Healthy Pursuits program, the Health Center at Auraria offers Mind Body Fitness classes. The classes are free of charge and no registration is required. These classes aim to improve an individual s health and fitness through a connection from the inside and out while reducing tension and stress. Mind Body Fitness classes may include Pilates, Tai Chi, Yoga and Zumba. In addition to consistent weekly classes the program offers several workshops throughout the semester that deepen the understanding of the ongoing classes. The goal of the Mind Body Fitness Program is for the members of Auraria Campus to lead a healthier and less stressful lifestyle. LIGHT UP YOUR LIFE IN A NEW WAY The Light Up Your Life in a New Way program is a free tobacco cessation program available to all students, faculty and staff on Auraria campus. The program includes a customized quit plan, nicotine replacement therapy (NRT), clinical visits with a medical provider, and ongoing support. All of the therapies are free of charge. Please call, for more information. BE WELL AURARIA Be Well Auraria is a tri-institutional committee dedicated to promoting a campus environment of culturally inclusive, health and wellness practices through multi-dimensional action. This includes special events and workshops ranging from nutrition education to mindfulness. STUDENT HEALTH 101 Student Health 101 is an online e-magazine focusing on college health. Articles include eating well, staying active, boosting academics, managing money, tips for eating well and much more. There are tools to help you manage your stress and stories and videos from students. By reading Student Health 101 students will gain valuable information to support their academic success on campus and learn about on-campus events. Page 3 Page 4

5 STUDENT HEALTH INSURANCE PLAN This brochure is designed to acquaint students and other interested parties with the medical services available, cost of the plan and exclusions to the services offered. We ask that you read it carefully so that you will know the extent of medical services and insurance available to insured students. The insurance plan is entirely supported by student premiums, no tuition or State appropriations are used to pay for these services. The insurance becomes effective for a student as provided in the policy and explained in this booklet. The Plan Policy can be found at under Health Insurance, MSU Denver Insurance, Student Insurance Resources. The description in this brochure is generalized information. In all cases the Master Policy with UnitedHealthcare Insurance Company is the document that will prevail for services outside the Health Center at Auraria, in accordance with policy regulations of the State of Colorado. Claims should be submitted to AmeriBen at P.O. Box 7186, Boise, Idaho Correspondence concerning claims status, eligibility and benefits should be directed to AmeriBen at the above address or by calling , reference the School s Group # Page 5 STUDENT ELIGIBILITY Health Insurance Premiums Fall Semester 2015 (Mandatory if taking 9 or more credit hours) $1,110 Combined Spring/Summer Semesters 2016 (Mandatory if taking 9 or more credit hours) $1,552 Summer 2016 (Mandatory if taking 9 or more credit hours) Only for students beginning school during Summer term $667 Summer Semester Students starting school for the first time in the Summer semester can purchase Summer only coverage since they were not enrolled in the Spring semester. Graduating Students If an undergraduate or graduate student has less than 9 (nine) credit hours in the Fall, Spring, or Summer semesters, to graduate, the student can enroll in the insurance plan for their last semester at Metropolitan State University. The Metro State Student Insurance Office requires a written statement from the student s major department or their Academic Advisor confirming that the student has less than 9 (nine) hours to graduate and that the student will graduate at the end of this last semester. The student should contact the Metro Student Health Insurance Office at for further information. Refunds Refunds of premium are allowed only upon entry into the armed forces. LATE ENROLLMENT Eligible students will not be allowed to enroll in the plan after the applicable enrollment/waiver deadline unless proof is furnished that the eligible student became involuntarily ineligible for coverage under a group insurance policy during the 30 days immediately preceding the date of the request for late enrollment in the plan provided by Metropolitan State University of Denver. In such cases, LATE ENROLLMENT (CONT D) the cost will be the same as it would have been at the beginning of the enrollment period, but the effective date will be the date the student enrolls and makes the required premium payment. UNIVERSITY HEALTH INSURANCE POLICY All Students, undergraduate and graduate, taking nine (9) credit hours or more in the Fall or Spring/Summer semesters of attendance are required to either a) Participate in the University offered health insurance program or b) Submit proof of having outside health insurance that meets the University s compliance standards by submitting an electronic waiver compliance form by the waiver deadline for the current semester. Proof of outside health insurance must be submitted each semester a student is taking nine (9) credit hours or more. Students who enroll in nine or more credits after Fall or Spring census will not be considered eligible for the student health insurance. The University health insurance plan offered each Fall semester provides coverage for five (5) months and the Spring/Summer semester plan provides coverage for seven (7) months. Premium rates for Fall and Spring/Summer semesters vary according to the number of months included in each of the coverage periods. Upon registering for courses, students taking nine (9) or more credit hours will automatically be billed for the Student Health Insurance on their tuition bill and will automatically receive an to their University account that informs them of this charge. Students will automatically be enrolled in the University offered health insurance plan unless they submit an electronic waiver compliance form by the waiver deadline that documents that they have outside health insurance that meets the published compliance standards. All submitted outside health insurance information will be audited to ensure that the compliance standards are met. Students whose waivers are approved will then have the insurance charge removed from their tuition bill. Waivers will not be granted if the submitted outside insurance does not meet the compliance standards. In addition, waivers will not be granted for any waivers submitted after the waiver compliance deadline for the current semester. Period: Beginning: Through: Waiver Deadline: Fall 08/17/ /18/ /02/2015 Spring/Summer 01/19/ /21/ /04/2016 Summer 06/06/ /21/ /14/2016 Note that students who register for nine (9) or more credit hours, but subsequently drop below nine (9) credit hours before the waiver compliance deadline, will automatically have the insurance charge removed from their tuition bill and will not be covered by the University offered health insurance for the current semester. For additional details of this requirement, including the University s Outside Health Insurance Compliance Standards and services outside the Health Center at Auraria, go to under Health Insurance, MSU Denver Insurance, Student Insurance Resources. The Student Health Insurance office is located in the Plaza Building, Suite 149 and can be reached by calling , Monday through Thursday, 8:00 a.m. - 5:00 p.m. and Friday, 8:00 a.m. - 3:00 p.m. Page 6

6 CONFIRMATION OF COVERAGE FOR SERVICES OUTSIDE THE HEALTH CENTER AT AURARIA It is the student s responsibility to confirm whether or not a particular service is covered under the plan. This confirmation must be done with AmeriBen at Health Center at Auraria staff, including medical providers, are not adequately trained to provide confirmation of coverage for any services. Cofinity PPO Network: Metro has a specially-designed PPO network through Cofinity in the State of Colorado for services covered by the separate insurance plan offered by UnitedHealthcare, Policy # The following hospitals are in the Network: Aurora Children s Hospital Medical Center of Aurora North Campus Medical Center of Aurora South Campus Spalding Rehabilitation Hospital University of Colorado Hospital Boulder Boulder Community Foothills Hospital Boulder Community Hospital Brighton Platte Valley Hospital Centennial Denver South Valley Hope Denver Denver Health Exempla St. Joseph National Jewish Health Porter Adventist Hospital PSL Medical Center Rose Medical Center Englewood Craig Hospital Swedish Medical Center Littleton Littleton Adventist Hospital Lakewood St. Anthony Hospital Lone Tree Sky Ridge Medical Center Louisville Avista Adventist Hospital Parker Parker Adventist Hospital Thornton North Suburban Medical Center North Valley Rehabilitation Hospital Westminster St. Anthony Hospital North Wheat Ridge Exempla Lutheran Medical Center NOTE: This is not an all-inclusive list of hospitals. For a more complete list and verification of hospitals, facilities and physician providers in the PPO network visit or call For participating providers outside the State of Colorado visit or call First Health at UNITEDHEALTHCARE GLOBAL: GLOBAL EMERGENCY SERVICES If you are a member insured with this insurance plan, you are eligible for UnitedHealthcare Global Emergency Services. The requirements to receive these services are as follows: International students: you are eligible to receive UnitedHealthcare Global services worldwide, except in your home country. Domestic students: you are eligible for UnitedHealthcare Global services when 100 miles or more away from your campus address and 100 miles or more away from your permanent home address or while participating in a Study Abroad program. The Emergency Medical Evacuation services are not meant to be used in lieu of or replace local emergency services such as an ambulance requested through emergency 911 telephone assistance. All services must be arranged and provided by UnitedHealthcare Global; any services not arranged by UnitedHealthcare Global will not be considered for payment. If the condition is an emergency, you should go immediately to the nearest physician or hospital without delay and then contact the 24-hour Emergency Response Center. UnitedHealthcare Global will then take the appropriate action to assist you and monitor your care until the situation is resolved. Key Services include: Transfer of Insurance Information to Medical Providers Monitoring of Treatment Transfer of Medical Records Medication, Vaccine Worldwide Medical and Dental Referrals Dispatch of Doctors/Specialists Emergency Medical Evacuation Facilitation of Hospital Admittance up to $5, payment (when included with your enrollment in a UnitedHealthcare StudentResources health insurance policy) Transportation to Join a Hospitalized Participant Transportation After Stabilization Coordinate the replacement of Corrective Lenses and Medical Devices Emergency Travel Arrangements Hotel Arrangements for Convalescence Continuous Updates to Family and Home Physician Return of Dependent Children Replacement of Lost or Stolen Travel Documents Repatriation of Mortal Remains Worldwide Destination Intelligence Destination Profiles Legal Referral Transfer of Funds Message Transmittals Translation Services Security and Political Evacuation Services Natural Disaster Evacuation Services Please visit for the United- Healthcare Global brochure which includes service descriptions and program exclusions and limitations. Page 7 Page 8

7 UNITEDHEALTHCARE GLOBAL: GLOBAL EMERGENCY SERVICES (CONT D) To access services please call: (800) Toll-free within the United States 1 (410) Collect outside the United States Services are also accessible via at assistance@uhcglobal.com. When calling the UnitedHealthcare Global Operations Center, please be prepared to provide: 1. Caller s name, telephone and (if possible) fax number, and relationship to the patient; 2. Patient's name, age, sex, and UnitedHealthcare Global ID Number as listed on your Medical ID Card; 3. Description of the patient s condition; 4. Name, location, and telephone number of hospital, if applicable; 5. Name and telephone number of the attending physician; and 6. Information of where the physician can be immediately reached. UnitedHealthcare Global is not travel or medical insurance but a service provider for emergency medical assistance services. All medical costs incurred should be submitted to your health plan and are subject to the policy limits of your health coverage. All assistance services must be arranged and provided by UnitedHealthcare Global. Claims for reimbursement of services not provided by UnitedHealthcare Global will not be accepted. IMPORTANT CONTACT INFORMATION HEALTH CENTER AT AURARIA To schedule an appointment call: Plaza Hours: Monday - Thursday, 8:00 am - 5:00 pm MST* Friday, 8:00 am - 3:00 pm MST* *(Mountain Standard Time) Send Medical Claims within 90 days from Date of Service to: AmeriBen P.O. Box 7186 Boise, ID Group # CLAIM PROCEDURES Send Prescription claims to: Magellan Rx Management 4801 S. Washington Street Suite 100 Phoenix, AZ CLAIMS, ELIGIBILITY AND BENEFITS QUESTIONS AmeriBen Group # Call AmeriBen to request a Medical/Rx ID Card or Certificate of Coverage PREFERRED PROVIDER ORGANIZATIONS To find a PPO Network provider: Cofinity (Inside Colorado) Toll-Free Number for PPO Information First Health Network (Outside Colorado) Toll-Free Number for PPO Information HEALTH CARE MANAGEMENT PROGRAM AmeriBen Compass Medical Management, Inc. For Pre-Admission Notification For questions about eligibility or waiver requirements: Plaza click on Health Insurance Page 9 Page 10

8 Plaza Mon-Thurs 8 a.m. 5 p.m. Fri 8 a.m. 3 p.m. Healthcare and Wellness Real Doctors. Real Savings. Real Convenience on Campus. After Hours Mental Health and Victim Assistance Crisis Line Page 11

9 (303) Plaza Building 150