Frequently Asked Questions Brooklyn Law School Student Health Insurance Plan

Transcription

1 Frequently Asked Questions Brooklyn Law School Student Health Insurance Plan Table of Contents Important Contact Information... 2 How do I learn more about what is covered, access to benefits, enrollment and replacement I.D. cards?... 2 How do I find out about a specific claim or claims payment?... 2 How can I find a preferred provider?... 2 How can I find a participating pharmacy?... 2 How do I learn more about Gallagher Koster Complements?... 2 How do I learn more about Worldwide Assistance Services?... 2 Enrollment & Eligibility... 3 Who is eligible for the Student Health Insurance Plan?... 3 How do I enroll?... 3 How do I enroll my eligible dependents?... 3 How do I waive coverage under the Student Health Insurance Plan?... 3 Is there anything I need to know before waiving coverage?... 4 Insurance Plan Benefits... 4 How much does the Student Health Insurance Plan cost?... 4 What changes have been made to the Student Health Insurance Plan for the policy year?... 4 What is covered under the Student Health Insurance Plan?... 4 What is a deductible? Does the Student Health Insurance Plan have a deductible?... 5 Is there any additional coverage I can purchase in addition to the Student Health Insurance Plan?... 5 Am I covered if I have a pre-existing condition?... 5 Does this plan cover me when I am off campus, traveling or studying abroad?... 5 How do I get my prescriptions filled?... 5 Do I get an I.D. card?... 6 How do I print an I.D. card online?... 6 How do I find out my Student Health Insurance Plan I.D. number without my I.D. card?... 6 Finding a Provider... 6 Can I go to any doctor or hospital?... 6 Claims Processing... 6 What should I do if I receive a bill or need to be reimbursed for services I received?... 6 Is any other information needed in order to pay a claim?... 6 How will my claims be paid if I have other health insurance in addition to the Student Health Insurance Plan?... 6 Dental Coverage... 7 Does the Student Health Insurance Plan provide any dental coverage?... 7 Continuation Coverage... 7 Will I be covered under the Student Health Insurance Plan after I leave Brooklyn Law School?... 7 Can I continue coverage after the policy terminates?... 7 Plan Enhancements... 7 What enhancements are available under the Student Health Insurance Plan?... 7 Are there any additional insurance products available?... 7 August 3, 2012 Page 1

2 Important Contact Information How do I learn more about what is covered, access to benefits, enrollment and replacement I.D. cards? Gallagher Koster 500 Victory Road Quincy, MA Website: Phone: (800) BLSstudent@gallagherkoster.com How do I find out about a specific claim or claims payment? Aetna Student Health P.O. Box El Paso, TX Phone: (866) Register for online claims lookup at: How can I find a preferred provider? Aetna Preferred Provider Network Website: Phone: (866) How can I find a participating pharmacy? Aetna Pharmacy Management Website: Phone: (800) How do I learn more about Gallagher Koster Complements? EyeMed Discount Vision Plan Website: Phone: (866) Basix Dental Savings and CampusFit Website: Phone: (888) How do I learn more about Worldwide Assistance Services? On Call International Website: Toll free from U.S. and Canada: (800) Worldwide direct dial: (603) August 3, 2012 Page 2

3 Enrollment & Eligibility Who is eligible for the Student Health Insurance Plan? Minimum Credit Hours Requirement: o All students taking a minimum of 8 credit hours are eligible to enroll in the Brooklyn Law School Student Health Insurance Plan. Dependents: o Eligible students who enroll in the Student Health Insurance Plan may also insure their eligible dependent(s). First-Year J.D. Students: o First-year J.D. students are automatically enrolled in and billed for the Student Health Insurance Plan and will remain enrolled unless proof of comparable coverage is provided prior to the waiver deadline. o Second and third-year students may enroll in the Student Health Insurance Plan on a voluntary basis. Spring Semester Enrollment: o Only students who are newly enrolled at Brooklyn Law School have the option to enroll in the Student Health Insurance Plan for the spring semester. Students who did not enroll in the fall for the annual coverage can only enroll in the Plan if they lose their health insurance coverage. Students who have lost their coverage must complete a Petition to Add Form, which can be downloaded at How do I enroll? Second or third-year students who decide they would like to actively enroll in the Student Health Insurance Plan may do so by completing the following steps: 1. Go to 2. Click on Student Direct Pay Enroll. 3. Create a user account, or log in if you are a returning user. 4. Once logged in, select Student Direct Pay Enroll again to complete the form. How do I enroll my eligible dependents? Students must purchase coverage for their eligible dependent(s) at the same time as their own initial plan enrollment. Dependent coverage must be purchased for the same time period as the student s period of coverage and cannot exceed coverage purchased by the student. For example, a student enrolled in annual coverage cannot purchase dependent coverage for the spring semester unless a qualifying event, as defined below, occurs. Students can add eligible dependent(s) if they experience one of the following qualifying events: (a) marriage, (b) birth of a child, (c) divorce or (d) if the dependent is entering the country for the first time. Please note, with the exception of the dependent entering the country for the first time, all other qualifying events noted above will only be approved if experienced by the student. If dependent enrollment meets one of these qualifying events, the Dependent Enrollment Form, supporting documentation and payment must be received by Gallagher Koster within 31 days of the qualifying event. Once a dependent is enrolled, coverage cannot be terminated unless the student loses eligibility. Students may enroll their eligible dependents online for an additional premium by visiting selecting Dependent Enroll, and completing the form by the published deadline. How do I waive coverage under the Student Health Insurance Plan? First-year J.D. students are automatically enrolled in and billed for the BLS Student Health Insurance Plan and will remain enrolled unless a waiver is submitted by the deadline. If you determine your alternative health insurance plan is comparable to the Student Health Insurance Plan and would like to waive the Student Health Insurance Plan: 1. Go to 2. Click on the Student Waive link. 3. Create a user account, or log in if you are a returning user. 4. Select the red I Want to Waive button. When waiving the insurance, have your current Student Health Insurance Plan I.D. card ready as you will need this information in order to complete the waiver form. After completing your online form, you will be asked to review your information and click Continue. Immediately upon submitting your online form, you will receive a confirmation number. You must save this confirmation number and print a copy of the confirmation for your records. August 3, 2012 Page 3

4 Is there anything I need to know before waiving coverage? As a first-year J.D. student, if you have alternative health insurance, for example, as a dependent under the employer plan held by your parent(s), then you should fully compare the alternative plan against the Student Health Insurance Plan to determine which plan s rates (taking into account deductibles and total out-of-pocket expenses), benefits and coverage are most appropriate for you. In making this determination, please consider the following: Does the plan cover doctor s office visits, diagnostic testing, x-rays, prescription drugs, etc. in the NYC area? Does the plan have participating network doctors and hospitals in the NYC area? Are there any administrative pre-certification or primary care referral requirements that may delay receipt of care? Insurance Plan Benefits How much does the Student Health Insurance Plan cost? Coverage Period Annual Rate 8/15/12-8/14/13 Enrollment Deadline (N/A to First-Year J.D. Students) 9/15/12 Student age 30 and under $1, Student age 31 and over $2, While the enrollment is for annual coverage, students will be billed 50% of the annual premium in the fall semester and 50% of the annual premium in the spring semester. What changes have been made to the Student Health Insurance Plan for the policy year? First-year J.D. students are automatically enrolled in and billed for the Student Health Insurance Plan and will remain enrolled unless a waiver is submitted by the deadline. The policy year aggregate limit has been increased from $50,000 to $100,000 per policy year. Preventative health and wellness benefits, including but not limited to routine physical exams, routine OBGYN exams, preventative screenings and certain immunizations, have been added and are now paid at 100% (for in-network providers only). Numerous internal policy benefit limitations have been removed. These benefits are subject only to the $100,000 maximum per policy year: o The $1,000 outpatient pharmacy maximum has been removed. Generic contraceptives will not require any copayment. o The $2,000 per day maximum for hospital room and board has been removed. o The $2,000 per day maximum for intensive care services has been removed. o The $2,000 per day maximum for hospital miscellaneous expenses has been removed. o The $5,000 maximum for surgeon s expenses has been removed. o The $2,000 maximum for ambulatory surgical expenses has been removed. o The $2,500 maximum for durable medical equipment has been removed. o The $500 maximum for wisdom teeth removal has been removed. o The $100 maximum for physical exams has been removed. Routine physical exams are now covered under the expanded preventative care services benefit. The office visit copayment has been increased to $25 per visit. What is covered under the Student Health Insurance Plan? The Student Health Insurance Plan offers comprehensive benefits, including physician office visits, consultant visits, labs and x-rays, prescription drugs, ambulatory and emergency care, hospital room and board, inpatient and outpatient surgical procedures, chemotherapy and radiation and inpatient and outpatient mental health services. The maximum benefit allowed for the policy year is $100,000; however, there are several additional expense limitations within the Student Health Insurance Plan. As a result, students should refer to their brochure schedule for details. Services provided by an in-network provider are generally covered at 90%, while services provided by an out-of-network provider are generally covered at 70%. There is a $150 per insured, per policy year deductible. Please refer to the plan brochure available at and click on My Benefits and Plan Information for complete details about coverage, limitations, and exclusions. August 3, 2012 Page 4

5 What is a deductible? Does the Student Health Insurance Plan have a deductible? A deductible is the amount for which you are responsible before payment is made by the claims company. Once you have paid the deductible, whether it is applied to one service or multiple services, the plan will pay for covered medical expenses as indicated in the plan brochure. The Student Health Insurance Plan has a $150 per insured, per policy year deductible. Is there any additional coverage I can purchase in addition to the Student Health Insurance Plan? No, there is no option to purchase additional coverage. Am I covered if I have a pre-existing condition? Students under the age of 19 are immediately covered for pre-existing conditions. If you are over the age of 19, you will be covered if you were continuously insured through another health insurance plan for the 6 months immediately prior to the effective date of the Student Health Insurance Plan without a lapse in coverage of more than 63 days. If you were not continuously insured or had a lapse in coverage of more than 63 days, you will not be covered for any preexisting condition. A pre-existing condition is one for which you sought medical advice, were diagnosed, received care or treatment or were recommended care or treatment during the 6 months prior to the effective date of this plan. Once you have been enrolled in this plan for 12 months, your pre-existing condition will be covered as any other condition. Does this plan cover me when I am off campus, traveling or studying abroad? Yes, the Student Health Insurance Plan covers you during semester breaks, summer vacation and even if you re traveling or studying abroad. You will be covered for the period for which you paid the premium. In addition to being covered for medical treatment and services, you will also be covered for Repatriation of Remains, Emergency Medical Expense Benefits and Travel Assistance Services through On Call International, the 24-hour worldwide assistance service. All services must be arranged for in advance and provided by On Call International. Any services not arranged by On Call International will not be considered for payment. When studying or traveling abroad, keep your student health insurance plan I.D. card with you and take a copy of the brochure for reference. When outside of the United States, you will likely be asked to pay for your medical care first and will then need to seek reimbursement. Covered expenses will be reimbursed on an out-of-network basis. When you submit claims for reimbursement, you will need to have the itemized bill(s) translated into English and include a letter informing the claims administrator that you are seeking reimbursement for charges previously paid. Please ensure that your name, I.D. number, address (to receive your reimbursement check) and Brooklyn Law School are clearly stated on the bill. How do I get my prescriptions filled? Prescriptions can be filled at an Aetna participating pharmacy. To find a list of participating pharmacies near you, visit At designated Aetna pharmacies, you will pay a $10 copayment for a 30-day supply of a Tier-1 drug, a $25 copayment for a 30-day supply of a Tier-2 drug and a $45 copayment for a 30-day supply of a Tier-3 drug, up to the $100,000 maximum benefit. Prescriptions are also available through a Mail Service Program. Through the Mail Service Program, you will pay 2.5x the cost of a 30-day supply for a 90-day supply of your prescription drug. Students who have a chronic condition or who take maintenance drugs are encouraged to use the Mail Service Program to be able to receive the maximum benefit available. To learn more details about the Prescription Drug Program, including the Mail Service Program, click on Pharmacy Program, at Students who plan on studying abroad may fill out a Prescription Override Form by visiting and selecting Pharmacy Program, then Pharmacy Override Form. August 3, 2012 Page 5

6 Do I get an I.D. card? Yes, I.D. cards are available online. They are also mailed to the address that Brooklyn Law Schoool has on file for you. Your Student Health Insurance Plan I.D. number will be listed on your I.D. card. How do I print an I.D. card online? 1. Go to 2. First time users will need to create a user account. Returning users can log in using their existing account information. 3. On the left toolbar, under My Account, click on Authorize Account. 4. Enter your student I.D. number and your date of birth and click on Authorize Account. 5. After you are redirected to the Account Home page, click on Generate I.D. Card. How do I find out my Student Health Insurance Plan I.D. number without my I.D. card? Students who do not have their ID card and need to know their Aetna I.D. number can call Aetna directly at (866) An Aetna I.D. number is not immediately generated, please allow 3-4 business days in order for your enrollment to be processed. Finding a Provider Can I go to any doctor or hospital? Yes, you can go to any doctor or hospital; however, you will save money by seeing providers that participate in the Aetna Preferred Provider Network because providers participating in this network have agreed to accept a predetermined negotiated amount, or Preferred Allowance, as payment for their services. Go to and click on Find a Doctor to locate participating providers. Claims Processing What should I do if I receive a bill or need to be reimbursed for services I received? Physicians should bill the claims administrator. The billing information is on the back of your Student Health Insurance Plan I.D. card. However, if you do receive a bill or if you have paid for a service and need to be reimbursed, please send your bill (and proof of payment if seeking reimbursement) to the claims administrator. You do not need an additional claim form. Make sure your name, Student Health Insurance Plan I.D. number and Brooklyn Law School are clearly stated on the bill. Make a copy for your records before sending them to the claims administrator at the following address: Aetna Student Health P.O. Box El Paso, TX Phone: (866) Register for online claims lookup at: Is any other information needed in order to pay a claim? If the treatment you received was a result of an accident, you will receive a letter from the claims administrator asking for information about the accident, i.e. whether the accident was the result of a car accident, from playing sports, etc. Your claim cannot be processed without this information, so please respond to the letter promptly. You may also receive a letter asking if you are covered by any other health insurance plan. It is important that you respond promptly to this as well. How will my claims be paid if I have other health insurance in addition to the Student Health Insurance Plan? The Student Health Insurance Plan has a coordination of benefits provision. This means your plan with Gallagher Koster will coordinate the payment of claims with your other insurance company. You will need to provide the claims company with information about your other health insurance company. Please refer to your brochure for details. August 3, 2012 Page 6

7 Dental Coverage Does the Student Health Insurance Plan provide any dental coverage? All students at Brooklyn Law School have the option of purchasing a dental insurance plan through Aetna. Further information on Aetna s Dental Insurance Plan can be found at or by calling Aetna Dental customer service at (800) Continuation Coverage Will I be covered under the Student Health Insurance Plan after I leave Brooklyn Law School? Yes, you will be covered under the Student Health Insurance Plan until the end of the policy year, with coverage terminating on August 9, Can I continue coverage after the policy terminates? Yes, students who graduate and were enrolled in the Student Health Insurance Plan during the policy year will be eligible to continue their coverage for an additional 6 months at an additional cost. Please contact Gallagher Koster to discuss your options. Plan Enhancements What enhancements are available under the Student Health Insurance Plan? The Student Health Insurance Plan provides many enhancements through Gallagher Koster and Aetna. Gallagher Koster Complements Gallagher Koster offers enrolled students access to a menu of products at no additional cost, including a discount vision plan and a dental savings plan. More information is available by visiting and clicking on the Discounts and Wellness link. Aetna Plan Enhancements Aetna offers 24-hour telephonic access to a registered nurse as well as a wide variety of discount programs for fitness, natural products, hearing, vision and tobacco cessation. To speak directly with one of Aetna s registered nurses, call Aetna s Informed Health Line at (800) For more information about Aetna s discount programs, visit Are there any additional insurance products available? Please visit and click on the Other Insurance Products link for complete details about additional insurance products that are available as well as enrollment information. This document is only a summary of the benefits available. Please refer to the Summary Plan Description for a description of the benefits available and exclusions and limitations of the plan. August 3, 2012 Page 7