Understanding Healthcare & Insurance at The University of Chicago STUDENT HEALTH AND COUNSELING SERVICES

Transcription

1 Understanding Healthcare & Insurance at The University of Chicago STUDENT HEALTH AND COUNSELING SERVICES

2 Accessing Healthcare at UC Student Health Service (SHS) 860 E. 59 th St. (at Drexel, Goldblatt Pavilion Entrance), R-100 (773) healthcare.uchicago.edu Student Counseling Service (SCS) 5555 S. Woodlawn Avenue (773) counseling.uchicago.edu Health Promotion & Wellness (HPW) Woodlawn Social Services Center, 950 E. 61 st St., 3 rd floor (773) wellness.uchicago.edu

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4 Student Life Fee vs. Insurance (U-SHIP) All registered students pay a quarterly Student Life Fee. Provides access to Student Health Service and Student Counseling Service Health services covered by the Student Life Fee: e.g., acute/chronic care, routine physicals, short-term psychotherapy, academic/study skills counseling, etc. Private insurance / U-SHIP covers: Prescriptions, hospitalizations, ER care, lab tests, long-term psychotherapy, consultation and treatment by specialists, etc.

5 Where to Go for Services Primary medical and mental health care, wellness programming: Covered by Student Life Fee & provided by SHS, SCS, HPW Referrals provided to specialists / for tests If on U-SHIP, referral required from SHS/SCS; if referral is not obtained in advance, $50 penalty is assessed Is it an Emergency? If SHS closed, call 24-hour Nurse Advice Line to determine if ER services are required (otherwise, claim may be denied)

6 University Annual Insurance Requirements Students are required to have good health insurance All registered students enrolled annually in U-SHIP Deadline: by 4 th Friday of one s first registered quarter, each year, all students must either: Waive out of U-SHIP (comparable coverage required) or Enroll dependents Spring 2015 deadline 5pm Central time, Friday, April 24 th ; Summer 2015 deadline 5pm Central time, Friday, July 17 th Students remain enrolled for the full academic year Enroll or waive at:

7 Navigating Health Insurance Insurance Terminology Premium The amount of money generally paid on a monthly, quarterly or annual basis that you pay to cover the cost of your health insurance. Deductible The amount you need to pay before your insurance plan starts to cover your medical costs. Annual out-of-pocket maximum The maximum amount of money you are expected to pay annually for medical costs before your plan starts to cover expenses at 100%. Co-insurance A percentage of the cost of your treatment that you are required to pay (i.e., 10%, 20%, or 30% typically), after your plan s deductible has been fully paid. For additional help, see the Health Insurance Glossary on the SCHS website: studenthealth.uchicago.edu/insurance

8 Navigating Health Insurance: U-SHIP Premium $3,162 billed in 3 installments of $1,054 Deductible $200 (in-network); $500 (out-of-network) Annual out-of-pocket maximum $1,500 (in-network); $2,500 (out-of-network) Co-insurance 10%; plan pays 90% after deductible has been met Prescriptions paid by co-pay, 3 tiers ($10, $25, $40) $20 co-pay for doctor/specialist visits

9 Understanding Health Insurance Costs These costs are interconnected Consider how changes in one impacts the others Consider YOUR individual health needs in assessing plans PREMIUM The Insurance Triangle

10 Assessing Health Insurance: A Comparison Here s a comparison of U-SHIP and two alternate plans: U-SHIP BCBS Gold PPO 004 ISO-Care Unlimited ( ACA Comparable ) Premium $ 3,162 $ 2,088 $ 2,148 Deductible $ 200 $ 2,500 $ 500 Annual out-of-pocket $ 1,500 $ 5,200 $ 6,350 Co-insurance 90% 80% 80% And here s what it would look like if you faced a $3,500 medical bill: U-SHIP BCBS Gold PPO 004 ISO-Care Unlimited ( ACA Comparable ) Total billed amount $ 3,500 $ 3,500 $ 3,500 Deductible owed $ 200 $ 2,500 $ 500 Co-insurance owed $ 330 $ 200 $ 600 Total amount due $ 530 $ 2,700 $ 1,100

11 Comparable Coverage Requirement To waive U-SHIP, students must have active insurance with comparable coverage: academic year requirements aligned with ACA Alternate plans must include 10 ACA essential health benefits No exclusions for pre-existing conditions (& no waiting periods) Individual plan o-o-p max < $6,350; family plan o-o-p max < $12,700 Also must provide coverage for non-emergency care in Chicago! Provides greater flexibility for students and families Wider range of plans will meet requirements to waive coverage

12 Researching Alternatives to U-SHIP To waive U-SHIP, alternate insurance plans must: Meet University requirements for comparable coverage Be active from the time of the student s arrival on campus through the end of their program or the end of the current academic year Beginning in , a subset of alternate insurance plans are being audited for compliance.

13 Researching Alternatives: Tax Subsidies Subsidies may be available to offset cost of insurance (premium), based on student s income: Only available for plans purchased through a state or federal Exchange in one s legal state of residence Only available to U.S. citizens and permanent residents Based on cost of silver-rated plans in one s regional market Calculated using prior year s tax records; if income changes across tax years, receipt of subsidy may impact subsequent year s tax bill.

14 Researching Alternatives: Considerations First, consider your specific health needs: Do you take maintenance medications? Do you have any chronic health conditions, ongoing needs, etc.? What type of health care do you receive in a typical year? Then, consider how plan benefits are provided: One annual deductible or deductible per sickness/injury? Prescription coverage: co-pay or co-insurance? Look at policy exclusions, i.e., no coverage for assistant surgeon fees Consider deductible, annual out-of-pocket rates, in addition to premium costs/subsidies, to evaluate true cost of insurance

15 U-SHIP CONTACT INFORMATION U-SHIP My Account Create or log into your account at UnitedHealthcare Student Resources On-campus Insurance Coordinators: Hours: Mon-Fri: 8:00am 4:30pm Woodlawn Social Services Center, 950 E. 61 st Street, rooms 368/ (press option #2) or Home Office: Customer Service:

16 24/7 ACCESS TO U-SHIP MY ACCOUNT U-SHIP MyAccount access information: Create or log into My Account to: Download an insurance I.D. card Check benefits status and policy details Check claims status and EOBs Locate network providers Access pharmacy benefit information

17 Summing Up Health Care at UC Health care access: SHS / SCS covered by Student Life Fee Add l testing, specialists, etc. covered by insurance Comparing alternate insurance plans: Consider impact of all costs: premium, deductible, outof-pocket max, co-insurance, co-pays Look at value when faced with actual medical expenses Must meet UC requirements for comparable coverage Review exclusions carefully!

18 Questions? studenthealth.uchicago.edu/insurance