2015-2016 STUDENT HEALTH BENEFIT PLAN Benefit Summary Plan issued & administered by: Student Educational Benefit Trust (hereinafter Trust ) 33479 Lake Road Avon Lake, OH 44012 Group Plan # 917367316 Coverage / Claim Questions: 419-530-3474 For more information visit: www.myutstudentbenefits.com Eligibility CampusFirst SM Domestic Plan - is a comprehensive plan for matriculated Domestic Students. It is the intent of this plan to offer coverage that meets or exceeds the Minimum Essential Coverage requirements as set forth by the Federal Department of Health and Human Services. Please note this plan will be assessed to your student account if you are a Domestic student taking 1 or more credit hours and your program requires coverage. Programs that require students to have coverage for the 2015-16 school year include the MD program, Colleges of Nursing, Pharmacy & Pharmaceutical Sciences, Health Sciences, and student-athletes. CampusFirst SM International Plan - is a comprehensive plan for matriculated International Students. It is the intent of the plan to offer coverage that meets or exceeds the J1-F1 Visa requirements, as set forth by the U.S. Department of State. Please note J1 international students will be automatically enrolled in Plan 1- Domestic Plan. These students only may opt out of plan 1 and purchase plan 2. CampusFirst SM Pre-Paid Main Campus, HSC Student Wellness Center and UTMC Plan (Supplemental Only) - is a supplemental plan that is intended for those students who have other coverage, but may want to pre-pay for primary care services at the Main Campus Medical Center or within UTMC. It also includes a modest out-patient and Rx benefit to help off-set the student s out-of-pocket costs under a high deductible plan or a plan with an insufficient network in the greater Toledo area. As this is a supplemental plan, please consult with your insurance agent or human resource representative to understand any implications that may result from electing this coverage in addition to your other insurance policy. Ohio Preferred Providers Student Educational Benefit Trust has arranged for you to access the Medical Mutual of Ohio SuperMed Plus network of local and state-wide providers. To confirm your physician or provider is part of the SuperMed Plus network you may call the Student Benefit Campus Liason at 419-530-3474 or visit www.myutstudentbenefits.com. The University of Toledo is pleased to offer the University-sponsored Student Health Benefit Plan (SHBP) administered by the Student Educational Benefit Trust. The Universitysponsored plan has no deductible and provides first dollar coverage. Many students find it is a better value and offers higher quality benefits than their parent, employersponsored, or individual health plan. We advise that you review your current health plan to determine if you could benefit by switching to the University-sponsored SHBP. This brochure does not constitute a promise of benefits on behalf of the University of Toledo, and is intended to provide an overview of the plan(s) benefits. A complete description of benefits, limitations, exclusions and special provisions is provided in the Plan Document which is posted on the University of Toledo student website. Although many of the program benefits meet or exceed requirements that would otherwise apply to group or individual plans, you may be eligible up to the age of twenty-six (26) for coverage under a group health plan through your parent s employer, or under an individual policy through an independent carrier or State Exchange. Contact the plan administrator for your parent s employer, an individual health insurance issuer or a State Exchange for more information.
Costs and Coverage Effective Dates Cost for student will be billed to your student account and can be waived with proof of comparable other health insurance. The student will need to pay all fees charged by the University prior to coverage becoming active. If Title IV funds are being used to pay the student fees the student must authorize the payment of allowable charges. Student s coverage is not active until the student account has been paid and students will be responsible for any claims incurred during the period. Costs for additional coverage, Dependents, Vision and Dental are the responsibility of the student and are only accessible through logging into your MyUT. From the MyUT, click on the enrollment button and you will be able to enroll and pay for the additional lines of coverage. How to Waive Coverage All Domestic Students attending the University of Toledo taking one (1) credit hour or more are required to carry a benefit plan that satisfies or exceeds the minimum essential benefit requirements under Health Care Reform. International J1 Visa Students are automatically enrolled in the Domestic Plan and do not need to complete an enrollment application. International J1 Visa Students may opt into the International Plan should they wish to take a lower cost benefit that still satisfies the health insurance requirements under J1 or F1 Visa. Domestic students whose programs require a student benefit plan are required to either enroll or waive-out of the Domestic Plan. Programs that require students to have coverage for the 2015-2016 school year include the MD program, Colleges of Nursing, Pharmacy & Pharmaceutical Sciences, Health Sciences, and student-athletes. Domestic Students waiving out of the Domestic Plan may still purchase the Pre-Paid Student Health Center Plan, as optional coverage. It is understood that neither the International Plan or the Pre-Paid Student Health Center Plan meet the Individual Mandate for healthcare coverage and that the student would be responsible for any potential tax consequence. Only the Domestic Plan will satisfy the Individual Mandate, as well as the Minimum Essential Coverage requirements, as set forth by Health Care Reform. If you do have other insurance, it is important to contact your Human Resource Manager or Agent to understand how these optional benefit plans could impact your high deductible health plan or out-of-state HMO. Students whose programs require a student benefit plan who do not complete an online waiver, with the necessary proof of current insurance prior to the waiver deadline, will be enrolled in the Domestic Plan and the cost of the plan will be billed as part of their tuition.
Cigna Global Health Benefits Student Health Anytime, Anywhere and from Any Device. A personal health crisis can strike at any time, which is why the Student Educational Benefit Trust (SEBT) is collaborating with Cigna Global Health Benefits to offer customer service that stretches beyond borders, across the globe and around the clock. Cigna s Global Customer Service Centre is open 24/7 to provide services on demand, so our model is always there to help students with any situation that might arise. From multilingual assistance with verification of benefits, payment guarantees, physician and hospital referrals, to coordination with emergency medical assistance providers. In most cases, Cigna s Global Service Centre is a single point of contact for students traveling abroad. Most calls are handled entirely within the unit but, when coordination with other parties is necessary, the Service Centre manages the process to ensure that the call is properly transferred, introduced and briefed. Cigna Envoy at Your Service Cigna Envoy provides parents, healthcare professionals and globally mobile students with personalized information and access to a range of convenient online services and resources both during and prior to the departure. Your students will benefit from instant access to their benefit information, claims status and healthcare professional options anytime, anywhere and from any device. Introducing the NEW Cigna Envoy Mobile App At SEBT, we are dedicated to ensuring your globally mobile students have quick and easy access to their benefits and services anytime and anywhere they need them. That s why we collaborated with Cigna Global Health Benefits to offer the Cigna Envoy mobile app. The Envoy Mobile App gives your students a quick and easy way to access their health information on the go. Download today from Google Play or the Apple App Store SM Enrollment: Students covered under a SEBT primary plan are automatically enrolled into Cigna Global Health Benefit. To activate coverage prior to departure, contact SEBT via your dedicated toll-free number (1-888-204-5770) and push (7) at the telephone prompt menu to be transferred to Cigna s Global Service Centre. 24 /7 Phone Service Voluntary Dental and Vision Your University sponsored Student Health Benefit Plan offers a quick, integrated, inexpensive, round-the-clock solution to provide access to primary physician care when your Main Campus Medical Center or HSC Student Health and Wellness Clinic is not available to you or your dependents due to limited hours of operation, time of day, or the nature of your medical necessity. Access to this cross coverage services is available in all fifty states. Please note this service is available at no additional cost to you or your dependents for the actual consultation. The intent of this service is to provide an integrated cross coverage capability for your Main Campus or Health Science Campus Medical Center and is not intended to replace an urgent care or emergency room, but, when medically appropriate, is able to provide treatments for common illness such as colds, flu, upper respiratory and sinus infections, allergies, bronchitis, and urinary tract infections. If appropriate, the board certified physician may phone a prescription of a non-dea controlled or lifestyle modification substance into a local pharmacy. As this service is integrated into your Main Campus Medical Center, the on-campus medical professional will receive a copy of all consultations performed during the period of cross coverage. You may be contacted by the same on-campus medical professional to follow up with the appropriate course of treatment. The 24/7 Physician Service is available toll-free at: 1-888-204-5770 All Students and Dependents may purchase voluntary Delta Dental and Davis Vision plans at: www.myutstudentbenefits.com. Questions: Contact Tonya Tressler, Student Benefits Campus Liason at 419-530-3474. Enroll: Log in to MyUT Preferred Delta Dental Plan of Ohio Provider: Go to www.deltadentaloh.com Delta Dental Plan of Ohio: Customer Service 1-800-524-0149 Davis Vision Plan of Ohio: Customer Service 1-800-999-5431 Go to www.davisvision.com Enroll today! You must log in to MyUT to enroll or waive coverages. Waiver Deadlines: Annual and Fall 09/30/2015 Spring/Summer 01/31/2016 Summer** 07/1/2016 **Summer (New or Transfer Students only)