Changes to the Student Health Insurance for 2003-2004
Coverage Dates for Fall Semester: August 21, 2003 -
January 8, 2004
Coverage Dates for Spring Semester: January 9, 2004 - August 18, 2004
Deductible: The deductible is still $250 per plan year.
Plan Maximum: The Plan Maximum is now $200,000 lifetime.
Premium: The premium per student per semester is now $548. See Plan Cost for details on premium costs for the Plan.
New Policy Number: SDHN00175924-03
New PPO Network: Mountain Medical Affiliates (MMA) is the PPO in Colorado with Beech Street as a Wraparound outside of Colorado.
Coverage in Colorado:
Exclusive Provider Network (EPO) are paid at 85% for In Patient services and 80% for Out Patient services
MMA Broad Network are paid at 75% for In Patient and 80% for Out Patient services.
Non Network (Providers not in MMA network) care is paid at 60%.
Outside of Colorado:
Beech Street is the preferred provider organization outside the State of Colorado. Covered benefits outside Colorado will be paid at 80% when using a Beech Street provider or at 60% when using a provider not in the Beech Street network.
Out Patient Emergency Room Care now subject to a $50 copay for each ER visit.
Ambulance Benefit paid at 70% of Usual & Customer charge.
Changes to the Prescription Medication Plan:
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Prescription Drug Network Remains: RxWEST
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New Policy Number: RXW03UNC
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$50 deductible
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Co-payment schedule remains the same:
$20 co-pay - generic
$30 co-pay - Preferred Brands
$50 co-pay - Non-Preferred Brands -
$2,500 plan maximum per year
-
Exclusions and Pre-Authorization requirements from last year still apply
BENEFITS AT THE STUDENT HEALTH CENTER:
Medications Dispensed at the Student Health Center Remains the Same as Last Year:
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No deductible
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Student will pay 20%; Plan will be billed the other 80%
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Prescriptions at the Student Health Center WILL apply to the $2,500 plan maximum
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Exclusions and Pre-Authorization requirements from last year still apply
IMPORTANT NOTE: Eligibility status will not be on-line at the pharmacy until approximately 2 months after the coverage beings for each semester. If you need to fill a prescription during this time, please contact the Student Health Insurance Office to make arrangements for obtaining your prescription.
Greeley pharmacies participating in the RxWEST network include: Albertsons, K-Mart, King Soopers, Rite-Aid, Safeway, WalMart, Longs, and Toddys. This is a nationwide network of pharmacies. Customer Services may be reached at 888-479-2000.
The pharmacies will have online access to the eligibility list and their computer system will keep track of the deductible paid/remaining and amount to bill the insurance.
Other Charges at the Student Health Center:
Covered expenses at the Student Health Center or at designated X-Ray facilities in Greeley (must have a signed Student Health Center Referral) will not be subject to the plan year deductible or the pre-0existing conditions limitation.
There are co-pays for visits at the Student Health Center that are not billed to the Student Health Insurance:
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Simple Nurse visits (inoculations - $10)
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Regular Nurse Visits - $15
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Nurse Practitioner Visits - $20
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Physician Visits - $20
Other covered medical services (including RX) at the Student Health Center will be paid at 80%.
Covered services at Greeley X-Ray with a Student Health Center referral will be paid at 100%. Services at the Student Health Center are available only to UNC students who have paid the current term's health fee and are enrolled in classes.
Mental Health Coverage
There will be a $10 co-pay in and outside the Counseling Center for Out Patient mental health care which will not be billed to the Student Health Insurance Plan. At the Counseling Center on campus, the balance of the visit is paid at 80% by the Student Health Insurance and 20% by the student. Outside the Counseling Center, the balance of the visit is paid by the Student Health Insurance at 80% PPO or 60% non-PPO. There is a combined $1,000 Out Patient Mental maximum per year for both Counseling Center and non-Counseling Center payments by the Student Health Insurance.
If you need assistance with filing
a claim or have other
questions regarding your policy, contact: Klais & Company,
Inc. (8:30 a.m.--5:00 p.m. (EST) 800-331-1096 .
Plan Changes
for 2003-2004
