Changes to the Student Health Insurance for 2004-2005
Coverage Dates for Fall Semester: August
19, 2004 -
January 6, 2005
Coverage Dates for Spring Semester: January 7, 2005 - August 17, 2005
Deductible: The deductible is still $250 per plan year.
Plan Maximum: The Plan Maximum is $200,000 lifetime.
Premium: The premium per student per semester is now $624. See Plan Cost for details on premium costs for the Plan.
New Policy Number: SDHN00175924-04
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 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: RXW04UNC
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$100 deductible
-
Co-payment schedule remains the same:
$20 co-pay - generic
$30 co-pay - Preferred Brands
$50 co-pay - Non-Preferred Brands -
Plan maximum per year is now $2,000
-
Exclusions and Pre-Authorization requirements from last year still apply
-
Oral contraceptives are no longer covered
BENEFITS AT THE STUDENT HEALTH CENTER:
Medications Dispensed at the Student Health Center Remains the Same as Last Year:
-
No deductible
-
Student will pay 20%; Plan will be billed the other 80%
-
Prescriptions at the Student Health Center WILL apply to the $2,000 plan maximum
-
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 area pharmacies participating in the RxWEST network include: Albertsons, K-Mart, King Soopers, Rite-Aid, Safeway, Wal-Mart, Target, and Longs . 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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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.
Intercollegiate Sports Coverage
Intercollegiate athletes may obtain coverage for injuries that occur while participating in an intercollegiate sport. This coverage is for injuries only and requires additional premium and proof of official player status on an official UNC intercollegiate sports teams.
This benefit is paid as any other injury
subject to a separate $150 per injury deductible and a maximum payment of
$10,000 per injury.
Repatriation and Medical Evacuation
In the even a covered Accident or Sickness causes the death of a student while he/she is in a foreign country (foreign country meaning the student is not a citizen of the country) for the purpose of obtaining academic credits in a degree-granting program, we will reimburse expenses incurred for returning the body to the country of citizenship not to exceed a maximum policy benefit of $7,500. All expenses must be approved by the insurance company in writing prior to their incurral to be covered.
If the student becomes unable to continue the academic program due to a life threatening accident or sickness, We will pay the necessary expenses not to exceed a maximum policy benefit of $10,000 for evacuation to their home country. A medical evacuation will be considered only after being hospitalized for at least 5 days. All expenses must be approved by the insurance company in writing prior to their incurral to be covered.
Travel Assistance Services
Insured students enrolled under the Plan shall have access to 24-hour assistance network services provided by Worldwide Assistance Services, Incorporated. The following services are included in the Plan: referral to the nearest, most appropriate medical facility and/or provider; medical monitoring by board certified emergency doctors in the United States; urgent message relay between family, friends, personal doctor, school and insured; guarantee of payment to provider and assistance in coordinating insurance benefits; ;arranging and coordinating Emergency Medical Evacuations and Repatriation of remains; referral to legal assistance; assistance in locating lost or stolen items including lost ticket application processing. Please contact Worldwide Assistance Services, Incorporated toll free at (800) 243-6124 for a complete description of the program services.
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 2004-2005
