Changes to the Student Health Insurance for 2007-2008
Coverage Dates for Fall Semester: August
17, 2007 -
January 5, 2008
Coverage Dates for Spring Semester: January 6, 2008 - August 17, 2008
Deductible: The deductible is still $300 per plan year.
Plan Maximum: The Plan Maximum is $200,000 lifetime.
Premium: The premium per student per semester is now $850. See Plan Cost for details on premium costs for the Plan.
Policy Number: 141249
PPO Network: UniCare is the PPO
network.
Eligibility for the Insurance: See
here for changes to eligibility
COVERAGE:
Covered Network services are paid at 80%.
Non Network (Providers not in Anthem network) care is paid at 50%.
Out Patient Emergency Room Care subject to a $50 copay for each ER visit.
Ambulance Benefit paid at 70% of Usual & Customer charge.
PRESCRIPTION MEDICATION PLAN:
-
Prescription Drug Network: UniCare (NextRx)
-
RX Bin: 610053
-
$100 deductible
-
Co-payment schedule:
$20 co-pay - generic
$45 co-pay - Preferred Brands
$65 co-pay - Non-Preferred Brands -
Plan maximum per year remains $2,000
-
Exclusions from last year still apply
-
Prior Authorization is not necessary
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 UniCare network include: Albertsons, Kmart, King Soopers, Rite-Aid, Safeway, Wal-Mart, Target, and Walgreens. This is a nationwide network of pharmacies. Customer Services may be reached at 888-218-4844.
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.
BENEFITS AT THE STUDENT HEALTH CENTER:
Covered expenses incurred at the NCMC Student Health Center will be paid at 80% of the Maximum Allowable after the $300 per Plan year Deductible has been satisfied.
NOTE: The NCMC Student Health Center is not a participating pharmacy for the prescription drug plan.
WELLNESS BENEFIT:
Annual Wellness Exam 80% Maximum Allowable ($150 maximum) at the Student Health Center only.
Mental Health Coverage
There will be a $15 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 50% 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
Insured Students enrolled under the Plan shall have access to 24-hour global emergency services provided by Scholastic Emergency Service, Inc.
If you are a U.S. student studying in a U.S. location, you are eligible for all services when traveling more than 100 miles away from your permanent residence and for selected services at your campus location. If you are a U.S. student studying abroad, you are eligible for all assistance services at your campus location. If you are a foreign national student studying in the U.S., you are eligible for services, both on campus and while traveling outside of home country for the duration of your studies. Foreign national students are not eligible for Scholastic Emergency Service, Inc. services in their home country of origin.
The services include referrals to qualified, local medical providers, transportation to the nearest appropriate medical facility if it is not available locally (evacuation), critical care monitoring and, upon discharge from the hospital, if ongoing assistance is needed, medically supervised transportation home (repatriation) with an escort, if necessary. The Scholastic Emergency Service, Inc. program also includes other services such as transportation of a family member to join hospitalized patient, emergency counseling, prescription replacement assistance, pre-trip information, lost luggage and document assistance, as well as return of mortal remains. Scholastic Emergency Service, Inc. completely arranges and pays for all of the assistance services it provides without limits on the covered cost. All services must be arranged and provided by Scholastic Emergency Service, Inc.. No claims for reimbursement will be accepted. (Scholastic Emergency Service, Inc. is not affiliated with UniCare Life & Health Insurance Company).
