Transcript Document

Graduate Research or
Teaching Assistant
Health Insurance
Student Medical Insurance
Coverage offered through
• As a Graduate Research or Teaching Assistant part of your benefits
package is medical insurance. Because you are a student not a
UofL employee, your insurance is provided by the STUDENT
MEDICAL INSURANCE PLAN with coverage provided by United
HealthCare Student Resources.
• This benefit can not be waived or taken in any other form.
• Dependents and/or spouse may be covered by completing a
dependent/spouse enrollment form available at the
AHPcare.com\Louisville web site. Payment for enrolling spouse or
dependents must be paid when submitting the form to AHP.
Benefits of the Student Policy
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Routine medical care and acute office visits
Preventative Care covered at 100%
Prescription coverage
Inpatient and Outpatient coverage at local and national hospitals
Maternity paid as any other sickness
$500,000 Maximum Benefit
24 hour Student Assistance Program
24 hour Nurse line
Meets ACA (Affordable Care Act) guidelines
Global Emergency Services for when you are travelling abroad
Deductibles, copays and/ or coinsurance apply for some services
Policy details available at AHPCare.com/Louisville
Dental and Vision discounts available through AHPCare.com/Louisville –
not included in the medical insurance policy
U of L Campus Health Services
• Routine visits for health maintenance, physicals and acute care
• Blood pressure checks
• Gynecological exams
• Annual surveillance TB skin testing, allergy injections, immunizations
and flu shots
• In office lab tests: strep, flu, pregnancy, urinalysis
• Low cost generic medications, birth control pills and free condoms
• Appointments are available daily on a first call basis
• Services are provided by board certified physicians and nurse
practitioners
• With the student insurance plan many of these services are at no
charge.
Student Health Insurance Coverage at
Campus Health Services
• Doctor Visits (including Mental Health Visits) are not charged to
insurance
• Laboratory Services for most labs performed at Campus Health are paid
at 100%
• Well Woman Exams are paid at 100% (labs are paid separately)
• Immunizations are paid at 100% (Hepatitis, MMR, Varicella, Tetanus,
HPV, Meningococcal & Pneumococcal)
• Treatment for Exposure to Blood Borne Pathogens is paid at 100%
• Campus Health provides students with an insurance advocate who
assists students with insurance questions and billing issues
• Campus Health accepts most insurance carriers and files claims for
patients
Providers Outside of Campus Health
The student and covered spouse should use the resources of Campus Health
Services where treatment will either be administered or a referral issued if
needed. Referrals are not required but it may cost more if using out-of-network
providers.
Covered Medical Expenses incurred for medical treatment rendered outside of
Campus Health Services, including after hours care, is subject to the applicable
copay, deductible and coinsurance.
Pediatric services are not available at Campus Health. Dependent children added
to the health plan should seek care from a licensed Pediatrician.
Doctor’s Office
(General Practitioner/Clinic/Specialists)
Most routine visits and health issues,
ongoing treatment
Examples: Family Practice, Internal
Medicine, OB/GYN, Neurologist
Minor Emergency Clinic
(Urgent Care Clinic)
If you have a non life-threatening health problem that
cannot wait, and your physician is unavailable (such as
evenings or weekends), these clinics can handle most
minor medical situations. Co-pay of $50 would apply.
Inpatient or Outpatient Hospital
Normally inpatient and outpatient hospital care is
at the direction of your doctor. This is not for
routine office visits or after hours care.
Emergency Room Care
In this type of situation, it is assumed that critical
emergency care is needed at a hospital.
You may need to call 911.
This should only be used in emergency situations.
A $150 copay would apply.
Finding a Doctor
Types of Providers
Use the AHP website to locate a doctor or
hospital
www.ahpcare.com/louisville
• Campus Health
• University of Louisville
Providers
University of Louisville
Hospital
University Physicians
• Preferred Providers
• Out of Network
Providers
In Network Providers
• Certain doctors, hospitals, and other
treatment facilities contract with a PPO
network, agreeing to provide services at a
lower cost.
• Doctors are screened for quality.
• There is less cost to you when you
receive care from a contracted healthcare
provider.
Benefit Coverage
In-Network- Preferred Providers
Preferred Allowance means the amount a Preferred Provider
will accept as payment in full for covered expenses.
Out-of-Network
Usual and Customary Charges (U&C) means the average
amount charged by most providers for treatment, service, or
supplies in the geographic area where the treatment, service
or supply is provided.
The student is responsible for costs that exceed the U&C
amount.
Benefit Coverage
Aggregate Lifetime Maximum $500,000 maximum benefit per Injury or Sickness
Tier One Provider
Preferred Provider
Out-of-Network
Provider
$250 per person
Per Policy Year
$500 per person
Per Policy Year
$1,000 per person
Per Policy Year
Inpatient Hospital
90%
80% of Preferred Allowance
70% of U&C Charges
Inpatient/Outpatient Surgery
90%
80% of Preferred Allowance
70% of U&C Charges
90% after $30
copay per visit
80% of Preferred Allowance
after $30 copay per visit
70% of U&C Charges
90%
80% of Preferred Allowance
70% of U&C Charges
Diagnostic X-Rays
deductible does not apply
90% after $25
copay per visit
80% of Preferred Allowance
after a $25 copay per visit
70% of U&C Charges
after a $25 copay per
visit
Laboratory Services
deductible does not apply
90% after $20
copay per visit
80% of Preferred Allowance
after a $20 copay per visit
70% of U&C Charges
after a $20 copay per
visit
Deductible
Physician’s Visits
Medical Emergency
$150 copay per visit
Benefit Coverage
Prescriptions
Prescriptions are classified as Generic
or as Brand-name.
Campus Health Services:
Discounted prescriptions are available.
Please call 502-852-6479 for the
Belknap Services at Cardinal Station on Central
Avenue or 502-852-6446 for the University of
Louisville Outpatient Center on Chestnut Street
United HealthCare Participating Pharmacies:
Retail:
$15 copay for Generic —
$30 copay for Brand Name
Mail-Order: up to a 90-day supply at twice
the Retail copay.
To find a UHC network pharmacy in your area,
call go to www.ahpcare.com/louisville.
Show your Student Health Insurance ID card
to the pharmacist. Your copay is listed on your ID
card.
Global Emergency Services
Medical Evacuation and Repatriation
Refer to brochure for complete information.
All care must be arranged by Assist
America/Scholastic Emergency Services in
order to be covered.
Scholastic
Emergency Services
(877) 488-9833 (inside U.S.)
or (609) 452-8570 (outside U.S.)
[email protected]
Reference Number
01-AA-AHP-05054
www.AHPCare.com/louisville
Identification (ID) Cards
ID cards will not be mailed! They can be obtained by
going to www.uhcsr.com or you may download an
application on your smart phone at My.UHCSR.com.
From either application, you can print or request a
card.
Contact the Insurance Advocate at 502-852-6519 or
send an e-mail to [email protected] if you have
questions about the insurance.
* Remember to take your medical
insurance ID card to each doctor visit.
For details on your plan call United Healthcare at (866) 907-6342,
8:30am–5:00pm CST
United Healthcare Site Information
Use this site to
print an ID card
and to view your
claims. Claim
payments are posted as
EOBs (explanation of
benefits).
Explanation of Benefits (EOB)
The EOB will indicate:
 Date of service
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Provider of service
Service rendered
Charges
Insurance payment
Patient responsibility
*Note the remark area if a service does not list an
insurance payment.
Sample Explanation of Benefits on next page.
Sample EOB
Maximize Your Benefits
1. Visit one of these offices:
Campus Health Belknap Office
Cardinal Station
215 Central Avenue, Suite 110
Louisville, KY 40292
(502) 852-6479
Health Science Center Office
U of L Health Care Outpatient Center
401 E Chestnut Street, Suite 110
Louisville, KY 40202
(502) 852-6446
2. Use University of Louisville Hospital and ULP Physicians to maximize your
benefits.
3. Use low cost generic medications.
4. Insurance is available only for the months you draw a stipend check.
5. The student health insurance plan would be secondary to any coverage provided
by a spouse, parent, guardian or individual plan.