Transcript Introduction to Healthcare and Insurance at UChicago

An Introduction to Healthcare
& Insurance at
The University of Chicago
STUDENT HEALTH AND COUNSELING SERVICES
Accessing Healthcare at UC
• Student Health Service (SHS)
860 E. 59th St. (Goldblatt Pavilion Entrance), R-100
(773) 702-4156
healthcare.uchicago.edu
• Student Counseling Service (SCS)
5737 S. University Avenue
(773) 702-9800
counseling.uchicago.edu
• Health Promotion & Wellness (HPW)
Woodlawn Social Services Center, 950 E. 61st St., 3rd floor
(773) 702-8247
wellness.uchicago.edu
Student Life Fee vs. Insurance (U-SHIP)
• All registered students pay a quarterly Student
Life Fee.
– Provides access to Student Health Service and Student
Counseling Service
• Health services covered by the Student Life Fee:
e.g., acute/chronic care, routine physicals, short-term
psychotherapy, academic/study skills counseling, etc.
• Private insurance / U-SHIP covers:
– Prescriptions, hospitalizations, ER care, lab tests, long-term
psychotherapy, consultation and treatment by specialists, etc.
Where to Go for Services
Primary medical and mental health care,
wellness programming:
• Covered by Student Life Fee & provided by SHS, SCS, HPW
Referrals provided to specialists / for tests
• If on U-SHIP, referral required from SHS/SCS; if referral is
not obtained in advance, $50 penalty is assessed
Is it an Emergency?
• If SHS closed, call 24-hour Nurse Advice Line –
773.702.1915 – to determine if ER services are required
(otherwise, claim may be denied)
Student Health Insurance Plan: U-SHIP
• UC requires ALL students to have adequate health
insurance
• All registered students enrolled annually in U-SHIP
• Deadline: by 4th Friday of one’s first registered
quarter, each year, all students must either:
– Waive out of U-SHIP (comparable coverage required) or
– Enroll dependents
• Students remain enrolled for the full academic year
Enroll or waive at:
http://studentinsurance.uchicago.edu
Navigating Health Insurance
Insurance Terminology
• Premium – The amount of money – generally paid on a monthly,
quarterly or annual basis – that you pay to cover the cost of your
health insurance.
• Deductible – The amount you need to pay before your insurance
plan starts to cover your medical costs.
• Annual out-of-pocket maximum – The amount your insurance
plan does not pay and you are expected to pay.
• Co-insurance – A percentage of the cost of your treatment that
you are required to pay (i.e., 10%, 20%, or 30% typically), after
your plan’s deductible has been fully paid.
For additional help, see the “Health Insurance Glossary” on the SCHS website:
studenthealth.uchicago.edu
Navigating Health Insurance : U-SHIP
• 2013-2014 Premium – $3,021
(billed in 3 quarterly installments of $1,007)
• Deductible – $200 (in-network); $500 (out-of-network)
• Annual out-of-pocket maximum –
$1,500 (in-network); $2,500 (out-of-network)
• Co-insurance – 10%; plan pays 90% after deductible
has been met
• Prescriptions paid by co-pay, 3 tiers of coverage
($10, $25, $40)
Navigating Health Insurance : U-SHIP Example
You’re running across the quad, slip on the ice, and break your leg. Ooops. SHS
refers you to a specialist who sends you to X-ray, then sets your leg, and gives
you a cast. When the cast is removed, you are referred to 12 sessions of physical
therapy. Here’s the bill, BEFORE insurance, and with U-SHIP applied:
Aggregated doctor/hospital bill:
What you’re responsible for:
Specialist visit (with tests):
$ 3,480
Deductible:
Cast & crutches:
$
(balance is now $ 11,277)
Follow-up doctor’s visit:
$ 2,750
U-SHIP covers 90% ($10,149.30)
Physical therapy:
$ 4,320
Co-insurance costs (10%): $ 1,127.70
Total billed costs:
$ 11,477
927
Your total bill for injury:
$ 200.00
$ 1,327.70
Alternative Insurance Examples
Here are two more possibilities, with two alternate insurance plans:
UHC Internat’l Plan
ISO Plan
$ 1,754
Premium
$1,428
$350
Deductible
$500
$7,500
Out-of-Pocket
$1,500
80%
Co-insurance
80%
Here’s how the insurance scenario plays out:
UHC Internat’l Plan
ISO Plan
$ 11,477
Total billed amount
$ 11,477
$350
Deductible owed
$500
$2,225.40
Co-insurance owed
$2,195.40
$2,575.40
Total amount due
$2,695.40
$4,329.40
Total paid (w/ premium)
$4,123.40
Alternative Insurance: Comparable Coverage
To waive U-SHIP, students must have active insurance
with comparable coverage:
2013-2014 plan year
• Alternate plans must include list of UC-designated required benefits
• Must provide benefits at established coverage levels (i.e., 80%)
2014-2015 plan year – requirements tied to ACA
• Alternate plans must include ACA “essential health benefits”
• Individual plan out-of-pocket maximum < $6,350
• Family plan out-of-pocket maximum < $12,700
• Must also provide coverage for non-emergency care in Chicago!
Provides greater flexibility for students and families
Wider range of plans will meet requirements to waive coverage
Researching Alternatives to U-SHIP
To waive U-SHIP, alternate insurance plans must:
• Meet University requirements for comparable coverage
• Be active from the time of the student’s arrival on
campus through the end of their program
or the end of the current academic year
Beginning in 2014-2015, a subset
of alternate insurance plans will be
audited for compliance.
Accessing Insurance Assistance at UC
Student Health Insurance office
• Woodlawn Social Services Center, 950 E. 61st Street, 3rd floor
United Healthcare Student Resources
On-campus insurance reps: Sue Williams & Janice Thomas
• Mon-Fri, 8:00 am-4:30 pm, rooms 368 / 370
• 773.834.4543 (option #2) or [email protected]
UC Student Health Insurance Coordinator
Student advocate: Marcy J. Hochberg
• Mon-Fri, 8:30 am-5:00 pm, room 366
• 773.702.1279 or [email protected]
ONE SERVICE <<< MULTIPLE LOCATIONS
Summing Up – Affording Health Care at UC
Health care access:
• Student Health / Student Counseling – covered by
Student Life Fee
• Additional services, testing, specialists – covered by
insurance
Reviewing alternate insurance plans:
• Consider impact of all costs: premium, deductible, outof-pocket max, co-insurance, co-pays
• Must meet UC requirements for comparable coverage
• Review exclusions carefully!
Questions?
shcs.uchicago.edu