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

• 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

Deductible Inpatient Hospital Inpatient/Outpatient Surgery Physician’s Visits Medical Emergency

$150 copay per visit

Diagnostic X-Rays

deductible does not apply

Laboratory Services

deductible does not apply

Tier One Provider

$250 per person Per Policy Year 90% 90% 90% after $30 copay per visit 90% 90% after $25 copay per visit 90% after $20 copay per visit

Preferred Provider

$500 per person Per Policy Year 80% of Preferred Allowance 80% of Preferred Allowance 80% of Preferred Allowance after $30 copay per visit 80% of Preferred Allowance 80% of Preferred Allowance after a $25 copay per visit 80% of Preferred Allowance after a $20 copay per visit

Out-of-Network Provider

$1,000 per person Per Policy Year 70% of U&C Charges 70% of U&C Charges 70% of U&C Charges 70% of U&C Charges 70% of U&C Charges after a $25 copay per visit 70% of U&C Charges after a $20 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 card. 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 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:

      D ate of service 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.