An Introduction to Healthcare & Insurance at

The University of Chicago

STUDENT HEALTH AND COUNSELING SERVICES

• Student Health Service (SHS) 860 E. 59th St. (at Drexel, Goldblatt Pavilion Entrance), R-100 (773) 702-4156 healthcare.uchicago.edu

• Student Counseling Service (SCS) 5555 S. Woodlawn 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

Accessing Healthcare at UC

• All registered students* pay a quarterly Student Life Fee – Provides access to primary medical and mental health care at Student

Health Service and Student Counseling Service

• Health services covered by the Student Life Fee: e.g., acute/chronic primary care, routine physicals, short-term

psychotherapy, academic/study skills counseling, etc.

• Private insurance / U-SHIP covers: – Prescriptions, lab tests, hospitalizations, ER care, long-term

psychotherapy, consultation and treatment by specialists, etc.

*applies to students enrolled in insurance-eligible programs

Student Life Fee vs. Health Insurance

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)

Where to Go for Services

Graham programs providing U-SHIP coverage:• GSAL• Returning Scholar• UTEP

Graham programs exempt from U-SHIP (must opt-in for coverage)• MLA• Master of Science, Analytics• Master of Science, Threat & Response Management• Returning Scholar, Graham in GSB• Masters in Biomedical Infomatics

Insurance Eligibility at The Graham School

• UC requires ALL students to have good health insurance

• All registered students* enrolled annually in University Student Health Insurance Plan (U-SHIP)

• Deadline: by 4th Friday of one’s first registered quarter, each year, students must either:– Waive out of U-SHIP (comparable coverage required) or– Enroll dependents

Autumn 2015 deadline – 5pm Central time, Friday, Oct. 23rd

• Students’ insurance selection applies for entire academic year

Confirm or waive U-SHIP enrollment at:http://studentinsurance.uchicago.edu

*applies to students enrolled in insurance-eligible programs

University Annual Insurance Requirements

• Enrollment in U-SHIP is on an annual basis: plan year runs from Sept. 1, 2015 – August 31, 2016

• U-SHIP coverage is tied to students’ registration status

• If a U-SHIP-enrolled student does not have an active registration status in a specific quarter, their coverage is not active that quarter

• Please note: coverage returns to active status in subsequent quarter if student returns to UC registered status, in current plan year

• Spring registration impacts summer enrollment status

U-SHIP Coverage & UC Enrollment

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 maximum amount of money you are expected to pay annually for medical costs before your plan starts to cover expenses at 100%.

• 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” at https://studenthealth.uchicago.edu/insurance

Navigating Health Insurance

• 2015-2016 Premium – $3,432 (billed in 3 installments of $1,144)

• Deductible – $500 (in-network); $1,000 (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 ($10, $25, $40)• $20 co-pay for doctor/specialist visits• $10 co-pay for psychotherapy with SCS community providers (SCS

referral required)

Navigating Health Insurance: U-SHIP

• These costs are interconnected• Consider how changes in one impacts the others• Consider YOUR individual health needs in assessing plans

Understanding Health Insurance Costs

Here’s a comparison of U-SHIP and two alternate plans:

And here’s what it would look like if you faced a $5,000 medical bill:

Assessing Health Insurance: A Comparison

U-SHIPLand of Lincoln PPO

SilverISO-Care ("ACA Comparable")

Premium $3,432 $1,524 $2,148Deductible $500 $1,500 $500Annual Out-of-Pocket $1,500 $6,450 $6,350Co-insurance 90% 70% 80%

U-SHIPLand of Lincoln

PPO SilverISO-Care ("ACA Comparable")

Total billed amount $5,000 $5,000 $5,000 Deductible owed $500 $1,500 $500Co-insurance owed $450 $1,050 $900 Total amount due $950 $2,550 $1,400 % of O-O-P covered 63% 40% 22%

2015-16 Comparable Coverage RequirementsTo qualify to waive U-SHIP, all alternate insurance plans must provide the following:Routine and emergency care provided in the Chicago area (or local area where student will be residing and studying for the academic year)

Treatment for pre-existing conditions (with no waiting periods or exclusions)Essential health benefits as defined by the Affordable Care Act (ACA): Outpatient care (ambulatory patient services) Emergency Services Hospitalization (treatment for inpatient care) Mental health services and addiction treatment Prescription drugs Maternity and newborn care Rehabilitative services and devices Laboratory services Inpatient mental health care Preventive services, wellness services, and chronic disease treatment Pediatric services

Plan has a claims administrator based in the U.S., a U.S. telephone number and address for submission of claims, and the insurance policy was issued in the U.S.

Coverage for medical evacuation and repatriation expenses: Required for all F1 / J1 students

Required for all other students ONLY when they will be studying / traveling / doing research out of the United States during the current academic year (otherwise exempt and can check “yes”)

Active coverage from the day student arrives on campus through either August 31, 2016 OR the end of their academic program (whichever comes first)

Plans must have a U.S.-based claims administrator and be issued in the U.S.• Plans issued outside U.S. require students to pay up front for medical

costs• Costs for medical care in U.S. can be very expensive prior to insurance

Adjustment to medical evacuation / repatriation requirement• Coverage required for all students in F1 / J1 status• Coverage required for al other students only when they will be

studying / traveling out of U.S. during current academic year

Remember: a random subset of waiver applications will be audited to ensure compliance with requirements!

Comparable Coverage Changes for 2015-2016

U-SHIP “My Account”• Create or log into your account at www.uhcsr.com/uchicago

UnitedHealthcare Student ResourcesOn-campus Insurance Coordinators:• Hours: Mon-Fri: 8:30am – 4:30pm• Woodlawn Social Services Center,

950 E. 61st Street, rooms 368/370• 773-834-4543 (press option #2) or

uchicagoadvocates@uhcsr.com

Home Office:• Customer Service: 866-348-8472• customerservice@uhcsr.com

U-SHIP Contact Information

U-SHIP MyAccount access information: www.uhcsr.com/uchicago

Create or log into My Account to:• Download an insurance I.D. card• Check benefits status and policy details• Check claims status and EOBs • Locate network providers• Access pharmacy benefit information

24/7 Access To U-SHIP “ MY ACCOUNT”

Benefit Highlights Cigna DHMO Delta PPO UHC "Low Plan"*Cleanings (2 annually) 100% 100% 100% / 60%

Fillings Co-pay per procedure 80% 100% / 60%

Oral Surgery Co-pay per procedure 80% 0% / 0%

Maximum annual benefit None$2,000 (12-mos plan);

$750 (6-mos plan) $500 *indicates in-network/out-of-network rates that plan pays

OPTIONAL DENTAL PLANS

For additional information on optional dental coverage, see:https://studenthealth.uchicago.edu/2015-2016-dental

OPTIONAL VISION PLANS

For additional information on optional vision coverage, see:https://studenthealth.uchicago.edu/2015-2016-vision

Health care access:• SHS / SCS – covered by Student Life Fee• Add’l testing, specialists, etc. – covered by insurance

Comparing alternate insurance plans:• Consider impact of all costs: premium, deductible, out-of-pocket

max, co-insurance, co-pays• Look at value when faced with actual medical expenses• Must meet UC requirements for comparable coverage• Consider how your course schedule impacts your health needs!

Summing Up – Health Care at UC

Questions?

studenthealth.uchicago.edu/insurance