Student Health Insurance Orientation for International Students … · Dental Benefits –19 years...
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Student Health Insurance Orientation for International Students Autumn 2018
Transcript of Student Health Insurance Orientation for International Students … · Dental Benefits –19 years...
Student Health Insurance
Orientation for International Students
Autumn 2018
Questions we will answer today:
General overview of U.S. systems
• Health insurance: Why it exists and how it works
• Health care system: Where people go for care
Specifics about your Ohio State Student Health Insurance
• What it covers
• How to use it best
• Automatic enrollment and waiver criteria
• Resources and next steps
Health Insurance in the United States
• No universal health coverage
• Individuals are responsible to pay for care
• Individuals purchase health insurance for financial protection
How it works
• You purchase a policy at a price called a “premium”
+ / ‐ You pay
Insurance pays+ / ‐
• After purchase, you still pay a portion of the cost as you use health care
• Policy reimburses providers for some costs, not all
• For coverage details, look inside your policy
• Free service = Risky assumption
Policy defines coverage
Learn the language of insurance:
shi.osu.edu > Health Insurance Literacy Tools > Terminology Translator
True or False:
If you have health insurance in the U.S., you pay nothing to get care.
False. Typically, you will pay some cost. Costs can include a flat fee (co‐pay), a percentage share(co‐insurance), or the full amount (deductible or non covered service). It depends on your policy.
Ohio State provides the SHI Benefits Plan to support student success. All international students are enrolled in the plan.
Unexpected medical bills can disrupt your academic progress Students are at high risk for illness, injury, accidents, depression, anxiety
– and, more likely to postpone care
Health insurance means more affordable, convenient, and quality care
Need: Where you go:
Care for your overall well‐being,when you are not sick
(called “preventive care”)
Doctor’s Office. Call ahead to schedule an appointment.
Primary Care doctors can provide preventive care and referrals.
Treatment for a non‐life‐threateningillness or injury,
including colds and flu
Doctor’s Office. Call ahead to schedule an appointment.
Need help within next 24‐28 hours and can’t find a doc? Try Urgent Care
Life‐threateningillness or injury
Hospital Emergency Room or call 9‐11
True or False:
In the U.S. health care system, you go to a hospital for your basic health needs.
False. Hospitals are not designed for basic health care. You should go to a doctor’s office.
Key words: Primary care, office visit, clinic, outpatient
True or False:
A primary care doctor is a doctor who looks after your overall well‐being and who can provide referrals as necessary.
True. Your primary care doctor is your main source of continual support and care.
Having and Using the
Student Health Insurance Benefits Plan
• Medical, mental health, prescription, dental and vision
• Office visits, diagnostic labs and X‐rays, physical therapy
• Surgery and outpatient procedures
• Preventive care, including some vaccines and screenings
• Year‐round coverage, can use across United States and abroad
Designed for students at Ohio State with student input * Exceeds ACA and ACHA Standards * Approved by Trustees
Deciding where to go for care:
• Provider options are grouped into “Tiers” based on the cost to you
• Tiers One and Two are lowest cost!
• Search the listings at shi.osu.edu > Find a Provider
Try these locations first:
Tier One
• Wilce Student Health Center
• Counseling and Consultation Services
• College of Optometry Clinics
• College of Dentistry Student Clinics
Search at shi.osu.edu > Find a Provider
Deciding where to go for care:
Many services covered at 100%
Student Health Services ‐ shs.osu.edu
Wilce Student Health Center
Hours: 8‐6 M‐Thurs, 8‐5 Fri, 9‐1 Sat
Not open evenings or Sundays
Counseling & Consultation – ccs.osu.edu
Younkin and Lincoln Tower
10 free sessions to all students
Additional visits for SHI members
Hours: 8‐8 M‐Thurs, 8‐5 Fri
Next try:
Tier Two:
• Costs: $150 deductible (one time), 10% co‐insurance,
$20 office visit co‐pay
• OSU Health Plan Network inside Franklin County
• UHC Options PPO Network outside Franklin County
• UHC Behavioral Health Network outside Franklin County
Search at shi.osu.edu > Find a Provider
Deciding where to go for care: Many services covered at 90% after deductible
Tiered Cost Overview Service Fee % Covered Up Front Cost
Tier One $0 100% $0Tier Two $20 90% $150Tier Three/Four $20 60% $500
Evenings and weekends? Can’t wait until Monday?
Go: Ohio State AfterHours Care at Martha Morehouse Medical Plaza• Tier 2 Benefits• Accessible by Campus Bus• 2050 Kenny Road, Suite 2250• Hours: 4‐9:30 M‐F, 10‐5:30 Sat and Sun
Call: HealthiestYou Telemedicine• Phone number is on your Insurance Member ID Card• Hours: 24/7• Free!
True or False:
If you utilize services covered by Student Health Insurance, your costs will be the same wherever you go.
False. Providers at Tier 1 will cost you the least, and Tier4 the most. Visit shi.osu.edu > Find a Provider for details.
True or False:
If you are very sick and getting worse but the Wilce Student Health Center is closed, you should stay at home until they open.
False. If you need help and no campus resources are available, you can visit an Urgent Care, call HealthiestYou, or in an emergency, go to the ER / call 911.
Preventive care – Care before you get sick
• Annual wellness exam ‐ 100% paid
• Certain cancer screenings – 100% paid
• Certain immunizations – 100% paid
• Adult Dental – 2 exams each year for $17 copay at SHS/College of Dentistry
• Vision – Annual exam for $15 copay at SHS/College of Optometry
Vision Exam:• One per Plan Year• SHI pays 100% after a $15 co‐pay at Wilce Student Health Center or College of Optometry Clinic
• SHI pays up to $50 elsewhere after $20 copay• Vision Exam with contact lens evaluation = $15 exam co‐pay + $25 CL evaluation co‐pay
Glasses / Contact Lenses:• Wilce Student Health Center or College of Optometry
Clinic• $100 allowance for glasses or contact lenses (students
only)
Vision Benefits
Dental Benefits – 19 years and older
• $750 annual maximum• Exams and Cleanings:
• 2 Exams and Cleanings per Plan Year• Other Preventive and Basic Procedures:
• Simple extractions, amalgam and composite restorations, x‐rays, single crowns
• Go to the Wilce Student Health Center or OSU College of Dentistry Student Clinic ; $17 co‐pay
Show your Delta Dental card to your provider
Dental Benefits – 18 years and younger
• $500 deductible per person, can see any provider • 50% coverage:
• 2 Exams and Cleanings per Plan Year• Preventive and Basic Procedures (i.e. simple extractions,
amalgam and composite restorations, x‐rays)• Single crowns
Show your UHCSR card to your provider
Dental Benefits – 18 years and younger
• UHCSR Primary coverage: $500 individual deductible, 50% coverage• Delta Dental Secondary coverage: reduces that expense!
• Use SHC, College of Dentistry Student Clinic, or Delta Dental PPO and Premier providers to utilize both your primary and secondary coverage
• 2 Exams and Cleanings per year • Preventive and Basic Procedures (i.e. simple extractions,
amalgam and composite restorations, x‐rays)• Single crowns
Show your UHCSR card and your Delta Dental card to your provider. Ask them to bill both.
Provider writes prescription and you pick up at pharmacy
Pharmacy locations to try first: • Wilce Student Health Center Pharmacy• Any HealthSmart RX network pharmacy
Formulary = list of specific drugs covered by your policyNot all drugs are on it. Visit shi.osu.edu > About SHI Benefits PlanNon‐formulary = $$$
Your co‐pay:
Prescription Drug Benefit
• 10% generic • 20% formulary brand • 50% non formulary
• $10 minimum payment
24/7 Medical and Travel Emergency Assistance Services
Provided by UnitedHealthcare Global
Visit www.uhcsr.com/uhcglobalInformation is on your ID card
IMPORTANT: CALL UnitedHealthcare Global BEFORE you travel or utilize the service
True or False:
True. Formularies organize drugs by generic ($), brand ($$), and brand non‐formulary ($$$) categories.
What you pay for a certain prescription will depend on whether the drug is on the formulary and what category it is in.
Visit shi.osu.edu
For International Students > What do I do if …
About the SHI Benefits Plan:
Member Overview Booklet• Highlights commonly used benefits
Summary Brochures • Details inclusions and exclusions
Find a Provider page• Search tools
Student Health Insurance has a dedicated staff to assist you! Visit us at
Lincoln Tower, 11th floorRoom 1100
8am ‐ 5pm M‐F
Ohio State partners with several other organizations:
Member ID Card is your proof of insurance
You must show it when you use services!
• August 14: Welcome email arrives in your OSU account
• Contains instructions to print electronic ID cards
• Medical ID cards are not mailed to your home address
• Dental ID cards are not mailed to your home address• Verify your Home/Current Address in My Buckeye Link
before September 1!
Explanation of Benefits (EOB)
• Document you receive in mail from the HealthSmart
• Describes if and how much your insurance plan is paying on your claim
• NOT A BILL. Do not pay upon receipt!
• Check your mail. You may need to respond to HealthSmart questions
• Note: No claims or EOBs are required for services at Tier 1 locations
HealthSmart processes your insurance claims
• Claim = How your provider bills your insurance for services provided
• Insurance pays its portion of the claim
• Provider then bills you for your portion
True or False:
If you have a question about Student Health Insurance, there is no campus resource available to help you.
False. There is an office staffed Monday through Friday 8am‐5pm, and we answer phone calls and emails M‐F as well.
True or False:
If you get mail from UnitedHealthcare or HealthSmart, throw it away. They are just trying to sell you something extra.
False! These companies partner with Ohio State’s Student Health Insurance. They will be sending you important documents regarding your Ohio State benefits.
True or False:
False. EOBs are real‐time updates on how a bill is being prepared. Do not pay an EOB. Pay in response to a bill.
If you get an Explanation of Benefits in the mail that shows a dollar amount due, you should immediately send money to HealthSmart.
When does my automatic Student Health Insurance enrollment occur?
After you register for classes on Buckeye Link, the SHI fee will appear on your Statement of Account.
The level of coverage defaults to Student Only.
Step‐by‐step instructions available
at shi.osu.edu
Deadline to add dependents: August 14
Fee on your Statement of Account confirms your coverage
fee = your “premium”
Fees
• Payable 2 times per year: Autumn and Spring
2018‐19 semester rates:
• $1626 Student Only
• $3252 Student + Spouse or Child
• $4878 Student + Spouse + Child / Student + 2 or more children
• $6504 Student + Spouse + 2 or more children
If your department pays 85% of your fee:• Your 15% will be deducted from the first 4 monthly paychecks
of each semester– Sept, Oct, Nov, Dec | Jan, Feb, Mar, April
Contact Buckeye Link Office at 614‐292‐0300 or [email protected]
Students receiving Graduate Subsidy
2018‐19 Dates: August 14, 2018 to August 12, 2019
Automatic enrollment is in effect year‐round • As long as you remain enrolled in classes
Spring enrollment includes summer• You do not have to be enrolled in courses for Summer Term
Qualifying Events• Allow you to add coverage• View our website or contact office within 31 days
True or False:
False. The fee appears two times a year on your Statement of Account – Autumn, and Spring.
You are billed once per year for your Student Health Insurance.
Who is eligible for a waiver?
One of the following:
You’re covered under a US‐based health insurance policy as a US‐based employee, or as a dependent of a US‐based employee
You have permanent residency status (a green card)
A government purchases an insurance policy that meets the Minimum Health Insurance Criteria on your behalf and fully financially sponsors you
Submit online: shi.osu.edu > Important Forms > Petition to Waive
Minimum Health Insurance Criteria
1. No limit on benefits2. An annual deductible < $5003. Pays 90% of U.S. based Reasonable and Customary charges for inpatient or
outpatient emergency, urgent or routine treatment for: medical, mental, prescriptions, and immunizations and screening tests per federal requirements
4. No exclusions for pre‐existing conditions, suicide, self‐inflicted injury, pregnancy, sexually transmitted diseases/infections, HIV/Immune deficiency disorders, cancer, alcohol/drug related conditions, recreational injuries.
5. Company has locations in U.S. and is licensed to do business in the U.S.6. Effective for the duration of the academic year or program7. Covers medical and mental health care in your campus location8. You aren’t required to leave the U.S. to receive care9. Includes payment for medical evacuation and repatriation expenses
• Review and read your emails and mail! • Confirm your Home/Current Address in My Buckeye
Link
• Read your policy and search for providers at shi.osu.edu
• Promptly review EOBs and bills
• Pay co‐pays, co‐insurance and deductible
Next steps:
• Once you have enrolled in classes, confirm your automatic SHI enrollment by checking your Statement of Account
• To add a spouse or children, follow instructions in My Buckeye Link Select/Waive Coverage before August 14
• If you meet waiver criteria, complete Petition to Waive online at shi.osu.edu > Important forms
Next steps:
Questions?
