graduate research or teaching assistant health insurance
TRANSCRIPT
Graduate Research or Teaching Assistant
Health Insurance
Student Medical Insurance
• 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.
Coverage offered through
• 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
Benefits of the Student Policy
• 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.
U of L 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
Student Health Insurance Coverage at Campus Health Services
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.
Providers Outside of Campus Health
Most routine visits and health issues, ongoing treatment
Examples: Family Practice, Internal Medicine, OB/GYN, Neurologist
Doctor’s Office(General Practitioner/Clinic/Specialists)
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.
Minor Emergency Clinic (Urgent Care Clinic)
Normally inpatient and outpatient hospital care is at the direction of your doctor. This is not for routine office visits or after hours care.
Inpatient or Outpatient Hospital
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.
Emergency Room Care
Finding a DoctorTypes of Providers
• Campus Health
• University of Louisville Providers
University of Louisville Hospital
University Physicians
• Preferred Providers
• Out of Network Providers
Use the AHP website to locate a doctor or hospital
www.ahpcare.com/louisville
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.
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
Benefit CoverageAggregate Lifetime Maximum $500,000 maximum benefit per Injury or Sickness
Tier One Provider Preferred Provider Out-of-Network Provider
Deductible $250 per personPer Policy Year
$500 per personPer Policy Year
$1,000 per personPer 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
Physician’s Visits 90% after $30 copay per visit
80% of Preferred Allowance after $30 copay per visit
70% of U&C Charges
Medical Emergency$150 copay per visit
90% 80% of Preferred Allowance 70% of U&C Charges
Diagnostic X-Raysdeductible 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 Servicesdeductible does not apply
90% after $20copay per visit
80% of Preferred Allowance after a $20 copay per visit
70% of U&C Charges after a $20 copay per
visit
PrescriptionsPrescriptions 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.
Benefit Coverage
Medical Evacuation and RepatriationRefer to brochure for complete information. All care must be arranged by Assist America/Scholastic Emergency Services in order to be covered.
Global Emergency Services
Scholastic Emergency Services (877) 488-9833 (inside U.S.)
or (609) 452-8570 (outside U.S.)
Reference Number 01-AA-AHP-05054
www.AHPCare.com/louisville
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
Identification (ID) Cards
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 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 Benefits1. Visit one of these offices:
Campus Health Belknap Office Health Science Center OfficeCardinal Station U of L Health Care Outpatient Center215 Central Avenue, Suite 110 401 E Chestnut Street, Suite 110Louisville, KY 40292 Louisville, KY 40202(502) 852-6479 (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.