Student Health Insurance Orientation for International Students Autumn 2017

Transcription

1 Student Health Insurance Orientation for International Students Autumn 2017

2 Topics today: General overview of U.S. systems Health insurance: Why it exists, 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

3 Health Insurance in the United States No universal health coverage Individuals are responsible to pay for care Individuals purchase health insurance for financial protection

4 How it works You purchase a policy at a price called a premium 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 + / - + / - You pay Insurance pays Policy defines coverage

5 Examples of our responsibility Copays Flat fees per service Coinsurance Percentage of total service cost Deductible None, some, or all may apply (depends on policy) Initial dollar amount threshold to pay towards first

6 Learn the language of insurance: shi.osu.edu > Health Insurance Literacy Tools > Terminology Translator

7 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, a percentage share, or the full amount. It depends on your policy.

8 Ohio State provides the SHI Benefits Plan to support student success. 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

9 Need: Care for your overall well-being, when you are not sick (called primary care ) Where you go: Doctor s Office. Call ahead to schedule an appointment. Primary Care Doctors can provide referrals. Treatment for a non-life-threatening illness or injury, including colds and flus Doctor s Office. Call ahead to schedule an appointment. Need help within next hours and can t find a doc? Try Urgent Care Life-threatening illness or injury Hospital Emergency Room or call 9-11

10 True or False: In the U.S. health care system, you go to a hospital for your basic health needs. False. We do not typically use the hospital first. Instead we see our doctors and providers at office locations. Office locations are sometimes called outpatient locations.

11 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.

12 Having and Using the Student Health Insurance Benefits Plan

13 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

14 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

15 Deciding where to go for care: Try these locations first: Tier One Wilce Student Health Center Counseling and Consultation Services College of Optometry Clinics College of Dentistry Student Clinics Many services covered at 100% Search at shi.osu.edu > Find a Provider

16 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 Addition visits for SHI members Hours: 8-8 M-Thurs, 8-5 Fri

17 Tier One Coverage Highlights At Tier One locations Annual check up visit (Primary Care) Annual women s services Immunizations and Cancer Screenings* Psychotherapy and Psychiatry Adult Dental Exam and Cleanings (2x) Annual Vision Exam Annual Vision Exam w/ Contact Lens Eyewear allowance per year 100%, no deductible 100%, no deductible 100%, no deductible 100%, no deductible 100% after $17 cleaning, no deductible 100% after $15 copay, no deductible 100% after $40 copay, no deductible $100 toward discounted glasses or contacts *As appropriate for age and risk, based on government guidelines see policy

18 Deciding where to go for care: Next try: Tier Two: 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 Many services covered at 90% after deductible Tier 2 Costs: $150 deductible (one time), 10% and $20

19 Tiered Cost Overview Service Fee % Covered Up Front Cost Tier One $0 100% $0 Tier Two $20 90% $150 Tier Three/Four $20 60% $500

20 Evenings and weekends? Can t wait until Monday? Go: Ohio State AfterHours Care at Martha Morehouse Medical Plaza Tier Two option & 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!

21 True or False: If you utilize services covered by Student Health Insurance, your costs will be the same wherever you go. False. Certain locations will be much more affordable for you, per the Tiered list structure of your SHI Benefits Plan. Choosing providers in Tiers 1 or 2 will provide best coverage. Visit Find a Provider for details.

22 True or False: If you are very sick and getting worse but the Wilce Student Health Center closed, you should stay at home until they open. False. Please don t postpone! Use our resources to plan ahead. Visit an Urgent Care, call HealthiestYou phone number, or in an emergency, go to the ER or call 911.

23 Prescription Drug coverage Provider writes prescription, 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 policy Not all drugs are on it. Visit shi.osu.edu > About SHI Benefits Plan Non-formulary = $$$. You pay: 10% generic 20% formulary brand 50% non formulary drugs $10 minimum payment

24 24/7 Medical and Travel Emergency Assistance Services - Provided by UnitedHealthcare Global Visit Information is on your ID card IMPORTANT: CALL UnitedHealthcare Global BEFORE you go or utilize

25 True or False: What you pay for a certain prescription will depend on whether the drug is on the formulary and what category it is in. True. Formularies organize drugs by generic ($), brand ($$), and brand non-formulary ($$$) categories.

26 visit shi.osu.edu

27 For International Students > What do I do if

28 About the SHI Benefits Plan: Member Overview Booklet Highlights commonly used benefits Summary Brochures Details inclusions and exclusions Find a Provider page Search tools

29 Student Health Insurance has a dedicated staff to assist you. Visit us! Lincoln Tower, 11th floor, Room am - 5pm shi_info@osu.edu

30 Ohio State partners with several other organizations:

31 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 Explanation of Benefits (EOB): Document you receive in mail from the HealthSmart Describes how/if insurance is calculating portion shares NOT A BILL. Do not pay upon receipt! Check your mail. You may need to respond to HealthSmart questions

32 Member ID Card is your proof of insurance You must show it when you use services! August 15: Welcome arrives in your OSU account Contains instructions to print electronic ID cards End of September: Permanent medical Member ID card arrives via U.S. Mail from UnitedHealthcare Verify your Home/Current Address in My Buckeye Link before September 1! No dental card mailed electronic access only

33 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 s M-F as well.

34 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.

35 True or False: If you get an Explanation of Benefits in the mail that shows a dollar amount due, you should immediately send money to HealthSmart. False. EOBs are not bills. They show you how the accounting is being processed. Do not pay an EOB!

36 Enrollment in Student Health Insurance is automatic for all eligible students. When: After you register for classes at Buckeye Link Fee then appears on your Statement of Account The coverage defaults to Student Only level.

37 Step-by-step instructions available at shi.osu.edu Deadline to add dependents: August 15

38 Fee on your Statement of Account confirms your coverage fee = your premium

39 Fees Payable 2 times per year: Autumn and Spring semester rates: $1497 Student Only $2994 Student + Spouse or Child $4491 Student + Spouse + Child / Student + 2 or more children $5988 Student + Spouse + 2 or more children

40 For students receiving Graduate Subsidy 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 or buckeyelink@osu.edu

41 Automatic enrollment is in effect year-round, as long as you remain enrolled in classes Dates: August 15, 2017 to August 13, 2018 Spring enrollment includes summer - you do not have to be enrolled in courses for Summer Terms Qualifying Events allow you to add coverage view our website or contact office within 31 days

42 Note about Pediatric Dental (members under 19) Show your UHCSR Member ID Card and your Delta Dental card to your providers. Ask them to bill both. Locations: Use Student Health Services, College of Dentistry Student Clinic, or Delta Dental PPO and Premier providers

43 True or False: You are billed once per year for your Student Health Insurance. False. The fee appears two times a year on your Statement of Account Autumn, and Spring.

44 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

45 Next steps: Carry your card Read mail, take action as needed Use our web tools Read your s and mail! Confirm your Home/Current Address in My Buckeye Link Visit shi.osu.edu and utilize resources. Promptly meet your financial responsibility (copays, coinsurance, deductible)

46 Next steps: Once you re enrolled in classes, confirm your automatic SHI enrollment by checking your Statement of Account To add spouse or children, follow instructions in My Buckeye Link Select/Waive Coverage before August 15 If you meet waiver criteria, complete Petition to Waive online at shi.osu.edu > Important forms

47 Questions?

48 Thank you! Welcome to Ohio State! Lincoln Tower 11th floor, 1800 Cannon Drive shi.osu.edu