Student Health Insurance Orientation for International Students Autumn 2018

Transcription

1 Student Health Insurance Orientation for International Students Autumn 2018

2 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

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

6 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.

7 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

8 Need: Care for your overall well being, when you are not sick (called preventive care ) Where you go: Doctor s Office. Call ahead to schedule an appointment. Primary Care doctors can provide preventive care and referrals. Treatment for a non life threatening illness or injury, including colds and flu 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

9 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

10 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.

11 Having and Using the Student Health Insurance Benefits Plan

12 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

13 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

14 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

15 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

16 Deciding where to go for care: 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 Many services covered at 90% after deductible

17 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

18 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!

19 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 Tier 4 the most. Visit shi.osu.edu > Find a Provider for details.

20 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.

21 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

22 Vision Benefits 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 copay + $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)

23 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

24 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

25 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.

26 Prescription Drug Benefit 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 policy Not all drugs are on it. Visit shi.osu.edu > About SHI Benefits Plan Non formulary = $$$ Your co pay: 10% generic 20% formulary brand 50% non formulary $10 minimum payment

27 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 travel or utilize the service

28 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.

29 Visit shi.osu.edu

30 For International Students > What do I do if

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

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

33 Ohio State partners with several other organizations:

34 Member ID Card is your proof of insurance You must show it when you use services! August 14: Welcome 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!

35 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 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

36 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.

37 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.

38 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 real time updates on how a bill is being prepared. Do not pay an EOB. Pay in response to a bill.

39 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.

40 Step by step instructions available at shi.osu.edu Deadline to add dependents: August 14

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

43 Fees Payable 2 times per year: Autumn and Spring 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

44 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

45 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

46 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.

47 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

48 Minimum Health Insurance Criteria 1. No limit on benefits 2. An annual deductible < $ 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 program 7. Covers medical and mental health care in your campus location 8. You aren t required to leave the U.S. to receive care 9. Includes payment for medical evacuation and repatriation expenses

49 Next steps: Review and read your s 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

50 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

51 Questions?

52 Contact us: Lincoln Tower 11th floor, 1800 Cannon Drive shi.osu.edu