WHAT WILL WORK BEST FOR ME AND MY FAMILY?

Transcription

1 WHAT WILL WORK BEST FOR ME AND MY FAMILY? Compare to the Ohio State Student Health Insurance Benefits Plan ( SHI Benefits Plan ) single student coverage SHI BENEFITS PLAN Average Monthly Premium $271 SHI BENEFITS PLAN - TIER 1 Enhanced Coverage on Campus Locations: Student Health Services (SHS), Counseling and Consultation Services (CCS), College of Dentistry Student Clinic and College of Optometry Clinic Deductible: $0 SERVICE LOCATION COVERAGE Office Visit SHS Tax ID % Annual Physical Exam SHS Tax ID % Physical Therapy SHS Tax ID % Diagnostic Labs SHS Tax ID % Outpatient Psychotherapy CCS 100% Outpatient Psychiatry CCS 100% Routine Vision Exam* SHS or College of Optometry 100% after $15 copay Routine Dental Exam* SHS or College of Dentistry 100% after $17 copay *For students age 19 and older. Pediatric coverage is a separate benefit. This is for comparison purposes only and is not a complete list of benefits. For additional information including limitations and

2 Preferred Provider Coverage in all 50 states Locations: OSU Health Plan network providers inside Franklin County, Ohio; United Healthcare Options PPO network providers outside Franklin County, Ohio. Combined Medical, Mental Health, Vision and RX Deductible: $150 Out-of-Pocket Maximum: $2,700 SERVICE Office Visit COVERAGE Annual Physical Exam 100% Emergency Room Urgent Care Physical Therapy Diagnostic Labs Outpatient Psychotherapy Outpatient Psychiatry Routine Vision Exam 90% after $100 copay 90% after $25 visit fee 90% after deductible 90% after deductible 100% up to $50 limit after $20 copay PRESCRIPTION COVERAGE AT SHS AND RETAIL PHARMACIES* Formulary Generic 90% Formulary Brand, No Generic 80% Formulary Brand with a Generic 50% DENTAL COVERAGE AT DELTA DENTAL PPO DENTISTS** Dental Deductible: $50 Policy Year Maximum Dental Benefit $750 Routine Dental exam (two per policy year) 70% X-Rays 70% *Any retail pharmacy in national HealthSmart RX network. **For students age 19 and older. Pediatric dental is a separate benefit. This is for comparison purposes only and is not a complete list of benefits. For additional information including limitations and

3 Maya Buckeye s Sinus Infection Maya has a sinus infection and goes to the Student Health Services on Columbus campus. The services she receives total $150. SHI BENEFITS PLAN - TIER 1 Deductible $0 Office Visit Copay $0 Laboratory Services Coinsurance $0 THE TOTAL MAYA WOULD PAY* $0 Ahmad Buckeye s Serious Car Accident Ahmad fully recovers from a serious car accident after receiving inpatient emergency care and outpatient therapy at Preferred Providers. The services he receives total $20,000. Deductible $150 Emergency Room Copay Waived Upon Admission Inpatient Coinsurance $1,900 Physical and Rehabilitative Therapy Coinsurance He reaches the $2,700 Out-of-Pocket Maximum after paying $650 toward his visits THE TOTAL AHMAD WOULD PAY* $2,700

4 Stanley Buckeye s Simple Fracture Stanley has an injury and goes to a Preferred Provider Emergency Room. The services he receives total $1,900. Deductible $150 Emergency Room Copay $100 Hospital Coinsurance $175 THE TOTAL STANLEY WOULD PAY* $425 Same Stanley Buckeye s Weekend Stomach Flu Stanley gets sick later in the same year he had his fracture (see above). He goes to a Preferred Provider Urgent Care Center. The services he receives total $300. Deductible $0 (he paid it already for his fracture) Urgent Care Visit Copay $25 Laboratory Services Coinsurance $25 THE TOTAL STANLEY WOULD PAY* $50

5 John Buckeye s ADHD John is a freshman on the Columbus campus. He was diagnosed and treated for ADHD in high school and would like to continue his treatment on campus. John is seen by a physician at the Student Health Center for his medication management. He also is seen at Counseling and Consultation Service (CCS) where his therapist recommends outpatient psychotherapy twice per month. She refers him to a Preferred Provider in the community.. SHI BENEFITS PLAN TIER 1 SHI BENEFITS PLAN TIER 2 Deductible $0 $0 Office Visit Copay at shc $0 $0 Outpatient Psychotherapy Copay at CCS $0 $0 Outpatient Psychotherapy Copay $0 $20 per visit THE TOTAL JOHN WOULD PAY* $0 $20 per visit Amy Buckeye s Anxiety and Depression Amy recently broke up with her partner of two years. She is having trouble focusing on her studies and makes an appointment at Counseling and Consultation Service (CCS). During her appointment the therapist recommends 15 sessions of outpatient therapy at CCS. Deductible $0 Outpatient Psychotherapy Copay Visits 1-10 at CCS No Charge** Outpatient Psychotherapy Copay Visits at CCS SHI BENEFITS PLAN TIER 1 SELF PAY No Charge** $0 Total Charge*** THE TOTAL AMY WOULD PAY* $0 Total Charge **All Ohio State students are eligible for 10 visits at CCS at no charge. ***CCS does not bill commercial insurance for services.