Health Insurance and Accessing Healthcare at NYU. Welcome to NYU!
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1 Health Insurance and Accessing Healthcare at NYU Welcome to NYU! 1
2 Agenda 1. Overview of SHC Services 2. Insurance Primer 3. Student Health Insurance Program Enrolling in the Plans Waiving the Plans Plan Highlights 4. Questions
3 STUDENT HEALTH AND INSURANCE AT NYU All matriculated NYU students have access to the Student Health Center services even if they don t have one of NYU s sponsored health insurance plans. Most students are automatically enrolled in an NYU sponsored health insurance plan as part of the course registration process. Please make certain you carry your health insurance ID cards. 3
4 Services Provided to All Matriculated Students Services with No Cost to You Primary Care* Women s Health* Men s Health* Short term counseling services Wellness Services Some laboratory/diagnostic tests Starter doses of some oral antibiotics Services with a Cost to You Allergy, Immunology & Travel Medicine Dermatology Physical Therapy Psychiatric Services Sports Medicine Laboratory tests X-Rays There are fees for some procedures and tests that may be performed during these visits. $10 Walk-In Fee for Urgent Care Services without an Appointment. 4
5 Types of Services VISITS are when you are examined or treated by: a physician a psychiatrist a counselor a nurse a therapist LABORATORY SERVICES involve: Any specimen from your body that needs to be analyzed to help treat you PROCEDURES include but are not limited to: X-rays Travel immunizations Allergy tests and shots Suturing cuts or lacerations Removal of skin lesions The SHC has a 24 hour hot line for any health concern
6 How Health Insurance Works You pay the premium for your insurance policy When you seek health care, you may be responsible for: a copay the specific amount you have to pay at the time of service, a coinsurance the percentage of the cost you are responsible for, or both deductible the amount you are responsible for before your insurance company starts to pay The insurance company pays their portion of the cost for the service after a deductible, if any If If you do not pay your portion of the bill at the time of bill you do not pay your portion of the billed at the by the time healthcare of service, provider s you will be office service, you will be billed by the healthcare provider s office 6
7 Know Your Health Insurance Plan Details Are you responsible for payment of deductibles, coinsurance or copayments? Does your insurance plan require you to obtain a referral or prior authorization prior to your receiving treatment? Will your health insurance company make direct payment to the health care provider or will the payment be mailed to you? What does your insurance plan cover? What is your financial obligation? Before your visit: Call the insurance company s Customer Service or Member Services telephone number indicated on your insurance card.
8 What will happen when you seek medical care? You will: register with a receptionist be asked for your insurance ID Card be asked to pay your copay responsibility. If you do not pay at that time, you will be billed. be seen by the provider A claim for the services will be submitted by the provider to your insurance company for them to pay their responsibility for the care You will be billed by the provider for your responsibility as reported by your insurance company 8
9 What is a Provider Network? A group of Doctors and Hospitals that have contracted with an Insurance Company. The insurance company evaluates and credentials providers to assure quality care. What does it mean to you? Going to a provider in your insurance company s network means you will pay less out of your own pocket Some insurance companies will not pay anything if you do not use one of their network providers It is important to know your insurance company s rules 9
10 CHP Provider Network If you have the NYU sponsored insurance, CIGNA PPO Network is the CHP Preferred Provider network. The SHC also participates in: United Health Care Commercial Plans Oxford Freedom and Liberty Plans The Student Health Center is out-of-network for all other insurance plans which utilize the Cigna PPO provider network.
11 NYU MANDATES THAT ALL MATRICULATED STUDENTS MAINTAIN ADEQUATE HEALTH INSURANCE Most students are automatically enrolled and charged for an NYU-sponsored Student Health Insurance Plan. The fee will appear as a separate line item on your tuition bill. NYU offers two WSQ health insurance plans, Basic and Comprehensive plan with the same coverage however they have different patient financial responsibility. International students in F1 or J1 status, regardless of credits, are enrolled in the Comprehensive Plan, which offers a higher level of coverage. Coverage can be downgraded to fit your needs. These plans can be waived entirely if you maintain alternate health insurance that meets the University s requirements. NYU offers one Tandon health insurance plan in which all international students in F-1 or J-1 status, regardless of credits, are enrolled in. The plan can be waived entirely if you maintain alternate health insurance that meets the University s requirements. Deadline for changing plans or waiving is September 30 th. 11
12 IMPORTANT INFORMATION ABOUT THE ENROLLMENT AND WAIVER PROCESSES Deadline for enrolling, changing plans or waiving is September 30 th. The plan in which you are enrolled by the fall semester deadline will remain in effect for the entire academic year. Any waiver approved for the fall semester will remain in effect for the following spring and summer semesters. Enrollments and waivers are not carried over to the next academic year. Exceptions for Qualifying Life Events 12
13 UNIVERSITY CRITERIA FOR WAIVING To waive the NYU Sponsored plans the alternate coverage must meet specific requirements that are outlined in the Insurance Brochure and on our website. Most important, it must provide coverage in the New York City area for In patient and out patient medical, surgical, mental health, substance abuse and alcohol related illness or injury care laboratory laboratory and radiology and procedures. radiology procedures. Coverage limited to emergency care does not satisfy this requirement. Coverage limited to emergency care does not satisfy this requirement. have an unlimited benefit limit There are some additional requirements for International students. Please make certain you carry your health insurance ID cards. 13
14 Student Health Insurance Plans Administered by Consolidated Health Plans (CHP) Insured by AIIC Coverage for pre-existing conditions No annual deductible* (*Tandon - $100 Out of Network) Medical/Mental Health Hospitalization Medical/Mental Health Office Visits Surgery Prescriptions Laboratory and Radiology Physical, Occupational, Speech and Hearing Therapy Travel Assistance/Medical Evacuation/Repatriation 14
15 Student Health Insurance Plan Benefits Coverage at the Student Health Center Many services are provided at no cost or low cost. Specialty Office Visits: WSQ - Covered 100% after a $20 copay for specialist services (Clinical Specialist, Psychiatrist, Physical Therapist, etc.) Tandon - Covered 100%with no copay Procedures: (Allergy shots, repair of lacerations, intravenous fluids, x-rays, etc.) Basic Plan: covers 80% Comp Plan: covers 90% Tandon Plan: covers 90%
16 Student Health Insurance Benefits - continued Coverage Outside the Student Health Center General Coverage Rates: In-Network Out-of-Network Basic Plan 80% 50% Comprehensive Plan 90% 60% Tandon Plan 90% 60% Additional Copays for Medical/Surgical Office Visits: Basic Plan Comprehensive Plan Tandon Plan In-Network $35 copay $30 copay $20 copay
17 Student Health Insurance Benefits - continued Coverage Inside or Outside the Student Health Center Prescriptions: Contraceptive Pills / Devices: Covered 100% WSQ: All Other (for a 30-day supply): Covered 100% after a: $15 copay for generic drugs $40 copay for preferred brand name drugs $60 copay for non-preferred brand name drugs Tandon: All Other (for a 30-day supply): Covered 100% after a: $10 copay for generic drugs $ 25 copay for brand name drugs
18 Student Health Insurance Benefits - continued Hospital Emergency Room Basic Plan $250 Copay per condition Co-insurance 80% Comprehensive Plan $100 Copay per condition Co-insurance 90% Tandon Plan $50 Copay per condition Co-insurance 90% Hospital emergency rooms are for treatment of a severe injury or sudden, acute medical or psychiatric illness. Insurance plans will not cover Emergency Room treatment if the treatment could have been provided in a doctor s office or clinic. The SHC has a 24 hour hot line for any health concern
19 REFERRAL REQUIREMENTS CHP Plans WSQ Based Students must first seek treatment at the Student Health Center. Services in Manhattan: referral is required to assure the service will be covered Services Outside Manhattan: a referral is not needed Referrals in Manhattan are not required for: Emergency medical treatment in a hospital Preventive Services Gynecological Care or Maternity Care Mental Health and Substance Abuse Services When the SHC is closed - Urgent Care - Services when the student is not eligible to be seen at the SHC - Laboratory tests All other plans Check with your insurance company to find out their requirements 19
20 INSURANCE PAYMENT OPTIONS The Student Health Insurance Plans are annual plans. Annual charges can be paid in full at the time of fall registration, or Insurance charges may be paid in two installments Annual (8/21/18-8/20/19) Fall (8/21/18-1/8/19) Spring (1/9/19-8/20/19) Summer (5/14/19-8/20/19) Basic $3,313 $1,280 $2,033 $899 Comprehensive $3,683 $1,423 $2,260 $999 Tandon $1,763 $681 $1,082 $478 The spring insurance charges are higher than the fall charges - they include coverage for summer semester as well. 20
21 GeoBlue HEALTH INSURANCE PROGRAM FOR STUDENTS STUDYING AWAY The GeoBlue Study Abroad plan* provides: easy access to care minimal out-of-pocket expenses. * For semester long and short trips The GeoBlue Study Abroad Plan does not provide health insurance coverage in the United States or in the student s home country. Students are required to maintain health insurance in their home countries. For more information, please visit: 21
22 STUDENT HEALTH AND INSURANCE AT NYU All matriculated NYU students have access to the Student Health Center services even if they don t have one of NYU s sponsored health insurance plans. Most students are automatically enrolled in an NYU sponsored health insurance plan as part of the course registration process. If you maintain other insurance coverage that meets the University s requirements you may apply to waive the NYU sponsored plan. Waiver Deadline: Fall: September 30th Please make certain you carry your health insurance ID cards. 22
23 QUESTIONS? Available online at Student Health Insurance Services can be contacted by: Telephone: (212)
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