You asked us We listened

Transcription

1 Important Information Regarding the Trinity - WEA Health Plan: You asked us We listened Who is WEA? WEA is the Plan Sponsor of your Student Health Plan. Is WEA recognized in the United States? Yes, the Network provider associated with WEA in the United States is UnitedHealthCare (UHC) Options PPO Network Who is PA Group Administration? PA Group Administration is the Plan Administrator and provides claims administration services for your WEA Plan. They provide WEA s customers the highest level of customer service. They are known as the healthcare provider in the United States and are backed by A+ rated reinsurers. Who is covered underneath the WEA plans? All Trinity students, whether attending class in St. Vincent or in clinical rotations in the U.S. and/or other locations, would be covered under the scope of the plan regardless of location and country of citizenship (see plan Eligibility for details). What network is used in the United States? In the States, the WEA plan utilizes the UnitedHealthCare (UHC) Options PPO Network. This is merely your network but is not your insurance carrier. You can see a listing of in-network providers (in the States) by visiting the UHC Options PPO Network: You will find this to be a huge network and you should not have any difficulties in finding coverage. What if I can t find my current provider in the UHC online system? You can contact Trinity s benefits broker directly at: Trinity School of Medicine Student Benefits Broker: World of America Global Partners Jessica Menendez Tel: (786) jm@woagp.com

2 You can also contact WEA directly at: PA Group Administration Call: (305) (local) or (from within the USA) or (International) Prompt options: a. English b. Spanish I. Emergency pre-certification II. Benefits & Claim Status III. Group Business IV. Operator I am a Trinity student in clinical rotations. Do I have coverage in the U.S.? Yes, all Trinity students have access to the plan, whether attending class in St. Vincent or in clinical rotations in the U.S. and/or other locations. Coverage under the plan is subject to your enrollment and continued eligibility. I am a Trinity student in clinical rotations outside of the U.S. and St. Vincent. What network do I use? Networks apply only when seeking health care in the United States. When studying outside of the U.S. you have access to any provider of your choice. You will merely need to submit a claim via the online (LyncOne) and it will be processed according to the in-network benefit. I visited the WEA website and it states that their plans only cover U.S. citizens living abroad. Is this an error? No. Any non-trinity affiliate would be unable to enroll on a WEA policy if they lived in the United States. WEA has partnered with Trinity in order to provide all of their students with coverage, whether studying in St. Vincent or attending clinical rotations in the U.S. and/or other locations. This is detailed on the left hand side of the WEA online enrollment login page which is accessible via the WEA enrollment website. When will I receive my ID cards? Once the registration period has closed for the semester, all students who have enrolled in a policy will receive an with login details to their own personalized Member Portfolio. Once logged in, you will be able to access your ID cards, submit claims online, have direct access to all of your policy details, have access to the message center to communicate directly with a claims processor, and much more. It is important to note that no ID cards will be sent to your physical mailing address.

3 Who can I contact for benefits questions throughout the year? For all questions, you can contact Trinity s benefits broker directly at: Trinity School of Medicine Student Benefits Broker: World of America Global Partners Jessica Menendez Head of Academic and Corporate Sales Tel: (786) jm@woagp.com You can also contact Lyncpay directly at: PA Group Administration Call: (305) (local) or (from within the USA) or (International) Prompt options: c. English d. Spanish V. Emergency pre-certification VI. Benefits & Claim Status VII. Group Business VIII. Operator Precertification@pagroupco.com for the following: a. Pre-certification b. Submit medical records Claims@pagroupco.com for the following: a. Submit claim via b. Submit medical records c. Benefit clarification d. Claim Status e. Anything relating to claims/benefits or status of reimbursement You can also contact WEA directly at: Worldwide Expatriate Association (WEA): healthservice@pagroupco.com for: a. Assistance with login b. Assistance changing address c. Assistance with website d. General questions not claims related

4 If all else fails: You should complete an Assistance Request Form. Click Here to access the form. The form will be reviewed by the Student Services Office for further action on your behalf. How do I submit my claims? Once you have received access to the online Member Portfolio, you will be able to upload all of your claims electronically. The system has real time capabilities, which allows you to view the processing of your claims as they are being handled by the carrier. The site will also serve as a record keeper for where you would like any reimbursements sent, including mailed checks and direct deposits into your own bank account. The Explanation of Benefits will also be placed here immediately following the completion of your claim s processing in case you need to reference prior to receiving the mailed copy. Providers within the United States may follow instructions on the back of your ID card. Always be sure to present your ID card to your provider. Claims may be submitted by mail as follows: Providers inside the UnitedHealthcare Options PPO: UnitedHealthcare P.O. Box Atlanta, GA All other providers: PA Group Administration 1901 Ponce De Leon Blvd. Coral Gables, FL USA If I choose to waive the plan during the open enrollment period, can I request enrollment at any time during the school year? No. Once you have submitted your waiver in the online system, you are unable to make any changes without contacting Trinity or the Student Benefits Broker directly. All requests for changes must be submitted in writing within 31 days from the effective date of the policy (based upon your Open Enrollment period). Any request made after the 31 days would be considered invalid and the student would have to wait until the next plan year to make any changes unless proof of a Qualifying Event is provided to the carrier. In the instance of a Qualifying Event, the carrier must be notified within 31 days of the event for the enrollment to be considered valid. What is a Qualifying Event? A Qualifying Event allows students to make midyear election changes when a change in a participant s status occurs. Examples of Qualifying Events for Trinity students are as follows: Change in marital status Change in number of dependents Change in Student Status (returning from LOA) Loss of Coverage from prior plan

5 I live in Massachusetts. Does WEA provide 1099 HC tax forms? No. WEA offers Trinity an international product that is written outside of the US. For this reason, they are exempt from providing any tax documents or following US mandates. I take prescription medications. Am I able to obtain a vacation override for more than a one month s supply? For members who will be physically located outside of the United States, the Trinity sponsored health plan will allow you to obtain an extended fill (up to a 6 month supply) as long as the medication is covered under the plan, and meets all other medical criteria. All prescription dispenses and refills, with more than a 3 month supply will require the Prescription Override Request Form and travel itinerary information be provided to the carrier for approval. Your physician will need to write the prescription to allow an extended quantity to be filled and the appropriate copayment(s) will apply. (Example: if you receive 6 months of medication, you will be responsible for 6x the copayment at time of fill). Members who are studying within the United States will be eligible for up to a 30 day supply only. It is important to note that there is a maximum annual fill of 365 days. Do I need to contact the carrier in order to fill my prescription if it is for more than a one month supply? No. As long as it is a covered medication under the plan, and you are studying abroad, you are able to obtain your prescription in an extended fill. If you have any questions you may contact OptumRx's Pharmacy Help Desk at Is the Trinity Sponsored Health Plan HealthCare Reform Compliant? Yes. The Trinity Sponsored Health Plan is HealthCare Reform Compliant. Students may purchase this plan and declare it when filing taxes in the US to avoid penalties for lack of coverage. Health Care Reform: What does that mean for you? Trinity School of Medicine has made the decision to offer a Health Care Reform Compliant Plan for the Student Health Plan. What does that mean for you? If you are a US Citizen, it means that your health insurance coverage is within the requirements for the IRS. When you file your taxes you will be compliant for the 2018 tax year. With regard to your benefits, it means you have additional benefits you did not have before. These benefits are for all students who are covered by the Student Health Plan for , regardless if you are a US Citizen or not. With a Health Care Reform (HCR) compliant plan, the plan is required to offer minimum essential benefits to the client. The type of coverage an individual needs to have to meet the individual responsibility requirement under the Affordable Care Act.

6 What are some benefit changes to the Trinity Student Health Plan due to Healthcare Reform? Platinum Plan Level Benefits No pre-existing conditions apply Wellness/Preventive Benefits are standard Immunizations covered at 100% (based on the CDC List) Emergency Services Hospitalization Ambulatory Patient Services Prenatal/ Postnatal and Newborn Preventive Services covered at 100% Prescription Medications Laboratory Services Mental Health and Substance Abuse Disorder/Behavioral Health Treatment Benefits for Hearing Aids, Prosthesis and Durable Medical Equipment included Family Planning including forms of sterilization (see plan details for list of benefits) Rehabilitation and Habilitation Services/ Devices Pediatric Dental and Vision Benefits (see plan details for list of eligibility requirements) Cost-Sharing and Out of Pocket Maximum limits apply