5/29/14. Insurance. Health Care Coverage for Baylor College of Medicine Students

Transcription

1 Insurance Health Care Cverage fr Baylr Cllege f Medicine Students Baylr Cllege f Medicine (The Cllege) believes student wellness is essential t academic prgress. In rder t supprt this philsphy, Baylr Cllege f Medicine maintains the Health Care Prgram fr Students (the Prgram) and requires that all individuals enrlled in any BCM academic prgram maintain medical cverage thrugh the Prgram r are enrlled in alternative cverage that meets the cverage requirements established by the Cllege. The Prgram prvides a benefit fr rutine care, illness, injury and is administered by Aetna Student Health. If the student chses t pt ut f the BCM Health Care Prgram they must apply fr a Waiver f Cverage. If the students Waiver f Cverage applicatin is apprved, the student is allwed t pt ut f the Prgram. If the student des nt practively enrll r waive during the designated time perid, the student will be autmatically enrlled in the BCM Health Care Prgram after the designated time perid. Practively enrlling rather than being autmatically enrlled ensures that cverage begins timely instead f retractively. Mre infrmatin abut the enrllment and waiver prcesses is discussed in detail belw. Enrllment in the BCM Health Care Prgram fr Students First Year Students Incming first-year Graduate and Medical students must cmplete the nline enrllment r waiver prcess during the mnth f August. Incming Allied Health students must cmplete the nline enrllment r waiver prcess during the mnth f July. Students must cmplete enrllment in the Prgram as sn as pssible during the specific enrllment r waiver perid fr their grup based n the date f matriculatin. Specific dates and infrmatin abut enrllment and applying fr a waiver will be given t incming students during the Benefits Orientatin. Infrmatin regarding the requirements fr waiving the Prgram is discussed under the sectin, Applying fr a Waiver f Cverage. Current Students Current students are required t enrll r waive the health insurance each academic year. Students are given a perid f time, referred t as the Annual Student Insurance Change Perid, during which they can enrll in the BCM Health Care Prgram, apply fr a waiver f cverage, r add r drp dependent cverage. The Annual Student Insurance Change Perid ccurs during the mnth f May. Any changes made during the Annual Student Insurance Change Perid will be effective July 1st. T ensure that cverage is readily available t access n July 1 st, the student must actively enrll during the Annual Student Insurance Change Perid. If a student takes n actin during this perid they will be cnsidered a Nn- Respnder and will autmatically be enrlled in the BCM Health Care Prgram. Nn- Respnders might experience a delay in accessing the benefits, s it is better t take actin and either enrll r waive during the Annual Student Insurance Change Perid. Prir t May 1 and cntinuing thrugh the mnth f May, infrmatin will be sent t all students via their BCM addresses. The messages will include instructins regarding the prcess fr enrllment fr cverage as well as hw t cmplete and submit an nline Applicatin fr Waiver f Cverage. All current students shuld review the sectin belw entitled, Applying fr a Waiver f Cverage befre cmpleting and submitting an nline waiver applicatin. An nline Applicatin fr Waiver f Cverage must be cmpleted and submitted by accessing the Aetna Student Health website at

2 Cverage fr Dependents under the BCM Health Care Prgram Students can enrll eligible family members during their specific initial enrllment perid (new students), r during the Annual Student Insurance Change Perid (returning students). Eligible family members include: spuse r dmestic partner, and/r dependent children up t age 26 wh are nt eligible fr cverage thrugh their wn r spuse s emplyer s grup health plan Returning dependents must be re-enrlled each year during the Annual Student Insurance Change Perid t maintain cverage under the Prgram. Cverage fr dependents that are nt re-enrlled will end effective June 30th. Cverage will begin July 1 st fr dependents that are successfully enrlled during the Annual Student Insurance Change Perid. Fr new students that add dependents their cverage will begin n the 1 st f the mnth after they are enrlled (ex: July 1 st r August 1 st ). Students are respnsible fr the cst f their family members' cverage, and premium payment arrangements must be made with the insurance carrier, Aetna Student Health. Premiums may be charged t credit cards r premiums may be paid by e-checks. N persnal checks will be accepted by Aetna Student Health. Students must enrll dependents fr cverage thrugh Aetna Student Health s web-based enrllment prcess and can nly be added after the student has enrlled fr cverage. Adding r Drpping Dependent Cverage during the Academic Year (Qualifying Events) Students wh experience a qualifying event have 31 days frm the date f the qualifying event t ntify Aetna Student Health at make a change in their dependents cverage. Qualifying events include, but are nt limited t, the birth f a baby, marriage, r divrce. When adding cverage fr a dependent the change will be effective the day f the qualifying event if crrect dcumentatin is prvided. Upn enrllment, the student will be charged the full premium fr the remaining mnths f the academic year, and the prrated mnthly premium fr the enrllment mnth, if applicable. When a student drps cverage f a dependent, the change will be effective the first f the mnth fllwing the qualifying event. A cmplete list f qualifying events and required dcumentatin is available n the Aetna Student Health website at INFORMATION ABOUT COVERAGE The Preferred Prvider Organizatin (PPO) BCM partners with Aetna Student Health t prvide ur students with access t an insured Preferred Prvider Organizatin (PPO) health care prgram fr bth medical and dental, underwritten by Aetna Life Insurance Cmpany (Aetna). A PPO allws yu flexibility and chice when making health care decisins. It is imprtant that yu understand the prgram s that yu can make infrmed health care decisins that best fit yur situatin. Belw is an verview f the PPO. Fr cmplete details, yu shuld visit Aetna Student Health s website at Aetna Student Health ffers an extensive lcal and natinal PPO f physicians, hspitals, and pharmacies. Yu can g t any prvider r facility yu chse in a PPO. Hwever, by chsing preferred prviders and facilities, there are n claims t file. There is an Annual Medical Plan

3 Deductible f $0 fr Preferred Prvider services and $500 fr Nn-Preferred Prvider services. In mst cases, when yu access a preferred prvider, yu will have t pay a small cpayment and/r c-insurance fr services prvided. When yu access a preferred prvider yu will have n mre than $1,000 ut-f-pcket expenses (including all c-payments, prescriptin drug c-payments, and pharmacy c-insurance) per persn r $3,000 ut-f-pcket per family in any Plicy year. The preferred physicians include general practitiners, internists, primary care physicians (PCPs), as well as specialists. N physician referral is necessary fr yu t see a specialist. Yu may chse the specialist yu wish t see. Fr specific exclusins and mre infrmatin, please access Aetna Student Health s website at Yu may als chse t receive care thrugh a nn-preferred prvider; hwever, yu will experience a reduced benefit, and yu will be respnsible fr a significant amunt f ut-fpcket expense. If yu chse t receive care thrugh a nn-preferred prvider, yu will als have t file yur wn claims, which means yur prvider will expect payment when services are prvided. There is an Annual Dental Plan Deductible f $25 fr Preferred Prvider services and $25 fr Nn-Preferred Prvider services. The plicy year maximum is $1,000. Fr specific exclusins and mre infrmatin, please access Aetna Student Health s website at Cst f Cverage Medical and Allied Health students are respnsible fr paying the cst f their health insurance cverage. Medical students pay fr eleven (11) mnths f cverage the first year f academic enrllment and twelve (12) mnths f cverage each subsequent academic year. Student financial aid and schlarship funds are used t reduce the balance f the student s cst f cverage. If a student is nt receiving such funds, he r she is expected t pay the charges as directed by Student Accunt Services. The current mnthly premium amunts are listed belw fr the perid f July 1, 2015 thrugh June 30, 2016 are as fllws: Cverage Level Medical Dental Ttal Premium Student/Internatinal Visitr Only $ $17.25 $ Student/Internatinal Visitr & Spuse/Dmestic Partner $ $43.74 $ Student/Internatinal Visitr & One Child $ $57.05 $ Student/Internatinal Visitr & Tw r Mre Children $ $96.85 $ Student/Internatinal Visitr & Spuse/Dmestic Partner & One Child Student/Internatinal Visitr & Spuse/Dmestic Partner & Tw r Mre Children $ $83.54 $ $1, $ $1, *These premiums are subject t change July 1 st f each academic year.

4 Applying fr a Waiver f Cverage A student may be allwed t submit an applicatin t waive participatin in the BCM Health Care Prgram if the student has alternative cverage that meets the minimum requirements established by the Cllege. The alternative cverage must be maintained thrugh the student s wn, their spuse's, r their parent's U.S. emplyer-spnsred grup health plan and the emplyer-spnsred plan must meet the cverage requirements established by the Cllege. A returning student wh has an apprved waiver n file fr the current academic year must submit anther applicatin fr review and apprval (r denial) during each Annual Student Insurance Change Perid (May 1, 2015 June 2, 2015). If apprved, the Waiver f Cverage is effective July 1, 2015 thrugh June 30, 2016, unless the alternative cverage terminates during the year fr such reasn as a student is n lnger eligible due t age limitatin (turning 26) r the cverage is n lnger available. If the student s alternative cverage ends during the academic year the student must ntify the Human Resurces - Benefits Office and enrll in the Prgram within 31 days frm date cverage was lst. Fr mre infrmatin abut enrlling during the year see Additinal Infrmatin abut Waiving Cverage. Failure t submit the nline applicatin fr a Waiver f Cverage during the Annual Student Insurance Change Perid (returning students) r during the initial enrllment r waiver perid (new students) will result in autmatic enrllment in the BCM Health Care Prgram fr Students. T avid unnecessary charges fr health insurance cverage, the cmpleted applicatin fr a Waiver f Cverage must be submitted by accessing the Aetna Student Health website at by June 2, 2015 fr current students r by the deadline date designated fr incming students. T ensure cmpliance, the requirements are strictly adhered t and n exceptins are made. Alternative Health Care Cverage Requirements In rder t waive the student health plan the student s alternative plan cverage must meet the fllwing minimum criteria established by the Cllege. Must prvide in-netwrk cverage in the greater Hustn metrplitan area (unless yu are a Distance Educatin Student, then yur plan must prvide in-netwrk cverage in the area in which yu reside). Des nt prvide emergency-nly cverage Prvides cverage f $500,000 r mre in plan year N mre than $5,000 annual deductible maximum per persn N mre than $10,000 annual ut-f-pcket per persn N less than 60 percent cvered expenses and 40 percent c-insurance Must prvide cverage fr prescriptin drugs If plan is a COBRA cntinuatin plan, student must prvide dcumentatin that indicates it des nt expire during the duratin f the current academic year, i.e., Certificate f Credible Cverage.

5 The applicatin fr Waiver f Cverage is administered thrugh Aetna Student Health by accessing the Aetna Student Health website at T avid delay in the apprval f an applicatin fr Waiver f Cverage, students shuld cmplete and submit their nline applicatin f Waiver during the Annual Student Insurance Change Perid r during their specific enrllment r waiver perid. Please be aware that alternative cverage is verified during the waiver applicatin review prcess, as applicable. Once the nline waiver applicatin review prcess is cmpleted, each student will be ntified f the apprval r denial f his r her applicatin. If a student s applicatin fr Waiver f Cverage is denied after the initial review, then the HR Benefits ffice will cntact yu and a secnd review will be cnducted by a BCM HR Benefits Representative. If then yur alternate cverage des nt meet the waiver criteria, yu will be enrlled int the Prgram and respnsible fr paying the related premiums. Students d have the pprtunity t waive the cverage utside f the initial enrllment perid r the Annual Student Insurance Change Perid. In rder t waive cverage during the year the student will need t cntact the BCM Human Resurces Benefits Office at ask-studentinsurance@bcm.edu t prvide the required infrmatin. Waiver f Cverage applicatins submitted during the year will be effective the 1 st f the mnth after the waiver is apprved. N adjustments r refunds will be made t the student s persnal accunts if cverage is later verified based upn additinal infrmatin prvided by the student. Additinal Infrmatin abut Waiving Cverage A student wh has an apprved waiver applicatin n file and experiences a lss f cverage during the academic year must ntify the Human Resurces Benefits Office at askstudentinsurance@bcm.edu and enrll in the BCM Health Care Prgram fr Students within 31 days f lss f cverage. This includes lss f cverage due t reaching the limiting age as defined by the spuse's r the parent's emplyer-spnsred grup health care plan. If submitted with 31 days f the lss f cverage the effective date f the BCM Health Care Prgram will be the day fllwing the lss f cverage. Health Insurance Benefits at a Glance The charts belw reflect a summary f benefits under the BCM Health Care Prgram fr Students fr academic year July 1, 2015 thrugh June 30, Mre detailed infrmatin abut the student health insurance fr bth medical and dental can be fund n the Aetna Student Health website, Medical Services Annual Out-f-Pcket maximum (penalties, and nn-cvered services d nt apply tward the ut-fpcket maximum) Preferred (In-Netwrk) $1,000/Persn $3,000/Family *Annual deductible, all c-pays, prescriptin drug c-pays, medial cinsurance and pharmacy cinsurance apply tward Preferred Care ut-f-pcket maximum. Nn-Preferred (Out-f- Netwrk) $3,000/Persn $6,000/Family Per Plicy Year Deductible $0/Persn $500/Persn

6 Inpatient Hspitalizatin Benefits 80% f the Negtiated Charge 60% f the Recgnized Charge Mental Health & Substance Abuse Benefits Prescriptin Drug Expenses Inpatient: 80% f the Negtiated Charge Outpatient: 100% f Negtiated Charge (thrugh an Aetna Pharmacy) Generic: 100% after $10 cpay Preferred Brand Name: 100% after $40 cpay Nn-Preferred Brand Name: 100% after $60 cpay Mail-Order (90 day supply): Generic - $20 cpay Preferred Brand Name - $80 cpay Nn-Preferred Brand Name - $120 cpay Inpatient: 60% f the Recgnized Charge Outpatient: 70% f the Recgnized Charge (Prescriptins dispensed at a Nn- Participating Pharmacy) Generic: 70% after $10 deductible Preferred Brand Name: 70% after $40 deductible Nn-Preferred Brand Name: 70% after $60 deductible *Cntraceptives nw cvered at 100% except fr Brand drugs with Generic equivalent. *Cntraceptives nw cvered at 100% except fr Brand drugs with Generic equivalent. Emergency Rm Care 80% f the Negtiated Charge 80% f the Recgnized Charge (deductible waived if admitted) Physician Office Visit Baylr Express Care Center and Quick Care: 100% f the negtiated charge (n c-pay) Preferred Primary Care Practitiner: 100% after $10 cpay Specialty Care Practitiner: 100% after $25 c-pay Preventive services per ACA guidelines are cvered at 100% with n cpayments r c-insurance 70% f Recgnized Charge after deductible is met Ambulance Expenses 80% f the Negtiated Charge 80% f the Recgnized Charge Surgery Expenses 80% after the Negtiated Charge (n c-pay) 60% after Recgnized Charge (n c-pay)

7 Dental Plicy Year Maximum $1,000 DEDUCTIBLE* *The deductible applies t: Basic & Majr Services nly Preferred Care Individual: $25 Family: $75 Nn-Preferred Care Individual: $25 Family: $75 PREVENTIVE SERVICES 100% f the negtiated charge BASIC SERVICES 80% f the negtiated charge MAJOR SERVICES 60% f the negtiated charge 100% f the recgnized charge 80% f the recgnized charge 60% f the recgnized charge ORTHODONTICS Nt Cvered Nt Cvered Students n an Apprved Leave f Absence Students n apprved leave f absence wh were enrlled in the BCM Health Care Prgram fr Students n the date prir t the effective date f the leave f absence may vluntarily cntinue cverage fr up t 12 mnths fllwing the effective date f the leave f absence. The student must check ut thrugh the Human Resurces Benefits Office t elect t cntinue cverage and pay the required premiums. Yur first payment fr cverage while n leave f absence is due the day f LOA checkut in the HR Benefits ffice. Thereafter, payment must be made (pstmarked) n r befre the first f each mnth fr that mnth s cverage. Payment may be made in persn r by mail in the frm f a persnal check, mney rder r cashier s check. Payment made t the HR - Benefits ffice is fr individual cverage nly. Cverage will be terminated effective the 1st f the mnth in which payment is nt received. If upn checkut a student chses t discntinue cverage, then cverage will end effective the last day f the mnth in which the leave is effective. If a student has financial aid that has been applied fr the semester the cverage will g thrugh the end f the semester (6/30 r 12/31), instead f ending at the end f the mnth the leave f absence is effective. Upn check with the Human Resurces Benefits Office the student will need t indicate if they wuld like t waive the cverage after the financial aid ends r cntinue it while n leave f absence. Students wh are n an apprved leave f absence and have cntinued their cverage may add r drp dependents during the Annual Student Insurance Change Perid r within 31 days f experiencing a qualifying event. Cntact Aetna Student Health at t add r drp dependents by cmpleting a paper enrllment frm while n leave f absence.

8 Terminatin f Cverage Upn graduatin the insurance will terminate the last day f the mnth f graduatin. There is nt a cntinuatin plan after graduatin hwever students have the pprtunity t purchase an individual plicy. Althugh BCM des nt endrse any particular health insurance cmpany, belw a list f pssible resurces Human Resurces Benefits Office The Human Resurces Benefits Office administers the BCM Health Care Prgram fr Students. The Human Resurces Benefits Office is lcated n the Jhn P. McGvern Campus, 2450 Hlcmbe Blvd., Suite OW100. The telephne number is , and the address is ask-studentinsurance@bcm.edu. Student Accunt Services administers charges placed n students' persnal accunts. Aetna Student Health Medical Insurance Cmpany The Aetna Student Health Custmer Service is available by phne at , Mnday thrugh Friday 7:30AM-4:30PM Central Time. Their website is Medical Student Lng Term Disability Insurance Effective July 1, 2014 Baylr Cllege f Medicine believes that prtecting each medical student s investment in their medical educatin and future earning ptential against the risk f disability is f paramunt imprtance. T supprt this philsphy, Baylr requires every medical student t be cvered by lng term disability insurance. Baylr has develped the BCM Lng Term Disability (LTD) Insurance benefit, effective July 1, 2014, which prvides all full-time medical students fully prtable deeply discunted individual disability plicy cverage withut submitting t full underwriting and regardless f health histry. The BCM LTD benefit is mandatry fr all medical students beginning with the class entering August Special Nte fr Medical Students Wh Matriculated Prir t July 1, 2014 All medical students wh matriculated prir t July 1, 2014 are required t have either enrlled in the BCM LTD benefit r t have acquired alternate lng term disability cverage n their wn.

9 Medical students wh matriculated prir t July 1, 2014 wh did nt chse the BCM LTD benefit will be required t sign a declaratin that they have acquired lng term disability cverage n their wn and will keep the cverage in frce until graduatin. The cllege is required t infrm these students f surces fr alternate LTD cverage. One surce is AMA Insurance. Third and furth year students may als cntact Jeffrey M. Miller with Jhn L. Wrtham & Sn, L.P. at r jeffrey.miller@wrthaminsurance.cm. Students wh chse t acquire cverage n their wn cannt participate in the BCM LTD benefit at a later date withut submitting t a full applicatin and medical underwriting which may include a physical exam. Students wh enrlled in the BCM LTD benefit will cntinue participating in the benefit until graduatin. Dual Degree Students and Students n an Official Leave f Absence Medical students enrlled in dual degree prgrams that are in the nn-md prtin f their training and students n an fficial leave f absence (LOA) are nt required t have lng term disability insurance. Hwever, they are encuraged t retain such cverage. Upn returning t medical schl frm LOA r t cmplete the MD prtin f a dual degree, students will again be required t be cvered by lng term disability insurance. If previusly enrlled in the BCM LTD benefit plan, students will be required t re-enrll in the BMC LTD benefit plan and can d s withut submitting t full underwriting. Dual degree students wh matriculated prir t July 1, 2014 can satisfy their disability insurance requirement by either enrlling in the BCM LTD benefit plan r acquiring alternate cverage. Upn returning t cmplete the MD prtin f their training, dual degree students can enrll in the BCM LTD benefit plan withut submitting t full underwriting. BCM LTD Summary f Benefits The infrmatin prvided belw is nly a summary f benefits and cverage. The Unum Incme Series 750 plicy that will be issued t yu supersedes any infrmatin in the summary and determines actual cverage. After yur applicatin is accepted by the insurance cmpany, yu will receive yur persnal individual plicy. Please read yur plicy fr a cmplete descriptin f benefits and cverage. Mnthly benefit amunt: $2,000 This is the amunt that will be paid t yu each mnth yu qualify as disabled under the terms f the plicy. Presumptive benefit amunt: $2,000 This is an incremental benefit paid fr mre severe disabilities such as the lss f sight r speech. Definitin f disability: Own ccupatin fr the full benefit perid Yur ability t perfrm the duties f yur wn ccupatin will be cnsidered. It des nt matter if yu can perfrm any ccupatin. While yu are in medical schl yur ccupatin is medical student.

10 Benefit Perid: T Age 65 The benefit will be paid t yu each mnth yu qualify as disabled under the terms f the plicy until yu reach age 65. Mental/Nervus Disrders: Full Benefit Perid If yur disability is due t a mental/nervus cnditin the benefit perid is nt limited. Eliminatin Perid: 90 Days Als knwn as the waiting perid this is the time yu must meet the definitin f disability befre benefits are paid. Premium discunt: 35% Individual plicies have state filed rates. Yur plicy premium is 35% lwer than what an individual f yur age wuld pay fr the same plicy in the retail market. Fixed terms and full prtability Yu wn the plicy and can take it with yu when yu graduate. The insurance carrier cannt change the terms r pricing t age 65 as lng as premiums are paid. Increased benefits at graduatin with n underwriting At graduatin yu can increase yur mnthly benefit t $3,000 withut submitting t full underwriting. In additin, yu can secure future benefit increases ttaling an additinal $2,500 in mnthly benefit amunt. The 35% discunt will apply t any increased cverage amunts under this ffer. This means that altgether thrugh this plicy yu can btain up t $5,500 f mnthly benefit amunt with premium discunted by 35%. As yur career prgresses and yur incme increases, yu will likely need mre cverage but by keeping yur BCM benefit as a base yu will save tens f thusands f dllars n that prtin ver the curse f yur career. If yu have any questins abut the Baylr LTD insurance benefit r t file a claim, please cntact Cvala Grup, the administrative service prvider fr this benefit at (800) r via at BCMLTD@cvalagrup.cm.