Your Loyola Health Care Plan for Students
Contents
1. An easy to use guide to get the care you need when you need it LOYOLA UNIVERSITY CHICAGO Preparing people to lead extraordinary lives rowing up is never easy especially when it comes to dealing with things like health insurance But now that you re on your own health care plan it s important to know how to use it This User s Manual is designed to guide you through the sometimes confusing world of health care with helpful tips and information about things like how to find a doctor what to do when you are sick and how to file a claim Keep it handy as a reference guide just in case you ever have questions and want to know where to turn With this guide you can take charge of your health and get the care you need LOYOLA UNIVERSITY CHICAGO Preparing people to lead extraordinary lives Who Is Required to Have Coverage 2 University Chicago s Board of Trustees requires that the following students have individual health care insurance All undergraduate students enrolled for 12 or more credit hours at the start of the fall or spring semester All graduate students enrolled for 8 or more credit hours or registered for thesis or dissertation supervision at the start of the fall or spring semester All students at the Stritch School of Medicine For many of you that means being covered under your parents plan or you may already have an individual policy in place If this is the case2. generally pay less as shown in the chart If you go to an out of network provider not only are your benefits paid at a lower level you are also responsible for paying the full cost of the service up front and filing a claim form for reimbursement To determine if your current doctor participates in the UniCare network or to find a new network doctor or hospital visit www unicare com or call 800 696 9776 An Overview of Your Benefits Under the Plan ere s a snapshot of your benefits under the Loyola Health Care Plan for Students Benefit In network Out of network After you meet the deductible the plan pays Doctor s office visit X ray lab 80 of negotiated rate 60 of reasonable expenses 80 of negotiated rate 60 of reasonable expenses Emergency 80 of negotiated rate 80 of reasonable expenses Hospitalization 80 of negotiated rate 60 of reasonable expenses Maternity 60 of reasonable expenses Mental health limited to 10 000 per plan year 80 of negotiated rate 80 of negotiated rate 60 of reasonable expenses Plan Year The plan year runs from August 1 through July 31 For Stritch School of Medicine students the plan year is July 1 through July 31 of the following year Receiving Medical Care here are a variety of situations in which you might need to receive medical care Depending on your circumstances here s how to get the care you need and maximize your benefits under the p
3. for Students certificate Please keep in mind that emergency services are subject to a deductible and coinsurance Additionally Loyola has a partnership with Ulifeline an online support system geared toward young adults At www ulifeline org you can access helpful tools and resources and get answers about mental health concerns you may have If you are a student at the Stritch School of Medicine contact the Office of Student Affairs for information about the mental health resources available to you In conjunction with these resources the Loyola Health Care Plan for Students provides coverage for mental health So if you need ongoing treatment you would pay 20 out of your pocket after the deductible when you visit a provider in the network Following Your Doctor s Orders o get the best care it s important to follow your doctor s recommenda tions for additional treatment but it s up to you to make sure that any extra services you receive are covered under the plan Here are some situations you may face and what you need to know If your doctor refers you to a specialist or another facility for lab work always check with UniCare to be sure that the other provider is in the PPO network If not ask your doctor for an alternate recommendation to avoid paying at the out of network level If your doctor recommends surgery or hospitalization try to get as much information as possible to be sure this is the appropriate treat
4. percentage cost of a certain service that is paid by the plan you pay the rest Out of Pocket Maximum The most you have to spend out of pocket in a year The Plan Pays y d Up to the d 500 000 d lifetime limit d p First you pay Then the plan pays Once the amount d your deductible a percentage you pay reaches the e 150 in network e 80 in network plan maximum e 400 out of network 60 out of network 3 000 in network And you pay the e 6 000 out of remaining amount network 20 in network The plan pays 100 40 out of network Of all remaining covered expenses To summarize Out of network In network After you pay the annual 400 per person deductible of The plan pays the following coinsurance 80 after deductible 60 after deductible 150 per person 6 000 per person 3 000 per person Up to the annual out of pocket plan year maximum Understanding the Network The Loyola Health Care Plan for Students is a Preferred Provider Organization PPO plan provided through UniCare one of the leading health care insurance companies in Chicago To help bring you the best coverage at the most affordable cost UniCare negotiates with doctors and hospitals who agree to become preferred providers in the UniCare network and to charge lower rates This network of health care providers is also known as the PPO When you access medical care through an in network PPO provider you
5. then you must complete a waiver to opt out of the plan if you want to avoid unwanted charges on your tuition bill If you meet the enrollment criteria above and do not have coverage you will be enrolled in Loyola s Health Care Plan for Students and your student account will be billed accordingly If you are a student and do not fall into one of these categories you may voluntarily purchase coverage under the plan Go to the Student Health Insurance link at www luc edu bursar How the Plan Works Health Insurance Basics T understand how Loyola s Health Care Plan for Students works you first need to be familiar with the basics Health insurance is based on the concept of shared risk That means you pay a certain amount up front to have coverage also known as your premium Then each time you need care whether it s for an accident illness or injury the plan pays the cost of the service after you pay the deductible and coinsurance As a covered individual you are also protected by the out of pocket maximum So in the event of an accident or other major unforeseen procedure you won t be burdened with excessive medical bills Some Important Terms to Know Premium The fee that s added to your student account at the beginning of the fall or spring semster allowing you to have coverage Deductible How much you are required to pay out of your pocket in a given year before the plan pays benefits Coinsurance The
6. 41 Dial a Nurse Dial a nurse is available to all Loyola students throughout the school year and can assist you with various health concerns and questions Contact Dial a Nurse during business hours at 773 508 8883 or Resurrection Health Care after hours at 877 RES INFO Healthcare Advisor by Subimo Healthcare Advisor is an innovative website that provides additional decision making resources and information that you may find useful when preparing for a medical procedure or managing a medical condition To access Healthcare Advisor log on to www unicare com Using the Prescription Drug Program hances are you ll need to have a prescription Navigating the prescription drug marketplace can be a challenge but with these tips you can be sure you re getting the right medication at the lowest possible cost Your Prescription Benefits Under Loyola s Health Care Plan for Students there are four categories of drugs and how much you pay depends on the drug type The categories are e Generic drugs that are labeled with the medication s basic chemical name and usually have brand name equivalents They have the same active ingredients and must meet the same FDA standards for quality strength purity and stability as their brand name counterparts Preferred brand drugs that do not have a generic equivalent They cost more than generics but less than non preferred brand name drugs Non preferred brand drugs
7. To purchase dependent coverage or if your situation changes during the year and you need coverage under the Loyola Health Care Plan for Students go to the Student Health Insurance link at www luc edu bursar Please note that insurance contributions for your dependents are paid separately not as part of your tuition If You Choose to Opt Out of Coverage Many students will waive coverage in Loyola s Health Care Plan for Students because they are covered under their parents insurance If you are covered under your parents medical insurance plan or have an individual policy in place then you must complete a waiver to opt out of the plan and avoid unwanted charges on your student account To waive coverage go to the Student Health Insurance link at www luc edu bursar Important Note for Stritch School of Medicine Students Stritch School of Medicine students have different waiver deadlines than Loyola University Chicago students For details contact Student Affairs or go to www meddean luc edu For information about the Health Care Plan for Students or to waive coverage go to www meddean luc edu click on Current Students scroll down to Student Resources and click on Loyola s Health Care Plan for Students If You Leave the University To be eligible for insurance coverage under the University plan you must be fully enrolled for the first 60 days of the academic year If you are not enrolled for the first 60 days or if you leav
8. a different name a brand name Products sold under their generic names are generally less expensive than products sold under a brand name because the companies that manufacture them usually do not spend money on the marketing of generic products Companies that sell brand name products on the other hand must charge more to offset their advertising and market ing costs Often the higher cost of brand name prescription drugs also helps offset the cost of the research conducted to develop that drug While all drugs have generic names some drugs are not yet available in a separate generic version New drugs are protected by patents for a period of time This means that only the company that developed the drug and obtained the patent can sell it during that period Once the patent expires other companies can seek FDA Food and Drug Administration approval to produce the drug and a generic can become available Virtually all pharmaceutical experts agree that drugs sold under a generic name are equivalent to brand name drugs because no matter the category all drugs must be approved by the FDA How to Fill a Prescription With approximately 54 000 participating pharmacies nationwide and a convenient mail order program UniCare makes it easy for you to get your prescription filled Just follow these steps Retail Pharmacy 30 day supply Mail Order Drug Program 90 day supply Step 1 Step 2 Step 3 Step 4 Find a
9. dit for prior health insurance as long as you did not have a break in coverage of 63 days prior to the effective date of coverage under the Loyola Health Care Plan for Students When You Are Sick or Injured If you have a sudden onset of illness or are injured in an accident you must first determine if your condition is an emergency as highlighted in the What Is an Emergency box If you need emergency care you should immedi ately go to the nearest emergency facility or dial 911 It doesn t matter if the facility is in the PPO network As long as it s a true emergency you will receive the same benefit either way in or out of network If your illness or injury does not require emergency care you have several options While heading straight to the doctor s office may seem like the best plan of attack you may be able to save yourself some time and money by consulting one of the health hotlines or online resources available to you as described in the box Health Resources at Your Fingertips If you feel that you need to see a doctor you can either e Visit the Wellness Center on Loyola s Lake Shore campus or the Student Health Service for medical students or e Go to a doctor who participates in UniCare s PPO network to receive maximum benefits under the plan When You Need Care for Mental Health or Substance Abuse Your emotions and mental well being are just as important as your physical well being and with
10. e cost of your prescription so you may be surprised to learn how much your medications really cost Each time you fill a prescription the plan pays the difference between the true drug cost and your copayment The plan has a 3 000 annual maximum benefit per person If the amount the plan pays reaches 3 000 you will have to pay all drug costs after that point Most likely you won t reach this limit but it s something to keep in mind if you expect to incur a lot of prescription drug expenses during the year What Is a Formulary A formulary is a list of effective affordable and commonly prescribed brand name and generic drugs Drugs that are classified as either generic or preferred brand name appear on the formulary Drugs that do not appear on the formulary are considered to be non preferred and are covered at the lowest benefit level To be sure that you re getting the most for your money you should always check the formulary before having a prescription filled As an added measure you may even want to bring a copy of the formulary to your next doctor s office visit so you can discuss which drug will be most appropriate and cost effective for you For a comprehensive list of formulary drugs log on to www unicare com Generic vs Brand Name Drugs Every single drug product has a generic name Some are easily recog nized like aspirin or penicillin but others are probably less familiar because they are sold under
11. e the University within the first 60 days of your enrollment as a student your coverage under the Loyola Health Care Plan for Students will end Continuing Coverage If your insurance under Loyola s Health Care Plan for Students ends for any reason you may be eligible to continue your coverage To qualify you must have participated in the Loyola plan for the six months immediately preceding the date your coverage ended Continuation coverage can be purchased for six months with payment due in full prior to the coverage effective date To learn more about continuation coverage contact UniCare before your student coverage ends on July 31 2007 This brochure highlights some of the features of the Loyola Health Care Plan for Students Full details of these benefits are provided in the official contract governing the plan If there is a discrepancy between the information contained in this brochure and the legal official contract the official contract will prevail How to Get More Information If you have questions or specific requests use the contact information in this chart to get the answers you need if you Want to fast track your enroll ment and ID card Want to opt out of student health care coverage Want to reverse a waiver for student health care coverage Want to voluntarily purchase coverage Want to find a doctor hospital or pharmacy Want to speak to a nurse about a health concern Have a concern about men
12. lan Services at the Wellness Center Staying healthy is especially important during your college years and getting routine physicals on a regular basis can help prevent problems from developing later on down the line Preventive care encompasses everything from annual check ups and immunizations to X rays and lab work Although the plan does not cover doctor visits for such routine care Loyola s Wellness Center at the Lake Shore campus is available to you for a variety of preventive care services Medical students are eligible for similar wellness services and resources through the Stritch School of Medicine Student Health Service The Wellness Center can help keep you healthy with services including Allergy injections e Pregnancy tests e Referrals e STI HIV antibody testing e Telephone advice e Gynecological exams e Health education e Immunizations e Lab tests e Mental health counseling and group therapies e Throat cultures e Tuberculosis screening Many of these services are included in the student activity fee This fee is included on your student account based on your number of credit hours Some lab tests immunizations medications and other materials are available for an additional low fee For more information about the Wellness Center visit www luc edu wellness Tips for Choosing a Doctor 1 4 The doctor you choose can have a significant impact on the quality of care you receive Some of you
13. may still have your long time family doctor but many of you probably live too far from home If you are looking for a doctor in the area here are some tips to find the right one for you Ask friends mentors professors and other local contacts for doctor recommendations e Review databases such as the American Medical Association s Physi cian Select to obtain information including credentials education and specialty about virtually every licensed physician in the U S e Verify the doctor s office hours and ask if he or she has admitting privileges at a convenient hospital e Verify that your doctor is in the UniCare network by logging on to www unicare com and clicking Online Provider Directory A Note About Pre existing Conditions Pre existing conditions are injuries or sicknesses for which you incurred expenses received medical treatment consulted a health care professional or took prescription drugs during the six month period immediately preceding your effective date of coverage If you have a pre existing condition the health care plan will not pay benefits for the condition until you have been continuously covered for six months The pre existing condition limit does not apply to pregnancy or to any newborn or adopted child Creditable Coverage This pre existing condition limit will be waived if you had prior creditable health care coverage such as another group or individual policy You will receive cre
14. ment for you You may also want to consider getting a second opinion What if I Need to See a Specialist Under the PPO plan you never need a referral to visit a specialist Log on to www unicare com and click on Online Provider Directory to find a doctor in your desired specialty Finding a Network Provider To find a network doctor or hospital go to www unicare com e In the middle of the page toward the right click Online Provider Directory e If you are enrolled in the plan Enter your member number in the Member Personalized Search column And follow the instructions for selecting the type of provider you are looking for If you are not yet enrolled Go to the Visitor Search column and click Next Select Large Group Plans Choose UniCare PPO 2007 And select your provider type Health Resources at Your Fingertips Thinking of running to the doctor Before you do check out one of these resources for information and tips about your ailment MedCall MedCall is a toll free patient assistance and health education line where trained registered nurses are available 24 hours a day seven days a week to give you free information and answer most general health questions MedCall nurses can e Provide information on diagnosed conditions medical tests and treat ment options prescription drugs etc and e Advise you on what may be an appropriate action for many situations To reach MedCall call 800 814 00
15. ncorrect If someone else such as your doctor gave UniCare the information they will let you know so that you can ask them to correct it e Ask UniCare not to use your health information for payment or health care operations activities They are not required to agree to these requests e Ask UniCare to communicate with you about health matters using reasonable alternative means or at a different address if communications to your home address could endanger you e Receive a list of disclosures of your health information that they make on or after July 1 2005 except when e You have authorized the disclosure e The disclosure is made for treatment payment or health care operations or e The law otherwise restricts the accounting of such disclosures LOYOLA UNIVERSITY CHICAGO Preparing people to lead extraordinary lives
16. participating pharmacy by calling Customer Service at 800 214 4844 or logging on to www unicare com and clicking Provider Finder Most major drug store chains including CVS and Walgreens are in the network Present your UniCare ID card along with the prescription from your doctor at the pharmacy counter Pay the prescription drug copayment either 15 30 or 60 depending on the type of drug You re done As long as you go to a participating pharmacy there are no claim forms to submit Step 1 Step 2 Step 3 Step 4 Ask your doctor for a written prescription for up to the maximum 90 day amount of the medication plus refills if appropriate Complete the Patient Profile Questionnaire and Mail Order Drug Request Form available online at www unicare com Include a check money order or credit card number for the amount of the copayment Mail the completed forms and written prescription to PrecisionRx P O Box 961025 Fort Worth TX 76161 9863 For refills Simply call the toll free number on your mail order form or on the box or bottle containing the medication The label will indicate whether refills are available When you call be prepared to give your ID number prescription number and credit card information You may also request your refill online at WwWw unicare com Tracking Your Medical Claims he claims filing process may seem a little a confusing to you especially if
17. rmacy or other facility to get the maximum benefits Only you and any covered dependents may use your ID card Helpful Online Tools at UniCare com pensino your health is easy at www unicare com To get started click on Members and then Register Now to create a User ID and password You will need the member ID number shown on your UniCare ID card to register Don t forget your User ID and password you ll need it every time you log on to the site Once registered you ll be able to perform a variety of functions quickly and easily e Check on the status of a claim e Search for a participating or contracted doctor e Verify deductibles coinsurance and out of pocket maximums e Review your Explanation of Benefits EOB e Check your plan coverage e Manage your profile e Contact UniCare customer service If You Choose to Remain in Loyola s Plan f you do not waive coverage and choose to remain in Loyola s plan the annual cost for coverage 1 595 will automatically be added to your student account for 2007 2008 If you have a spouse or child ren whom you would like to cover under Loyola s Health Care Plan for Students your annual cost for health care insurance is listed in the chart below The costs are the same whether you voluntarily enroll or are required to have coverage If You Want Coverage For Annual Cost You only 1 595 Your spouse add 3 527 One child add 2 315 Two or more children add 2 916
18. tal health Need to verify benefits eligibility or obtain a predeter mination of benefits Have a claim question Contact Go to the Student Health Insurance site at www luc edu bursar Go to www luc edu bursar and click on Student Health Insurance Complete the waiver and submit electronically by October 1 2007 Send an e mail request to luc hthworldwide com If you are not required to have coverage but want to buy it for yourself or dependents go to Student Health Insurance at www luc edu bursar UniCare 800 696 9776 WwWwW unicare com click on Online Provider Directory MedCall 800 814 0041 24 hours a day 7 days a week Loyola University Wellness Center Dial a Nurse weekdays during school year 773 508 8883 Resurrection Health Care after hours 877 RES INFO Stritch School of Medicine Student Health Service 708 531 7900 Loyola University Wellness Center www luc edu wellness Phone 773 508 2530 Ulifeline www ulifeline org UniCare 800 696 9776 UniCare 800 696 9776 Www unicare com click on View Claims Your Rights Insurance Portability and Accountability Act of 1996 HIPAA Privacy Rule you have the right to e See or get a copy of certain information that peden law dictates your rights concerning your own health information Under the Health UniCare has about you contained in the Designated Record Set or ask that they correct your personal information that you believe is missing or i
19. that generally have either an equally effective generic equivalent and or one or more preferred brand name options These drugs do not appear on the formulary described on page 7 Self injectables drugs including insulin and other self injectable medications Certain limitations may apply Depending on how much medication you need you may fill your prescription either through a paticipating network retail pharmacy such as Walgreens or CVS or through UniCare s Mail Order Drug Program If you need a certain drug for a chronic condition such as allergies or asthma you can save time and money by using the Mail Order Drug Program The following chart shows how much you pay for a prescription based on the type of medication and whether you use a retail pharmacy or mail order filled at some point during your time at Loyola Drug Category How Much You Pay How Much You Pay fora for a 30 day Supply 90 day Supply through the Mail Order Drug Program Generic 30 copay Preferred brand 30 copay 60 copay Non preferred brand 60 copay 120 copay Self injectables 20 coinsurance per 20 coinsurance per prescription up to prescription up to 200 maximum copay 200 maximum copay per prescription per prescription Subject to a 3 000 annual maximum benefit per person How Much Do Prescription Drugs Really Cost Although you pay a fixed fee 15 30 or 60 at the pharmacy counter the plan pays the majority of th
20. the stress of school work and other commitments it s not uncommon for college students to feel depressed lonely or confused If you think your mental health might be suffering and that counseling would be beneficial help is available to you Loyola s Wellness Center provides students with six individual short term counseling sessions each year You also have the opportunity to participate in various group therapy sessions depending on your comfort level What Is an Emergency Using the emergency room for non emergency medical care doesn t make sense Not only does it tie up important resources that may be needed for a true emergency but it can fail to provide the best care given your medical history and overall health status It can also cost you money since use of the emergency room for non emergency services is not covered under the Loyola Student Health Plan Emergency means serious impairment to a bodily function or serious dysfunction of any bodily organ An emergency places the health of the individual or for a pregnant woman the health of the woman or her unborn child in serious jeopardy How do you know when it s a real emergency Examples of symptoms that may indicate the presence of an emergency medical condition include e Difficulty breathing e Severe chest pains e Convulsions or e Persistent severe abdominal pain For a detailed explanation of plan benefits refer to the UniCare Health Care Plan
21. this is the first lt time you re on your own health care plan To make things a little clearer here s an easy step by step look at how the claims process works depending on if you go to an in network or out of network provider In network Out of network Step 1 Go to your provider to receive Step 1 Go to your provider to receive medical care medical care Step 2 Present your ID card Step 2 Pay for the entire cost of the Step 3 Your doctor will submit a claim service up front to UniCare for you Step 3 Print out a claim form from Step 4 You will receive an Explanation www unicare com and of Benefits EOB from UniCare submit it along with your showing what was paid by saaa to P O Box 4458 UniCare the amount of the Chicago IL 60680 4458 provider contracted discount Step 4 UniCare will reimburse you and any balance the deductible based on the out of network and or 20 you are responsible benefit level 60 of the cost for that you must pay after the deductible for most Step 5 You will receive a bill for the services balance from your provider Step 6 Make your payment directly to the provider To check on the status of your claim log on to www unicare com and click on View Claims If you have specific questions and need to speak with a customer service representative call 800 696 9776 Your ID Card Always be sure to present your ID card whenever you go to a doctor hospital pha
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