Medical, Prescription and Vision Benefits for Retired Officers Under Age 65

Related Documents 
2018 Retiree Health Plan Comparison Chart - Pre-65
For retirees under age 65, Columbia University offers three medical plan choice with UnitedHealthcare: Choice Plus 80, Choice Plus 90 and Choice Plus 100 plan. 
 

The Medical Plan Comparison Chart and Vision Coverage chart below summarizes the differences between each of the three University-provided medical plans. For detailed information, please review the Summary of Benefits and Coverage (SBC) and Summary Plan Description (SPD)

 

2018 Retiree Medical Plan Comparison Chart - Under Age 65 
BenefitChoice Plus 80Choice Plus 90Choice Plus 100
 In-NetworkOut-of-Network*In-NetworkOut-of-Network*In-NetworkOut-of-Network*
Annual Deductible 
  Individual 
  Family


$600 per person**
 


$850 per person


$400 per person


$850 per person


$200 per person


$850 per person
Coinsurance80% after deductible60% after deductible90% after deductible60% after deductible100% after deductible90% after deductible
Out-of-pocket
Maximum 
   Individual
   Family


$3,750
$7,500


$5,250
$10,500


$3,250
$6,500


$5,250
$10,500


$4,750
$9,500


$5,250
$10,500 
Preventive Care100%Not covered100%Not covered100%Not covered
Physician Office Visits,
including specialists
$30 copay60% after deductible$30 copay60% after deductible$30 copay60% after deductible
Laboratory/ Radiology Services,
including services rendered
in a physician’s office
80% after deductible60% after deductible90% after deductible60% after deductible100% after deductible
if non-hospital location. 
$150 copay if hospital***
60% after deductible
Inpatient Hospital Care80% after deductible60% after deductible; Precertification required90% after deductible60% after deductible; Precertification required$500 copay per admission60% after deductible; Precertification required
Outpatient Hospital Care80% after deductible60% after deductible; Precertification required90% after deductible60% after deductible; Precertification required$150 copay (including
lab and radiology)***
60% after deductible; Precertification required
Mental Health and Substance Abuse—Inpatient care80% after deductible60% after deductible; Precertification required90% after deductible60% after deductible; Precertification required$500 copay per admission60% after deductible; Precertification required
Mental Health and Substance Abuse—Outpatient programs$30 copay70% after deductible for facility-based care including intensive outpatient programs; Precertification required$30 copay70% after deductible for facility-based care including intensive outpatient programs; Precertification required$30 copay****70% after deductible for facility-based care, including partial hospital/ day treatment and intensive outpatient programs Precertification required 
Mental Health and Substance Abuse—Outpatient counseling$30 copay70% after deductible$30 copay70% after deductible$30 copay70% after deductible
Emergency Room$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)$150 copay (Waived if admitted)
Basic and Comprehensive Infertility TreatmentUnlimited benefit for diagnosis and basic medical treatment, including artificial insemination
Advanced Infertility Treatment$30,000 lifetime maximum for advanced treatments and Assisted Reproductive Technology including IVF, GIFT and ZIFT
Prescription Drug coverage with OptumRxNon-preventive prescription drugs are subject to an annual in-network deductible. Copays apply up to the annual in-network out-of-pocket maximum 
Retail (30 days) 
• Generic: $10 copay
• Single-source: $50 copay 
• Multi-source: $45 copay 
 
 
Mail-order (90 days)     
• Generic: $15 copay   
• Single-source: $25 copay    
• Multi-source: $90 copay
 

*  Out-of-network coinsurance reimbursement is indexed to 190% of the Medicare Maximum Allowable Charge (MAC), including expenses in excess of the out-of-network out-of-pocket maximum. 

** To meet the requirements of the U. S. Department of State, J-1 Visa holders will have a $500 per person deductible applied. 

***  No copay for lab and radiology at certain designated New York Presbyterian (NYP) locations. See the list of NYP participating locations

**** No copay for partial hospitalization/intensive outpatient treatment. 

REMEMBER: In the Choice Plus plans, in-network deductible, coinsurance and medical and prescription copays accumulate toward the in-network out-of-pocket maximum. In addition, out-of-network out-of-pocket expenses accumulate toward the in-network out-of-pocket maximum. In the HDHP, the in-network deductible, coinsurance and prescription copays accumulate toward the in-network out-of-pocket maximum.

 

ImportantImportant Notes: UHC’s Choice network is a national provider network and does not require a primary care physician or referrals to see specialists. UHC requires precertification for some services. If you use an in-network provider, your participating network physician or hospital generally handles the precertification process. However, it is your responsibility to confirm that your provider has obtained the necessary authorizations from UHC. If you see a provider who is out-of-network, you are responsible for obtaining precertification for most services except routine office visits. 

 

Vision Coverage

Vision BenefitsChoice Plus Plans 80,90 and 100
Benefits apply both In-Network and Out-of-Network
 
Routine Eye Exams 
Adults:* One exam every 12 months with a $10 copay 

Children: One exam every 12 months with a $10 copay 
LensAdults:* Every 24 months, $20 allowance for single lenses, $30 for bifocal, $40 for trifocal or $75 for lenticular. 

Children: Lenses covered in full every 12 months. More frequently if medically necessary.  
FramesAdults:* $30 allowance every 24 months

Children:* Up to $100 covered in full every 12 months.  More frequently if medically necessary. Cost above $100 covered at 60%.
Contacts
Adults:* $75 allowance every 24 months

Children: Single purchase of a pair of contact lenses or 1 box of contact lenses per eye covered at 100% every 12 months. 
 
Available for either frames and lenses or contact lenses
 
Note: Provider might require payment in full at the time of service  The patient then submits a claim to UHC for reimbursement.
 
For a listing of vision providers, log in to www.myuhc.com and click “Coverage & Benefits,” “Vision” and then “Vision benefit highlights.” You will be taken to the UHC Vision website where you can search for a vision provider under “Find a Provider."
 
ID CARD
You do not need a vision ID card to use your benefits. Your vision ID number is the same ID that is on your UHC Medical card. However, if you would like one, you may print one from the Vision website. Go to myuhc.com and select “Vision” from the “Coverage & Benefits” tab, then click “Vision Benefit highlights,” and you will be taken to the UHC Vision website.