2018 Postdocs - Medical Plan

Columbia University offers the Choice Plus 80 plan through UnitedHealthcare (UHC). The Plan covers in-network preventive care, such as annual physicals, immunizations and well-baby visits, at 100% with no deductible. The plan also includes coverage for out-of-network services. If you enroll in the medical plan, you will also be automatically enrolled in prescription drug and vision coverage.

The medical plan covers only medically necessary services and supplies for the purpose of preventing, diagnosing or treating an acute sickness, injury, mental illness, substance abuse or symptoms:

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  • Contributions: The amount you pay toward the cost of your medical, vision and prescription drug coverage Your contributions do not accumulate toward your deductible or out-of-pocket maximum.
     
  • Copay: The amount you pay directly to the medical service provider at the time of service The copay for the Choice Plus 80 plan is $30 for in-network providers Your in-network copays accumulate toward your in-network out-of-pocket maximum Copays do not accumulate toward your deductible.
     
  • Deductible: The amount you must pay each year before the Plan begins to pay for non-preventive expenses Your in-network deductible accumulates toward your in-network out-of-pocket maximum.
     
  • Coinsurance: Once you reach your deductible, coinsurance is the amount the Plan will cover of your remaining eligible in-network medical expenses You are responsible for directly paying the remaining balance, until you reach the out-of-pocket maximum The amount you pay in coinsurance will vary by your usage of medical services.
     
  • Out-of-Pocket Maximum: The most you will be responsible for paying out of your own pocket each year for covered medical services Once you reach your in-network out-of-pocket maximum, the Plan will pay 100% of all remaining in- network covered medical expenses for the year.
     

Tax Implications

If any portion of your health insurance is paid by your fellowship allowance, training grant expense account, department or Principal Investigator, it is considered imputed income under IRS regulations and will be included as taxable income on your W-2 or 1099-MISC Form.
 

In-Network Coverage

With the Choice Plus 80 medical plan, you have the flexibility to use in-network or out-of-network providers each time you seek care. However, you can minimize your out-of-pocket expenses by using in-network providers.
 
When you use UHC network providers, you pay a $30 copay for physician office visits (including specialists and urgent care). Preventive care is covered at 100% with no deductible for in-network services. The deductible, coinsurance and all medical and prescription drug copays accumulate toward your annual out-of-pocket maximum.
 
Other than preventive care and copays, for most in-network medical services you must meet an annual deductible of $600* per member before the Choice Plus 80 plan pays the coinsurance of 80% of the negotiated fee; you are responsible for the remaining 20% of the coinsurance. After you reach the in-network out-of-pocket maximum of $3,750 for an individual and $7,500 for a family, the Plan pays 100% of covered in-network medical charges and prescription drug copays for the remainder of the calendar year.
 
Whenever you are having diagnostic or preventive tests, be sure to ask your physician if he/she is referring you to a provider who is in-network.
 
* To meet the requirements of the U.S. Department of State, J-1 Visa holders will have a $500 per person deductible applied.
 

Out-of-Network Coverage

Most out-of-network services are covered at 60%** after the annual deductible of $850 per member. Out-of-network expenses are always handled the same way, as outlined below:
  • You are responsible for obtaining precertifications from UHC before most non-office visit treatment begins (unless it is an emergency). If you do not request precertification before having inpatient or outpatient surgery and/or certain treatment, you will be subject to a $500 penalty.  If you are having trouble finding providers and/or services in the network, please call UHC at 800-232-9357. In an emergency, if you or your covered dependent is admitted to a non-network hospital, you must contact UHC within 48 hours of admission or you will be subject to a $500 penalty.
     
  • Before the Plan starts to pay anything for out-of-network services, you must meet your out-of-network deductible.
     
  • Then the Plan pays coinsurance of 60% of remaining covered charges up to a maximum of 190% of the Medicare Maximum Allowable Charge (MAC)
If you reach the out-of-network out-of-pocket maximum, the Plan will pay 190% of the Medicare MAC.
 
Note: Your out-of-network expenses can be used to satisfy the in-network deductible and in-network out-of-pocket maximum in the Choice Plus 80 plan
 
** 70% for outpatient mental health/substance abuse services

 

Travel Vaccination Coverage

If you are traveling out of the country, travel vaccinations will be covered under the medical plan (for the Choice Plus 80 plan, deductible and coinsurance will apply).
 

Preventive Care

 
 
MEDICAL & PRESCRIPTION DRUG ID CARDS 
If you newly enroll in medical benefits, you will receive a UHC ID card. This card will include member information for medical and prescription drug coverage. It takes approximately three weeks for new hires to receive an ID card. If you need a temporary ID card sooner, go to www.myuhc.com two weeks after you complete your benefits enrollment to download and print your temporary card. 


Medicare Maximum Allowable Charge (MAC) 

Out-of-network services in the healthcare plans are indexed to 190% of the Medicare MAC. Out-of-network services are covered at 60% of 190% of the Medicare MAC, except for mental health and substance use disorder outpatient counseling and outpatient programs which are covered at 70% of 190% of the Medicare MAC.
 
Here’s an example: Your out-of-network physician charges you $200 for an office visit. The claim submitted to UHC has a billing code of 99212 (office visit for an established patient in ZIP code 10010 in New York City). 190% of the Medicare MAC for this billing code is $95.87. Therefore, $95.87 (not $200) is the basis for the out-of-network reimbursement.
  • If you had not met the out-of-network annual deductible, you would be responsible to pay the full $200, and $95.87 would be applied to the out-of-network deductible.
     
  • If you had already met the out-of-network annual deductible, the Plan would pay the coinsurance of 60% of $95.87, which is $57.22. Your share of the coinsurance is 40% of $95.87, which is $38.35. You are also responsible to pay the amount in excess of the 190% of the Medicare MAC; that is $200 - $95.87 = $104.13. In total, you would pay $38.35 + $104.13 = $142.48, and $38.35 would be applied toward your out-of-pocket maximum.
     
  • If you had met the out-of-network annual out-of-pocket maximum, the medical carrier would pay 190% of the Medicare MAC ($95.87), and you would be responsible for the balance ($104.13).
Charges in excess of 190% of the Medicare MAC (in this example, $104.13) do not count toward the out-of-network out-of-pocket maximum.
 
Important noteImportant! Providers can bill you for any unpaid balance for amounts above these limits, and you are solely responsible for these payments.
 
  • Any charges exceeding plan limits do not count toward the out-of-pocket maximum, including any charges exceeding 190% of the Medicare MAC.
     
  • You can find out how much you will be reimbursed for out-of-network services before you seek treatment by first asking your physician for the medical “procedure code” along with the associated fee. Then, call UHC’s member services to request an estimate of their reimbursement.