2018 SSA - Medical Plans

Choice Plus Plans

Columbia offers two different Choice medical plan options, the Choice Plus 90 plan and the Choice In-Network plan.

In-Network Coverage: For the Choice Plus 90 plan and the Choice In-Network plan, you pay a $30 copay for physician office visits (including specialists and urgent care) when you use a UHC network provider. Find a DoctorPreventive care is covered at 100% with no deductible for in-network services. In the Choice Plus 90 plan, the deductible, coinsurance and all medical and prescription drug copays accumulate toward your annual out-of-pocket maximum.
 

Choice Plus 90 Plan

Preventive care is covered at 100%. Other than preventive care and copays, for most in-network medical services you must meet the annual deductible of $200 per member before the Choice Plus 90 plan pays the coinsurance of 90% of the negotiated fee; you are responsible for the remaining 10% of the coinsurance. After you reach the in-network out-of-pocket maximum of $2,500 for an individual and $5,000 for a family, the Choice Plus 90 plan pays 100% of covered in-network medical charges and prescription drug copays for the remainder of the calendar year.
 

Choice In-Network Plan

Preventive Care is covered at 100%. The Plan has no deductible for all in-network services. Copays apply for certain services and in some cases are dependent on where the service is received. For example, inpatient hospital services require a $500 per admission copay; outpatient hospital services, including lab and radiology, require a $150 copay. In addition, after you reach the in-network out-of-pocket maximum of $3,500 for an individual and $7,000 for a family, the Choice In-Network plan pays 100% of covered medical charges for the remainder of the calendar year. Out-of-network services are not covered.

Note: The $150 outpatient hospital copay does not apply if you obtain your lab and/or radiology at certain New York Presbyterian (NYP) locations. See the list of NYP participating locations at http://hr.columbia.edu/forms-docs/nyp-outpatientlaboratory- locations.

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.
 

Out-of-Network Coverage

Most out-of-network services are covered at 60%* of 190% of the Medicare Maximum Allowable Charge (MAC) after the annual deductible of $600 per member. For the Choice Plus 90 plan, out-of-network expenses are handled 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 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
 

* 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 90 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 Choice Plus 90 plan 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-ofnetwork 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 to your out-of-network 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.

For information on specific Medicare MAC(s) talk to your physician or his/her office staff.

ImportantImportant! 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.

* 70% for outpatient mental health/substance abuse services.
 

Retiree Medical Insurance

You may be eligible for this coverage if you leave the University on or after age 55 and you complete at least 10 years of full-time benefits-eligible service with the University after age 45. To learn more, please contact the Columbia Benefits Service Center at 212-851-7000, Monday through Friday, 9 a.m. to 4 p.m. You may also contact us via email
at hrbenefits@columbia.edu.


Note: A spouse or dependent is only eligible to enroll if the retiree is a participant or if the retiree is deceased. Spousal coverage will only be offered to a spouse the retiree is legally married to on the date of retirement. Eligible children are covered until age 26 as long as they are full-time students. Qualifying events must be reported within 31 days of the event.