Sarah Lawrence College
FREQUENTLY ASKED QUESTIONS

2013-2014 Academic Year

This information should be used in conjunction with the Student Accident and Sickness Insurance Plan brochure, as well as University Health Plan's frequently asked questions.

1. How do I know if I am eligible to enroll in the Accident and Sickness Plan?
2. How do I know if my current coverage is comparable coverage?
3. What is covered under the Student Accident and Sickness plan?
4. Can I go to any health care provider?
5. How do I find a Network Provider?
6. Do I have to get a referral from the Student Health Service before seeking treatment elsewhere?
7. Am I covered for a pre-existing condition?
8. How do I fill a prescription?
9. When I receive services, how and where do I submit my bill?
10. Where and when will ID Cards be distributed?
11. What if I leave Sarah Lawrence College, will I get a refund?
12. Does this plan cover me when I am off campus during semester breaks or summer vacation?
13. Does the Student Accident and Sickness Plan cover me if I decide to study abroad?
14. What other plans and services are available to me as an enrolled student in the Student Accident and Sickness Insurance Plan?
15. Who do I contact if I have questions?

1.

How do I know if I am eligible to enroll in the Accident and Sickness Plan?

All registered students of Sarah Lawrence College are automatically enrolled in the Student Accident and Sickness Plan.

Students who do not want to be enrolled must submit a completed Waiver Form and provide proof of comparable coverage by August 10, 2013 for the Fall Semester, or by January 6, 2014 for students newly enrolled for Spring Semester. If you do not submit a completed Waiver Form by the waiver deadline date for the term you are enrolling in at Sarah Lawrence College, you will be responsible for the insurance premium posted to your student account.

2.

How do I know if my current coverage is comparable coverage?

For coverage to be comparable, the policy must: be in effect throughout the school year, provide comprehensive coverage of hospital (inpatient and outpatient) and physician services, provide coverage which is accessible to students in the New York area, and be underwritten by a U.S. based insurance carrier (foreign policies are not acceptable).

If you are not sure if your current insurance plan is comparable to the 2013-2014 Sarah Lawrence Student Insurance Plan, please determine if you have the following coverage...

  • Your coverage may end at age 26. Most health plans have age restrictions that limit coverage for dependents. Under the Student Accident and Sickness plan, you’re covered for as long as you are a full-time student.
  • You may not be covered outside your State of permanent residency. Many health plans are regionally-based HMO type plans, and will only provide coverage if seen by a specified local provider. The Student Accident and Sickness plan provides coverage on a nationwide basis with a comprehensive network of Preferred Providers available.
  • You may not be covered abroad. Under the Student Accident and Sickness plan, you are covered if you travel in the U.S. or study abroad.
  • You may not have coverage for Mental Health or Counseling if your other coverage is just a basic health insurance plan. It is not uncommon for college-age students to need counseling benefits, and the Student Accident and Sickness plan provides fairly extensive outpatient and inpatient Mental Health Benefits (please refer to brochure for specific benefits).
  • You may not have prescription drug coverage. Under the Student Accident and Sickness plan, you pay a low flat fee (co-pay) each time you need to fill a prescription.

3.

What is covered under the Student Accident and Sickness plan?

The chart below shows how the Plan pays benefits for the major types of health care expenses. You can see the difference in your cost when you use preferred providers. For more details about Plan benefits, provisions, exclusions, appeals and grievance procedures, disclosure information, and other plan features, be sure to see University Health Plan’s brochure or call them at 800-437-6448 to request a copy of the brochure, or to ask a question specifically about the 2013-2014 Sarah Lawrence College Student Insurance Plan.

2013–2014 Accident and Sickness Plan
At a Glance

Please Note:
- In-Network Charges are paid at the Negotiated Rate.
- Out-of-Network Charges are paid at the Reasonable and Customary Rate.

Lifetime Maximum

$500,000 Per Condition

Plan Deductible

$150 Per Policy Year

Annual Out-of-Pocket Maximum

$3,000 (deductible, non-covered services and prescription drug copays do not apply towards meeting the out-of-pocket maximum).

Referral Requirement

Referral from Student Health Services is required before any benefits will be paid under the Sickness and Accident Plan. The Referral Requirement is waived under the following circumstances:

  • Medical Emergency (the student must return to SHS for necessary follow up care.
  • When the SHS is closed.
  • Medical Care received when the student is no longer eligible to use SHS due to a change in student status.
  • Gynecological Care, including Maternity Care.
  • When having a prescription filled under the pharmacy benefit.
  • Insured Dependents.

Type of Service or Supply

Benefit Level

 

In-Network
MagnaCare PPO Network and MultiPlan Network.

Out-of-Network

Hospital Inpatient
(including Room & Board, ICU, Miscellaneous Charges, and Physician Charges)

Plan pays 90%

Plan pays 60%

Surgical Benefits
(Inpatient and Outpatient), including Surgeon, Assistant Surgeon, Anesthetist

Plan pays 90%

Plan pays 60%

Outpatient Benefits
(including Physician Office, Lab and x-ray)

Plan pays 80% after a $15 copay

Plan pays 60% after a $15 copay

Emergency Room (for treatment of an Emergency Medical Condition)

Plan pays 80% after a $100 copay per visit

Plan pays 80% after a $100 copay per visit

Ambulance Expense

Plan pays 100%

Plan pays 100%

Maternity Expense

Covered on the same basis as any other Sickness.

Covered on the same basis as any other Sickness.

Voluntary Termination of Pregnancy

Plan pays 100% up to $500 per policy year.

Plan pays 100% up to $500 per policy year.

Inpatient Mental Health and Chemical Abuse

Covered on the same basis as any other condition up to 60 days per policy year (7 days for detoxification).

Covered on the same basis as any other condition up to 60 days per policy year (7 days for detoxification).

Outpatient Mental Health

Plan pays 80%

Plan pays 80%

Outpatient Chemical Abuse

Plan pays 80% including 60 visits for treatment and 20 visits for counseling per policy year.

Plan pays 80% including 60 visits for treatment and 20 visits for counseling per policy year.

Prescription Drugs - Please Note – if you fill a prescription at an out-of-network pharmacy, you will be required to pay for the prescription up-front, and submit the receipt to the claims administrator for reimbursement, less the applicable co-pay.

Plan Pays 80% after a $15 co-pay per generic and $25 co-pay per brand name prescription to a plan maximum of $500,000 per policy year. Includes coverage for contraceptives.

Participating Pharmacies can be found on-line at www.express-scripts.com

Plan Pays 80% after a $15 co-pay per generic and $25 co-pay per brand name prescription to a plan maximum of $500,000 per policy year. Includes coverage for contraceptives.

4.

Can I go to any health care provider?

After receiving the required referral from the Sarah Lawrence College Student Health Services, you may see whichever provider you choose. However, if you choose to see a Preferred Provider, the benefits available under the Sarah Lawrence College Student Accident and Sickness Plan are significantly higher.

CHP and Sarah Lawrence College are pleased to announce the addition of the MagnaCare Preferred Provider network in the New York/New Jersey area with a network of over 70,000 healthcare provider locations. MagnaCare is your primary network in NY/NJ. If your provider is not in the MagnaCare Network, then you may also search for providers in the MultiPlan network on a national basis.

To find a MagnaCare provider in the New York/New Jersey area, please go to http://clm.magnacare.com/ProviderLocator/Default.aspx

To find a MultiPlan provider outside the New York/New Jersey area, please go to www.multiplan.com

The doctors and other health care providers who belong to MagnaCare and MultiPlan network are called preferred providers*. They include general practitioners and internists, as well as specialists, hospitals and other health care facilities. Because the MultiPlan network extends across the country, you'll find preferred providers locally as well as nationally.

Remember, using preferred providers saves you money because preferred providers agree to accept negotiated fees that may be lower than what non-preferred providers would charge. Also preferred providers do not charge more than the reasonable charge for a given service. The Plan pays benefits for reasonable charges only. If a non-preferred provider charges more than the reasonable charge allowance, you must pay the difference.

*Preferred providers are independent contractors and are neither employees nor agents of Sarah Lawrence College, University Health Plans, Inc. or Nationwide Life Insurance Company.

5.

How do I find a Network Provider?

To find a preferred provider on national basis, you can go to:

  • www.multiplan.com
  • Select "PHCS" as the network type.
  • You can look up providers by location, and by name. You can refine your search to look for providers by specialty, gender and languages spoken or contact University Health Plans at 800-437-6448.

To find a preferred provider on local basis in the NY/NJ area, you can go to:

  • http://clm.magnacare.com/ProviderLocator/Default.aspx
  • Select MagnaCare PPO plan as your Network Plan.
  • You can look up providers by location, entering city & state, or zip code. You can refine your search to look for providers by specialty and languages spoken or contact University Health Plans at 800-437-6448.

6.

Do I have to get a referral from Student Health Services before seeking treatment elsewhere?

When the College is in session, and Health Services is open, insured students must first visit Health Services before seeking treatment, and receive a referral in order to have treatment covered under the Accident and Sickness Insurance Plan.

Exceptions to the Referral Requirement for insured students:

  • Medical Emergency (the student must return to SHS for necessary follow up care).
  • When the SHS is closed.
  • Medical Care received when the student is no longer eligible to use SHS due to a change in student status.
  • Gynecological Care, including Maternity Care.
  • When having a prescription filled under the pharmacy benefit.
  • Insured Dependents.

7.

Am I covered for a pre-existing condition?

Students and dependents previously enrolled in the Sarah Lawrence College Student Accident and Sickness Plan must re-enroll for coverage by September 6, 2013, for the Fall Semester in order to avoid a break in coverage for conditions which existed in prior Policy Years. Once a break in continuous coverage occurs, the definition of a Pre-Existing Condition will apply in determining coverage of any condition which existed during the break.
Definition of a Pre-Existing Condition:

Any Injury, Sickness, or condition for which medical advice, diagnosis, or treatment was recommended or received within six months prior to the Covered Person’s effective date of insurance.

Limitation: Preexisting conditions are not covered unless the Covered Person has had six (6) months of Continuous Coverage (10 months for Pregnancy).

These limitations will not apply if, during the period immediately preceding the Covered Person's Effective Date of coverage under this Policy, the Covered Person was covered under prior Creditable Coverage for six (6) consecutive months (ten (10) months for Pregnancy). Prior Creditable Coverage of less than six (6) months (10 months for Pregnancy) will be credited toward satisfying the Pre-existing Condition limitations.

Please refer to the Plan Brochure for additional information regarding Pre-Existing Conditions.

8.

How do I fill a prescription?

Preferred Care: When obtaining a covered Prescription, please present your insurance ID card at an Express-Scripts participating pharmacy, along with your applicable co-pay. The Pharmacy will bill Express-Scripts for the cost of the drug, plus a dispensing fee, less the co-pay amount. Preferred Care Pharmacy locations can found through www.express-scripts.com.

When you need to fill a Prescription and do not have your ID card with you, you may obtain your Prescription from an Express-Scripts Pharmacy and be reimbursed by submitting the receipt with a completed Prescription Drug claim form.

Non-Preferred Care: You may obtain your Prescription from a Non-Preferred Pharmacy and be reimbursed by submitting a completed Express-Scripts claim form. You will be reimbursed for covered medications at the Reasonable Charge, less any applicable Deductible, directly by Express-Scripts. Please note: You will be required to pay in full at the time of service for all Prescriptions dispensed at a Non-Participating Pharmacy.

Claim forms, Pharmacy locations, and claims status information can be obtained by contacting Express-Scripts at 800-451-6245, or by visiting their website at www.express-scripts.com.

When submitting a claim, please include all Prescription receipts; indicate that you attend Sarah Lawrence College and include your name, address, and student identification number.

9.

When I receive services, how and where do I submit my bill?

All bills should be mailed to the claims administrator at the following address:

Consolidated Health Plans
2077 Roosevelt Avenue
Springfield, MA  01104
Toll Free: 800-633-7867
Local: 413-733-4540

Customer Service Representatives are available 8:00 a.m. to 4:30 p.m. (ET), Monday through Friday, for any questions.

  1. Bills must be submitted within 90 days from the date of treatment.
  2. Payment for Covered Medical Expenses will be made directly to the hospital or Physician concerned unless bill receipts and proof of payment are submitted.
  3. When using a claim form, if itemized medical bills are available at the time the claim form is submitted, attach them to the claim form. Subsequent medical bills should be mailed promptly to the address listed above.
  4. In the event of a disagreement over the payment of a claim, a written request to review the claim must be mailed to Consolidated Health Plans within 60 days from the date appearing on the Explanation of Benefits (EOB).

10.

Where and when will ID Cards be distributed?

Enrollees in the Student Sickness and Accident Plan will be issued a permanent ID card as soon as possible. The cards will be sent to the Sarah Lawrence College Student Accounts office. When the ID Cards are received, insured students will receive an email instructing them to pick up their card at the Student Accounts Office. If a student does not pick up their insurance ID Card within a week or 2, the card will be sent to them via campus mail.

This card is for identification only. It is not a guarantee of eligibility or benefits. If you need medical attention before your permanent ID card is received, benefits will be payable according to the Policy. You do not need an ID card to be eligible to receive benefits.

For lost ID cards, contact:

- https://consolidatedhealthplan.com/members/online_id_card_login OR
- contact Consolidated Health Plans at 800-633-7867.

11.

What if I leave Sarah Lawrence College, will I get a refund?

Except for medical withdrawal due to a covered Accident or Sickness, any student who has not incurred any claims and who withdraws from school during the first 30 days of the period for which coverage is purchased shall not be covered under the Plan and a full refund of premium will be made. Students withdrawing after such waiver deadline date will remain covered under this Plan for the full period for which premium has been paid. No refund will be allowed.

A Covered Person entering the armed forces of any country will not be covered under the Policy as of the date of such entry. A pro-rata refund of premium will be made for such person upon written request received by University Health Plans, Inc. within 90 days of withdrawal from school.

12.

Does this plan cover me when I am off campus during semester breaks or summer vacation?

Yes, the Student Accident and Sickness Plan provides coverage from September 1, 2013 to September 1, 2014 for students enrolled in the Fall Semester. New Sarah Lawrence College Students enrolling for the Spring Semester will have coverage from January 20, 2014 through September 1, 2014. You will be covered for eligible expenses whether you are on campus or traveling nationwide.

13.

Does the Student Accident and Sickness Plan cover me if I decide to study abroad?

Yes, the Student Accident and Sickness Plan provides worldwide coverage. The plan provides the same benefits as if you were at Sarah Lawrence College, plus provides additional Worldwide Assistance, Medical Evacuation and Repatriation of Remains benefits.

14.

What other plans and services are available to me as an enrolled student in the Student Accident and Sickness Insurance Plan?

The Student Accident and Sickness Plan is more than comprehensive health coverage. It also offers you these important programs, services, and benefits:

  • Emergency Travel Assistance Services
    (Provided by Europ Assistance USA)
    If you have a medical emergency while traveling outside of your home country, or more than 100 miles from home or campus, you can take advantage of emergency assistance services provided by Europ Assistance USA. These services are available 24 hours a day, 365 days a year and include medical consultation and evaluation, medical referrals, travel advisories and much more.
  • Accidental Death and Dismemberment Benefit
    (Underwritten by Nationwide Life Insurance Company)
    The plan pays a benefit of up to $10,000 if you die or suffer certain types of injuries as the result of an accident.
  • Medical Evacuation and Return of Mortal Remains Services
    (Provided by Nationwide Student Travel Assistance)
    If you need medical care that is not available locally, MEDEX will provide the transportation, personnel and equipment needed to get you to the nearest facility capable of providing the required care. In the event of your death, MEDEX will provide assistance in returning your mortal remains.
For more information about the benefits and programs described above, visit the University Health Plans website at www.universityhealthplans.com, and select the link for Sarah Lawrence College.

15.

Who do I contact if I have questions?

For questions about:

Please contact:

  • Insurance Benefits
  • Claims Processing
  • Lost ID Card

Consolidated Health Plans, Inc.
2077 Roosevelt Avenue
Springfield, MA 01104
Toll Free: 800-633-7867
Local: 413-733-4540
www.consolidatedhealthplan.com

  • Student Health Services
  • Immunizations
  • Referral Information

Sarah Lawrence College Student Health Services
914-395-2350
www.sarahlawrence.edu/health

  • Enrollment Process
  • Waiver Process

University Health Plans, Inc.
One Batterymarch Park
Quincy, MA 02169-7454
Phone: 800-437-6448
Fax: 617-472-6419
www.universityhealthplans.com
Email: info@univhealthplans.com

  • Listing of Preferred Providers

MultiPlan
www.multiplan.com

Magna Care
http://clm.magnacare.com/ProviderLocator/Default.aspx

  • Status of Pharmacy Claim
  • Pharmacy Claim Forms
  • Excluded Drugs
  • Member Pharmacies

Express-Scripts
800-451-6245
www.express-scripts.com

  • Travel Assistance Services
Europ Assistance USA
Phone: 877-496-1175
Outside the US, call collect: 240-330-1530