Worcester Academy

FREQUENTLY ASKED QUESTIONS

 

GENERAL


Who is Consolidated Health Plans? Who is University Health Plans? What are their roles?

Consolidated Health Plans (CHP) is the claims administrator for the health insurance plan. CHP is responsible for answering questions about insurance benefits, claims, and providing lost ID cards. If you have any questions for CHP, please call 800-633-7867. University Health Plans (UHP) is the broker/plan manager who handles the enrollment and waiver process for the school health insurance plan. Please call UHP at 800-437-6448 if there are any questions about the enrollment and waiver process or if there are any customer service or claims processing issues related to CHP.

What is a reasonable and customary charge and how does that charge affect me as a consumer?

Reasonable & Customary (R&C) charges are guidelines developed by an independent source and used by insurance companies. These guidelines help to assure that the fees providers are charging are reasonable for the service provided in their geographic area. Nationwide and Security Mutual utilize the 80th percentile of R&C for most of its plans.

Can I enroll in the insurance plan after the enrollment deadline?

You can enroll in our plan within 30 days of a qualifying event (loss of other coverage) during the academic year. You must supply written proof that your other coverage has terminated through a qualifying event within the 30 days after losing your other insurance coverage.

What is a "pre-existing condition"? How does this affect me as a consumer of health insurance?

A pre-existing condition is any condition that manifested itself or for which you have had symptoms or medical services provided during the 6 months immediately prior to your effective date of coverage under this plan.  Pre-existing conditions are not covered for the first 6 months following your effective date of coverage under this plan.

If I am in a car accident or have another injury, what kind of documents will I need in order to submit a claim form for reimbursement?

You will be asked for a description of the accident, other coverage information and a police report (under certain circumstances). A letter from CHP will be sent to you requesting the pertinent information.

What are some of the reasons CHP might not pay for a claim I submitted?

Other insurance may be responsible for paying the claim; the services may not be covered according to the exclusions listed in your brochure or Plan Document; the claim may not have occurred while you were covered; or the charges may be over Reasonable and Customary. A letter or explanation of benefits from CHP will accompany any denied claim.

How can I determine which Preferred Provider Network I have access to?

There is no Preferred Provider Network included in your plan.  You are allowed to access to any provider under this plan for covered medical benefits.

When scheduling an appointment should I tell the provider's office that I have the Worcester Academy Student Health Insurance Plan?

Please inform the doctor’s office that Consolidated Health Plans is your claims administrator and any medical claims should be forwarded to Consolidated Health Plans, 2077 Roosevelt Avenue, Springfield, MA  01104. The phone number for CHP is 800-633-7867 to call to verify benefits and check on claims status.

How can I check the status of a claim I submitted?

You can check the status of a claim that you have submitted to CHP by visiting their website at https://consolidatedhealthplan.com/members/chps_exclusive_claim_view_access. You must enter your Username and Password to access online-claims status.

What is my login and password?

Your login consists of a user id (member number) and a password. The password is located in the upper right-hand corner of the mailer containing your identification card.

What if my password doesn't work?

Passwords are case-sensitive. Please be sure you have entered it exactly as it is printed. If you continue to have a problem please call CHP at 1-800-633-7867.

 

STUDENT HEALTH INSURANCE PLAN


Will I receive an insurance ID card?

Yes. Once you are enrolled in the Student Health Insurance, your insurance card will be sent to your school for distribution.

What if I lose my insurance ID card?

Please contact CHP at 800-633-7867 to request a replacement insurance ID card.

Who should I contact for updating my personal information such as a mailing address, name, etc.?

Please call UHP at 800-437-6448 to update your personal information.

If I have a benefit question about my policy, who should I ask?

Please review the insurance benefits in your student accident and sickness brochure. If you still need assistance, please call CHP at 800-633-7867 and a customer service representative can help you with your benefit questions.

Do I need a password to print a claim form?

No, passwords are not required to print claim forms. To access a claim form, please go to this link https://consolidatedhealthplan.com/members/chps_exclusive_claim_view_access.

What happens if I withdraw from school while I am enrolled in the student health insurance plan? Will you refund my premium? If not, am I still insured?

You will not receive a refund. However, your plan will continue through the end of the period for which you paid premium.

Does the Student Insurance plan cover prescription drugs?

Yes, your prescription drugs are covered through Express Scripts pharmacy.  Please refer to your brochure for details on covered and excluded medications.

Which pharmacy can I go to get my prescription?

You can go to any pharmacy that is participating in the Express Scripts pharmacy network.  A directory of participating pharmacies is available by calling Express Scripts at 800-451-6245.

Does the Student Insurance provide Dental Benefits?

No, however you may purchase a separate voluntary Dental Plan thru Delta Dental of MA.  Please visit http://www.universityhealthplans.com/letters/letter.cgi?group_id=196 for details.

Does this plan offer any vision benefits?

No, however you may purchase a separate voluntary VSP Vision Care Plan.  Please visit http://www.universityhealthplans.com/letters/letter.cgi?group_id=170 for details.