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Risk Strategies - University Health Plans

New York School of Interior Design
STUDENT HEALTH INSURANCE PLAN

FREQUENTLY ASKED QUESTIONS

GENERAL

Who is Wellfleet Student? Who is University Health Plans? What are their roles? How do I contact them?
Wellfleet Student is the claims administrator for the health insurance plan. Wellfleet Student is responsible for answering questions about insurance benefits, claims and providing replacement ID cards. If you have any questions for Wellfleet Student, please call 877-657-5030. University Health Plans (UHP) is the broker/plan manager who handles the enrollment process for the school health insurance plan. Please email UHP at info@univhealthplans.com or call 800-437-6448 if there are any questions about your enrollment or if there are customer service issues with Wellfleet Student.

What is a PPO?
A PPO is a Preferred Provider Organization. It is a type of Preferred Provider Option health insurance plan that allows you to see any doctor or specialist of your choice. It does not require that you have a primary care physician. Please refer to your plan document at www.universityhealthplans.com to see if your plan is a PPO plan.

What does in-network and out-of-network mean?
An in-network provider is one contracted with your student health insurance plan to provide services for specific pre-negotiated rates. An out-of-network provider is one not contracted with your student health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider.

How can I determine which providers I can see?
You can seek treatment from any provider. The insurance will pay a percentage of the Reasonable & Customary charges for services that are covered by the plan.

Your out-of-pocket costs may be lower when you utilize an in-network provider. For a listing of participating providers, please go www.wellfleetstudent.com, select your school, and then select “Find health professionals”

If you see an out-of-network provider, your out-of-pocket costs will be higher. It is to your advantage to see an in-network provider to maximize your benefits.

Do I get an insurance card?
Yes. When your enrollment in the Student Health Insurance Plan is submitted to Wellfleet Student, you will receive an email with instructions on how to create an account and download your insurance ID Card.

What if I loose my insurance card?
You will have the ability to download as many copies of your ID card as is necessary.  It is suggested that you save the image of your insurance ID card to your mobile or smart phone device.

Who should I contact for updating my personal information such as mailing address, name, etc.?
Please call UHP at 800-437-6448 to update your personal information.

Can I enroll in the insurance plan after the enrollment deadline?
You can enroll in the SHIP plan after the enrollment deadline should a qualifying event occur while school is in session, and you are actively attending classes. Examples of qualifying events include reaching the dependent are age limit under a parent's policy, marriage, etc. You must supply written proof that your other coverage has terminated through a qualifying event. Please visit www.universityhealthplans.com and select your school to review information about your school’s process and deadlines for enrolling due to a qualifying event.

I have purchased coverage for myself, but can I also purchase coverage for my dependents (spouse, child)?
Please refer to your student health insurance plan document at www.universityhealthplans.com to see if your plan provides dependent coverage.

 

 

CLAIMS

Once I receive treatment, is there anything that I need to do to have my claim processed?
Be sure you provide a copy of your insurance ID card at the time of your visit. In-network providers will submit a claim on your behalf. If you see an out of network provider who will not submit a claim for you and you pay out of pocket, you will need a claim form to submit for reimbursement.

There may be situations where Wellfleet Student contacts you for additional information about your injury, other insurance plans that are possibly covering you, etc. If Wellfleet Student sends you a form to complete, the processing of your claim may stop until the form is properly completed and returned to the address indicated in the request.

How can I check the status of a claim I submitted?
You can check your claims status at www.wellfleetstudent.com. To view information unique to you, you must register online. For first time users, you may register at www.wellfleetstudent.com. For returning users, simply "Login" with your username and password. You can also contact Wellfleet Student via phone at 877-657-5030.

What if I can't remember my password?
You can retrieve your password by providing answers to the security questions you established when you registered on www.wellfleetstudent.com.

What are some of the reasons Wellfleet Student might not reimburse my medical provider for a claim I submitted?
Wellfleet Student will send a letter when a claim is denied. The following are common reasons for denial:

  • Claims submitted directly to Wellfleet Student will be denied and you will be asked to resubmit them to the address shown on the back of your ID card.
  • Other insurance may be responsible for paying the claim.
  • The services may not be covered according to the exclusions listed in your Student Health Insurance Program brochure.
  • The claim may not have occurred while you were covered.
  • The charges may be over the Reasonable and Customary amount (any questions about the Reasonable and Customary policy please contact Wellfleet Student).

If I am in a car accident or sustain any other injury, what kind of documents will I need to submit a claim form for reimbursement?

You will be asked for a description of the accident, other coverage information and perhaps a police report. A letter from Wellfleet Student will be sent to you requesting the pertinent information.

 

 

BENEFITS/COVERAGE

If I have a benefit question about my policy, who should I ask?
We recommend that you familiarize yourself with your covered benefits located in the Student Health Insurance Program brochure. If you still need assistance, please email, or call Wellfleet Student and a claims administrator can help you with your benefit questions.

Does the Student Health Insurance Plan cover prescription drugs?
Yes. Your student insurance covers prescription drugs. Please refer to the plan brochure for coverage details.

Which pharmacy can I go to get my prescription?
You can go to any participating pharmacy. Popular in-network pharmacies are CVS, Walgreens, Rite-Aid. To find out more about participating pharmacies, you can look up participating pharmacies at www.wellfleetstudent.com. Prescriptions filled at an Out-of-Network Pharmacy are not covered by this Plan.

Does my health insurance plan cover treatment for substance abuse and mental illness?
The Student Health Insurance Plan provides coverage for medically necessary treatment of substance abuse and mental illness conditions. Generally, the extent of coverage depends on whether the treatment is provided on an inpatient or outpatient basis. Please refer to your student health insurance plan document for specific details or call Wellfleet Customer Service at 877-657-5030.

Does my health insurance plan cover pregnancy?
The Student Health Insurance Plan provides coverage for a pregnancy on the same basis as any other medical condition. Please refer to your student health insurance plan document for specific details or call Wellfleet Customer Service at 877-657-5030.

Does the Student Health Insurance Plan cover dental?
There is no adult dental coverage for members age 19 and older. There may be a voluntary dental plan available. Please go to www.universityhealthplans.com, select your school, and review the “Optional Plans” in the navigation menu on the left-hand side of the page. Members under age 19 are covered by the pediatric dental benefit. Please refer to the plan brochure for coverage details.

Does the Student Health Insurance Plan offer any vision benefits?
There is no adult vision coverage for members age 19 and older, however there is a voluntary VSP Vision Care Plan that is available. The premium for the voluntary vision plan is not included with your Student Health Insurance Plan premium. You may enroll in and pay for the VSP Vision Care plan on the UHP website during open enrollment periods. Please see the UHP website for enrollment deadlines and more details. From the UHP home page, select your school and then click on "Voluntary VSP Vision Care Plan".

What is a "pre-existing condition"?
A pre-existing condition is any condition which originates, is diagnosed, treated, or recommended for treatment within six (6) months immediately prior to the insured person's Effective Date of coverage under this Policy (Diagnosis, care and treatment will not include any prior diagnosis of or treatment for infertility.)

What is the policy regarding pre-existing conditions?
Pre-existing conditions are not excluded and will be covered the same as any other condition and are subject to the same limitations that all other conditions are subject to.

What is a reasonable and customary charge and how does that charge affect me as a consumer?
Reasonable and Customary (R&C) charge means the normal and customary charge of the provider, incurred by the Covered Person, in the absence of insurance for a service or supply, but not more than the prevailing charge in the area. If you are treated by an out-of-network provider, there may be a difference between what they are charging and what is considered Reasonable & Customary. You would be responsible for that difference.