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All
students at Occidental College must document health
insurance coverage. There are two types of student health
insurance plans with United Healthcare; Injury and
Sickness.
The
Injury coverage is required and must be purchased by all
students. Undergraduate Students are required to purchase
Sickness coverage unless proof of comparable coverage is
furnished. International students and students
participating in the Oxy abroad programs are not allowed to
waive Sickness coverage. Graduate Students may purchase
Sickness coverage on a voluntary basis. Questions regarding
purchasing or waiving student health insurance should be
directed to Student Accounts.
Based on
the coverage purchased, the Injury and Sickness policies
cover students year round, when they are on or off campus
and whether they are in the U.S. or abroad. United
Healthcare issues an insurance ID card to covered students
annually. If you are covered by more than one insurance,
United Healthcare has to address claims first, since the
Injury and Sickness plans are primary.
The
student health insurance plans with United Healthcare are
fee-for-service plans. The Injury and Sickness plans offer
the freedom to choose your own doctors (including
specialists) and hospitals. Based on the coverage
purchased, the student insurance plans provide benefits for
Usual & Customary (U&C) Charges for a covered injury or
illness. When United Healthcare processes a claim, they
send students an explanation of benefits (EOB) indicating
among other things, the amount claimed, total covered and
the patient balance. Correspondence from United Healthcare
will be mailed to students at their campus mailbox.
United
Healthcare has an on-site Client Services Representative
available part-time to assist you with Student Insurance
issues. If you need assistance, please contact Julie Gordon
at (323) 259-2836 or
jgordon@oxy.edu.
STUDENT INSURANCE
SUMMARY
Underwritten by: United HealthCare Insurance Co.
Administered by: UnitedHealthCare StudentResources
Policy number: 2007-810-1
Policy term: August 1, 2007 to July 31,
2008
Premium: Injury - $104/semester
Sickness - $217/semester
INJURY
POLICY
(required)
*
Basic
Medical
The Basic Policy provides
benefits for Usual and Customary
Charges incurred by an insured person up to the maximum of
$5,000 of covered expenses for each injury.
*
Major Medical
The
Major Medical begins payment after the Basic Medical maximum
benefit of $5,000 has been paid and after the $250 Major
Medical deductible has been satisfied. The insurance will
pay 80% for additional covered medical expenses up to the
maximum of $25,000 for each injury.
*
Intercollegiate Sports
The
Policy provides benefits for Usual & Customary Charges up to
a maximum of $4,000 of covered medical expenses for each
intercollegiate sports injury.
SICKNESS POLICY
(optional with proof of comparable coverage)
*
Basic Medical
The
Basic Policy provides benefits for Usual and Customary
Charges incurred by an insured person up to the maximum of
$500 of covered expenses for each sickness.
*
Major Medical
The
Major Medical begins payment after the Basic Medical maximum
benefit of $500 has been paid and after the $250 Major
Medical deductible has been satisfied. The insurance will
pay 80% for additional covered medical expenses up to the
maximum of $25,000 for each sickness.
The Master Policy on file at the College
contains all of the provisions, limitations, exclusions and
qualifications of your insurance benefits. The Master
Policy is the contract and will govern and control the
payment of benefits. For a full description of coverage
including costs, benefits, exclusions, any reductions and
limitations, and the terms under which the coverage may
remain in force, contact Julie Gordon at Emmons Health
Center.
United Healthcare Claim Procedure
Mail
all medical and hospital bills to the address below.
Include your name, address, insurance ID number (on ins.
ID card), and a reference to Occidental College with the
paperwork. This information can be handwritten on the
bill. A company claim form is not required for filing a
claim.
UnitedHealthcare
Student Resources
P.O. Box 809025
Dallas, Texas 75380-9025
Phone: 800-767-0700 or
www.uhcsr.com
File claims within 90 days of injury or first treatment
for a sickness. For injury claims you must be treated
by a physician within 30 days after the date of the
accident.
UnitedHealthcare has a website that can be used to track
claim status. Before accessing the site for the first
time, please call 800-767-0700 to set up a user ID and
password. Please visit the website at
www.uhcsr.com for brochures, ID cards, claim status
and other services.
SHORT-TERM
OR ALTERNATIVE COVERAGE
For
information on Dental and Vision plans that may be
available, visit
www.uhcsr.com or call 800-237-0903.
Students
looking for short-term or alternative coverage after
graduating can go to
www.goldenrulehealth.com or call 800-980-7395.
***************************************************
STUDENT
INSURANCE FAQ'S
1) Does the sickness coverage with UnitedHealthcare cover
birth control?
Yes,
UnitedHealthcare will reimburse covered students for up
to a maximum of six months of birth control each
semester.
2) Does the sickness coverage with UnitedHealthcare provide
any benefits for wellness care, physical exams or STD
testing?
Yes,
UnitedHealthcare will reimburse covered students for up
to a maximum of $200/year for the physical exam, pap
smear, and testing for sexually transmitted diseases
including HIV.
3) Does the sickness coverage with UnitedHealthcare cover
the HPV vaccine?
No, Gardasil is
not currently covered by the student health insurance
plan.
4)
Does the injury and sickness coverage with
UnitedHealthcare cover prescriptions?
Yes, based on the coverage purchased, covered
prescription drugs will be reimbursed. Since the
Student Insurance plans are not part of a prescription
drug network,
students should take their prescription to the pharmacy,
pay for the prescription, then remit both the pharmacy
receipt and the cash register receipt showing payment to
UnitedHealthcare for reimbursement.
Why did I receive an Additional Benefits
ID card?
Based on the coverage purchased, students may be
eligible for a discount on prescriptions. When filing a
prescription, present your Medco Rx Discount Program
Card and your Insurance ID card to a participating
pharmacy. When eligible, you will receive discounts on
your prescriptions - up to 15% off on brand name
medications and up to 50% off on generic medications.
5)
Does the sickness coverage with UnitedHealthcare cover
psycho-therapy?
Yes, inpatient psychotherapy is covered when provided by
a hospital. Outpatient psychotherapy is covered under
the Basic then Major Medical sickness policy.
6) If I sustain an injury, can I submit
my claims to UnitedHealthcare?
Yes, it’s mandatory for all full-time Oxy students to
have injury coverage with UnitedHealthcare. You, your
doctor or hospital can submit a claim to United
Healthcare. Students will receive a letter from
UnitedHealthcare requesting injury details.
UnitedHealthcare cannot continue processing your claim
until they receive this information. If the student has
other insurance coverage, the Student Insurance with
UnitedHealthcare is primary.
7) What should I do if I haven’t
received an explanation of benefits from
UnitedHealthcare but I’m still receiving bills from the
provider?
CContact
UnitedHealthcare to see if they received your claim or
to check the status. You can visit their website at
www.uhcsr.com. Before accessing the website for the
first time, please call 800-767-0700 to set up a user ID
and password.
8) If I’m injured while playing intercollegiate sports,
can I submit claims to the Student Insurance?
Yes, the student insurance pays up to $4,000 of covered
expenses for each intercollegiate sports injury. If
your claim exceeds $4,000, contact the Athletic
department for information on a secondary insurance
carrier and provide copies of your explanation of
benefits from UnitedHealthcare.
9) What
should I do if I have insurance questions or I need help
with an insurance problem?
Contact Julie Gordon, UnitedHealthcare’s part-time
Client Services Representative, located at Emmons Health
Center.
Julie Gordon n
Client Services Representative
Emmons Health Center
(323) 259-2836
or
jgordon@oxy.edu
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