STUDENT HEALTH PLAN 2020-2021 - NYU
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2020-2021 STUDENT HEALTH PLAN TANDON SCHOOL OF ENGINEERING ("the Policyholder") Policy Number: WNY2021NYSHIP04 Group Number: ST0645SH Effective: 8/21/2020 – 8/20/2021 Underwritten By: Provider Network: Administered By: Wellfleet Group, LLC Wellfleet New York Insurance Co. ("the Company")
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN WHAT’S INSIDE (Click on section header below to go to section in brochure.) Student Health and Insurance at NYU ...........................................................................................................................3 Confidentiality ...............................................................................................................................................................3 Patient Protection and Affordable Care Act (PPACA) ....................................................................................................4 Student Health Insurance Plan Overview ......................................................................................................................4 Information for Graduate Employees NYU/UAW Local 2110 ........................................................................................5 Schedule of Benefits ......................................................................................................................................................5 Accidental Death and Dismemberment ..............................................................................................................22 Preauthorization Procedure ................................................................................................................................23 Student Health Insurance Plan Costs ...................................................................................................................23 Insurance Payment Options ................................................................................................................................24 Insurance Cards ...................................................................................................................................................24 Enrolling in the Student Health Insurance Plan ...........................................................................................................24 Eligibility...............................................................................................................................................................24 Automatic Enrollment .........................................................................................................................................25 Voluntary Enrollment ..........................................................................................................................................25 Dependents .........................................................................................................................................................25 How to Enroll .......................................................................................................................................................26 Enrollment Deadlines ..........................................................................................................................................26 Important Enrollment Rules for Matriculated Students ......................................................................................26 Fall 2020/Spring 2021 Automatic Enrollment Guide ...........................................................................................27 Special Enrollment Periods ..................................................................................................................................27 Waiving the Student Health Insurance Plan ................................................................................................................28 Waiver Criteria Applicable to All Students ..........................................................................................................28 How to Waive Online ...........................................................................................................................................29 Waiver Deadlines .................................................................................................................................................29 Important Waiver Rules .......................................................................................................................................29 International Students in F-1 or J-1 Visa Status ...........................................................................................................30 International Students Waiver Process ...............................................................................................................30 Information for Parents ...............................................................................................................................................31 Exclusions and Limitations ...........................................................................................................................................32 Claim Procedures .........................................................................................................................................................34 Grievances, Utilization Review, and Appeals...............................................................................................................34 Definitions ...................................................................................................................................................................35 Contact Information (pp. 41-42) ..................................................................................................................................41 Students Studying Away Insurance Program ...............................................................................................................43 Information for Graduate Employees NYU/UAW Local 2110 ......................................................................................43 Stu-Dent Dental Health Program .................................................................................................................................43 2 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN Student Health and Insurance at NYU New York University values the health of its students and is committed to offering all students access to quality healthcare and reasonably priced health insurance plans to help protect against financial hardships that may result from high healthcare expenses. While most undergraduate and graduate students are in good health and face few serious illnesses while in school, medical and psychological issues can arise at any time, sometimes without warning. There are also certain health concerns that may become apparent for the first time in early adulthood. The high cost of healthcare in the United States presents a potentially serious financial risk to students. The absence of adequate insurance coverage can result in temporary or permanent interruption of Your education; therefore, NYU requires that all students registered in degree-granting programs maintain health insurance. Most students are automatically enrolled in and charged Premium for the NYU sponsored student health insurance plan (NYU sponsored plan) as part of the course registration process. Students who maintain alternate health insurance coverage that meets the University’s minimum health insurance criteria may waive the NYU sponsored student health insurance plan entirely (see Waiving the Student Health Insurance Plan section). This brochure has been prepared to help You understand the benefits and levels of coverage the NYU sponsored student health insurance plan offers. Student Health Center Locations Manhattan 726 Broadway, 2nd, 3rd, and 4th Floors New York, NY 10003 (212) 443-1000 Brooklyn 6 MetroTech Center, ROG-B020 Brooklyn, NY 11201 (646) 997-3456 Confidentiality Your privacy is Our priority. The Student Health Center (SHC) is legally and ethically obligated to protect the privacy of a student’s health information. Treatment of student health information is governed by the Family Educational Rights and Privacy Act (FERPA) and the requirements of applicable New York State law. The SHC will only disclose this information in limited circumstances in accordance with applicable law. The SHC will not release medical information to anyone, including family, parents/legal guardians, NYU faculty/staff, or outside agencies, without the written authorization of the student, except in emergency situations or to comply with a subpoena or judicial order. In the case of a minor, the authorization of a parent or legal guardian is required to release medical records. In a medical emergency, only relevant health information will be released to another healthcare Provider. The underwriter and administrator of the NYU-sponsored student health insurance plan also handle student health information in connection with the operation of the plan. Treatment of such information is governed by the Health Insurance Portability and Accountability Act (HIPAA) and the requirements of applicable New York State law. 3 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN Patient Protection and Affordable Care Act (PPACA) The Affordable Care Act (ACA) was enacted to increase the availability of health insurance coverage to more Americans. There are a multitude of medical coverage requirements and it is important for You to know that the NYU sponsored student health insurance plan is fully ACA compliant. Here’s additional information about the ACA to assist You in making coverage decisions: Students are eligible to remain on a parent’s plan until age 26. However, You should compare the cost and benefits of coverage under a parent’s plan to those of the NYU sponsored student health insurance plan. Employer plans held by You or Your parents may be local HMO’s that are not appropriate for a student attending school out of state. The ACA created health insurance marketplaces for individuals to obtain coverage. However, You should carefully review the terms of the coverage to compare with any other alternatives including in terms of: Deductibles, Copayments, Coinsurance, and limited Provider networks. If You are interested in exploring this option, the web site is www.healthcare.gov. You will be directed to the appropriate online marketplace for Your home state of residence. Generally, international students holding an F-1 or J-1 visa are not eligible to purchase insurance through the marketplaces because they must show permanent residency. Student Health Insurance Plan Overview Wellfleet Student Health Insurance Plan The NYU sponsored student health insurance plan, administered by Wellfleet Group, LLC, is designed to provide reasonably priced healthcare coverage. The insurance plan supplements the free services (as does any other health insurance) provided at the SHC. The NYU sponsored student health insurance plan covers most medical treatments and procedures provided at the SHC, for which there is a fee, as well as national coverage for medically necessary healthcare services. All matriculated students are eligible for enrollment in the Student Health Insurance Plan sponsored by NYU. See Voluntary Enrollment section for more information about enrolling Dependents and other eligible enrollees. The Insurance consists of the Tandon Student Health Insurance Plan designed to provide reasonably priced healthcare coverage. The plan offers coverage for services rendered by healthcare Providers who participate in the Cigna PPO network. Visit www.wellfleetstudent.com/nyu to search for Cigna PPO Providers. Out-of-network Providers are also covered but at a lower reimbursement level. (See Schedule of Benefits). Please note: The SHC is an in-network Preferred Provider under the NYU sponsored student health insurance plan underwritten by Wellfleet New York Insurance Company. 4 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN Information for Graduate Employees NYU/UAW Local 2110 Effective September 1, 2015, the University began providing its student health insurance plan (Basic Health Plan – Individual Coverage) at 10% of the applicable premium rate to eligible graduate student employees. In addition, eligible graduate student employees will be covered by the Stu-Dent Plan for NYU at no cost and will be automatically enrolled in the Stu-Dent Plan upon confirmation of union eligibility. For eligible Tandon graduate student employees, a Basic Health Plan insurance charge may initially appear on the graduate student employee’s tuition bill, but will be adjusted when the student’s union eligibility is confirmed. At that time the insurance charge on the Bursar account will be adjusted to 10% of the Basic Health Insurance Plan charge for that term. Dependent Coverage Premium Support Plan Effective September 1, 2015, the University established a Graduate Employee Student Health Insurance Dependent Premium Support Plan. For Academic Year 2019-2020, the Plan will be funded with $200,000, divided equally between the fall and spring semesters. Those eligible graduate employees who are doctoral candidates who actually purchase dependent coverage under the Basic Student Health Insurance Plan and provide proof thereof, may, during the subject semester, apply for up to 75% reimbursement of dependent coverage premiums. Actual reimbursement will depend on the number of applications and the funds allocated for that semester. Unused funds, if any, will not carry over to a future semester. The application deadline for reimbursement for fall 2019 is January 8, 2020 and for spring 2020 is August 20, 2020. Schedule of Benefits Availability of services at SHC locations varies, please verify location when making appointments. For a more complete description of plan benefits, general terms and conditions, Preauthorization requirements, etc., please review the 2020-2021 Student Health Insurance Certificate at www.wellfleetstudent.com/nyu. NYU TANDON SCHOOL OF ENGINEERING SCHEDULE OF BENEFITS Metal Level: Platinum NYU Tandon School of Engineering Policy Number: WNY2021NYSHIP04 Group/Plan Number: ST0645SH Policyholder Effective Date: August 21, 2020 Policyholder Termination Date: August 20, 2021 COST-SHARING Student Health Center Participating Provider Non-Participating Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Medical Deductible • Individual $0 $0 $100 5 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN COST-SHARING Student Health Center Participating Provider Non-Participating Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Out-of-Pocket Limit • Individual $6,350 $6,350 $6,350 • Family $12,700 $12,700 $12,700 Accidental Death and See the Cost-Sharing Dismemberment Expenses and Allowed Benefits Amount section of this $10,000 Certificate for a Annual and Lifetime description of how We Maximum. calculate the Allowed Amount. Any charges of a Non- Participating Provider that are in excess of the Allowed Amount do not apply towards the Deductible or Out- of-Pocket Limit. You must pay the amount of the Non- Participating Provider’s charge that exceeds Our Allowed Amount. OFFICE VISITS Student Health Center Participating Provider Non-Participating Limits Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Primary Care Office Covered in full $20 Copayment 30% Coinsurance after See benefit for Visits 0% Coinsurance Deductible description (or Home Visits) Specialist Office Visits Covered in full $20 Copayment 30% Coinsurance after See benefit for (or Home Visits) 0% Coinsurance Deductible description 6 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PREVENTIVE CARE Student Health Center Participating Provider Non-Participating Limits Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing • Well Child Visits Covered in full Covered in full 30% Coinsurance after See benefit for and Deductible description Immunizations* • Adult Annual Covered in full Covered in full 30% Coinsurance after Physical Deductible Examinations* • Adult Covered in full Covered in full 30% Coinsurance after Immunizations* Deductible • Routine Covered in full Covered in full 30% Coinsurance after Gynecological Deductible Services/Well Woman Exams* • Mammograms, Covered in full Covered in full 30% Coinsurance after Screening and Deductible Diagnostic Imaging for the Detection of Breast Cancer • Sterilization Covered in full Covered in full 30% Coinsurance after Procedures for Deductible Women* • Vasectomy Covered in full $20 Copayment] 30% Coinsurance after 0% Coinsurance Deductible • Bone Density Covered in full Covered in full 40% Coinsurance Testing* after Deductible • Screening for Covered in full Covered in full 30% Coinsurance after Prostate Cancer Deductible 7 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PREVENTIVE CARE Student Health Center Participating Provider Non-Participating Limits Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing • All other Covered in Full Covered in full 30% Coinsurance after preventive Deductible services required by USPSTF and HRSA. *When preventive Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for services are not appropriate service appropriate service appropriate service provided in (Primary Care Office (Primary Care Office Visit (Primary Care Office accordance with the Visit Specialist Office Specialist Office Visit Visit Specialist Office comprehensive Visit Diagnostic Diagnostic Radiology Visit Diagnostic guidelines supported Radiology Services Services Laboratory Radiology Services by USPSTF and HRSA. Laboratory Procedures Procedures and Laboratory Procedures and Diagnostic Testing) Diagnostic Testing) and Diagnostic Testing) EMERGENCY CARE Student Health Center Participating Provider Non-Participating Limits Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Pre-Hospital N/A Covered in full Covered in full See benefit for Emergency Medical description Services (Ambulance Services) Non-Emergency N/A Covered in full Covered in full See benefit for Ambulance Services description Emergency N/A $50 Copayment $50 Copayment See benefit for Department 10% Coinsurance 10% Coinsurance not description subject to Deductible Copayment waived if Health care forensic Health care forensic Hospital admission examinations examinations performed performed under Public under Public Health Law Health Law § 2805-I are § 2805-I are not subject not subject to Cost- to Cost-Sharing Sharing Urgent Care Center N/A $20 Copayment 30% Coinsurance after See benefit for 0% Coinsurance Deductible description 8 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES and Member Responsibility Member Responsibility Provider Member OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Advanced Imaging See benefit for Services description • Performed in a N/A 10% Coinsurance 40% Coinsurance after Specialist Office Deductible • Performed in a N/A 10% Coinsurance 40% Coinsurance after Freestanding Deductible Radiology Facility • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services Preauthorization Required Allergy Testing and See benefit for Treatment description • Performed in a Covered in full $20 Copayment 30% Coinsurance after PCP Office 0% Coinsurance Deductible • Performed in a Covered in full $20 Copayment 30% Coinsurance after Specialist Office 0% Coinsurance Deductible Ambulatory Surgical N/A 10% Coinsurance 40% Coinsurance after See benefit for Center Facility Fee Deductible description Preauthorization Required Anesthesia Services N/A 10% Coinsurance 40% Coinsurance after See benefit for (all settings) Deductible description Autologous Blood N/A 10% Coinsurance 40% Coinsurance after See benefits Banking Deductible for description Cardiac and See benefits Pulmonary for description Rehabilitation • Performed in a N/A 10% Coinsurance 30% Coinsurance after Specialist Office Deductible • Performed as N/A 10% Coinsurance 30% Coinsurance after Outpatient Deductible Hospital Services • Performed as N/A Included as part of Included as part of Inpatient Hospital inpatient Hospital service inpatient Hospital Services Cost-Sharing service Cost-Sharing 9 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES and Member Responsibility Member Responsibility Provider Member OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Chemotherapy See benefit for description • Performed in a N/A 10% Coinsurance 40% Coinsurance after PCP Office Deductible • Performed in a N/A 10% Coinsurance 40% Coinsurance after Specialist Office Deductible • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services Preauthorization Required Chiropractic Services N/A $20 Copayment 30% Coinsurance after See benefit for 0% Coinsurance Deductible description Preauthorization Required Clinical Trials Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for See benefit for appropriate service appropriate service appropriate service description Diagnostic Testing See benefit for description • Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after PCP Office Deductible • Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after Specialist Office Deductible • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services Dialysis See benefit for description • Performed in a N/A $20 Copayment 30% Coinsurance after PCP Office 0% Coinsurance Deductible • Performed in a N/A $20 Copayment 30% Coinsurance after Specialist Office 0% Coinsurance Deductible • Performed in a N/A $20 Copayment 30% Coinsurance after Freestanding 0% Coinsurance Deductible Center • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services • Performed at N/A 10% Coinsurance 40% Coinsurance after Home Deductible 10 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES and Member Responsibility Member Responsibility Provider Member OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Habilitation Services 10% Coinsurance 10% Coinsurance 40% Coinsurance after 60 visits per (Physical Therapy, Deductible condition, per Occupational Therapy Plan Year or Speech Therapy) combined therapies Home Health Care N/A 10% Coinsurance 40% Coinsurance after 40 visits per Deductible Plan Year Preauthorization Required Infertility Services Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for See benefit for appropriate service appropriate service appropriate service description (Office Visit Diagnostic (Office Visit Diagnostic (Office Visit Diagnostic Radiology Services Radiology Services Radiology Services Surgery Laboratory & Surgery Laboratory & Surgery Laboratory & Diagnostic Procedures) Diagnostic Procedures) Diagnostic Procedures) Infusion Therapy See benefit for description • Performed in a Covered in full $20 Copayment 30% Coinsurance after PCP Office 0% Coinsurance Deductible • Performed in Covered in full $20 Copayment 30% Coinsurance after Specialist Office 0% Coinsurance Deductible • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services • Home Infusion N/A 10% Coinsurance 40% Coinsurance after Home infusion Therapy Deductible counts toward home health care visit limits Inpatient Medical N/A 10% Coinsurance 40% Coinsurance after See benefit for Visits Deductible description Interruption of Pregnancy • Medically N/A Covered in full 40% Coinsurance after Unlimited Necessary Deductible Abortions • Elective Abortions N/A 10% Coinsurance 40% Coinsurance after One (1) Deductible procedure per Plan Year 11 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES and Member Responsibility Member Responsibility Provider Member OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Laboratory See benefit for Procedures description • Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after PCP Office Deductible • Performed in a N/A 10% Coinsurance 40% Coinsurance after Specialist Office Deductible • Performed in a N/A 10% Coinsurance 40% Coinsurance after Freestanding Deductible Laboratory Facility • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services Maternity and See benefit for Newborn Care description • Prenatal Care N/A Covered in full 30% Coinsurance after provided in Deductible accordance with the comprehensive guidelines supported by USPSTF and HRSA • Prenatal Care that Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for is not provided in appropriate service appropriate service appropriate service accordance with (Primary Care Office (Primary Care Office (Primary Care Office the comprehensive Visit, Specialist Office Visit, Specialist Office Visit, Specialist Office guidelines Visit, Diagnostic Visit, Diagnostic Visit, Diagnostic supported by Radiology Services, Radiology Services, Radiology Services, USPSTF and HRSA Laboratory Procedures Laboratory Procedures Laboratory Procedures and Diagnostic Testing) and Diagnostic Testing) and Diagnostic Testing) • Inpatient Hospital N/A 10% Coinsurance 40% Coinsurance after Services and Deductible One (1) home Birthing Center care visit is covered at no • Physician and N/A 10% Coinsurance 40% Coinsurance after Cost-Sharing if Midwife Services Deductible mother is for Delivery discharged from Hospital early 12 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES and Member Responsibility Member Responsibility Provider Member OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Maternity and Maternity and Newborn Care Newborn Care (continued) (continued) • Breastfeeding N/A Covered in full 30% Coinsurance after Covered for Support, Deductible duration of Counseling and breast feeding Supplies, Including Breast Pumps • Postnatal Care N/A $20 Copayment 30% Coinsurance after 0% Coinsurance Deductible Preauthorization Required Outpatient Hospital N/A 10% Coinsurance 40% Coinsurance after See benefit for Surgery Facility Deductible description Charge Preauthorization Required Preadmission Testing N/A 10% Coinsurance 40% Coinsurance after See benefit for Deductible description Prescription Drugs See benefit for Administered in Office description or Outpatient Facilities • Performed in a Covered in full Covered in full 30% Coinsurance after PCP Office Deductible • Performed in Covered in full Covered in full 30% Coinsurance after Specialist Office Deductible • Performed in N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Facilities 13 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES and Member Responsibility Member Responsibility Provider Member OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Diagnostic Radiology See benefit for Services description • Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after PCP Office Deductible • Performed in a N/A 10% Coinsurance 40% Coinsurance after Specialist Office Deductible • Performed in a N/A 10% Coinsurance 40% Coinsurance after Freestanding Deductible Radiology Facility • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services Preauthorization Required Therapeutic Radiology See benefit for Services description • Performed in a N/A 10% Coinsurance 40% Coinsurance after Specialist Office Deductible • Performed in a N/A 10% Coinsurance 40% Coinsurance after Freestanding Deductible Radiology Facility • Performed as N/A 10% Coinsurance 40% Coinsurance after Outpatient Deductible Hospital Services Preauthorization Required Rehabilitation 10% Coinsurance 10% Coinsurance 40% Coinsurance after 60 visits per Services (Physical Deductible condition, per Therapy, Occupational Plan Year Therapy or Speech combined Therapy) therapies 14 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES and Member Responsibility Member Responsibility Provider Member OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Second Opinions on Covered in full $20 Copayment 30% Coinsurance after See benefit for the Diagnosis of 0% Coinsurance Deductible description Cancer, Surgery and Other Second opinions on diagnosis of cancer are Covered at participating Cost- Sharing for non- participating Specialist when a Referral is obtained. Surgical Services See benefit for (including Oral description Surgery Reconstructive Breast Surgery Other Reconstructive and Corrective Surgery; and Transplants • Inpatient Hospital N/A 10% Coinsurance 40% Coinsurance after Surgery Deductible • Outpatient N/A 10% Coinsurance 40% Coinsurance after Hospital Surgery Deductible • Surgery N/A 10% Coinsurance 40% Coinsurance after Performed at an Deductible Ambulatory Surgical Center • Office Surgery 10% Coinsurance 10% Coinsurance 40% Coinsurance after Deductible Preauthorization Required ADDITIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES, Member Responsibility Member Responsibility Provider Member EQUIPMENT and for Cost-Sharing for Cost-Sharing Responsibility for DEVICES Cost-Sharing ABA Treatment for Covered in full $20 Copayment 30% Coinsurance after See benefit Autism Spectrum 0% Coinsurance Deductible description Disorder Assistive Covered in full $20 Copayment 30% Coinsurance after See benefit for Communication 0% Coinsurance Deductible description Devices for Autism Spectrum Disorder 15 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN ADDITIONAL Student Health Center Participating Provider Non-Participating Limits SERVICES, Member Responsibility Member Responsibility Provider Member EQUIPMENT and for Cost-Sharing for Cost-Sharing Responsibility for DEVICES Cost-Sharing Diabetic Equipment, See benefit for Supplies and Self- description Management Education See Prescription Diabetic Equipment, See the Prescription See the Prescription See the Prescription Drug benefit Supplies and Insulin Drug Cost-Sharing Drug Cost-Sharing Drug Cost-Sharing (up to a 90 day supply) • Diabetic Covered in full $20 Copayment 30% Coinsurance after Education 0% Coinsurance Deductible Durable Medical 10% Coinsurance 10% Coinsurance 40% Coinsurance after See benefit for Equipment and Braces Deductible description External Hearing Aids N/A 10% Coinsurance 40% Coinsurance after Single Deductible purchase once every 3 years Cochlear Implants N/A 10% Coinsurance 40% Coinsurance after One per ear Deductible per time Preauthorization Covered Required Hospice Care • Inpatient N/A 10% Coinsurance 40% Coinsurance after 210 days per Deductible Plan Year • Outpatient N/A 10% Coinsurance 40% Coinsurance after Five (5) visits Deductible for family bereavement counseling Medical Supplies 10% Coinsurance 10% Coinsurance 40% Coinsurance after See benefit for Deductible description Prosthetic Devices • External 10% Coinsurance 10% Coinsurance 40% Coinsurance after One (1) Deductible prosthetic device, per limb, per lifetime • Internal N/A 10% Coinsurance 40% Coinsurance after Unlimited Deductible See benefit for description 16 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN INPATIENT SERVICES Student Health Center Participating Provider Non-Participating Limits and FACILITIES Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Inpatient Hospital for N/A 10% Coinsurance 40% Coinsurance after See benefit for a Continuous Deductible description Confinement (including an Inpatient Stay for Mastectomy Care, Cardiac and Pulmonary Rehabilitation, and End of Life Care) Preauthorization Required. However, Preauthorization is not required for emergency admissions or services provided in a neonatal intensive care unit of a Hospital certified pursuant to Article 28 of the Public Health Law. Observation Stay N/A 10% Coinsurance 40% Coinsurance after See benefit for Deductible description Skilled Nursing Facility N/A 10% Coinsurance 40% Coinsurance after 200 days per (including Cardiac and Deductible Plan Year Pulmonary Rehabilitation) See benefit for description Preauthorization Required Inpatient Habilitation N/A 10% Coinsurance 40% Coinsurance after Unlimited days Services (Physical Deductible Speech and See benefit for Occupational description Therapy) Preauthorization Required 17 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN INPATIENT SERVICES Student Health Center Participating Provider Non-Participating Limits and FACILITIES Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Inpatient N/A 10% Coinsurance 40% Coinsurance after Unlimited days Rehabilitation Deductible Services (Physical See benefit for Speech and description Occupational Therapy) Preauthorization Required MENTAL HEALTH and Student Health Center Participating Provider Non-Participating Limits SUBSTANCE USE Member Responsibility Member Responsibility Provider Member DISORDER SERVICES for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Inpatient Mental N/A 10% Coinsurance 40% Coinsurance after See benefit for Health Care for a Deductible description continuous confinement when in a Hospital (including Residential Treatment) Preauthorization Required. However, Preauthorization is not required for emergency admissions or for admissions at Participating OMH- licensed Facilities for Members under 18. Outpatient Mental Covered in full $20 Copayment 30% Coinsurance after See benefit for Health Care 0% Coinsurance Deductible description (including Partial Hospitalization and Intensive Outpatient Program Services) Except for Office Visits, Preauthorization Required 18 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN MENTAL HEALTH and Student Health Center Participating Provider Non-Participating Limits SUBSTANCE USE Member Responsibility Member Responsibility Provider Member DISORDER SERVICES for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Inpatient Substance N/A 10% Coinsurance 40% Coinsurance after See benefit for Use Services Deductible description for a continuous confinement when in a Hospital (including Residential Treatment) Preauthorization Required. However, Preauthorization is Not Required for Emergency Admissions or for Participating OASAS- certified Facilities. Outpatient Substance N/A $20 Copayment 30% Coinsurance after Up to 20 visits Use Services 0% Coinsurance Deductible per Plan Year (including Partial may be used Hospitalization, for family Intensive Outpatient counseling Program Services, and Medication Assisted See benefit for Treatment) description Except for Office Visits, Preauthorization Required. However, Preauthorization is not required for Participating OASAS- certified Facilities. 19 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN PRESCRIPTION DRUGS Student Health Center Participating Provider Non-Participating Limits Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing You may request a copy of the Wellfleet Rx/KPP Formulary. The Formulary is also available on the Wellfleet Rx website at www.WellfleetRx.com. You may inquire if a specific drug is Covered under the Certificate by contacting Wellfleet Student at the number on Your ID card, (877) 373-1170. *Certain Prescription Drugs are not subject to Cost-Sharing when provided in accordance with the comprehensive guidelines supported by HRSA or if the item or service has an “A” or “B” rating from the USPSTF Retail Pharmacy Supply Limits. Except for contraceptive drugs, devices, or products, We will pay for no more than a 30-day supply of a Prescription Drug purchased at a retail pharmacy. You are responsible for one (1) Cost-Sharing amount for up to a 30- day supply. You may have the entire supply (of up to 12 months) of the contraceptive drug, device, or product dispensed at the same time. Contraceptive drugs, devices, or products are not subject to Cost-Sharing when provided by a Participating Pharmacy. Please refer to Certificate of coverage for details. 30-day supply See benefit for description Tier 1 $10 Copayment $10 Copayment $10 Copayment 0% Coinsurance 0% Coinsurance 0% Coinsurance not subject to Deductible Tier 2 $25 Copayment $25 Copayment $25 Copayment 0% Coinsurance 0% Coinsurance 0% Coinsurance not If You have an subject to Deductible Emergency Condition, Preauthorization is not required for a five (5) day emergency supply of a Covered Prescription Drug used to treat a substance use disorder, including a Prescription Drug to manage opioid withdrawal and/or stabilization and for opioid overdose reversal. Enteral Formulas See benefit for Tier 1 $10 Copayment $10 Copayment $10 Copayment description 0% Coinsurance 0% Coinsurance 0% Coinsurance not subject to Deductible Tier 2 $25 Copayment $25 Copayment $25 Copayment 0% Coinsurance 0% Coinsurance 0% Coinsurance not subject to Deductible 20 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN WELLNESS BENEFITS Student Health Center Participating Provider Non-Participating Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Gym Reimbursement N/A Up to $200 per six (6) Up to $200 per six (6) See Benefit month period; up to an month period; up to an description additional $100 per six additional $100 per six (6) month period for (6) month period for Covered Dependents Covered Dependents DENTAL and VISION Student Health Center Participating Provider Non-Participating Limits CARE Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Pediatric Dental Care • Preventive Dental N/A $40 Copayment 40% Coinsurance after Care 20% Coinsurance Deductible One (1) dental exam and • Routine Dental N/A $40 Copayment 40% Coinsurance after cleaning per six Care 20% Coinsurance Deductible (6)-month period • Major Dental N/A $40 Copayment 40% Coinsurance after (Endodontics, 20% Coinsurance Deductible Periodontics, Oral Surgery and Full mouth x- Prosthodontics) rays or panoramic x- • Orthodontics N/A $40 Copayment 40% Coinsurance after rays at 36 20% Coinsurance Deductible month Orthodontics and intervals and Major Dental Require bitewing x-rays Preauthorization at six (6) month intervals Pediatric Vision Care • Exams Covered in full $30 Copayment 40% Coinsurance after One (1) exam 20% Coinsurance Deductible per Plan Year • Lenses and $30 Copayment $50 Copayment 40% Coinsurance after One (1) Frames 20% Coinsurance 20% Coinsurance Deductible prescribed lenses and • Contact Lenses $30 Copayment $50 Copayment 40% Coinsurance after frames per 20% Coinsurance 20% Coinsurance Deductible Plan Year Contact Lenses Require Preauthorization 21 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN DENTAL and VISION Student Health Center Participating Provider Non-Participating Limits CARE Member Responsibility Member Responsibility Provider Member for Cost-Sharing for Cost-Sharing Responsibility for Cost-Sharing Adult Vision Care • Exams Covered in full $30 Copayment 40% Coinsurance after One (1) exam 20% Coinsurance Deductible per Plan Year Contact Lenses Require Preauthorization Emergency Medical 0% coinsurance of - Actual Cost Unlimited Evacuation Annual Limits Combined with Repatriation Benefit. Repatriation of 0% coinsurance of - Actual Cost Unlimited Remains Annual Limits Combined with Medical Evacuation Benefit. Accidental Death and N/A N/A N/A $10,000 Dismemberment Annual and Benefits Lifetime Maximum Accidental Death and Dismemberment If, as the result of a covered Accident, You sustain any of the following losses, We will pay the benefit shown. The loss must occur within 365 days of the Accident. Percentage of Maximum Amount Loss of Life ........................................................................................................100% Loss of hand ....................................................................................................... 50% Loss of Foot ....................................................................................................... 50% Loss of either one hand, one foot or sight of one eye ....................................... 50% Loss of more than one of the above losses due to one Accident......................100% Accident means a sudden, unforeseeable external event which directly and from no other cause, results in loss of life, hand, foot or sight. Loss of hand or foot means the complete severance through or above the wrist or ankle joint. Loss of eye means the total permanent loss of sight in the eye. The maximum amount is the largest amount payable under this benefit for all losses resulting from any one Accident. 22 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN Preauthorization Procedure Preauthorization is required before You receive certain Covered Services. You are responsible for requesting Preauthorization for the in-network and out-of-network services listed in the Schedule of Benefits section of the Certificate. If You seek coverage for services that require Preauthorization, You must call Wellfleet Student at the number indicated on Your NYU sponsored Tandon student health insurance ID card. You must contact Wellfleet Student to request Preauthorization as follows: • At least two (2) weeks prior to a planned admission or surgery when Your Provider recommends inpatient Hospitalization. If that is not possible, then as soon as reasonably possible during regular business hours prior to the admission. • At least two (2) weeks prior to ambulatory surgery or any ambulatory care procedure when Your Provider recommends the surgery or procedure be performed in an ambulatory surgical unit of a Hospital or in an Ambulatory Surgical Center. If that is not possible, then as soon as reasonably possible during regular business hours prior to the surgery or procedure. You must contact Wellfleet Student to provide notification as follows: • If You are hospitalized in cases of an Emergency Condition, You must call Wellfleet Student within 48 hours after Your admission or as soon thereafter as reasonably possible. After receiving a request for approval, Wellfleet Student will review the reasons for Your planned treatment and determine if benefits are available. Criteria will be based on multiple sources which may include medical policy, clinical guidelines, and pharmacy and therapeutic guidelines. Student Health Insurance Plan Costs Costs for Students Coverage Period Cost Annual 8/21/20 – 8/20/21 $1,964 -------------------------------------------------------------------------------------------------------------------------------------------------------- Fall Term 8/21/20 – 1/8/21 $759 -------------------------------------------------------------------------------------------------------------------------------------------------------- Spring/Summer Term 1/9/21 – 8/20/21 $1,205 -------------------------------------------------------------------------------------------------------------------------------------------------------- Summer Term 5/14/21 – 8/20/21 $533 ------------------------------------------------------------------------------------------------- ------------------------------------------------------- Costs for Dependent Coverage (Spouse/Domestic Partner/One or More Children) Coverage Period Cost Annual 8/21/20 – 8/20/21 $1,964 -------------------------------------------------------------------------------------------------------------------------------------------------------- Fall Term 8/21/20 – 1/8/21 $759 -------------------------------------------------------------------------------------------------------------------------------------------------------- Spring/Summer Term 1/9/21 – 8/20/21 $1,205 -------------------------------------------------------------------------------------------------------------------------------------------------------- Summer Term 5/14/21 – 8/20/21 $533 23 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN Costs for Family Coverage (Student/Spouse/Domestic Partner/One or More Children) Coverage Period Cost Annual 8/21/20 – 8/20/21 $1,964 -------------------------------------------------------------------------------------------------------------------------------------------------------- Fall Term 8/21/20 – 1/8/21 $759 -------------------------------------------------------------------------------------------------------------------------------------------------------- Spring/Summer Term 1/9/21 – 8/20/21 $1,205 -------------------------------------------------------------------------------------------------------------------------------------------------------- Summer Term 5/14/21 – 8/20/21 $533 Insurance Payment Options The NYU sponsored student health insurance plan is an annual policy for students enrolled in NYU sponsored plan. Students may choose from the following payment options: A. ANNUAL PAYMENT IN FULL at the time of fall registration, with no insurance charge at spring registration. • Student’s coverage will continue through August 20th, even if they are not registered for spring classes. (However, they will not have access to services at the SHC after January 8th for January graduates and after graduation for May graduates.) • Students cannot get a partial refund of the spring/summer portion of the annual insurance charge after the September 30th enrollment deadline. B. TWO INSTALLMENT PAYMENT PLAN (default plan): The first payment is due at the time of fall registration and the second at spring registration. The spring insurance charge is higher than the fall charge because it includes payment for coverage over the summer months. • Students will be automatically enrolled in the plan and billed the spring/ summer health insurance charge if, and only if, they are registered for classes or maintaining matriculation for the spring semester. • Students who are not registered for classes or maintaining matriculation for the spring semester will have their insurance coverage end on January 8th. Insurance Cards Insurance ID Cards are available to each student in a variety of ways: • An online insurance card can be obtained by going to the Wellfleet Student web site (www.wellfleetstudent.com/nyu). Click the link for “Online ID Card.” • An email will be sent on September 1, 2020 to those students enrolled in the NYU sponsored student health insurance plan with instructions on how to obtain their electronic ID cards. We encourage You to carry Your NYU ID and insurance card at all times. Enrolling in the Student Health Insurance Plan Eligibility Students are eligible to enroll in the NYU sponsored student health insurance plan if they are: • registered for one or more credits in a degree-granting program at NYU • maintaining matriculation (completing certain academic programs and not enrolled in classes) • Students with F-1 or J-1 visa status 24 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN • post-doctoral research trainees/fellows, paid by NYU on stipends (code 542) or paid directly by external sponsors • Dependents of an insured Students (Spouse/domestic partner and Children up until the end of the month in which the Child turns age 26) Automatic Enrollment Most students are automatically enrolled in and charged Premium for the NYU sponsored student health plan as part of the course registration process. Students should see the Automatic Enrollment Guide to determine if they will be automatically enrolled. Students who maintain alternate health insurance coverage that meets the University’s minimum health insurance criteria may apply to waive the Student Health Insurance Plan entirely (see Waiving the Student Health Insurance Plan section). Please note: Adding or dropping courses during the registration period may affect a student’s automatic enrollment in the NYU sponsored student health insurance plan. In such situations, confirm Your enrollment status before the appropriate semester deadline (see Enrollment Deadlines section) to ensure Your coverage. For students eligible for Graduate Employee NYU/UAW Local 2110, please see Graduate Employee NYU/UAW Local 2110 section. Voluntary Enrollment Students registered for classes or maintaining matriculation but not automatically enrolled, have the option to enroll in the NYU sponsored student health insurance plan before the appropriate semester deadline (see Enrollment Deadlines section) by completing the online enrollment process at www.nyu.edu/health/insurance (See Automatic Enrollment Guide). If You are on a school sanctioned leave: click here for NYU's policy. Dependents Eligibility Eligible Dependents are: a) the covered Student’s Spouse or domestic partner; and/or b) the covered Student’s Child under the age of 26 years. How to Enroll To enroll eligible Dependents, insured Students must complete the online enrollment application and make payment at www.wellfleetstudent.com/nyu by clicking on the Dependent Enrollment link from the menu on the left side of the webpage by the appropriate deadline (see Enrollment Deadlines section). Dependent enrollment will be available from 8/1 - 9/30. Payment Options (Please see Costs section for costs.) Students enrolling Dependents in the NYU sponsored student health insurance plan before the September 30th fall term deadline may choose an annual payment option or an installment payment option. For students choosing the installment payment option: • The fall payment is due at the time of the fall enrollment. • The spring payment is due by January 8th for the Dependent coverage to continue until August 20, 2021 (the end of the Plan Year). Students will receive a 30-day notice before their fall coverage ends with a request for payment for the spring term coverage. 25 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN Effective Dates of Coverage Annual 2020-2021 August 21, 2020 - August 20, 2021 Fall 2020 August 21, 2020 - January 8, 2021 Spring/Summer 2021 January 9, 2021 - August 20, 2021 Summer 2021 May 14, 2021- August 20, 2021 How to Enroll Students should evaluate their options by reviewing the benefits and exclusions of the NYU sponsored student health insurance plan. Students should have their student ID number (shown on the admissions letter or on the back of the NYU ID card) handy before accessing the online system during the enrollment periods. • Go to www.nyu.edu/health/insurance • Click on the box that indicates, “Enroll in or Waive out.” Read the general information and follow the instructions for enrolling. • At the end of the process, You must confirm Your enrollment selection in order for Your request to be processed. • Print the Confirmation of Status letter. A confirmation will also be sent to the e-mail address provided. Enrollment Deadlines If Your first semester of The online enrollment The SEMESTER DEADLINE for the academic year is: system becomes available: enrolling in the NYU Plans is: Fall 2020 June 16 September 30 -------------------------------------------------------------------------------------------------------------------------------------------------------- Spring 2021 November 3 February 10 -------------------------------------------------------------------------------------------------------------------------------------------------------- Summer 2021 April 6 June 5 -------------------------------------------------------------------------------------------------------------------------------------------------------- Important Enrollment Rules for Matriculated Students • If the online enrollment process is not completed by the deadline, the plan in which the student is automatically enrolled will be in effect for all or any remaining part of the academic year. • Students who were only billed the fall semester health insurance charge at the time of fall registration: o will be automatically enrolled in the plan and billed the spring/summer health insurance charge if, and only if, they are registered for classes or maintaining matriculation for the spring semester. o will have their insurance coverage end on January 8th if they are not registered for classes or maintaining matriculation for the spring semester. • Students who paid the annual health insurance charge at the time of fall registration: o will continue coverage through August 20th, even if they are not registered or matriculated for spring classes. (However, they will not have access to services at the SHC after January 8th for January graduates and after graduation for May graduates.) o cannot get a partial refund of the spring/summer portion of the annual insurance charge after the September 30th enrollment deadline. 26 Wellfleet Student PO Box 15369 Springfield, MA 01115-5369
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