NUSS - Medical Coverage

NUSS Medical Coverage

Columbia University offers the UnitedHealthcare Choice Plus 100 medical plan to Non-Union Support Staff and their families. 

See the Glossary for help identifying common medical insurance terms.

Medical Plan Coverage

Columbia University offers the UnitedHealthcare Choice Plus 100 medical plan. The Choice Plus 100 plan covers a comprehensive set of services and provides in-network preventive care, such as annual physicals, immunizations and well-baby visits, at 100%. The Plan also includes coverage for out-of-network services. If you enroll in the medical plan, you will be automatically enrolled in prescription drug and vision coverage.

The Choice Plus 100 plan covers only medically-necessary services and supplies for the purpose of preventing, diagnosing or treating an acute sickness, injury, mental illness, substance abuse or symptoms. For more details on the medical plan, review the UHC Choice Plus 100 - Summary Plan Description (SPD) for Non-Union Support Staff and the Summary of Benefits Coverage (SBC), which you can find in Documents.

Contributions are the amount you pay toward the cost of your medical, vision and prescription drug (“Rx”) coverage through pre-tax payroll contributions. Your healthcare contributions are deducted from your pay before any taxes are taken out.

Monthly Medical Contributions

Same-Sex Domestic Partners

Federal income tax rules require that your contributions toward the coverage of a same-sex domestic partner be deducted from your pay on an after-tax basis. In addition, University contributions toward the total cost of coverage for your same-sex domestic partner are taxable to you. To assist with this tax burden, if you are eligible for same-sex domestic partner medical coverage and you elect coverage, Columbia will provide a credit of $1,000 per year ($41.67 two times per month), beginning the pay period following the effective date of your election.

With the Choice Plus 100 plan, you have the flexibility to use in-network or out-of-network providers each time you seek care. However, you can minimize your out-of-pocket expenses by using in-network providers.

In-Network Coverage

When you use UHC network providers, you pay a $30 copay for physician office visits (including specialists and urgent care). Preventive care is covered at 100%. All medical and prescription drug copays accumulate toward your annual out-of-pocket maximum.

The Choice Plus 100 plan has a $200 deductible for some in-network services. Copays apply for certain services and in some cases are dependent on where the service is received. For example, inpatient hospital services require a $500 per admission copay; outpatient hospital services, including lab and radiology, require a $150 copay.* In addition, after you reach the in-network out-of-pocket maximum of $4,750 for an individual and $9,500 for a family, the Choice Plus 100 plan pays 100% of covered in-network medical charges for the remainder of the calendar year.

Whenever you are having diagnostic or preventive tests, be sure to ask your physician if he/she is referring you to a provider who is in-network.

Out-of-Network Coverage

Most out-of-network services are covered at 60%** of 190% of the Medicare Maximum Allowable Charge (MAC). For the Choice Plus 100 plan, out-of-network expenses are handled as outlined below:

  • You are responsible for obtaining precertifications from UHC before most non-office visit treatment begins (unless it is an emergency). If you do not request precertification before having inpatient or outpatient surgery and/ or certain treatment, you will be subject to a $500 penalty. If you are having trouble finding providers and/or services in the network, please call UHC at 800-232-9357. In an emergency, if you or your covered dependent is admitted to a non-network hospital, you must contact UHC within 48 hours of admission or you will be subject to a $500 penalty.
     
  • Before the Plan starts to pay for out-of-network services, you must meet your out-of-network deductible.
     
  • Then the Plan pays coinsurance of 60%** of remaining covered charges up to a maximum of 190% of the Medicare MAC.
     
  • If you reach the out-of-network out-of-pocket maximum, the Plan will pay 190% of the Medicare MAC.

* No copay for lab and radiology at certain designated NYP locations.
** 70% for outpatient mental health and substance abuse services.

Note: Your eligible out-of-network expenses can be used to satisfy the in-network
deductible and in-network out-of-pocket maximum.

Remember: The medical and prescription drug copays and deductible accumulate toward the in-network out-of-pocket maximum. In addition, out-of-network out-of-pocket eligible expenses accumulate toward the in-network out-of-pocket maximum.

Important Notes on Precertification

UHC’s Choice network is a national provider network and does not require a primary care physician or referrals to see specialists. UHC requires precertification for some services. If you use an in-network provider, your participating network physician or hospital generally handles the precertification process. However, it is your responsibility to confirm that your provider has obtained the necessary authorizations from UHC. If you see a provider who is out-of-network, you are responsible for obtaining precertification for most services except routine office visits.

If you are traveling out of the country, travel vaccinations will be covered under the medical plan.

If you travel 100 miles or more from home or abroad and need assistance, see the Emergency Travel Assistance program.

Learn more about preventive care.

Out-of-network services for all medical plans are indexed to 190% of the Medicare MAC. Most services are covered at 60% of 190% of the Medicare MAC, except for mental health and substance use disorder outpatient counseling and outpatient programs, which are covered at 70% of 190% of the Medicare MAC. You are solely responsible for charges in excess of 190% of the Medicare MAC.

Here’s an example: Your out-of-network physician charges you $200 for an office visit. 190% of the Medicare MAC is $100. Therefore, $100 is the basis for out-of-network reimbursement.

  • If you have not met the out-of-network annual deductible, you will be responsible to pay the full $200. Only $100 will apply to your deductible.
     
  • If you have already met the out-of-network annual deductible, the Plan will pay coinsurance of 60% of $100, or $60. Your share of the coinsurance is 40%, or $40. You are also responsible for the charges above 190% of Medicare MAC, so your total responsibility is $140.
     
  • If you have met the out-of-network annual out-of-pocket maximum, the Plan will pay 190% of the Medicare MAC, or $100. You are responsible for the remaining balance.

Learn More

You can find out your reimbursement amount for out-of-network services before you seek treatment by first asking your physician for the medical “procedure code” along with the associated fee. Then, call UHC’s Member Services at 800-232-9357 to request an estimate of their reimbursement.

Information Notice

ID CARD

If you newly enroll in medical benefits, you will receive a UHC ID card. This card will include member information for medical, vision and prescription drug coverage. It takes approximately three weeks for new enrollees to receive an ID card. If you need a temporary ID card sooner, go to www.myuhc.com two weeks after you complete your benefits enrollment to download and print your temporary card.