Officers - Medical Coverage

Officers Medical Plans

Columbia University offers four comprehensive medical plan options through UnitedHealthcare (UHC). Consider which plan is best for your and your family's needs and the costs involved. See the Glossary for help identifying common medical insurance terms.

Medical Plans

Columbia offers three different Choice Plus medical plans—80, 90 and 100—so that you can choose the plan that best suits your needs. With any of these plans, 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 when you use in-network providers.

All of the plans cover the same comprehensive set of services and provide in-network preventive care, such as annual physicals, immunizations and well-baby visits, at 100% with no deductible. Learn more about preventive care. All medical plan options also include coverage for out-of-network services. If you enroll in a medical plan, you will be automatically enrolled in prescription drug and vision coverage.

Medical Plan Descriptions

All University medical plan options cover 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 details on the medical plan options, review the Summary Plan Description (SPD) and Summary of Benefits and Coverage (SBC)

Important Note on Referrals and 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.

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.

Consider the Costs

As with any major purchase decision, cost will likely play a factor when selecting your medical plan. But costs can be difficult to accurately calculate. Lower payroll deductions might make a particular plan option look inexpensive, but you may have a higher deductible to meet. Or, a particular option may have higher payroll deductions, but lower costs when you receive care. Since everyone is different—requiring different levels of care—it is important to consider the total costs for each medical plan option: the cost you pay at the time you use health care (e.g., your deductible, coinsurance or copay) plus the cost you pay out of your paycheck. If you don’t take the time to consider the total cost of each medical plan, you may end up paying for more coverage than you need.

Use SmartSelect, a comparison tool on CUBES, to help determine which medical plan is best for you. You can model different health scenarios for yourself and your family to estimate what your total out-of-pocket costs will be.

Other than preventive care and copays, for most in-network medical services you must meet an annual deductible of $600 per member before the Plan pays the coinsurance of 80% of the negotiated fee; you are responsible for the remaining 20% of the coinsurance. After you reach the in-network out-of-pocket maximum of $3,750 for an individual and $7,500 for a family, the Choice Plus 80 plan pays 100% of covered in-network medical charges and prescription drug copays for the remainder of the calendar year. Most out-of-network services are covered at 60%* after the annual deductible of $850 per member.

* of 190% of the Medicare Maximum Allowable Charge (MAC)

Other than preventive care and copays, for most in-network medical services you must meet the annual deductible of $400 per member before the Choice Plus 90 plan pays the coinsurance of 90% of the negotiated fee; you are responsible for the remaining 10% of the coinsurance. After you reach the in-network out-of-pocket maximum of $3,250 for an individual and $6,500 for a family, the Plan pays 100% of covered in-network medical charges and prescription drug copays for the remainder of the calendar year. Most out-of-network services are covered at 60%* after the annual deductible of $850 per member.

* of 190% of the Medicare Maximum Allowable Charge (MAC)

The Choice Plus 100 plan has a $200 deductible for some in-network services, such as such as professional fees for surgical and medical 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 Plan pays 100% of covered in-network medical charges for the remainder of the calendar year. Most out-of-network services are covered at 60%* after the annual deductible of $850 per member.

* of 190% of the Medicare Maximum Allowable Charge (MAC)

** The $150 outpatient hospital copay does not apply if you obtain your lab and/or radiology at certain New York Presbyterian (NYP) locations. See the list of NYP participating locations.

Columbia University offers a High Deductible Health Plan (HDHP) that provides comprehensive coverage through UHC. The Plan has low monthly contributions in exchange for a higher deductible and out-of-pocket maximum. If you elect the HDHP, you can enroll in a Health Savings Account (HSA), a portable, personal savings account that lets you set aside pre-tax dollars to use for eligible healthcare expenses now or in the future. Note: If you enroll in the HSA, you cannot enroll in the Healthcare FSA at the same time.

What You Need to Know About the HDHP

  • Preventive medical care is covered at 100% with no deductible when you use an in-network provider.
  • For non-preventive care—and non-preventive drugs—you pay for your expenses until you reach your deductible: $1,500 for individual coverage or $3,000 for family coverage.
  • For family coverage, the entire $3,000 deductible must be met, even if only one family member has expenses. there is no individual deductible when you elect family coverage.
  • After you reach the deductible, the Plan begins to pay for covered services.
  • Any additional medical expenses are shared between the Plan and you as coinsurance. The Plan’s coinsurance is 90% and your coinsurance is 10%.
  • When your coinsurance, plus deductible and prescription drug copays reach the out-of-pocket maximum, the Plan pays 100% of your remaining in-network covered medical services, including prescription drug costs, for the rest of the calendar year. The out-of-pocket maximum for in-network expenses is $3,550 for individual coverage or $7,100 for family coverage. For family coverage, the entire $7,100 out-of-pocket maximum must be met, even if only one family member has claims.

Plan Comparisons & Costs

* IRS limits are subject to change

For complete summary of the four plans, See the Medical Plan Comparison Chart

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.

See Cost of Coverage: Your Contributions
 

Same-Sex Domestic Partner Credit

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.

As an Officer of Columbia University, you have a choice of several medical plans through UnitedHealthcare.

Need help comparing your options? Try SmartSelect, a comparison tool on CUBES that helps you compares how much you’ll pay for medical services under each option. Just answer a few simple questions. 

In-Network vs. Out-of-Network Coverage

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.

For the 80, 90 and 100 medical plans, you pay a $30 copay for physician office visits (including specialists and urgent care), when you use UHC network providers. Preventive care is covered at 100% with no deductible for in-network services. The deductible, coinsurance and all medical and prescription drug copays accumulate toward your annual out-of-pocket maximum.

All four medical plan options handle out-of-network expenses the same way, 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 Maximum Allowable Charge (MAC).
     
  • If you reach the out-of-network out-of-pocket maximum, the Plan will pay 190% of the Medicare MAC.

Note: For the Choice Plus 80, 90 and 100 plans, your eligible out-of-network expenses can be used to satisfy the in-network deductible and in-network out-of-pocket maximum. For the HDHP, these expenses do not satisfy the in-network deductible and out-of-pocket maximum.

* 70% for outpatient mental health and substance abuse services.

Important: Most out-of-network services are covered at 60%* of 190% of the Medicare Maximum Allowable Charge (MAC) after the annual
deductible for out-of-network services has been met.

Medicare Maximum Allowable Charge (MAC)

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.

Medical Coverage When Traveling

The Cigna International Plan is a medical plan option for which you may be eligible, if you are out of the U.S. for an extended period of time (six months or more), provided you receive pay through Columbia University’s U.S. payroll. You must be covered under this option to cover any dependents under this plan. If you are enrolled in one of the Columbia University medical plans (the Choice Plus plans or the HDHP), it is important to know that these plans provide overseas coverage for emergencies only, while the Cigna International Plan provides comprehensive coverage while you are outside of the U.S. Some of the benefits of Cigna International’s coverage include:

  • Easy access to comprehensive, quality healthcare around the world
     
  • Around-the-clock support, regardless of your time-zone
     
  • Connection to the right physician or hospital in your area 24/7

When you need assistance, contact Cigna anytime by phone or fax. Collect calls are accepted anytime.

If you believe you are eligible for this medical plan option, please contact the Columbia Benefits Service Center at 212-851-7000 for more information.

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

The Cigna International Medical Gap Plan, called “Medical Benefits Abroad (MBA),” provides faculty and staff traveling on international business for six months or less with medical coverage. It is administered in conjunction with International SOS. The program provides full coverage for medically necessary services, without deductibles, coinsurance or copays. The Plan also includes emergency dental coverage up to a $1,000 limit. Preventive and routine care is not covered under this policy. For more information, visit Global Travel

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

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.