Postdoctoral Fellows - Medical Coverage

NUSS Medical Coverage

Columbia University offers the UnitedHealthcare Choice Plus 80 medical plan through UnitedHealthcare (UHC) to full-time Postdoctoral Clinical Fellows and Postdoctoral Research Fellows and your family.

See the Glossary for help identifying common medical insurance terms.

Medical Plan Coverage

Columbia University offers the Choice Plus 80 plan through UnitedHealthcare (UHC). The Plan covers in-network preventive care, such as annual physicals, immunizations and well-baby visits, at 100% with no deductible. To learn more about preventive care, go to https://humanresources.columbia.edu/preventive-care. The Choice Plus 80 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.

Medical Plan Descriptions

The Choice Plus 80 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 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.

For complete summary of the Plan, see the Medical Plan Summary
 

Contributions are the amount you pay toward the cost of your medical, vision and prescription drug (“Rx”) coverage through Employee Benefits Plan Administration (EBPA).

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.

 

With the Choice Plus 80 medical 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% 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.

Other than preventive care and copays, for most in-network medical services you must meet an annual deductible of $600* per member before the Choice Plus 80 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 Plan pays 100% of covered in-network medical charges and prescription drug copays 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.

 *To meet the requirements of the U.S. Department of State, J-1 Visa holders will have a $500 per person deductible applied.

Out of Network Coverage

Most out-of-network services are covered at 60%** after the annual deductible of $850 per member. Out-of-network expenses are always handled 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: Your eligible out-of-network expenses can be used to satisfy the in-network deductible and in-network out-of-pocket maximum in the Choice Plus 80 plan.

** 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.

If you are traveling out of the country, travel vaccinations will be covered under the medical plan (deductible and coinsurance will apply).

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.