TWU - Medical Coverage
Columbia University offers the UnitedHealthcare Choice Plus 80 and the Choice In-Network medical plan options. Both plans cover a comprehensive set of services and provide in-network preventive care, such as annual physicals, immunizations and well-baby visits, at 100% with no deductible. The Choice Plus 80 plan also includes coverage for out-of-network services. If you enroll in either medical plan, you will be automatically enrolled in prescription drug and vision coverage.
See the Glossary for help identifying common medical insurance terms.
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 more details on the medical plan, review the Summary Plan Description (SPD) and Summary of Benefits and Coverage (SBC).
Preventive Care is covered at 100%. Other than preventive care and copays, for most in-network medical services you must meet an annual deductible of $400 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 $3,000 for an individual and $6,000 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.
Preventive Care is covered at 100%. The plan has no deductible for all 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 $3,500 for an individual and $7,000 for a family, the Choice In-Network plan pays 100% of covered medical charges for the remainder of the calendar year. Out-of-network services are not covered.
There is an out-of-network Emergency Room $150 copay (waived if admitted). The $150 outpatient hospital copay does not apply if you obtain your lab and/ or radiology at certain New York Presbyterian (NYP) locations. For a list of NYP participating locations, go to Forms & 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.
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 both plans there is 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. In the Choice Plus 80 plan, the deductible, coinsurance and all medical and prescription drug copays accumulate toward your annual out-of-pocket maximum.
Most out-of-network services are covered at 60%* of 190% of the Medicare Maximum Allowable Charge (MAC) after the annual
deductible of $600 per member. For the Choice Plus 80 plan, out-of-network services 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 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.
* 70% for outpatient mental health and substance abuse services.
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 outside of the U.S., travel vaccinations will be covered under the medical plan. For the Choice Plus 80 plan, deductible and coinsurance will apply.
If you travel 100 miles or more from home or abroad and need assistance, see the Emergency Travel Assistance program.
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.
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 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.