Officers - Medical Coverage

Officers Medical Plans

Columbia University offers four comprehensive medical plan options through UnitedHealthcare (UHC). Each plan includes vision and prescription drug coverage. 

Virtual Visits provides online access to physicians at your convenience.

Medical Plans

The University provides Officers four medical plan options: a High Deductible Health Plan (HDHP) and three different Choice Plus medical plans—80, 90 and 100—so you can choose the plan that best suits your needs. If you enroll in a medical plan, you will be automatically enrolled in prescription drug and vision coverage.

All of the University's medical plans cover the same comprehensive set of services. They all provide in-network preventive care, such as annual physicals, immunizations and well-baby visits, at 100% with no deductible. 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.

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

HDHP vs. Choice Plus Plans

* IRS limits are subject to change.

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

Contributions for your medical, vision and prescription drug coverage are deducted from your pay before any taxes are taken out.

See Cost of Coverage: Your Contributions

 

Same-Sex Domestic Partners

Federal income tax rules require that contributions toward coverage of a same-sex domestic partner be deducted from 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 elect same-sex domestic partner medical coverage, Columbia will provide a credit of $1,000 per year ($41.67 per pay period) beginning the pay period following the effective date of your election.

To select the plan that best suits your family, use SmartSelect, a comparison tool accessible through CUBES, to consider differences between plans, the cost of coverage (including your contributions), model different health scenarios, estimate out-of-pocket costs and determine which medical plan is best for you. SmartSelect can use your past calendar year’s health claims if you were enrolled in a Columbia medical plan last year.

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.

Out-of-network services are covered identically by each of the University’s medical plans, and are subject to the out-of-network deductible and out-of-pocket maximum. You can use out-of-network providers for preventive services, subject to a separate deductible and coinsurance.

You are responsible for obtaining precertifications from UHC before most non-office visit treatment begins, and within 48 hours of an emergency hospital admission. If you do not obtain precertification, you will be subject to a $500 penalty.

Coverage for out-of-network services is capped at 190% of the Medicare Maximum Allowable Charge. If your provider charges more than 190% of the Medicare Maximum Allowable Charge, you may be responsible for the difference in cost which will not apply to your deductible, coinsurance, or out-of-pocket maximum.

To determine your approximate covered cost, obtain the procedure code and associated fee amount from your provider, and contact UHC for an estimate. UHC will also request their office zip code and type of provider (i.e. M.D., nurse, licensed counselor) for more information, contact UHC at 800-232-9357.

Medical Coverage When Traveling

Columbia University faculty and staff traveling outside the U.S. for Columbia Travel for less than 6 months automatically have health insurance coverage through Aetna International.

Administered in conjunction with International SOS (ISOS), Aetna International provides full coverage for illness and injury that occur while abroad. Medically-necessary services are covered at no cost if ISOS is contacted for assistance before a patient is treated. 

Aetna International health coverage is coordinated through ISOS. In the event of an emergency while traveling outside of the U.S. for Columbia Travel, call ISOS at +1-215-942-8478 or use the ISOS mobile app.

For more information, go to Global Travel.


If you believe you are eligible for this medical plan option, contact the Columbia Benefits Service Center at 212-851-7000 or hrbenefits@columbia.edu for more information, including monthly rates.

In the event of an emergency, if on Columbia business abroad, call International SOS: 215-942-8478.

If you travel 100 miles or more from home or abroad and need assistance, go to Emergency Travel Assistance.

The Cigna International Plan provides comprehensive coverage if you are traveling outside the U.S. for six months or more while still on the University’s U.S. payroll. To cover any dependents,  you must have this coverage as well.

Benefits include:

  • Easy access to comprehensive, quality healthcare anywhere in the world
  • 24/7 support; collect calls accepted
  • 24/7 connection to the nearest and most appropriate physician or hospital

If you believe you are eligible for this medical plan option, contact the Columbia Benefits Service Center at 212-851-7000 or hrbenefits@columbia.edu for more information, including monthly rates.

In the event of an emergency, if on Columbia business abroad, call International SOS:
+1-215-942-8478.

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

When you are covered under the University's Basic Term Life Insurance Plan (from Cigna), you and your eligible dependents are also covered for emergency travel assistance. 

For more information, go to Emergency Travel Assistance.

Information Notice

ID Card

When you enroll in medical benefits, you get a UHC ID card with member information for medical, vision and prescription drug coverage. It takes approximately three weeks for new enrollees to receive an ID card. Create an account on myuhc.com to check health information, FSA balances and print a temporary ID card. The temporary ID card will be available two weeks after enrolling. Use your Social Security Number, date of birth and Group 712790 to register.

You do not need a vision ID card to use your benefits. However, you may print a separate vision card from the UHC website. Log in to myuhc.com, go to the “COVERAGE & BENEFITS” tab, choose “VISION” then “Vision benefit highlights” then “Print ID Card.”