TWU - Medical Coverage

TWU Medical Coverage

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

Flu shots are covered at $0 out-of-pocket as part of your preventive benefit. Virtual Visits provides online access to physicians at your convenience.

Medical Plans

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.

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. See list of participating NYP locations.

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.

View 2022 Medical Plan Comparison Chart

View 2021 Medical Plan Comparison Chart


Important Notes on Referrals 

United Healthcare’s (UHC) Choice network is a national provider network. It does not require a primary care physician or referrals to see specialists. UHC does require precertification for some services. If you use an in-network provider, your participating network physician or hospital generally handles the precertification process. It is your responsibility to confirm 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.

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.

2022 Monthly Pre-Tax Contributions for Medical & Rx

2021 Monthly Pre-Tax Contributions for Medical & Rx

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.

In-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 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.

Out-of-Network Coverage

Out-of-network services are covered by the UHC Choice Plus 80 medical plan, and are subject to deductibles and out-of-pocket maximums. 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.

Eligible Expenses are determined in accordance with the Claims Administrator’s reimbursement policy For more information, contact UHC at 800-232-9357.


Out-of-Pocket Maximum 

The in-network deductible, coinsurance and medical and prescription copays accumulate toward the in-network out-of-pocket maximum. In addition, under the Choice Plus 90 plan, 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 (for the Choice Plus 90 plan, deductible and coinsurance will apply).

Emergency Travel Assistance

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

Global Travel Support

The University maintains additional travel resources to support Columbia-related travel. To learn more—and register your trip—please visit globaltravel.columbia.edu.

 

Find basic information on the Patient Protection and Affordable Care Act (ACA)

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

Administered in conjunction with International SOS (ISOS), Zurich Travel Assist 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. 

Zurich Travel Assist 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 CU Global Travel.

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.

Information Notice

ID Card

UHC ID cards have member information for medical, vision, and prescription drug coverage. You do not need separate cards for each benefit. After enrolling in a medical plan, it can take three weeks for a UHC ID card to arrive in your mail. If necessary, you can print a temporary UHC ID card two weeks after enrolling. Create an account on myuhc.com to print a temporary ID card. Use your Social Security Number, date of birth, and Group number 712790.