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What is a Deductible?
For a covered medical expense, the deductible is the portion of
your medical bill that is your responsibility. The
deductible will first be subtracted from the total medical
bill and you will need to pay this portion directly to the
doctor or hospital.
Your deductible is $100 annually.
What is Co-insurance?
For the Certificate Period, the Insurance Company will pay 80% of Eligible Expenses after the Deductible,
up to the out-of-pocket maximum. After the out-of-pocket
maximum has been met, the Insurance Company will pay 100%.
How do I Pay
for My Prescriptions?
Your plan includes a Prescription Rx Card.
$15 Copay for Tier 1 / $30
Copay for Tier 2 / $50 Copay for Tier 3 up to a 31-day
supply per prescription filled at a UnitedHealthcare
Network Pharmacy (UCHP). Prescriptions must be filled at
a UnitedHealthcare Pharmacy (UHCP).
If you need to apply for a reimbursement,
please
click here to download a Claim Form.
What is a pre-existing condition?
Any (1) condition for which medical advice,
diagnosis, care, or treatment (includes receiving services and
supplies, consultations, diagnostic tests or prescription
medicines) was recommended or received during the 12 months
immediately preceding the Certificate Effective Date; (2)
condition that had manifested itself in such a manner that would
have caused a reasonably prudent person to seek medical advice,
diagnosis, care, or treatment (includes receiving services and
supplies, consultations, diagnostic tests or prescription
medicines) within the 12 months immediately preceding the
Certificate Effective Date; (3) injury, illness, sickness,
disease, or other physical, medical, mental, or nervous
conditions, disorder or ailment (whether known or unknown) that,
with reasonable medical certainty, existed at the time of
application or within the 12 months immediately preceding the
Certificate Effective Date.
What is Precertification?
Emergency Pre-certification: In the event
of an Emergency Hospital admission, Pre-certification must be
made within 48 hours after the admission, or as soon as is
reasonably possible.
Pre-certification Does
Not Guarantee Benefits – The fact that expenses are
Pre-certified does not guarantee either payment of benefits or
the amount of benefits. Eligibility for and payment of benefits
are subject to all the terms, conditions, provisions and
exclusions herein.
Concurrent Review – For Inpatient stays of any
kind, the Plan Administrator will Pre-certify a limited number
of days of confinement. Additional days of Inpatient confinement
may later be Pre-certified if a Member receives prior approval.
What is a Reasonable & Customary charge?
Reasonable and Customary charge is the amount normally charged
by medical service providers for similar services and supplies
in your area of living.
What is Medical Evacuation?
Medical Evacuation means transferring the insured person to the
nearest hospital or medical facility in case of an emergency
injury or sickness or back to his/her home country. It can be
done by any necessary means of transportation.
Click here for more information.
What is Repatriation?
In case of death, the Repatriation benefit covers the
transportation of your remains back to your family and your home
country.
Click here for more information.
Are Injuries from Sports Covered?
Recreational sports are covered through the regular medical
coverage. Injuries
from intercollegiate, interscholastic, intramural or club
sports are not covered.
Is there Dental Coverage?
There is limited coverage injury to natural
teeth on your policy.
Do I need a referral to go to a Specialist?
A doctor’s referral typically is not required.
If you have a special medical condition, we recommend
that you check with the Customer Service
(888)
251-6253 , prior
to making an appointment with a Specialist.
A
Nurse 24-Hour Hotline is also available
to assist you with medical questions. To access Nurseline,
please locate the number on your Insurance ID card. If you do
not have an ID card, you can print one by accessing
MyAccount.
If you have an emergency medical
condition, please call 911 or your local
emergency services number.
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