An Introduction to Healthcare & Insurance at

The University of Chicago

STUDENT HEALTH AND COUNSELING SERVICES

• Student Health Service (SHS) 860 E. 59th St. (Goldblatt Pavilion Entrance), R-100 (773) 702-4156 healthcare.uchicago.edu

• Student Counseling Service (SCS) 5737 S. University Avenue (773) 702-9800 counseling.uchicago.edu

• Health Promotion & Wellness (HPW) Woodlawn Social Services Center, 950 E. 61st St., 3rd floor (773) 702-8247 wellness.uchicago.edu

Accessing Healthcare at UC

• All registered students pay a quarterly Student Life Fee.

– Provides access to Student Health Service and Student Counseling Service

• Health services covered by the Student Life Fee: e.g., acute/chronic care, routine physicals, short-term

psychotherapy, academic/study skills counseling, etc.

• Private insurance / U-SHIP covers: – Prescriptions, hospitalizations, ER care, lab tests, long-term

psychotherapy, consultation and treatment by specialists, etc.

Student Life Fee vs. Insurance (U-SHIP)

Primary medical and mental health care, wellness programming:• Covered by Student Life Fee & provided by SHS, SCS, HPW

Referrals provided to specialists / for tests• If on U-SHIP, referral required from SHS/SCS; if referral is

not obtained in advance, $50 penalty is assessed

Is it an Emergency?• If SHS closed, call 24-hour Nurse Advice Line –

773.702.1915 – to determine if ER services are required (otherwise, claim may be denied)

Where to Go for Services

• UC requires ALL students to have adequate health insurance

• All registered students enrolled annually in U-SHIP

• Deadline: by 4th Friday of one’s first registered quarter, each year, all students must either:– Waive out of U-SHIP (comparable coverage required) or– Enroll dependents

• Students remain enrolled for the full academic year

Enroll or waive at:http://studentinsurance.uchicago.edu

Student Health Insurance Plan: U-SHIP

Insurance Terminology

• Premium – The amount of money – generally paid on a monthly, quarterly or annual basis – that you pay to cover the cost of your health insurance.

• Deductible – The amount you need to pay before your insurance plan starts to cover your medical costs.

• Annual out-of-pocket maximum – The amount your insurance plan does not pay and you are expected to pay.

• Co-insurance – A percentage of the cost of your treatment that you are required to pay (i.e., 10%, 20%, or 30% typically), after your plan’s deductible has been fully paid.

For additional help, see the “Health Insurance Glossary” on the SCHS website: studenthealth.uchicago.edu

Navigating Health Insurance

• 2013-2014 Premium – $3,021 (billed in 3 quarterly installments of $1,007)

• Deductible – $200 (in-network); $500 (out-of-network)

• Annual out-of-pocket maximum – $1,500 (in-network); $2,500 (out-of-network)

• Co-insurance – 10%; plan pays 90% after deductible has been met

• Prescriptions paid by co-pay, 3 tiers of coverage

($10, $25, $40)

Navigating Health Insurance : U-SHIP

You’re running across the quad, slip on the ice, and break your leg. Ooops. SHS refers you to a specialist who sends you to X-ray, then sets your leg, and gives you a cast. When the cast is removed, you are referred to 12 sessions of physical therapy. Here’s the bill, BEFORE insurance, and with U-SHIP applied:

Navigating Health Insurance : U-SHIP Example

Aggregated doctor/hospital bill: What you’re responsible for:

Specialist visit (with tests): $ 3,480 Deductible: $ 200.00

Cast & crutches: $ 927 (balance is now $ 11,277)

Follow-up doctor’s visit: $ 2,750 U-SHIP covers 90% ($10,149.30)

Physical therapy: $ 4,320 Co-insurance costs (10%): $ 1,127.70

Total billed costs: $ 11,477 Your total bill for injury: $ 1,327.70

Here are two more possibilities, with two alternate insurance plans:

Here’s how the insurance scenario plays out:

Alternative Insurance Examples

UHC Internat’l Plan ISO Plan

$ 1,754 Premium $1,428

$350 Deductible $500

$7,500 Out-of-Pocket $1,500

80% Co-insurance 80%

UHC Internat’l Plan ISO Plan

$ 11,477 Total billed amount $ 11,477

$350 Deductible owed $500

$2,225.40 Co-insurance owed $2,195.40

$2,575.40 Total amount due $2,695.40

$4,329.40 Total paid (w/ premium) $4,123.40

To waive U-SHIP, students must have active insurance with comparable coverage:

2013-2014 plan year• Alternate plans must include list of UC-designated required benefits• Must provide benefits at established coverage levels (i.e., 80%)2014-2015 plan year – requirements tied to ACA• Alternate plans must include ACA “essential health benefits”• Individual plan out-of-pocket maximum < $6,350• Family plan out-of-pocket maximum < $12,700• Must also provide coverage for non-emergency care in Chicago!

Provides greater flexibility for students and familiesWider range of plans will meet requirements to waive coverage

Alternative Insurance: Comparable Coverage

To waive U-SHIP, alternate insurance plans must:

• Meet University requirements for comparable coverage• Be active from the time of the student’s arrival on

campus through the end of their program or the end of the current academic year

Researching Alternatives to U-SHIP

Beginning in 2014-2015, a subset of alternate insurance plans will be audited for compliance.

Student Health Insurance office• Woodlawn Social Services Center, 950 E. 61st Street, 3rd floor

United Healthcare Student ResourcesOn-campus insurance reps: Sue Williams & Janice Thomas• Mon-Fri, 8:00 am-4:30 pm, rooms 368 / 370• 773.834.4543 (option #2) or uchicagoadvocates@uhcsr.com

UC Student Health Insurance CoordinatorStudent advocate: Marcy J. Hochberg• Mon-Fri, 8:30 am-5:00 pm, room 366• 773.702.1279 or mhochberg@uchicago.edu

Accessing Insurance Assistance at UC

ONE SERVICE <<< MULTIPLE LOCATIONS

Reviewing alternate insurance plans:• Consider impact of all costs: premium, deductible, out-

of-pocket max, co-insurance, co-pays• Must meet UC requirements for comparable coverage• Review exclusions carefully!

Summing Up – Affording Health Care at UC

Health care access:• Student Health / Student Counseling – covered by

Student Life Fee• Additional services, testing, specialists – covered by

insurance

Questions?

shcs.uchicago.edu