Student Health Insurance

Orientation for International Students

Autumn 2017

Topics today:

General overview of U.S. systems

• Health insurance: Why it exists, How it works

• Health care system: Where people go for care

Specifics about your Ohio State Student Health Insurance

• What it covers

• How to use it best

• Automatic enrollment and waiver criteria

• Resources and next steps

Health Insurance in the United States

• No universal health coverage

• Individuals are responsible to pay for care

• Individuals purchase health insurance for financial protection

How it works

• You purchase a policy at a price called a “premium”

+ / - You pay

Insurance pays+ / -

• After purchase, you still pay a portion of the cost as you use health care

• Policy reimburses providers for some costs, not all

• For coverage details, look inside your policy

• Free service = Risky assumption

Policy defines coverage

Examples of our responsibility

• Copays

• Flat fees per service

• Coinsurance

• Percentage of total service cost

• Deductible

• Initial dollar amount threshold to pay towards first

None, some, or all may apply

(depends on policy)

Learn the language of insurance:

shi.osu.edu > Health Insurance Literacy Tools > Terminology Translator

True or False:

If you have health insurance in the U.S., you pay nothing to get care.

False. Typically, you will pay some cost. Costs can include a flat fee, a percentage share, or the full amount. It depends on your policy.

Ohio State provides the SHI Benefits Plan to support student success.

Unexpected medical bills can disrupt your academic progress Students are at high risk for illness, injury, accidents, depression, anxiety –

and, more likely to postpone care

Health insurance means more affordable, convenient, and quality care

Need: Where you go:

Care for your overall well-being,when you are not sick (called “primary care”)

Doctor’s Office. Call ahead to schedule an appointment.

Primary Care Doctors can provide referrals.

Treatment for a non-life-threateningillness or injury,

including colds and flus

Doctor’s Office. Call ahead to schedule an appointment.

Need help within next 24-48 hours and can’t find a doc? Try Urgent Care

Life-threateningillness or injury

Hospital Emergency Room or call 9-11

True or False:

In the U.S. health care system, you go to a hospital for your basic health needs.

False. We do not typically use the hospital first. Instead we see our doctors and providers at office locations. Office locations are sometimes called “outpatient” locations.

True or False:

A primary care doctor is a doctor who looks after your overall well-being and who can provide referrals as necessary.

True.

Having and Using the

Student Health Insurance Benefits Plan

• Medical, mental health, prescription, dental and vision

• Office visits, diagnostic labs and X-rays, physical therapy

• Surgery and outpatient procedures

• Preventive care, including some vaccines and screenings

• Year-round coverage, can use across United States and abroad

Designed for students at Ohio State with student input * Exceeds ACA and ACHA Standards * Approved by Trustees

Deciding where to go for care:

• Provider options are grouped into “Tiers” based on the

cost to you

• Tiers One and Two are lowest cost!

• Search the listings at shi.osu.edu > Find a Provider

Try these locations first:

Tier One

• Wilce Student Health Center

• Counseling and Consultation Services

• College of Optometry Clinics

• College of Dentistry Student Clinics

Search at shi.osu.edu > Find a Provider

Deciding where to go for care:

Many services covered at 100%

Student Health Services - shs.osu.eduWilce Student Health Center

Hours: 8-6 M-Thurs, 8-5 Fri, 9-1 Sat

Not open evenings or Sundays

Counseling & Consultation – ccs.osu.edu

Younkin and Lincoln Tower

10 free sessions to all students

Addition visits for SHI members

Hours: 8-8 M-Thurs, 8-5 Fri

Tier One Coverage Highlights

At Tier One locations

Annual check up visit (Primary Care) 100%, no deductible

Annual women’s services 100%, no deductible

Immunizations and Cancer Screenings* 100%, no deductible

Psychotherapy and Psychiatry 100%, no deductible

Adult Dental Exam and Cleanings (2x) 100% after $17 cleaning, no deductible

Annual Vision Exam 100% after $15 copay, no deductible

Annual Vision Exam w/ Contact Lens 100% after $40 copay, no deductible

Eyewear allowance per year $100 toward discounted glasses or contacts

*As appropriate for age and risk, based on government guidelines – see policy

Next try:

Tier Two:

• OSU Health Plan Network inside Franklin County

• UHC Options PPO Network outside Franklin County

• UHC Behavioral Health Network outside Franklin County

Search at shi.osu.edu > Find a Provider

Tier 2 Costs: $150 deductible (one time), 10% and $20

Deciding where to go for care: Many services covered at 90% after deductible

Tiered Cost Overview

Service Fee % Covered Up Front CostTier One $0 100% $0Tier Two $20 90% $150Tier Three/Four $20 60% $500

Evenings and weekends? Can’t wait until Monday?

Go: Ohio State AfterHours Care at Martha Morehouse Medical PlazaTier Two option & Accessible by Campus Bus2050 Kenny Road, Suite 2250Hours: 4-9:30 M-F, 10-5:30 Sat and Sun

Call: HealthiestYou TelemedicinePhone number is on your Insurance Member ID CardHours: 24/7Free!

True or False:

If you utilize services covered by Student Health Insurance, your costs will be the same wherever you go.

False. Certain locations will be much more affordable for you, per the Tiered list structure of your SHI Benefits Plan. Choosing providers in Tiers 1 or 2 will provide best coverage. Visit Find a Provider for details.

True or False:

If you are very sick and getting worse but the WilceStudent Health Center closed, you should stay at home until they open.

False. Please don’t postpone! Use our resources to plan ahead. Visit an Urgent Care, call HealthiestYou phone number, or in an emergency, go to the ER or call 911.

Provider writes prescription, you pick up at pharmacy Pharmacy locations to try first: • Wilce Student Health Center Pharmacy• Any HealthSmart RX network pharmacy

Formulary = list of specific drugs covered by your policyNot all drugs are on it. Visit shi.osu.edu > About SHI Benefits PlanNon-formulary = $$$.

You pay:

Prescription Drug coverage

• 10% generic • 20% formulary brand • 50% non formulary drugs

• $10 minimum payment

24/7 Medical and Travel Emergency Assistance Services -Provided by UnitedHealthcare Global

Visit www.uhcsr.com/uhcglobalInformation is on your ID card

IMPORTANT: CALL UnitedHealthcare Global BEFORE you go or utilize

True or False:

True. Formularies organize drugs by generic ($), brand ($$), and brand non-formulary ($$$) categories.

What you pay for a certain prescription will depend on whether the drug is on the formulary and what category it is in.

visit shi.osu.edu

For International Students > What do I do if …

About the SHI Benefits Plan:

Member Overview Booklet• Highlights commonly used benefits

Summary Brochures • Details inclusions and exclusions

Find a Provider page• Search tools

Student Health Insurance has a dedicated staff to assist you.Visit us!

Lincoln Tower,11th floor,Room 11008am - 5pm

shi_info@osu.edu

Ohio State partners with several other organizations:

Explanation of Benefits (EOB):

• Document you receive in mail from the HealthSmart

• Describes how/if insurance is calculating portion shares

• NOT A BILL. Do not pay upon receipt!

• Check your mail. You may need to respond to HealthSmart questions

HealthSmart processes your insurance claims. • Claim = How your provider bills your insurance for services provided

• Insurance pays its portion of the claim

• Provider then bills you for your portion

Member ID Card is your proof of insurance

You must show it when you use services!

• August 15: Welcome email arrives in your OSU account

• Contains instructions to print electronic ID cards

• End of September: Permanent medical Member ID card

arrives via U.S. Mail from UnitedHealthcare

• Verify your Home/Current Address in My Buckeye Link before September 1!

• No dental card mailed – electronic access only

True or False:

If you have a question about Student Health Insurance, there is no campus resource available to help you.

False. There is an office staffed Monday through Friday 8am-5pm, and we answer phone calls and emails M-F as well.

True or False:

If you get mail from UnitedHealthcare or HealthSmart, throw it away. They are just trying to sell you something extra.

False! These companies partner with Ohio State’s Student Health Insurance. They will be sending you important documents regarding your Ohio State benefits.

True or False:

False. EOBs are not bills. They show you how the accounting is being processed. Do not pay an EOB!

If you get an Explanation of Benefits in the mail that shows a dollar amount due, you should immediately send money to HealthSmart.

Enrollment in Student Health Insurance is automatic for all eligible students.

When: After you register for classes at Buckeye LinkFee then appears on your Statement of Account

The coverage defaults to Student Only level.

Step-by-step instructions available

at shi.osu.edu

Deadline to add dependents: August 15

Fee on your Statement of Account

confirms your coverage

fee = your “premium”

Fees

• Payable 2 times per year: Autumn and Spring

2017-18 semester rates:

• $1497 Student Only

• $2994 Student + Spouse or Child

• $4491 Student + Spouse + Child / Student + 2 or more children

• $5988 Student + Spouse + 2 or more children

If your department pays 85% of your fee:• Your 15% will be deducted from the first 4 monthly paychecks

of each semester– Sept, Oct, Nov, Dec | Jan, Feb, Mar, April

Contact Buckeye Link Office at 614-292-0300 or buckeyelink@osu.edu

For students receiving Graduate Subsidy

Automatic enrollment is in effect year-round, as long as you

remain enrolled in classes

2017-18 Dates: August 15, 2017 to August 13, 2018

Spring enrollment includes summer - you do not

have to be enrolled in courses for Summer Terms

Qualifying Events allow you to add coverage

– view our website or contact office within 31 days

Note about Pediatric Dental (members under 19)

Show your UHCSR Member ID Card and your Delta Dental card to your providers. Ask them to bill both.

• Locations: Use Student Health Services, College of Dentistry Student Clinic, or Delta Dental PPO and Premier providers

True or False:

False. The fee appears two times a year on your Statement of Account – Autumn, and Spring.

You are billed once per year for your Student Health Insurance.

Who is eligible for a waiver?

One of the following:

You’re covered under a US-based health insurance policy as a US-based employee, or as a dependent of a US-based employee

You have permanent residency status (a green card)

A government purchases an insurance policy that meets the Minimum Health Insurance Criteria on your behalf and fully financially sponsors you

Submit online: shi.osu.edu > Important Forms > Petition to Waive

• Read your emails and mail! Confirm your Home/Current Address in My

Buckeye Link

• Visit shi.osu.edu and utilize resources.

• Promptly meet your financial responsibility (copays, coinsurance, deductible)

Next steps:

Carry your card Read mail, take action as needed Use our web tools

• Once you’re enrolled in classes, confirm your automatic SHI

enrollment by checking your Statement of Account

• To add spouse or children, follow instructions in My Buckeye Link

Select/Waive Coverage before August 15

• If you meet waiver criteria, complete Petition to Waive online at

shi.osu.edu > Important forms

Next steps:

Questions?

Thank you!

Welcome to Ohio State!

614-688-7979

shi_info@osu.edu

Lincoln Tower 11th floor, 1800 Cannon Drive

shi.osu.edu