Student Health Insurance

It is recommended that all UGA students be covered by health insurance either with an individual student policy or through their family policy. For international students and some graduate students, carrying health insurance is mandatory. Complete information about student health insurance requirements and policies can be found on the UGA Human Resources website at www.hr.uga.edu/benefits/stuins/stuins.html

Please review the following information to help make decisions regarding insurance:

Information about the 2011-12 student health insurance policies

Tips for accessing and using health insurance
Health insurance plan categories
Common Insurance Terms

Pearce and Pearce website -- Voluntary plan
(This plan is for students who are not mandated by the University of Georgia to carry insurance.)

GM Southwest website -- Mandatory plan
(This plan is for students who are required by the University of Georgia to carry insurance.)

Free Graduation Toolkit (Information on Health Insurance and the New Health Care Reform Law)

What is the health fee and what does it cover?

The health fee is paid by every full time student and is optional for students taking 5 or fewer credits. Your health fee covers office visits from 8 am to 5 pm Monday through Friday to the Urgent Care, Medical teams, Women's and Sports Medicine Clinics. A $36 co-payment is charged for all visits in the Urgent Care Clinic during their open hours but after regular UHC hours. These hours are from 5 pm to 8 pm Monday through Friday, and 10 am to 5 pm on Saturday and Sunday.

The health fee also supports low cost Counseling and Psychiatric Services (CAPS) visits.

Services, including physical therapy, prescriptions, laboratory tests, x-rays and dental care, are charged at reduced rates on a per-visit basis. Always ask if you're not sure of cost so that there aren't any unpleasant surprises when you receive your bill.

What is health insurance?

Health insurance is a contract between you and the insurance company that says that the insurance company will pay a portion of your medical expenses if you get sick or hurt and have to visit a doctor's office or hospital. Some contracts also specify that the insurance company will pay a portion of your medical expenses to ensure you don't get sick, such as paying for annual physicals or immunizations. However, the amount of your bill that the insurance company will pay, and under what circumstances they'll pay it is known as coverage and can vary greatly from policy to policy. Many students continue to be covered under their parent's insurance policies. Ask your parent(s) if you aren't sure about your coverage.

Does UGA offer student insurance?

Definitely. There's a student health insurance policy available to all UGA students.
Complete information about student health insurance requirements and policies can be found on the UGA Human Resources website at www.hr.uga.edu/benefits/stuins/stuins.html

Why do I need insurance?

Although health care costs are quite reasonable at the health center, unexpected illness or an accident that results in a single hospital visit can be really pricey without insurance. An uninsured hospital stay can cost even more - up to thousands of dollars – and can generate bills that you will have to pay on for many, many years. Insurance makes health care affordable by compensating patients for the cost of some services and some drugs. If the facility or doctor participates with the insurance plan the insurance company gets a lesser rate that has previously been negotiated and often picks up the majority of the bill.

Insurance always seems so overwhelming...How can I understand it?

Understanding the basics of your insurance is key, but beyond that, just ask!
First ask your parents, then call your insurance company and remember to look at your insurance card. Every insurance plan is individualized. Therefore, understanding the basics of YOUR insurance plan is what is important.

Do you accept my insurance?

The student insurance, which UGA provides, is the only insurance that the health center has a contract - or is in-network - with. For all other insurance policies, the health center can't guarantee that your services will be fully covered. When it comes to the matter of accepting your insurance, the health center will accept your insurance information (you must have this on file, see question about filing) and will file a claim to your insurance company as a courtesy. Certain exceptions do apply so please ask if the health center will file to your particular insurance. From that point, it's up to your insurance company to decide whether they will make a payment for your service.

If your insurance company is one of the few which considers the health center to be in-network they are likely to cover your services. Most insurance plans do provide out-of-network benefits, but many have a deductible that has to be met before coverage kicks in. Be sure to contact your insurance company and ask whether they will cover your services at the health center. Charges incurred are the responsibility of the student when not paid by the insurance company.

What is filing insurance and how do I go about doing it?

Filing insurance is simply providing your insurance information to the health center so that a claim can be filed for any service you have. If you have your insurance card and know some basic information about the primary insured (usually yourself of a parent) all you need to do is present this information to the cashier at your first visit. If you do not have all the required information to file, you can present the information within 30 days of your visit in order to have your claim(s) filed. The pharmacy operates on a different system than the rest of the Health Center, therefore your insurance information will need to be presented in the pharmacy separately.

Does the pharmacy accept all insurance cards?

The pharmacy can process most prescription insurance cards. Some insurance cards provide only medical coverage and may require a separate card for pharmacy coverage. Check with your insurance company about this and be sure to bring in your current card. Even though your medical insurance may not cover your visits to the health center, it might be likely that they will cover your prescriptions at the health center pharmacy.

How are emergencies covered?

The health center isn't able to provide emergency care. In the case of a life-threatening emergency, you should visit an area hospital.
Although it is important to have insurance and your insurance card on you at all times, the Federal Emergency Medical Treatment and Labor Act (EMLTA) ensures that all people can receive emergency medical care, regardless of their health insurance status. But after initial treatment, bills get very costly...so insurance is always the best idea.

Tips For Accessing and Using Health Insurance

Health Insurance can be a complicated and confusing subject. Many health insurance plans are available with all sorts of varying coverage, exclusions, deductibles, co-pays, and so on. Following are generally accepted tips for accessing and utilizing any health insurance plan.

• Carry your insurance plan card(s) with you at all times. You may have more than one card for your medical plan, prescription plan, dental plan, and so forth.
• Carry some form of photo identification with you at all times.
• Review your health insurance benefits before you need them. By doing so, you will know what to expect at the time of need.
• Review your health insurance plan limitations and exclusions before you need the coverage. Again, this will help you know what to expect at the time of need.
• Know your deductible amount.
• Know your co-pay amount.
• Know your stop loss amount.
• Check with your health insurance company to determine if it considers the University Health Center to be "In-Network" or "Out-of-Network" for reimbursement purposes.

For a detailed list of definitions of insurance terms, follow the "Insurance Definitions" link on the Pearce & Pearce website.

Health Insurance Plan Categories

Indemnity Plan
With an indemnity plan (sometimes called fee-for-service), you can use any medical provider (such as a doctor and hospital). You or they send the bill to the insurance company, which pays part of it. Usually, you have a deductible-such as $200-to pay each year before the insurer starts paying.

Once you meet the deductible, most indemnity plans pay a percentage of what they consider the "Usual and Customary" charge for covered services. The insurer generally pays 80 percent of the Usual and Customary costs and you pay the other 20 percent, which is known as coinsurance. If the provider charges more than the Usual and Customary rates, you will have to pay both the coinsurance and the difference.

The plan will pay for charges for medical tests and prescriptions as well as from doctors and hospitals. It may not pay for some preventive care, like checkups.

Preferred Provider Organization (PPO)
A PPO is a form of managed care closest to an indemnity plan. A PPO has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services. As a result, your cost sharing should be lower than if you go outside the network. In addition to the PPO doctors making referrals, plan members can refer themselves to other doctors, including ones outside the plan.

If you go to a doctor within the PPO network, you will pay a co-payment (a set amount you pay for certain services-say $20 for a doctor or $15 for a prescription). Your coinsurance will be based on lower charges for PPO members. If you choose to go outside the network, you will have to meet the deductible and pay coinsurance based on higher charges. In addition, you may have to pay the difference between what the provider charges and what the plan will pay.

Health Maintenance Organization (HMO)*
HMOs are the oldest form of managed care plan. HMOs offer members a range of health benefits, including preventive care, for a set monthly fee. There are many kinds of HMOs. If doctors are employees of the health plan and you visit them at central medical offices or clinics, it is a staff or group model HMO. Other HMOs contract with physician groups or individual doctors who have private offices. These are called individual practice associations (IPAs) or networks.
*The University Health Center does not file HMO plans.

HMOs will give you a list of doctors from which to choose a primary care doctor. This doctor coordinates your care, which means that generally you must contact him or her to be referred to a specialist. With some HMOs, you will pay nothing when you visit doctors. With other HMOs there may be a co-payment, like $5 or $10, for various services. If you belong to an HMO, the plan only covers the cost of charges for doctors in that HMO. If you go outside the HMO, you will pay the bill. This is not the case with point-of-service plans.

High-deductible Plan (HDHP)
High-deductible plans typically have lower monthly premiums and higher deductibles that traditional health insurance plans. They can be considered catastrophic coverage. Health savings accounts (HSAs) are commonly related to high-deductible plans. Buying a high deductible health insurance plan can keep your monthly premiums low, but the plan may not be suitable for those that get sick often or those who cannot afford to pay out of pocket for basic doctor visits. High deductible health insurance plans are best for people who can afford to pay out of pocket for minor things, but don't want to pay for major surgeries, illnesses, or accidents. The higher the deductible though, the lower the monthly premium. If you ever develop a serious illness in the future, your high deductible health insurance plan will have you covered.
Source: highdeductiblehealthinsuranceplan.org

Medicare
Americans age 65 or older and people with certain disabilities can be covered under Medicare, a Federal health insurance program. In many parts of the country, people covered under Medicare now have a choice between managed care and indemnity plans. They also can switch their plans for any reason. However, they must officially tell the plan or the local Social Security Office, and the change may not take effect for up to 30 days. Call your local Social Security office or the State office on aging to find out what is available in your area.

Medicaid*
Medicaid covers some low-income people (especially children and pregnant women), and disabled people. Medicaid is a joint Federal-State health insurance program that is run by the States. In some cases, States require people covered under Medicaid to join managed care plans. Insurance plans and State regulations differ, so check with your State Medicaid office to learn more.
*The University Health Center does not participate with Medicaid.

Source: The Agency for Healthcare Research and Quality (AHRQ), a unit of the United States Department of Health and Human Services. (www.ahrq.gov)

Common Insurance Terms:

Claim
A formal request made by an insured person for the benefits provided by a policy

Co-Pay/Co-Payment
Amount an insured person is expected to pay for a medical expense at the time of the visit

Deductible
A fixed amount of money an insured individual must pay before the benefits of the policy can apply for the calendar/policy year

Formulary
A list of drug choices that are commonly prescribed based on the drugs' proven effectiveness, safety and cost

In-Network
A provider or health care facility that is part of a particular health plan's network

Network
A group of doctors, hospitals and other providers contracted to provide services to insured individuals for less than their usual fees

Out-of-Network
Doctors, hospitals and other providers which are not part of a health plan's network. If a plan uses a network, insured individuals usually pay more when they use an out-of-network provider.

Pre-Existing Condition
An injury or condition for which the insured individual received medical treatment or had symptoms of typically within 12 months before the effective date of insurance coverage

Premium
The money that you pay to your insurance company to guarantee your coverage

Prior Authorization
Verifies the medical necessity of certain treatments

Provider
Whoever is providing the health care service, such as a doctor, a particular clinic, or a particular health center, a nursing home or hospital. These entities are usually licensed by the state, and the University Health Center is a licensed health care provider.

Referral
A formal recommendation made by a primary health care provider for a patient to visit a special type of doctor or get specialty medical services. Referrals are often necessary for specialty doctor visits to be covered by insurance policies.