Student Health Insurance

Information about the 2007-8 student health insurance policies can be found on the following website: www.hr.uga.edu/benefits/stuins/stuins.html

Information about the 2007-8 student health insurance policies

Tips for accessing and using health insurance
Health insurance plan categories
Pearce and Pearce website

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

The only insurance plan that considers the University Health Center "in-network" is Pearce & Pearce, Inc. (the student health insurance plan). If your insurance policy provides out-of-network coverage, our Business Office will file claims for services incurred at the Health Center as a courtesy.

Charges incurred are the responsibility of the student when not paid by the insurance company.

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.

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.

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.

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