United Healthcare StudentResources Questions

dmk16 — Fri, 15 Aug 2008 14:03:58 -0400

Your Duke Student Medical Insurance Plan

There are many changes to how the new plan operates. As we start the school, and policy, year, the following information will be helpful in getting you squared away with your new insurance plan. The topics are written in chronological order, so read over the subjects (bold) of each item to make sure you haven't missed a step.

Introduction
The new plan is administered by United Healthcare StudentResources. This is a special division of United Healthcare that deals exclusively with student plans. They perform most of their services independently from United Healthcare, but still carry the widely recognized name and the associated nationwide network. The new plan maintains almost all of the benefits of the previous (Blue Cross and Blue Shield) plan, so if there is a benefit that you are confused about, let us know and we can help you out. E-mail us at dukestudentinsurance@gmail.com.

Am I enrolled?
If you are a full-time Duke student and are subject to the Student Health fee, or your department typically charges the Student Health fee, and you have not waived out of the plan, you are enrolled and your coverage begins on August 16, 2008. There are some departments that are not eligible for the Duke Medical Insurance Plan (SMIP) and include some Masters programs and Professional programs. The vast majority of students on campus are eligible for this plan including undergraduates.

If:

You would like your ID card to arrive at the beginning of your coverage or as soon as possible or
You need to enroll dependents or
You would like your coverage to begin on August 1, 2008 and you are not a new student,
or
If you don't want this plan

You will need to "positive enroll" by visiting https://www.srstudentcenter.com/Default.aspx?schoolId=243. Near the bottom there is a link for "Enrollment form for students" - fill this out to enroll. You must fill this form out before enrolling your dependents. This link will bring you to a page that requests your date of birth and student ID or social security number. Enter your date of birth and your Duke Unique ID (do not bother with your social security number as Duke did not share this information with United). If you don't want this plan, you may apply for a waiver if you have comparable insurance by clicking on the waiver card (you will still need to sign is as described here).

You can find your Duke Unique ID number on your University Identification Card on the back (see:
http://dukecard.duke.edu/card_numbers.html for a picture) or new students can find their Unique ID number by logging onto ACES:
http://www.siss.duke.edu/siss/aces (on the new ACES) your Unique ID appears on the top of the first page.

To enroll dependents:
If you would like to enroll dependents on your plan (spouse, same-sex-spousal equivalent, and/or dependent children) follow the same link as the last step and (after you have positive enrolled yourself) select "Enrollment form for dependents." Fill in the information of the dependents that you want covered on your policy and select the terms that you want to pay for at that time. You do not have to pay for the whole year at once. To pay by semester, only select the fall. In December you will receive an e-mail reminder to go in and pay for the next term.

I'm/We're enrolled, where is my/are our ID cards?
Your insurance cards will be mailed to your address on file with the University after you have filled out the positive enroll form, or after September 15, whichever is sooner. If you would like your ID card sooner than September 15th, please make sure you have filled out the enrollment form. If you would like to obtain a card from the website, follow these steps:

Go to https://www.uhcsr.com/duke
On the bottom of the page, click on "My Account"
If you have not already created an account, click on "create My Account now" in the text under "My Account Login"
You will then create an account using your name and date of birth

Under the "My Account" menu, there is a section called "ID card information" and below that is "view or print ID card." Click on that to view a custom .pdf file with your card information.

Student Health, your preferred first stop
It is typically more cost-effective and timely to visit Student Health for all of your medical needs or Counseling and Psychological Services (CAPS) for your mental health needs. Most situations can be taken care of there, but there are times when you will need outside help for yourself or dependents (dependents are not seen at Student Health).

The reason that we advocate using Student Health and Counseling and Psychological Services (CAPS) is that the cost is much lower than outside providers. These small, Duke student-only clinics are run so efficiently because they are serving a young, mostly healthy population. Furthermore, students pay for these services with the Student Health fee, so they are already paid for, you might as well use them. The Duke Student Health pharmacy can also provide some medications at a lower cost than outside pharmacies due to bulk purchasing through the hospital (Although current federal law has greatly limited this, there are some items that are still cheaper at Student Health - lawmakers are working to change that restriction).

In-network providers
Even though you should go to Student Health for practical reasons, you don't have to - ever. You don't need a referral. So, should you have to venture outside of Student Health and CAPS, it is always a good idea to use an in-network provider. These providers (clinics and hospitals also) have a special arrangement with the insurance company to provide services at a reduced rate. In addition, services from in-network providers are paid at a higher percentage than services from providers whom are not in-network. Consider this example of two identical doctors providing a service for the same price, $100; except one is in-network, the other is not.

In-network

Base price: $100

Discount: $40 (this is the amount that is negotiated for by the insurance company - you get it just for belonging to the plan)

Amount insurance company pays: $48 (that is the remaining $60 x 80% = $48)

Amount you owe: $12

Not in-network

Base price: $100

Amount insurance company pays: $70 (that is $100 x 70%, since providers that are not in-network are only paid at 70%, not 80%)

Amount you owe: $30

And, just for fun (although it's not funny), if you don't have insurance

Base price $100

Amount you owe: $100

As you can see, it is advantageous for the customer (you), the plan (Duke students who pay for the amount the insurance company pays), and the insurance company to stay in-network whenever possible. Of course, you can also see why having insurance in the first place is important - most bills are not for $100, they are more like hundreds or thousands for more involved services.

Ok, how do I find an in-network provider?
If you have to visit a provider outside of Student Health or CAPS, try to get a referral from Student Health or CAPS - remind them, but they should be able to locate an in-network provider (as long as there is one for the specialty you seek). They can also usually get you an appointment sooner than if you go on your own. But should you have to, for yourself, or your dependents, you can search the list of in-network providers from https://www.uhcsr.com/duke: click on "UHC Choice Plus" for in-network providers, or "United Behavioral Health" for mental health providers.

You may still need help selecting from all of the providers. It is a good idea to use the GPSC Forums at http://gpsc.duke.edu/forums to get recommendations for providers.

As a part of our contract, all Duke Medical Center providers, including the hospital are in-network; however this does not necessarily include the Physicians Diagnostic Clinic, which uses the same logo. You can always ask a provider if they are in-network. There is a caveat in our plan that a provider will be treated as in-network is there is no suitable in-network provider within a certain distance. You will have to contact Customer Service for help with that.

If you are not in-network, you may have to pay the full amount for services and be reimbursed from the insurance company. You can find instructions on how to do this under My Account on the United Healthcare Student Resources website - instructions for creating your account are in the ID Card section above.

Dental Plan
We have two options for a dental plan. There is a discount plan that is included with the insurance plan at no extra cost and without signing up. Details can be found at http://www.basixstudent.com/duke/. If you require dental insurance, United Healthcare is offering a plan $357.84 per year that covers a wide range of services. Details can be found under "2008 Dental Benefit Summary" on https://www.uhcsr.com/duke. The form is also available to sign up.

Duke GPSC - United Healthcare StudentResources Questions - Comments

United Healthcare StudentResources Questions

Your Duke Student Medical Insurance Plan