Health Care and Vision Plans

Members of the part-time faculty can elect to participate in the university's health care and dental care plans as long as they meet the eligibility requirements set forth in the collective bargaining agreement between The New School and ACT-UAW. Part-time faculty members are eligible for health care and dental care plan coverage only after working at the university for at least one academic year (August–May). Newly hired part-time faculty members thus are not eligible for coverage during the first year of their employment at the university. Please review the Benefits Eligibility Criteria Checklist for Academic Year 2013-2014 to determine whether you are eligible for health care and dental care coverage through the university.

The university offers two health care plans with UnitedHealthcare (UHC). These plans do not require the designation of a primary care physician and do not require referrals for visits to specialists.

Once you are enrolled, you will receive a UHC ID with your covered dependents (if any) listed on it at the home address on record with The New School. Present your ID card whenever you receive medical services or fill a prescription at the pharmacy. Once you become a member, you can find information about eligibility, benefits, claims payments, discounts, and special programs by going to the UHC's member portal, www.myuhc.com, and registering with the ID number on the front of your UHC card.

Refer to the Health Care Plan Comparison Chart (PDF) to view the differences in coverage between the plans, and refer to the information below for specifics on each plan. If you have questions about coverage, call UHC at 888.322.2646. The New School Health Plan Notice of Privacy Practices (PDF) provides information on the use and disclosure of protected health information and your rights under HIPAA privacy laws. To obtain forms and documents related to health care coverage, go to Benefits Forms and Documents.

Choice Plus 1000 Plan

Choice Plus 1000 is a point-of-service (POS) plan that allows you to receive care either from UHC participating (in-network) providers or providers who do not participate in the UHC provider network (out-of-network).

There is a $30 co-payment for office visits to in-network primary care physicians (including outpatient mental health providers) and a $50 co-payment for office visits to in-network specialists. There is no co-payment for annual preventive care services. To find Choice Plus 1000 in-network providers, go to www.uhc.com, select "Find a Doctor," and then select "UnitedHealthcare Choice Plus." You can also call UHC at 888.322.2646 for provider information.

You can also receive care from out-of-network providers, but at a greater cost. The calendar year deductible (the amount you will pay in a calendar year for out-of-network services before expenses are considered for reimbursement) is $1,000 for employee-only coverage and $2,000 for family coverage.

Thereafter, the plans pay 70 percent of the Usual and Customary Rate (UCR); you are responsible for the remaining 30 percent of the UCR plus any billed amount exceeding the UCR. You must complete and submit to UHC a Reimbursement Claim Form (PDF) to receive reimbursement for out-of-network services (the request for reimbursement must be received within 12 months of the date of service). Call UHC at 888.322.2646 before seeking services from out-of-network providers, as pre-certification may be required.

The Choice Plus 1000 Summary Plan Description (SPD) and the Choice Plus 1000 Summary of Benefits and Coverage (PDF) provide additional information about the plan.  

Choice EPO Plan

The Choice EPO Plan covers only services received from UHC participating (in-network) providers. There is no coverage for services provided by nonparticipating providers except in the case of emergency care. To find EPO in-network providers, go to www.uhc.com, select "Find a Doctor," and then select "UnitedHealthcare Choice." You can also call UHC at 888.322.2646 for provider information. Primary care physician visits (including visits to outpatient mental health providers) require a $25 co-payment and specialist visits require a $40 co-payment. There is no co-payment for annual preventive care services.

The Choice EPO Summary Plan Description (SPD) and Choice EPO Summary of Benefits and Coverage (SBC) provide additional information about the plan.  

Prescription Drug Program

UHC's Prescription Drug Program is administered by Optum Rx. Present your UHC member ID card when filling a prescription at the pharmacy. The following co-payment amounts apply for a one-month (30-day) prescription at the retail pharmacy:

  • $15 co-payment for tier 1 medications
  • $25 co-payment for tier 2 medications
  • $50 co-payment for tier 3 medications

To determine the co-payment tier associated with your medication, view the 2014 Optum Rx Advantage Prescription Drug List (PDF).  Read the document carefully, as pre-authorization and quantity limitations may apply. A notation of "SDP" indicates the Select Designated Pharmacy Program, a notation of "ST" indicates the Progressive Rx Program, and a notation of "DSN" indicates the Specialty Pharmacy Program.  Additional medications and products are covered at no cost to you.

Prescriptions for medications taken on an ongoing basis (such as those for high cholesterol or high blood pressure) can be filled through the Optum Rx Mail Order Delivery Program. This program allows you to purchase a three-month (90-day) prescription for twice the retail monthly co-payment amount noted above, enabling you to save money on your prescriptions. To begin mail order delivery, complete an Optum Rx Mail Order Form (PDF) and submit it to Optum with your prescription.

If you have questions about your prescription drug coverage or the mail order delivery program, call UHC at 888.322.2646.

Routine Vision Care Benefits

UnitedHealthcare participants are automatically enrolled in the UnitedHealthcare Vision Plan at no additional cost. (You must be enrolled in the health care plan to receive vision care benefits; there is no option to enroll separately.) The plan allows you to receive routine vision services either from participating (in-network) vision providers or from providers who do not participate in the UHC vision network (out-of-network). To search for in-network providers, go to www.myuhcvision.com and log in using your UnitedHealthcare member ID number. You should also print your vision care member ID card once logged in to present at the time you receive routine vision services.  

The Vision Care Plan covers an examination and new lenses (contact and glasses) every 12 months and new frames every 24 months. Review the Summary Plan Description and Plan Summary for coverage details. Call UnitedHealthcare Vision at 800.638.3120 for additional information.

UHC Member Portal and UnitedHealth Allies

Once you receive your ID card, you can register at UHC's member portal, www.myuhc.com. There you can view plan benefits and claims information, complete your personal health record, and gain access to UnitedHealth Allies, a health discount program that can save you money on a wide range of health-related products and services not covered by most medical plans.

 
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