The university offers three 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 your home address of 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 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.
The 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 in-network primary care physician office visits (including visits to outpatient mental health providers) and a $50 co-payment for in-network specialist office visits. There is no co-payment for annual preventive care services. There is also a $100 calendar-year in-network deductible (the amount you pay in a calendar year for certain services before the services are paid). To find Choice Plus 1000 in-network providers, go to www.myuhc.com, select "Find Physician, Laboratory or Facility" under "Links and Tools," and then select "All United Healthcare Plans." Then select "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. There is a calendar-year out-of-network deductible (the amount you pay in a calendar year before eligible out-of-network expenses are considered for reimbursement) of $1,000 for an individual and $2,000 for a family.
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 by UHC within 12 months of the date of service). The employer name is The New School, and our group number is 752051. Call UHC at 888.322.2646 before seeking services from out-of-network providers, as pre-certification may be required.
The Summary Plan Description (SPD) (PDF) and Summary of Benefits and Coverage (SBC) (PDF) provide additional information about this plan.
The Choice EPO Plan covers 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.myuhc.com, select "Find Physician, Laboratory or Facility" under "Links and Tools," and then select "All United Healthcare Plans." Then select "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. There is also a $100 calendar-year in-network deductible (the amount you pay in a calendar year for certain services before the services are paid).
The Choice EPO Summary Plan Description (SPD) (PDF) and Choice EPO Summary of Benefits and Coverage (SBC) (PDF) provide additional information about the plan.
The High Deductible Health Plan (HDHP) with Health Savings Account (HSA) allows you to receive care either from UHC participating (in-network) providers or providers who do not participate in the UHC network (out-of-network). To find HDHP in-network providers, go to
www.myuhc.com, select "Find Physician, Laboratory or Facility" under "Links and Tools," and then select "All United Healthcare Plans." Then select "ChoicePlus." You can also call UHC at 888.322.2646 for provider information.
Unlike the other UHC plans, the HDHP has a calendar-year in-network deductible and in-network co-insurance (office visit co-payments do not apply) in addition to a calendar-year out-of-network deductible and out-of-network co-insurance. The deductible is the amount you pay in a calendar year prior to eligible expenses' being considered for reimbursement. The only services not subject to the deductible or co-insurance are in-network annual preventive care services (covered at 100 percent). All other expenses, including prescriptions, are not considered for reimbursement until the calendar-year deductible is met.
The calendar-year deductibles are:
Thereafter the plan pays 90 percent of the contracted rate for in-network services; you pay the remaining 10 percent. For out-of-network services, the plan pays 70 percent of the Usual and Customary Rate (UCR); you pay 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 (request for reimbursement must be received by UHC 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.
HDHP Summary Plan Description (SPD) (PDF) and
HDHP Summary of Benefits and Coverage (SBC) (PDF) provide additional information about the plan.
If you enroll in the HDHP, you can open a Health Savings Account (HSA). The HSA is an account to which the university contributes and to which you can contribute to pay for current and future qualified health care–related expenses not covered by the plan. The 2016 maximum allowable contribution is $3,350 for those enrolled in employee-only coverage and $6,750 for those enrolled in family coverage. The maximum allowable contribution includes both employee and employer contributions. Contributions roll over from year to year, and you can take your account, including any accumulated contributions, with you if you leave The New School.
The university contributes $750 to the HSA if you are enrolled in employee-only coverage and $1,500 if you are enrolled in employee plus dependent coverage (note that domestic partners are not eligible dependents for reimbursement through the HSA, per IRS rules). Before contributions begin, you must complete an
HSA enrollment form (PDF) and submit it to Optum Health Bank in order to open your HSA. University contributions begin once The New School is notified that your account has been opened and occur each time you receive a regular biweekly paycheck.
Note: If your HSA is opened with Optum Health Bank after January 1, the annual university contribution will be prorated according to the date that your account is opened.
You can make pre-tax payroll contributions to your HSA after it has been opened by completing the
HSA contribution form (PDF) and submitting it to the Benefits Department. You can also make after-tax contributions to your HSA by submitting contributions with the required contribution form directly to Optum Health Bank.
Please note that if you enroll in the HDHP with HSA, you cannot enroll in The New School's health care flexible spending account (FSA). For important information about HSAs, refer to the HSA section of
IRS publication 969.
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:
To determine the co-payment tier associated with your medication, view the 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 (PDF), a notation of "ST" indicates the Progression Rx Program (PDF), and a notation of "DSN" indicates the Specialty Pharmacy Program (PDF).
Prescriptions for medications taken on an ongoing basis (such as those for high cholesterol and 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 2.5 times 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.
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 can also refer to this listing of in-network providers (PDF). You should also print your vision care member ID card once logged in to present at the time you receive routine vision services. Follow these instructions on how to print your vision ID card.
The Vision Care Plan covers an examination and new lenses (contact and glasses) every 12 months and new frames every 24 months. Review the Contact Lens Formulary for a listing of covered contact lenses. Review the Summary Plan Description (PDF) and Plan Summary (PDF) for coverage details. Call UnitedHealthcare Vision at 800.638.3120 for additional information.
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. Review the Health Discount Flyer (PDF).
UHC's member portal, www.myuhc.com, also features a tool called MyClaims Manager that provides an enhanced view of your claims and account balances. MyClaims Manager can be accessed through the "Manage My Claims" button or "View Account Balances" button on your home page. MyClaims Manager also allows you to use credit or debit cards, bank accounts, or an HSA to pay your providers online for any out-of-pocket expenses. Review the UHC MyClaims Manager Flyer (PDF) for more information about this tool.
If you are a student in a New School degree program and are also a member of the full-time faculty, full-time administrative staff, or regular part-time (20+ hours per week) administrative staff, you must enroll for employee health care coverage at whatever point you become eligible; your student health insurance coverage (if you are enrolled) will be waived automatically. At that point, you are no longer eligible to receive services from the Student Health Center. Student health insurance coverage for a dependent (spouse, domestic partner, or child) enrolled in a degree program is not waived automatically. If you choose to cover such a dependent on your employee insurance, he or she must file the proper forms at registration to waive student health insurance. For more information, including instructions for waiving student health insurance for a dependent, go to the Student Health Services website; contact Student Health Services at 212.229.1671, option 3; or visit the Student Health Center.
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