When will my coverage become effective?
Coverage will be effective on August 1, 2008, if UPMC Health Plan has received the correct premium payment and enrollment information. Premium payment and application forms will be accepted through September 30, 2008.
What is the period of coverage?
University of Pittsburgh Student Health Plan defines its benefit year as August 1, 2008, to July 31, 2009. An opportunity to enroll in the middle of the benefit year occurs with the spring semester and covers the period from January 1, 2009, to July 31, 2009.
What is open enrollment and when does it occur?
Open enrollment is the period during which a student may enroll for coverage. Students enrolling for the fall semester have until September 30, 2008, to enroll for health care coverage. Students who are not eligible for the fall semester but who become eligible for the spring semester may enroll during the period that ends January 31, 2009.
What if a student lives in another state but attends one of University of Pittsburgh’s campuses? Is this student covered while he or she is outside of Western Pennsylvania?
Students are covered for out-of-network care through a nationwide network of participating providers. In addition, if a student travels outside of the plan area and needs medical care, he or she can call Assist America at 1-800-872-1414 (in the United States) or 1-609-986-1234 (for travel outside of the United States). This benefit helps members locate providers.
Who is considered an eligible student?
All registered full-time students are eligible for coverage under UPMC Health Plan. The number of credits an individual must carry to be considered a full-time student varies depending on the degree program. Please check with your Home Department Academic Advisor if you have any questions regarding your status as a full-or part-time student. Students must be actively registered for at least the first 31 days of the school term for which coverage is established. Eligible students who enroll may also insure their dependents. Eligible dependents include the spouse and any unmarried children under 19 years of age or up to 25 years of age if the children are full-time students at an accredited institution of higher learning and are not self-supporting.
What if I am not eligible by August 1, 2008, but become eligible for the spring semester?
A student who becomes eligible for the spring semester can enroll any time during the open enrollment period between November 1, 2008, and January 31, 2009. The effective date of coverage for this open enrollment period will be January 1, 2009.
What if I register as full-time but later decide to drop a class?
If after 31 days of the school term a student is listed as an eligible full-time student by the University of Pittsburgh, he or she will be covered for the remainder of the school health plan coverage year (August 1, 2008, through July 31, 2009).
As a member, do I have to do anything in order to continue my coverage for spring 2009?
Students who pay an annual premium are not required to do anything for the spring semester and are covered through July 31, 2009. Students who choose the installment plan (paying half the premium by September 30, 2008, and the other half by January 15, 2009) are responsible for making a timely renewal payment.
Is there a “family deductible” in this student benefit plan?
No. All student and eligible dependents (spouse and children) are required to satisfy an individual deductible each plan year. There is no family deductible for this student benefit plan.
Can I add a newborn child to my coverage?
Yes. Your newborn will automatically be covered by UPMC Health Plan for 31 days from the date of birth. Unless you call the Health Plan at 1-888-876-2756 to enroll your son or daughter within this 31-day period, your child will lose coverage on the 32nd day following birth. Likewise, a child legally placed with a covered student for adoption or a legally adopted child of a covered student will automatically be covered for 31 days from the date of placement. The covered student must call the Health Plan within 31 days of placement for the coverage to continue. In all of these instances, your premium may be adjusted.
What if UPMC Health Plan receives my payment and enrollment form after September 30, 2008?
If UPMC Health Plan receives an enrollment form and premium after September 30, 2008, the payment and form will not be accepted and will be returned to the student.
What if I cannot pay the annual premium in one payment?
An alternative payment option allows students to pay for their medical coverage in two installments. Provided the first half of the premium payment and the enrollment application are postmarked by September 30, 2008, the second half of the premium must be paid by January 15, 2009. Premium bills for the second half of the year will be mailed in December.
This statement constitutes warning of cancellation. If you haven’t received your premium bill by December 31, 2008, please contact the student payment line at 1-800-889-2193 to make the payment. Payments after this date will not be accepted and coverage will be terminated January 31, 2009.
What method of payment can I use to pay the premium for the student health plan coverage?
The student may pay for the student health plan coverage with a credit/debit card, check, or money order. If payment is made with a debit/credit card, the payer must call the student payment line at 1-800-889-2193 to make the payment. The completed enrollment form should be mailed back in the enclosed postage-paid envelope. If payment is made with a check or money order, it should be mailed with the completed enrollment form in the enclosed postage-paid envelope.
Under what circumstances can premiums be refunded?
If you drop below full-time student status and notify UPMC Health Plan at 1-888-876-2756 by September 30, 2008 (annual term), or January 31, 2009 (spring term), and no claims have been filed for you or your covered dependents, then you will receive a full refund. If you enter the armed forces, your premium will be refunded from your effective date in the armed forces.
What are some of the non-covered services?
In addition to items that are considered standard exclusions, the following is a list of non-covered services:
Allergy Services
Speech Therapy
Skilled Nursing Facility
Private Duty Nursing
Durable Medical Equipment (corrective appliances)
Prosthetic Devices
Podiatry Services
Chiropractic Services
Where can I get a directory or list of participating providers?
Visit the UPMC Health Plan website at upmchealthplan.com.
What if I have been seen by a non-participating physician?
Visits to non-participating providers are covered at 60 percent of reasonable and customary charges after the student meets his or her deductible. Additionally, student members may be responsible to pay the difference between the provider’s charge and the UPMC Health Plan payment.
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