The information on this website is intended to provide guidance to the benefits of the insurance and how to utilize its services. It in no way constitutes a guarantee of payment for claims submitted to the insurance company.
Benefits are underwritten by UnitedHealthCare and are based on policy TBA and the benefits payable are as defined in and subject to all provisions of the Policy. The master policy on file at the university contains all the provisions, limitations, exclusions, and qualifications of the plans, which may not be included on the web pages. The master policy is the contract and will govern and control the payment of benefits.
Most outpatient physicians Office visits and lab work are covered at 100% after your Co-Payment. Some exceptions to the CO-Payment are all outpatient/inpatient surgeries, MRI's and Catscan's which would apply towards the deductible and co-insurance before payable at the specific network coinsurance level.
After the plan deductible is met, eligible inpatient and outpatient specialty care is paid for by the Student Health Insurance Plan on a percentage basis. The percentage that the Student Health Insurance Plan pays depends on where service is rendered.
In the State of Colorado:
The Participating Provider Organization network in Colorado is Cofinity www.cofinity.net. Generally the plan pays 80% of outpatient and inpatient charges when the Co-Payment is not applicable within the Participating Provider
Organization.. Some exceptions exist! For detailed Plan information please review SHI brochure or, contact the Student Insurance Office. To find a network provider in Colorado you can call Cofinity at 1-800-850-2249 or visit www.cofinity.net. You may also contact AmeriBen for assistance at 1-855-639-8679.
The Participating Provider Organization network outside of Colorado is First Health Network. To find a network provider outside Colorado you can call First Health at 1-800-226-5116 or visit www.myfirsthealth.com or call AmeriBen for assistance at 1-855-639-8679.
Outside the Network
Know your provider's affiliation! Visits outside the networks are covered at 50% of reasonable and customary charges only.
Health Care Management and Pre-Notifications
Anschutz Medical Campus has contracted with a professional health care management company to assist Insured Persons in determining whether or not proposed services are appropriate for reimbursement under the plan. The program is not intended to diagnose or treat medical conditions, guarantee benefits or validate eligibility. The medical professionals who conduct the program focus their review on the appropriateness of hospital stays and proposed surgical procedures. This confirmation must be done with AmeriBen by calling them at 1-800-388-3193
Required Pre-Admission Notification
Utilization Management Department should be notified of all Hospital Confinements prior to admission by calling AmeriBen 1-800-388-3193. AmeriBen is open for Pre-Admission notification from 8:00 a.m. to 5:00 p.m. MST, Monday through Friday calls may be left on the Customer Service Department's voice mail after hours.
- Pre-Notifications should be done at least five working days prior to any elective admission to a hospital.
- Insured Persons must also call within 48 hours (two working days) of any emergency admission.
When calling, it will be necessary to provide the program with your name, the patient's name, the name of the Physician and hospital, the reason for the hospitalization and any other information needed to complete the review.