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Summary of Benefits

Anschutz Medical Campus Student Health


Summary of Health Insurance  Benefits: 2018-2019 Plan

 Highlights of the Student Injury and Sickness Insurance Plan

Metallic Level – Gold

 

Preferred Providers

Out-of-Network Providers

Overall Plan Maximum

The is no overall maximum dollar limit on the policy.

Plan Deductible

$500

$1,000

Out-of-Pocket Maximum

$6,000

$12,000

Coinsurance

20%

50%

Prescription Drugs

$15 Copay for Tier 1

20% Coinsurance for Tier 2

20% Coinsurance for Tier 3

Up to a 31-day supply per prescription filled at a UnitedHealthcare Pharmacy

$15 Copay for generic drugs

20% Coinsurance for brand-name drugs

Up to a 31-day supply per prescription

100% of Usual and Customary Charges

Preventative Care Services

(Including but not limited to: annual physicals, GYN exams, routine screenings and immunizations. No deductible, Copays, or Coinsurance will be applied when the services are received from a Preferred Provider. Please see the Preventative Health Benefits section for a complete list of services provided for specific age and risk groups.)

100% of Preferred Allowance

Usual and Customary Charges

The following services have per Service Copays

Physician’s Visits: $25

Medical Emergency: $100

Physician’s Visits: No Copay

Medical Emergency: $100

Pediatric Dental and Vision Benefits

Refer to the plan certificate for details (age limits apply)

Healthiest You: National Telehealth Service  

- No deductibles, copays, or coinsurance will be applied 
- 24/7 access to medical providers through HealthiestYou. 
- Access to board-certified physicians via phone and/or video where permitted 
- Based on the condition being treated, the doctor can prescribe certain medications, saving you a trip to the doctor's office. 
- Every call with a HealthiestYou doctor is covered at 100% 
- Call the toll-free number listed on the front of your medical ID card or visit www.telehealth4students.com.  


Summary of Dental Insurance Benefits: 2018-2019 Plan

 Highlights of the Dental Insurance Plan

Metallic Level – Gold

 

In-Network Providers

Out-of-Network Providers

Overall Plan Maximum - (Contract Year)


Per insured person

Diagnostic & Preventive Services are applied to Annual Benefit Maximum


Annual Maximum Carryover

$1,500                                               $1,500



No                                                      No

Orthodontic Lifetime Benefit Maximum


Per eligible insured - Select one





N/A                                            




N/A

Annual Deductible 


Per insured person


Family maximum 



$0


No limit


$50
No limit

Deductible Waived for Diagnostic/Preventive Services

Yes Yes

Out-of-Network Reimbursement

80th percentile 

80th percentile 


  • The Campus Health Center is In-Network for the Student Health Insurance plan.  
  • For more information on the Campus Health Center and services they offer please visit the CHC website

*Disclaimer : 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. 

Office of Student Health

Phone: 303-724-7674

Street Address: Education II, North, Room #3213

E:mail: CUAnschutzStudentInsurance@ucdenver.edu

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