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Summary of Benefits

Anschutz Medical Campus Student Health


Summary of Benefits: 2017-2018 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

80%

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

(Included 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 visit the Preventative Health Benefits 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  

  • ​​24/7 access to medical advice 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. 

​Massage Therapy Benefit  ​​​80% of total massage cost for in-network providers

Massage Therapy Reimbursement Form 17-18.pdf

  • The Campus Health Center is in network for the Student Health Insurance plan.  
  • For more information on the Campus Health Center and servcies they offer please visit the CHC website​


Please read the Certificate of Coverage ​for complete list of benefits or the Summary of Benefits Brochure for more information. 


Summary of Benefits: 2016-2017 Plan

Benefits are underwritten by UnitedHealthCare and are based on policy 2016-202512-1&2 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.

Health Plan Benefits​

To see a detailed description of the AMC Student Health Insurance plan 2016-2017

Plan A 2016-202512-1 Brochure_Final_070116.pdf

Plan B 2016-202512-2 Brochure_Final_070116.pdf​​

Outpatient/Inpatient

Most outpatient physician 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 CT scans which would apply towards the deductible and co-insurance before payable at the specific network co-insurance 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 Colorado, the Preferred Provider Network is Cofinity and outside of network is Colorado First Health

Outside the Network

Know your provider's affiliation. Visits outside of network are covered at 50% of reasonable and customary charges only for covered services.

The Utilization Management Department should be notified of all hospital confinements prior to admission by calling AmeriBen at 1-855-639-8679

  • 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.

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​*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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