Georgetown University :: Office of Student Affairs

The Premier Plan offered by Georgetown University is underwritten by the United HealthCare Insurance Company (United). Because you are responsible for understanding your health benefits, carefully read the enrollment and benefit details, including the exclusions and limitations on page 26, in the Premier Plan Description of Benefits, Policy #2008-32-1, before making an enrollment decision.

Coverage begins August 15, 2008, and remains in effect through August 14, 2009. Claims should be sent to United HealthCare Student Resources, P.O. Box 809025, Dallas, Texas 75380-9025.

No Changes to the Premier Plan

No changes have been made to the 2008-2009 Benefit Design or companies servicing the Plan. The underwriter is United HealthCare Insurance Company; the Preferred Provider Network (Schedule 2) is United HealthCare Options PPO (which includes Georgetown University Hospital/Medstar, [GUH]); the pharmacy network is United Healthcare Network Pharmacy (contracted with MEDCO Pharmacy); and, the Claims Administrator is Student Resources. Also, review the Executive Summary of the 2008-2009 Premier Plan Negotiations for more detail. Again, carefully read the benefit details of the Premier Plan Description of Benefits.

Accepting the Premier Plan

Students must attend classes for the first 31 days to remain eligible for the Premier Plan, unless they qualify to renew coverage under the continuation or leave of absence provisions.

Early submission of your acceptance form enables the United HealthCare Network Pharmacy Card to be activated and claims to be promptly paid. If you are eligible to enroll in the Premier Plan and have been assessed the $1,710 on your student account for the annual health insurance, accept the plan online by clicking on Student Access+ Online Acceptance/Waiver by September 15, 2008. If an acceptance submission is not executed, submission of your name to the insurance agent will be delayed until late September, although your effective date will remain as August 15, 2008.

Accepting the plan online is preferred, but faxing an acceptance form to the GU Student Health Insurance Office is another option. To expedite the processing of your election, please do not submit your election both online and on a form, unless requested by the GU Student Health Insurance Office.

Key Points of the Premier Plan Benefit Design

To reduce your out-of-pocket costs, access providers according to the following schedules:

The Student Health Center and the Counseling and Psychiatric Service, Schedule 1, first;
The United HealthCare Options PPO network, Schedule 2, second; and,
Other providers, worldwide, Schedule 3, last.

To access your prescription card benefits:

Allow two weeks for processing your enrollment acceptance to access pharmacy providers with your United HealthCare Network Pharmacy Card.

Present your health insurance identification card at United HealthCare Network Pharmacies and pay only the co-payment to access the discount prescription drug benefit.

After open enrollment, if you pay for prescription drugs in full at the retail rate and then submit the claim, the plan will apply the co-payment and then reimburse you at the prescription drug discount price. You will be responsible for prescription drug payments in excess of the discounted price. The discount price is significantly less than the retail price. To reduce your out-of-pocket expenses, accessing the discount pharmacy benefit at the time you purchase the prescription is imperative.

Your nine digit GoCard number beginning with an "8" is your subscriber number.

To estimate your financial responsibility when seeking treatment, refer to page 12 of the Premier Plan Description of Benefits brochure for the applicable deductibles, co-payments, and co-insurance.

To obtain the greatest reduction of your out-of-pocket costs under Schedule 2, access the United HealthCare Options PPO network because this network offers the greatest overall provider discounts. Most providers at GUH are United HealthCare Options PPO providers.

To reduce your inpatient out-of-pocket costs, you must obtain an inpatient admissions pre-certification from AdvoCare. Refer to page 16 of the Premier Plan Description of Benefits booklet.

To qualify for outpatient psychotherapy benefits after the sixth visit under Schedules 2 and 3, obtain pre-certification from AdvoCare, first. Refer to page 16 of the Premier Plan Description of Benefits booklet.

Referrals to Providers Under Other Reimbursement Schedules

Page 12 in the Description of Benefits Booklet summarizes the plan reimbursement schedules. Plan reimbursement differs according to which provider bills for a service, not which provider refers you for a service. Any provider may order services from or refer you to another provider. For example, the Student Health Center may order labs or x-rays from GUH hospital and the services will be billed by the hospital and paid under Schedule 2 rather than Schedule 1. The responsibility for reducing your out-of-pocket expenses falls on you, the patient.

For additional information, call the contacts listed inside the front cover of the Premier Plan Description of Benefits booklet. Best wishes for your success in the new year.

Sincerely,

Laura Hardman Crosby
Director, GU Student Health Insurance

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