Office of Student Health Benefits
http://www.shb.umn.edu
(612) 624-0627
myU OneStop


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Twin Cities Campus
2010-2011 Graduate Assistant Health Plan

Eligibility

Students meeting certain conditions are eligible to participate in the Plan. You must be properly registered for the number of credits required for your job class or appointment. All eligible graduate assistants, trainees, and fellows who wish to take advantage of the Graduate Assistant Health Plan fall semester must complete the enrollment process by the Twin Cities class registration deadline (found on One Stop), or within 14 days of their appointment start date, whichever is later.

After losing eligibility for the Graduate Assistant Health Plan (for example, your assistantship drops below 25%, you leave your appointment, or your appointment, fellowship, or traineeship ends), plan members have the option to continue coverage for up to 18 months at their own expense. To enroll in the Graduate Assistant Health Plan, please complete Step 1 and Step 2 below by the Twin Cities class registration deadline (found on One Stop), or within 14 days of your appointment start date. Coverage will terminate at the end of the month in which a student graduates.

Enrollment

Students meeting certain conditions are eligible to participate in the Plan. You must be properly registered for the number of credits required for your job class or appointment.

Current graduate assistants enrolled in the plan with enrolled dependents—If you have dependents enrolled, you MUST RE-ENROLL yourself and dependents at the start of each academic year. Even if you do not want to re-enroll for dependent coverage, you must re-enroll yourself for your coverage to be continued. We will be sending an enrollment packet with enrollment forms to these students via U.S. mail in July. Enrollment forms are also available below.

Current graduate assistants enrolled in the plan with NO enrolled dependents—If you have no dependents enrolled, you do not have to do anything. As long as you remain an eligible graduate assistant, fellow, or trainee your enrollment in the GAHP will automatically continue next term. If you would like to enroll dependents, you must complete the enrollment for and payment worksheet found below.

Students currently enrolled in the Continuation of Coverage option—You MUST RE-ENROLL to remain covered on the Continuation of Coverage option.

New graduate assistants—departments will give enrollment packets to these students. These students MUST ENROLL to be covered.

To enroll in the Graduate Assistant Health Plan, please complete Step 1 and Step 2 below by September 20, 2010 or within 14 days of your appointment start date. Coverage will begin September 1 for those who meet the enrollment deadline, or from the starting date of a qualifying appointment. Coverage for those who miss the deadline will begin on the date forms are processed by the Office of Student Health Benefits.

Step 1. Complete and Submit Enrollment Forms
To enroll in the University Health Plan for Graduate Assistants, please complete and return the following materials to the Office of Student Health Benefits by the Twin Cities class registration deadline (found on One Stop), or within 14 days of your appointment start date.


Once an applicant’s eligibility is verified by the Office of Student Health Benefits, enrollment will be processed. Plan members will see a charge for the plan on their University bill once at the beginning of each semester. Member ID cards will be sent to the plan member by U.S. mail approximately four weeks after the start of the first semester of enrollment. Cards will be mailed to the mailing address indicated on OneStop.

Step 2. Update OneStop

Make sure your U.S. mail address is up-to-date:

Twin Cities Campus Students: Look under Quick Links, Student Records and click on Personal Information. http://www.onestop.umn.edu

Enter your new health plan information:

Twin Cities Campus Students: Look under Quick Links, Registration and click on Health plan coverage. http://www.onestop.umn.edu

All students enter the following:

– Name of Health Insurance Plan: Graduate Assistant Health Plan
– Health Plan Telephone Number: (612) 624-0627
– Member ID Number: (your student ID number)

Dependents can only be enrolled at the same time the graduate assistant is enrolling; within 31 days of involuntary loss of other coverage; within 31 days of marriage, birth or adoption; or during the open enrollment period. The open  enrollment period is August 1 to the Twin Cities class registration deadline (found on One Stop). Failure to enroll a new born child within 31 days of birth will result in non-payment of the child's medical expenses from the moment of birth onward. Newborns are not automatically covered under the mother's insurance. Once you choose a dependent Plan 1 or Plan 2, you cannot change the plan until the next open enrollment period.

Plan Details

2010-2011 Graduate Assistant Health Plan Enrollment Brochure
2010-2011 Summary of Benefits: Plan 1
2010-2011 Summary of Benefits: Plan 2

Please note the following modification to the 2010-2011 plan: When a member purchases a brand drug when a chemically equivalent generic is available, the member will pay the brand copay and the difference in cost between the brand drug and the generic drug, regardless of whether “dispense as written” is written on the prescription.

Plan Card

Member ID cards will be sent to the plan member by U.S. mail. Cards will be mailed to the mailing address indicated on One Stop. For instructions on how to update your address in One Stop, see Step 2 under Eligibility and Enrollment. If you need health care before receiving the card, your health care provider may contact the Office of Student Health Benefits to verify your enrollment and eligibility.

NEW! Access your HealthPartners Member ID anytime, anywhere with our new mobile application for your smart phone. Just log on to m.healthpartners.com from your smart phone. This great new feature allows you to view both medical and dental insurance cards as soon as it’s issued by HealthPartners, so you don’t have to wait for it to arrive in the mail.

Change or Cancel Coverage

Please notify the Office of Student Health Benefits of any change in dependents, or cancellation of coverage by completing and submitting a Change or Cancellation Form (PDF). Mailings will be sent to the U.S. Mail address indicated in One Stop. For instructions on how to update your address in One Stop, see Step 2 under Eligibility and Enrollment.

Summer Coverage

Wondering how much you will be billed for summer 2011 coverage? Find out using the Summer Premium Calculator.

Students enrolled in the Graduate Assistant Health Plan for spring semester will automatically remain enrolled for summer unless you fill out a Change or Cancellation Form (PDF). Deadline to submit the form May 31.

Students with Graduate Assistantships will receive a University contribution toward summer coverage based on the semesters during the academic year in which you held a qualifying graduate assistantship.

Graduate students covered by Graduate Fellowships or department fellowships will be responsible for the entire summer premium, unless the department of the school in which you are enrolled offers to pay for your coverage. Students who do not receive a full contribution for summer coverage will be billed for the balance on their Student Account Receivable.

If you are unsure about your eligibility or percentage of appointment time, please contact the department of the school in which you are enrolled.

Out of Area Benefits

If you are traveling or visiting family outside of Minnesota and need non-emergency medical care, you may present your HealthPartners card to any provider.

You will have a deductible to meet before benefits are paid; once the deductible has been satisfied, the plan will pay 80% and you will pay 20% of any eligible charges.

If the provider participates in its local HealthPartners plan network, you do not have to file your own claim and, more importantly, the provider has agreed to accept the local HealthPartners plan allowed amount and any payment will be paid directly to the provider. This means you are not responsible for the difference between the provider’s billed charges and the amount that is considered reasonable for the service in the state where you received care.

If the provider does not participate with the local HealthPartners plan, you will need to file your own claim and make payment to the provider, as any payment will be sent directly to you. Additionally, you will be responsible for the difference between what the provider bills and the allowed amount for the services provided.

Emergency Travel Assistance Program

Plan members and their dependents traveling 100 or more miles away from home and outside of their home country, have emergency medical, travel, and personal security assistance 24 hours a day, anywhere in the world, through MEDEX, a leading provider of international travel assistance services. From finding an English-speaking doctor to replacing a prescription, MEDEX has the resources and experience to offer rapid coordination and monitoring of medical care while you are abroad.

Medical Services Available
- 24-hour worldwide medical referrals
- Medical evacuations and repatriation of mortal remains
- Verification of insurance coverage to facilitate hospital admission

Personal and Travel Services Available
- Assistance with lost or stolen travel documents (i.e. passport)
- Emergency language interpretation services
- Emergency cash advance

MEDEX Member Website

MEDEX ID Card (267K, PDF)
MEDEX Assistance 1-800-527-0218

Continuation of Coverage

After losing eligibility for the Graduate Assistant Health Plan (for example, your assistantship drops below 25%, you leave your appointment, or your appointment, fellowship, or traineeship ends), plan members have the option to continue coverage for up to 18 months at their own expense. To request continuation, please complete and return the following form to the Office of Student Health Benefits within 60 days of loss of coverage. You must enclose method of payment for the first two months of coverage with the Continuation of Coverage Form.

Continuation of Coverage Form (PDF)

Primary Member Cost (Premium): $326.65 per month. Dependent coverage may also be continued on the same terms as previously enrolled, but the insured will pay the full cost of dependent coverage. Continuation dependent rates will be as follows. (Total cost to the member will be cost of selected dependent plan PLUS cost of Primary Member Coverage. Family Coverage is defined as a spouse and one or more children.)

Dependent Plan 1
Spouse/SSDP*
$584.40 per month
One child
$378.60 per month
Two or more children
$678.80 per month
Family
$1,005.00 per month

 

Dependent Plan 2
Cost
Spouse/SSDP*
$509.00 per month
One child
$327.30 per month
Two or more children
$548.90 per month 
Family
$884.90 per month

     * spouse or same-sex domestic partner

Payment is due no later than the 20th of the month proceeding the coverage month (for example, payment is due no later than October 20th for November coverage.) Failure to remit payments by the payment due date will result in interruption or loss of coverage.

The first payment by the student will be for coverage from the date of loss of eligibility through the current month plus one month in advance, and may reflect several months’ coverage if enrollment for continuation coverage has been delayed. Payments are made directly to the University of Minnesota and sent to the Office of Student Health Benefits.

Dental Coverage

Boynton Health Service Dental Clinic provides dental care for students on the Graduate Assistant HealthPlan. Please identify yourself as a Graduate Assistant Health Plan member and have your student ID number ready when making appointments for yourself or your dependents to assure that you receive appropriate discounts on services.

As a member of the Graduate Assistant Health Plan, you will receive the following preventive services at Boynton Health Service Dental Clinic at no out-of-pocket cost:
- One dental exam at six and twelve month intervals
- One routine adult teeth cleaning at six and twelve month intervals
- Four bitewing radiographs one additional radiograph per year
- One panorex once every five years if needed, only at the time of the dental exam

Plan members have an added benefit of $1,000 in restorative dental services. The plan will pay 80% on basic restorative services and 50% on major restorative services up to $1,000. This benefit is in addition to the diagnostic and preventive services already covered.

Dependents will receive preventive and other covered restorative dental services at a discount of 20-30% below the regular fee schedule when treatment is paid for at the time of service. The discount does not apply to patients who already have other dental insurance coverage. Your dependents can be treated even if you have not enrolled them in the plan. They should always use your student ID number when making appointments to assure them of their discounts.

Restorative and preventive services for dependents will be charged at the completion of treatment. Payment is expected at the time of service. If payment is not made at the time of service, your student account will be debited the appropriate amounts.

For Primary Members only: If you choose to have preventative dental work performed outside of Boynton's Dental Clinic, a one-time credit (per academic year) of up to $150.00 will be refunded to you by check. To request for this reimbursement, fill out the Dental Reimbursement Form and follow the instructions on the form on how to submit. You must provide, within 45 days of the appointment, a copy of your bill, clearly indicating your name and the treatment received from the provider. Example: You have your teeth cleaned at Dr. Smith’s office, you receive and pay a bill for $150.00 for your hygiene appointment (restorative procedures do not receive credit). When you provide us with a copy of your bill, we will refund you with a check for $150.00. Electing this reimbursement option means that you may not receive free preventive treatment during the plan year.

Emergency care is available to alleviate pain and/or discomfort. During normal clinic hours call Boynton's Dental Clinic (612) 624-9998. After normal clinic hours, during evenings and weekends calling this same number will provide contact information for emergency care.

Student Notices

05/04/11 Email: Clarification, grad reminder, summer coverage
03/28/11 Email: Summer coverage, grad reminder
07/13/10 Email to GAs with no enrolled dependents
07/12/10 Email to GAs with enrolled dependents

Contact Us

Eligibility Questions
Office of Student Health Benefits
University of Minnesota
410 Church Street S.E., N323
Minneapolis, MN 55455
Phone: 612-624-0627 or 1-800-232-9017
Fax: 612-626-5183 or 1-800-624-9881
E-mail: umgahbo@umn.edu

Coverage Questions
HealthPartners
Phone: 952-883-7500 or 866-270-5434
Website

Dental Questions
Boynton Health Service Dental Clinic
Phone: 612-624-9998
E-mail: mkiffe@bhs.umn.edu
Website

On-Campus Health Care Questions
Boynton Health Service
Appointments: 612-625-3222
Website

Emergency Travel Assistance Questions
FrontierMEDEX
Phone: 1-800-527-0218
E-mail: info@medexassist.com
FrontierMEDEX Member Website

Coverage Dates

Academic Year 2010-2011
Term
Dates
Fall
9/1/2010 - 1/31/2011
Spring
2/1/2011 - 5/31/2011
Summer
6/1/2011 - 8/31/2011

Cost of Coverage

Primary Member Cost (Premium): $303.40 per month. $91.50 will be charged to your account at the beginning of each semester (monthly cost $15.25). The remaining $288.15 monthly balance is paid as follows.

Graduate Assistants (not fellows, trainees, or post-doctoral fellows): The University share (of the $288.15 balance) is equal to twice your appointment percentage. For example, if you have a 50% appointment, the University will pay the entire $288.15. If you have a 25% appointment, the University will only pay half (that is 50% of $288.15, or $144.075 per month) and you pay the rest, which is billed once at the beginning of the semester to your student account.

Graduate Fellows, Trainees and Post-doctoral Fellows (not Graduate Assistants): You may only enroll in the University Health Plan for Graduate Assistants if your program agrees to pay the remaining premium, which is $319.95

The University subsidizes dependents on the Graduate Assistant Health Plan at 65 percent of the lower cost plan. The amount subsidized by the University has already been substracted from the amounted listed below.

Dependent Plan 1
Cost
Spouse/SSDP*
$253.60 per month
One child
$165.90 per month
Two or more children
$298.60 per month
Family
$429.80 per month

 

Dependent Plan 2
Cost
Spouse/SSDP*
$178.20 per month
Single child
$114.60 per month
Two or more children
$204.70 per month
Family
$309.70 per month

* spouse or same-sex domestic partner

Co-pays

The Primary Member will have a $10 office visit co-pay. Dependents covered under Dependent Plan 1 will also have a $10 office visit co-pay. Dependents covered under Dependent Plan 2 will have a $25 office visit co-pay and are subject to an annual deductible and coinsurance. See benefit charts in Welcome Brochure or Summary of Benefits in Plan Details section for details.

Additional Forms

Student Info Release Authorization Form (PDF)