While UCCS does not require that students have medical insurance, the Student Health Center does recommend it. Students may enroll in a voluntary insurance plan by going to https://eligibility.eciservices.com/UCCS/UCCS_Enrollment.aspx and completing the online application. Payment is due at time of enrollment. Please note that refunds will not be given once this process is complete. Students may enroll by semester or choose the annual plan.

Please see below for eligibility requirements, enrollment deadlines, rates, and basic information for this insurance plan. This plan is still in the final stages of implementation so a final brochure will be available in the coming weeks. Please note that referrals will be required prior to seeing health care providers outside of the UCCS Student Health Center.

University of Colorado Colorado Springs

Student Injury and Sickness Insurance Plan

BENEFITS FLYER

for

Students and Dependents

Plan Year 2012-13

THIS BENEFITS FLYER IS PENDING APPROVAL FROM THE INSURANCE CARRIER, UNITEDHEALTHCARE STUDENT RESOURCES, FOR LEGAL COMPLIANCE

Effective with Plan Year 2012-13 the University of Colorado Colorado Springs is pleased to offer a new insurance plan for voluntary enrollment of students and their dependents with enhanced benefits that are Health Care Reform (PPACA) compliant and lower in cost than in previous years. This plan is offered to students who meet the following eligibility criteria: 1) an undergraduate student taking 9 or more credit hours or, 2) a graduate student taking 6 or more credit hours; or 3) full-time intern students and students enrolled in certain approved certificate seeking programs at University of Colorado Colorado Springs.

Coverage in this student health plan will be void and never effective if the University does not verify that I am eligible for this plan. Students must actively attend classes the first 31 days of the semester for which the student purchased insurance coverage. If the student drops out of school or drops below the required amount of credit hours within the first 31 days, they are not eligible for the Student Health Plan and the entire cost of the coverage will be refunded. Such a student will not be entitled to any benefits during the days described above and no claims received will be honored. The cost of this plan and effective dates for each semester are:

DATES

RATES 

Schedule of Benefits

University of Colorado Colorado Springs

Student Injury and Sickness Insurance Plan

Policy # 2012-4038-1

Maximum Benefit: $500,000 (per Insured Person per Policy Year)

Deductible: $250 PPO Network (per Insured Person per Policy Year)

       $500 OON (per Insured Person per Policy Year)

Co-Insurance 80% PPO Providers (except as noted below)

          60% OON (except as noted below)

Out-of-Pocket $2,500 PPO (excluding Deductible and non-covered expenses)

             $5,000 OON (excluding Deductible and non-covered expenses)

The PPO Network is Cofinity (in the State of Colorado) and FIRST HEALTH (outside the State of Colorado). PA = Preferred Allowance for PPO providers. U&C = Usual & Customary of Fair Health Index for non-network (OON) providers.

Eligible Student Health Center (SHC) benefits are paid at 100% with no copayment or deductible for covered Medical or Rx Expenses. Services at the Student Health Center are not subject to the pre-existing condition limitations of the Plan. Pregnancy is not subject to the pre-existing condition limitations of the Plan. SERVICES OUTSIDE THE STUDENT HEALTH CENTER ARE ONLY ELIGIBLE FOR PAYMENT UPON REFERRAL FROM THE STUDENT HEALTH CENTER except for the following: Medical Emergency, Maternity, when the SHC is closed, Medical Care more than 50 miles from Campus, Medical Care when a student can no longer access the SHC (i.e., Continuation Students), or Psychotherapy.

Please note: The exclusions and limitations below have not been updated to conform with the Health Care Reform Act and will be subject to change.

No benefits will be paid for: a) loss or expense caused by, contributed to, or resulting from; or b) treatment, services or supplies for, at, or related to:

1. Acupuncture;

2. Addiction, such as: nicotine addiction except as specifically provided in the policy;

3. Assistant Surgeon Fees;

4. Autistic disease of childhood, except as specifically provided in the Benefits for the Treatment of Autism Spectrum Disorders, milieu therapy, learning disabilities, behavioral problems, parent-child problems, conceptual handicap, developmental delay or disorder or mental retardation, except as specifically provided in the policy;

5. Cosmetic procedures, except cosmetic surgery required to correct an Injury of which benefits are otherwise payable under this policy;

6. Custodial care; care provided in: rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places mainly for domiciliary or custodial care; extended care in treatment or substance abuse facilities for domiciliary or custodial care;

7. Dental treatment, except for accidental Injury to Sound, Natural Teeth. Injury as a result of chewing or biting will not be considered an accident or Injury;

8. Elective Surgery or Elective Treatment;

9. Elective abortion;

10. Eye examinations, eye refractions, eyeglasses, contact lenses, prescriptions or fitting of eyeglasses or contact lenses, vision correction surgery, or other treatment of visual defects and problems; except when due to a disease process;

11. Health spa or similar facilities; strengthening programs;

12. Hearing examinations or hearing aids, except as specifically provided in the policy; or other treatment for hearing defects and problems. "Hearing defects" means any physical defect of the ear which does or can impair normal hearing, apart from the disease process;

13. Hirsutism; alopecia;

14. Hypnosis;

15. Immunizations, except as specifically provided in the policy; preventive medicines or vaccines, except where required for treatment of a covered Injury or as specifically provided in the policy;

16. Injury or Sickness for which benefits are paid or payable under any Workers' Compensation or Occupational Disease Law or Act, or similar legislation;

17. Injury sustained by reason of a motor vehicle accident to the extent that benefits are paid or payable by any other valid and collectible insurance;

18. Injury sustained while (a) participating in any intercollegiate, or professional sport, contest or competition; (b) traveling to or from such sport, contest or competition as a participant; or (c) while participating in any practice or conditioning program for such sport, contest or competition;

19. Inpatient convenience items such as guest meals, telephone, televisions;

20. Investigational services;

21. Lipectomy;

22. Medical and non-medical self-care or self-help training and occupational therapy, recreation therapy, educational therapy, dance therapy, art therapy;

23. Non-Medically Necessary Maintenance Care expenses. Example: physical therapy or chiropractic maintenance care as opposed to treatment of a condition. Maintenance care means treatment which is administered after the patient's status remains the same and no further improvement is expected; remaining symptoms are considered residual; it is indicated by infrequent, sporadic treatment (i.e. Once a month or every other week);

24. Participation in a riot or civil disorder, commission of or attempt to commit a felony; or fighting;

25. Pre-existing Conditions in excess of $1,000 for a period of 6 months, except for: individuals who have been continuously insured for at least 6 consecutive months under the school's student insurance policy; The Pre-existing Condition exclusionary period will be reduced by the total number of months that the Insured provides documentation of continuous coverage under prior Creditable Coverage if such Creditable Coverage was continuous to a date not more than 90 days prior to the Insured's Effective Date under this policy;

26. Prescription Drugs, services or supplies as follows:

a. Therapeutic devices or appliances, including: hypodermic needles, syringes, support garments and other non-medical substances, regardless of intended use; except as provided under Benefits for Diabetes;

b. Immunization agents, biological sera, blood or blood products administered on an outpatient basis;

c. Drugs labeled, "Caution - limited by federal law to investigational use: or experimental drugs;

d. Products used for cosmetic purposes;

e. Drugs used to treat or cure baldness; anabolic steroids used for body building;

f. Anorectics - drugs used for the purpose of weight control;

g. Fertility agents or sexual enhancement drugs, such as Parlodel, Pergonal, Clomid, Profasi, Metrodin, Serophene, or Viagra;

h. Growth hormones; or

i. Refills in excess of the number specified or dispensed after one (1) year of date of the prescription.

27. Reproductive/Infertility services including but not limited to: family planning; fertility tests; infertility (male or female), including any services or supplies rendered for the purpose or with the intent of inducing conception; premarital examinations; impotence, organic or otherwise; tubal ligation; vasectomy; sexual reassignment surgery; reversal of sterilization procedures;

28. Research or examinations relation to research studies, or any treatment of which the patient is to participate as a research study or clinical research study;

29. Residential treatment of eating disorders, such as anorexia or bulimia;

30. Routine Newborn Infant care, well-baby nursery and related Physician charges in excess of 48 hours for vaginal delivery or 96 hours for cesarean delivery. If forty-eighth hours following a vaginal delivery fall after 8 p.m., coverage shall continue until 8 a.m. the following morning, except as specifically provided in the policy;

31. Routine physical examinations and routine testing; preventive testing or treatment; screening exams or testing in the absence of Injury or Sickness; except as specifically provided in the policy;

32. Services mainly rendered for custodial, occupational therapy or in-vivo therapy; (except for rehabilitation facility treatment charges incurred for the treatment of mental or nervous conditions);

33. Services provided normally without charge by the Health Service of the Policyholder; or services covered or provided by the student health fee;

34. Skeletal irregularities of one or both jaws, including orthognathia and mandibular retrognathia; deviated nasal septum, including submucous resection and/or other surgical correction thereof; nasal and sinus surgery, except for treatment of chronic purulent sinusitis;

35. Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planning, bungee jumping, or flight in any kind of aircraft, except while riding as a passenger on a regularly scheduled flight of a commercial airline;

36. Speech therapy, except as specifically provided in the policy; naturopathic services;

37. Supplies, except as specifically provided in the policy;

38. Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, or gynecomastia;

39. Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment;

40. War or any act of war, declared or undeclared; or while in the armed forces of any country other than the United States (a pro-rata premium will be refunded upon request for such period not covered); and

41. Weight management, service and supplies related to weight reduction programs, weight management programs, nutrition programs, related nutritional supplies and treatment for obesity, (except surgery for morbid obesity), treatment for Morbid Obesity is covered. Morbid Obesity is defined as follows: Morbid Obesity associated with serious and life threatening disorders such as diabetes mellitus and hypertension. Morbid Obesity means a body weight of two times the normal weight or greater, or 100 pounds in excess of normal body weight based on normal body weight using generally accepted height and weight tables for a person of the same age, sex, height and frame. Benefits will be provided only upon written request for treatment with a treatment plan written by a Physician, and services or treatment must meet the Company's medical criteria) and surgery for removal of excess skin or fat, except as specifically provided in the policy.

42. The following items are not covered under this Policy, as they are deemed to be elective surgery, elective treatment, not a covered medical expense, or not a medical necessity: adoption and surrogate expenses; charges made by a relative (related by blood, marriage, or Domestic Partner); non-medical expenses; medical expenses for which the insured is not obligated to pay; non-covered prescription drugs; experimental treatment; complications from a non-covered benefit; educational, vocational or training services and supply expenses; travel expenses for a physician or other medical provided expenses related to personal comfort; removal of breast or other implants (covered only if initial implant was not for cosmetic purposes and removal is medically necessary); penile prosthetic implants; massage therapy and rolfing; occupational therapy supplies; wigs or artificial hairpiece; morbid obesity; tiredness; vision therapy; genetic test (unless covered under the covered Maternity Testing expenses as stated in Covered Expenses item number 27 and counseling and coverage for dandruff.

If you have general questions about the plan in regards to "am I eligible", or "how do I enroll", etc. please call the UCCS Student Health Center at:

719-255-4444

Student Health Center (SE Corner of Parking Garage Bldg., East of Columbine Hall)

Ask to speak to Melissa Kuykendall, UCCS Student Insurance Coordinator

For enrollment, please visit www.eciservices.com, pick UCCS and you can enroll on-line.

The Claims Administrator for this Plan is AmerIBen (Boise, ID). If you have questions in regards to claims or benefits please call AmeriBen at:

1-855-539-8677 AmeriBen Group # is 0812015

You can access the school's website at AmeriBen at uccs.ameriben.com

If you have questions about whether your provider is in the PPO network, call Cofinity at 800-831-1166 or you can go to their website at www.cofinity.net.