CSU Student Health Insurance Plan Benefits
Summary of Benefits
Overview and Changes to SHIP for the 2017/2018 Academic Year:
- Benefits will remain compliant with Federal and State requirements
- Claims administrator will remain AmeriBen
- Flex Benefits will remain included. Students will be able to use their $100 annual benefit for dental, vision and other specific services rendered at the CSU Health Network
- Charges for diagnostic lab services (excluding preventive or wellness services) sent to an outside lab will be subject to the plan deductible and coinsurance.
- Deductible will remain at $1,000 Preferred Provider / $2,000 Out-of-Network
- Out of Pocket Maximum will remain at $6,850 Preferred Provider / $13,700 Out-of-Network
- Prescription copay will remain at $10/$35/$60
- Carrier has changed to Anthem Blue Cross Blue Shield of Colorado
- Waiver administrator will be SIS (Specialty Insurance Solutions)
For students with SHIP, the CSU Health Network will process office visit charges under the $1500 Campus Advantage plan or forward them to Anthem Blue Cross Blue Shield of Colorado for consideration if the Campus Advantage benefit has been exhausted. For students who have exhausted the $1500, a 20% cost share will be applied to the student account after the insurance has paid their portion.
- All students enrolled in at least six resident instruction credit hours are automatically enrolled in the CSU Student Insurance Plan each semester.
- Graduate students who are enrolled in less than six resident instruction credits (including CR) may voluntarily enroll by completing an enrollment form at the CSU Student Insurance Office before the 10th day of classes. Students taking less than 6 credits are not charged the University General Fees, therefore, health access and counseling charges are added to the student account approximately 4-6 weeks after the beginning of the semester.
- Undergraduate students enrolled in less than six resident instruction credits are not eligible for coverage.
- Students wishing to elect coverage through an Individual Health Insurance Plan must demonstrate proof of comparable coverage by completing a waiver process. Students who have been granted a waiver in the fall semester will be automatically waived in the spring semester.
- All waiver requests must be made no later than the 10th day of classes.
- No enrollment or cancellations may be made after the University Add/Drop date. Students are responsible for viewing their online Colorado State University Online Account Statements prior to the University Add/Drop date to ensure that it reflects the intended level of Student Health Insurance enrollment.
|Coverage Dates (Domestic Students)|
|Fall||8/1/17 to 12/31/17|
|Spring/Summer||1/1/18 to 7/31/18|
|Summer Only||5/1/18 to 7/31/18|
|Fall 2017||Spring/Summer 2018||Summer Only 2018|
CSU has found that health insurance coverage for students’ dependents, spouses or domestic partners is most affordable through the open market. The Colorado Health Insurance Exchange is a marketplace where Coloradans can shop for and buy health insurance based on quality and price. The Exchange also provides financial assistance to people with certain income levels to reduce up-front costs.
Frequently Asked Questions
What health services are available on campus for my dependents and spouse/domestic partner?
Enrolled students and their spouses or domestic partners have access to all services at the CSU Health Network including medical care, counseling and health education/prevention services. Students’ dependents (child or children) would be referred to a community provider based on their age or need. More information about CSU Health Network services can be found at health.colostate.edu.
What health insurance options are available for my dependents and spouse/domestic partner?
CSU has found that health insurance coverage for students’ dependents, spouses or domestic partners is most affordable through the open market.
Where can I find health insurance coverage for my dependents and spouse/domestic partner?
The Colorado Health Insurance Exchange is a marketplace where Coloradans can shop for and buy health insurance based on quality and price. The Exchange also provides financial assistance to people with certain income levels to reduce up-front costs.
What steps can I take to find health insurance for my dependents and spouse/domestic partner?
At the Colorado Health Insurance Exchange website (ConnectForHealthCo.com) students can browse plans anonymously and compare prices, coverage levels and provider network coverage. The website is easy to navigate and provides customized quotes based on each family’s needs. Students can chat online with a Health Guide while on the site or can call to speak with someone at (855) 752-6749.
Where can I get help with the process?
For students that may need more specific guidance, they can schedule an appointment locally with a Larimer County Health Guide by calling (970) 420-7313 or logging on to Larimerhealthconnect.org.
How much will health insurance cost for my dependents and spouse/domestic partner?
Cost for health insurance plans for dependents, spouses or domestic partners vary and are dependent on income and other factors. Students’ dependents, spouses or domestic partners may be eligible for Medicaid or subsidies through the Exchange, which will reduce insurance costs. Costs could be as low as $200 per month, which is much more affordable than the rate the University’s plan could provide.
When I arrive in the fall, can I access the Colorado Health Insurance Exchange to find coverage for my dependents and spouse/domestic partner?
The Colorado Health Insurance Exchange opens for enrollment in mid-November and closes mid-February. However, students’ families can enroll in a health insurance plan if there is a qualifying health event, which includes:
- Moved to Colorado
- Marriage or civil union
- Birth or adoption
- Change of American Indian/Alaska Native status
- Change of residence (if moving out of a service area)
- Gain or loss of eligibility for the tax credit or cost sharing reduction
- Incorrect or inappropriate enrollment NOT due to customer error
- Loss of minimum essential coverage (MEC)
- Employer-sponsored coverage becomes unaffordable
- Gain of Citizenship or Immigration status
For more information about qualifying health events, visit the Connect for Health Colorado Website.
What requirements must I meet in order to be eligible for the graduate assistant health insurance contribution?
Students must meet the following eligibility requirements:
- Have an assistantship appointment of at least 25% (10 hours per week) by the end of the regular add/drop period and
- Hold CSU health insurance and
- Be enrolled in at least 5 resident instruction on-campus credits (excluding Online Plus credits)
What will the amount of the graduate assistant's health insurance contribution be?
- For students who meet the GA eligibility requirements in both the fall and spring semesters, the CSU health insurance contribution will cover 100% of the fall, spring and summer health insurance premiums, effective Fall 2015.
- For students who meet the GA eligibility requirements for only one semester,the CSU health insurance contribution will cover 100% of the insurance premium only in that semester.
- Students who serve as a GA for one semester will not be eligible for CSU’s summer health insurance contribution.
If I am eligible as a graduate assistant for the health insurance contribution, when is the contribution applied to my CSU student account?
The health insurance contribution will appear on the student’s CSU account as a credit, approximately one week after the end of the regular add/drop date.
Is the health insurance contribution taxable?
The contribution is considered “supplemental wages”. Supplemental wages are taxed at a higher tax rate and will decrease the first paycheck of the semester for the student (once only each semester, fall and spring).
Do I need to apply for the health insurance contribution?
Students do not need to apply for the health insurance contribution. They will automatically be identified.
No enrollment or cancellations may be made after the University Add/Drop date. Students are responsible for viewing their online Colorado State University Online Account Statements prior to the University Add/Drop date to ensure that it reflects the intended level of Student Health Insurance enrollment.
Using the Plan
- Students who need health care should access the CSU Health Network first for treatment. Referral services are available to assist with obtaining a referral to an outside provider.
- In the event of an emergency, benefits will be paid at a higher level if you obtain treatment or medical services from an Anthem, in-network provider.
- Detailed information about emergency/emergent care procedures is available in the After Hours and Emergency Care tab.
In-Network Preferred Providers
The plan is structured so that benefits are paid at a higher level if you obtain treatment or medical services from a provider in the Anthem networks. You are strongly encouraged to utilize these providers whenever possible given this can reduce your out-of-pocket expenses.
CSU Health Network Campus Advantage Benefits
Students do not need to submit a claim to the Student Health Insurance Plan for benefits provided at the CSU Health Network. Campus Advantage benefits will be processed by the CSU Student Insurance Office and any ineligible expense not payable under Campus Advantage benefits or by the student health fee will be charged to the student’s University account after consideration of coverage by the insurance carrier.
Individuals enrolled on the plan and who obtain services from an in-network provider will usually not be required to submit a claim form; most offices will direct bill insurance. However, if you receive a bill from a provider’s office, you can submit the claim for processing:
- Make a copy of the bill for your own records, and ensure the bill indicates:
- The insured student’s name, address and student ID number
- Colorado State University Fort Collins
- Ensure the bill itemizes services provided
- Make a copy of the bill for your own records
- Mail the bill to:
- AmeriBen P.O. Box 6947 Boise, ID 83707-0947
- For pharmacy reimbursement please provide your insurance card at the time of service. If you purchased a prescription without providing your insurance card and would like to submit a claim for possible reimbursement please complete the Magellan RX Reimbursent Form.
Use this form when you have paid full price for a prescription drug at a retail pharmacy or need to submit claims under Coordination of Benefits rules:
- You must complete a separate claim form for each pharmacy used and for each patient.
- You must submit claims within 1 year of date of purchase or as required by your plan.
- Be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed at the top of this page. Your pharmacist can provide the necessary information if your claim or bill is not itemized.
- The plan member should read the acknowledgment carefully, and then sign and date this form.
- Return the completed form and receipt(s) to: Express Scripts ATTN: Commercial Claims P.O. Box 14711
- You may also fax your claim form to: 608.741.5475.
Claim information must be received as soon as possible and no later than 365 days after the date you received treatment or services. For questions about benefits or claims:
- Visit www.myameriben.com where you can check the status of a submitted claim, view your benefits, find an in-network provider, or submit a request for assistance – all through a secure, password protected system.
- Call AmeriBen at (855) 258-2656 to speak to a Customer Care Representative.
Who is AmeriBen?
AmeriBen functions as the third party claims administrator for benefits provided under the Student Health Insurance Plan (excluding Campus Advantage Benefits). AmeriBen provides the following services to plan participants in support of the plan:
- Assists plan participants in identifying in-network providers
- Provides information about plan benefits to prospective and current plan participants.
- Processes off-campus benefit claims submitted for processing
- Assists plan participants with questions about the status or disposition of off-campus claims
- Assists with the preparation of written plan material and participates in presentations to campus designed to disseminate information about the plan
Non-Life-Threatening Emergent or Urgent Care
- If during CSU Health Network clinic hours, seek care at the CSU Health Network first (no deductible, no co-pay).
- If the CSU Health Network is closed or you are out of the Fort Collins area, seek care at the nearest in-network urgent care facility (subject to plan deductible and $50 co pay).
- If an urgent care facility is not available, seek care at the nearest in-network hospital emergency room (subject to plan deductible and $100 co-pay).
- If an in-network provider is not available, seek care at the nearest urgent care or hospital emergency room facility (subject to plan deductible, out-of-network reimbursement rate and a $ 100 co-pay).
Dial 911 and seek care at the nearest hospital emergency room facility (subject to plan deductible, reimbursement rate based upon network status of provider and $100 co-pay which is waived if admitted.
How do I get an insurance card? Insurance cards are no longer mailed and students should be directed to MyAmeriben to access their card electronically. If you would like a hard copy of your card you may call AmeriBen at (855) 258-2656 to request one.
How do I provide input about suggested changes in plan benefits and coverage? Your input about plan benefits and coverage is important! We welcome your comments and suggestions.
Why do I have to pay the student health and counseling fees to be enrolled on the student insurance plan? The insurance plan is designed to work in conjunction with the student fee funded services provided at the CSU Health Network.
Why do the premiums vary? Premium rates are calculated separately by the underwriter and are based on an actuarial analysis of claims history for each student group.
I was enrolled in the plan during the spring semester. I will not be attending summer school. Do I have plan coverage during the summer? Students who are enrolled in the plan in the spring have coverage that extends through the subsequent June, July and a portion of August. Refer to the coverage date information provided above for specific coverage dates for the specific plan year.
Automatic Enrollment – Graduate Students
I am a graduate student taking less than 6 credits, so I am not subject to the mandatory insurance requirement. How do I enroll in the Student Insurance Plan? Domestic Graduate Students who are enrolled in less than six credit hours are not subject to the mandatory insurance requirement and can complete an enrollment form online or with the student insurance office at any time during the open enrollment period to change their enrollment status. Because credit hours can vary during the open enrollment period, graduate students who are enrolled in one to five credit hours including continuous registration students will be given an opportunity to enroll in the plan during the week following add/drop if they have not already done so during the open enrollment period. Under the terms of our insurance provider, no changes can be made to enrollment status and no changes or refunds from our insurance provider can be made after that time.
Why does the University require students who are enrolled in 6 or more resident instruction credits to have a specified level of health insurance coverage? If you get sick or injured, insufficient health insurance can lead to financial hardships that can threaten your ability to attend class, pay tuition, get student loans or live independently. In order to minimize the health risks that may impact a student’s ability to complete his or her studies, Colorado State University mandates that all CSU students enrolled in 6 or more resident instruction units be covered by a comprehensive health insurance plan. Having comprehensive health insurance is a safety net that helps ensure you will be able to stay in school, graduate and and achieve your professional goals.
I am a graduate student and was waived from the mandatory insurance requirement in the fall because I was covered under another plan that was approved as comparable coverage by Ascension. Do I need to submit another waiver request in the spring semester if I was approved for a waiver in the fall semester? No.
I have the same plan and coverage this year as I did last year. Do I need to submit proof of coverage and plan documents again? Yes. If you completed the waiver process and were approved, your private health insurance information is on file with Ascension. However, each fall, you will need to validate the information through the online waiver process. Look for an email to your student account in the summer.
Finding A Provider
Should a student have a referral to use other providers? Yes. Coverage may be denied under the Student Health Insurance Plan for students who did not receive a referral from the CSU Health Network prior to receiving care from a community provider. Your first and primary source for medical care under the Student Insurance Plan is at the CSU Health Network as you will receive the most benefit from your plan by beginning here. Depending upon need, you may be referred to an outside provider for additional care. Using our referral system can assist you with finding in-network providers under the off campus care benefit which will maximize your benefits.
Student Insurance Office
I am enrolling in an outside plan and need a letter of credible coverage or proof of prior coverage. How do I obtain such a letter? The student insurance office can help you with this. See above tab titled Student Health Insurance Office.
This glossary is to assist you in understanding the most used terms related to the insurance industry. It can also help in understanding the student insurance program; however, all of the terms are not specific to the program offered at Colorado State and therefore the glossary should only be used as an educational reference.
An event that is sudden, unexpected, and unintended, and over which the Covered Person has no control.
A statement allowing your insurance company to make (assign) payments for your medical treatment directly to the hospital or physician. Otherwise, the money will be paid to the insured when bills and claim forms are returned to the insurance office.
Carrier, Underwriter, Insurer
The company that insures you.
A document that an insured person must complete as a part of the filing process. The form will usually ask specific questions relating to the medical treatment, previous history, etc.
A provision of the insurance by which the covered person and the insurance carrier share in a specified ratio the eligible hospital or medical expenses resulting from a sickness or accident, (e.g. 80%:20% the carrier paying 80%, the insured person paying 20%).
A specified dollar amount a Covered Person must pay for specified services.
Coordination of Benefits/Anti-Duplication Provision
Provision of the insurance designed to eliminate duplicate payments and provide the sequence in which coverage will apply when a person is insured under two or more health plans. This provision assures that no more than 100% of all incurred expenses will be paid by all insurance companies combined.
The amount of out-of-pocket expenses that must be paid by the insured for health services before benefits become payable by the insurance carrier.
A licensed practitioner of the healing arts acting within the scope of his or her license and practice.
Date the insurance coverage commences.
Elective Surgery and Elective Treatment
Surgery or medial treatment which is not necessitated by a pathological or traumatic change in the function or structure in any part of the body.
Usual and customary expenses that may be used as the basis for a claim under the terms of the insurance.
A hospital admission for inpatient hospital confinement for a condition which, unless promptly treated on an inpatient bases, would (1) put the patient’s life in danger; or (2) cause serious damage to a bodily function of the patient.
Specified conditions or circumstances for which a policy does not provide benefits.
An institution operating under the supervision of a licensed physician primarily for the care and treatment of injured and sick persons confined as inpatients, having organized facilities on the premises for diagnosis, major surgery and 24 hour-a-day nursing services but not primarily a place for alcoholics or drug addicts, not a nursing, rest or convalescent home.
A medically necessary overnight confinement in a hospital when room and board and general nursing care are provided and a per diem charge is made by the hospital.
Time period when students are eligible to enroll for coverage without having to prove insurability.
Includes the coinsurance payable by the claimant and any co-payments paid by the claimant. Out of Pocket does not include any excluded amounts (including but not limited to amounts over Reasonable and Customary or Usual and Customary and charges not covered by the policy) or amounts that exceed the maximum benefit allocation as listed in the Schedule of Benefits.
A pre-existing condition is a condition for which the person received medical treatment or advice, or which was diagnosed in the six months preceding the effective date of the person’s coverage. An accidental injury sustained during the six months preceding the effective date of the persons coverage will also be considered a pre-existing condition.
Cutting, suturing, treating burns, correcting fracture, reducing a dislocation, manipulating a joint under general anesthesia, electrocauterizing, tapping (paracentesis), applying plaster casts, administering pneumothorax, endoscopy or injecting, sclerosing solution.
Therapy Services (Medical)
Services used to treat or promote recovery from illness/injury.
A) radiation therapy is treatment using x-ray, radium, cobalt, or high energy particle sources. Radiation therapy includes rental or cost of radioactive materials. Diagnostic services requiring use of radioactive materials are not radiation therapy.
B) Chemotherapy is treatment of malignant disease by using chemical or biological antineoplastic agents.
Medical care provided by means of consulting any medical provider about symptoms resulting from injury or sickness. Also includes, (but is not limited to) care by means of diagnostic procedures (i.e., x-rays, lab, surgery); the taking of medications; therapy (physical, mental health, etc.); or the use of any appliance (mental or dental).
Usual and Customary Charge/Reasonable and Customary
The charge for the offered service or supply usually made by the provider when there is no insurance, not to exceed the prevailing charge in the area for a service of the same nature and duration and performed by a person of similar training and experience, or for a substantially equivalent supply.