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Gaucho Health Insurance 2014-2015

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Benefit Changes

The 2014-2015 Gaucho Health Insurance plan benefits were recommended by the Gaucho Health Insurance Advisory Committee.  This Committee, comprised of representatives from various campus departments and both undergraduate and graduate students, meets throughout the year to analyze the current plan and propose recommendations for the next year's plan.  The recommendation are based on evaluation of benefit utilization and cost effectiveness.  The changes from the 2013-2014 GHI plan are as follows:

Continuation Coverage

Beginning fall quarter, 2014, continuation coverage for recently Graduated Students will no longer be available.  If your final quarter is spring, 2014, your last day of GHI coverage is September 21, 2014.

Deductible

$300 annually

co-insurance

85% in network, 60% out-of-network

Out-of-pocket maximum

$5,000 per year, in-and out-of-network combined

Costs

Undergraduate and Graduate Students premiums are the same:

Quarterly:  $856.27 (paid 3 times a year; spring covers through summer)

Annually:  $2,568.81

Waiver Deadlines

The Aetna waiver website is open. The deadline to submit waiver requests for fall quarter is September 1, 2014.  Requests must be submitted online.

Waiver Criteria

Please Note:  ALL waiver requests are audited.  If the information in the request is not verified as correct by the insurance company, the waiver will be denied, the premium for GHI will appear on the billing statement (BARC) and the student will be enrolled in GHI.

UC Student Health Insurance Waiver Criteria for the 2014-15 Academic Year

Under any type of plan, the student must have an in-network doctor and hospital providing full non-emergency medical and behavioral health care within a specified number of miles of the campus or the student’s place of residence while attending school.  The mileage requirement is established by each campus and depends on the accessibility of providers in the area local to campus.

 

Here are the distance (mileage) requirements for a network hospital and primary care per campus for 2014-15:

  1. UCB        30
  2. UCD        175
  3. UCH        30
  4. UCI          50
  5. UCLA      100
  6. UCM        55
  7. UCR         30
  8. UCSD      40
  9. UCSF       50
  10. UCSB      30
  11. UCSC      30

To satisfy the UC health insurance requirement for students, the plan held by the student must:

  1. Have no pre-existing condition exclusion; if the plan has a pre-existing condition waiting period, that period has expired
  2. Have no maximum lifetime benefit limit
  3. Have no per-injury or per-illness maximum benefit limits
  4. Have an annual out-of-pocket maximum of no more than $6,350 for an individual (this is the ACA required level).  Deductibles, co-payments and coinsurance paid by the member accrue toward meeting the out-of-pocket maximum.
  5. Have coinsurance of no greater than 20% (that is, the plan pays 80% of the allowed amount for services subject to coinsurance).
  6. Have an annual prescription drug deductible of no greater than $250.
  7. Cover the following services (ACA Essential Health Benefits)
    • Preventive health care services, including an annual physical exam, preventative immunizations and laboratory/diagnostic tests to help determine your state of health
    • Chronic disease management for such conditions as asthma, diabetes or other chronic medical conditions
    • Hospital stays for medical and surgical care
    • Hospital stays for mental health and alcohol/drug abuse conditions, covered the same as any other medical condition
    • Doctor office visits for medical, mental health, and alcohol/drug abuse conditions
    • Emergency room services
    • Diagnostic services including laboratory tests
    • Medications prescribed by a doctor (including contraceptives)
    • Pre-natal and maternity care, with no pre-existing condition limitation
    • Medical services related to injury from participation in all types of recreational activities or amateur sports

For international students, the following criteria also apply.  The plan must:

  1. not be a health care reimbursement arrangement with the student’s home country or another party.
  2. have policy written in standard English with benefits expressed in U.S. dollars
  3. have a claims payment office with an address in the United States
  4. pay at least $10,000 annually for medical evacuation
  5. pay at least $7,500 for repatriation of remains