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Frequently Asked Questions about Healthcare

Healthcare Reform and Adult Children

1. Who is eligible?

Applicable to children age 19-25

Under federal law, the child may be married or unmarried and must:

  • be the child of the employee as that is defined under the plan or policy (for UC this means a natural, legally adopted, step, or other child for whom the employee has legal guardianship); and
  • have not yet reached their 26th birthday.

Applicable to children ages 26 and 27

Under Ohio state law, the child must be unmarried and:

  • the natural child, stepchild, or adopted child of the employee;
  • have not yet reached their 28th birthday;
  • a resident of the state of Ohio or a full-time student at an accredited public or private institution of higher education;
  • not employed by an employer that offers any health benefit plan under which the child is eligible for coverage, and
  • not eligible for coverage under Medicaid or Medicare.

Please note that neither the state nor federal law require the adult child to live with or be financially dependent on the parent.

2. How do the state and federal laws work together?

The federal law requires that health plans and health insurers that offer dependent coverage make coverage available under the plan until a child reaches age 26 (through age 25).  Health insurers and health plans subject to state law must provide coverage or offer the parent the opportunity to purchase coverage for the child from age 26 until age 28, at which age the coverage extension ends.

3. When can I add my adult child?

You will be able to add your eligible adult child during the plan's annual enrollment period. Coverage will be effective on the following January 1.

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4. What is the process for requesting coverage for my adult child?

You and your adult child are  required to submit a form to UC Benefits.  Forms are available at the Benefits website and HR Forms.

5. Can I enroll my adult child in medical and dental coverage under the federal law?  State law?

Under the federal law, you can enroll your adult child in medical and/or dental coverage as long as the child otherwise meets the eligibility criteria outlined above.  Your adult child must be enrolled in the same plan as you are enrolled.

Under the state law, you can enroll your adult child in medical coverage only as long as the adult child otherwise meets the eligibility criteria outlined above.

6. Does either the state or federal allow for the adult child to remain covered under Dependent Life Insurance or Personal Accident Insurance (PAI) until age 26 or 28?

No.  Neither the federal nor state laws permit for extension of Dependent Life Insurance nor Personal Accident Insurance beyond the age limits currently in place.

7. Will an adult child be allowed to terminate individual (non-group) coverage in order to receive coverage under the parent's coverage?

Yes, as long as the adult child otherwise meets the eligibility criteria outlined above.

8. Will an adult child who previously reached the maximum age for coverage under the plan and elected COBRA continuation coverage be eligible for coverage under the parent's plan when these changes become effective?

Yes, as long as the adult child meets the eligibility criteria stated above.

9. Must the adult child have been continuously covered under the parent's plan in order to be eligible for coverage under the new state or federal law?

No.  Neither law requires the adult child to have been continuously covered under the parent's plan or policy.  The adult child must meet the state eligibility criteria for state coverage or the federal eligibility for federal coverage.

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10. I am a resident of Kentucky/Indiana and have a 26 year old adult child who doesn’t have access to any medical coverage through his employer.  He is a resident of Ohio.  Is he eligible for coverage under the State of Ohio law?

Yes, as long as the adult child otherwise meets the eligibility criteria outlined above.

11. I am a resident of Kentucky/Indiana and have a 26 year old adult child who doesn’t have access to any medical coverage through his employer. He is a resident of Kentucky/Indiana and is NOT a full-time student.  Is he eligible for coverage under the State of Ohio law?

No.

12. My 24 year old adult child is offered coverage through his employer but the employer doesn't subsidize the cost.  Is he eligible for coverage under the federal law?

Yes.

13. When the adult child reaches the limiting age of 26 under the plan, what coverage options will be available?

Medical Coverage: When the adult child reaches the limiting age of 26 under the plan, if otherwise eligible, the child will be able to choose the state coverage extension until age 28 or COBRA coverage if not eligible for the state coverage extension.

Dental Coverage: When the adult child reaches the limiting age of 26 under the plan or policy, extension of coverage will be available through COBRA.

14. When the adult child reaches age 28 and loses medical coverage under the plan, may the child elect COBRA and receive additional coverage?

Yes, if otherwise eligible, the adult child will be able to elect COBRA.

15. Will my cost for coverage increase?

Federal law (adult children through age 25):

  • While the cost to cover children under UC's medical plans will likely go up in the coming plan year, the cost to participants to enroll adult children through age 26 will be the same as the cost to enroll any other child.
  • Please note that your cost will increase if your coverage level changes.  For example, if you are currently enrolled in Employee Only coverage and add your adult child to your medical coverage, your coverage level will change to Employee Plus One dependent coverage.
  • Your contributions for coverage will continue to be deducted from your paycheck on a pre-tax basis.

State law (children age 26 or 27):

  • If you request medical coverage for an adult child age 26 or 27, you will pay an 'adult child surcharge' in addition to your monthly pre-tax contribution for coverage.  The 'adult child surcharge' will be pre-tax (if the adult child is 26) or post-tax (if the adult child is 27). Cost information will be shared as soon as it is available.  The adult child surcharge applies separately to each adult child; if you have both a 26 year old and a 27 year old adult child for whom you request coverage, you will pay the adult child surcharge for each.

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16. Are the children of my adult child eligible for coverage?

Dependent children of an adult child are NOT eligible for coverage UNLESS you (the member) have legally adopted the child or are the child's legal guardian. Court documentation is required to prove adoption or guardianship.

17. Is the spouse or domestic partner of my adult child eligible for coverage?

No.

18. What if my adult child no longer qualifies for coverage?

If, at any time, the adult child becomes ineligible for coverage (for example, because he becomes eligible for coverage through his own employer), it is your responsibility to immediately notify Human Resources. Adult children who lose eligibility for coverage will be offered the option of continuing coverage under the provisions of COBRA.

19. My 24 year old adult child has coverage through his employer.  If he is laid off and loses that coverage, can he be added to my UC health plan?

Yes, as long as the adult child otherwise meets the eligibility criteria outlined above. You must request coverage within 31 days of the date of your adult child lost coverage and provide proof that the prior coverage ended.

20. Who can I contact if I have questions?

Contact UC Benefits at 513-556-6381.

21. Where can I find these rules and regulations?

You can review the Federal Acts and Regulations at the following websites:

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Medicare

1. What is Medicare?

Medicare is a health insurance program for people age 65 or older, some disabled people under age 65, and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).

2. What are the Different Parts of Medicare?

The different parts of Medicare help cover specific services if you meet certain conditions. Medicare has the following parts:

Medicare Part A (Hospital Insurance) (FREE – No Premium).

  • Helps cover inpatient care in hospitals.
  • Helps cover skilled nursing facility, hospice, and home health care.

Medicare Part B (Medical Insurance) (Individuals pay a premium on a monthly basis).

  • Helps cover doctors’ services and outpatient care.
  • Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.

Medicare Part C (Medicare Advantage Plans) (like an HMO or PPO).

  • A health coverage choice run by private companies approved by Medicare.
  • Includes Part A, Part B, and usually other coverage including prescription drugs.

Medicare Part D (Prescription Drug Coverage).

  • Helps cover the cost of prescription drugs.
  • May help lower your prescription drug costs and help protect against higher costs in the future.

3. I am turning 65 and I am still actively employed.  Do I need to sign up for Medicare?  What about my spouse?

Medicare A (hospital coverage) is automatic and (generally) does not have a cost associated with it.  You should NOT enroll for Medicare B (Doctor) or Medicare D (prescription) while you are still actively employed and eligible for benefits.  As long as your spouse is covered as a dependent on your employee medical coverage, he/she does not need to enroll in Medicare.

At the point in time that you resign or retire you (and your spouse, if applicable) must enroll in Medicare B. You may also want to enroll in Medicare D.  If you do not sign up for Parts B and D when you are first eligible you will be charged a penalty.

You cannon enroll in the HDHP/HSA if you are enrolled in Medicare.

4. Where can I learn more about Medicare?

You can learn more about Medicare by contacting the Social Security Administration www.ssa.gov.

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Medical and Dental

1. How can I find out what is covered under the Medical Plan or Dental Plan?

You have several options for learning more about what is covered under the plans.  You can refer to the Benefits web page.  You can refer to the Plan’s Summary Plan Description (available at the same website).

2. How do I print a copy of my Humana Identification (ID) cards? What is the Humana phone number?

In order to print a Humana ID card, follow this process: Go to the Humana website, select Members, scroll down to Quick Links on right hand side, click on View ID Card, and fill in the information requested on right hand side of the screen.

The phone number for Humana is 1-800-4-HUMANA. 

3. I lost my Humana identification (ID) card, how do I obtain a new one?

You must be a registered Humana member in order to print an ID card from the Humana website. Instructions for becomeing a registered member can be found at on the Coordination of Benefits FAQ page.

4. I checked with Humana regarding a medical claim and was told I don’t have coverage. What do I do?

If you are a new employee, please note that enrollment and eligibility information is sent to Humana on a weekly basis.  It may be that we have not yet submitted your coverage information to Humana.  You can confirm your enrollment online by accessing Employee Self Service and printing a Confirmation Form.  Note that your coverage is not effective until the first day of the month following 28 days of employment.  If your Confirmation Form shows that you are currently covered, contact the Human Resources Department for additional assistance.  The number is 513-556-6381.

If you are not a new employee, be sure that the provider submitted your claim using your current Humana member ID number. Many times with the first claim of a new calendar year employees forget to use their new card which may have a new group number.  If the claim was submitted to Humana under the wrong member ID number, you’ll need to ask your provider to resubmit the claim.

If you need further assistance, contact the Human Resources Department for additional assistance.  The number is 513-556-6381.

5. I checked with Humana regarding a claim for my dependent and I was told my dependent is not covered.  What do I do?

If you are a new employee, please note that enrollment and eligibility information is sent to Humana on a weekly basis.  It may be that we have not yet submitted your coverage information to Humana.  You can confirm your enrollment online by accessing Employee Self Service and printing a Confirmation Form.  Note that your coverage is not effective until the first day of the month following 28 days of employment.  If your Confirmation Form shows that you are currently covered, contact the Human Resources Department for additional assistance.  The number is 513-556-6381.

Has your dependent reached the maximum age limit for coverage? If your dependent is over the limiting age of 26, coverage has ended.

If you are not a new employee and your dependent is not over the limiting age, be sure that the provider submitted your dependent’s claim using your current Humana member ID number. Many times with the first claim of a new calendar year employees forget to use their new card which may have a new group number.  If the claim was submitted to Humana under the wrong member ID number, you’ll need to ask your provider to resubmit the claim. 

If you need further assistance, contact the Human Resources Department for additional assistance.  The number is 513-556-6381.

6. My claims are not being paid. Why?

If the claim was submitted to Humana under the wrong member ID number, you’ll need to ask your provider to resubmit the claim.  If you need further assistance, contact the Human Resources Department for additional assistance.  The number is 513-556-6381.

Have you received an Explanation of Benefits indicating the claim is not covered?

In this case, you should contact Humana for details regarding claim denial.  If you have already spoken with Humana and the issue wasn’t resolved, contact the Human Resources Department for additional assistance.  The number is 513-556-6381.

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7. What is the Spousal Surcharge?  It is being deducted from my paycheck and I don’t think it should be. How do I stop the deduction?

A monthly spouse/domestic partner surcharge will be added to your monthly contribution for medical coverage if you elect to cover your spouse/domestic partner and your spouse/domestic partner is eligible for coverage through his/her employer but chooses not to enroll in employer-provided coverage.  If your spouse/domestic partner loses or obtains medical coverage through his/her employer, you must notify Human Resources within 31 days of such change.

If you elect to cover your spouse or domestic partner while enrolling online, you will be prompted to indicate whether or not the surcharge applies to you. If you elect SURCHARGE NOT APPLICABLE, the surcharge will not apply.

If you elect SURCHARGE APPLICABLE, the monthly surcharge will apply and will continue to be deducted until you notify Human Resources of a change in your spouse/domestic partner’s coverage status. You must notify HR within 31 days of a change.

You will NOT be able to complete your enrollment in a university medical plan without indicating whether or not the Surcharge applies to you. 

The Spousal Surcharge DOES NOT APPLY in the following situations:

  • Your spouse/domestic partner does not work, or is self employed. 
  • Your spouse/domestic partner is also an employee of the University of Cincinnati.
  • Your spouse/domestic partner is covered on your University of Cincinnati sponsored medical plan, and does not have medical coverage available through his/her employer.
  • Your spouse/domestic partner is covered on your University of Cincinnati sponsored medical plan, and is also enrolled in medical coverage through his/her employer.

The Spousal Surcharge APPLIES if your spouse/domestic partner is covered on your University of Cincinnati sponsored medical plan, and has medical coverage available through his/her employer but has elected not to enroll in his/her employer's medical coverage. 

If you are being charged for the Spousal Surcharge and don’t feel as though you should be, contact the Human Resources Department for additional assistance.  The number is 513-556-6381.

8. My spouse just had a baby.  How do I add the baby to my health insurance coverage?

In order to process the change, it will be necessary for you to contact Human Resources.  You will be instructed to access UCFlex Employee Self Service (ESS) in order to add your new dependent.  You will need to add your dependent to your record as well as elect the desired coverage (medical, dental, life insurance) and levels of coverage (employee and one dependent, family coverage, etc.). 

You must make any desired changes with 31 days of the effective date of the qualified status change.  If you miss the 31-day deadline, you must wait until the next annual enrollment period in order to add the dependent. 

In addition to the above, it is necessary for you to submit a copy of the child’s birth certificate.  

9. I just got married.  How do I add my new spouse to my health insurance coverage?

In order to process the change, it will be necessary for you to contact Human Resources.  You will be instructed to access UCFlex Employee Self Service (ESS) in order to add your spouse. You will need to add your dependent to your record as well as elect the desired coverage (medical, dental, life insurance) and levels of coverage (employee and one dependent, family coverage, etc.). Instructions are attached. 

You must make any desired changes with 31 days of the effective date of the qualified status change.  If you miss the 31-day deadline, you must wait until the next annual enrollment period in order to add the dependent. 

In addition to the above, it is necessary for you to submit a copy of the marriage certificate. If the documentation is not submitted, your dependent will be removed from coverage retroactively.  

10. I don’t understand how much I am paying for medical coverage.  My paycheck is so confusing. How much am I really paying?

On your paycheck you will notice two entries: Medical EE Pre-tax and Medical Contr ER.  The difference between these two amounts is what you are paying per pay period.

11. How can I find out my discounts for vision care (eyemedvisioncare.com)?

In order to learn more about the EyeMed Vision Plan, go to www.humana.com. You must be a registered Humana member. Once registered, information can be found at the "Coverage, Claims, & Spending" option.

12. I am a former employee and I have not received my HIPAA Certificate. What do I do?

HIPAA certificates are mailed with the COBRA application. If you haven't received your COBRA application, please contact United Healthcare (COBRA Administrator) at 866-747-0048.

If the termination has been processed, the COBRA application and HIPAA certificate are generally sent out within 3 weeks following processing of termination. 

13. I am a retiree. Why does my medical plan cost so much more than my friend’s medical coverage?

Your medical insurance is only offered to participants in the grandfathered retirement plans (TIAA/Fidelity/Vanguard). This plan must be self-sufficient—the university cannot subsidize it.  Premiums for this group are actuarially determined based on the prior claims experience.  Since the number of people in the group is relatively small, the premium per person is higher than a plan which has a large number of people among whom to spread the risk.

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General Medical Plan Questions

1. What is a copayment (copay)?

A copay is a flat fee that you pay for some services at the time you receive treatment, such as a one-time per visit charge at the doctor’s office.

2. What is a deductible?

A deductible must be paid before the plan starts paying certain expenses. Once you have met the deductible, the plan will begin paying benefits in accordance with plan provisions.

3. What types of expenses are subject to the PPO deductible?

The following are examples of the types of expenses that are subject to the POS plan deductible: hospital inpatient and outpatient services, lab tests, X-rays, ambulance, MRI, etc.

4. How does a deductible work?

You incur an expense covered by the plan.  Prior to the plan paying its share of the expense, you pay the deductible.  In most cases, you will be billed by the provider for the deductible after services are rendered.

            Example:              $250 lab test
                                        (100) deductible – paid by member

                                        $150 – paid by plan

5. Do office visit or prescription drug copays apply to the deductible?

No. Copays do not apply to the deductible.

6. What is a co-insurance maximum?

A co-insurance maximum is the amount of medical expenses that you are required to pay before a plan pays 100% of covered expenses.

7. What is a primary care physician?

Examples include Family practice, pediatrician, internal medicine, general practitioner, nurse practitioner, physician assistant, registered nurse, retail/minute clinic

8. What is a specialist?

A specialist is any type of physician NOT identified as a primary care physician (cardiologist, endocrinologist, etc.)

9. Why is the copay higher for a specialist office visit?

The increased copay reflects the increased cost to the plan for specialist office visits

The 50% discount continues to be available for UC Physicians specialist office visits.

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