Frequently Asked Questions

The questions and answers below are divided up into the following categories:

General Enrollment and Waivers
Obtaining Medical Care and PPO Network Questions
Plan Coverage and Mental Health Questions
Prescription Drug Coverage
Other Insurance Questions

Still have questions?

Feel free to call our insurance broker, Collegiate Insurance Resources at 1-800-322-9901 and push option 0 to reach a Customer Service Representative.

General Enrollment & Waiver Questions

Q. What if I don’t want health insurance?

A. All international students are required to be enrolled in the school sponsored insurance plan. The enrollment is automatic. There is no waiver available.

All domestic students taking 9 or more units or who are considered a full-time student at NYU-Poly, must carry valid accident and sickness insurance that is comparable to the institute-sponsored plan. HMO plans that do not have local coverage will not be considered adequate coverage. If you do not show proof of existing coverage through the waiver process, you will be automatically billed and enrolled in the school plan.

Newly Enrolled FALL 2012 Students ONLY

Q. How can I waive this coverage?

A. Only domestic students may waive the school-sponsored plan and must do so bySeptember 14, 2012. To waive coverage you must complete the online "Student Insurance Waiver Form" which can be obtained by going to www.cirstudenthealth.com/poly In order to waive coverage under the school’s program, you must have comparable personal coverage, which will provide full coverage in the local area. You will be required to provide us with the name, policy number, phone number, and who is the primary insured for your policy. You will also be asked to complete a few other required questions, so that our insurance carrier and we can properly identify you and contact you, if necessary.

Q. If I waive, when will the fees be removed from my tuition bill?

A. If you waive enrollment, and your waiver is accepted, your insurance fees will be removed from your tuition bill within 10 business days.

Q. Why would my waiver not be accepted, and how will I be notified.

A. If you are in a HMO which does not provide local coverage, or if, upon review, your plan does not provide adequate (equal or better coverage) to the NYU-Poly-sponsored plan, we would not approve your waiver. You will be notified within 5 days of completing your waiver request of this decision via email and/or US mail. You will be contacted by our broker for more information about your private insurance, if additional information is needed.

Q. What does it cost and when does it cover me?

A. For the fall 2012 semester, the cost for all students, both full time and part time students, is $468. Coverage goes from August 24, 2012 to January 1, 2013. The cost for the spring/summer coverage that will be added to a full time student’s tuition statement will be $373. Continuing part-time students will have to submit their payment into USI prior to January 1, 2013 for coverage to continue. New students entering Polytechnic for the first time in spring, will have a cost of $575. The spring/summer coverage will be from January 1, 2013, to August 24, 2013.

Q. Will my family insurance cover me while at NYU-Poly?

A. In most cases, your family medical coverage will provide you with adequate coverage while attending NYU-Poly. However, it is a good idea to call your benefits administrator, tell him/her that you will be studying in Brooklyn, NY, and ask how benefits will be administered if you need care while on campus. Most "out-of-area" HMO-style plans will only pay for local treatment in the event of an emergency, (requiring that you return home for the treatment of any non-emergency conditions). If that is the case with your coverage, you MUST enroll in the school’s plan.

Q. If I enroll in the plan for spring 2013 when will my coverage become effective under the policy?

A. Your coverage would begin January 1, 2013. Your insurance identification card will list the beginning and ending dates of coverage. If you were enrolled in the plan for fall 2012, your coverage is continuous from August 24, 2012, to August 24, 2013.

Q. If I do not enroll in the student insurance plan during the open enrollment period at the beginning of the spring semester (until January 30, 2012), what will happen?

A. If you are taking 9 or more units or are considered full-time, the fees will be included on your tuition bill. You will be charged for the insurance and will be automatically enrolled. If you are taking less than 9 units or are considered part-time, enrollment is voluntary. You will not be enrolled and will not have the option of enrolling in the insurance plan until next fall.

Q. If I do not enroll in the student insurance plan during the open enrollment period at the beginning of the fall semester, can I enroll later?

A. You can only enroll in the plan if you lose your private insurance coverage. You will hae 30 days from the time you lose coverage to contact USI to talk about enrolling. USI will calculate a pro-rata rate for you and provide you with an enrollment form to complete. Every situation may be different so please ask us for a decision concerning your specific situation..

Obtaining Medical Care and PPO Network Questions

Q. Will doctors require that I pay them before treatment?

A. As NYU-Poly’s plan utilizes a national preferred provider organization (PPO), PHCS, if you go to a PHCS provider, you will have a $20 office visit copay, and the insurance will pick up the remaining balance for the office visit. If you go to an out-of-network provider, yo will have a $20 copay to pay at the time of the visit, and the plan will pick up 60% of the reasonable and customary charges. You will be responsible for the 40% of reasonable and customary charges, plus any amount over reasonable and customary charges. This amount will show on your explanation of benefits. Please note: PHCS is a PPO network owned by MultiPlan and provides additional savings to the individuals utilizing PHCS network providers.

Q. What is a Preferred Provider Organization (PPO) Network?

A. A PPO is a listing of independent doctors, hospitals and health care professionals organized into a network for the purpose of delivering quality health care at affordable prices. PPO’s should not be confused with Health Maintenance Organizations (HMO). Very simply stated, an HMO is a group of medical providers controlled by a common employer. An HMO requires that all of your care be managed by an appointed primary care physician or gatekeeper. A PPO is a group of independent medical providers affiliated simply by a common agreement to discount the price of their services to individuals insured under specified insurance policies.

Q. How does a PPO differ from an HMO?

A. A PPO differs primarily from an HMO in that the patient has the ability to go to any doctor for their treatment. They do not need referrals to see specialists. When they go to a PPO provider, they receive a higher benefit, than when they go to a non-network provider. With an HMO, the member/patient must go to a Primary Care Physician (PCP) first, and then be referred to a specialist. They can only see providers that are within the HMO.

Q. Do all student insurance plans involve PPO networks?

A. No. If your plan refers to in-network and out-of-network benefits, then it includes a PPO Network. PPO- type plans pay substantially higher benefits, with substantially lower out-of-pocket expenses than do plans that do not involve PPOs.

Q. Are PPO network providers just located in the area around my college campus?

A. No. Your PPO has both a strong local presence and national representation. While most of your care is expected to be in the area of the college, we also know you may need medical attention when you are at home or traveling. To find network providers anywhere within the country, go to MultiPlan’s web site. Your coverage is good worldwide. If you are in an area where there are no network providers, e.g. overseas, you will not be penalized. The claim should be processed at the higher coinsurance level. If it is not, and that is the situation, please contact Administrative Concepts, Inc., and explain the situation and ask them to reprocess the claim.

Q. How do I find a PPO network physician or hospital?

A. There are usually a variety of sources to obtain information about who is a Network approved provider. You can go to MultiPlan’s web site directly, to search for network providers. The best, most up-to- date and flexible method is to access the PPO’s Web Site. The address is also printed on your brochure and ID card. You can also contact the PPO by telephone at 1-800-922-4362. They are available 24 hours a day, 7 days a week.

NOTE: NYU-Poly students have full access to the NYU Student Health Center (SHC) whether enrolled in the NYU-Poly-sponsored health insurance plan or maintaining alternate health insurance coverage. For a sample of services offered by SHC, download this list of sample services. For hours of operation and other pertinent information on the NYU Student health center, visit the SHC web site.

Q. Do I need to be referred from a family or primary physician before I can see a PPO network physician?

A. No. Referral from a primary physician is a common requirement of an HMO but not of a PPO.

Q. Do I need a referral to see a specialist?

A. No.

Q. How does a PPO provider know that my plan has access to the network?

A. You should show your student insurance identification card to the provider at the time of service. Your card has the network logo on it, which will identify you as eligible to be seen and receive the network agreed upon rates.

Q. Is there a list of doctors from which I must choose? Must I pick a “gatekeeper” or “primary care physician”?

A. No. The NYU-Poly school plan leaves the choice of physician up to you. However, NYU-Poly’s plan does utilize a national preferred provider organization (PPO), PHCS. You can go to the MultiPlan website, www.MultiPlan.com to select a network provider to receive the highest level of benefits and reduce your costs. You can also contact PHCS by calling their toll-free customer service center at 1-800-922-4362.

Q. How can my charges be lower by using a PPO network approved provider?

A. Network providers have already signed agreements discounting their standard charges for insureds associated with a specific insurance plan. Typically you will see a discount between 20-60% from the providers standard fees.

Q. In a PPO-type plan, must I use a PPO provider?

A. No, you may use any provider you wish. However, plan benefits and out-of-pocket expenses are more favorable if you use a PPO provider.

Plan Coverage and Mental Health Questions

Q. What type of medical expenses are covered by the policy?

A. Usually those that are medically necessary, that do not exceed reasonable and customary charges and that are not specifically excluded in the policy.

Q. What does the plan cover?

A. If network providers are utilized, there is $0 deductible for either injuries or sickness and you simply will pay a $20 copay for an office visit. Other services are covered at 90%. If a non-network provider is utilized for injuries (accidents), 100% of the first $2,500 is paid and then 60% of the remainder up to the $100,000 maximum. If a non-network provider is utilized for a sickness, after a $100 deductible per condition, 60% of usual and customary charges. For office visits, you would pay a $20 copay at the time of service and then the plan would pay 60% of usual and customary charges.

The plan generally covers medically necessary care for conditions that are not specifically excluded. Please download the brochure for a complete description of benefits and exclusions.

Q. Plans say they pay for usual, customary, and reasonable (UCR) or reasonable and customary (R&C) charges. What does UCR and R&C mean and how is it determined?

A. UCR and R&C are interchangeable terms. They refer to a method by which the insurance industry determines what most providers’ charge for a specific service in a specific area of the country. These standards are developed based on actual charges and are up-dated constantly based on current pricing.

Q. What if a condition exceeds the benefit period or maximum amount payable?

A. No more benefits are payable for that condition under the insurance plan. Costs above your maximum would be your responsibility to pay.

Q. Is mental health covered under the plan?

A. Yes, both inpatient and outpatient mental health care is covered up to specific limits.

Q. Do I need a referral to see a mental health professional?

A. No.

Q. What are the limitations on mental health care?

A. For outpatient mental health, for non-biologically-based diagnoses, you are covered for 20 outpatient visits. For biologically-based diagnoses, there is no limit on the number of outpatient visits. Utilization of a PHCS network provider will provide you with the lowest out of pocket costs, as reduced rates have been negotiated with the providers in the network.

Inpatient mental, nervous, or emotional disorder expenses are covered the same as any other sickness for a maximum of 30 days per sickness.

Q. I see the term provider or medical provider used quite frequently. What does this mean?

A. A medical provider is a general term used to describe a person or entity licensed to deliver health care. The term includes physicians, hospitals, clinics, group practices, pharmacies, radiology, and lab facilities.

Prescription Drug Coverage

Q. Does my student insurance plan include a drug card program?

A. Yes. Your plan utilizes Medco, which is a national pharmacy program.

Q. How do I use this plan benefit?

A. At the end of the on-line enrollment process, you will be able to print your ID card. Keep this with you, as it will identify you to providers. Show your participating pharmacist your insurance identification card. Your plans provide up to a $100,000 annual discounted benefit after a $10 co-pay for generic or $20 copay for brand name medications, or $40 for brand drugs when generics are available.

Q. What is a participating pharmacist?

A. This is a pharmacy that has an agreement with the drug card company to provide you with medications at a discount as outlined in your student insurance plan. You will find that the majority of pharmacies around the country participate in your network.

Q. How do I identify a participating pharmacy, or find out if the pharmacy that I use is part of the network?

A. There are usually a variety of sources to identify network pharmacies. Medco has a toll-free telephone number that you can contact to verify if your pharmacy is in their network. It is 1-800-400-0136. This toll-free phone number is also listed on your insurance brochure and insurance identification card. The best way is to access the drug company web site. Please note: In order to access the Medco site, your group, member number, and name must be in the Medco system. If you have not received your insurance identification card yet, this has not taken place.

Q. Is home delivery service available?

A. Yes. Your Student Accident and Sickness Insurance Plan includes an option for home delivery of maintenance prescriptions that are medically necessary to treat chronic conditions. This service is not available to one-time only prescriptions. One-time only prescriptions should be filled at a participating pharmacy as outlined in the brochure.

Use of the home delivery service can provide a 3-month supply of medically necessary medications at a reduced co-pay amount. Covered prescriptions may be refilled until the annual policy CAP maximum benefit has been reached. Please refer to the brochure for specific maximum benefit information relevant to your plan. The medication will be delivered to your home within 14 days after you mail your order. Orders placed via the Internet, telephone, or fax may be received even faster. Standard shipping is free. Express shipping is available for an added charge.

Using The Home Delivery Service

By mail: Ask your doctor to write a new prescription for up to the days supply permitted, plus refills (if appropriate) for up to one year. Mail the new prescriptions along with an “order Medications” form and the appropriate co-payments to Medco Health at the address shown on the form.
By fax: Ask your doctor to write a new prescription for up to the days supply permitted, plus refills (if appropriate) for up to one year. Give your doctor your Member ID number, which is on you prescription ID Card. As your doctor to call 888-EASY-RX1. Your doctor will be given instructions for faxing your prescription to Medco Health. You will be billed later.
Online: Register with Medco Health. Follow the prompts to register. When registering online to use Home Delivery Service you must use the Mail Registration Group Identifier “ACIMAIL”. Once you are registered and logged in, select the “My Benefits” tab at the top of the page.

Health and Wellness

Health + Wellness