Student Gold 2011–12

This information is for the 201112 plan year.

2011–2012

The Student Gold Health Insurance Plan offers quality health insurance coverage for CU-Boulder students (and their spouses/domestic partners and dependents), with primary care at Wardenburg Health Center on campus as well as coverage for services outside of Wardenburg Health Center.

NOTE: The information below is a summary of the plan. Please view the brochure for complete details, exclusions, and a benefits chart.

This plan does not cover club sports injuries. Click here for additional coverage options.

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Plan Eligibility

Eligible students must actively attend classes for at least the first 31 days after the date for which coverage is purchased.

  • Degree-seeking undergraduate students enrolled in six or more credit hours and graduate students enrolled in one credit hour or more are eligible and are automatically enrolled in the Gold Plan.
  • Continuing Education, ACCESS, and Study Abroad students enrolled in six or more credit hours, and paying the base student fee and Wardenburg Health Center fees, may be eligible to enroll in the Gold Plan and must do so by visiting Wardenburg Health Center.
  • Students approved for the Time Off or Stay Connected programs for medical reasons are eligible to enroll in the Gold Plan and must do so by visiting Wardenburg Health Center.

Plan Summary

  • Wardenburg Health Center (WHC) is the Primary Care Provider with no deductible or co-pay for covered services inside WHC.
  • $40 co-pay per visit for specialists outside of WHC (co-pays do not apply to the deductible)
  • $250 deductible per person per policy year for services outside WHC using a preferred (PPO) provider; once deductible is met, 20 percent co-insurance applies.
  • $500 deductible per person per policy year for services outside WHC using a non-PPO provider; once deductible is met, 50 percent co-insurance applies.
  • Prescription benefit
  • National and international coverage
  • Out-of-pocket maximum of $5,000 for PPO network and $10,000 for non-PPO network per plan year
  • Maximum lifetime benefit of $500,000 for services outside WHC with option to increase to $1 million
  • Referrals to specialists in the community (required for most services outside of WHC)
  • Optional additional coverage
  • The plan administrator is AmeriBen

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Dates of Coverage and Costs

Fall: 8/18/2011–12/31/2011
Spring & Summer: 1/1/2012–8/17/2012
Summer Only: 6/1/2012–8/17/2012

Enrolling in the Student Gold Health Insurance Plan for fall and spring semesters provides a full year of coverage. Spring coverage extends through August 17, 2012, regardless of whether the student graduates in May or is not taking summer classes.

  Fall Spring & Summer Summer Only
Student $1,215 $1,215 $607
Spouse / SGDP $2,767 $2,767 $1,383
Per Dependent $1,552 $1,552 $776

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Covered Services INSIDE Wardenburg Health Center

No co-pay or deductible Medical Clinic

  • Primary care for illnesses and injuries that do not require the services of an outside specialist
  • Routine immunizations
  • Travel Clinic services (excluding specialty travel immunizations)
  • Men’s health services including one annual exam per policy year
  • Sexually Transmitted Infection testing and education
  • Allergy injections
  • Nutrition services

Laboratory and X-Ray

  • Coverage for laboratory services ordered by a WHC provider
  • Coverage for X-ray services

Psychological Health & Psychiatry

  • Initial assessment/urgent care
  • Individual, couples, and group therapy
  • Substance abuse evaluation and treatment
  • Eating disorders evaluation and treatment
  • Medical evaluation and medication management
  • Stress management services

Sports Medicine

  • 25 physical therapy visits per policy year
  • 10 chiropractic visits per policy year
  • Orthopedic surgeon consultations

Women's Health Services

  • One annual exam per policy year
  • Gynecology services and consultations that do not require the services of a specialist outside of WHC
  • Birth control consultations
  • Human Papillomavirus (HPV) vaccinations
  • Sexually Transmitted Infection testing and education

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Covered Services OUTSIDE Wardenburg Health Center

Eye Exam

  • No co-pay or deductible
  • One routine eye exam per plan year through a Wardenburg-contracted optometrist (College Optical). Glasses, contacts, and contact lens fittings are not covered.

Specialist Visits For patients requiring a specialist:

  • The patient must first be seen by a WHC provider to obtain a referral to an appropriate PPO provider.
  • All relevant records are shared with the specialist, who reports back to WHC with results, thereby setting up a system for continuity of care between WHC and the specialist.
  • For a complete list of PPO providers visit: https://www.cofinity.net.

PPO Providers:

  • $40 co-pay per visit for specialists outside of WHC (co-pays do not apply to the deductible)
  • A $250 deductible per person per policy year will apply for major surgical procedures and imaging such as MRIs, ultrasounds, and CTs
  • Once the deductible is met, co-insurance applies; the Gold Plan pays 80 percent of the preferred allowance and the policy holder is responsible for 20 percent of the charges

Non-PPO Providers:

  • A $500 deductible per person per policy year will apply.
  • Once the deductible is met, co-insurance applies; the Gold Plan will pay 50 percent of reasonable charges and the patient is responsible for the remaining 50 percent and will be billed accordingly

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Prescription Benefit

  • A $50 deductible per person per policy year will apply.
  • Once the deductible is met, co-pays will apply: $15 for generic, $30 for brand, and $60 for nonformulary prescriptions.
  • $7,500 maximum benefit per year
  • The prescription drug program is managed by Express Scripts: www.expressscript.com

Urgent Care/Emergency/Hospitalization

  • $75 co-pay per urgent care visit
  • $150 co-pay per emergency room visit
  • $200 charge for hospitalization per admission in addition to the deductible

Optional Additional Coverage

Plan Brochure

For complete details on the Student Gold Plan click here (PDF).

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