Understanding Student Health at UMDNJSOM

1
Understanding Student Health at UMDNJ-SOM

• Carman A. Ciervo, D.O., FACOFP
• Director of Student Health

2
UMDNJ Student Health Requirements

• All students are required to have and maintain
  health insurance.
• To waive the Schools insurance, students are
  required to provide the following to Chickering
  Claims Administrators, Inc at [phone].
  You can also do online at www.chickering.com.
• A completed waiver form.
• A copy of your insurance identification card.

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UMDNJ Student Health Requirements

• All students must complete a medical history
  questionnaire and undergo a physical examination
  upon matriculation/ transfer.
• This should be done by your private physician
• If needed, you can make a new patient
  appointment at the SOM Department of Family
  Medicine for your new student history and
  physical exam.

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UMDNJ Student Health Requirements

• All students are required to have the following
  testing
• A mantoux (TB) test - 2-step
• Hepatitis B infection screening
• HepBsurf Ag, HepBsurf AB, HepBcore AB
• Serologic proof of immunity to Varicella-Zoster
  virus or appropriate vaccination against
  Varicella
• Serologic proof of immunity to Hepatitis B
  following immunization

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UMDNJ Student Health Requirements

• All students are required to have the following
  immunizations
• A Tdap if 2 or more years have past since your
  last tetanus.
• Two doses of MMR vaccine or one does of MMR and
  one dose of measles vaccine or serologic proof of
  immunity to Roseola (measles) and Rubella (German
  measles) within the past five years.
• Hepatitis vaccine prior to patient contact.
• Annual influenza vaccination (Fall/Winter) is
  required

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UMDNJ Student Health Services

• Student health services are provided by the staff
  of Department of Family Medicine in Stratford.
• Maintenance of student health records.
• Administrative review of student records.
• Documentation of all immunizations.
• Administration of the annual PPD (Mantoux)
  testing and influenza vaccination of all
  students.

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UMDNJ Student Health Services

• The Office of Student Affairs provides the
  following services
• provides general information about student health
  insurance
• claims consultations
• dissemination of student health policies
  related information

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Obtaining Health Care Services

• You must work within the guidelines established
  by your health insurance coverage
• Obtain health care at the least cost to you

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What is the Aetna Plan?

• It is NOT an HMO
• No referrals needed from your primary care doctor
• You may self refer to a doctor
• It is a Preferred Provider Network (PPO)
• Use In-Network doctors, hospitals, labs and
  X-ray facilities to reduce your out -of -pocket
  expenses

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Enrolling in Aetna

• All full time students of UMDNJ will be
  automatically enrolled effective August 1, 2009
  (unless waived by student)
• There are no enrollment forms to complete
• If you wish to waive this insurance you must
  electronically complete the waiver form by
  August 15, 2009.

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Out-of-Pocket Expenses (in-network / Preferred
Care)

• 75 annual deductible
• 10 of the negotiated fee
• you pay 10 of the charge for the service
  rendered
• Doctor / lab / radiology
• 500 for inpatient hospital care per admission
• 1,500 annual out of pocket maximum (does not
  include prescription costs)

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Out-of-Pocket Expenses (Out-of-network /
Non-Preferred Care)

• 1000 annual deductible
• Remainder of fee after 60 of Reasonable Charge
  paid
• ER is still only 10 of the charge (paid 90)
• 500 for inpatient hospital care per admission
  and remainder of fee
• 10,000 annual out of pocket maximum (does not
  include prescription costs)

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Who are Participating Physicians?

• Call Chickering Claims Administrators, Inc at
  [phone]
• Check DocFind on the internet
• www.chickering.com
• find your school
• Policy 812807

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Hospitalization and ER Visits

• Use a network hospital for maximal coverage,
  unless its an emergency.
• You must notify Aetna within 24 hours of an
  emergent admission
• You must pre-certify a non-emergent
  hospitalization in advance

15
Laboratory X-ray

• In- Network - 90 covered
• Out of Network 60 of Reasonable charge
  covered
• Will cover routine annual cholesterol and blood
  glucose testing
• Immunization titers are not covered

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Immunizations

• Necessary immunizations are covered like any
  expense
• 90 in-network
• 60 out of network

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OB/GYN Visits

• Aetna will cover a routine gynecological visit
  with pap smear once a year
• Same as any outpatient service
• Aetna will pay for routine mammograms
• Once between 35-40
• Annually after 40
• Maternity care is covered like any medical problem

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Annual Routine Physical Examinations

• Aetna will pay 90 of the fee up to
• 191 for ages 20-39
• 222 for men age 40 and older
• 360 for women age 40 and older

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Mental Health Benefits

• Maximum of 20 visits per year
• Aetna will pay 90 in-network and 60 out of
  network per visit
• In-patient mental health and substance abuse
  treatment are also covered

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Prescriptions

• In-network 100 coverage after co-pay
• Out of network 70 of reasonable charge after
  co-pay
• Maximum Coverage - 2500/year

21
Prescriptions

• Three-Tier system for co-payments
• 15 - Tier one generic on formulary
• 20 Tier two brand name on formulary
• 40 Tier three generic or brand NOT on
  formulary
• Locate formulary at
• www.aetna.com/formulary

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Dental and Vision

• Routine dental or vision care not covered.
• Opthomology care will be covered for medical
  problems of the eyes
• Dental care is available locally at the UMDNJ
  Dental Clinic (566-6969).
• Student Dental Insurance plans are available at
  www.unversityhealthplans.com

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For Further Assistance

• Dr. Carman A. Ciervo - 566-6789
• Ms. Nancy Grasso 566-6825
• Director of Student Health
• Stratford Family Practice Office Manager
• Suite 2100 UDP

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UMDNJ Student Health Services

• We want you to stay healthy
• We are here to help
• We care