Medical/Dental Insurance Options
Medical Insurance Options
- Selecting The PPO Plan Document
- List of Urgent Care Facilities
- CDPHN Extended Network Find-a-Doc flyer
- PPO product page
Union College offers two medical insurance plan options through CDPHP, PPO Plan U (Higher Premium/Lower Out-of-Pocket) or PPO Plan C (Lower Premium/Higher Out-of-Pocket), which will best meet your health care needs. Both the “U” or “Union” plan and the “C” or “College” plan are intended to provide comprehensive health insurance coverage at reasonable rates. Union’s medical insurance plan options provide a choice between a plan that is primarily copay based on the in-network side and a plan that combines copays and coinsurance. Both options are primarily coinsurance-based on the out-of-network side. Services received from Capital District Physician’s Healthcare Network (CDPHN) participating providers are considered as "in-network". Services received from non-participating providers are considered as "out-of-network". Your out-of-pocket expenses will vary depending upon how you use these plans. Both options include prescription drug coverage using a copay structure at participating pharmacies.
Both options are administered by the Capital District Physician’s Healthcare Network (CDPHN) and Union College is the self-insured provider. If you do not need Union’s medical insurance coverage you may also choose to opt out of medical coverage by providing proof of coverage elsewhere.
PPO PLAN U
The PPO Plan U is a plan administered by CDPHP. You have a great degree of flexibility with the PPO Plan U. You may choose to use participating physicians and hospitals. This is called "IN-NETWORK". You may choose to use non-participating physicians and hospitals. This is called "OUT-OF-NETWORK". You can use a combination of "IN-NETWORK" or "OUT-OF-NETWORK" providers. Your out-of-pocket cost will vary depending upon how you use the PPO Plan U.
The "IN-NETWORK" benefit is designed to save you money and is easier to use because there are no forms to fill out. Choosing the "OUT-OF-NETWORK" benefit is entirely up to you and is totally permissible. When you use the "IN-NETWORK" system, you pay only a copay. Since the in-network option does not have an in-network deductible, financial out-of-pocket exposure is primarily limited to the stated copays. Financial out-of-pocket exposure is further limited, under the in-network option, by individual and family out-of-pocket maximums for inpatient care and outpatient ambulatory surgery. The rest of your covered medical expenses are paid in full.
The "OUT-OF-NETWORK" system allows you to use doctors and hospitals who are not participating in the network. When you use the "OUT-OF-NETWORK" system, you will pay an annual deductible amount and the plan will pay 80% of allowable covered expenses. You have the choice of using either the "IN-NETWORK" OR "OUT-OF-NETWORK" system at any time.
PPO PLAN C
The PPO Plan C is a plan administered by CDPHP. The plan was developed to offer comprehensive coverage, to promote greater financial awareness in healthcare choices, and to provide lower payroll contributions. The PPO Plan C has considerably more services covered on a co-insurance basis. The risk of financial out-of-pocket exposure is therefore increased, up to the stated out-of-pocket maximum amounts. It should be noted that this plan, unlike the PPO Plan U (Higher Premium/Lower Out-of-Pocket) plan, does not have separate out-of-pocket maximums for "In-Network" care and outpatient surgery. Although this plan is also comprehensive, because of the higher deductibles, prevalence of co-insurance, and higher out-of-pocket limits, the premiums for this plan are lower. On the "In-Network" side of the plan, a participant who uses their primary care physician, visits a specialist, has an emergency room or urgent care visit, and/or uses the prescription program will incur a fixed dollar copay for each visit. For an inpatient or outpatient procedure, or for most medical services on the "Out-of-Network" side of the plan, the participant will be required to pay a portion of the cost under the co-insurance arrangement. The participant is first responsible for costs up to the stated deductible. Depending on how the plan is used, the respective deductible must be met before services subject to coinsurance will be paid. After the stated deductible has been met, the participant and the plan (Union) share the cost according to the schedule of benefits (copays do NOT count towards the deductible). Participants are responsible for a portion of the cost of medical services, above the deductible, until total participant out-of-pocket costs (copays, the deductible, and coinsurance) reach the out-of-pocket maximum.
* Please note that for the PPO Plan C plan there are different deductibles for in-network and out-of-network. Charges incurred and applied toward a deductible or the out-of-pocket maximum is specific to the in or out of network category in which they occurred.
Dental Insurance Plan
PLUS AND BASIC OPTIONS
Union offers two levels of dental insurance coverage through Delta Dental - Dental Basic or Dental Plus. Both options offer a network of participating dentists and provide coverage for Out-of-Network services. The Out-of-Network option allows you to choose dentists not participating in the Delta Dental network at an increased cost. The Dental Basic Plan has lower premiums, a higher annual deductible, a lower percentage of payment for most dental services, and does not include orthodontic coverage. Dental Plus has higher premiums, a lower annual deductible, a high percentage of payment for most dental services, and includes orthodontic coverage for adults and dependent children. Some limitations exist when switching from the Basic to the Plus option or for enrolling in the Plus Plan other than at time of hire or due to a Qualifying Life Event You must provide notice to Human Resources of your intention to elect the Plus plan a full enrollment year before you can transfer to the Plus plan. Complete details of each Plan are contained in the Summary Plan Description available from the Human Resources Office.
Delta Dental of New York
1 Delta Drive Mechanicsburg, PA 17055-6999
1-(717) 766-8500 or 1 (800) 932-0783