Navigating Health Insurance Options at the University of Utah

Health insurance is a mechanism to manage and pay for healthcare expenses, encompassing prescription medications, doctor visits, hospital stays, and surgeries. Selecting the right health insurance plan can be daunting, especially with terms like "open enrollment" and "special enrollment" adding to the complexity. Understanding the available options and how they work is crucial for making informed decisions about your healthcare coverage. This article provides an overview of health insurance options, with a focus on plans available through the University of Utah Health Plans.

Understanding Health Insurance Basics

Before diving into the specifics of University of Utah Health Plans, it's important to understand some fundamental concepts of health insurance.

Primary vs. Secondary Insurance

Many individuals have more than one health insurance plan. In such cases, one plan is designated as the primary plan and the other as secondary. The primary plan is the one that pays first. Coordination of benefits determines which plan pays first.

The Birthday Rule: For children covered by both parents' insurance plans, the "birthday rule" typically applies. This rule dictates that the parent whose birthday falls earlier in the calendar year holds the primary plan.
Auto Insurance: If you're injured in a car accident, the auto insurance of the driver is usually the primary payer, with your health insurance acting as the secondary plan.
Worker's Compensation: In the event of a workplace accident, worker's compensation insurance typically takes precedence as the primary payer.

Government-Sponsored Insurance

Medicare: Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as some younger individuals with disabilities or end-stage renal disease. For many, Medicare serves as their primary insurance plan.
Medicaid: Medicaid is a joint federal and state program providing insurance coverage to individuals with limited financial resources. Eligibility requirements vary by state.

University of Utah Health Plans: An Overview

University of Utah Health Plans (UofU) stands out as the only university healthcare system in Utah offering health insurance. It serves an estimated 8% of Utahns who purchase their own health coverage, which translates to approximately 30,000 individuals. UofU is recognized for its extensive provider network, which includes the University of Utah and MountainStar facilities.

Plan Types

UofU offers a variety of plans to cater to different needs and budgets. These include:

Low Deductible and Copay Plans: These plans typically have lower out-of-pocket costs when you receive care, but may have higher monthly premiums.
High-Deductible Plans: These plans have lower monthly premiums but require you to pay more out-of-pocket before your insurance coverage kicks in. Many high-deductible plans are "HSA-qualified," meaning you can contribute to a health savings account (HSA) on a tax-free basis.

Provider Networks: Healthy Premier and UHealth Plus

UofU offers two distinct provider networks: Healthy Premier and UHealth Plus.

Healthy Premier: This network is the larger of the two, covering nearly the entire state of Utah (excluding Rich, Cache, and Sanpete counties). It includes a broader range of in-network providers, resulting in higher costs compared to the UHealth Plus network.
UHealth Plus: This network is more limited, primarily serving Salt Lake and Davis Counties. While it still provides access to providers beyond the University of Utah Health system, its smaller size translates to lower premiums.

When selecting a UofU plan, carefully consider the network to ensure it aligns with your preferred providers and geographic location. A plan with the Healthy Premier network will generally be more expensive than a comparable plan with the UHealth Plus network. You can utilize the provider lookup tool on the University of Utah Health Plans website to verify whether your preferred providers are in-network for each network.

Additional Benefits and Perks

University of Utah Health Plans offer several additional benefits and perks to its policyholders:

Fitness and Gym Membership Discounts: Encouraging a healthy lifestyle, UofU plans provide discounts on fitness and gym memberships.
Alternative and Self-Care Discounts: Policyholders can access discounts on alternative and self-care services at the South Jordan Health Center.
Optical Eye Care Discounts: UofU provides discounts for optical eye care services at the Moran Eye Center.
Annual Flu Shot Incentive: Promoting preventative care, UofU offers an annual flu shot incentive.

Virtual Care Coverage

Recognizing the growing importance of telehealth, UofU offers two options for virtual care:

MDLive: This 24/7 virtual care network provides access to medical and behavioral health care providers. Most individual and family plan policyholders can access MDLive at a $0 copay.
Telehealth through your Provider: Contact your provider to determine if telehealth options are available through their practice.

Customer Service

University of Utah Health Plans offers several customer service resources to assist policyholders:

Access Assistant: This tool helps policyholders find and schedule appointments with providers.
Customer Service Department: You can contact your health plan's customer service department using the phone number on the back of your insurance card to confirm in-network access to University of Utah Health Care.

University of Utah Health Care accepts traditional Medicare for all facility and professional services. Medicare Advantage plans differ from traditional Medicare and are provided through a third-party commercial insurance company.

University of Utah Health Care accepts Utah Medicaid for all facility and professional services. For information about benefits and coverage, please contact the Medicaid customer service department using the phone number on the back of your insurance card. University of Utah Health Care accepts most Medicaid HMOs for facility and professional services.

Navigating Enrollment and Plan Selection

Selecting the right health insurance plan requires careful consideration of your individual needs and circumstances.

Open Enrollment and Special Enrollment Periods

Health insurance plans typically have designated enrollment periods. Open enrollment is the annual period when individuals can enroll in or change their health insurance plans. Outside of open enrollment, you generally need a qualifying life event (such as marriage, birth of a child, or loss of other coverage) to be eligible for a special enrollment period.

Factors to Consider When Choosing a Plan

Premiums: The monthly cost of your insurance plan.
Deductibles: The amount you need to pay out-of-pocket before your insurance coverage kicks in.
Copays: A fixed amount you pay for specific services, such as doctor visits or prescription refills.
Coinsurance: The percentage of healthcare costs you pay after you've met your deductible.
Provider Network: Ensure your preferred doctors and hospitals are in-network to minimize out-of-pocket costs.
Prescription Coverage: Check the plan's formulary (list of covered drugs) to ensure your medications are covered.
Out-of-Pocket Maximum: The maximum amount you'll have to pay out-of-pocket for covered healthcare expenses in a year.

Additional Resources

University of Utah Health Plans Website: Explore available plans, compare benefits, and find in-network providers.
HealthMarkets: Compare University of Utah Health Insurance Plans plans in Utah, at no cost to you.
Utah Global Student Health Insurance Plan (SHIP): Utah Global students are required to enroll in the Utah Global SHIP.

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