Type of Procedure
Where Procedure is Performed
Freestand- ing Facility
Hospital-based Center or Doctor’s Office 5% after a $250 per occurrence deductible 5% after a $250 per occurrence deductible 20% after satisfying a $500 annual deductible 20% after satisfying a $500 annual deductible
In-Network Doctor’s Office (Not owned by a Hospital)
Scopic Procedures Outpatient
5%*
$20/$35 copay, then 100%*
Outpatient Surgery
5%*
$20/$35 copay, then 100%*
Outpatient Lab/ X-Ray
5%*
$20/$35 copay, then 100%*
CT Scans, PET Scans, MRI, MRA & Nuclear Medicine
$20/$35 copay, then 100%*
5%*
*No deductible To avoid having to pay a deductible and depending on the procedure, a higher coinsurance, find a doctor who is not part of a hospital system. If going to a doctor who is part of a hospital system, and they recommend lab tests, x-rays, CT scans, MRI, MRA & Nuclear Medicine, you can request a prescription and then locate a free-standing facility to obtain these services. These free-standing facilities will transmit their findings to your doctor. These are difficult but necessary decisions to safeguard the financial strength of the Laboratory while continuing to offer health plans that meet the needs of our employees. As you look to decide which plan best meets your needs, please take the time to review the various plan details and research doctors on the UHC provider network on www.uhc.com. We have included the following definitions section to assist you in understanding the information throughout this guide.
Benefit Eligibility
Eligibility Information As an employee working 30 hours or more per week, you and your eligible dependents qualify for Medical, Dental, Vision, and Life/AD&D Insurance benefits. If your spouse or domestic partner has access to group coverage through his or her own employer, they are not eligible for CSHL medical/ vision and/or dental benefits. Special enrollment rules apply if you are married to another CSHL Generally, you can only change your benefit elections during the annual benefits Open Enrollment period. An exception is made for any Qualifying Life Event (QLE), such as marriage, divorce, birth, or adoption. You must notify Human Resources within 31 days of any QLE to make changes. Otherwise, you’ll have to wait until the next Open Enrollment period. Any changes you make to your benefit choices must be directly related to the QLE. Proof of the change will be requested (example: a marriage license or birth certificate). When Coverage Ends All benefits end on your last day of work. However, under certain circumstances, you may continue your health care benefits through COBRA Insurance. employee or graduate student. Making Changes During the Year
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