Health Insurance

For the most up-to-date information about the

UMass Amherst Student Health Benefit Plan,

visit https://www.umass.edu/uhs/insurance


Administrative Basics – 
Your health coverage (Student Health Benefit Plan or “SHBP) isn’t run by the Graduate Employee Organization (GEO); it’s administered by University Health Services (UHS) and Cigna, and is underwritten by Consolidated Health Plans (CHP). We refer to it as a “UHS/GEO” plan, however, for a number of reasons. First, because your ability to get the plan at an affordable-rate is entirely dependent your GEO-status. GEO’s contract with the University ensures that almost every graduate employee who works for UMass-Amherst gets discounted health insurance.

There’s a reason why the university covers most of the health fee for GEO eligible employees: the hard work of graduate students through GEO since its inception. Before grad employees decided to unionize, many of us on campus did not have our health insurance paid for by the University. In 1991, a year after UMass grad students voted in favor of unionization, GEO won a 79% waiver of health fees for grad employees and their families after a 10-day strike. Since then, subsequent GEO contracts have gradually added benefits and new forms of coverage to our health coverage.

In past negotiations, we won a dental plan (available only to GEO members), making UMass-Amherst graduate students some of the few graduate employees in the country to receive subsidized dental care. In our negotiations for the 2004-2007 contract we lowered the cost of family health insurance, and secured full 12 month coverage for graduate students.

We also refer to it as a “GEO” plan because the GEO leadership and staff is happy to assist you in answering any questions you may have about your coverage. If you have any questions, give us a call at 545-0705, or send us an an email at info@uaw2322.org.

(Lack of) Costs for the GEO-Eligible – Every student at UMass taking 5 or more credits is required to enroll in the Student Health Benefit Plan offered by University Health Services, unless you have comparable coverage under another major medical insurance plan (see Waiving the Student Health Benefit Plan below). The Mandatory Student Health Fee is a separate charge which allows you to be seen at University Health Services for free.

But whereas most students have to pay for the Student Health Benefit Plan, GEO-eligible graduate students who meet the minimum earning requirements only have to pay a small percentage of the premium. The chart below lists the relative costs of the plan to GEO-eligible and non-GEO-eligible graduate students:

Individual Health Care Costs – August 1, 2017 to July 31, 2018 *Enrollments are by semester—not a full year.  If you are enrolled for both semesters it will equal a full year of coverage.

Cost of Health Plan Amount Waived by GEO Contract (95%) You Pay
Fall SHBP $1,485.00 $ 1,410.75 $74.25
Fall Health Fee $ 374.50 $ 355.77 $18.73
Spring SHBP $1,485.00 $ 1,410.75 $74.25
Spring Health Fee $374.50 $ 355.77 $18.73
Total for Year: $3,719.00 $3,533.04 $185.96
Additional Cost for a Family Plan (in addition to your individual plan) $3,000.00 Family SHBP +  $1239.00 Family Student Health Fee = $4,239.00/semester Amount Waived by GEO Contract (90%) = $2,700.00 Family SHBP & $1,115.10 Family Student Health Fee = $3815.50 Total amount for a student with a family plan who is GEO eligible: $516.88/semester, $1,033.76/year

How do I enroll into the SHBP? Enrollment is on a semester basis. If you are covered both semesters, that equals a full year of coverage.

Automatic enrollment Those taking five or more credits as a matriculated student in a day academic program are automatically enrolled in the individual SHBP each semester and charged on the semester’s tuition bill. Enrollment is based on credit count, not full time status. Students wishing to waive SHBP coverage must meet eligibility guidelines and complete the waiver process before the stated deadline.

Optional enrollment (for students taking less than 5 credits, or on Continuous Enrollment (Program Fee), or are doing online classes, or are doing Continuing and Professional Education programs).

Optional enrollment is available for those who are:

  • matriculated in a day academic program taking fewer than five credits per semester
  • graduate students matriculated in a day academic program who’ve paid the Continuous Enrollment Fee for the semester
  • matriculated into an undergraduate program through Continuing Education or University Without Walls, are legal residents of Massachusetts and are taking six or more credits per semester
  • matriculated into a graduate program through Continuing Education, are legal residents of Massachusetts, and are taking six or more credits per semester
  • online students matriculated into a graduate program through Continuing Education, are legal residents of Massachusetts, and are taking six or more credits per semester

-or-

  • matriculated Continuing Education students participating in off-campus programs

Enrollment forms must be filled out each semester for any optional enrollment.

This is very important. Every year, many graduate students who are eligible for health coverage don’t get it because they do not fill out and return an Enrollment Form to UHS before the Add/Drop date. Enrollment Forms can be found at UHS or online on the UHS website in the Forms section. You can hand deliver the form to UHS or email it to patientservices@uhs.umass.edu , or fax it to Patient Services at 413.577.5023.

When to re-enroll: If you need to complete the enrollment form for the Fall semester, it’s highly recommended that you submit it in late June or early July. Fall semester coverage begins August 1. For the Spring semester, it’s best to submit the enrollment form in December; coverage begins mid-January.

Requirements for enrollment: You must be registered for at least one credit or be registered on SPIRE for the Continuous Enrollment Fee for your enrollment form to be processed, and have filled out and submitted an Enrollment Form. If you haven’t registered yet, Patient Services will hold your enrollment form until you do, but processing will be delayed.

Processing can take up to 20 business days. If you submit the enrollment form before the semester’s Add/Drop deadline, enrollment will backdate to the start date of that semester’s SHBP. You’ll be able to be seen at UHS right away; if you’re seen elsewhere or try to obtain prescriptions, you may encounter difficulties until the enrollment is fully processed.

SHBP family plan –The available SHBP family plan covers a student’s spouse or domestic partner, and/or unmarried dependent children under age 26. To purchase the family plan and enroll eligible family members, you must be personally enrolled in the SHBP. Eligible graduate employees pay only 10% of the family plan premium. A marriage certificate and birth certificates for qualifying dependents are required to enroll in the family plan. There are certain requirements for domestic partnership—please contact patientservices@uhs.umass.edu for more information.

Family plan enrollments must be renewed every semester by filling out the enrollment form. Fax, email, mail, or deliver the form to UHS Patient Services before the end of the semester’s Add/Drop period.

Off-campus programs – Matriculated students participating in official off-campus programs are eligible to enroll in the individual SHBP and purchase the SHBP family plan. Non-matriculated students are not eligible for health plan enrollment.

Eligibility for the GEO cost reductionWho is eligible for the health insurance cost waivers? In general, if you are working at least 10 hours a week in two semesters or 20 hours a week in one semester, you’ll be eligible for waivers for the entire plan year. However, if you are unsure it’s important to pay close attention to what is specified in our contract (article 35):

  • Graduate student employees who are employed for at least 190 hours in fall semester or previous summer, or who earn the equivalent of at least 190 hours times the campus minimum hourly rate in fall semester or previous summer, or who have full responsibility for teaching one 3-credit course section in the fall semester or previous summer will be provided with a health fee exemption of 95% of the Basic Health Fee from August 1 through Mid-January, and 95% of the Student Health Benefit Plan (SHBP) from August 1 through Mid-January, and 95% of the Student Health Benefit Plan (SHBP) from Mid-January through July 31 as long as said graduate student employee is a graduate student during the following spring semester, and 90% of the Student Family Health Plan from August 1 through Mid-January for those electing family health plan coverage.
  • Graduate student employees who are employed for at least 190 hours in spring semester, or who earn the equivalent of at least 190 hours times the campus minimum hourly rate in spring semester, or who have full responsibility for teaching one 3-credit course section in the spring semester, will be provided with a health fee exemption of 95% of the Basic Health Fee from Mid-January through July 31, and 95% of the Student Health Benefit Plan (SHBP) from Mid-January through July 31, and 95% of the Student Health Benefit Plan (SHBP) from the previous August 1 through Mid-January as long as said graduate student employee was a graduate student during the previous fall semester, and 90% of the Student Family Health Plan from Mid-January through July 31 for those electing family health plan coverage.
  • Determining Health Fee Exemption Eligibility From Cumulative Earnings: Graduate student employees who are employed for at least 380 hours in the one year period beginning with the first payroll date of summer and ending with the last payroll date of the spring semester, or who earn the equivalent of at least 380 hours times the campus minimum hourly rate in the one year period beginning with the first payroll date of summer and ending with the last payroll date of the spring semester, or who have full responsibility for teaching two 3-credit course sections during the one year period beginning with the first payroll date of summer and ending with the last payroll date of the spring semester, will be provided with a health fee exemption of 95% of the Basic Health Fee from the Fall and Spring semesters, and 95% of the Student Health Benefit Plan (SHBP) from the Fall and Spring semesters, and 90% of the Student Family Health Plan from the Fall and Spring semesters for those electing family health plan coverage. Summer earnings shall be applied forward within the one year period described above.
  • Determining Health Fee Exemption Eligibility From Cumulative Earnings: Graduate student employees who: are employed for at least 190 hours in the one year period beginning with the first payroll date of summer and ending with the last payroll date of the spring semester, or who earn the equivalent of at least 190 hours times the campus minimum hourly rate in the one year period beginning with the first payroll date of summer and ending with the last payroll date of the spring semester, or who have full responsibility for teaching one 3-credit course in the one year period beginning with the first payroll date of summer and ending with the last payroll date of the spring semester, will be provided with a health fee exemption of 95% of the Basic Health Fee for one six-month health coverage period, and 95% of the Student Health Benefit Plan (SHBP) from the Fall and Spring semesters, and 90% of the Student Family Health Plan for one six-month health coverage period for those electing family health plan coverage. The one six-month health coverage period shall be the one in which the graduate student employee’s health premium costs are the highest. Summer earnings shall be applied forward within the one year period described above.
  • Graduate student employees who are academically enrolled for fewer than five (5) credits or on program fee and who are eligible for health plan fee exemptions per Section A above are not automatically enrolled for the Basic Health, SHBP, or Student Family Health Plans. The graduate student employee must enroll at University Health Services via Patient Services representatives before the end of the add/drop period of each semester to ensure no lapse in health plan coverage. You can also get the Enrollment Form on the UHS website, fill it out, and email to the Patient Services email address at the top of the form.

Paying for Health Insurance

  • You can pay for your individual Mandatory Student Health Fee and SHBP right on your Bursar Bill. You may receive a bill that will say you owe the University an enormous sum of money for health insurance – but if you read the fine print, you actually don’t. Flip over your bill and on the back side you’ll see a little box marked “Check here if you are GEO Eligible” (or something to that effect). By checking that box, you instantly cancel 95% of the amount listed under health fees.
  • Just to be safe, when you go to Whitmore to pay the non-waivable fees on your Bursar’s bill, be sure to mention that you are GEO-eligible. Whatever you do, don’t pay the full amount for health insurance and wait for reimbursement – this can be a long and uncertain process. (The only time you will want to pay and get reimbursed is if you are working 20 hours a week ONLY in the spring – your health waiver will be applied retroactively and you’ll get reimbursed). If you’re receiving financial aid, be vigilant as well. Many GEO-eligible grad employees have had health insurance fees subtracted from their financial aid award without knowing it.
  • If you want to pay through payroll deduction – All graduate student employees are allowed to pay for their health insurance costs through payroll-deduction. Contact the Bursar’s office for details.

Graduate Student Health Fee

The mandatory Student Health Fee is NOT insurance. It is charged to graduate students enrolled in 5 or more credits.

This fee entitles the student to be seen at UHS without paying co-pays and co-insurance for visits with UHS providers. Patients are responsible for any required insurance plan deductibles. The fee supports an array of programs and services, including health education and promotion services, four (4) initial visits for mental health crisis management, public health, and emergency preparedness activities.

Coverage Dates
Fall 2017 Coverage Dates: August 1, 2017 to January 14, 2018
Spring 2018 Coverage Dates: January 14, 2018 to July 31, 2018

Remember, it does take approximately 10-20 business days to process your enrollment form, so the faster you sign up for classes and get the enrollment form to UHS the better it works out for you. The insurance will retroact to that semester’s start date if you sign up before the Add/Drop deadline, but you may experience difficulties in obtaining prescription drugs or receiving medical treatment during that processing period.

Does your coverage end when you graduate?

  • Fall semester graduates:Coverage ends January 1
  • May graduates: Coverage ends July 31
  • September graduates: Regular coverage ends July 31, but you may apply at Health Services for supplemental coverage until August 31. You will need to be on the September 1st Graduation list, fill out an enrollment form, and have a letter from your department stating that you have meet all of your degree requirements and that you are graduating September 1st.
  • February graduates: Coverage ends Mid-January

For graduates, there are some options for health insurance after graduation:

Summer Coverage and Earnings – Summer coverage is now included in your Fall and Spring health coverage. All qualified earnings between May 25, 2017 and May 23, 2018 will be used to calculate Health Plan exemptions for the 2017 – 2018 plan year.

Traveling – Many graduate students go out of the state or to their home countries for the summer and wonder whether they are covered. If you’re on SHBP over the summer, you will still receive its benefits wherever you go in the world.  When possible, see a provider in the Cigna PPO network, for lower cost to you.  If you are abroad, you will need to pay the provider yourself, then send your receipts and a reimbursement form to Consolidated Health Plans to be refunded.  The forms are on CHP’s website.

Waiving the Student Health Benefit Plan – If you are covered by another health insurance plan, you can waived the Student Health Benefit Plan. The waiver process is done through the Consolidated Health website, and generally must be completed before the Add/Drop deadline for that semester. (Usually two weeks into classes.) Information about accepted health insurance plans, the waiver process, and more can be found on the UHS website.

Family and Medical Leave – Under Article 44 of GEO’s contract, graduate employees may take up to 12 weeks per year of unpaid Family and Medical Leave. To be eligible, you must have been employed in a position covered by the GEO contract for at least 4 months prior to the start of the leave.

Leave may be granted to grad employees for:

  • the birth of a child and care for the newborn
  • the placement of a child with a graduate employee for adoption or foster care
  • the care of a spouse, parent, grandchild, grandparent, domestic partner, or child with a serious medical condition
  • a serious health condition of your own that makes you unable to perform your job (Article 44 of the GEO contract defines “serious health condition”)

During leave, you receive the same health benefits you would have received had you continued to work. You do not receive your stipend, however. Once you return, you are also guaranteed your former position or an equivalent position with the same stipend and benefits.

To be granted Family or Medical Leave, you must submit a leave application to your immediate supervisor, who will forward it to the Graduate School. If the leave is for your own medical condition, you must submit a medical certification form explaining the need to leave. This form can be obtained from the Graduate School and must be filled out by the health care provider.

University Health Services

This is the main healthcare facility on the UMass Amherst campus, located at 150 Infirmary Way. University Health Services is a progressive, state of the art medical facility offering single-payer coverage to the campus community. It is staffed by board certified physicians, nurse practitioners, physician assistants and a variety of support staff. It is accredited by the Accreditation Association for Ambulatory Health Care, Inc.

In its main building on campus one can visit general practitioners, a Walk-In-Clinic, Women’s Health Clinic, physical therapists, get X-rays, allergy shots, blood work, eye exams and pharmaceuticals, purchase eye glass frames and over the counter drugs, etc. UHS physicians can also refer you to any one of a wide range of specialists. UHS is not an emergency facility.

Appointments and Walk-in Care

Advance appointments are best for routine care and minor problems. Call (413) 577-5101. If you have a UHS primary care provider, great! If not, we’ll match you with one that meets your needs and preferences.

Same-day appointments get you seen quickly, at a time that’s best for you. Call (413) 577-5101. These appointments fill up fast – call early in the morning. Hours are posted on the home page.

Walk-in care is for problems that can’t wait. Just walk in during health center hours, or use our text service and wait where you’re most comfortable. Text “clinic” to (413) 944-8562. You’ll receive a response text with your number and a reminder text when it’s almost your turn to be seen.

Questions? Need help? Call the Triage Advice Nurse, (413) 577-5229 during health center hours.

Hearing or speech impairments? Access the UHS TTY system; call (413) 545-5905.

Getting to UHS

UHS is at 150 Infirmary Way, in the Central residential area near Franklin Dining Commons. Click for detailed maps of the UMass Amherst campus.

Free UMass Transit buses make several stops within walking distance of UHS.

The UHS Shuttle offers free rides from residence halls to the main UHS building. Rides can be scheduled until a half hour before UHS’ closing time. Call UMass Transit, (413) 577-7425.

A gated patient parking area is just beyond UHS, on the left side of Thatcher Way, next to the Durfee greenhouses. Parking is free while at the health center. Register your license plate number when you arrive at UHS.

For a complete list of hours for the various UHS departments, click here.

Outside Referrals – Although there are many medical professionals available in-house at UHS, you have access to plenty of other health providers off-campus as well. CHP/Cigna maintains a long list of doctors in Western Massachusetts whose services are covered under your health plan. To see a provider off campus, you usually should first be referred by someone at UHS.

Preferred and Non-Preferred Providers – Cigna maintains a list of health care facilities and personnel called the “Network of Participating Providers.” A “Preferred Provider” is a doctor or other professional in this network and covered under the UHS health plan — services rendered by a Preferred Provider are generally covered at 90%. Non-preferred providers are generally covered by our plan at 80%, after a $200 deductible. Needless to say, it’s better to stick with someone on the Participating Provider list.

The Network of Participating Providers is both local and national in scope (but primarily local). To see the complete list of providers and to check if a particular doctor is on it, visit Cigna’s website.

Emergencies – As long as you are covered under SHBP, medical emergencies are covered at 100% of the “negotiated” or “reasonable” charge, after you pay a $100.00 co-pay. (Co-Pay waived if you are admitted.) You don’t need to be referred by UHS to the emergency room you’re taken to, nor does the hospital you are using have to be part of the Preferred Network.

If you have a medical emergency, such as heart attack symptoms, loss of consciousness, severe difficulty in breathing, seizure, or spinal or neck injury, dial 911 and a local ambulance will take you to the nearest hospital (the ambulance will not take you to UHS). Ambulance rides are covered at 100% if you receive the ride from the American Medical Response or the Amherst Fire Department, all other ambulance rides are covered at 80% of the reasonable charge. Make sure to give the ambulance service your insurance information.

SHBP will NOT cover any non-emergency use of the emergency room. Please go to UHS for all preventative and routine care.

The Walk-In-Clinic unit in UHS’ main building is a clinic, not an emergency room. For serious emergencies, go to an area hospital such as Cooley-Dickinson in Northampton. Important: only go to UHS Walk-In-Care if you have a non-emergency illness or condition that simply can’t wait for the normal appointment procedure.

The patient, the patient’s representative, physician, or hospital must contact Cigna Claims within 1 business day following admission and notify them of your visit to the emergency room. The number is 1-866-494-2111.

Non-Emergency Inpatient Hospitalization – SHBP also covers non-emergency inpatient hospitalization. If your provider is part of the Participating Provider Network, is referred by UHS, and is approved by the Pre-Certification procedure outlined below, SHBP can cover 90% of the cost of an overnight stay, intensive care unit expenses, miscellaneous hospital expenses, surgical expenses (including anesthesiology), and physician hospital visits.

For Non-Preferred providers referred by UHS, coverage for the above is generally 80% of the Reasonable and Customary Charge.

Prescriptions – Prescription copayments are $15 for generic medications, $30 for name-brand medications, and no copay for birth control.

OB/GYN and Contraception – Staff from Baystate OB/GYN come to UHS several days a week and their services are billed to the Student Health Benefit Plan. Contraception services are also available through General Medicine and the Woman’s Health Clinic. Generic brand birth control is covered 100%.

Pregnancy – Pregnancy is covered under SHBP like most medical conditions – that is to say, hospitalization and delivery costs are covered so long as the provider is part of the Participating Provider Network. You can see a certified midwife or OB/GYN without a referral for pre-natal care. Pre-natal classes are not currently covered by SHBP.

For info on maternity leave, see Family and Medical Leave (contract article 44).

Mental Health – Mental health is also covered under the Mandatory Student Health Fee for four visits per semester. Mental Health Services, located on the second floor in Bartlett, has a staff of psychologists, social workers, and psychiatrists to provide crisis intervention and short-term psychotherapy to individuals, families, and groups (family and couples counseling is also available).

Four visits per semester are fully covered by the Mandatory Student Health Fee. To request services, call 545-2337, Monday through Friday between 8:00 AM and 5:00 PM, and a senior clinician will help match you to the service appropriate to your needs.

Twenty-four hour emergency mental health is available every day of the year. For mental health emergencies, call 545-2337 between 8:00 AM and 5:00 PM on weekdays and ask for an “on-all” clinician. After 5:00 PM and on weekends and holidays, call 577-5000 or come directly to UHS.

Optical – At UHS’ Eye Care Services you can get complete optometry examinations, choose from a wide selection of eyeglass frames, buy contact lenses. and more. Optical services are not covered by the Mandatory Student Health Fee and thus require additional fees. The Mandatory Student Health Fee, however, allows you to get most optical services done at UHS at well below the average market cost. A complete optometry examination, for example, is only $20 for those on our plan. Eyeglass frames by designers such as Gucci, Giorgio Armani, and Calvin Klein are also available at UHS at a cheaper rate than just about anywhere else you’d find them.

Emergency optometric care for eye diseases and disorders is covered by the Mandatory Student Health Fee. Call Eye Care Services at 577-5244 for details.

Allergy Treatment – Allergy injections are given by appointment (serum is not included) and billed to your primary insurance (SHBP for most GEO members). Only certain allergy serums are covered by SHBP; call Cigna to find out if yours is covered. Allergy testing with a preferred doctor is covered at 85% of the negotiated charge.

Physical Therapy – UHS also has a Physical Therapy Department which is located on the ground floor and is staffed with physical therapists specializing in the treatment and evaluation of orthopedic as well as sports-related injuries. Pulmonary function testing is also available. Routine services are also covered under the Mandatory Student Health Fee, but they require a referral first.

Glossary

Mandatory Student Health Fee – This fee entitles the student to be seen at UHS without paying co-pays and co-insurance for visits with UHS providers. Patients are responsible for any required insurance plan deductibles. The fee supports an array of programs and services, including health education and promotion services, four (4) initial visits for mental health crisis management, public health, and emergency preparedness activities.

Student Health Benefit Plan (SHBP) – This is the student insurance.  For a detailed list of what is covered, use this link: https://studentinsurance.com/SI/Schools/source/PDFs/brochures/MA/UMASS/UMASSuibro17.pdf

Primary Insurance – If you are covered by another insurance plan at the same time you’re covered by our health plan, UHS refers to your other health coverage as your Primary insurance

Preferred Provider – Cigna maintains a list of health care facilities and personnel called the “Participating Provider Network.” A “Preferred Provider” is a doctor or other professional covered under the Cigna plan — services rendered by a Preferred Provider are generally covered at 90%.

Non-Preferred Provider – A Non-Preferred Provider is a facility or health care professional not part of the “Network of Participating Providers.” With the exception of emergency room care, services rendered by a Non-Preferred provider are generally covered at between 80% after your$200.00 deductible.

Reasonable and Customary Charge (R&C). Consolidated Health Plans defines this as the following: “Reasonable & Customary (R&C) charges are guidelines developed by an independent source and used by insurance companies to help assure that the fees providers are charging for services are reasonable for their geographic area. Consolidated Health Plans utilizes the 80th percentile of R&C for most of our plans.”

Phone Numbers
UHS General: 577-5000
UHS Main Appointment Line: 577-5101
Billing: 577-5256
Health Plan Information: 577-5192
Urgent Care Clinic (8am-5pm): 577-5229
Urgent Care Clinic (after hours): 577-5000
Family Practice: 577-5312
Ob/Gyn Specialty: 577-5150
Mental Health Services: 545-2337
Mental Health, after hours urgent: 577-5000
Eye Care Services: 577-5244
Physical Therapy: 577-5158
Pediatrics: 577-5311
Internal Medicine: 577-5313
Pharmacy Prescription/Refill: 577-5066
Pharmacist: 577-5031

For Further Information… on the Health Plan not answered by UHS or GEO, call Cigna at 1-866-494-2111 or visit their website: https://my.cigna.com/web/public/guest  or you can call Consolidated Health Plans at 877-657-5027, or visit https://consolidatedhealthplan.com/group/173/home.

(The above information was revised 08.17.17)