Most of the information on this page has been recently revised to take into account the terms of our new contract. Please read through carefully, and feel free to contact the GEO office with any questions.

ADMINISTRATIVE BASICS
Who Runs it? Why "GEO" Health Plan?
Your health coverage isn't technically run by the Graduate Employee Organization (GEO): it's administered by University Health Services (UHS) , Whitmore and Chickering Claims, and is underwritten by Aetna . We refer to it as a "UHS/GEO" plan in this booklet, 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 grad employee who works for UMass-Amherst gets discounted health insurance.

There's a reason for this: the hard work of graduate students through GEO is the reason we have affordable health care in the first place. 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've gained a Dental Plan (available only to GEO members) – making UMass-Amherst grad students some of the few grad 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 grad 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 an email to geo@external.umass.edu

(Lack of) Costs for the GEO-Eligible
Every student at UMass taking 5 or more credits is required to enroll in the Basic Health Plan offered by University Health Services (according to Massachusetts State Law, every student taking more than 5 credits must have medical insurance).

But whereas most students have to pay for the UHS health plan, GEO-eligible grad students 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 grad students:

INDIVIDUAL HEALTH COVERAGE COSTS
(August 1, 2005 to July 31, 2006) - in $

Comparison to Coverage under our last contract
Under the 2001-2004 GEO contract individual grad students got 12 months of SHIP and 9 months of Basic for free, but had to pay $262 for summer Basic if they wanted to have 12 month health coverage. Now grad student employees get full 12 month coverage for less than half what it used to cost.

Eligibility
Who can get the health plan? In general, if you are working at least 10hrs/week in two semesters or 20hrs/week in one semester you get year round health coverage.

Eligibility is determined in dollars earned, but to make it easier for you to calculate you can generally base calculations on how many contracted hours (per week/ per semester) you would have to work to become eligible, based on the absolute GEO minimum pay. This means that if you actually earn more than the GEO minimum you would potentially qualify for the same benefits having worked less hours per week.

An easier way to calculate eligibility for most people is by looking at their hours. If you are earning near the GEO minimum stipend of around $16 per hour (most grad employees on campus earn this minimum amount), then the following can serve as a guideline:

· If you have a 20 hour per week position in either the Fall or the Spring semester, you are eligible for the GEO-rate for basic and SHIP coverage the entire year. If you have a 20 hour position in the Spring and you don't work in the Fall, you are reimbursed for the Fall

· If you work a 10 hour/week position in the Fall and the Spring, you also get the GEO-rate for Basic and SHIP the whole year.

· If you have a 10 hour/week position in only the Fall or only the Spring, you are eligible for the GEO-rate for Basic only for the semester you are working and the GEO-rate for SHIP for the whole year.

· If you have a summer position your earnings can be banked forward to get you the GEO-eligible rate for the next coverage period (August 1 st start). Contact GEO to learn more about banking your earnings.

Paying for Health Insurance
IF YOU'RE TAKING MORE THAN 5 CREDITS -
If you're taking more than 5 credits, you can pay for your individual Basic & SHIP 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 (these have traditionally been in the $200-$600 range, though the amount has been increasing due to the budget cuts), be sure to mention that you are GEO-eligible . Whatever you do, don't pay the full amount for health insurance and wait for re-imbursement - this can be a long and uncertain process. (The only time you will want to pay and get reimbursed is if you are working 20hrs/week ONLY in the spring – your health waiver will be applied retroactively and you'll get reimbursed). And 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'RE TAKING FEWER THAN 5 CREDITS-
Grad student employees enrolled for less than 5 credits will NOT be automatically enrolled for health insurance. If you want Health Insurance you need to go to UHS, sign-up and pay 5% of the premium. (If you're not working enough to be “GEO-eligible” (see above) you would have to pay the whole premium).

IF YOU WANT THE FAMILY PLAN-
If you would like to get health coverage for your spouse, same-sex domestic partner, children or other dependents you have to pay an extra fee for “the family plan”. GEO-eligible grad employees pay only 10% of the family plan premium. To purchase the family plan you must already be signed up for individual Basic and SHIP. You must go to UHS to sign up and pay the fee.

IF YOU WANT TO PAY BY PAYROLL DEDUCTION-
All grad student employees are allowed to pay for their health insurance costs through payroll-deduction. Ask UHS specifically for a payroll deduction form when you sign-up for coverage.

Basic vs. Student Health Insurance Plan (SHIP)
"Basic" and "Student Health Insurance Plan" (SHIP) are terms UHS uses to denote categories of coverage. In a nutshell, Basic coverage includes the cost of general practitioners, mental health physicians, and some services for things like physical therapists that are not covered by your primary insurance. For a list of other services, please visit the UHS website at www.umass.edu/uhs.

The Student Health Insurance Plan (SHIP) covers catastrophic emergencies, prescriptions, hospitalizations, and specialty and outside referrals. For those of you who've been around for a while, SHIP used to be called "Supplemental Insurance." If you read UHS's literature about coverage SHIP is also classified as your “Primary Insurance” if you have no other insurance.

UHS has several on-site specialty clinics that require a referral from a primary care doctor at UHS. These clinics include services from Northampton Ob/GYN Associates, Hampshire Orthopedics, Northampton Surgical Associates and Valley Acupuncture. Your primary (SHIP) insurance will be billed and acupuncture is available on a fee-for-service basis.

When you visit any doctor outside UHS you should always try to ensure that it's somewhere/ someone on the preferred list of Chickering practitioners, and to first get a referral from UHS. If you don't, the chance of you having to pay out of pocket greatly increases. There is no definite scale to apply to this, but one might roughly consider this chart an example of the potential costs:

**This is a guide to show likely costs, but the actual amounts may vary.


FAMILY HEALTH INSURANCE ADDITIONAL COSTS
Costs: August 1, 2005 to July 31, 2006 -in $

To pay for the family plan, go to UHS before the add/drop period of the semester you want your family to be enrolled. You can either pay by check or make arrangements for the amount to be deducted from your paycheck. Please note that “payroll deduction” and a “payment plan” are two separate things. You must ask specifically for “payroll deduction” if you would like your health premium to come directly from your paycheck.

Who is "family"?
Your spouse or same-sex domestic partner and all of your dependents can be enrolled in the family plan at the rates listed above. There is no price difference between enrolling 2 kids, 4 kids, or just your partner alone. The Family Plan does not cover aunts, uncles, grandparents, etc. -- nor does it currently cover opposite sex domestic partners.

Enrollment
For GEO-eligible individuals taking 5 or more credits, enrollment in the individual health plan is automatic. There are exceptions, however.

Enrollment is not automatic for the family plan . If you are interested in enrolling in the family plan, you must bring a check to UHS before the add/drop period of every semester you wish to be enrolled.

GEO is researching options for September graduates.

Summer Coverage and Earnings
Summer Coverage is now included in your fall & spring health coverage.
Earnings in the summer can be “banked” forward an counted towards your GEO-eligible status for the next academic year.

Traveling
Many grad students go out of the state or to their home countries for the summer and wonder whether they are covered. If you're on SHIP over the summer, you will still receive its benefits (i.e., emergency care, prescriptions, referrals) wherever you go in the world.

If you have a chronic health condition or you know you'll need to see a doctor for office visits over the summer, be sure to get a referral from UHS before you leave, as this will reduce the amount of your co-payment.

If your physician is outside of the United States , they will most definitely be Non-Preferred. Likewise, if they're in the U.S. but out of Massachusetts , they are probably Non-Preferred.

If You Have Other Insurance…
If you read the info bulletins put out by UHS, you'll quite often see the phrase "This service will be billed to your primary insurance first." 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. A lot of procedures will be billed to your other insurance plan first, with UHS picking up the tab for many services that fall through the cracks. UHS recently adopted this policy as a result of the cuts to the state budget, and in doing so has been able to save a lot of money without compromising the extensive range of services it offers.

Maximum Copayments
According to Article 35(g) of the GEO contract, no one should make more than $250 in co-payments per year. Members have to keep track of their co-payments themselves, however, because UHS does not automatically stop charging co-pays once this limit is reached. Anyone who thinks they may have paid more than $250 in co-payments over an academic year should contact the GEO office immediately.

Family & Medical Leave
Under Article 44 of GEO's contract, grad 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 grad 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.

GOING IN FOR A VISIT: MEDICAL SPECIFICS

UHS Basics
The main facility. 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 Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

In its main building on campus one can visit general practitioners, allergists and physical therapists, get X-Rays, 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. While you can get urgent care treatment at UHS (i.e., you can see a doctor for sicknesses and minor injuries that can't wait for an appointment), UHS is not an emergency facility.

Appointments & Waiting Rooms: Using UHS
Like most medical facilities in the U.S. , UHS is by-appointment only. Call the appointment line at 577-5101 and someone will schedule you with the doctor, nurse practitioner or physician assistant appropriate to your needs.

Urgent care is the exception to the appointment-only rule -- one may simply come to the Urgent Care clinic and sit in the waiting room. You can also call ahead to make an appointment at 577-5101. If you simply want to talk to a triage nurse about your illness or injury, you can do that as well - just dial 577-5229.

Clinic hours are from 8:30 am to 5 pm, Monday thru Friday. The Urgent Care clinic is open 24 hours a day during the semester. Click here for directions to UHS.

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. Aetna/Chickering maintains a long list of doctors in Western Massachusetts whose services are covered under your health plan. The main guideline for seeing off-campus providers is this: to see a provider off campus, you should first be referred by someone at UHS.

Preferred and Non-Preferred Providers
Aetna maintains a list of health care facilities and personnel called the "Preferred Provider Network." A "Preferred Provider" is a doctor or other professional covered under the UHS health plan -- services rendered by a Preferred Provider are generally covered at 80% to 100%. Non-preferred providers are generally covered by our plan at 60%, after a $200 deductable. Needless to say, it's better to stick with someone on the Preferred list.

The Preferred Network 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 Aetna's website. Be sure to select OpenChoice PPO as the health plan type.

Emergencies
So long as you are covered under SHIP, medical emergencies are covered at 100% of the “negotiated” or “reasonable” charge, after you pay a $35 co-pay. 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.

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

The Urgent Care 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 Urgent Care if you have a non-emergency illness or condition that simply can't wait for the normal appointment procedure as urgent care office visits are not covered by the Basic plan!

For Non-Preferred providers referred by UHS, coverage for the above is generally 80% of the Reasonable and Customary Charge. Most non-emergency in-patient hospitalization expenses incurred at a facility not referred by UHS are generally covered at 60% of the Reasonable and Customary Charge, whether the facility is part of the Preferred Network or not. Further details are available from Chickering at their website.

Pre-certification. The patient, Physician or hospital must call Chickering Claims at least 3 business days prior to the planned admission for "Pre-Certification." In the Pre-Certification process, Chickering will subject your claim to a medical policy review to ensure it is in line with the exclusions and limitations contained within the Policy. The number for Pre-Certification is (877) 480-4167. For further details on Pre-Certification contact Chickering.

Prescriptions
Prescriptions are covered by SHIP, which means that many grad employees can continue to receive pharmaceuticals over the summer at little cost. There is always a copayment for prescriptions which amounts to $5, $10 or $15, depending on the medication. You can get your prescriptions filled either at the in-house pharmacy in UHS or off-campus. As of 2003, the University will cover up to $5000 in prescription drug costs per plan year.

OB/GYN AND CONTRACEPTION
Staff from Hampshire OB/GYN Associates (HOGA) come to UHS several days a week and their services are billed to the Student Health Insurance Plan. Contraception services are also available through General Medicine. Some birth control pills are available from the UHS pharmacy at a reduced "clinic" price.

Pregnancy
Pregnancy is covered under SHIP like most medical conditions - that is to say, hospitalization and delivery costs are covered so long as the provider is part of the Preferred Network and the patient goes through the Pre-Certification process (see previous page on Pre-Certification). You can see a certified midwife or OB/GYN without a referral for pre-natal care. Pre-natal classes are not currently covered by SHIP.

For info on maternity leave, see Family and Medical Leave

Mental Health
Mental Health is also covered under the Basic plan for six visits per semester. Mental Health Services, located in 127 Hills North, 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). Basic also covers referrals by UHS to other therapists in the area.

Six visits per semester are fully covered by the Basic plan. To request services, call 545-2337, Monday through Friday between 8am and 5pm, 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 8am and 5pm on weekdays and ask for an "on-all" clinician. After 5pm 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 Basic Health Plan and thus require additional fees. Those insured under the Basic plan, however, can 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 Basic Health plan. 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 (SHIP for most GEO members). Only certain allergy serums are covered by SHIP, call Aetna Pharmacy Management at 1-800-238-6279 to find out if yours is covered. Allergy testing with a preferred doctor is covered at 100% of the negotiated charge if you get a referral.

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 Basic Plan, but they require a referral first.

APPENDICES
Glossary
Most of these terms are dealt with in greater detail in the body of this guide. Thus, each term includes a link so that you can easily reference a more detailed definition.

Basic Plan: This includes office visits at UHS including Physical Therapy, allergy shots, mental health, radiology, and lab work. All grad students taking five ore more credits are required to get Basic.

Student Health Insurance Plan (SHIP): This covers catastrophic emergencies, prescriptions, specialty referrals and non-emergency hospitalizations. Most GEO-eligible grad employees receive SHIP over the entire academic year, including the summer

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: Aetna maintains a list of health care facilities and personnel called the "Preferred Provider Network." A "Preferred Provider" is a doctor or other professional covered under the Chickering plan -- services rendered by a Preferred Provider are generally covered at 80% to 100%

Non-Preferred Provider: A Non-Preferred Provider is a facility or health care professional not part of the "Preferred Provider Network." With the exception of emergency room care, services rendered by a Non-Preferred provider are generally covered at between 60-80%

Reasonable and Customary Charge (R&C). Aetna defines this as the following: "The charges which are the smallest of: (a) the Actual Charge (the actual charge made for a covered service by the provider that furnishes it), (b) the charge usually made for a covered service by the provider that furnishes it, and (c) the prevailing charge made for a covered service in the geographic area by those of similar professional standing.

Phone Numbers
University Health Service

For Further Information…
For further information on the Health Plan not answered by UHS or GEO, call Chickering Claims at (877) 480-4167 or visit their website.

Credits
This guide was written in June 2002, revised in August 2003 by Chris Vials and revised in August 2004 by Craig Sinclair. Special thanks to Donna Yezierski (UHS), Josh Mason, James Shaw, and Analiz Figueroa (GEO/Local 2322) for their generous assistance. This guide was further revised in July 2005 by Megan McDonough and read through by many wonderful folks.