Prescription Claim Costs

Student Health Insurance 2017 - 2018 Plan Year

REFILLS DURING OPEN ENROLLMENT

To have continual access to prescriptions, you must have prescription refills available and you must accept the Premier Plan at least 15 days before the effective date of the new Plan Year.

SUBSCRIBER NUMBER

Your nine digit GUID/GoCard number beginning with an "8" is your Premier Plan health insurance subscriber number.

ACCESSING PHARMACY DISCOUNTS WITH YOUR ID CARD

Present your ID card at United HealthCare Network Pharmacies and pay only the co-payment or co-insurance to access the discount prescription drug benefit. 

If instead of using your pharmacy card to purchase a prescription, you pay for the prescription drugs in full at the retail price and submit a prescription claim form; the plan will apply the applicable Co-payment or Co-insurance and reimburse you at the discount price, not the retail price. You will be responsible for prescription drug payments in excess of the discounted price.

PRESCRIPTION DEDUCTIBLE, CO-PAYMENTS, and CO-INSURANCE

After a separate $150 Prescription Plan Year Deductible, a $15 Co-payment applies to Tier 1 medications and 20% Co-insurance applies to Tier 2 and 3 medications.  Tier assignments are subject to change for any given prescription drug as bulk discounts change.  To determine the payment, call the pharmacy network at 1-855-828-7716.

PRESCRIPTION PRE-AUTHORIZATION

A few high dollar prescriptions require pre-authorization before purchasing the medication, generally those purchased from a Specialty Pharmacy.  Call the pharmacy network at 1-855-828-7716 to determine if your medication requires pre-authorization or refer to the UHC prescription drug list.

CONTRACEPTIVE COVERAGE

Georgetown University has certified that this student health insurance plan qualifies for an accommodation with respect to the Federal requirement to cover all Food and Drug-administration approved contraceptive services for women, as prescribed by a health care provider, without cost sharing.  This means that Georgetown will not contract, arrange, pay or refer for contraceptive coverage.  The accommodation remains in place, thereby, UnitedHealthcare will continue to provide separate payments for contraceptive services that you use, without cost sharing and at no other cost, for so long as participants are enrolled in this plan.  Georgetown University will not administer or fund these payments.

UPDATE 12/1/2017:  As it has for the past four years, Georgetown will continue to claim the accommodation related to contraceptive coverage under the Affordable Care Act.  This means that UnitedHealthcare will provide separate payments for contraceptive services that plan participants use, without cost sharing and at no other cost to plan participants.  Georgetown will not administer or fund these payments.   

Contraceptives for medical conditions for which such medicatons are indicated are prescribed by physicians and nurse practitioners at Georgetown Student Health Center.  See the Student Health Center website FAQs for more information.

PRESCRIPTION EXTENSION REQUEST FORM

To request an extension of prescription coverage beyond an authorized 30 day supply due to traveling outside of the United States, download a Prescription (RX) Extension Request Form from the Arthur J. Gallagher & Co., Student Health & Special Risk Web site.