The Health, Dental and Prescription Drug Card program available to CU GME Residents, Fellows, and their dependents is the: CU GME Health/Dental Benefits Plan.

Refer to the Plan Document for details of health, prescription and dental insurance coverage. (NEW July 1, 2008 Plan Document is here!)

The Provider Directory is your source for in-network providers and facilities.

NEW Plan Information effective March 1, 2008

PRE-CERTIFICATION IS REQUIRED on services specified in the Plan Document. Contact UPI Medical Management: phone: 303-493-7507; fax: 303-493-7501. If you are unsure of pre-certification requirement, ASK! It is the insured's responsibility to make certain pre-certification is obtained when required. When pre-certification is required and not obtained, all associated charges will be the responsibility of the insured. AVOID PROBLEMS. Pre-cert when required!!

NEW!! July 2008 "Benefits Summary"
Click here to view the Notice of Privacy Practices for the CU GME Health Benefits Plan.
Click here to view CU GME Health Benefits Plan - Medicare Part D Prescription Drug Coverage Information.
Same Gender Domestic Partner (SGDP) add forms/information:
Affidavit
Tax Cert of Dependency

To View these files GET:

It is the resident's responsibility to know the terms of coverage.

This is a brief summary of benefits available to the residents. Benefits are subject to enrollment, verification of eligibility and may change without notice. Contract provisions prevail over any written or verbal interpretation.

Submit medical/dental claims to:

CU GME Health/Dental Benefit Plan
C/O EBMS
P.O. Box 21367
Billings MT 59104-1367

Direct questions to:

EBMS Member Contact: 1-866-276-5301 (Mon-Thu 7am - 9pm; Fri 7am - 6pm)
EBMS Provider Contact: 1-866-223-5593
CU GME Benefits Office: 303-724-6024

Pre-certification:

Medical/Surgical: 303-493-7507 (UPI Medical Management)
In-patient/partial hospitalization/intensive out-patient mental health: 1-800-670-7718 (Hines &Associates)

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In-Network Providers

No deductible
$10 copayment for office visits
$100 copayment for MRI, CT, PET scans (per scan)
$200 copayment for maternity care per global physician fee.
Other copayments apply. See Plan Document and Amendments.

Out-of-Network Providers:

$750 per person ($1200 per family) deductible per plan year
Plan pays 50% of usual, customary and reasonable charges (UCR) after deductible is met

This plan does not require PCP selection, however, residents are STRONGLY ENCOURAGED to establish care with a PCP. This will improve access to care should you become ill or have an injury, may help avoid an ER visit, etc. Many PCP providers have same day access when immediate care is necessary. Residents should seek medical attention when needed and know how to do so BEFORE an urgent situation arises. Click here for "Urgent Care" options.

*A $100 co-pay per emergency room will apply unless patient is admitted directly to the hospital from the emergency room, and/or if services are accident-related.

Certain benefits have plan year (July 1 - June 30) maximums. For example, adult wellness services have a $400 maximum paid per plan year.

Pre-certification is required for all inpatient hospital stays, outpatient surgery, MRIs, CTs, PETs, physical therapy, occupational therapy, speech therapy, home health, medical equipment rental or purchase exceeding $500 and/or rented for more than 60 days, sleep studies, synagis injections, and other services listed in the Plan Document. When certification is required but not obtained, benefits will be denied and the resident will be responsible for payment of all related charges.

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If an eligible member and/or dependent decline coverage when initially eligible, they may enroll only during special enrollment periods. These include open enrollment (July 1-31) or within 31 days of a qualifying event.

Residents are not allowed to provide treatment or prescribe medication that is self prescribed, prescribed by one resident for another, prescribed by resident for a family member, or prescribed by resident for a family member of another resident.

PRESCRIPTION DRUG COVERAGE

  • Copayments:
    • Participating local pharmacies
      • Generic drug $10 copay for up to 30-day supply
      • Brand name drug $25 copay for up to 30-day supply
    • Mail Order
      • Generic drug $20 copay up to 90-day supply
      • Brand name drug $50 copay up to 90-day supply

ID CARDS
A combination Medical/Dental/Prescription Card is issued for each plan member (resident). Only the resident's (not dependent's) name is listed on the ID cards. An enrolled family member who is covered under the CU GME Health/Dental Benefits Plan may use the ID card.

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