Benefits Heading link
All services must be medically necessary, authorized by a CampusCare Primary Care Provider (PCP) and provided at a Contracted Network Provider unless they are authorized by the CampusCare Medical Director in order to be covered under the rates listed below. All members must establish a provider relationship prior to any referrals or treatment. This can currently be done remotely via a telehealth visit. Call your PCP for an appointment.
**All members must make an appointment with one of the CampusCare Primary Care Provider to receive authorization or a referral before seeking care with a specialty physician in order to be covered under the benefits listed below.
There are no exclusions for pre-existing medical conditions. There are no deductibles and minimal co-payments for services. For additional information about benefits, limitations, and exclusions refer to the CampusCare Certificate of Coverage.
Please click here for information regarding CampusCare member rights and responsibilities.
Benefits Summary Heading link
Covered medical services will be paid up to maximum and at the rates listed below:
| Benefits Summary | |
|---|---|
| Hospital In Network | |
| Inpatient | 100% minus a $50 per day co-payment |
| Outpatient | 100% |
| Emergency Care | |
| In Network | 100% minus a $50 co-payment |
| Out of Network | 100% minus a $50 co-payment |
| Physician Services | |
| Physician Visits In Network | 100% minus a $15 co-payment |
| Occupational Therapy | 100% minus a $15 co-payment (max 20 sessions/AY) |
| Physical Therapy | 100% minus a $15 co-payment (max 40 sessions/ AY) |
| Speech Therapy | 100% minus a $15 co-payment (max 20 sessions/AY) |
| Respiratory Therapy | 100% minus a $15 co-pay |
| Preventative Services (Excludes services covered by Student Health Service Fee) | Plan year preventative services covered at first dollar |
| Telehealth | 100% |
| Routine Vision Exam | One per plan year. Covered at first dollar when provided by select providers |
| Ancillary Services | |
| Ambulance | 90% |
| Pharmacy Formulary | 100% for prescriptions with: |
| $10 Generic co-payment | |
| $20 Brand co-payment | |
| $40 Non-formulary co-payment | |
| Diabetic Supplies and DME | 90% |
| Home Health Care | 90% |
| Medical Supplies (in hospital or physician's office) | 100% |
| Mental Health Care & Substance Abuse Care | |
| Inpatient | 100% minus a $50 per day co-payment |
| Outpatient | 100% minus a $15 co-payment |
| Telehealth | 100% |