How the Maroon Plan Works

When You Must Pre-certify Care

What Happens After You Call

Once you call, your information will be reviewed. If necessary, a physician will talk with your doctor to discuss the proposed treatment plan and length of your Hospital stay to determine whether it is medically necessary. You, your doctor, the Hospital and the claims administrator will be notified of whether they will approve the treatment plan and Hospital stay. If your Hospital stay is extended beyond the approved stay, you or your physician should call (by your last day of the approved stay) to pre-certify any additional days.

Alternative medical care may be recommended, which may not be otherwise covered under the plan. Upon recommendation and the consent of the attending physician, the University and you, you may be reimbursed for services that are not otherwise covered (for example, home health care expenses instead of continued hospitalization).

To get maximum coverage under the plan, you must call before any admission to the Hospital. The toll-free number is on your medical ID card. If you do not call and receive approval, the first $250 of your expenses will not be covered. This amount does not count toward your Out-of-Pocket Limit.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.