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1. What coverage is provided for COVID-19?
Critical Illness Plan: Hospitalization due to Human Corona Virus of five or more days is paid as 25% of the participant’s elected coverage level ($10,000 or $30,000).

Hospital Indemnity Plan: Participants hospitalized for COVID-19 illness will receive a benefit for hospital admittance and subsequent confinement days.

Accident Plan: There is no COVID-19 coverage available under the Accident Plan, and none of the supplemental health plans offer benefit payments for at-home quarantine.

2. What is UC Plus?
UC has partnered with Prudential to offer group coverage with preferred pricing designed especially for UC employees. This group of plans is commonly referred to as UC Plus, or UC Plus Supplemental Health Plans.

3. What are supplemental health plans?
The UC supplemental health plans pay cash benefits directly to you when you or an enrolled dependent experiences a qualifying injury, critical illness, or hospital stay. These plans provide an extra layer of protection that complements your UC medical and disability insurance.

4. How are these plans different from medical and disability plans?
These plans are designed to supplement other health insurance plans; they are not a replacement for them.

Medical plans are designed to pay doctors and hospitals for specific medical services after you pay your deductible or copayment/coinsurance. The supplemental health plans don’t pay doctors or hospitals—they pay you. Supplemental health plans are not a replacement for medical coverage and do not meet the minimum essential coverage requirements of the Affordable Care Act.

Disability plans provide regularly scheduled monthly income replacement payments for non-occupational injuries/illnesses. The supplemental health plans do not provide monthly income. They pay one-time lump-sum cash benefits to you. Once you’ve spent the money, you don’t get more.

5. Am I eligible to participate?
UC faculty and staff employees eligible for full-time, part-time or core benefits are eligible to participate. Retirees, postdoctoral scholars/fellows, and medical residents are not eligible.

6. Can my dependents participate?
You can enroll your eligible spouse/domestic partner and children in the same plans you enroll yourself in.

7. Who do I call with questions about benefits or help with filing claims?
Call Prudential customer service toll-free at (855) 483-1438, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific.

8. Can I receive benefits from more than one plan?
Yes—in certain limited situations where you are enrolled in multiple plans and have a medical situation that qualifies for benefits under each of those plans. For example, if you were to be diagnosed with a qualifying critical illness and subsequently hospitalized, you could be eligible for benefits from both the Critical Illness and Hospital Indemnity plans. If you have additional questions about qualifying for or claiming benefits from more than one plan, contact Prudential customer service toll-free at (855) 483-1438, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific.

9. Can I enroll if I already have a supplemental health insurance policy with Prudential?
Yes. You may have coverage in another Prudential insurance policy and enroll for coverage in the UC plans. If you decide to keep coverage in multiple plans, please carefully consider the benefits and cost of each, and make sure your coverage is appropriate for your needs. If you have additional questions, contact Prudential customer service toll-free at (855) 483-1438, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific.

10. How do I enroll, change or cancel my coverage?
If you are a new hire, you can enroll online.

11. How do I pay for these benefits?
You pay the full cost of coverage through convenient payroll deductions. Your premiums are paid with after-tax dollars, which means you don’t pay taxes on benefit payments received from the plans.

12. How do I file a claim for benefits?
You can file claims for benefits online or by mail. For information on how to submit a claim, visit the Claims & Help page. Claims for benefits should be filed within 20 days of a critical illness diagnosis or hospitalization and within 90 days of a covered accident. If you have questions or need assistance, contact Prudential customer service toll-free at (855) 483-1438, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific.

13. How do I check the status of a claim?
You can check the status of your claim, including any supporting documents you provided, from the claim detail page on prudential.com/mybenefits. Once you log in, go to Claims & Absence > File a Voluntary Claim.

14. How do I appeal a claim decision?
If your claim for benefits is denied, you have the right to file an appeal with Prudential within 180 days of notice of denial. Appeals must be submitted in writing (free-form letter) to:

Appeals Review Unit
The Prudential Insurance Company of America
P.O. Box 71330
Philadelphia, PA 19176-1330

Include additional medical documentation and other pertinent information you would like considered.

15. When can I cancel my coverage?
You may request to cancel coverage anytime. Coverage will end on the last day of the month following your cancellation request.

16. What happens to my coverage if my employment ends?
If you retire or terminate employment, you have the option to port (buy and pay for) the coverage for yourself and your participating dependents. Portability allows you to continue coverage with the same benefits, plan provisions, and premium rates as the UC plan(s). Your premium payment for ported coverage is made directly to Prudential.

1. Are work-related injuries covered?
Yes. The UC plan provides 24-hour coverage for qualifying injuries occurring both on and off the job.

2. How is this plan different from worker’s compensation?
Workers’ compensation provides regularly scheduled monthly income replacement payments for occupational injuries/illnesses. This plan does not provide monthly income. It pays one-time lump-sum cash benefits to you. Once you’ve spent the money, you don’t get more.

3. How is this plan different from UC’s AD&D plan?
The accidental death and dismemberment (AD&D) plan pays a death benefit if you die in an accident. This plan does not provide a death benefit.

1. Can I enroll if I have a pre-existing condition?
There are no pre-existing condition exclusions that prevent you from enrolling in this plan. Coverage is guaranteed issue, meaning eligible employees can enroll regardless of health status. However, only qualifying illnesses diagnosed while you are participating in the plan are eligible for benefits.

2. How are benefits paid for a cancer recurrence?
The plan has limitations on how benefits for a recurrence or new diagnosis of cancer are paid. Benefits are payable for a recurrence or new diagnosis of cancer only if a participant is (1) treatment-free from cancer for at least 180 days after the prior benefit payment, and (2) in complete remission prior to the diagnosis date. See the Critical Illness plan Certificate of Insurance [PDF] for complete information, or contact Prudential customer service toll-free at (855) 483-1438, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific, if you have additional questions about the cancer limitation provision.

3. Are benefits available for a recurrence of the same critical illness?
The plan will pay benefits a second time for the same critical illness if (1) the second date of diagnosis is least 90 days after the prior benefit payment and (2) the second date of diagnosis occurs while the participant is covered in the plan.

4. How are benefits paid if I am diagnosed with a second unrelated critical illness?
The plan will pay benefits for a diagnosis of a second (different and unrelated) critical illness. See the Critical Illness plan Certificate of Insurance [PDF] for complete information.

5. Why isn’t my illness covered?
Not all critical illnesses are covered. The Critical Illness plan provides coverage for a limited number of pre-determined illnesses, including cancer, heart attack, stroke, and severe burns. Those selected for inclusion are representative of illnesses most commonly included in group critical illness supplemental health plans. UC reviews benefit plan design annually, and plans are subject to change at time of renewal. A complete list of qualifying illnesses is available for review in the Critical Illness plan Certificate of Insurance [PDF].

6. Does a wellness exam with my physician qualify for the health screening benefit?
Routine wellness exams on their own do not qualify. This benefit is payable only for health screening tests or diagnostic procedures that are performed in connection with a routine examination. Qualifying health screening tests include, but are not limited to, lab tests for cholesterol or triglycerides, diabetes screenings, and colonoscopy. See the Critical Illness plan Certificate of Insurance [PDF] for a complete list of qualifying tests and procedures.

7. Why is the cost for my coverage different from my spouse’s cost?
Monthly premiums for the plan are age banded. Generally, the older you are, the higher the premium. Costs for you and your spouse may differ based on your ages.

1. How do hospital confinement benefits work?
The plan pays a standard benefit of $200 per day for each day you are confined in a hospital as an in-patient (up to 30 days). In addition to the standard $200 daily benefit, the plan pays a benefit of $400 for each day you are confined in an Intensive Care Unit (up to 30 days).

2. Are visits to an Emergency Room or Urgent Care Center covered?
No. The plan does not provide coverage for treatment in an emergency room or urgent care center, or for outpatient treatment or confinement to an observation unit.

3. I am pregnant now. Is this considered a pre-existing condition?
No. There are no pre-existing condition exclusions in the plan. Qualifying hospital admissions/confinements occurring after your enrollment date are eligible for coverage.

4. If I have my baby in a hospital, will we both receive benefits?
You will be eligible for admission and confinement benefits. Healthy newborns are not generally admitted into the hospital following birth. However, the plan will pay benefits for each day the newborn is confined to the hospital. If a newborn is ill and admitted to the hospital, the plan will pay applicable admission and confinement benefits.