Referrals are required for services in Manhattan outside the Student Health Center.
Except for situations listed below, all students enrolled in the CHP health insurance plan in need of medical care in Manhattan are required to first seek treatment and be evaluated at the SHC. If the evaluation by the SHC provider determines that the services are not available at the SHC, an off-site referral will be issued. Covered services received in Manhattan without an appropriate referral will not be paid by CHP. Any co-pays or co-insurance fees incurred with respect to such referrals will be the responsibility of the student.
Services Exempt from Referral Requirement:
- Medical Emergency Treatment in a Hospital*
- Gynecological Care
- Laboratory Tests
- Maternity Care
- Mental Health and Substance Abuse Services
- Treatment for TMJ
- When Student Health Center is closed
*Referrals are required for follow-up visits after an emergency.
Referrals for Services Outside Manhattan
Students may use any provider outside the borough of Manhattan without an off-site referral from the SHC. Any co-pays or co-insurance fees incurred will be the responsibility of the student.
We encourage students to first seek services from an SHC provider who will be able to supervise and coordinate care with minimal out-of-pocket expense for medically necessary treatment.
Students seeking care from providers outside the SHC should consider choosing a provider who participates in the MagnaCare (NY/NJ area) or MultiPlan networks to ensure maximum benefits and reduce out-of-pocket expenses. To find a MagnaCare (NY/NJ area) or MultiPlan provider go to www.chpstudent.com or call (877) 373-1170 and a CHP representative will assist you in locating a participating provider. Any co-pays or co-insurance fees incurred will be the responsibility of the student.
Important: A referral cannot be granted after services have been rendered.
The referral is only valid for treatment of a specific condition for the period of time stated on the referral.
The referral may also limit the number of visits allowed within that time frame.
The condition must be re-evaluated by the SHC healthcare provider once the limits of the referral have been reached.
The school-sponsored health insurance plans require Pre-Certification/Authorization for certain out-patient and in-patient services. Hines Associates Inc., administers the Pre-Certification/Authorization process for the plans. To contact Hines Associates, call (866) 327-4520.
Pre-certification of coverage is required, except in emergencies, for services including, but not limited to:
- At least two (2) days prior to a planned admission or surgery when your Provider recommends inpatient hospitalization.
- At least two (2) days prior to ambulatory surgery or any ambulatory care procedure when your Provider recommends it be performed in a Hospital or Ambulatory Surgical Center.
- Within the first three (3) months of a pregnancy and again within 48 hours after the delivery if Your Hospital stay is expected to extend beyond 48 hours for a vaginal birth or 96 hours for cesarean birth.
If pre-certification is not secured, eligible expenses will be subject to either a $500 deductible or 50% of what would have been paid, whichever results in a greater benefit to you. Please see your Schedule of Benefits in the 2016-2017 Student Health Insurance Certificate at www.chpstudent.com/nyu for more details on Pre-Certification.
Please note: Pre-certification is not required before beginning physical therapy treatment.