Counseling and Support Services

Domestic Student Health Insurance Plan

Aetna Student Health Policy #711146 for 2014 - 15


This summary provides highlights of the plan. Details are available online or in a brochure. See Further information, brochures and applications


Why buy this health insurance plan?

Students should have health insurance to help cover products and services not covered by the health service fee. Health insurance is not required to receive care at UHS. Many UHS services are covered by the health service fee (part of tuition) when a student is enrolled for classes for the current semester on the Ann Arbor campus. See Who Can Use UHS? for information about eligibility to use UHS and coverage through the health service fee.

Students should have health insurance to help cover costs for:

  • Medical care received outside of UHS (for example, emergency room visits, hospitalizations or ambulance service)

  • Services not covered by students’ health service fee (including medication, immunizations, orthopedic equipment, eye care and eye wear)

  • Medical services for dependents, spouses and domestic partners

Without insurance, fees for these services are the patient's responsibility.

Health care costs are at an all-time high, and unexpected medical expenses can set students back financially. The Domestic Student Health Insurance Plan was developed with student needs and budgets in mind. For example:

  • Most health plans have age restrictions (e.g. 18 or 21 years old) that limit coverage for dependents, but this plan covers you as long as you are a student (or a student's dependent). Age is not a factor in determining eligibility for students.

  • If you are away from home or campus, this plan provides coverage including travel health assistance.

  • This plan provides prescription drug coverage.

  • Coverage periods are consistent with academic semesters.

  • This plan is endorsed by the Michigan Student Assembly.


Eligibility

This plan is available (subject to verification) to:

  • UM students enrolled in classes or between semesters (e.g. during spring/summer session) at the Ann Arbor, Dearborn or Flint campuses, including:
    • Graduate and doctoral students who are completing graduation requirements (writing thesis, preparing dissertation, studying for prelims, studying abroad on detatched study, pre-doctoral candidates, etc.)
    • International students, students with dual citizenship and visiting scholars who are not eligible for international insurance
    • Green card holders who meet the above qualifications
  • Eligible spouses, unmarried domestic partners of any gender and children of all the groups listed above
  • A UM student enrolled in the Plan who receives an approved medical leave of absence (coverage for medical leave will not extend past the current year enrolled)
  • Age is not a factor in determining eligibility for students, spouses or domestic partners with this plan.


Use one of these providers

Use one of these Preferred Providers

  • To reduce your out-of-pocket expenses.
    • In the Dearborn area: Henry Ford Medical Center-Fairlane or Oakwood Hospital

Please consult the insurance brochure for additional information about network providers


How to find another Preferred Provider?

Go to the Aetna website , search by zip code, then select Open Choice ® PPO under Aetna Standard Plans.


Coverage periods, costs and payment:

2013-14 Policy Year

Coverage Period

A. Annual
(See also Payment Option )

B. Winter

C. Spring/Summer

Effective Dates

8/24/13-8/23/14

1/1/14-8/23/14

5/1/14-8/23/14

Payment Deadline

9/24/13

1/31/14

5/31/14

Costs:

Student only

$3,284

$2,190

$1,105

Student + Adult

Contact Aetna Insurance Co

 

 

Student + Adult + Child(ren)

Contact Aetna Insurance Co

 

 

Student + Child(ren)

Contact Aenta Insurance Co

 

 

You can enroll at any time, even if a payment deadline has passed, but costs are neither prorated nor retroactive. Coverage will end August 23.

You can also request a coverage period other than the established Annual, Winter, or Spring/Summer periods. Again, costs are not prorated, and coverage will end August 23. For more information, contact Aetna Student Health , for policy #711146 at 800-242-3721.


Payment option for the Annual coverage period:

Payment option for the Annual coverage period: If you chose the Annual coverage period and paid by 9/24/13, you can make payments. (This option is not available after the 9/24/13 deadline. Insurance coverage may be interrupted if you do not pay for the second installment by 1/15/14 and for the third installment by 5/15/14 and the pre-existing limitation may apply.)

Annual Coverage Period with Payment Option (2013-14 policy year):

Installment

First installment

Second installment

Third installment

Effective Dates

8/24/13-8/23/14

1/1/14-8/23/14

5/1/14-8/23/14

Payment Deadline

9/24/13

1/15/14

5/15/14

Costs:

Student only

$1,454

$1,076

$754

Student + Adult

Contact Aetna

 

 

Student + Adult + Child(ren)

Contact Aetna

 

 

Student + Child(ren)

Contact Aetna

 

 

 


 

How to enroll or make payments

Enroll anytime via paper applications (see Further information, brochures and applications ) or enroll online. Note: eligibility for enrollment is subject to verification.

To enroll online:

  1. Go to the Aetna Student Health website
  2. Click on "Student Connection" on bottom of page
  3. Click on "Find Your School"
  4. Search for the University of Michigan
  5. On the UM web page, click on "Medical Plan & Rates" then "Enroll"
  6. You will receive enrollment confirmation via email. Processing pharmacy benefits may take 5 business days following Aetna Student Health's receipt of a complete enrollment form and appropriate premium payment. 


Plan benefits

The chart below describes some (not all) benefits. Please note that when you use preferred providers, you save money because preferred providers agree to accept negotiated fees which may be lower than what non-preferred providers would charge. If a non-preferred provider charges more than the reasonable fee allowed, you must pay the difference.

Also, this plan does not cover pre-existing conditions unless members have been continuously insured (see Definitions ) or until a 180-day waiting period has been met. (This limitation does not apply to prescription medications.)

Type of Service:

Benefit Level:

Lifetime aggregate maximum

$1,000,000 per covered accident, injury or sickness

Annual deductible

$100 per Covered Person per policy year (does not apply to prescription drug expenses)

 

 

With Preferred Provider:

With Non-Preferred Provider:

Covered medical expenses (co-insurance) Note: annual deductible and copays do not apply to maximum out-of-pocket expense

80% with $2,500 out-of-pocket maximum limit per Covered Person per policy year

60% with $2,500 out-of-pocket maximum limit per Covered Person per policy year

Physician office visits

Negotiated fee after $15 per visit copay

Reasonable fee after $50 deductible per visit

Inpatient hospitalization

Negotiated fee
Note: $200 penalty if no pre-certification for hospitalization

Reasonable fee
Note: $200 penalty if no pre-certification for hospitalization

Emergency room

Negotiated fee after $75 per visit copay (waived if admitted)
Note: $200 penalty if no notification for emergency admissions

Reasonable fee after $75 per visit deductible (waived if admitted)
Note: $200 penalty if no notification for emergency admissions

Outpatient mental health
(no yearly/lifetime visit limit)

Negotiated fee after $15 per visit copay

Reasonable fee after $50 deductible per visit

Prescription drugs
(to maximum $2,500 per Covered Person per policy year)

100% after:
•$15 copay for generic drugs
•$30 copay for brand-name drugs

You must pay in advance and seek reimbursement from Chickering Claims Administrators, Inc.
•$15 copay for generic drugs
•$30 copay for brand-name drugs

Vision
(to maximum $30 per policy year)

Comprehensive eye examination (although dilation is included only at the UHS Eye Care Clinic - see also UHS Vision Benefit below) with $15 copay (Ann Arbor campus students and dependents must receive exam at UHS Aug 24 - April 30)

For details, read two paragraphs below and/or see Plan Brochure  

   

Benefits also include well-baby care, allergy care, physical therapy, chiropractors, nutritional counseling, maternity expenses, abortion, discounts at participating health clubs, special rates on alternative therapies, discounted health-related products such as vitamins, and unlimited mental health visits.

The UHS vision benefit includes a comprehensive eye examination including dilation with a $15 copay, to a maximum of $30 per policy year. (This benefit is managed by UHS and is not underwritten by Aetna.) Ann Arbor campus students and dependents must receive service at UHS between August 24 and April 30. Some people (i.e. children under 3 years of age, Ann Arbor students studying out of the Ann Arbor area, Flint and Dearborn students and dependents living outside the Ann Arbor area) may need to use a provider other than UHS. UHS will reimburse for one routine eye exam per policy year (not to exceed $30 per policy year, after a $15 copay per exam, and subject to UHS guidelines). For reimbursement, send the original paid receipt (be sure to keep a copy for your records) to the UHS Managed Care/Student Insurance Office . In addition to the annual exam, you can receive discounts on products and services at the UHS Optical Shop and VisionOne® providers.

Worldwide Emergency Travel Assistance: Participants have access to emergency medical assistance provided by On Call International while traveling more than 100 miles from home, anywhere in the world. Benefits include: 24/7 consultation; foreign hospital admission guarantee; prescription assistance; lost luggage assistance; legal and interpreter assistance; and travel information such as Visa and passport requirements, travel advisories, etc. Medical Repatriation and Return of Mortal Remains services are also available at the participant's campus location. You must call 866-525-1956 within the US or 603-328-1956 outside the US to arrange services, as On Call International will not reimburse you if you pay.


Exclusions

This plan does not cover the following.

  • Pre-existing conditions for 180 days (6 months) unless members have been continously insured (see Definitions for Pre-existing Conditions)
  • Dental services are not covered. For other options:
  • Preventive care (that is, "physicals") is not covered. (For women, pap smears and gonorrhea and chlamydia screening plus associated visit charges are covered. For men, gonorrhea and chlamydia screening are covered but associated visit charges are not covered.)


Definitions

Co-insurance: The amount paid by the Covered Person and the amount paid by insurance for services. Usually, this amount is a percentage split, e.g. 80% paid by insurance and 20% paid by the Covered Person.

Copay: The amount that must be paid by the Covered Person at the time services are rendered by a provider. Copay amounts are the financial responsibility of the Covered Person.

Continously Insured: Persons who have remained continously insured under the Policy or other prior health insurance policies will be covered for any Pre-Existing Condition that first manifests itself while continously insured, except for expenses payable under prior policies in the absence of the Policy. Previously Covered Persons must re-enroll for coverage. including dependent coverage, by September 24, in order to avoid a break in coverage for conditions that existed in the prior Policy Year. Once a break in continous coverage occurs, the definition of Pre-Existing Conditions will apply.

Covered Person: A student, or dependent, whose coverage is in effect under the Policy.

Deductible: The amount which is the Covered Person's financial responsibility at the first time services are rendered. Usually, this is a fixed amount per person, per Policy Year (August 24 - August 23).

Negotiated Charge (fee): The maximum charge a Preferred Care Provider has agreed to accept for any service or supply for the purpose of the benefits under the Plan.

Non-Preferred Provider: A health care provider that has not contracted to furnish services or supplies at a Negotiated Charge.

Pre-existing Condition: Any Injury, Sickness or condition for which medical advice, diagnosis, care or treatment was recommended or received by the Covered Person within the six months (180 days) immediately preceding the effective date of their coverage, or up to six months (180 days) after the effective date of coverage. If a Covered Person has continuous coverage under the Policy or other prior health insurance policies for 180 days prior to purchase, an Accident or Sickness that first manifests itself during the prior year’s coverage shall not be considered a Pre-Existing Condition.

Preferred Provider: A health care provider that has contracted to furnish services or supplies for a Negotiated Charge, but only if the provider is included in the directory as a Preferred Care Provider for the services or supply involved, and the class of which the Covered Person is a member.

Reasonable Charge (fee): The average fee charged by a particular Provider, or paid by the insurance, within a geographic area.


Student Health Insurance Committee

The Student Health Insurance Committee negotiates this insurance plan for students and addresses domestic student health insurance issues. See Student Health Insurance Committee for more information.


Further information, brochures and applications

Further information, brochures and applications: