This is intended to provide students with a brief summary of benefits that can be reviewed as you are determining whether you wish to enroll in or waive out of the Student Insurance Plan. It is not intended to provide you with a full description of the benefits or the policy provisions. Students are advised to review the plan brochure in its entirety so that you are familiar with what the plan does and doesn't cover, any limitations that may apply as well as specific plan provisions so that you can make the most of your Student Insurance Plan.
- All covered medical expenses will be paid at the Student Health Center (SHC) including providers fees.
- All covered prescription drugs will be paid at 100% after a $5 copay for generic and a $15 copay for brand per prescription (up to a 31-day supply) when filled at the SHC Pharmacy (stimulant medications are not filled at the SHC). Prescriptions for dependents may also be filled at the SHC Pharmacy (pediatric suspensions are not typically available.)
- Benefits for laboratory services performed at the SHC will be payable after a $10 copay. Labs that must be referred to an outside lab will be billed separately and are subject to the applicable coinsurance and policy deductible.
- Outpatient physician's visits will be paid at 100% of the Preferred Allowance after a $30 copay per visit (Preferred Providers) or 70% of the Allowable Charges after a $30 Deductible per visit (Out-of-Network Providers). This is in lieu of the Policy Deductible.
- Medical emergency expenses including the use of the emergency room and supplies will be paid at 100% of Preferred Allowance/Allowable Charges after a $75 copay per visit (Preferred Provider) or a $75 Deductible per visit (Out-of-Network Providers). The copay /deductible per visit is in addition to the Policy Deductible. Additional medical expenses incurred in the ER such as labs and x-rays will be subject to the applicable coinsurance.
- The Student Health Center providers are the primary care providers for this plan because students are required to use the resources of the SHC first, where treatment will be administered or referral issues (see plan brochure for exceptions to this requirement).
- No overall Maximum Dollar Limit (Per Insured Person/Policy Year).
- Preferred Provider Deductible $100 (per Insured Person/Policy Year); Out-of-Network Deductible $350 (Per Insured Person/Policy Year).
- Coinsurance factor for Preferred Providers is 80% of Preferred Allowance and for Out-of-Network Providers is 50% of Allowable Charges except as specifically noted in the policy. (Use the healthcare Provider Directory to search for a UHC Choice Plus Preferred Provider or ask the provider at the time that you make the appointment).
- Out-of-Pocket Maximum for Preferred Providers is $6,350 (Per Insured Person/Policy Year) or $12,700 (For all Insured in a Family/Policy year).
- $250 Copay/Deductible (Per Insured Person/Policy Year) for Inpatient Room & Board expense, in addition to the Policy Deductible.
- Prescription drugs benefit for prescription drugs dispensed outside the SHC. Copays per prescription at a participating UnitedHealthcare Network Pharmacy for up to a 31-day supply per prescription are $15 - Tier 1, $30 - Tier 2 and $50 - Tier 3. Mail order prescription drugs through UHPS at 2.5 times the retail copay up to a 90-day supply subject to the prescription drug maximum.
- Students who enroll may also insure their eligible dependents in the plan on a voluntary basis.