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 current plan certificate in its entirety so that you are familiar with what the plan does and does not 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 available.)
- Benefits for Laboratory Procedures performed at the SHC will be paid after a $10 copay. Labs that must be referred to an outside lab for processing will be billed separately by the outside lab 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 $25 copay per visit (Preferred Providers) or 70% of the Allowable Charges after a $25 Deductible per visit (Out-of-Network Providers). This is in lieu of the Policy Deductible.
- Urgent Care Center visits will be paid at 100% of the Preferred Allowance after a $20 copay per visit (Preferred Providers) or 70% of the Allowable Charges after a $20 Deductible per visit (Out-of-Network Providers). The copay/deductible per visit is in addition to the Policy Deductible.
- Medical emergency expenses, including the use of the emergency room (ER) and supplies, will be paid at 100% of Preferred Allowance/Allowable Charges after a $100 copay per visit. (Insured students may be balanced billed for the remainder of Out-of-Network Provider charges). The copay 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 (SHC) providers are the Primary Care Providers for this plan because students are required to use the services of the SHC first, where treatment will be administered or a referral will be issued when the medical care is received within 10 miles of the William & Mary campus (see plan certificate for exceptions to this SHC Referral requirement). Only one referral is required for each illness or injury per policy year.
- No overall Maximum Dollar Limit (Per Insured Person/Policy Year).
- Policy Deductible $200 (per Insured Person/Policy Year).
- Coinsurance factor for Preferred Providers is 80% of Preferred Allowance and for Out-of-Network Providers is 50% of Usual and Customary Charges except as specifically noted in the policy. Use the healthcare Provider Directory to search for a UHC Options Preferred Provider or ask the provider at the time that you make the appointment).
- Out-of-Pocket Maximum for Preferred Providers is $5,750 (Per Insured Person/Policy Year) or $11,500 (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.
- Benefits are available for Prescription Drugs on our Prescription Drug List (PDL) when dispensed by a UnitedHealthcare Pharmacy outside the SHC. Copays and/or Coinsurance per prescription for up to a 31 day supply is determined by the tier to which the drug is assigned on the PDL. There is a $20 copay for a Tier 1 prescription drug, a $30 copay for a Tier 2 drug and a 25% coinsurance for a Tier 3 drug. Mail order prescription drugs are available at 2.5 times the retail copay up to a 90-day supply.
- Students who enroll may also insure their eligible dependents in the plan on a voluntary basis.