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 per prescription for generic and a $15 copay per prescription for brand-name drugs (up to a 31-day supply per prescription) when filled at the SHC Pharmacy (controlled substances and 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 Usual & Customary Charges after a $25 Copay per visit (Out-of-Network Providers). This is not subject to the Policy Deductible. Consultant Physician fees will be paid under the Physician's Visit benefit.
- 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 Usual & Customary Charges after a $20 Copay per visit (Out-of-Network Providers). This is not subject 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. This is not subject to the Policy Deductible. The Copay will be waived if admitted to the Hospital.
- Mental Illness Treatment - Outpatient Office Visits will be paid at 100% of the Preferred Allowance after a $20 Copay per visit (Preferred Providers) and 70% of the Usual & Customary Charges after a $20 Copay per visit (Out-of-Network Providers). This is not subject to the Policy Deductible.
- Preventive Care Services will be paid at 100% of the Preferred Allowance. No Deductible, Copays or Coinsurance will be applied when the services are received from a Preferred Provider. Please visit, www.healthcare.gov/preventive-care-benefits/ for a complete list of services provided for specific age and risk groups.
- See the Prescription Drug Plan for more detailed information about the Prescription Drug benefit.
- 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 SHC 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).
- No overall Maximum Dollar Limit (Per Insured Person/Policy Year).
- Policy Deductible $150 (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 & 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 $7,350 (Per Insured Person/Policy Year) or $14,700 (Per Insured Person/Policy Year)
- The Preferred Provider for this plan are UnitedHealthcare Options PPO network providers.
- Out-of-Country Claims will be paid at 80% of Usual & Customary for Covered Medical Expenses incurred when treatment is received outside the U.S.
- $250 Copay for Inpatient Room & Board Expense (per Hospital Confinement), in addition to the Policy Deductible with benefits paid at the 80% (Preferred Allowance) after Deductible and 50% (Out-of-Network) of Usual & Customary Charges.
- Students who enroll may also insure their eligible dependents in the plan on a voluntary basis.
For specific information about the benefits, exclusions or other plan information, view the plan brochure on the W&M's UHCSR page. Please refer to the Medical Expense Benefit - Injury and Sickness section of the Plan Certificate of Coverage for a description of the Covered Medical Expenses for which benefits are available.