Student Health Insurance: Frequently Asked Questions
Who provides the insurance, and what is covered?
How much does insurance cost through the University?
|2013-2014 Year||Full year 8/1/13 - 7/31/14||Fall Semester 8/1/13-12/31/13||Spring Semester 1/1/14-7/31/14|
|Full time student - Accident plan only (Please note: All full time students at Eastern and all CSUs automatically receive, and are covered under, this accident policy as part of their general university fee. See Accident Insurance section below for details.)||$257.00||$128.50||$128.50|
|Full time student - Sickness plan only||$1384.00||$692.00||$692.00|
|Spouse Accident & Sickness||$2361.00||$1180.50||$1180.50|
|Child(ren) Accident & Sickness||$1398.00||$699.00||$699.00|
|Part time student Accident & Sickness||$1645.00||$822.50||$822.50|
|nternational Students (J1 Visa)|
|Full time student Accident & Sickness||$1645.00||$822.50||$822.50|
NEW — What Changes/Additions have been made to the 2013-14 Sickness Plan/Policy?
Many. The maximum sickness coverage per condition increases from $100,000 to $500,000 per policy year. Likewise, the medication (pharmacy) benefit has increased to a maximum of $500,000 with a $20 copay for brand name medications or a $10 copay for generic prescriptions. Also new, the 2013-14 plan covers a number of conditions not previously covered including acne treatment, temporomandibular joint dysfunction (TMJ), transgender surgery and related services. Additionally, the policy will now provide the existing immunization benefit to those students over 19 whereas, before, this benefit was limited to students under that age.
Yes. Primary care services are prepaid by your general university fee so there is no charge or copay when you are seen.
Do we have to pay for medications and tests at the Health Service?
Yes. There is a small charge for certain medications the SHS dispenses and some office-based lab tests the SHS does. You can pay by having the charge put on your student fee bill so you do not need to have money with you. You will be given a receipt which you can submit to your insurance companies which may or may not reimburse you. Or you can pay for these charges with cash or with the Express card — Eastern’s version of a debit card. The Aetna Student Health plan does reimburse for prescription medications, but you may also obtain medications at a pharmacy using your Aetna Student Insurance ID card. With this card, there is a $10 copay for generic drugs, $20 for brand name drugs. Maximum prescription drug coverage for the 2013-14 year is $500,000.
Accident Insurance – What happens if I get injured and I don’t have the school’s sickness insurance?
All full time students at Eastern, regardless of what health insurance they have, are covered under an accident insurance plan provided by Aetna from August 1, 2013 through July 31, 2014, or until full-time enrollment is terminated. The $257 cost of this accident policy, which covers accidents both on and off campus, is already included in the general University fee each full time student pays. Please note: For those students on their parents’ health insurance plan or another plan, and not on the Aetna Student Health plan, this accident policy is an excess policy. This means the Aetna insurance will pay only accident-related costs that are not covered by your other (primary) health insurance policy.
My mom lost her job and now we don’t have health insurance! Can I sign up for the plan even though it’s not during the enrollment period?
Yes, but you will need a letter from your previous insurance company, dated WITHIN 30 DAYS of losing your health insurance coverage, certifying that you have had a “loss of coverage”. Then you will need to complete an application form that we can help you fax to Aetna Student Health. Your cost of the insurance for the remainder of the semester will be prorated, depending on when you sign up. Please call 877-375-4244 from 8:30AM to 5:30PM, Monday through Friday, for assistance.
Will this insurance pay for me to see my own doctor?
Yes. You may go to a doctor or other health care provider of your own choosing or to another facility, such as a walk-in clinic. However, there may be a co-payment or other charges, the amount depending on whether or not the health care provider provider you choose participates with the Aetna plan. To see if your health care provider participates with the Aetna plan, use the “DocFind” feature of Aetna Student Health’s web page.
Does school sickness insurance cover birth control pills?
Yes. Starting in August 2012, the Aetna Student Health Plan will provide 100% coverage of certain brands of birth control pills, as well as other forms of contraception, meaning you will no longer have to pay anything for them at the pharmacy when you use your Aetna insurance card. The student health insurance plan also covers 100% of the cost of an annual women’s gynecological exam, including a pap test.
Does school sickness insurance cover psychological counseling services outside Eastern?
Yes. The student health plan will cover outpatient mental health care up to a maximum of $100,000. Psychoactive medications such as antidepressants are also covered. Please remember that Counseling and Psychological Services (CAPS) at Eastern is available to students free of charge.
Does the school insurance policy cover dental work?
Other than prompt repair of injury to natural teeth, no, it does not. However, the policy may cover removal of impacted or partially impacted wisdom teeth, but only the surgery and anesthesiology fees. Another option to consider is Aetna Student Health’s “Vital Savings” dental discount program for $25 per year (Click on the “Dental and Rx Discount program” link for details.)
I am a part-time student at Eastern. Can I still enroll in the school insurance plan?
Yes. Part-time students enroll through the web site, www.AetnaStudentHealth.com. Insurance for dependents of part time students is not available.
I’m going to change from being full-time to part-time. Will I still be covered?
If you change to a part-time status, you will lose your insurance coverage. If you want to continue the coverage, you must contact Aetna directly and request it. Call 988-375-4244 or go to www.AetnaStudentHealth.com to enroll.
What do I do if I need medical care when I am traveling?
Any full-time student who requires medical care while traveling at least 100 miles from home or campus (including anywhere outside the United States) should use Emergency Travel Assistance Services to coordinate any needed transfers, referrals, or evacuation. Go to Aetna Student Health’s web site, click on the “Medical Plan: enroll” link then the “Travel Assistance” link for detailed information about this service.
I graduate in December. Will my sickness insurance still be good in the Spring?
No. You purchase sickness insurance one semester at a time. So, if you graduate in the fall, your insurance expires on the day before the start of spring semester (See dates above.)
After I graduate, can I still get insurance through Aetna Student Health?
No. But a related Aetna company has a web site called Plan for your Health (www.planforyourhealth.com/) which is a resource for students who need to transition between health plans. This is just one plan; there are many others available by searching online. It’s important to avoid lapses in health insurance coverage if possible.
Who issues our insurance policy? How do I get in touch with them?
Aetna Student Health issues the policy and administers the plan. For questions and assistance with enrollment, getting an ID card, and submitting claims, go to their web page or contact their Customer Service Department Monday through Friday at 877-375-4244 from 8:30AM to 5:30PM. How do I submit a claim?
If the health care provider is an Aetna provider, the health care provider will file a claim electronically for you. To see if your health care provider participates with the Aetna plan, use the “DocFind” feature of the Aetna Student Health web page. If the health care provider does not participate in the Aetna network, you may download a claim form from the Aetna Student Health web site and send it in to the company with an itemized receipt. Send claims to:
Aetna Student Health
P.O. Box 981106
El Paso, TX 79998
(Plan’s Group # is 890433)