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Domestic Student Health Insurance Plan 2012-13

Aetna Student Health Policy #711146
This page provides highlights of the plan. See details at:

  

3rd installment paid is due June 24.

To save money on health care, currently enrolled U-M students on the Ann Arbor campus should visit UHS first. See First, go to one of these Preferred Providers.

On this page:

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:

  • 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 sponsored by the University of Michigan in collaboration with Central Student Government.

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 is on an approved medical leave of absence needs to have purchased the insurance prior to the event causing medical leave. Coverage for medical leave cannot extend beyond one Policy Year past the current year enrolled for classes.
  • Age is not a factor in determining eligibility for students, spouses or domestic partners with this plan.

First, go to one of these Preferred Providers to reduce your out-of-pocket expenses.

UM-Ann Arbor - University Health Service: Currently enrolled U-M students on the Ann Arbor campus should visit UHS (207 Fletcher St) first to save money. UHS offers comprehensive outpatient medical services including primary health care, specialty clinics, health support services and health education. Many UHS services are covered by the health service fee when a student is enrolled for classes for the current semester on the Ann Arbor campus. UHS does not provide pediatric (for children ages 10 and younger) or pre-natal (pregnancy) care. See Who Can Use UHS? for eligibility to use UHS and Schedule an Appointment to arrange a visit.

UM-Ann Arbor: East Ann Arbor Health Center:
4260 Plymouth Road Ann Arbor, Phone 734-647-5715
Provides medical services for infants, children and adults of all ages. Services include general medicine, preventive care, pediatric care, adolescent medicine, women's health care including obstetrics, family planning, geriatric medicine, sports medicine, minor surgical procedures and immunizations and allergy injections. Family Practice physicians staff this center.

Packard Health:
3174 Packard Road, Ann Arbor, Phone 734-971-1073
501 N. Maple Road, Ann Arbor, Phone 734-926-4900

UM-Dearborn Counseling and Support Services provides nursing consultation and referral to community sources of care.

4901 Evergreen Road, 2157 UC
Dearborn MI 48128-1491
313-593-5430

UM-Flint Urban Health and Wellness Center provides nursing consultation and referral to community sources of care.

1153 William S. White Bldg.
309 N. Harrison
Flint, MI 48502-1950
810-424-5269

How to find another Preferred Provider: Call Aetna at 800-242-3721, or go to the Aetna website, click Enter DocFind and follow instructions.

Coverage periods, costs and payment:

2012-13 Policy Year
Coverage Period A. Annual
(See also Payment Option)		 B. Winter C. Spring/Summer
Effective Dates 8/24/12-8/23/13 1/1/13-8/23/13 5/1/13-8/23/13
Payment Deadline 9/24/12 1/31/13 5/31/13
Costs:
Student only $2,974 $1,984 $1,001
Student + Adult $8,598 $5,735 $2,875
Student + Adult + Child(ren) $12,050 $8,040 $4,028
Student + Child(ren) $6,426 $4,289 $2,154

Annual Installment Option: You may elect the Annual Installment Option, which consists of three payments throughout the annual enrollment period. You must purchase the insurance on or prior to 9/24/12 to be eligible for the annual installment option. Premium payments for Period 2 and Period 3 will automatically be charged to the same form of payment used for Period 1. An email notification will be sent 14 days prior to the premium being charged to your credit card for Period 2 and Period 3. In the event that your credit card is denied, you will be given the opportunity to provide alternate payment details, but this must be received no later than the deadline as listed below. No late enrollment is allowed. Once the Annual Installment Option has been elected, there are no cancellations, and no refunds other than those described elsewhere in this brochure under Premium Refund. In order to be eligible

Annual Coverage Period with Payment Option (2012-13 policy year):
  1st payment: 2nd payment: 3rd payment:
Effective Dates 8/24/12-1/31/13 2/1/13-5/31/13 6/1/13-8/23/13
Payment Deadline 9/24/12 2/24/13 6/24/13
Costs:
Student only $1,317 $974 $683
Student + Adult $3,799 $2,823 $1,976
Student + Adult + Child(ren) $5,322 $3,959 $2,769
Student + Child(ren) $2,840 $2,110 $1,476

How to enroll or make payments: Enroll anytime online. Note: eligibility for enrollment is subject to verification. To enroll online:

  1. Go to the Aetna website.
  2. You will receive enrollment confirmation via email. Processing pharmacy benefits may take 7 business days following Aetna Student Health's receipt of a complete enrollment form and appropriate premium payment. If you need a prescription filled immediately, contact UHS Managed Care/Student Insurance Office.

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.

Note: This plan has a Pre-Existing Conditions clause. See Exclusions for details.

Type of Service:
Benefit Level:
Aggregate maximum per year $1,000,000 per covered accident, injury or sickness
Annual deductible $500 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 70% with $2,500 out-of-pocket maximum limit per Covered Person per policy year 50% with $2,500 out-of-pocket maximum limit per Covered Person per policy year
Physician office visits Negotiated fee after $20 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 Negotiated fee after $20 per visit copay Reasonable fee after $50 deductible per visit

Prescription drugs
(to maximum $100,000 per Covered Person per policy year)

100% of the Negotiated Charge after:
•$20 copay for each generic drug at a Preferred Care Pharmacy
•$40 copay for each brand-name drug at a Preferred Care Pharmacy
•$60 copay for each brand-name non-preferred drug at a Preferred Care Pharmacy

Click for a list of Preferred Care Pharmacies near campus.

100% of the Recognized Charge after:
•$20 copay for each generic drug at a non-Preferred Care Pharmacy
•$40 copay for each brand-name drug at a non-Preferred Care Pharmacy
•$60 copay for each brand-name non-preferred drug at a non-Preferred Care Pharmacy

You must pay in advance and seek reimbursement from Aetna Pharmacy Management. Use the Aetna Prescription Drug Claim Form (PDF).
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, see Full Plan Details (page 8 - PDF) on the Aetna Student Health website

Exclusions (what this plan does not cover):

  • Pre-existing Conditions are payable up to a maximum of $1000 per accident or sickness; this exclusion:

  • Dental services are not covered. For other options:
  • Glasses and contact lenses are not covered.

Definitions:

For definitions, see Full Plan Details on the Aetna Student Health website.

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: