University Health Service
207 Fletcher Street
Ann Arbor, MI 48109-1050
(734) 764-8320

DOMESTIC STUDENT HEALTH INSURANCE PLAN (Chickering/Aetna, Policy #711146, 2007-08)

Note: Third installment payment is due 5/24/08. See How to enroll or make installment payments.

The Chickering Group is now known as Aetna Student Health

This summary provides highlights of the plan. Details are available online or in a brochure.  See Further information, brochures and applications.

On this page

• Why buy this health insurance plan?
• Eligibility
• First, go to one of these Preferred Providers
• How to find another Preferred Provider
• Coverage periods, costs and payment
• How to enroll or make payments
• Plan benefits
• Exclusions (what this plan does not cover)
• Definitions
• Student Health Insurance Committee
• Further information, brochures and applications

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:

• Most health plans have age restrictions (e.g. 18 or 21 years old) that limit coverage for dependents, but 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 endorsed by the Michigan Student Assembly.

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
  • 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 dependents, spouses, unmarried domestic partners of plan participants
• A University of Michigan student enrolled in the Plan who receives an approved medical leave of absence
• Age is not a factor in determining eligibility for students

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

UM-Ann Arbor University Health Service 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. See Who Can Use UHS? for eligibility to use UHS and coverage under the health service fee. See Appointments or Walk-in to arrange a visit.

UM-Ann Arbor Nurse Managed Centers  are community-based family practice clinics, managed by nurse practitioners who are primary care providers for many insurance programs. The Nurse Managed Centers emphasize patient-centered care, with complete services for men, women and children, including acute care for illness and chronic care for more serious problems. Prenatal care, well-woman care and well-child care are also available. There are two locations:

North Campus Family Health Service
2364 Bishop
Ann Arbor, MI 48109
734-647-1636

Community Family Health Center
1230 North Maple Road
Ann Arbor, MI 48109
734-998-6117

UM-East Ann Arbor Health Center  provides medical services for infants, children and adults of all ages, including general and preventive medicine. Services include 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.

4260 Plymouth Road
Ann Arbor, MI 48109-2700
734-647-5715

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

2157 University Center
Dearborn MI 48128
313-593-5430

UM-Flint Health Services provides nursing consultation and referral to community sources of care.

264 University Center
Flint, MI 48502-1950
810-762-3456

How to find another Preferred Provider Go to the Aetna website, search by zip code, then select Open Choice ® PPO under Aetna Standard Plans.

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Coverage periods, costs and payment

You can enroll at any time, even if a payment deadline has passed, but costs are neither prorated nor retroactive. Coverage will end August 23, 2008.

You can also request a coverage period other than the established Annual, Winter, or Spring/Summer periods. Again, costs are not prorated, and coverage will end August 23, 2008. For more information, contact The Chickering Group, Inc., for policy #711146 at 800-242-3721.

Payment Option for the Annual coverage period: If you chose the Annual coverage period and paid by 9/24/07, you can make payments. (This option is not available after the 9/24/07 deadline). Insurance coverage will be interrupted if you do not pay for the second installment by 1/24/08 and for the third installment by 5/24/08.

How to enroll or make payments  Enroll anytime via paper applications (see Further information, brochures and applications ) or enroll online. Note: eligibility for enrollment is subject to verification.

To enroll online:

1. Go to the Chickering website
2. Choose "Students: Find Your School"
3. Type in policy #711146 or search by school name.
4. On the UM web page, choose "Enrollment Information" then "Enroll Online for Your Chickering Insurance Plan"
5. You will receive confirmation via email. Processing pharmacy benefits may take 5 business days following The Chickering Group's receipt of a complete enrollment form and appropriate premium payment.

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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.

Also, this plan does not cover pre-existing conditions unless members have been continously insured (see Definitions) or until a 180-day waiting period has been met. (This limitation does not apply to prescription medications.)

Benefits also include well-baby care, allergy care, physical therapy, chiropractors, nutritional counseling, maternity expenses, abortion, discounts at participating health clubs, special rates on alternative therapies, discounted health-related products such as vitamins, and limited mental health visits.

The UHS vision benefit includes a comprehensive eye examination including dilation with a $15 copay, to a maximum of $30 per policy year. (This benefit is managed by UHS and is not underwritten by Aetna.) Ann Arbor campus students and dependents must receive service at UHS between August 24 and April 30. Some people (i.e. children under 3 years of age, Ann Arbor students studying out of the Ann Arbor area, Flint and Dearborn students and dependents living outside the Ann Arbor area) may need to use a provider other than UHS. UHS will reimburse for one routine eye exam per policy year (not to exceed $30 per policy year, after a $15 copay per exam, and subject to UHS guidelines). For reimbursement, send the original paid receipt (be sure to keep a copy for your records) to the UHS Managed Care/Student Insurance Office. In addition to the annual exam, you can receive discounts on products and services at the UHS Optical Shop and VisionOne® providers.

Worldwide Emergency Travel Assistance: Participants have access to emergency medical assistance provided by Assist America while traveling more than 100 miles from home, anywhere in the world. Benefits include: 24/7 consultation; foreign hospital admission guarantee; prescription assistance; lost luggage assistance; legal and interpreter assistance; and travel information such as Visa and passport requirements, travel advisories, etc. Medical Repatriation and Return of Mortal Remains services are also available at the participant's campus location. Participants can contact Assist America at 800-872-1414 (within US) or 01-301-656-4152 (outside US).

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Exclusions  This plan does not cover the following.

• Pre-existing conditions for 180 days (6 months) unless members have been continously insured (see Definitions)
• Dental services are not covered; see UM Dental School for patient services and M-Dent dental plan or call 734-763-6933 or toll-free 888-707-2500.
• Preventive care (that is, "physicals") is not covered. (For women, pap smears and associated visit charges are covered.)

Definitions

Co-insurance: The amount paid by the Covered Person and the amount paid by insurance for services. Usually, this amount is a percentage split, e.g. 80% paid by insurance and 20% paid by the Covered Person.

Copay: The amount that must be paid by the Covered Person at the time services are rendered by a provider. Copay amounts are the financial responsibility of the Covered Person.

Continously Insured: Persons who have remained continously insured under the Policy or other prior health insurance policies will be covered for any Pre-Existing Condition that first manifests itself while continously insured, except for expenses payable under prior policies in the absence of the Policy. Previously Covered Persons must re-enroll for coverage. including dependent coverage, by September 24, 2007, in order to avoid a break in coverage for conditions that existed in the prior Policy Year. Once a break in continous coverage occurs, the definition of Pre-Existing Conditions will apply.

Covered Person: A student, or dependent, whose coverage is in effect under the Policy.

Deductible: The amount which is the Covered Person's financial responsibility at the first time services are rendered. Usually, this is a fixed amount per person, per Policy Year (August 24 - August 23).

Negotiated Charge (fee): The maximum charge a Preferred Care Provider has agreed to accept for any service or supply for the purpose of the benefits under the Plan.

Non-Preferred Provider: A health care provider that has not contracted to furnish services or supplies at a Negotiated Charge.

Preexisting Condition: Any Injury, Sickness or condition for which medical advice, diagnosis, care or treatment was recommended or received by the Covered Person within the six months (180 days) immediately preceding the effective date of their coverage, or up to six months (180 days) after the effective date of coverage. If a Covered Person has continuous coverage under the Policy or other prior health insurance policies for 180 days prior to purchase, an Accident or Sickness that first manifests itself during the prior year’s coverage shall not be considered a Pre-Existing Condition.

Preferred Provider: A health care provider that has contracted to furnish services or supplies for a Negotiated Charge, but only if the provider is included in the directory as a Preferred Care Provider for the services or supply involved, and the class of which the Covered Person is a member.

Reasonable Charge (fee): The average fee charged by a particular Provider, or paid by the insurance, within a geographic area.

Student Health Insurance Committee negotiates this insurance plan for students and addresses domestic student health insurance issues on campus. See Student Health Insurance Committee for more information.

Further information, brochures and applications

• The Chickering Group, Inc., policy #711146, 800-242-3721 (application available on-line)
• UHS Managed Care/Student Insurance Office, 734-764-5182 or toll-free 866-368-0002 or email mancare-stuins@umich.edu
• Campus Information Centers at the Michigan Union and Pierpont Commons (brochures with applications only)
• Michigan Student Assembly (brochures with applications only)
• For international student insurance, see International Student/Visiting Scholar Health Insurance Plan

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