Oregon Health & Science University

Student Insurance Plan 2010-2011

Aetna Student Health, working with Oregon Health & Important Information:
Science University offers a student-focused health
insurance plan that helps protect students at school, at After June 25th additional information on the
home, and while traveling or studying abroad. plan including dependent rates will be
available online at
www.aetnastudenthealth.com and
What is the Plan All About? www.ohsu.edu/academic/acad/health/
Your school-endorsed Student Health Insurance Plan offers you
access to: Eligibility Information:
OHSU requires that ALL full-time students
ƒ Aetna’s nationwide network of doctors, hospitals, pharmacies and
specialists throughout the country. have supplemental health insurance. This
will help to cover the cost of care that
ƒ An award-winning online secure member website, Aetna cannot be obtained on campus, especially
Navigator® in emergency situations where
ƒ Informed Health® Line – Our 24-hour toll-free number that puts you hospitalization may be required.
in touch with experienced registered nurses and an audio library for You are automatically enrolled in the
information on thousands of health topics. OHSU Student Health Insurance Plan if
you are:
ƒ Fitness Program, Alternative Health Care Programs, Weight
Management Discounts, Zagat Survey® Healthy Dining, eDiets® , − Taking 6 or more units
Mayo Clinic Bookstore.com and many more!
− Enrolled at OHSU campus in Portland,
ƒ Travel Assistance Services and Worldwide Medical Coverage while Marquam Hill, South Waterfront, or
traveling or studying abroad West Campus.
ƒ Dental insurance plan included for all OHSU programs excluding − An international student
the School of Dentistry, PharmD and CDRC. If you already have a health insurance plan
(or you are on your parents' plan) you may
How much does it cost? be eligible to waive enrollment in the
OHSU Student Health Insurance Plan by
Monthly Student Rate
providing proof of comparable coverage.
Local $269.93
Distant $325.60 Email communications will be sent during
the month of June regarding the waiver
application process for 2010-2011.
This material is for information only. Health insurance plans
contain exclusions and limitations. Health information programs
provide general health information and are not a substitute for
diagnosis or treatment by a physician or other health care
professionals. Preferred providers are independent contractors and
are neither employees nor agents of Aetna Life Insurance
Company, Chickering Claims Administrators, Inc. or their affiliates.
The [school name] Student Health Insurance Plan is underwritten
by Aetna Life Insurance Company (ALIC) and administered by
Chickering Claims Administrators, Inc. Aetna Student HealthSM is
the brand name for products and services provided by these
companies and their applicable affiliated companies.
Policy forms issued in OK include GR-96134.
© 2010 Aetna Inc.
15.03.318.1 D
 Oregon Health & Science University
Student Insurance Benefit Overview
PREFERRED CARE NON-PREFERRED CARE
Lifetime Maximum $1,000,000
Annual Deductible $350 Individual/$1,050 Family $700 Individual/$2,100 Family
Annual Out of Pocket Maximum - Medical $2,000 Per Person Per Policy Year
Annual Out of Pocket Maximum - Prescription $1,000 Per Person Per Policy Year

INPATIENT EXPENSES
Hospital Room and Board Expenses 80% of Negotiated Charge 60% of RC
Intensive Care Expenses 80% of Negotiated Charge 60% of RC
Physician Hospital Visit Expenses 80% of Negotiated Charge 60% of RC
SURGICAL EXPENSES
Inpatient/Outpatient Surgical Facility Expenses 80% of Negotiated Charge 60% of RC
Anesthetist Expenses 80% of Negotiated Charge 60% of RC
Inpatient Assistant Surgeon Expenses 80% of Negotiated Charge 60% of RC
Outpatient Assistant Surgeon Expenses 80% of Negotiated Charge 60% of RC
OUTPATIENT EXPENSES
Physician’s Office Visit/Consults Expenses 80% of Negotiated Charge 60% of RC
Laboratory & X-Ray Expenses 100% of Negotiated Charge after a $10 60% of RC
Copay
Therapy Expenses –Chiropractic limited to 20 visits 80% of Negotiated Charge 60% of RC
per policy year
Emergency Room Expenses - Copay/Deductible 100% of Negotiated Charge after a $150 100% of RC after a $150 Copay
waived if admitted. Copay
MENTAL HEALTH AND SUBSTANCE ABUSE EXPENSES
Inpatient Mental Health, 80% of Negotiated Charge 60% of RC
Outpatient Mental Health 80% of Negotiated Charge 60% of RC
Inpatient Substance Abuse Expenses, 80% of Negotiated Charge 60% of RC
Outpatient Substance Abuse Expenses, 80% of Negotiated Charge 60% of RC
ADDITIONAL EXPENSES
Ambulance Expenses, benefit is limited to:
maximum of $500 per trip 100% of the Actual Charge

Durable Medical Equipment Expenses 80% of Negotiated Charge 60% of RC

PRESCRIPTION DRUG EXPENSES – 100% of the Negotiated Charge after a: 100% of the Reasonable Charge after a:
Retail 30 Day Supply $15 Copay for Generic Drugs $15 Copay for Generic Drugs
$25 Copay for Preferred Brand Drugs $25 Copay for Preferred Brand Drugs
$50 Copay for Non-Preferred Brand Drugs $50 Copay for Non-Preferred Brand Drugs

PRESCRIPTION DRUG EXPENSES – 100% of the Negotiated Charge after a:
Mail Order 90 Day Supply $30 Copay for Generic Drugs
$50 Copay for Preferred Brand Drugs
$100 Copay for Non-Preferred Brand
Drugs
100% of the Reasonable Charge after a:
$30 Copay for Generic Drugs
$50 Copay for Preferred Brand Drugs
$100 Copay for Non-Preferred Brand
Drugs

The OHSU school plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it
will pay. Please read the OHSU brochure carefully before deciding whether this plan is right for you. While this document and the OHSU] brochure tell you about
some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look at the full plan
description, which is contained in the Master Policy issued to OHSU, you may view it upon request at Student Services or you may contact us at (617) 218-
8400].
This plan will never pay more than $1,000,000 in a coverage year or more than $1,000,000 per lifetime Additional plan maximums may also apply. Some
illnesses may cost more to treat and health care providers may bill you for what the plan does not cover.
© 2010 Aetna Inc.
15.03.318.1 D