Click here to read the complete Student Health Insurance Plan brochure on-line
The following listing of benefits is a partial listing only. This benefit listing applies to students only.
|
Benefit Category |
Health Center |
Preferred Provider |
Non-Preferred |
| Basic Medical Benefits |
$50,000 aggregate maximum per condition, per policy year |
$50,000 aggregate maximum per condition, per policy year |
$50,000 aggregate maximum per condition, per policy year |
|
Optional Catastrophic Can only be purchased in conjunction with Basic Medical Benefits Plan |
$950,000 | $950,000 | $950,000 |
|
Deductible |
Waived |
$300 annually |
$300 annually |
|
Prescriptions See limitations for mental health prescriptions |
70% Accutane & Retin-A covered only if prescribed & filled at HC Pharmacy |
50% of the Reasonable Charge after deductible is satisfied |
50% of the Reasonable Charge after deductible is satisfied |
|
Physician/Clinician Office Visits |
80% |
80% negotiated charge |
60% of the Reasonable Charge |
|
Emergency Room $50 copayment each visit |
NA |
80% negotiated charge |
80% of the Reasonable Charge |
|
Hospital Care - Inpatient |
NA |
80% negotiated charge |
60% of the Reasonable Charge |
|
Hospital Care - Outpatient |
NA |
80% negotiated charge |
60% of the Reasonable Charge |
|
Laboratory Tests |
80% |
80% negotiated charge |
60% of the Reasonable Charge |
|
Maternity Care Newborn nursery care charges are not a covered expense |
NA | 80% negotiated charge | 60% of the
Reasonable Charge |
|
Mental Health - Inpatient $2,000 maximum per policy year |
NA |
Limited to $250 per day
for room & board |
Limited to $250 per day
for room & board |
| Mental Health -
Outpatient Counseling |
80% |
Maximum of $70 per visit $1,000 maximum per policy year for therapy and prescriptions |
Maximum of $56 per visit $1,000 maximum per policy year for therapy and prescriptions |
|
Physical Therapy $1000 maximum per condition, per policy year |
80% Requires a physician referral every 30 days |
80% up to maximum of $35 per visit/Requires a physician referral every 30 days |
60% up to maximum of $35 per visit/Requires a physician referral every 30 days |
|
X-rays |
80% |
80% negotiated charge |
60% of the Reasonable Charge |
|
Allergy testing, allergy serum, allergy injections |
80% |
80% negotiated charge |
60% of the Reasonable Charge |
|
Ambulance |
NA |
80% of the Reasonable Charge |
80% of the Reasonable Charge |
|
Mammograms, diagnostic |
NA |
80% negotiated charge |
60% of the Reasonable Charge |
|
Mammograms, screening Covered on the following schedule: Ages 35 through 40 - 1 baseline mammogram After 40 - 1 annual mammogram |
NA | 80% negotiated charge | 60% of the
Reasonable Charge |
|
Women’s annual GYN exam |
80% |
80% negotiated charge |
60% of the Reasonable Charge |
| Travel Assistance |
This insurance plan will provide medical coverage for study/travel abroad. The coverage includes unlimited medical evacuation and repatriation coverage. |
|
Vision Care |
The Vision One Discount Program offers access to savings on eye exams, eyeglasses and contact lenses. These discounts are ONLY available through “Vision One” providers. Further details available in plan brochure. |
|
Acupuncture |
Not a covered benefit. |
|
Chiropractic |
Not a covered benefit. |
|
Dental Care |
Not a covered benefit.Treatment of TMJ (temporomandibular joint) conditions is specifically excluded. |
|
Immunizations |
Not a covered benefit. |
|
Massage Therapy |
Not a covered benefit. |
|
Naturopathy |
Not a covered benefit. |
|
Pre-existing conditions |
Excluded from coverage until student has been continuously insured by the UO Student Health Insurance plan for 6 months. This exclusion can be waived by showing proof of prior health insurance coverage. Click here for information. |
|
Preventative care |
Not a covered benefit. Such as immunizations, STD screenings, well physicals, school physicals, sports physicals, travel physicals, travel immunizations & medications, nutrition counseling, etc. |
|
Vision exams, glasses, contacts |
Not a covered benefit. |
The deductible is waived for care received at the University Health Center.
There is a $300 deductible per insured/per academic year for medical charges incurred or prescriptions filled outside the Health Center.
The deductible is accumulated from the first $300 of eligible medical charges submitted to the insurance company. The deductible applies for ANY care received outside the Health Center (even if the student is referred by a Health Center practitioner; the Health Center is closed; student has elected NOT to pay or is not eligible to pay the Health Center fee; or student needs care when outside the Eugene area.)
This plan provides coverage for treatment of illness and injury. The plan provides year round coverage including coverage during school breaks and over the summer. The plan does not include vision or dental coverage.
This plan attempts to balance benefit levels and premium affordability. Out-of-pocket expenses should be anticipated. The plan does not cover preventative or elective health care except as specifically noted in benefit details.
The plan provides coverage for treatment at the Health Center, treatment outside the Health Center, treatment anywhere in the U.S. and coverage is worldwide.
Click here for more information. Understanding how the insurance company defines pre-existing conditions and if a pre-existing condition will be covered for you is very important.
The University Health Center provides a wide range of health care services at very affordable prices. There is no deductible for care received at the Health Center. Use of the Health Center can lower a student’s out-of-pocket medical expenses.
A Preferred Provider Organization (PPO) is a network of physicians, hospitals and other health care professionals who have contracted with an insurance company to provide care at a set reimbursement rate in an effort to reduce costs to patients. The Preferred Provider Organization for the UO Student Health Insurance plan is Aetna. It is always to your advantage to use Aetna Preferred Providers whenever you receive medical care outside the Health Center. The discounts granted by Preferred Providers saves you money. Click here to find Aetna Preferred Providers.
There are many Preferred Providers in the Eugene area. If you receive medical care from a Preferred Provider, payment for covered medical expenses will be made at 80% of the negotiated rate (after the deductible has been met). Payment for covered medical expenses will be reduced to 60% of the reasonable charge if a student receives care from a practitioner who is not a Preferred Provider. It will save students money if they return to the Health Center when it opens for any remaining follow-up care.
The Health Center closes:
Physicians - When a student is outside the Eugene area, they may receive care from ANY licensed practitioner and payment for covered medical expenses will be made at 80% of the reasonable charge (after the deductible has been met). However, it is always to your advantage to use Preferred Providers when you receive care because the discounts granted will save you money.
Hospitals/Surgery - If a student is going to have a non-emergency hospital stay or an elective surgery, they do need to find the hospitals or outpatient facilities in their area that are Preferred Providers. Benefits will be reduced to 60% of the reasonable charge if the student does not use Preferred Provider facilities.
Lab/x-rays/CT scans, MRIs, etc. - Students do need to find the hospitals, outpatient facilities, labs, imaging facilities, etc., in their area are Preferred Providers. Benefits will be reduced to 60% of the reasonable charge if the student does not use Preferred Provider facilities.
When a student is no longer eligible to use the University Health Center (because the student is no longer registered for classes and can no longer qualify to pay or do not wish to pay the “Stop-out” or “Summer Health Center” fee), the student will need to choose a Preferred Provider in the community as their Primary Care Provider. If a student receives medical care from a Preferred Provider, payment for covered medical expenses will be made at 80% of the negotiated rate (after the deductible has been met). Payment for covered medical expenses will be reduced to 60% of the reasonable charge if you receive care from a practitioner who is not a Preferred Provider for this plan.
Aetna Student Health ◆ PO Box 15708 Boston, MA 02215 ◆ 877-480-3916
UO Student Insurance ◆ Phone (541)346-2832 ◆ Fax (541) 346-6579 ◆ E-mail - heainsur@uoregon.edu
Policy # 100097