Plan Summary

The following information is provided to give a brief overview of the insurance plan. The information below is being provided as a summary only. In the event of any discrepancies between this summary and the policy brochure, the terms and conditions of the master policy shall apply.

Eligibility

Spouses, domestic partners and unmarried children under the age of 19 are eligible for coverage on the UO insurance plan. The student must be covered by this insurance in order to insure family members.

Enrollment Process

The enrollment process for students insuring family members is handled through the Student Health Insurance office on campus. The student will need to provide dependents’ names and birthdays, complete an enrollment form and pay the premium.

*Contact the Health Insurance Office if you missed an open enrollment period. You may be eligible for a late enrollment “exception” if you have lost of other health insurance coverage within the past 63 days.

Benefit Schedule

The following listing of benefits is a partial listing only and applies to dependents only.

Benefit Category	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
Optional Catastrophic - Can only be purchased in conjunction with Basic Medical Benefits Plan	$50,000	$50,000
Deductible	$300 annually	$300 annually
Prescriptions - See limitations for mental health prescriptions	50% of the Reasonable Charge after deductible is satisfied	50% of the Reasonable Charge after deductible is satisfied
Physician/Clinician Office Visits	80% negotiated charge	60% of the Reasonable Charge
Emergency Room $50 copayment each visit	80% negotiated charge	80% of the Reasonable Charge
Hospital Care - Inpatient	80% negotiated charge	60% of the Reasonable Charge
Hospital Care - Outpatient	80% negotiated charge	60% of the Reasonable Charge
Laboratory Tests	80% negotiated charge	60% of the Reasonable Charge
Maternity Care Newborn nursery care charges are not a covered expense	80% negotiated charge	60% of the Reasonable Charge
Mental Health - Inpatient $2,000 maximum per policy year	Limited to $250 per day for room & board	Limited to $250 per day for room & board
Mental Health - Outpatient Counseling	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% 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% negotiated charge	60% of the Reasonable Charge
Allergy testing, allergy serum, allergy injections	80% negotiated charge	60% of the Reasonable Charge
Ambulance	80% of the Reasonable Charge	80% of the Reasonable Charge
Mammograms, diagnostic	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	80% negotiated charge	60% of the Reasonable Charge
Women’s annual GYN exam	80% negotiated charge	60% of the Reasonable Charge

Additional Services

Exclusions

The following listing of exclusions is a partial listing only.

Deductible

There is a $300 deductible per insured/per academic year. Benefits are paid after the $300 deductible is met. The deductible is accumulated from the first $300 of eligible medical expenses (including prescriptions) submitted to the insurance company.

Type of Coverage

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.

Area of Coverage

The plan provides coverage for treatment anywhere in the U.S. and coverage is worldwide.

Pre-Existing Conditions - IMPORTANT PLEASE READ

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.

Preferred Providers

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. The discounts granted by Preferred Providers saves you money. Click here to find Aetna Preferred Providers.

Student family members need to select a Primary Care Provider in the community to coordinate their medical care. There are many Primary Care Providers in the Eugene area who are Preferred Providers for this plan.

If your Primary Care Provider decides that you need specialized care not available in his/her office, your Primary Care Provider will refer you to a specialist. There are many specialists in the Eugene area that are Preferred Providers for this plan. You need to request that your Primary Care Provider refer you to a specialist who is a Preferred Provider for this plan.

Medical Care outside the Eugene Area

Physicians - When a dependent 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 it will save you money.

Hospitals/Surgery - If the insured 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 insured does not use Preferred Provider facilities.

Lab/x-rays/CT scans, MRIs, etc. - If the insured does 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 insured does not use Preferred Provider facilities.

Medical Bills & Filing Insurance Claims

It is the responsibility of the insured person to provide insurance information to medical providers when receiving medical care. Show the insurance ID card whenever receiving medical care. The insurance card lists the policy number and billing address.

If an insured pays cash for any medical services, you will need to provide the Health Insurance Office with receipts.

The insured dependent must pay cash for all prescriptions. Outside pharmacies CANNOT bill the student health insurance for your prescriptions. You will need to provide the Health Insurance Office with the receipts from the pharmacy in order to be reimbursed.

All charges incurred with a medical provider are owed to that provider. It is the responsibility of the insured to make arrangement to pay the deductible and copayment to the medical provider who provided the medical care.

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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

Latest revision - 8/5/2008