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 - Visiting Scholars, spouses, and unmarried children under the age of 19 are eligible for coverage on the UO insurance plan. The Visiting Scholar must be covered by this insurance in order to insure family members.

Enrollment Periods - There are established health insurance periods during the first 3 weeks of each term. Visiting Scholars may enroll themselves and their dependents during these open enrollment periods only. Visiting Scholars may also purchase health insurance on a monthly basis at any time during the term.

Enrollment Process - The enrollment process for Visiting Scholars and their members is handled through the Student Health Insurance office on campus. The Visiting Scholar will need to provide dependents’ names and birthdays, complete an enrollment form and pay the premium.

BENEFIT CATEGORY	Preferred Provider	Non-Preferred
Basic Medical Benefits	$250,000 aggregate maximum per condition, per policy year	$250,000 aggregate maximum per condition, per policy year
Deductible	$50 per accident/sickness	$50 per accident/sickness
Prescriptions See limitations for mental health prescriptions	50% of the Reasonable Charge after deductible satisfied	50% of the Reasonable Charge after deductible satisfied
Physician/Clinician Office Visits	100% negotiated charge	75% of the Reasonable Charge
Emergency Room $50 copayment each visit	100% negotiated charge	100% of the Reasonable Charge
Hospital Care - Inpatient	100% negotiated charge	75% of the Reasonable Charge
Hospital Care - Outpatient	100% negotiated charge	75% of the Reasonable Charge
Laboratory Tests	100% negotiated charge	75% of the Reasonable Charge
Maternity Care Newborn nursery care charges limited to $750 maximum	100% negotiated charge	75% of the Reasonable Charge
Mental Health - Inpatient	100% for first 10 days	75% for first 10 days
Mental Health - Outpatient Counseling $1,000 maximum per policy year for therapy and prescriptions	Maximum of $70 per visit	Maximum of $56 per visit
Physical Therapy $1000 maximum per condition, per year	100% up to $35 per visit Requires a physician referral every 30 days	75% up to $35 per visit Requires a physician referral every 30 days
X-rays	100% negotiated charge	75% of the Reasonable Charge
Allergy testing, allergy serum, allergy injections	100% negotiated charge	75% of the Reasonable Charge
Ambulance	100% of the Reasonable Charge	100% of the Reasonable Charge
Mammograms, diagnostic	100% negotiated charge	75% of the Reasonable Charge
Mammograms, screening Covered on the following schedule: Ages 35 through 40 - 1 baseline mammogram After 40 - 1 annual mammogram	100% negotiated charge	75% of the Reasonable Charge
Women’s annual GYN exam	100% negotiated charge	75% of the Reasonable Charge

Acupuncture	Not a covered benefit.
Care in home country	Not a covered benefit.
Chiropractic	Not a covered benefit.
Contraceptives	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.
Preventative care	Not a covered benefit. Such as immunizations, well child/infant checkups, STD screenings, well physicals, school physicals, sports physicals, travel physicials, travel immunization & medications, nutrition counseling, etc.
Vision exams, glasses, contacts	Not a covered benefit.

Pre-existing conditions - Covered medical expenses for a pre-existing condition are limited to a maximum of $2,000 during the first 6 months of coverage on the UO insurance plan. Pre-existing conditions are any injury, sickness or condition that was diagnosed or treated within 6 months prior to beginning coverage on the UO insurance plan. Treatment includes a prescription for treatment of injury, sickness or condition.

Deductible -There is a $50 deductible per accident/sickness. If you or your dependent sees a physician once or 3 times for the same medical problem, there will be only one $50 deductible. However, if you or your dependent sees a physician 3 times for 3 different illnesses/injuries, there will be a $50 deductible each time.

Type of Coverage - This plan provides coverage for treatment for 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 at the Health Center. Covers eligible medical expenses in the United States and abroad EXCEPT IN THE VISITING SCHOLAR’S or DEPENDENT’S HOME COUNTRY.

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.

Visiting Scholars and their 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 you is a Preferred Provider for this plan.

Physicians - When a Visiting Scholar or their dependent is outside the Eugene area, they may receive care from ANY licensed practitioner and payment for covered medical expenses will be made at 100% 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 a Visiting Scholar or their dependent 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 75% of the reasonable charge if the student does not use Preferred Provider facilities.

Lab/x-rays/CT scans, MRIs, etc. - Visiting Scholar and their dependents do need to find the hospitals, outpatient facilities, labs, imaging facilities, etc., in their area are Preferred Providers. Benefits will be reduced to 75% of the reasonable charge if the student does not use Preferred Provider facilities.

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.

Visiting Scholars and their dependents 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.

UO Student Insurance ◆ Phone (541)346-2832 ◆ Fax (541) 346-6579 ◆ E-mail - heainsur@uoregon.edu

PREMIUM COSTS	Annual	Term	Month
Visiting Scholar	$1229	$410	$105
Scholar & Spouse	$3590	$1197	$301
Scholar & 1 Child	$2790	$930	$235
Scholar & 2 or more Children	$3532	$1178	$297
Scholar, Spouse & 1 Child	$5151	$1717	$431
Scholar, Spouse & Children	$5893	$1965	$493

Travel Services	This insurance plan will provide medical coverage for study/travel abroad. The coverage includes unlimited medical evacuation and repatriation coverage. This service is provided by Assist-America, Inc. Further details available in plan brochure.
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.