A student health insurance plan customized for you. Deadline sensitive. Brought to you by Long Island University and Aetna Student Health

Transcription

1 A student health insurance plan customized for you. Deadline sensitive Brought to you by Long Island University and Aetna Student Health School Policy Information D

2 Dear Students and Families: Long Island University is dedicated to providing quality and affordable health care options for our students and their families during the academic year and beyond through our partnership with Aetna Student Health. Our Student Health Insurance Plan offers students and their dependents access to Aetna s nationwide network of doctors, hospitals, and pharmacies throughout the country; no annual deductibles; coverage for pre-existing conditions; annual routine physical exams; expanded coverage for State mandated vaccinations, surgical expenses, and prescription drugs; and travel assistance services with worldwide medical coverage while traveling or studying abroad. For this year, we have doubled the aggregate plan maximum per condition per policy year to $100,000, eliminated a number of important per day maximums, and expanded prescription drug coverage to $5,000 per year. The Plan is available to all students enrolled and registered in degree-granting programs at Long Island University, regardless of credits. Students participating in the University s Global College are mandated to enroll in the Plan, even if they have comparable coverage. All international students, clinical students, residential students, and intercollegiate athletes are automatically enrolled in the Plan but can waive participation online if they have verifiable coverage under a family plan or other policy. All remaining students are not automatically enrolled but are eligible to purchase the same Plan on a voluntary basis. Beginning on August 15, 2011, in conjunction with the start date of the Plan, students can log into their MyLIU account at and click on the Student Health Insurance link from the Student Center Home Page to voluntarily enroll in the Plan, waive coverage, add spouses or dependents, print temporary ID cards, and file or check claims. Remember that if you have been automatically enrolled in the annual plan and wish to waive coverage, you must go online and receive electronic confirmation prior to the published deadline. Long Island University takes the health of our students and families very seriously. The University welcomes your feedback so that we can constantly improve our student health insurance offerings over time, keeping you well so you can excel! Sincerely, Long Island University Offices of Student Financial Services The Long Island University Student Health Insurance Plan is underwritten by Aetna Life Insurance Company (Aetna) and administered by Chickering Claims Administrators, Inc. Aetna Student Health is the brand name for products and services provided by these companies and their applicable affiliated companies.

3 Aetna is a leader in the insurance industry with a strong knowledge of health insurance benefits and an expansive network of physicians, hospitals, and other health care providers. We ve been offering health insurance coverage to students like you for 30 years at colleges and universities across the country. We work with Student Health Services professionals and administrators to give you access to medical care when you need it. You are even covered when you travel home or to another country, throughout the policy/school year. Who Is Aetna Student Health? Why Is a Student Health Insurance Plan Important? Health care costs are at an all-time high. Don t let an unexpected trip to the doctor or hospital set you back financially. Here are some things to think about: Take a look at the Long Island University Student Health Insurance Plan and compare it to your current coverage. Look at premiums, deductibles, benefits provided and the time covered. You re covered for as long as you are registered with Long Island University as an international, clinical and residential student or an intercollegiate athlete. You may not be covered away from home or abroad. If you travel in the U.S. or study abroad, it s good to know you re covered if you need health care. You may not have prescription drug coverage. The cost of prescription drugs is growing by double digits. Under our Plan, you pay a flat fee each time you need to fill a prescription for pharmacy at in-network pharmacies subject to an annual maximum of $5,000. Out of network pharmacy services are covered up to the same $5,000 annual maximum, as well.

4 What Is This Health Insurance Plan All About? The Student Health Insurance Plan helps keep health care cost effective. Please check with your student health center to see if there is a referral requirement. Here s a brief description of the Plan benefits. Your Benefits at a Glance Aggregate Maximum $100,000 per policy year Pharmacy Maximum Mental Health Maximum Expenses Physician s Office Visit Preferred: Non-Preferred: Inpatient Hospitalization Preferred: Non-Preferred: Emergency Room, Preferred: 100% Non-Preferred: 100% X-ray and Lab Preferred: Non-Preferred: Prescription Drug $5,000 per policy year 20 visit maximum per Policy Year (20 visit maximum does not apply for biologically based mental health conditions.) 100% up to $2,000 per condition per policy year, 80% thereafter 100% reasonable and customary up to $2,000 per condition per policy year, 65% thereafter 100% up to $2,000 per condition per policy year, 80% thereafter 100% reasonable and customary up to $2,000 per condition per policy year, 65% thereafter $2,000 per condition per policy year. $500 per condition per policy year. 100% up to $2,000 per condition per policy year, 80% thereafter 100% reasonable and customary up to $2,000 per condition per policy year, 65% thereafter 100% after the copay up to $5,000 at in or out of network pharmacies The Plan will pay benefits in accordance with any applicable New York insurance law. The Long Island University Student Health Insurance 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 Long Island University brochure carefully before deciding whether this plan is right for you. While this document and the Long Island University 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 Long Island University, you may view it at the University s Student Finance Office during business hours or you may contact us at (866) This plan will never pay more than $100,000 in a coverage year or more than $5,000 per policy year for pharmacy. 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.

5 Where Can I Go for Service? When you need care, consider Student Health Services as your first stop. Located at the Brooklyn Campus University Health & Medical Services (UHMS) and C.W. Post Campus Student Health and Counseling Center. They can provide many of the routine health services you need. If you need care they can t provide, they ll refer you to a doctor or other health care provider who belongs to Aetna s Preferred Provider* network (doctors, specialists and facilities). You also may visit any licensed health care provider directly for covered services in Aetna s Preferred Provider* network (doctors, specialists, facilities) except that specific Plan restrictions on certain services may apply. However, when you visit Student Health Services first, you ll generally pay less out of your own pocket for your care. To learn more about Preferred Providers, visit *Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. How Much Does It Cost? Coverage Annual *Spring *Summer 8/15/11 1/01/12 5/15/12 8/14/12 8/14/12 8/14/12 Hardwaiver Student $ 999 $ 619 $252 (Resident Students, Clinical Students, International Students and Intercollegiate Athletes) Voluntary Student $2,781 $1,722 $701 (All other degree seeking LIU students) Spouse/ Domestic $3,553 $2,200 $896 Partner Children $2,937 $1,819 $740 * These plans are only offered to new students who begin their studies during the Spring or Summer term. Students previously eligible, but who waived coverage, are not permitted to participate until the following plan year.

6 Enrollment/Waiver Deadline Dates Fall Students: October 15, 2011 New Spring Students: February 15, 2012 New Summer Students: July 06, 2012 Waiver submissions may be audited by Long Island University, Aetna Student Health, and/or their contractors or representatives. You may be required to provide, upon request, any coverage documents and/or other records demonstrating that you meet the school s requirements for waiving the student health insurance plan. By submitting the waiver request, you agree that your current insurance plan may be contacted for confirmation that your coverage is in force for the applicable policy year and that it meets the school s waiver requirements. Global College Students** Students enrolled in Global College Programs are automatically enrolled in the Plan on a term basis. Due to the travel requirements of these programs, mandatory students are not permitted to waive coverage. Charges are placed on the student s account at the time of registration. How And When Do I Enroll in the Plan? Hardwaiver Students* All international students 1, clinical students, resident students and intercollegiate athletes 2 (hardwaiver students) attending Long Island University are automatically enrolled in the Long Island University Student Health Insurance Plan. The premium for the Plan will be added to your tuition bill. If you have comparable coverage and wish to waive coverage under the Plan, you must submit an Online Waiver Form and provide proof of comparable coverage by October 15, If you are a new Spring or Summer semester hardwaiver student attending Long Island University for the first time, the premium for the Plan will be added to your tuition bill. If you have comparable coverage and wish to waive coverage under the Plan, you must submit an Online Waiver Form and provide proof of comparable coverage by February 15, 2012 for students newly enrolled for the Spring semester and by July 06, 2012 for students newly enrolled for the Summer semester. To complete the Online Waiver Form: Go to Click on Compulsory/Hardwaiver Students: Enroll/Waive. Complete the online waiver form. Voluntary Students (all other degree seeking Long Island University students)*** Students who are not participating in one of the hardwaiver or Global College programs are permitted to enroll themselves and their dependents into this Plan on a voluntary basis: Go to Click on Voluntary Students/Dependents: Enroll. Please make sure you understand your school s credit hour and other requirements for enrolling in this plan. Aetna Student Health reserves the right to review, at any time, your eligibility to enroll in this plan. If it is determined that you did not meet the school s eligibility requirements for enrollment, your participation in the plan may be rescinded in accordance with its terms. * Hardwaiver Enrollment: Eligibility defined as students enrolled in a clinical degreed program(s), athletics, international status and/or resident of the L.I.U. campus /allowed to waive out by deadline noted. ** Mandatory Enrollment: All Global College students (not eligible for waiver process). *** Voluntary Enrollment: Eligibility defined as a student enrolled in a credited/degree program and NOT part of hardwaiver category. 1 International Designations: F1 Visa student: Full-time international student enrolled in an academic or language program. (ESLs fall under F1.) J1 Visa exchange: International student needing practical training not available in his/her home country. M1 Visa vocational: International student enrolled in a non-academic trade or vocational program. 2 Athletic Designations: Participation in intercollegiate athletics.

7 And There s More As a member of the Plan, you can also take advantage of the following services, discounts, and programs. These are not underwritten by Aetna and are not insurance. Please note that these programs are subject to change. To learn more about these additional services and search for providers visit Aetna Book discount program: Access to discounts on books and other items from the American Cancer Society Bookstore, the MayoClinic.com Bookstore and Pranamaya. Aetna Fitness discount program: Access to preferred rates on gym memberships and discounts on at-home weight loss programs, home fitness options and one-on-one health coaching services through GlobalFit TM. Aetna Hearing discount program: Access to discounts on hearing aids and hearing tests from HearPO. Guaranteed lowest pricing* on over 1,000 models from seven leading manufacturers. *Competitor copy required for verification of price and model. Limited to manufacturers offered through the HearPO program. Local provider quotes only will be matched, no Internet quotes. Aetna Natural Products and Services discount program: Access to reduced rates on services from participating providers for acupuncture, chiropractic care, massage therapy and dietetic counseling. Also, access to discounts on over-the-counter vitamins, herbal and nutritional supplements and natural products. All products and services are provided through American Specialty Health Incorporated (ASH) and its subsidiaries. Aetna Vision discount program: Access to discounts on vision exams, lenses and frames when a member utilizes a provider participating in the EyeMed Select Network. Aetna Weight Management discount program: Access to discounts on ediets diet plans and products, Jenny Craig weight loss programs and products, and Nutrisystem weight loss meal plans. Oral Health Care discount program: Access to discounts on oral health care products. Save on xylitol mints, mouth rinses, gum, candies and toothpaste from Epic. Additionally, receive exclusive savings on Waterpik dental water jets and sonic toothbrushes. Zagat discounts: Discount off a one-year online membership to ZAGAT.com, with access to ratings and reviews of over 40,000 restaurants, hotels and more in hundreds of cities worldwide. At Home Products discount program: Access to discounts on health care products that members can use in the privacy and comfort of their home. Emergency Travel Assistance Services and Medical Evacuation: Access to travel assistance services including emergency assistance available 24/7. Aetna Specialty Pharmacy provides specialty medications and support to members living with chronic conditions and illnesses. These medications are usually injected or infused, or some may be taken by mouth. Custom compounded doses and forms are also available. For additional information please go to Quit Tobacco Cessation Program: Say goodbye to tobacco and hello to a healthier future! The one-year Quit Tobacco program is provided by Healthyroads, a leading provider of tobacco cessation programs. You ll get personal attention from health professionals that can help find what works for you. Beginning Right Maternity Program: Make healthy choices for you and your baby. Learn what decisions are good ones for you and your baby. Our Beginning Right maternity program helps prepare you for the exciting changes pregnancy brings. Informed Health Line: Get health answers 24/7. Talk directly to a registered nurse. Our nurses can discuss a wide variety of health and wellness topics. Discount programs and other programs above provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Discount programs may be offered by vendors who are independent contractors and not employees or agents of Aetna. Aetna may receive a percentage of the fee you pay to the discount vendor. These services, programs or benefits may be offered by vendors who are independent contractors and not employees or agents of Chickering Claims Administrators, Inc., Aetna Life Insurance Company or their affiliates.

8 Optional Products: Vital Savings by Aetna on Pharmacy is a discount program helping you and your dependents lower your prescription drug costs. Present your card to participating pharmacies and receive a discount at the time of purchase, no claims to file. Enroll online at Price: Student only $25 Student + 1 Dependent $44 Student + 2 or more Dependents $63 Vital Savings by Aetna on Dental* is a dental discount program helping you and your dependents save. In most instances, savings range from percent on services from general dentistry and cleanings to root canals, crowns, and orthodontia (braces). No claims to file. Enroll online at Price: Student only $25 Student + 1 Dependent $44 Student + 2 or more Dependents $63 *Actual costs and savings vary by provider and geographic area. Vital Savings by Aetna on Pharmacy and Dental* is a discount program helping you and your dependents save on prescription drug costs and a wide array of dental services. Enroll online at Save time and money on enrollment fees by joining both programs in one step. In most instances, for dental, savings range from percent on services from general dentistry and cleanings to root canals, crowns, and orthodontia (braces). No claims to file. Price: Student only $ 40 Student + 1 Dependent $ 70 Student + 2 or more Dependents $100 *Actual costs and savings vary by provider and geographic area. The Vital Savings by Aetna program (the Program ) is not insurance. The program does not meet the Minimum Creditable Coverage requirements in Massachusetts. It provides Members with access to discounted fees according to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna discount program. The range of discounts provided under the Program will vary depending on the type of provider and type of service received. The Program does not make payments directly to the participating providers. Each Member must pay for all services or products but will receive a discount from the providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, BeVital, is the Discount Medical Plan Organization.

9 Dental PPO For all states except for Texas Our Aetna Dental PPO insurance plan provides coverage for both in and out of network covered services (member coinsurance levels may vary). Participating dentists have agreed to provide covered services at negotiated rates, so you will generally pay less out of pocket when you visit a network dentist. (Participating dentists may also offer discounted rates on additional services such as tooth whitening.*) Enroll and search dentists online at Fall Price: Annual Student only $533 Spouse Domestic partner $559 Child(ren) $728 Spring Price: New Spring Students and Dependents of New Spring Students Student only $330 Spouse Domestic partner $346 Child(ren) $451 *Discounts for non-covered services may not be available in all states. The Aetna Dental PPO insurance plan is underwritten by Aetna Life Insurance Company. Policy form numbers in Oklahoma include: GR-9 and/or GR-9N, GR-23, GR-29 and/or GR-29N. Your Home Aetna Navigator Once you re a member of the Plan, you have access to Aetna Navigator, your secure member website. It s packed with personalized benefits and health information. When you register with Aetna Navigator, you ll have your own personal home page to: View your most recent claims Print a temporary ID card See who is covered under your Plan Use cost of care tool View your health history report which provides your health data in a portable and easy to read format And much more! Learn More! Go to to learn more or call (866) This material is for information only. Health/Dental insurance plans contain exclusions, benefit maximums and limitations. The plan will pay benefits in accordance with any applicable New York insurance law. If any discrepancy exists between this pamphlet and the Master Policy, the Master Policy will govern and control the payment of benefits. 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 agents nor employees of Aetna Life Insurance Company, Chickering Claims Administrators, Inc., or their affiliates. Aetna does not provide care or guarantee access to health/dental services. The CareEngine is a proprietary technology platform developed by ActiveHealth Management, an Aetna company. In conjunction with clinicians, the CareEngine continuously analyzes claims and other data against evidence-based best practices and alerts the members and their physicians about possible care gaps and other inconsistencies. Information is not a substitute for diagnosis or treatment by a physician or other health care professional. While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Line nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs. Information is believed to be accurate as of the production date; however, it is subject to change. Policy forms issued in OK include: GR NOTICE: Any person who knowingly and with intent to injure, defraud or deceive any insurance company or other person files an application for insurance or statement of claim containing any materially false information or who conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties Aetna, Inc D

10 Aetna Student Health c/o Communications Department 1 Charles Park Cambridge, MA Aetna, Inc.