Aetna Student Health SM St. Catherine University's choice for student health insurance

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1 Aetna Student Health SM St. Catherine University's choice for student health insurance (5/13) 8901

2 Dear St. Catherine University Student: For those of you who are new to St. Kate s, welcome to the University! For those of you returning to St. Kate s, welcome back! St. Catherine University requires that all degree-seeking students enrolled in the St. Paul Day and Dear Minneapolis St. Catherine Associate University and Certificate Student: programs be covered by health insurance. All students For registered those of in you these who programs are new are to automatically St. Kate s, welcome enrolled in to and the charged University! for the plan offered by the For University. those of Spouses you returning and dependents to St. Kate s, can also welcome be enrolled back! in the plan for an additional charge. The cost for students for this annual health insurance policy is $1,740, with $870 automatically St. charged Catherine to your University student account requires each that semester. all degree-seeking If you wish to students participate in the plan you need to do enrolled nothing in more the St. you Paul are already Day and automatically Minneapolis enrolled Associate for the and calendar year (August 15, 2013 through Certificate August 14, programs 2014) and be will covered receive your by health insurance. and All prescription registered drug cards in early October. students are automatically enrolled in and charged for the plan offered by However, the University. students Spouses who do not and wish dependents to be charged can for also the be insurance enrolled and in the who plan can for demonstrate an additional that charge. they already have comparable health insurance coverage can waive out of the University s program and their student account will be credited for the policy premium. Waivers must be submitted online by Friday, September 20, 2013 (February 21, 2014 for new students beginning attendance Spring, 2014). The Students cost for who students do not successfully for this annual complete health a waiver insurance by that policy deadline is $1,740, will be with enrolled $870 in the automatically student charged health insurance to your student plan for the account full plan each year semester. and billed If $870 you each wish semester. to participate If you in wish the to plan waive you the need plan, to or do enroll nothing your eligible more dependents, you are simply follow the directions contained in this brochure. already automatically enrolled for the calendar year (August 15, 2013 through We are excited August to 14, offer 2014) the St. and Kate s will insurance receive your plan health through insurance AETNA insurance. and As you ll see in this prescription brochure, the drug AETNA cards insurance in early plan October. provides extensive coverage at an affordable cost. Please review the enclosed highlight sheet to see if the plan meets your needs, or visit AETNA S website in order to determine if your current health care practitioner is on their list of in-network providers. However, students who do not wish to be charged for the insurance and Please who know can that demonstrate all students, that whether they already they are have participating comparable in the health University s or any other insurance insurance plan, are encouraged coverage can to make waive use out of of the the services University s offered program in the St. Catherine University Health and and Wellness their student Center, located account in the will Aimee be credited and Patrick for the Butler policy Center premium. for Sports and Fitness. Waivers You may must call the be St. submitted Kate s Health online and by Wellness Friday, Center September at , 2013 for additional information (February about the 22, plan 2014 or the for waiver new or students enrollment beginning process, attendance or Please Spring, include 2014). your full Students name and who St. Kate s do not student successfully ID number complete in the subject a waiver line by of your correspondence. that Sincerely, deadline will be enrolled in the student health insurance plan for the full plan year and billed Jane Fredrickson $870 each semester. If you wish to waive the plan, or enroll your eligible dependents, simply The St. Catherine St. follow Catherine University directions University Health contained and is Wellness underwritten in this Center brochure. by Aetna Life Insurance Company (Aetna) and administered by Chickering Claims Administrators, Inc. We The are St. excited Catherine to offer University the St. Kate s is underwritten insurance plan by through Aetna Life AETNA Insurance Company (Aetna) insurance. Aetna and administered Student As you ll Health see by SM Chickering in this the brochure, brand Claims name the Administrators, AETNA for products insurance Inc. and plan services provided by Aetna provides Life Aetna Insurance Student extensive Company Health coverage (Aetna) at an affordable and CCA cost. and Please their review applicable the affiliated companies enclosed (Aetna). SM is the brand name for products and services provided by Aetna Life Insurance highlight Company sheet to see (Aetna) if the plan and meets CCA and your their needs, applicable or visit affiliated companies AETNA S (Aetna). website in order to determine if your current health care practitioner is on their list of in-network providers.

3 You have found the school that s the right fit Now choose the insurance plan that s the right fit Aetna Student Health custom protection for you Health insurance coverage any time school, travel, summer Large nationwide network of doctors, hospitals and specialists Savings on dental, vision and pharmacy services No-hassle payment. It can be included in your tuition bill But what if I already have insurance? Check us out. You may be able to do better on costs Your school may require this insurance Your plan may not cover you this far from home don t take a chance Aetna Student Health More than 200 colleges and universities use our services. We ve been in the student insurance business for more than 30 years. What else is included? Access to travel assistance services, including 24/7 emergency assistance Access to discounts on massage therapy, over-the-counter vitamins, oral health care products, acupuncture, and weight-loss programs and products to name a few Quit smoking: One year of personal coaching, interactive web tools and motivational materials To find out more about the plan and to sign up, go to

4 Preferred Care Non-Preferred Care Annual Deductible $200 Here's what the plan offers $400 Services Here is a at brief description of the plan benefits. St. Catherine University Policy Year Maximum NONE Health and Wellness Pharmacy Maximum Clinic 2004 Randolph Ave. NONE Preferred Care Non-Preferred Care #4112 St. Annual Paul, Deductible MN $200 $400 Services Physician at Office St. Visits Catherine University Health and Wellness Clinic 2004 Emergency Randolph Room Ave. #4112 Expense St. (* Per Paul, visit MN Copay/Deductible is Physician waived if member Office is Visits admitted as inpatient) Routine Physical Exam Expense Emergency Room Expense Inpatient ( Hospitialization * Per visit Copay/Deductible is waived if member is Prescription Drug admitted as inpatient) Drug Benefit Routine Physical Exam Expense Inpatient Hospitialization Negotiated Charge after a $25 per visit copay 90% of the Negotiated Charge after a $100 per visit Copay* Negotiated Charge after a $25 per visit copay Negotiated Charge 90% of the Negotiated Charge 90% of the after Negotiated a $100 per Charge visit after Copay* a $50 per visit Copay 100% 100% of of the the Negotiated 80% Charge after a $15 Copay 100% for Generic, of the $45 Copay Negotiated for Brand Name, Charge and $75 Copay for Non-Formulary 90% of the Negotiated for each prescription item Charge after a $50 per visit Copay Recognized Charge after a $40 per visit Deductible 90% of the Recognized Charge after a $100 per visit Copay* Recognized Charge after a $40 per visit Deductible Recognized Charge 90% of the Recognized Charge 70% of the after Recognized a $100 per Charge visit after Copay* a $ 100 per visit Deductible 80% of the Recognized Charge Recognized Charge 70% of the Recognized Charge after a $ 100 per visit Deductible Prescription Drug 80% Benefit Negotiated Charge after a $15 Copay for Generic, $45 Copay for Brand Name, and $75 Copay for Non- Formulary for each prescription item. Benefit Negotiated Charge after a $15 Copay for Generic, $45 Copay for

5 of the plan, there may be other specifics of the p some limit what the plan will pay. If you want to look at the full plan description, w Please read carefully before deciding whether this issued plan to is the right school, for you: you may view it at the U This plan will not pay more than the overall maximum during benefit business of UNLIMITED hours or contact benefits us at during the plan year. Once any of these limits have been reached, the plan will not pay any more toward the cost of the applicable services, and your health care provider can bill you for what the plan does not pay. Some illnesses cost more to For treat more than information this plan will cover. on other plan ex maximums, please refer to the St. Catherin Please read the St. Catherine University brochure Policy. carefully This before plan enrolling. pays benefits While only for expe this document and the St. Catherine University brochure in force describe and only important for the medically features necessary of the plan, there may be other specifics of the plan coverage that are displayed important in to this you, document and reflect some limit what the plan will pay. which the policy was written. However, ce could also affect how this coverage pays. Unl If you want to look at the full plan description, which is contained in the Master Policy and limitations are per covered person. issued to the school, you may view it at the University's Health and Wellnes Clinic during business hours or contact us at Where can I go for service? All St. First stop, student health services. When you cov need care, consider student health services as For more information on other plan exclusions, limitations and benefits Thi your first stop. They can provide many of the maximums, please refer to the St. Catherine University's brochure and Master visi Policy. This plan pays benefits only for expenses routine health incurred services while you the need. coverage is in force and only for the medically necessary treatment of injury or disease. The Dep You also may visit any licensed health care coverage displayed in this document reflects certain mandate(s) of the state in elig provider directly for covered services in which the policy was written. However, certain federal laws and regulations We Aetna s preferred provider* network (doctors, could also affect how this coverage pays. Unless otherwise indicated, all benefits and limitations are per covered person. specialists, facilities) except that specific plan The restrictions on certain services may apply. ren We Where can I go for service? All However, Covered when Medical you visit Expenses student for health students at the St. services Catherine's first, you ll Health generally and Wellness pay less Clinic out of are First stop, student health services. When you covered your own at pocket 100% for up to your $500 care. per To policy learn year. more need care, consider student health services as This about amount preferred is estimated providers, to visit cover about 3-4 your first stop. They can provide many of the visits at the Health and Wellness Clinic. routine health services you need. Dependent children and spouses are not You also may visit any licensed health care eligible to use the services of the Health and provider directly for covered services in Wellness Clinic. Aetna s preferred provider* network (doctors, specialists, facilities) except that specific plan The *Providers Annual are Deductible independent is waived contractors for services and are not restrictions on certain services may apply. rendered may change at the without St. Catherine notice. Aetna Health does and not provide services. Wellness Clinic and or when referred out by However, when you visit student health the Health and Wellness Clinic. 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.

6 insured benefits. The member is responsible for the full cost of the discounted services. Discounts and programs may be offered by vendors who are independent contractors The discount and offers not and employees programs or agents above provide of Aetna. access Aetna to may discounted receive a prices percentage and are of NOT the fee insured you pay benefits. to a discount The member vendor. is These responsible services, programs for the full or benefits cost of may the be discounted offered by vendors services. who Discounts are independent and programs contractors may and be not offered employees by vendors agents who of Chickering are independent Claims Administrators, contractors and Inc., not Aetna employees Life Insurance or agents Company of Aetna. or Aetna their may affiliates. receive a percentage of the Discount fee you pay programs to a discount and travel vendor. assistance These services, programs may be or offered benefits by may vendors be offered who are by independent vendors who are contractors independent and not contractors employees and or not agents employees of Aetna or or agents their of affiliates. Chickering Claims Health Administrators, information Inc., programs Aetna Life provide Insurance general Company health or information their affiliates. and are not a substitute for diagnosis Discount or programs treatment and by travel a physician assistance or other services health may care professional. be offered by vendors who are Providers independent are contractors independent and contractors not employees and are or agents not agents of Aetna of Aetna. or their Provider affiliates. participation may Health change information without programs notice. provide Aetna general does health not provide information care and or are guarantee not a substitute access for to health.services. diagnosis or treatment by a physician or other health care professional. Policy Providers forms are issued independent OK include: contractors GR and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to Your health.services. student health insurance coverage, coverage, offered offered by Aetna by Student Aetna Policy forms issued in OK include: GR Health, Student may Health, not may meet not the meet minimum the minimum standards standards required required by the by health the Your health student care care reform health reform law insurance for law the for restrictions the coverage, restrictions annual offered on annual dollar by Aetna limits. dollar The limits. Student annual The Health, annual dollar may dollar limits not limits meet ensure ensure the that minimum that consumers standards have required sufficient by access the health to medical care reform benefits law throughout for the restrictions the annual the annual term on annual of term the of policy. dollar the Restrictions policy. limits. The Restrictions annual for annual dollar for dollar limits annual limits ensure for dollar that group consumers limand its individual for have group sufficient health and insurance individual access to coverage health medical insurance benefits are $2 million coverage throughout for are policy $2 the million years annual beginning for term policy of on years the or after beginning policy. September Restrictions or 23, after 2012, September for but annual before 23, dollar January 2012, limbut 1, its before group Restrictions January and 1, for individual annual Restrictions health dollar for limits insurance annual for coverage student dollar limits health are for $2 insurance student million health for coverage policy insurance years are $500,000 coverage beginning are for on or policy $500,000 after years September for beginning policy 23, years 2012, on or beginning but after before September on January or after 23, 1, 2012, September Restrictions but 23, before 2012, for January but annual before 1, dollar January limits Your 1, for student Your health student insurance health coverage insurance includes coverage are $500,000 an includes annual for an policy limit annual of years UNLIMITED limit beginning of UNLIMITED benefits on or benefits on after all covered on September all covered services, 23, 2012, including services, but before essential including January health essential 1, benefits. Your health Other student benefits. internal health maximums Other insurance internal coverage (on maximums essential includes health (on an essential benefits annual limit health and certain of benefits UNLIMITED other and services) benefits certain are other on described all services) covered more are services, fully described in including the benefits more essential fully chart in included the health benefits inside benefits. chart this plan included Other summary. internal inside maximums If this you plan have (on summary. any essential questions If health you or have concerns benefits any and about questions certain this notice, or other concerns services) contact about are this described notice, contact Be more advised fully that in the you benefits may Be advised eligible chart for that included coverage you inside may under be this eligible a plan group summary. for health coverage plan If of you under a parent s have a any group employer questions health or under plan or concerns of a parent s a about individual employer this notice, health or contact under insurance a parent s policy individual if you Be are advised health under the insurance that age you of may policy 26. be Contact if eligible you are the under for plan coverage the administrator of under 26. Contact a of group the the parent s health plan employer administrator plan of a plan parent s or of the employer the parent s or individual under employer a health parent s plan insurance individual or the issuer parent s health for more individual insurance information. policy health if insurance you are under issuer the for age more of 26. information. Contact the plan administrator of the parent s employer plan or the parent s individual health insurance issuer for more information.

7 Important Note General 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. Waiver submissions may be audited by St. St. Catherine University, Aetna Student Health, and/or its contractors or representatives. You may be be required to to provide, upon request, any any coverage documents and/or other records demonstrating that you meet the the school s requirements for for waiving the student health insurance plan. By submitting the waiver request, you you agree that that your your current insurance plan may be contacted for confirmation that your coverage is is in in force for for the the applicable policy year and that it meets the school s waiver requirements. Please make sure you understand your school s credit hour and other requirements for for enrolling in this plan. Aetna Student Health reserves the the right right to to review, at any at any time, time, your your eligibility eligibility to enroll to in enroll this in plan. this If plan. it is If it is determined that that you you did did not not meet meet the the school s eligibility requirements for for enrollment, your your participation in the in the plan plan may may be be terminated or or rescinded in in accordance with its terms its terms and and applicable law. law. This material is for information only. Health benefits and insurance plans contain exclusions, benefit maximums and limitations. The plan will pay benefits in in accordance with with any any applicable Minnesota insurance law. If any If any discrepancy exists exists between between this pamphlet this pamphlet and the and Master the Policy/ Master Policy/Group Agreement, Agreement, the Master the Policy/Group Master Policy/Group Agreement Agreement will govern will and control govern the and payment control of the payment benefits. Information of benefits. Information is believed to is believed accurate to be as accurate of the production as of the date; production however, date; it is however, subject it is to subject change. to change. Policy forms issued in OK include: GR

8 How much does it cost? Coverage Annual (8/15/13-8/14/1 Coverage Annual Student Spring Semester $1,740 (8/15/13-8/14/14) (1/15/14-8/14/14) Student $1,740 Spouse $870 $3,396 Spouse $3,396 Child(ren) $1,698 $2,568 Child(ren) $2,568 Weekend Students $2,568 $1,284 and Graduate Students Weekend Students $2,568 $1,284 and Graduate Students The rates above include both the premium for the stud Insurance Company, as well as St. Catherine University The rates above include both the premium for the student health plan underwritten by Aetna Life Insurance Company, as well as St. Catherine University s How administrative and when fee. do I enroll in the plan? Participation in St. Catherine University s stud How and when do I enroll in the plan? Student Health Insurance Plan is required by cha St. Participation Catherine in University St. Catherine requires University s that all degree-seeking Student Health Insurance students enrolled Plan is required in the by St. your Paul school Day and for all Minneapolis eligible full-time Associate your To students Enroll school or are Waive for automatically all in eligible the St. full-time Catherine enrolled in and undergraduate University charged for endorsed the students, plan plan, offered unless visit by they University. are covered aetnastudenthealth.com/schools/stkate. Students under who do another wish comparable to be charged plan. for Stud the they and undergraduate Certificate programs students, be unless covered they by are Proof Click the insurance on of the comparable link and entitled who coverage, can Enroll/Waive. demonstrate in accordance In that hea health covered insurance. under another All students comparable registered plan. in with order they your already to waive school s have participation comparable requirements, in the must Student be the these Proof programs of comparable are automatically coverage, in accordance enrolled completed Health Insurance Plan, please complete health insurance and returned coverage to can St. Catherine waive out of in with and your charged school s for requirements, the plan offered must by the be University the Online Waiver form by the applicable the University s each academic program year by the and University. completed Graduate and returned students to St. and Catherine Weekend enrollment deadline date deadlines. listed below. the College University students each academic are eligible year to by purchase the this and their student account will be credited for Plan enrollment on a voluntary deadlines. basis. Students who do not wish to be charged for the insurance and who Here s can when demonstrate you have that to sign they up already have comparable Enrollment and health Waiver insurance deadline coverage dates: can waive Fall - September out of the University s 20, 2013 program and their student account will be credited for the policy Spring premium. - February 21, 2014 St. Catherine University requires that all Students degree-seeking who do students not successfully enrolled complete in the St. a Paul waiver Day by and the Minneapolis deadline will Associate be enrolled and in the Certificate student programs health insurance be covered plan by for health the full plan insurance. year and All billed registered $870 each semester. How much does it cost? Here s the policy when premium. you have to sign up Enrollment and Waiver deadline dates: Fall Students - September who do not 20, successfully 2013 complete a Spring waiver by - February the deadline 21, 2014 will be enrolled in the student health insurance plan for the full plan St. Catherine University requires that all year and billed $870 each semester. degree-seeking students enrolled in the St. Paul To Enroll Day and or Waive Minneapolis the St. Associate Catherine and Certificate University endorsed programs plan, be covered visit by health insurance. All registered s/stkate. Click on the link entitled Enroll/Waive. In order to waive participation Stud wai stud yea To E Uni http s/st En

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10 Aetna Student Health c/o Communications Dept. 200 Rivers Edge Dr. Medford, MA Aetna Inc (5/13)

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