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.
Click here to read the complete Student Health Insurance Plan brochure on-line
Dependents are not eligible to use the University Health Center.
Family Premium Costs |
Basic Medical
|
Basic Medical
|
Catastrophic
|
|
Student & Spouse/Partner |
$1935 |
$5806 |
$1240 |
|
Student & 1 Child |
$1499 |
$4498 |
$ 834 |
|
Student, Spouse/Partner & 1 Child |
$2780 |
$8340 |
$1605 |
|
Student & 2 or more children |
$1905 |
$5715 |
$466 +$366 per child |
|
Student, Spouse/Partner, Children |
$3186 |
$9557 |
$1240 + 366 per child |
Coverage Periods |
Begins |
Ends |
Enrollment Periods* |
|
Annual |
9/21/09 |
9/20/10 |
9/21/09 - 10/16/09 |
|
Fall Term |
9/21/09 |
1/03/10 |
9/21/09 - 10/16/09 |
|
Winter Term |
1/04/10 |
3/28/10 |
1/04/10- 1/22/10 |
|
Spring/Summer Terms |
3/29/10 |
9/20/10 |
3/29/10 - 4/16/10 |
|
Summer Term only |
6/21/10 |
9/20/10 |
6/21/10 - 7/9/10 |
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.
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.
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 |
$50,000 | $50,000 |
Deductible |
$300 annually |
$300 annually |
|
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 |
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 |
80% negotiated charge | 60% of the Reasonable Charge |
|
Mental Health - Inpatient |
Limited to $250 per day for room & board |
Limited to $250 per day for room & board |
|
Mental Health |
Maximum of $70 per visit |
Maximum of $56 per visit |
|
Physical Therapy |
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
|
80% negotiated charge
|
60% of the Reasonable Charge |
|
Women’s annual GYN exam |
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. This service is provided by On Call International. 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. |
|
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 dependent 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. |
|
Preventative care |
Not a covered benefit. Such as immunizations, well child/infant checkups, STD screenings, well physicals, school physicals, sports physicals, travel physicals, travel immunizations & medications, nutrition counseling, etc. |
|
Vision exams, glasses, contacts |
Not a covered benefit. |
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.
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 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.
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.
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 a 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 60% of the reasonable charge if the dependent does not use Preferred Provider facilities.
Lab/x-rays/CT scans, MRIs, etc. - Dependents 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 dependent 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.
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.
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