University Health Service (UHS)
Choosing Health Insurance
Students are financially responsible for the cost of services not covered by their health insurance. It is important to know what your insurance covers and does not cover. You do not want to be surprised to find out a charge you thought was covered is not covered. Familiarize yourself with your plan, noting any restrictions (e.g., prior referrals needed, limits on number of visits, deductibles, out-of-the-area coverage, co-payments, etc.). Keep information about your insurance plan for reference as long as you are on the plan. There may be times you need to call your insurance company for clarification about your coverage before receiving a service.
Deciding which insurance plan to choose can be a difficult decision. As you consider which insurance to purchase, look carefully at the plan's benefits and restrictions to be sure the plan provides adequate coverage. A plan that costs less may not be the best plan if the coverage is poor. Insurance plans with a lower cost usually have fewer benefits and more out-of-the-pocket expenses when you use the plan.
Before you waive the Aetna Student Health insurance:
Students who have insurance coverage that meets University criteria can waive the Aetna Student Health insurance plan if the insurance plan is with a U.S.-based company. Generally, insurance from international-based companies does not meet the University criteria. For this reason, a request to waive the University-sponsored insurance with an international-based insurance will be denied. Students can appeal this denial by submitting the Insurance Waiver Appeal Form if their plan meets all of the University criteria. For information about submitting an appeal, check "Health Insurance for Full-time Students."
When you complete the waiver process, you will be asked to verify that your insurance plan meets all of the University criteria. If you do not know if your plan meets the University criteria (listed below), you may need to call your insurance company to verify your plan meets the criteria. You will also be asked to provide information about your insurance company (e.g., address, phone number, contract number, etc.). This information can be found on your insurance card.
University Criteria for Insurance – For 2012-2013
To be eligible for waiver of the University-sponsored insurance, the student's insurance plan must be from a U.S. based company. International-based companies are not eligible for waiver. (See below.)
To be eligible for waiver:
- The plan must cover a minimum of $500,000 US in medical benefits due to illness, accident, or injury per plan year.
- The plan must have a deductible of no more than $5,000 US per covered person per plan year. (Note: Plans without a deductible meet this requirement.)
- The plan must cover prescription medications both in the hospital and out of the hospital to a minimum of $100,000 US per plan year.
- The plan must have no restrictions for coverage of any pre-existing health condition.
- The plan must cover biologically-based mental health conditions at the same level as other medical conditions.
- The plan must cover care related to pregnancy and delivery, including newborn care for the first 30 days of life.
- The plan must not exclude care for self-inflicted injury, intercollegiate athletics, and recreational activities.
- The plan must be in force for the duration of the academic year, or through the end of the month in which graduation occurs or the student's academic program ends.
If you are insured by an insurance plan outside of the Rochester area
Check your coverage for care received in the Rochester area. Some insurance plans provide only emergency coverage for out-of-area care and/or require a prior referral from the primary care physician at home. It is your responsibility to know about your health insurance plan and to contact your physician when appropriate.
When selecting health insurance, we suggest you consider the following:
- Lifetime or per-occurrence maximums – Check to see if there are lifetime or per-occurrence maximums with the plan. Remember that medical expenses are costly. A $100,000 maximum might sound good, but it might fall short of covering the expenses for a medical emergency. [To waive the Aetna Student Health insurance plan, your insurance plan must cover a minimum of $500,000 US in medical benefits due to illness, accident, or injury per plan year.]
- Deductibles – Some plans require you to meet a deductible before the insurance begins to pay. If your plan has a $2,000 deductible, that means you are responsible for paying the first $2,000 of your medical expenses. The insurance plan will begin paying for covered services after you meet the deductible. [To waive the Aetna Student Health insurance plan, your plan cannot have a deductible higher than $5,000.]
- Location of the insurance company – To waive the Aetna Student Health insurance plan, your company must be based in the United States or Canada. If your company does not meet this requirement, your request to waive the Aetna Student Health insurance will be denied.
- Co-Payments – These are payments you need to make when you receive the benefit. Some co-payments are fairly small; however, some co-payments can be much larger. An example of a fairly small co-payment is the $10 co-payment for the visit to a specialist if you are on the Aetna Student Health insurance plan. With a co-payment, you pay the co-payment charge at the time of the visit; the insurance plan covers the remainder of the cost of the visit.
- Restrictions/Exclusions – You need to know what the plan does not cover. This section of the plan description can be as helpful as the list of benefits. On the Aetna Student Health insurance, visits to primary care providers outside UHS with 50 miles of the University are not covered by the plan. The reason for this exclusion is that primary care visits are covered in full at UHS by the mandatory health fee.
- Specific limits of coverage – Check to see if the plan limits the coverage for some of the benefits. For example, does the plan cover hospitalization fully or partially? Some plans, such as the Aetna Student Health insurance, provide different levels of coverage for doctors who are in the company's network and doctors who are out of network.
- Out-of-area coverage – If the plan you are considering is from another part of the United States, check to see if there are any restrictions in coverage when you are using the insurance when you are in Rochester or elsewhere out of the area.
- Prior approvals and referrals – You will want to notice if benefits require prior approvals and/or referrals. You will be responsible for knowing this information and sharing this information with your UHS health care provider when you come to UHS for care.
- Pre-existing conditions and waiting periods – Be sure to check to see if there are restrictions to the benefits for pre-existing conditions. The plan should have specific information about pre-existing conditions. Some plans may have waiting periods for certain benefits. This information should be included in the plan's description.
- Cost of the plan – You may want to choose a lower cost plan because it is more affordable when you are paying the premium. It is a good idea to review what is covered and what is not covered to determine if the plan provides the protection you need without extensive additional costs if you were to use the insurance.