At a Glance: Student Coverage
The Student and Dependent Medical Plans are administered by Aetna Student Health (877.850.6038). Prescriptions are administered by Envision Rx (800.361.4542).
| Aggregate Medical Policy Year Maximum |
$250,000 |
| Aggregate Mental Health Policy Year Maximum |
$20,000 |
| Annual Out-of-Pocket Limit |
$5,000 |
The following table includes the percentage and/or fees students will pay for healthcare while enrolled in the Student Medical Plan. For example, students who schedule an office visit through an Aetna Network Provider are responsible for paying a $20 co-pay due at the time of the visit. In addition to the co-pay, students are required to pay 20 percent of the cost of care while Aetna pays 80 percent.
In the case of Non-Network Providers, 60/40 means Aetna pays 60 percent of the cost while students pay the remaining 40 percent.
|
| Aetna Network Provider |
Out of Network Provider |
Point of Service Costs |
| Physician's Office Visit |
80/20 |
60/40 |
$20* |
| Inpatient Hospitalization |
80/20 |
60/40 |
|
| Urgent Care |
80/20 |
60/40 |
$30 |
| Emergency Room |
80/20 |
80/20 |
$50** |
| X-Ray and Lab |
80/20 |
60/40 |
|
| Mental Illness and Chemical Dependency Treatment. (Outpatient visits limited to 26 per plan year). |
80/20 |
60/40 |
|
*$20 Copay for In-Network providers and $20 co-pay for Out-of-Network providers
**$50 Copay for In-Network providers and $50 co-pay for Out-of-Network providers, waived if admitted