Aetna Student HealthSM
Rochester Institute of Technology's
choice for student health insurance
www.aetnastudenthealth.com
15.02.382.1 (5/13)
9365
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Aetna
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AetnaStudent
StudentHealth
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CCA and
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(Aetna).
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 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
What I can buy from Aetna Student
Health — even if I decide not to buy
this insurance:
Discount programs on dental and prescription
services
To find out more about the
plan and to sign up, go to
www.aetnastudenthealth.com.
Here's what the plan offers
Here is a brief description of the plan benefits.
Aggregate Maximum: $500,000 per sickness per policy year
Pharmacy Maximum: $500,000 per policy year
Basic Accident Plan
Maximum
$500,000 per Accidental Injury
Basic Sickness
Plan Expenses
Preferred
Non-Preferred
Physician's Office
Visit
100% of the
Negotiated Charge for
the first $2000 of
Medical Expenses:
80% thereafter
100% of the
Recognized Charge for
the first $2000 of
Medical Expenses:
80% thereafter
Inpatient
Hospitalization
80% of the Negotiated 80% of the Recognized
Charge per sickness Charge for a semiper policy year
private room
Emergency Room
100% of the
Negotiated Charge for
the first $2000 of
Medical Expenses:
80% thereafter
100% of the
Recognized Charge for
the first $2000 of
Medical Expenses:
80% thereafter
Outpatient Mental
100% of the
Negotiated Charge for
the first $2000 of
Medical Expenses:
80% thereafter
100% of the
Recognized Charge for
the first $2000 of
Medical Expenses:
80% thereafter
Prescription Drug
100% of the
Negotiated Charge
after a $10 copay for
generic drugs; $30 for
brand name drugs
100% of the
Recognized Charge
after a $10 copay for
generic drugs; $30 for
brand name drugs
Basic Accident Plan
Expenses
Preferred
Non-Preferred
Accident Coverage
100% Negotiated Rate 100% Recognized
of the first $3,000 of Charge of the first
Covered Medical
$3,000 of Covered
Expenses;
Medical Expenses:80%
80%Negotiated Rate Recognized Charge
thereafter
thereafter
Please read carefully before deciding whether this plan is right for you:
• This plan will not pay more than the overall maximum benefit of $500,000 per
condition per policy year during the plan year.
• This plan will not pay more than $500,000 per condition per policy year 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 treat than this plan will cover.
• Please read the Rochester Institute of Technology brochure at www.aetnastudenthealth.com
carefully before enrolling. While this document and the Rochester Institute of Technology
brochure describe important features of the plan, there may be other specifics of the
plan that are important to you, and some 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 the school, you may view it at www.aetnastudenthealth.com or contact us at
800-466-3185.
For more information on other plan exclusions, limitations and benefits
maximums, please refer to the Rochester Institute of Technology's brochure and
Master Policy. This plan pays benefits only for expenses incurred while the
coverage is in force and only for the medically necessary treatment of injury or
disease. The coverage displayed in this document reflects certain mandate(s) of
the state in which the policy was written. However, certain federal laws and
regulations could also affect how this coverage pays. Unless otherwise
indicated, all benefits and limitations are per covered person.
Where can I go for service?
First stop, the student health center. When
you need care, consider the student health
center as your first stop. They can provide
many of the routine health services you need.
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 the student health
center first, you’ll generally pay less out of
your own pocket for your care. To learn more
about preferred providers, visit
www.aetnastudenthealth.com.
*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.
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
not and
employees
or agents
of Aetna.
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Policy forms
in OK include:
GR-96134.
may change without notice. Aetna does not provide care or guarantee access to
Your
student health insurance coverage, offered by Aetna Student
Your
student
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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.
International student waiver submissions may be audited by Rochester Institute of Technology,
Waiver
submissions
may
be audited
by Rochester
Institute of Technology,
Student
Health,
Aetna Student
Health,
and/or
its contractors
or representatives.
You may beAetna
required
to provide,
and/or
its contractors
or representatives.
Youother
may records
be required
to provide,that
upon
any
upon request,
any coverage
documents and/or
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meet the
coverage
documents for
and/or
other
recordshealth
demonstrating
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meet the
school’s
school’s requirements
waiving
the student
insurance plan.
submitting
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By contacted
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requirements.
Please make sure
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andother
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enrolling
forfor
enrolling
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eligibility
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plan.Aetna
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its terms
applicable
This material is
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informationonly.
only.Health
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benefitsand
andinsurance
insuranceplans
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Information is believed to
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theproduction
productiondate;
date;however,
however,ititisissubject
subjecttotochange.
change.
Policy forms issued in OK include:
include: GR-96134.
GR-96134.
How much does it cost?
Annual
Spring
Coverage
8/15/13-8/14/14
1/15/14-8/14/14
Student Only
$1248
$725
Spouse
$2477
$1439
Child(ren)
$2007
$1166
How and when do I enroll in the plan?
RIT
requires allinstudents
toInstitute
have adequate
Participation
Rochester
of
Here's
when
you have to
signon
uptheir active
be billed
semi-annually
based
medical
insurance.
registrationand
status.
All other
international
Technology’s
Student
Waiver
deadline
dates:
How
much
does itHealth
cost?Insurance Plan Enrollment
students
wishing
to
enroll
should
download
is
required
by
your
school
for
all
eligible
fullDomestic students may voluntarily elect to
Fall
-fill9/30/13
Annual
Spring
and
out
the
application
found
at
www.
time
undergraduate
students,
unless
they
are
enroll in the plan by:
universityhealthplans.com.
2/27/14
Spring
covered
under
another
comparable
plan.
Coverage
1/15/14-8/14/14
8/15/13-8/14/14
Going
Online at www.universityhealthplans.com
Proof of comparable
coverage,
in accordance
Please note that enrollment deadlines
Students
have
the
option
to
either
put
the
Student Only
$1248
$725
with your
must
and termination dates may vary for
charge
onschool’s
their RITrequirements,
student account
or be
completed
and
to Rochester
Spouse can
$2477
$1439
international students.
payment
bereturned
made online
with a credit
Institute
of Technology
each academic
year
card.
Please
review
the
requirements
below:
Dependent Coverage
Child(ren)
$2007
$1166
by the enrollment deadlines.
Domestic Students
Eligible students who enroll may also cover
their eligible dependents. The coverage
RIT requires all domestic students to have
period must be concurrent with the insured
adequate medical insurance. If a student
Hownot
and
when
do I this
enroll
in the plan? student’s.
does
have
coverage,
requirement
may be satisfied by enrolling for Basic
Participation in Rochester Institute of
Here's when you have to sign up
Accident & Sickness coverage.
Technology’s Student Health Insurance Plan
Enrollment and Waiver deadline dates:
International
Students
is required by your
school for all eligible fullFall - 9/30/13
All
matriculated,
RIT International
students
time
undergraduate
students, unless
they are
on
A, B, E,
F,G, I,another
J, K, O, Q,
R and V visas
will be
Spring - 2/27/14
covered
under
comparable
plan.
automatically
enrolledcoverage,
in RIT’s Aetna
Student
Proof of comparable
in accordance
Health
Plan.
Theserequirements,
international students
with your
school’s
must be will
completed and returned to Rochester
Institute of Technology each academic year
by the enrollment deadlines.
©2013 Aetna Inc.
15.02.382.1 (5/13)
Aetna Student Health
c/o Communications Dept.
200 Rivers Edge Dr.
Medford, MA 02155