Alfred University
2014-2015 Student Health Insurance
Your school-endorsed Plan offers you these benefits, services
and programs.
Academic HealthPlans and Aetna Student Health, working with Alfred
University, offers a student-focused health insurance plan that helps protect
students at school, at home and while traveling or studying abroad.
What is the Plan all about?
Your Student Health Insurance Plan offers you access to:

Aetna’s nationwide network of doctors, hospitals, pharmacies and
specialists throughout the country.


No Benefit Maximum .
Informed Health® Line – Call our toll-free number to talk to
registered nurses. They can share information on a range of
healthy topics.

Savings on vision, fitness, alternative health care, weight
management, books and many more!

Travel assistance services and worldwide medical coverage while
traveling or studying abroad.
 Prescription drugs are covered after $30 Copay for each Brand
Name Prescription Drug or a $15 Copay for each Generic
Prescription Drug. No Benefit Maximum
 Covered medical expenses for preventative care are paid at
100%.
How much does it cost?
ANNUAL
INSURANCE RATE
SPRING / SUMMER
INSURANCE RATE
08/14/14 to 08/13/15
01/14/15 to 08/13/15
August 5, 2014
January 11, 2015
Student Only*
$1,499
$875
Spouse Only
$4,762
$2,766
All Children
$2,458
$1,428
Coverage Dates
WAIVER DEADLINE
*The rate above includes both premium for the student health plan underwritten by Aetna
Life Insurance Company and a $10 Administrative fee charged by Alfred University.
Who is eligible?
All registered students (matriculating and non-matriculating) are
required to show proof of health insurance. Once you register
at AU, you will be automatically enrolled in the Plan and the
insurance premium will be applied to your student account.
If you have family or private health insurance, you may waive
enrollment into the Alfred University Student Health Insurance
Plan. The waiver form must be completed online at
http://www.alfred.myahpcare.com. The waiver must be
completed by August 5, 2014. Please note that international
students on F-1 visas are not eligible for this waiver and must
carry the AU insurance.
Learn More!
Call Toll Free (855) 844-3016
www.alfred.myahpcare.com
This Plan may not cover all of your health care expenses.
You are strongly encouraged to research the Plan online
and to contact the AU Wellness Center with questions at
healthinsurance@alfred.edu or call (607) 871-2400.
The Alfred University Student Health Insurance Plan is underwritten by Aetna Life Insurance Company and administered by
SM
Chickering Claims Administrators, Inc. Aetna Student Health is the brand name for products and services provided by these
companies and their applicable affiliated companies.
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Plan Maximum
Unlimited
Deductible
Non-Preferred Care: $250 for each Covered Person per Policy Year
Student Health Center Coverage
Benefits will be paid at 100% of Usual & Customary Charge up to the limits specified in the schedule for
covered expenses incurred, with the exception of Prescription Drugs and Mental Health Services.
Prescription drugs will be paid at $15 copay for generic prescriptions and $30 for brand name
prescriptions. Mental Health Services will be paid at 100% of the Covered Expenses.
In Patient Benefits
Hospital Room and Board Expense
Preferred Care
Non-Preferred Care*
80% of the Negotiated Charge for the semi-private
room rate for an overnight stay.
60% of the Reasonable Charge for the semi-private
room rate for an overnight stay after Deductible.
Surgical Expense- In Patient & Out Patient
80% of the Negotiated Charge.
60% of the Reasonable Charge.
Outpatient Benefits
Preferred Care
Non-Preferred Care
Covered Medical Expenses include, but are not limited to: Physician’s office visits, hospital or out-patient department or emergency room visits, durable medical equipment, physical therapy,
clinical lab, radiological facility or other similar facility licensed by the state.
Outpatient Miscellaneous Expense
80% of the Negotiated Charge
60% of the Reasonable Charge
Physician’s Office Visits (Copay waived for preventive services)
100% of the Negotiated Charge after $25 Copay
60% of the Reasonable Charge
X-Rays
80% of the Negotiated Charge.
60% of the Reasonable Charge.
Laboratory
80% of the Negotiated Charge.
60% of the Reasonable Charge.
Emergency Care (Copay/deductible if admitted)
100% of the Negotiated Charge after $150 Copay
100% of the Reasonable Charge after $150
deductible.
Prescription Drug Benefit
Preferred Care
Non-Preferred Care
Covered Medical Expenses for Outpatient Prescription
Drugs associated with a covered Sickness or covered
Accident occurring during the Policy Year. Please note:
Generic Prescription Drug: 100% after $15 Copay
Generic Prescription Drug: 100% after $15 Copay
Brand Name Prescription Drug: 100% after a $30
Copay
Brand Name Prescription Drug: 100% after a $30
Copay
You are required to pay in full at the time of service for all
prescriptions dispensed at a Non-Participating Pharmacy.
Your student health insurance coverage, offered by Aetna Student Health*, may not meet the minimum standards required by the health care reform law
for the restrictions on annual dollar limits. The annual dollar limits ensure that consumers have sufficient access to medical benefits throughout the
annual term of the policy. Restrictions for annual dollar limits for group and individual health insurance coverage are $1.25 million for policy years before
September 23, 2012; and $2 million for policy years beginning on or after September 23, 2012 but before January 1, 2014. Restrictions for annual dollar
limits for student health insurance coverage are $100,000 for policy years before September 23, 2012, and $500,000 for policy years beginning on or
after September 23, 2012, but before January 1, 2014. Your student health insurance coverage includes an annual limit of $500,000 on all covered
services including Essential Health Benefits. Other internal maximums (on Essential Health Benefits and certain other services) are described more fully
in the benefits chart included inside this Plan summary. If you have any questions or concerns about this notice, contact (855) 247-2273. Be advised that
you may be eligible for coverage under a group health plan of a parent’s employer or under a parent’s individual health insurance policy if you are under
the age of 26. Contact the plan administrator of the parent’s employer plan or the parent’s individual health insurance issuer for more information.
PLEASE READ CAREFULLY BEFORE DECIDING WHETHER THIS PLAN IS RIGHT FOR YOU:
• Please read the Alfred University Student Health Insurance Plan Summary of Benefits located at www.alfred.myahpcare.com carefully before
enrolling. While this document and the Alfred University Student Health Insurance Plan 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 by calling toll-free
(855) 844-3016.
For more information on plan exclusions, limitations and benefit maximums, please refer to the Alfred University Student Health Insurance Plan Summary of
Benefits 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.
This material is for information only. Health insurance plans contain exclusions, limitations and benefit maximums. Discount programs provide access to discounted rates
and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Discounts are subject to change without notice. Discount programs
may not be available in all states. Discount programs and travel assistance services may be offered by vendors who are independent contractors and not employees or
agents of Aetna. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care
professionals. Preferred providers are independent contractors and are neither employees nor agents of Aetna Life Insurance Company, Chickering Claims Administrators,
Inc. or their affiliates.
Policy forms issued in OK include GR-96134.
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© 2014 Aetna Inc.