Health Insurance FAQs

Student health insurance concerns are handled primarily by the Student Health Insurance office.  You should contact the Student Health Insurance office directly if you have specific concerns over how current insurance cases of yours are being handled or need clarification concerning the student insurance policy beyond what is included in this FAQ.

The FAQ is currently divided into three sections: two with general information on health insurance for students, and one with information specific to the current (2016-2017) policy year. As soon as information is known about the 2017-2018 plan year, information will be posted here. Links are provided at the top and bottom of each section. Throughout the document, “UHS” refers to the University Health Services clinic on the Penn State University Park campus and “ACA” refers to the Patient Protection and Affordable Care Act (also known as ObamaCare).

This FAQ is developed and maintained by the health insurance committee of the GPSA. It is for informational purposes only. While we make every effort to keep it accurate and up to date, it does not constitute legal or financial advice. If you believe it contains an error or have specific concerns about the FAQ, please contact the GPSA office.


FAQ Topics Directory:


 

Health Insurance Terminology FAQs

Updated April 16, 2015

 

What is a health insurance premium?

The premium is the cost paid by an individual or sponsor to purchase insurance coverage. This money is pooled together to pay health care costs for members. Premiums are subsidized by the university for graduate assistants and graduate fellows.

What is the difference between copays and coinsurance?

A copay is a set fee which individuals pay each time they receive a certain type of treatment (appointment, procedure, prescription). Copays are the same regardless of how much the insurance pays for the care, but may vary depending on the location (e.g. emergency room) or details (e.g. name brand vs. generic prescription) of the treatment.

Coinsurance is a set percentage of the cost which individuals pay when they receive treatment. They are calculated based on the amount the insurance provider has negotiated with the doctor as payment.

What is a deductible?

A deductible is the dollar amount of treatment which individuals or families must pay directly out-of-pocket each policy year (August-August for student health insurance, January-December for marketplace plans) before insurance will pay for treatment. Once the deductible has been met, insurance pays for treatment at the rates listed in the plan brochure. Adults on the student health insurance policy can receive treatment at UHS without paying the deductible, but the deductible will still apply for any non-UHS care. Plans which are copay-based sometimes do not require a deductible.

Is there a limit to how much I have to pay for treatment?

All insurance policies are required to have an out-of-pocket maximum for treatment by in-network providers. Once an individual or family has paid the out-of-pocket maximum through any combination of deductibles, copays and coinsurance, the insurance policy is required to pay 100% of the costs for covered treatment by in-network providers. Some plans also have overall out-of-pocket maximums for any treatment, regardless of whether the provider is in-network.

 


Terminology | General Information | Current Plan


 

Student Health Insurance General FAQs

Updated September 24, 2015

Are graduate and professional students required to have health insurance?

Yes. The Affordable Care Act requires all adults in the United States to carry adequate health insurance. Students may choose to purchase the student health insurance plan, purchase insurance through an eligible family member’s employer sponsored plan, apply for Medicaid, or purchase insurance on the health insurance exchange. However, for graduate assistants and fellows, the university will only subsidize premium payments for the student health insurance plan. International students who decide not to opt in to the student health insurance plan offered through Penn State must additionally provide proof that any outside plan meets the mandatory insurance waiver standards.

How can I add my family to the student health insurance plan?

At the beginning of Fall or Spring semester, an enrollment period for adding dependents is available online through the Student Health Insurance office’s website. Once a spouse and/or child(ren) are added in the Fall semester of each year, they do not need to be re-enrolled in the Spring if the current graduate assistant appointment or fellowship continues. You must contact the Student Health Insurance office for enrolling individuals during a special enrollment period.  If the family of an international student arrives in the U.S. at a date later than the student and outside the open enrollment period, the student must contact the Student Health Insurance office within 10 days to add their dependents to the plan.

How can I opt out of the student health insurance plan?

Graduate assistants and fellows are automatically enrolled in single student health insurance and must opt out every fall through the Student Health Insurance office’s website during the open enrollment period if they wish to use a different insurance provider. Email reminders are sent out at the beginning of each semester reminding students of when open enrollment is occurring.

Where should I go to get treated?

If you are experiencing a life-threatening emergency, call 911 or go to the nearest emergency room immediately. In most other situations, adults on the student health insurance policy are expected to make an appointment at UHS before seeing an outside provider. If necessary, a UHS physician can refer you to an in-network provider in the necessary specialty. If you require urgent non-emergency treatment (such as minor injuries) on evenings, Sundays, or holidays when UHS is closed, a number of urgent care facilities (MedExpress Urgent Care at 1613 N. Atherton is one such in-network center)* also accept the student health insurance. Network providers for the 2015-2016 plan year can be located using Aetna Navigator.

If you are not certain whether you need to see a doctor, a 24-hour nurse line is available to all students and plan members on the student health insurance policy. The phone number is 814-863-4463.

If you are traveling and unable to visit UHS, consult Aetna Navigator to find an eligible in-network provider in your area. After an unplanned trip to the hospital or emergency room, you must contact Aetna within 48 hours for pre-certification or you may be responsible for additional charges. The phone number is 877-480-4161.

How do I obtain a referral to see an outside specialist?

Typically, you will be referred to a specialist by a UHS physician. If a non-UHS provider (including specialists and emergency room providers) refers you to another provider, it is the student’s responsibility to see a primary care physician at UHS prior to seeing the specialist to verify whether additional action is necessary to obtain a referral which is valid for insurance purposes. Referrals may not be valid if they were made in the previous policy year and it is the student’s responsibility to verify referral status with UHS before being treated by an outside specialist.

How do I find a mental health provider?

If you suspect that you or someone you know may be in imminent danger due to a mental health condition, call 911 or the Centre County CAN HELP Crisis Line (1-800-643-5432). CAPS (Penn State Counseling and Psychological Services) also provides short-term counseling and mental health provider recommendations at no cost to students. Referrals are not required for mental health counseling providers, but it is important to verify that a provider accepts the student health insurance as an in-network provider prior to beginning treatment. If you elect to seek treatment with a non-network mental health provider, you will be responsible for higher portion of per-appointment costs and experience higher maximum annual out-of-pocket treatment costs.

How do I know how much and when to pay?

Monthly premiums are automatically deducted from graduate assistant and graduate fellows’ paychecks. For self-paying students, premiums are due to the medical insurance carrier or the Student Health Insurance office on or before the enrollment deadline for each semester.

After you receive treatment, in-network providers will bill your insurance. If you see an out-of-network provider, you will likely have to submit the bill to the insurance yourself. Once the insurance provider has paid their portion, you will receive an EOB (Explanation of Benefits) statement from the insurance provider. This is not a bill but instead shows what the provider charged, what portion the insurance paid and what portion will be patient responsibility. If there is patient responsibility remaining, the provider will send you a bill which lists a payment due date.

How can I keep my health care costs to a minimum?

Understanding your insurance and treatment options is the most important step to controlling costs. By using UHS whenever possible, ensuring you have valid referrals to in-network providers, and eliminating visits to the emergency room or out-of-network providers, you can keep costs down for yourself and others. Using the UHS pharmacy whenever possible and choosing the 90-day supply option for long-term prescriptions can also provide substantial savings.

What if I still can’t afford the out-of-pocket costs?

A number of options may still be available to you if you are unable to afford necessary medical treatment. Penn State has set up a student emergency fund for unexpected and emergency expenses, which students can apply to here. Most medical and mental health providers are willing to set up a payment plan for those who are unable to immediately pay their costs in full. Hospitals may also have charity care programs where patients under a certain income who cannot pay for their treatment can receive a discount or forgiveness.

 

*This is purely informational and does not constitute an endorsement of any treatment facility

 


Terminology | General Information | Current Plan


 

2016-2017 (Current) Student Health Insurance FAQs

Updated September 1, 2016

 

What is the current student medical plan?

After a competitive bidding process, Aetna was selected to continue as the Penn State Student Health Insurance provider. The plan is similar to the previous 2015-2016 plan. Nearly all visits and procedures at University Health Services will continue to be covered at 100%, while services elsewhere will require some payment by the insured student or dependent. It is a platinum value plan, meaning that it covers the highest proportion of medical expenses allowed on an individual plan under the Affordable Care Act.

For a full list of costs and coverage, view the 2016-2017 Plan Design and Benefits Summary. The table below summarizes the major features of the medical insurance plan:

  • Annual Deductible: $250 individual/$500 family
  • Out of Pocket Limit: $1,300 individual/$2,600 family in-network; $15,000 out-of-network
  • Non-UHS Primary Care Physician Office Visit: 100% after $10 copay preferred care/30% coinsurance non-preferred care
  • Specialist Physician Office Visit: 10% coinsurance preferred care/30% coinsurance non-preferred care
  • Outpatient Mental Health: 100% after $10 copay preferred care/30% coinsurance non-preferred care
  • Inpatient Hospitalization: 10% coinsurance preferred care/30% coinsurance non-preferred care
  • Emergency Room: 10% coinsurance after $150 copay (waived if admitted)
  • Lab/X-Ray: 100% at UHS/10% coinsurance preferred care/30% coinsurance non-preferred care
  • Prescribed medicines: 100% at UHS and Hershey Medical Center/$10 (generics); $30 (formulary brand name); $60 (non-formulary brand name) copay in-network/50% coinsurance out-of-network
  • Treatment at UHS: 100% coverage with deductible waived

How much does the medical plan cost?

Annual premiums will be:

  • Medical Students (1st year students – starting 7/15/2016):  $3448
  • Undergraduate/Graduate/Law/Medical (other than 1st year medical) Students:  $3296
  • Spouses and Dependents of students: $3296 per individual
  • Visiting Scholars (monthly rate):  $274.17

Compared to the 2015-2016 rates, this represents a 7.9% increase for students and dependents. Additionally, federal law requires that premiums be set at the same rate for each individual, so all spouses and dependents will pay the same rate as students.  A family of four or more would pay 4 times the individual rate, and this is the highest premium any student with a family would pay.

Graduate Assistants and Fellows will continue to receive subsidies from the University at the 2015-16 rates, as outlined below:

Screen Shot 2016-09-01 at 9.40.17 AM

That’s a lot of money…

The premium cost may be high upfront for some students without assistantships/fellowships; however, the plan is very comprehensive. For many appointments and medications treated at UHS, the student will encounter no costs when they receive treatment and/or drugs.

How do copays and deductibles work together?

As long as they are with preferred providers, most non-UHS primary care physician office visits (not specialist visits) and non-CAPS outpatient mental health visits will fall under a copay system in the new health insurance plan. Deductibles do not apply to these appointments. An in-network outpatient mental health visit, for example, will cost $10 regardless of whether you have previously paid any or all of your deductible. Non-UHS or Hershey prescriptions at in-network pharmacies will also have deductible-exempt copays (see below). The deductible will still be applied for emergency room visits, however, as 10% coinsurance is required after the copay.

What about prescription benefits?

Formulary prescriptions available at UHS and Hershey will continue to be covered at 100% and prescriptions at out-of-network pharmacies will continue to require a 50% coinsurance. Prescriptions at pharmacies in the Aetna provider network are available for $10/$30/$60 copays. This allows greater flexibility for students and families who need prescriptions when UHS is closed, over holidays, and when traveling.

Can I add my spouse or child(ren)?

In principle, any student can add their spouse/domestic partner and/or child(ren). Dependents must be enrolled every fall semester. Spouses/domestic partners can use UHS doctors. Children must use non-UHS doctors. Graduate students with assistantships and fellowships receive 75-76% subsidy of premiums for their dependents (See Table above).

Is there any other time I can enroll myself/my dependents in the Health Insurance plans?

Once new open enrollment for the 2016-2017 student health insurance is closed, new babies can be enrolled in the plan within 31 days after birth. A limited window is available after life changes (marriage, job change, death of family member providing insurance). For special enrollment, please contact UHS directly.

Why does my assistantship/fellowship contribution go up in Spring semester?

The Spring semester insurance contributions also pay for the summer following Spring semester, even if you graduate in the spring. Contributions are not made during the summer.

Is the Penn State plan in compliance with the Affordable Care Act (ACA)?

Yes. It is an individual insurance plan in full compliance with ACA standards.

I heard that I can’t go to UHS at the end of the semester if I want to register for classes on time.

This information is not true. Formerly, pending insurance charges were placed on the bursar account and held up some students’ registration. All billing is now done in-house.

But I have a bill on my bursar’s account for UHS…

If you have charges on your bursar’s account and carry the student health insurance plan, the insurance company has declined payment of those services. You owe the balance listed. If you think this is a mistake, please contact UHS or Aetna directly.

How does this plan compare to those on the exchange?

Everyone’s healthcare needs are different.  This plan provides very comparable benefits and premium rates to the Platinum plans on the exchange for individuals, better for many people when you consider the UHS coverage and pharmacy benefits available in our plan.  Families vary widely in their composition and healthcare needs, making it harder to say.  Do be aware that the plans on the exchanges will likely vary in their networks, resulting in a different collection of doctors and hospitals/care centers being covered.  International students should be sure they understand the plans they are considering and ensure the plan meets the Mandatory Health Insurance requirements.

What about International students?

International students are required to provide proof of adequate insurance according to current waiver standard criteria (found here). The Student Health Insurance Plan saw a 39% decrease in enrollment of international students during the 2015-2016 academic year, which resulted in a smaller pool for the student plan (and higher premiums). In addition, some of the international students who left the Student Health Insurance Plan had unsatisfactory experiences with other providers who had designed their plans to meet the current waiver standards, but were not comprehensive in other aspects. Penn State has instituted new strict criteria (that can be found here) in order to assure quality healthcare for international students as well as encourage them to enroll in the Student Health Insurance Plan to keep the pool size large, and, therefore, premium rates low.

What should we expect in the future (beyond 2016-2017) and is there anything we can do now to look ahead?

The current contract with Aetna will end after the 2016-2017 academic year. The University along with the Student Insurance Office, Student Insurance Advisory Board and Counsel, and other pertinent parties will be putting out a request for proposals in the 2016-2017 academic year in preparation for the 2017-2018 plan year. Potential providers will put forth proposed plans and premium bids. The GPSA and its liaisons will be involved in this process and provide updates as they are available.

Regardless of the provider selected, the basic structure of benefits will, most likely, remain similar to the current plan, with adjustments being made primarily to reflect any legal changes or changes in services available through UHS. If any major plans are deemed necessary, the student body will be contacted to provide feedback, questions, and concerns.

The premium is always subject to annual adjustment based on utilization, enrollment and overall growth in health care costs. The more people that are enrolled in our plan and the less costly treatment they require as an entire population, the lower rates are likely to be in following years. This does not mean that a single individual should not seek necessary treatment in hopes of keeping cost low; insurance is meant to be utilized and any one individual is not likely to affect the overall premium level substantially. ACA-related taxes on health insurance are also set to increase, adding costs over time to the plan.

Nevertheless, even once a new contract is enacted, it will be difficult to predict all future changes. Utilization fluctuates from year to year. In addition, changes to definitions, formulae, or legal interpretation can produce notable consequences for our plan.

I’ve heard about a requirement of insurance for all students. What about that?

The University is in the process of enacting a hard waiver for health insurance that will impact all students (domestic and international) beginning in the Fall of 2017. This step comes after the recommendation put forth in the report submitted by the Student Health Insurance Task Force  in October of 2014 that encouraged the University to require that all full-time students have proof of insurance. Beginning with enrollment in the 2017-2018 academic year, all domestic and international students will need to provide proof of adequate insurance to waive out of the Student Health Insurance Plan. The implementation of this waiver will help provide insurance to currently uninsured or under-insured individuals, while providing a larger enrollment pool for the Student Health Insurance Plan and possibly lowering premium rates.

What about International Students being required to enroll in the Student Health Insurance Plan?

When the requirement for insurance of all full-time students is implemented (Fall of 2017), the University will add an additional mandate for international students that will require them to enroll in the Student Health Insurance Plan. The only exceptions to this requirement are students with an employer-sponsored plan or those with a sponsor who guarantees coverage equal to or better than the current student health insurance plan and provide a letter of financial guarantee for any medical charges not covered by the plan.


Terminology | General Information | Current Plan

 


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