Oregon Health & Science University Student Insurance Plan 2010-2011

Aetna Student Health, working with Oregon Health & Science 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 school-endorsed Student Health Insurance Plan offers you access to:

Aetna’s nationwide network of doctors, hospitals, pharmacies and specialists throughout the country.

An award-winning online secure member website, Aetna Navigator®

Informed Health® Line – Our 24-hour toll-free number that puts you in touch with experienced registered nurses and an audio library for information on thousands of health topics.

Fitness Program, Alternative Health Care Programs, Weight Management Discounts, Zagat Survey® Healthy Dining, eDiets® , Mayo Clinic Bookstore.com and many more!

Travel Assistance Services and Worldwide Medical Coverage while traveling or studying abroad

Dental insurance plan included for all OHSU programs excluding the School of Dentistry, PharmD and CDRC.

How much does it cost?

Monthly Student Rate Local $269.93

Distant $325.60

Important Information:

After June 25th additional information on the plan including dependent rates will be available online at www.aetnastudenthealth.com and www.ohsu.edu/academic/acad/health/

Eligibility Information: OHSU requires that ALL full-time students have supplemental health insurance. This will help to cover the cost of care that cannot be obtained on campus, especially in emergency situations where hospitalization may be required. You are automatically enrolled in the OHSU Student Health Insurance Plan if you are:

− Taking 6 or more units

− Enrolled at OHSU campus in Portland, Marquam Hill, South Waterfront, or West Campus.

− An international student

If you already have a health insurance plan (or you are on your parents' plan) you may be eligible to waive enrollment in the OHSU Student Health Insurance Plan by providing proof of comparable coverage. Email communications will be sent during the month of June regarding the waiver application process for 2010-2011.

This material is for information only. Health insurance plans contain exclusions and limitations. 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

ompany, Chickering Claims Administrators, Inc. or their affiliates. C

The [school name] Student Health Insurance Plan is underwritten by Aetna Life Insurance Company (ALIC) and administered by Chickering Claims Administrators, Inc. Aetna Student HealthSM is the brand name for products and services provided by these companies and their applicable affiliated companies.

Policy forms issued in OK include GR-96134. © 2010 Aetna Inc.

15.03.318.1 D

Oregon Health & Science University Student Insurance Benefit Overview

PREFERRED CARE NON-PREFERRED CARE

Lifetime Maximum $1,000,000 Annual Deductible $350 Individual/$1,050 Family $700 Individual/$2,100 Family Annual Out of Pocket Maximum - Medical $2,000 Per Person Per Policy Year Annual Out of Pocket Maximum - Prescription $1,000 Per Person Per Policy Year INPATIENT EXPENSESHospital Room and Board Expenses 80% of Negotiated Charge 60% of RC Intensive Care Expenses 80% of Negotiated Charge 60% of RC Physician Hospital Visit Expenses 80% of Negotiated Charge 60% of RC SURGICAL EXPENSESInpatient/Outpatient Surgical Facility Expenses 80% of Negotiated Charge 60% of RC Anesthetist Expenses 80% of Negotiated Charge 60% of RC Inpatient Assistant Surgeon Expenses 80% of Negotiated Charge 60% of RC Outpatient Assistant Surgeon Expenses 80% of Negotiated Charge 60% of RC OUTPATIENT EXPENSESPhysician’s Office Visit/Consults Expenses 80% of Negotiated Charge 60% of RC Laboratory & X-Ray Expenses 100% of Negotiated Charge after a $10

Copay 60% of RC

Therapy Expenses –Chiropractic limited to 20 visits per policy year

80% of Negotiated Charge 60% of RC

Emergency Room Expenses - Copay/Deductible waived if admitted.

100% of Negotiated Charge after a $150Copay

100% of RC after a $150 Copay

MENTAL HEALTH AND SUBSTANCE ABUSE EXPENSESInpatient Mental Health, 80% of Negotiated Charge 60% of RC Outpatient Mental Health 80% of Negotiated Charge 60% of RC Inpatient Substance Abuse Expenses, 80% of Negotiated Charge 60% of RC Outpatient Substance Abuse Expenses, 80% of Negotiated Charge 60% of RC ADDITIONAL EXPENSESAmbulance Expenses, benefit is limited to: maximum of $500 per trip

100% of the Actual Charge

Durable Medical Equipment Expenses 80% of Negotiated Charge 60% of RC PRESCRIPTION DRUG EXPENSES – Retail 30 Day Supply

100% of the Negotiated Charge after a: 100% of the Reasonable Charge after a:$15 Copay for Generic Drugs $25 Copay for Preferred Brand Drugs $50 Copay for Non-Preferred Brand Drugs

$15 Copay for Generic Drugs $25 Copay for Preferred Brand Drugs $50 Copay for Non-Preferred Brand Drugs

PRESCRIPTION DRUG EXPENSES – 100% of the Negotiated Charge after a: 100% of the Reasonable Charge after a:Mail Order 90 Day Supply $30 Copay for Generic Drugs $30 Copay for Generic Drugs

$50 Copay for Preferred Brand Drugs $50 Copay for Preferred Brand Drugs $100 Copay for Non-Preferred Brand Drugs

$100 Copay for Non-Preferred Brand Drugs

The OHSU school plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the OHSU brochure carefully before deciding whether this plan is right for you. While this document and the OHSU] brochure tell you about some of the important features of the plan, other features may be important to you and some further 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 OHSU, you may view it upon request at Student Services or you may contact us at (617) 218-8400].

This plan will never pay more than $1,000,000 in a coverage year or more than $1,000,000 per lifetime Additional plan maximums may also apply. Some illnesses may cost more to treat and health care providers may bill you for what the plan does not cover.

© 2010 Aetna Inc. 15.03.318.1 D