Hobart Undergrad Benefit Highlight Flyer 2014.indd

Hobart and William Smith Colleges
Student Health Insurance Plan
Eligibility Highlights
Staying healthy is one of the most important things you can do for yourself. When facing a health
problem that may come up while you are at college, not getting the care you need due to lack of
insurance or high out-of-pocket costs can turn into a roadblock in achieving your academic goals. Student
Health Insurance provides you coverage for the unexpected, as well as
Need to Make a decision?
access to the medical services available on-campus, near campus and
anywhere that you may live or travel.
Keep in mind that your Student Health
Insurance Plan:
To help all students have health insurance coverage, your School has
„ Coordinates with your on-campus
automatically enrolled you in and billed you for the Student Health
Student Health Services
Insurance Plan.
„ Gives you easy access to providers in
and out-of -network, both near campus
or anywhere you may live or travel
„ Includes access to Worldwide Travel
Assistance, Medical Evacuation and
Repatriation Coverage
„ Provides comprehensive benefits,
including wellness services
„ Allows access to discounts on dental &
vision services
„ Does not require you to submit a claim
form; participating providers will bill
the claims company (Aetna Student
Health) directly
„ Offers access to exceptional service from
Gallagher Student’s Customer Service
team, ready to assist you with your
insurance needs and questions
7/1/14 -6/30/15
1/1/15 - 6/30/15
Student Only
Spouse/Domestic Partner
Coverage Period
The rate above includes both premium for the student health plan underwritten by Aetna Life Insurance
Company and as well as a HWSColleges administrative fee
Toll-Free Phone
Monday-Friday 8:30 a.m. – 6:30 p.m. EST
Email (Responses generally within 1 business day)
Online Plan Information
Available 24/7, LiveChat available during business hours
[email protected]
Mailing Address
500 Victory Road
Quincy MA 02171
This plan is subject to benefit limitations and exclusions and is
Underwritten by:
Aetna Life Insurance Company
Claims are administered by
Aetna Student Health*
*The HWS Student Health Insurance Plan is underwritten by Aetna Life Insurance Company 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.
Hobart and William Smith Colleges
2014-2015 Student Health Insurance Plan Benefit Highlights
The information provided below is used as a general summary of benefits. For a detailed plan description, limitations, and exclusions, visit
Plan Maximum
Policy Year Deductible
Inpatient Hospital Expense
Surgery Expense
Physician’s Office Visit
Laboratory, X-rays and Diagnostic Testing
Emergency Room
Inpatient Mental Health
Outpatient Mental Health
Outpatient Pharmacy Program
Prescriptions must be filled at a Aetna Pharmacy Network
Wellness/Preventive Services
$200 Per Insured, Per Policy Year
$400 Per Insured, Per Policy Year
90% of the Negotiated Charge (NC),
after a $50 per admission Copay
70% of the Recognized Charge (RC),
after a $100 per admission Deductible
90% NC,
after Deductible
70% RC,
after Deductible
100% NC,
after a $25 Copay per visit
100% RC,
after a $40 Deductible
100% NC,
after Deductible
70% RC,
after Deductible
90% NC,
after a $100 per visit copay
(waived if admitted)
Policy Year Deductible applies
90% RC,
after a $100 per visit deductible
(waived if admitted)
Policy Year Deductible applies
90% NC,
after a $50 per admission Copay
70% RC,
after a $100 per admission Deductible
100% NC,
after a $25 Copay per visit
100% RC,
after a $40 Deductible
$15 generic Copay, $45 brand name
Copay, $75 non-formulary brand name
80% RC
100% NC
70% RC,
after Deductible
• Please read the HWS Colleges brochure when available located at www.gallagherstudent.com/hws carefully. While this document
describes 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.gallagherstudent.com/hws when available or contact us at 877-367-2835.
For more information on plan exclusions, limitations, and benefit maximums, please refer to the HWS Colleges school 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] or [dependents
in total].This material is for information only. 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.
Underwritten bt:
Aetna LIfe Insurance Company