2008-09 Health Insurance Requirement for all Emory Students

THE 2008-09 STUDENT HEALTH INSURANCE REQUIREMENT WAIVER SITE IS OPEN
April 15-August 28, 2008 AT www.opus.emory.edu

When uninsured/underinsured students become seriously ill or injured, their academic careers can be significantly threatened by substantial healthcare debt, disability or both.   Therefore, all new and continuing degree-seeking and international Emory University students (including Oxford College) are required to have health insurance.   Under this requirement, students must either purchase the Emory University Student Health Insurance Plan (offered by Aetna/The Chickering Group) or provide documentation of enrollment in a comparable United States-domiciled plan.   All 2008-09 degree-seeking students and all international students will have a link on their OPUS account at www.opus.emory.edu beginning April 15, 2008, requiring them to complete the waiver process on-line by the first day of Fall Semester classes (August 28, 2008).

  If a student has not waived out of the Emory Student Health Insurance Plan by July 1^st, he/she will be automatically enrolled in the Emory/Aetna plan for 2008-09 and billed by the Emory Student Financial Services (SFS).  However, the student will still have until August 28, 2008 at 5:00 pm to complete a waiver and have the insurance enrollment and charge reversed.  

Students will need to complete the annual insurance enrollment/waiver process each year they are enrolled at Emory.  If the student wishes to be enrolled in the Emory University Student Health Insurance Plan, that enrollment will happen automatically at the end of the waiver process.

To complete the insurance enrollment/waiver process for 2008-09, do the following: Go to www.opus.emory.edu   Enter using your Emory Network ID and Password Select “Mandatory Student Health Insurance Waiver” on the Learner Services page Follow the four-steps to complete the waiver process

In order for an insurance plan to meet the 2008-09 Emory University health insurance requirement waiver criteria, the insurance plan must feature, at a minimum, all three of the following:

1. Coverage that allows the insured student to receive outpatient, emergency, specialist and inpatient care, diagnostic testing and procedures, and mental health inpatient and outpatient care, including alcohol and substance abuse treatment, in Atlanta, GA.  (Please note that coverage in Atlanta for emergency care only does not meet this waiver criterion.)
2. An individual annual deductible not greater than $2,500 per policy year.   If the annual deductible exceeds $2,500, the insured student must have an approved Healthcare Savings Account (HSA) that will allow the student to seek needed medical and mental health care when recommended by a healthcare provider and will cover all deductible expenses over $2,500.  
3. The insurance must be provided by an insurance company domiciled in the United States.

Please be aware the Emory/Aetna Student Health Insurance Plan meets, and in most cases significantly exceeds, these required coverage minimums.   In addition, the Emory/Aetna plan has no pre-existing condition limitations or exclusions. To read the 2008-09 plan brochure, go to www.aetnastudenthealth.com , click on Student Connection, choose Find Your School and enter Emory University.   You will need Adobe Acrobat Reader to view the brochure.  

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Please also be aware that every Emory degree-seeking and international student must complete the student health insurance requirement waiver process once a year (each Fall Semester) every year.

Frequently Asked Questions About the Emory University

  Student Insurance Requirement

Questions about Emory's reasoning behind the health insurance requirement:

“Why did Emory institute a student insurance requirement for all students in Fall 2006?”

Emory University has always strongly encouraged students to carry medical insurance.   However, for several years we have been deeply concerned about our uninsured Emory students.   When uninsured/underinsured students become seriously ill or injured, their academic careers are seriously threatened by substantial healthcare debt, disability or both.   The University agrees, and now all Emory students across the university are required to have health insurance. 

“Why is Emory doing this when other universities are not?”

Well, actually, Emory was the only university in the 2005 US News and World Report America 's Best Colleges Top 20 without a health insurance requirement for all students.   In addition, the American College Health Association recommends that all colleges and universities require students to provide evidence that they have appropriate health insurance coverage.   As a result, there has been a very strong national movement towards a health insurance requirement for all students over the past 5 years.

“Why do Emory students need health insurance, when we can be seen for free at Student Health Services?”

Yes, visits to Student Health Services are free, but thinking that this is enough is a common and dangerous misconception.   While Emory Student Health Services provides excellent out-patient care for enrolled Emory students, EUSHS provides only out-patient primary care, short-term (but not long-term) counseling and psychiatry services.   If and when Emory students need specialist care, emergency services or hospitalization, the bills can run quickly into the tens of thousands of dollars.   Such unexpected expenses can derail, or even end, a promising academic career.

Questions about the quality and cost of the Emory/Aetna Student Health Insurance Plan and Scope of Coverage:

“Is the Emory student insurance plan any good?”  

We feel strongly that our student health insurance plan is among the best student plans in the nation.   The 2008-09 Emory/Aetna plan features the following:

• A national preferred provider network of over 610,000 providers and over 3,700 hospitals, which includes all Emory outpatient and hospital facilities.   
• Students do not have to personally complete and submit claim forms for care received.  The provider submits bills directly to Aetna.
• There are no pre-existing condition exclusions under the Emory/Aetna student plan and no waiting period for coverage to begin. 
• The plan covers 100% of covered medical expenses at Emory Student Health Services, including the on-site EUSHS Dermatology and Gynecology/ Colposcopy clinics (after specialist $25 co-payment), immunizations, TB skin tests and Travel Clinic.  
• The plan covers 80% of negotiated charges outside Emory University Student Health Services (EUSHS) and within the Aetna network (which, once again, includes all Emory facilities).   There is a $100 total annual deductible in-network and a $25 co-pay for physician visits outside EUSHS.   Outside the Aetna network, coverage is 60% with a $200 annual deductible.
• All non-emergency specialist care must first have a written referral from the Student Health Service, unless you are more than 50 miles away from Emory or the EUSHS is closed.  
• The plan offers outpatient prescription pharmacy coverage up to $1,500 (after co-pays) and $500 of coverage at EUSHS (which includes oral contraceptives).
• Mental health outpatient and inpatient coverage has no cap on coverage, including treatment for alcohol and substance abuse.
• Coverage is also available for student's spouse, qualified domestic partner and children.

We strongly encourage you to read the plan brochure before you draw conclusions about the quality of coverage.

“What are the 2008-09 premium rates of the Emory/Aetna plan?”

The premium rates for annual 2008-09 coverage for students under the Emory/Aetna plan is $1,998. This comes out to approximately $167 per month for students.

“Why is this student insurance plan so expensive?    My spouse/partner pays a lot less for his/her health insurance.”

While it is possible that that is true, it is unlikely if the coverage is comparable.   Many employers provide health insurance as an employee benefit, and provide a large subsidy toward the employee's premium.   That being said, if you want lower rates, get your friends to sign up!   The more students on the plan, the more widely the risk is spread, so the rates go lower.

“Aren't there cheaper insurance policies available that meet the minimum waiver criteria?”

Yes, there are.  As noted earlier, the Emory/Aetna student policy far exceeds the coverage minimums in several areas.   However, you get what you pay for, and insurance companies are in business to make money.   We implore you to read the summary of benefits (and the fine print) and compare and contrast insurance policies before you make your decision to purchase one plan over the other.   The time to determine whether your level of coverage is adequate is now, not when you are sitting in the emergency room or lying in a hospital bed.    

“Why should students who already have excellent insurance coverage via their parents' or spouse/partner's plans be forced to also pay for the Emory plan?”

They won't be.   Emory has a health insurance requirement with a “hard waiver.”   Under this approach, students must either purchase the Emory Student Health Insurance Plan or show evidence of enrollment in a comparable health insurance plan.   If the student has not waived out of the Emory plan by July 1, 2008, he/she will be automatically enrolled in the Emory plan and billed via Student Financial Services.   However, the student will still have until the first day of Fall Semester classes (August 28, 2008) to complete the waiver through OPUS and get the insurance enrollment and charge reversed.  Therefore, no student should find himself or herself in a situation where they have two insurance plans. . . . unless he/she ignores deadlines.  

  “When I leave Emory, will I automatically lose my insurance coverage?”

No, not necessarily.   The Emory/Aetna is a student plan, and if you graduate in May 2009, you will continue until the end of your plan year in July or August. If you want to extend your coverage beyond that, you will be eligible for the Continuation Plan, which can cover you for up to an additional 3, 6, or 9 months. Arrangements for continuation coverage must be made while your current policy is still in effect.  Please be aware that the continuation plan is significantly more expensive than coverage for enrolled students, which is true of all COBRA-type coverage.

If you graduate in December, or if you take a leave of absence and do not enroll for classes in the Spring, your insurance plan will terminate on January 7^th. However, if you want to extend your coverage beyond that, you will be eligible for the Continuation Plan, which can cover you for up to an additional 3, 6, or 9 months. Arrangements for continuation coverage must be made while your current policy is still in effect.  Please be aware that the continuation plan is significantly more expensive than coverage for enrolled students, which is true of all COBRA-type coverage.

“I will be going abroad in the Spring Semester.   Will the Emory plan give me coverage while I am away from the United States ?”

  Yes.   The Emory/Aetna Student Plan gives coverage both in the United States and abroad.

“Are there reasons that I might not want to enroll in the Emory student plan?”

Yes, possibly.  The Emory student plan is designed to meet the insurance needs of the vast majority of Emory students while keeping premium costs in mind (since cost is a big issue for many/most students).  As a result, there are at least two features of the plan of which students should be aware:

• The Pharmacy Cap:  The plan offers outpatient prescription pharmacy coverage up to $1,500 (after co-pays) and $500 of coverage at EUSHS (which includes oral contraceptives).  If you have a condition that will require prescription medications that far exceed this cap, you may want to consider another insurance plan.
• The $250,000 Lifetime Aggregate Maximum:   Although the plan has no pre-existing condition exclusion (which is great), it features a $250,000 aggregate lifetime maximum for each covered illness or injury.  It also only provides coverage while you are a student at Emory.  If you have a severe pre-existing illness (cancer, a complex cardiac condition, etc.) and your physician feels that your expenses for that condition could exceed $250,000 during the time you are a student at Emory, you should consider another insurance plan.   

Questions about issues of importance to International Students:

“I am an international student and I have always been required to have health insurance at Emory.   However, I never heard about this ‘United States-domiciled' insurance company requirement.   Is this new?   Can't I have insurance from my home country?”

All international students at Emory have been required to have health insurance or to purchase the Emory student plan.   However, the requirement that the insurance company be domiciled in the United States is a Fall 2005 change in the insurance requirement for international students.   Emory has found that receiving health insurance benefits from international carriers for medical care in the United States can often be incomplete and problematic.

Under certain circumstances, we will allow students to have insurance with an international carrier if the insurance company has a claims-processing agreement with an American firm.  Please contact our Student Health Services Insurance Office if you have questions about this situation.

“Are there any additional insurance requirements for International Students that do not apply to domestic students?”  

Yes.   In addition to the coverage requirements listed for all students, International Students must have insurance that meets the following additional requirements:

•     Coverage for medical evacuation and repatriation of remains to the Insured Person's place of residence in his or her home country ($10,000 for evacuation, $7,500 for repatriation)

For J-1 exchange visitors and their J-2 dependents, the U.S. Department of State regulations require that the health insurance plan must also meet one or more of the following criteria:

•     Part of a group benefits program offered to enrolled students by a designated sponsor, or

•     A health maintenance organization (HMO) that is federally qualified as determined by the Health Care Financing Administration (HFCA) of the U.S. Department of Health and Human services, or

•     A Competitive Medical Plan (CMP) as determined by the Health Care Financing Administration (HFCA) of the U.S. Department of Health and Human services, or

•     Underwritten by an insurance company having an AM Best rating of “A-“ or above, an Insurance Solvency International, LTD. (ISI) rating of “A-“ or above, a Standard and Poor's Claims-Paying Ability rating of “A-“ or above, or a Weiss research, Inc. rating of “B+” or above.

The Emory University Student Health Insurance Plan, offered by Chickering/Aetna, meets all additional insurance requirements for international students and dependants

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Questions about enrollment in the Emory/Aetna Plan:

 “What if I find out that I have a serious illness or suffer an injury after the enrollment deadline, can I sign up for the insurance plan then?”

Sorry, no again.   The Emory/Aetna insurance plan is an annual plan with no pre-existing condition exclusions.   If the insurance company let students sign up at any time during the semester, after finding out that they have a serious, expensive medical problem or injury, then the rates of coverage would go way up for everybody else covered under the plan.   That's why it is called an insurance plan, not a “wait until I need it and then sign up” plan.

“What if I lose my current insurance during the school year.   Can I sign up for the Emory insurance plan then?”

Yes, you can.  After the enrollment deadline, students who have involuntarily lost health insurance coverage through a “Qualifying Life Event” (such as (1) removal from a parent's health insurance plan after achieving a landmark birthday that disqualifies them from a parent's health insurance plan, or (2) losing private insurance through loss of employment or divorce) may apply for late enrollment in the Emory University Student Health Insurance Plan. These students must provide proof that they have lost insurance through another group (certificate and letter of ineligibility) within 30 days of the qualifying event. The premium will be the same as it would have been at the beginning of that period, but the effective date would be the later of the date the student enrolls and pays the premium or the day after prior coverage ends. Premiums are not pro-rated, and the student will be responsible for paying the full premium for the term in which they enroll.

“I would like to enroll my spouse and children in the Emory/Aetna plan.   Can I do that?”  

Yes.   Go to www.aetnastudenthealth.com for more information about dependent coverage.

“Can I enroll my domestic partner in the plan?”  

Yes, qualified domestic partners are eligible for enrollment in the plan.   To be considered a Domestic Partner, and eligible to be covered as a Dependent of an Insured Student under the Emory University Student Health Insurance Plan, you must meet the following criteria:

1. The Domestic Partnership must have been in existence for a period of 12 consecutive months prior to the application for coverage under this Plan.
2. The members of the Domestic Partnership are not legally married to anyone.
3. The members of the Domestic Partnership must be 18 years of age or older.
4. The members of the Domestic Partnership are not related by blood closer than would bar marriage in the State of Georgia and are mentally competent to consent to a contract.
5. The members of the Domestic Partnership are each other's sole Domestic Partner, and intend to remain so indefinitely and are responsible for their common welfare.

Students who elect to enroll their Domestic Partner are required to complete an Affidavit for Domestic Partnership, which is available at the Student Health Services Insurance Office in the 1525 Clifton Road Building.   Call 404-727-7560 or 404-727-7284 if you have questions.

Questions about dates of coverage, including the continuation plan:

“What are the dates of coverage of the 2008-09 Emory/Aetna plan?”  

The Emory/Aetna student health insurance is an annual plan.   Dates of coverage are as follows:

• Medical students                    7/15/2008 – 7/14/2009
• International students             8/1//2008 – 7/31/2009
• All other students                    8/15/2008 – 8/14/2009

“What if I want to continue coverage after I graduate or otherwise leave Emory?   Can I do so under the Emory/Aetna plan?”  

Yes.   Students can purchase a continuation plan to continue coverage for 3, 6 or 9 months after they leave Emory.   For more information about the continuation plan, go to www.aetnastudenthealth.com.

Questions about primary care at Student Health Services and referrals for specialist care:

“Where do I get my primary medical care under the Emory/Aetna student plan?   At Student Health Services?”  

Yes.   Emory Student Health Services is the primary care provider under the plan.   Visits to EUSHS are free for enrolled students, and the insurance plan pays 100% of covered services at EUSHS (lab tests, medical supplies, medications, immunizations, Travel Clinic, etc.).

“What if I don't have the Emory/Aetna plan?   Can I still go to Student Health Services?”  

Yes, absolutely!   Your visits are still free (covered by your tuition).

“What if I don't have the Emory/Aetna plan and I get billed for ancillary services at Student Health Services?”  

EUSHS accepts cash, checks, EmoryCard, Visa and MasterCard for ancillary services (lab, medications, etc.). Although EUSHS participates in the Emory/Aetna student insurance plan, we are non-participants (sorry!) in all other plans.   However, we will file any charges a student incurs at EUSHS with his/her primary insurance carrier.   Since we are non-participants, it is possible that the carrier may not pay for these charges.   We will also provide students with copies of all relevant paperwork they will need to resolve any payment issues with your carrier.   We will wait 90 days from the date of filing the claim to receive payment.   If the charges are unpaid at that time, we will transfer the balance to the Bursar's office for billing on the student's account. But please take note: if a student's account becomes past due, Emory may withhold transcripts, grades, registration or other University provided services or goods until all past due amounts are paid.      

“I have heard that I have to have a referral to see a specialist under the Emory/Aetna student health insurance plan.   Is that true?”  

Yes, it is.   There is a referral requirement under the plan.   Emory University Student Health Services (EUSHS) offers students comprehensive primary and specialty services coordinated by EUSHS. All covered students and covered dependents age 12 years or older in need of medical care should, except in the case of a medical emergency, first seek treatment and be evaluated at EUSHS.   You may be referred to an outside medical provider if required specialist medical care is unavailable at EUSHS.  

If you are enrolled in the Student Health Insurance Plan, a referral is necessary to receive the maximum benefit under your Student Health Insurance Plan, except in the following instances:

1. Treatment of an Emergency Medical Condition; or
2. When EUSHS is closed; or
3. When the service is rendered at another facility during breaks or vacation periods; or
4. When medical care is received by a Covered Person who is more than 50 miles from campus; or
5. When medical care is received by a Covered Person who is no longer able to use the EUSHS due to a change in student status; or
6. Ob/Gyn services.
7. Dermatological services.  

A new referral must be obtained if continuous treatment is being received from one Policy Year to the next.   Please note that dependents under age 12 are not permitted to use EUSHS and therefore are exempt from the referral limitations and requirements.

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Questions about other optional coverage, including the dental plan and the supplemental plan:

“I am interested in getting dental coverage.   Does the Emory/Aetna plan cover dental care?”  

No, except for care for injuries to sound, natural teeth and TMJ care.   However, Aetna/The Chickering Group offers a dental plan for Emory students.   You can get more information at www.aetnastudenthealth.com.

“Does Emory require dental insurance for students?”                   

No, it does not.

“What if I want more coverage than an aggregate lifetime maximum of $250,000 per illness or injury?”  

Effective 2007-08, the Emory/Aetna student plan does not offer a supplemental plan with an increased lifetime aggregate maximum.

  Questions about payment options under the Emory/Aetna plan, including financial aid:

“How will I be billed for the Emory/Aetna insurance plan?”  

If you are enrolled into the Emory/Aetna insurance plan, you will be billed by Emory Student Financial Services via your student account.   If you have the payment plan, the cost of the insurance will be divided into your individual Fall and Spring payments.   You should see your first insurance charge with your July 2008 bill.   If you are not on the payment plan, but would like to be, contact Student Financial Services at 404-727-6095.

“Can I get financial aid to cover the Emory/Aetna insurance plan?”  

Because health insurance is now mandatory for all Emory students, if you are eligible for financial aid, you can request access to additional loans for the amount of the premium.   Contact the Office of Student Financial Aid at 404-727-6039 or stop in at their offices at the B. Jones Center.

“Can I charge the cost the Emory/Aetna insurance plan for my spouse, domestic partner or children to my Emory Bursar account?”  

Sorry, no.   If you wish to enroll dependents in the plan, you must go to www.aetnastudenthealth.com.   The Emory Bursar (Student Financial Services) will only bill for student insurance, since students are required to have insurance.   Spouses, partners and children are not.

Questions about the waiver process, including appeals:

“If I waived off the insurance plan 2008-09, then I am good for the next four years at Emory, right?”  

No!   Every Emory degree-seeking and international student must complete the enrollment/waiver process once a year (each Fall Semester) every year.

“What if I make a mistake while I am completing the waiver, or if my insurance situation changes between the day I complete the 2008-09 waiver and the August 28^th deadline?”  

You may reenter the OPUS mandatory insurance waiver site as many times as you wish prior to August 28^th and cancel or change your waiver.

“Why does Emory have a requirement that the individual annual deductible on my plan must be $2,500 or less or I must have a certified Healthcare Savings Account (HSA)?”  

Emory has found that students avoid going to the doctor or the emergency room, refuse needed hospitalizations, or won't allow important tests, x-rays or scans to be done, if their deductible is very high (e.g. $5,000, $10,000).   The whole point of the health insurance requirement is to give Emory students insurance coverage that will allow them to get important, needed healthcare so that they can successfully complete their degrees.   This waiver criterion helps us to achieve that goal.

“What if I fail the waiver process or I miss the deadline and get charged for the Emory/Aetna insurance plan and I want to appeal the charge?   Can I do that?”  

Yes.   Emory has a formal committee to review and vote on appeals.   Each Fall, the deadline for this appeals process for the annual plan will be on or about September 15^th. If you have questions or concerns about the student insurance requirement or your individual situation relative to the requirement, please contact the Student Health Services Insurance Office at 404-727-7560, 404-727-7284 or mandatoryinsurance@listserv.cc.emory.edu . To view the Mandatory Insurance Waiver FAQ's page, click here.

Questions about how to get help if you have a question or problem:

“Where do I go if I have questions about Emory's health insurance requirement or the online enrollment/waiver process?”  

For answers to these questions, please contact:

Emory University Student Health Services

Insurance Office

1525 Clifton Road

Atlanta , GA 30322

404-727-7560

mandatoryinsurance@listserv.cc.emory.edu

“What if I want to talk to the main person in charge of all of this, the Student Health Executive Director himself?”  

To reach the Student Health Services Executive Director, please contact:

Michael Huey, MD

Executive Director

Emory University Student Health Services

1525 Clifton Road

Atlanta , GA 30322

404-712-8652

mhuey@emory.edu

“Where do I go if I have questions about enrollment, insurance benefits or claims processing?”  

For answers to these questions, go to:

Aetna Student Health Claims Administrators, Inc.

P.O. Box 15708

Boston , MA 02215-0014

(877) 261-8403

www.aetnastudenthealth.com

“What if I am more comfortable looking up answers to my questions and getting information on line?”  

As a Chickering/Aetna student health insurance member, you have access to Aetna Navigator ®, your secure member web site, packed with personalized benefits and health information. You can take full advantage of this interactive web site to complete a variety of self-service transactions online.   By logging on to Aetna Navigator, you can:

• Review who is covered under your plan.
• Request member ID cards.
• View Claim Explanation of Benefits (EOB) statements.
• Estimate the cost of common health care services and procedures to better plan your expenses.
• Research the price of a drug and learn if there are alternatives.
• Find health care professionals and facilities that participate in the Emory Student Insurance Plan.
• Send an e-mail to Chickering Customer Service at your convenience.
• View the latest health information and news, and more!

To register for Aetna Navigator:

• Go to www.aetnastudenthealth.com
• Click on “Find Your School.”
• Enter “ Emory University ” and then click on “Search.”
• Click on Aetna Navigator and then the “Access Navigator” link.
• Follow the instructions for First Time User by clicking on the “Register Now” link.
• Select a user name, password and security phrase.

If you need help with registration, assistance is available toll free, Monday through Friday, from 7 a.m. to 9 p.m. Eastern Time at 1-800-225-3375.

“What if I have questions about or problems with my Aetna insurance ID card?”  

Permanent ID cards will be issued as soon as possible after the enrollment/waiver on line site closes.   If you need medical attention before your ID card is received, benefits will be payable in accordance with the Policy.   You do not need an ID card to be eligible to receive benefits.  If you need a temporary ID card, you can obtain one from the Chickering website or contact the EUSHS Insurance Office for assistance.  Once you have received your ID card, present it to the provider to facilitate payment of your claims.   You will receive a unique Aetna member ID number on your membership card.   For lost ID cards, contact Chickering Claims Administrators, Inc. at (877) 261-8403, or visitwww.aetnastudenthealth.com, click on “Find Your School” and enter “Emory University.”

“How do I find a list of preferred providers under my Emory/Aetna student health insurance plan?”  

A complete list of preferred providers can be found at Emory University Student Health Services (EUSHS), or you can use Aetna 's DocFind® Service located at www.aetnastudenthealth.com.   Click on “Find Your School” and enter “Emory University.” You can use DocFind to find out whether a specific provider belongs to Aetna 's network or to find Preferred Providers practicing in your area.

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© 2008 Emory University, Atlanta, GA

Revised 4/21/2008