Tufts University Student Health Insurance Plan: Frequently Asked Questions

What is the student health insurance plan?
The student health insurance plan is offered through the school to provide basic medical coverage to eligible students who become sick or injured. It meets state of Massachusetts's requirements for health insurance for students attending colleges or universities in this state.

What does the plan cover?
The plan covers accident and sickness expenses including hospital room and board, emergency outpatient care, lab and x-rays, inpatient and outpatient surgical procedures and physician office visits.

Do I have to enroll in the student health plan?
Massachusetts State Law requires that you have some form of health insurance, but it doesn't have to be the student health plan. If you don't want to enroll, you will be able to waive your Insurance Charge beginning July 9, 2008 at this site. Please have your Insurance Card Information ready and continue until you receive a Confirmation #.

Can I go to any doctor or hospital?
You can go to any doctor or hospital, but there are doctors, hospitals and other health care providers that are part of the Aetna Network, a preferred provider organization. When you receive treatment from a provider in the Aetna Network, the plan provides coverage and your out-of-pocket costs will be less.

Do I have to get a referral before going to the doctor or hospital?
Yes. When the health service is open you need to visit the health service first and receive a referral from the health service before seeking treatment, whether you're going to an Aetna Network Provider or not.

What's the difference between the student health plan and the Health Service?
The student health plan provides coverage for injury or sickness, covered at a specific level up to a set maximum dollar amount. It covers hospital room and board, physician fees, prescription drugs, lab, x-ray expenses and more. The Health Service provides services typically not covered under the student health plan, such as immunizations, allergy clinic, sports physicals, walk-in visits and primary care, as well as health promotion and educational programs.

Are prescription drugs covered?

• Prescription Drug Expenses offered through Aetna Pharmacy Management up to $1,500 per Policy Year.
• Plan pays 100% of the negotiated charge after $10 Copay for each Generic RX and $25 Copay for each Brand-Name.
• Plan pays 80% of the negotiated charge after $10 Copay for each Generic RX and $25 Copay for each out of network Brand-Name RX

Will I get an ID card?
ID cards will be issued as soon as possible. If you need medical attention before the ID card is received, benefits will be payable according to the Policy. You do not need an ID card to be eligible to receive benefits. Once you have received your ID card, present it to the provider to facilitate prompt payment of your claims.

For lost ID cards, contact:
Aetna Student Health

Can I cover my spouse/domestic partner or children?
If you enroll in the student health plan, you can also enroll your spouse/domestic partner or child(ren) as your dependent(s) by completing a separate Dependent Enrollment Card. This card is available by contacting Aetna Student Health.

What if I leave the University; can I get a refund?
To qualify for a refund, a student must withdraw from the University within 31 days of the period for which coverage is purchased. For example, if you enroll for the fall semester coverage becomes effective on August 28th. You would need to withdraw within 31 days of August 28th in order to get a refund. If you withdraw from the University after 31 days, you will not be allowed to withdraw from the student health insurance plan and you will not get a refund. However, students withdrawing from school to enter military service would be entitled to a pro-rated refund if requested.

Does the Student Injury and Sickness Plan cover me if I travel abroad?
Yes, the Student injury and Sickness Insurance Plan provides worldwide coverage, whether studying abroad or traveling abroad. The plan provides the same benefits as if you were on campus. In addition through participation in the student insurance plan, each student and his or her enrolled dependents are eligible for travel assistance services. The services are provided through Assist America Inc. and include language interpretation assistance, evacuation to the nearest facility to receive medical treatment, hospital admission guarantee, and repatriation of remains services.

When traveling you should make sure you have our student insurance ID card. When traveling internationally, you may be asked to pay first for your services and then seek reimbursement.

You don't need a specific claim form to be reimbursed, but you will need to have the itemized bill(s) translated into English (if needed) and sent with a letter to the claims administrator explaining that you need reimbursement.

If you have any questions, you can call: Aetna Insurance at 1-800-954-5797.

Who do I call if I have questions about enrollment, eligibility, coverage or other service issues?
Aetna Student Health
P.O. Box 15708
Boston MA 02215-0014
(800) 954-5797

Who do I call if I have questions about a specific claim or claims payment?
Please contact Aetna Insurance at 1-800-954-5797.

How can I find out about providers who participate in the preferred provider network?
The doctors and other health care providers who belong to Aetna's network are called preferred providers. They include general practitioners and internists, as well as specialists, hospitals and other health care facilities. Because Aetna's network extends across the country, you'll find preferred providers locally as well as nationally. To find a preferred provider, you can:

• Refer to the list kept at Tufts University Health Service
• Use Aetna's on line DocFind service at www.aetna.com/docfind. You can use DocFind to find out whether a specific doctor belongs to Aetna's network or to find preferred providers practicing in your area.

What are routine GYN lab fees?
Students often have questions about the cost of tests done at a routine gyn appointment. Listed below are the charges for some of the more commonly ordered tests. Your clinician will talk to you about what tests are recommended for you. You may need some of these tests, but not all.

If you have student health insurance, the cost of these tests will be billed directly to student insurance, and not appear on your bursar bill.

If you do not have student insurance, (i.e. covered under a spouse, partner or parents' insurance), the charges for your laboratory tests WILL appear on your bursar bill. The bill will state: "health service charge" rather than give any specifics of what tests were performed.

Our business office will then mail you an itemized bill to your school address that can be submitted to your insurance company.

• Chlamydia Test $75.00
• Cholesterol $30.00 (Not covered by student health insurance for routine gyn exams)
• Gonorrhea Test $75.00
• Pap Smear- Thin Prep with Imaging $70.00
• VIP (Vaginal Infection Preparation) $30.00

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