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Am I required to have insurance?
- If you are a full-time, dissertation status, or exchange students (here for at least 1 term), the University requires you to have medical insurance.
- If you are a part-time student, you are not required to purchase insurance or show proof of alternative coverage. However, all degree seeking candidates, including part-time students, are eligible to enroll in the Penn Student Insurance Plan.
- If you become full-time at any point during academic year, you will have to show proof of insurance or you will be placed on the University’s plan.
- If you are unsure of your registration status, please speak with your department.
Why do I have to have insurance?
- Health insurance guarantees that you will be able to obtain necessary treatment in the event that you develop a serious illness or injury.
- Health insurance also protects you against potential catastrophic financial losses by limiting the extent of your fiscal responsibility for the cost of medical treatment.
- In addition to protection against catastrophic illness, many students look to health insurance to provide for an array of other medical treatment and preventive care.
Do I have to enroll in the Penn Student Insurance Plan (PSIP)?
- You may satisfy the insurance requirement through any private plan that meets University criteria for coverage or through enrollment in the Penn Student Insurance Plan (PSIP).
- Regardless of the coverage that you select, you must submit information about your insurance coverage each year. You do this by filing either a waiver or an enrollment in PSIP to the online system.
How do I enroll or waive the Penn Student Insurance plan?
- Before you submit your selection, be sure to secure a PennKey and Password.
- If you want to waive PSIP, be sure to have all of the information about your alternative coverage at hand.
- Enroll or request a waiver here
- You may also access the site through the Penn Portal.
- Is there an alternative to submitting my selection on-line?
- No. In order to ensure that your selection is properly recorded, you must use the on-line system. Documentation mailed, e-mailed or faxed will NOT be processed unless requested by the Penn Insurance Office.
What is the deadline for filing a waiver or application for enrollment?
- The online system is open from July 1, 2011 through August 31, 2011.
What happens if I fail to waive or accept the student insurance?
- If you are full-time, dissertation status, or an exchange student (here for more that at least 1 term), and do not file a selection by the deadline, you will be default enrolled in the student-only insurance plan in September.
I am a full-time student. Why can’t I simply ignore the process since I’ll be enrolled by default anyway?
- At the beginning of the semester, the university’s systems may not always accurately reflect your status as a full-time student. If so, you will not be default enrolled.
- There are often delays between default enrollment in an insurance plan and registration in the insurance carrier’s medical and pharmacy databases. This can impact your ability to access care if you need it. Also changes in registration status can affect your eligibility and can result in a denial of coverage.
I am a Penn employee and a full-time student. Am I still required to submit a waiver or enrollment for PSIP?
- Yes, regardless of employment in the University, all full-time students are required to file a selection showing their insurance coverage.
I have private insurance already. How can I determine if it meets the standards for alternative coverage?
For 2011-2012, alternative coverage must meet the following minimum standards:
http://www.vpul.upenn.edu/shs/insurance.php
When do I pay the premium for my insurance?
- The annual premiums are billed in 2 increments. The first will be billed directly to your account in within a few weeks of your enrollment online, and the second installment will be billed in late in the fall term.
- If you receive funding from your school, you may receive refunds which include premium to be repaid for insurance. Be sure to monitor your account closely to determine whether your premium has been paid, or speak to an advisor in Financial Services.
I am a PhD graduate student. Will my school be paying for my insurance?
- You should speak directly to your school to find out if you qualify for subsidy.
How does PSIP affect the clinical fee?
- All full-time students residing in the Greater Delaware Valley area are required to have coverage in Student Health, either through payment of the clinical fee or through PSIP.
- The clinical fee is automatically posted to the accounts of all full-time students on the first tuition bills of the fall and spring semesters.
- If you enroll in PSIP, the clinical fee will be reversed when the PSIP premium is posted to your student financial service account.
I am covered through private insurance now, but will be in need of coverage during the academic year. How do I proceed?
- You may enroll in the middle of the year within 31 days of a qualifying life changing event.
- Qualifying Life Events include: Removal from a parent’s health insurance plan after achieving a landmark birthday that disqualifies you from that coverage
- Loss of private insurance through loss of employment or divorce
- Please contact Student Insurance within 31 days of the occurrence of the event.
I have PSIP insurance. My dependent will be in need of coverage during the middle of the plan year. How do I proceed?
- You may enroll your dependent in the middle of the year within 31 days of a qualifying life changing event.
- Qualifying Life Events for dependents include:
- Marriage or establishment of a domestic partner relationship
- Birth or adoption of a child
Please contact Student Insurance within 31 days of the occurrence of the event.
If I obtain acceptable alternative insurance and want to cancel my enrollment in PSIP, how do I proceed and what are the guidelines?
- You have until August 31, 2011 to cancel your enrollment.
When will I receive my PSIP insurance card?
- You should receive your card within 14 business days after applying.
- If a card does not arrive within a reasonable amount of time please, call Aetna Student Health directly at 1 800 841-5374 or send an e-mail to their Student Connection web site www.aetnastudenthealth.com.
What if I lose my student health insurance identification card?
What is does PSIP cover?
PSIP covers:
- Hospitalization
- Outpatient office visits
- Primary and specialty care office visits/referrals
- Mental health benefits
- Diagnostic studies
- Outpatient therapy/treatments
- Prescription medications
Three tiers of coverage:
Care at SHS:
- All office visits covered in full, no deductible or co-pays
- Most other charges are also covered in full
In-network care (preferred provider):
- You are responsible for payment of allowable charges up to $250 (deductible)
- Once you have met deductible for the year, you are responsible only for the relevant co-pay
- The deductible may be waived for certain services or care
Out-of-network care (non-preferred care):
- You are responsible for payment of charges up to $1500 (deductible)
- Provider balance may bill you for difference between actual charge and any PSIP payment
- After the deductible is met, the plan pays a percentage of reasonable and customary charges
Key features of PSIP
- $2,000,000 lifetime maximum benefit
- Annual deductible of $300 In-network/$1500 Out-of-network The deductible is waived for Emergency Room visits, mental health visits, prescription drugs, immunizations, annual eye exam
- Annual maximum out-of-pocket expense of $1,500 in-network/$4,000 out-of-network
Co-pays (in-network)
- Emergency Room: $100
- Office visits: $30 after deductible satisfied
- Mental health visits: $25 (deductible waived)
- Lab/x-ray: $35 after deductible satisfied
- In-patient Hospital Room and Board $100 after deductible satisfied
- Surgical expenses (inpatient and outpatient) $150 after deductible satisfied
- High Cost Procedures $50 after deductible satisfied
Prescription coverage:
- 30-day supply of medication: $15 generic/$30 brand
- 90-day supply of medication (mail-order)): $30 generic/$60 brand
SHS referral is required for care within 25 miles of the University of Pennsylvania.
If a referral is not obtained in advance of service, the benefit is paid at out-of-network level
Referrals are not required for Emergency Room care, Mental Health visits, Women’s Health visits, eye exam or dental care
I have enrolled in the 2011-12 PSIP and need to see a doctor. What is the next step?
- Outpatient medical care is available to students through the Student Health Service.
- If you are within 25 miles of the University, you should first seek treatment at SHS. There is no deductible or co-pay for office visits to SHS
- If you need additional care outside of SHS, you will be given a referral by your provider.
- You are responsible for payment of deductible and/or co-pays for care outside SHS.
- If you are outside of the 25-mile radius, you may self-refer to any provider, but your costs will be significantly lower if you seek care from a participating Aetna provider.
- You are responsible for payment of any deductible and/or co-pays for care.
When is a referral not required?
You do not need a referral for:
- Emergency Room Services (all follow up treatment must be obtained through SHS)
- Inpatient and Outpatient Mental Health and Substance Abuse Services
- Women’s Health Services (routine and non-routine)
- Annual Eye Examination
- Injury to Sound Natural Teeth or Removal of Impacted Wisdom Teeth.
- You do not need a referral for care outside the 25-mile radius of the campus.
How long is the referral valid for?
- A referral is valid only for the specific medical condition defined by the SHS provider.
- The referral can be valid up for the entire policy year (to August 14, 2012) per condition. However, if the SHS provider limits the number of visits, a new referral will be required once the allowed number of visits have been exceeded.
My primary care provider is in the area. Do I need a referral to see him/her?
- Yes, you need a referral by a Student Health Service provider.
- You are responsible for payment of any relevant deductible and/or co-pay charges.
I have my own women’s health provider. Do I need a referral to see her?
- No, you do not need a referral to see a women’s health provider.
- You are still responsible for payment of any relevant deductible and/or co-pay.
Are my dependents required to visit SHS for a referral to see a doctor?
- The referral requirement does not apply to covered dependents.
Is Emergency Room care covered? Do I need a referral to the Emergency Room?
- Emergency Room care is covered. You do not need a referral for Emergency Room care.
- The deductible is waived for Emergency Room visits.
Am I required to obtain a referral after an Emergency Room visit for any
follow-up treatment?
- Yes, all follow up treatment must be obtained through SHS, including referrals to outside specialists (unless the servicing provider(s) is outside the 25 mile radius of the University).
- This is true even if the Emergency Room providers refer and/or schedule you to see a specialist.
Does PSIP cover treatment for mental health and substance abuse?
- Yes, the plan provides treatment for mental illness and substance abuse.
- You do not need a referral for any mental health visits.
- The deductible is waived for mental health visits.
Are X-rays and lab tests subject to the annual deductible and co pay if services were rendered at SHS?
- Yes, while specimens for lab tests are obtained at SHS, they are sent to outside labs for processing and are subject to the deductible and applicable co-pay.
- X-rays are ordered and scheduled by SHS but are performed by outside radiology offices, and are subject to the deductible and applicable co-pay.
Why am I charged for care at HUP? There is no deductible or co-pay for care at SHS.
- Student Health is a department of the University, and is separate from HUP. Most of the providers at HUP are in the Aetna preferred provider network.
- Are Diabetic supplies subject to the annual deductible?
- Diabetic supplies are not subject to the deductible. Insulin is covered through the Prescription Drug Benefit and not subject to the deductible.
Is Durable Medical Equipment subject to the annual deductible?
- Yes, durable Medical Equipment is subject to the deductible.
- After the deductible is met, you are responsible for 90%of the Negotiated Charge for in-network care and 60% of the Reasonable Charge
Are dental benefits covered under PSIP?
- PSIP will only pay dental benefits in the event that you sustain an injury to a sound tooth or for the removal of an impacted wisdom tooth (referral not required).
- Routine dental care is not covered under the plan.
- However, you are eligible to purchase additional dental insurance provided by Aetna. Applications and benefit descriptions are available in Student Health or on the Aetna Student Health web site.
- Please keep in mind that your dental insurance is independent to your health plan. Payment should go directly to Aetna when billed
Is routine eye care, such as annual eye exams covered under PSIP?
- PSIP will pay medical expenses for one routine eye exam per policy year at the negotiated rate of 90% for in-network treatment.
- You do not need a referral
I will be out of the Philadelphia area. What do I do if I need to see a doctor?
- You do not need a referral from Student Health for care outside of the Philadelphia area.
- Keep in mind that you are responsible for paying your deductible. Treatment by an Aetna Preferred Provider reduces your out-of-pocket costs.
Where can I access a listing of in-network providers and facilities?
- A complete listing of participating Preferred Providers and Pharmacies is available through the internet by accessing DocFind at: www.aetnastudenthealth.com.
- Click on “Student Connection” and under “Find Your School” enter 724535 as your Policy number. You may also contact Aetna Student Health Claims Administrators, Inc. at (800) 841-5374.
Am I covered for medical treatment while studying or traveling abroad?
- Yes, no matter where you travel as an insured student, you are covered under the Penn Student Insurance Plan 24 hours, worldwide. Coverage is also provided for Accidental Death and Dismemberment insurance up to $10,000.
Is it my responsibility to file a medical claim?
- If you visit an In-network Preferred Provider, they will file a medical claim on your behalf.
- If you visit a Non-Preferred Provider, please request that they do so. If they decline, it will be your responsibility to do so.
- Please provide your Penn Student Health Insurance identification card at the time you receive services.
When is Pre-certification required?
- Pre-certification is required for all inpatient admissions. Pre-certification is obtained by contacting Aetna Student Health Claims Administrators, Inc. (Please note: pre-certification is not required for any outpatient services).
Is there any penalty for not pre-certifying an in-patient admission?
- Yes, if you do not secure Pre-certification for non-emergency inpatient admissions or provide notification for emergency admissions, your covered Medical Expenses will be subject to a $200 per admission Deductible.
FAQ for Transgender Coverage through the Penn Student Insurance Plan
What is/are the transgender-specific benefit(s)?
- Certain sex/gender reassignment surgery for transgender students who meet certain criteria will be covered under the Penn Student Insurance Plan (PSIP).
What criteria must be met prior to surgery?
- Please see the Clinical Policy Bulletin # 0615 (insert clinical policy bulletin here)
Will I require a referral from Student Health Service?
- A Student Health provider referral is required for care within 25 miles of the University of Pennsylvania. If a referral is not obtained in advance of service, the benefit is paid at out-of-network level.
What are my deductible and co-payments/coinsurance amounts?
How do I contact the Student Health Insurance Office?
Student Health Insurance
University of Pennsylvania - Student Health Service
3535 Market Street
Suite 100, Room B101
Philadelphia, PA 19104-3376
Phone Number: 215 746 3535, menu option #3
Fax Number: 215 746 0904
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