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.
• You may for this at http://www.vpul.upenn.edu/shs/inreq.php

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 http://www.vpul.upenn.edu/shs/inreq.php

Is there an alternative to submitting my selection online?
• No. In order to ensure that your selection is properly recorded, you must use the online 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, 2014 through August 31, 2014.

I am a Penn employee and a full-time student. Am I still required to submit a waiver?
• Yes, regardless of employment in the University, all full-time students are required to file a waiver showing their insurance coverage.

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 through payment of the clinical fee.
• 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.

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
• Entrance into the US (passport stamp required)

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, 2014 to cancel your enrollment for the year.
• A Midyear Life Change waiver is also accepted. This must be done before January 31, 2015. Acceptable life change events for a Midyear waiver are:
• Marriage/domestic partnership
• Change in job
• Change in employer sponsored plan

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 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
• Please see website for summary of benefits and exclusions: https://www.aetnastudenthealth.com/students/student-connection.aspx?GroupID=724535

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

**Please note that the deductible can be applied for certain things at Student Health. Be certain to ask the Insurance Desk located in Student Health if you have any questions

In-network care (preferred provider):
• You are responsible for payment of allowable charges up to $300 (deductible) unless the deductible is waived for that particular service – Please see the summary of benefits: https://www.aetnastudenthealth.com/students/student-connection.aspx?GroupID=724535
• Once you have met deductible for the year, you are responsible only for the relevant co-pay for items covered at 100% after the deductible
• There is a $900 out-of-pocket max for individual in-network coverage. This is for items covered at less than 100%. The deductible is included in this cost

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
• There is a $4,000 out-of-pocket max for individual out-of-network coverage. The out-of-network deductible is included in this cost

Key features of PSIP

• Unlimited lifetime maximum benefit
• Annual deductible of $300 In-network/$1,500 Out-of-network.
• In-network the deductible is waived for Emergency Room visits, pap smear screening, mammogram expense, immunizations, routine physical exams, routine screening for sexually transmitted diseases, routine colorectal cancer screening, routine prostate cancer screening, annual vision exam, pediatric vision care, pediatric dental exam, mental health, prenatal care/comprehensive lactation support and counseling services, breast feeding durable medical equipment, voluntary sterilization, contraceptives *Please see summary of benefits for details as exceptions may apply*
• Annual maximum out-of-pocket expense of $900 in-network/$4,000 out-of-network Co-pays (in-network)
• Emergency Room: $100
• Office visits: $30 after deductible satisfied
• Mental health visits: $30 (deductible waived)
• Lab/x-ray: $35 after deductible satisfied
• In-patient Hospital Room and Board $100 after deductible satisfied
• Surgical expenses inpatient $200, outpatient $100 after deductible satisfied
Prescription coverage:
• 30-day supply of medication: $20 generic/$40 brand
• 90-day supply of medication (mail-order)): $40 generic/$80 brand SHS referral is required for care within 25 miles of the University of Pennsylvania.

Important: SHS referral is required for care within 25 miles of the University of Pennsylvania

*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 2014-2015 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.

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 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 the University of Pennsylvania, Dental School. Online applications and benefit descriptions are available at the My Penn Dentist website: https://www.mypenndentist.org/
• Please keep in mind that your dental insurance is independent to your health plan. Payment should go directly to the University of Pennsylvania, Dental School at the time of application.

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
• Glasses/contacts are NOT a covered benefit

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.
• You may also contact Aetna Student Health Claims Administrators, Inc. at (800) 841-5374.

When is a referral not required?
You do not need a referral for:
• Emergency Room Services - Important: all follow up treatment must be obtained through SHS or a referral from SHS must be obtained if the care is being obtained within a 25mile radius of the University of Pennsylvania.
• 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. One referral per conditions per policy year
• The referral can be valid up for the entire policy year (to July 31, 2015) 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.

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 Copay is $100. 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.

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 (Hospital of the University of Pennsylvania). Most of the providers at HUP are in the Aetna preferred provider network but please always double check at the Aetna Student Health DocFind. https://www.aetnastudenthealth.com/students/student-connection.aspx?GroupID=724535

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 for out-of-network care

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.

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 abroad is on a reimbursement basis and uses the in-network deductible
• 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 (including maternity and partial hospitalizations in a treatment facility or hospital). 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.