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
• 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 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, 2012 through August 31, 2012.

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.

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 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, 2012 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

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

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 $300 (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: $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
• High Cost Procedures $50 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: 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 2012-2013 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 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 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

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:
• 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.

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, 2013) 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 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. 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 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 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.