Guide to Vandy Student Insurance Plan PART 1

Overview

Hello everyone! Tomorrow is the first day of the new semester. iCare would like to wish you all a happy start of the school year! In the new semester, we hope you all can get your desired scores! At the same time, we hope you don't forget to take care of your health amid your busy schedule. But don't be afraid if you get sick. iCare will explain how to maximize the use of our student insurance.

First, the table below gives you the most basic information about student insurance, including deductibles and maximum out-of-pocket limits.

What to do if you

are sick or injured...

For general injuries or illnesses, the co-payment is only $25 at in-network medical centers (comparable to a registration fee) and 40% at out-network medical centers (this 40% is the individual co-payment, i.e. the insurance company will pay 60%). Note that if

you choose to see an in-network provider, you will be covered even if you do not pay the full deductible. If you need specialist treatment after seeing a general practitioner, first we need to get a referral from the general practitioner, which is a letter referring you to a specialist. Then the co-payment for each in-network specialist is $25, and the out-network specialist benefit rate is 40%. Again, if you choose an in-network specialist, coverage is effective immediately, regardless of whether or not you have paid your full deductible.

What if I need vaccines

/preventive treatments/medical exams?

There is no cost at in-network medical centers, and the benefit rate at out-network medical centers remains at 40%.

What if I need a CT screening?

Diagnostic tests such as blood tests and x-rays are covered at 10% at designated in-network centers, 20% at non-designated in-network centers, and 40% at out-of-network centers. Diagnostic imaging such as MRI, PET, and CT are also covered at the same rate.

How are drugs covered?

In general, drugs are not reimbursed at out-of-network health centers or pharmacies. At an in-network medical center or pharmacy, the co-payment is $15 for regular prescription drugs, $50 for non-preferred brand drugs, and $75 for non-preferred brand drugs when purchased over the counter. For mail orders, the co-payment is $30 for regular prescription drugs, $100 for non-preferred brand drugs, and $150 for non-preferred brand drugs. Regardless of the method of purchase, coverage is effective immediately regardless of whether or not the deductible is paid. It is important to note that prescription drugs purchased over the counter are covered for up to a 30-day supply, while drugs purchased by mail to home are covered for up to a 31-day to a 90-day supply.

How is emergency care covered?

Here we will first introduce the facility and emergency treatment costs (excluding follow-up surgery), and in the next article, we will focus on surgery costs.

Emergency room (ER) treatment: $100 co-payment and 10% coverage regardless of whether the treatment is at an in-network or out-of-network medical center; coverage is effective immediately whether the deductible is paid or not.

Emergency transportation costs (e.g. ambulance): 0% (no fee).

Emergency treatment (treatment outside the emergency room): 10% at designated in-network medical centers; 20% at non-designated in-network medical centers; 40% at out-of-network medical centers.

How to distinguish between

in-network and out-of-network medical centers?

Some students may have questions about which health centers are in-network and which are out-of-network.

Generally speaking, if you are near the school, the student health center is the most convenient place for us to go for medical treatment. You can get the most basic checkups, including flu shots, covid tests, and basic medications. If we need more comprehensive services, VUMC is the nearest in-network provider. Aetna health's network is quite extensive, so if some students are not on vacation in Nashville but need services, they can check if the hospital in their area is in-network/out-of-network. It is very convenient, you can see your insurance card, bills, etc. If you need, you can search for clinics/hospitals/pharmacies in the search. It will show you the search results according to your area and display in-network, out-of-network, and other insurance-related information.

For example, here are the results of a search near Seattle, where you can contact the hospital directly, in addition to whether it is in-network or not, and whether there is infrastructure like wheelchair service.

Summary

As mentioned above, the costs and insurance coverage vary depending on the medical needs and the location. If you still have questions, check the table provided by aetna student plan to estimate the amount you should pay for the medical services you need, depending on your needs. In the next issue, we will explain the rates of benefits for surgery and other services. We will also begin to explain the referral process, i.e. how to get a referral from the student health center if you need specialist care, etc. Stay tuned!