Health Services - Domestic Health Insurance

University of Michigan - Dearborn
2008/2009 Student Health Insurance Plan

1-800-242-3721
On-line Enrollment http://www.aetnastudenthealth.com/

Offered by: Chickering Benefit Planning Insurance Agency, Inc.
Underwritten by: Aetna Life Insurance Company (ALIC)
Policy No. 711146
Aetna Open Choice PPO

University of Michigan Student Health Insurance Plan has been developed especially for University of Michigan students and their eligible dependents. The Plan, which is underwritten by Aetna Life Insurance Company (Aetna), provides coverage for illnesses and Injuries that occur on and off campus and includes special cost-saving features to keep the coverage as affordable as possible. The plan is administered by Chickering Claims Administration

1. Plan Highlights Include

• Affordable co-payments for prescription drugs at local and national pharmacies.·
• Travel assistance when traveling or studying at school or abroad·
• Hospitalization and Emergency Room Services

For more details about Plan benefits, provisions, exclusions, appeals and grievance procedures, disclosure information and other Plan features, view the entire Plan Brochure at http://www.aetnastudenthealth.com, click on "Find Your School" and enter 711146 as your Policy Number.

2. Student Coverage Eligibility

Any UM student enrolled in classes or a student not enrolled but between semester (spring/summer session)
This includes the following:

• Undergraduate students taking classes are eligible to purchase the current Policy year Student Health Insurance Plan whether or not they are taking classes at the time of purchase.
  
• All graduate students or doctoral candidates who may not be taking credit hours but are completing requirements necessary to graduate (writing thesis, preparing dissertation, studying for prelims, studying abroad, on detached study, pre doctoral candidates, etc.).
  
• Visiting scholars and students with Dual Citizenship who are not eligible for international insurance.
  
• All international students and visiting scholars attending the Ann Arbor, Dearborn and Flint campuses are eligible to enroll in this Plan.
  
• Green card holders who meet the above qualifications.
  
• Spouses, domestic partners and children of all the groups listed above.

Eligibility is subject to verification by Aetna Student Health through the University to ensure student registration. Students enrolled in the Plan who do not meet the eligibility requirements listed above will be removed from the Plan and their coverage may be terminated without advance notice.

3. Policy Period

The Master Policy on file at the school becomes effective ay 12:01 a.m., August 24, 2008. Coverage becomes effective on that date or the day after the postmarked date of the Enrollment Form, whichever is later. The Master Policy terminates on 12:01 a.m., August 23, 2009.
Coverage terminates on that date or at the end of the period through which premium is paid whichever is earlier.
Dependent coverage will no be effective prior to that of the insured student or extend beyond that of the insured student.

4. Cost

The chart below shows the 2008/2009 Premium Rates:

2008/2009 Premium Rate

Installment Option (only available if first installment payment is made by 9/24/08)

• Installment Payment Options for the Annual Coverage period is available if the first installment is paid by 10/1/08. (This payment option is no longer available after the 9/24/08 deadline). Insurance coverage will be interrupted if payment is not made by the deadlines for the second and third installment periods (1/24/09 and 5/24/09) and the pre-existing clause will apply. Installment payments may now be made online.

• Students may purchase the plan at anytime, even if the deadline has passed, but premium costs are neither prorated nor retroactive.

5. For Help and Information About:

• Medical Claims
• Enrollment
• Identification cards
• Plan Benefits
• Inpatient admission pre-certification, or
• To request a printed brochure

Monday through Friday, 8:30 a.m. to 5:30 p.m. EST

You may also visit http://www.aetnastudenthealth.com for details about the Plan benefits available to you. Just click on "Find Your School" and enter 711146 as your Policy Number.

6. For Questions About

• A prescription drug claim question
• Pharmacy claim forms
• Drugs that are not covered and drugs that require prior authorization. Prior Authorization is required for prescriptions filled for more more than a 30 day supply, growth hormones and drugs used for the treatment of malaria.

Contact: Aetna Pharmacy Management at (800)238-6279 - Available 24 hours a day.

7. Vital Savings on Dental by Aetna

Vital Savings on Dental by Aetna is a dental discount program helping you save on a wide array of dental services - with one low fee of $25 for students. Enroll online at http://www.aetnastudenthealth.com, click on "Find your School" and enter 711146 as your policy number.

Fees:

• Student - $25.00
• Student + 1 Dependent - $44.00
• Student + 2 Dependents = $63.00

8. Vision Services

University Health Services (UHS) will manage the vision benefit for those insured by the Domestic Student Health Insurance Plan. UHS Eye Care Clinic will provide the following:

One Routine Eye Exam (Refraction with Dilation) per Policy Year with a $15 Copay per exam.

For an appointment contact the Eye Care Clinic at (734) 764-8325.

For additional assitance with

• On-Campus Support
• Enrollment forms
• Brochures
• Liason for students with the insurance company and others

Contact:

Suzette Crandell or Judy Walker
Counseling & Support Services
2157 UC
313-593-5430
http:/www.umd.umich.edu/support

For more information contact UHS Managed Care/Student Insurance Office at 734-764-5182 or mancare-stuins@umich.edu