Lehigh University

STUDENT INJURY & SICKNESS INSURANCE PLAN FAQs
2010-2011 Academic Year

Are your physicians at the Health Center in my HMO?

You will need to call your HMO's Plan Administrator to determine this. Be sure to ask about the plan's "Out of Network" options.

Will you submit information to my insurance company?

Not generally. However, you may request to have copies of medical visits or tests mailed. You may then submit this information.

Which services must I be prepared to pay for while my son or daughter is at school?

It is up to each provider of medical care whether they will (1) accept insurance and not require the student to pay "up front" for services, or (2) require the student to pay "up front" for all services and be reimbursed by the insurance company.

What else should I know if I have a managed care/HMO style plan?

It is important to bring a copy of your Identification Card, Plan Booklet, and contact information with you to campus.

Tell me about the student insurance that may be purchased through the university bursar.

The University offers a low-cost plan for students. Plan brochures are available on-line at www.universityhealthplans.com or calling University Health Plans (800) 437-6448.

I already have my parent's insurance. Should I purchase the student insurance?

You do not need to purchase the student insurance if you are already covered by your parent's plan. However, you should carefully investigate whether you are eligible for coverage in the Bethlehem area and compare the cost of the student plan versus the cost of your continuing dependent coverage.

I am an international student. Must I purchase the student insurance?

International students must either purchase the student plan or show proof of comparable coverage. You should contact the Office of International Students and Scholars for details.

How much does the student insurance cost?

The basic annual cost is $1,363. Please check the enrollment form on-line or in the plan brochure for details.

Can I be seen at the Health Center if I do not purchase the student insurance?

Yes.

How does the student insurance reimbursement work for treatment?

Students must fill out a claim form for each injury and sickness and submit it to the Agent. You or your medical provider then submit bills which are reimbursed according to the terms of the policy.

Can my spouse and children be covered under the student insurance?

No.

Are there different times you can purchase the insurance besides fall and spring?

Yes. Please see the brochure enrollment card for the details of coverage periods.

What prescriptions are covered?

Most prescriptions are covered, except preventative or those which are not medically necessary. The plan brochure includes a complete list of exclusions and limitations.

Is dental covered?

Only accidental injuries to sound, natural teeth are covered. Typical dental treatment such as fillings and teeth cleaning are not.

Are eye doctors covered?

Only treatment for sicknesses of the eye are covered. Routine vision care is not. However, a discount program through Vision One is available to students. Please refer to the brochure for full details.

Does insurance cover pregnancy termination?

Elective abortion is covered up to a maximum of $400.

Do you need referrals from "primary physicians" to see specialists?

Please see the "Student Health Center Referral" section of your plan brochure. This section describes the requirement to use the Health Center. There are no "preferred providers" that you must use beyond this.

How do I get reimbursed for prescriptions?

Students must complete the same claim form as they would for all other services. You will attach copies of the prescription (not the cash receipt, the forms stapled to the prescription bag) and submit to Consolidated Health Plans. All prescriptions will be reimbursed according to the terms of the policy.

How do I know what is covered and what is not covered? I don’t want to pay for a prescription or service, only to find out later that I won’t be reimbursed.

There is a $750 maximum for prescriptions. If you have any questions on whether or not a specific prescription is covered please contact the claims administrator (Consolidated Health Plans) at 1-800-633-7867.

What are the coverage limits on this policy?

The Policy provides benefits for the Reasonable and Customary Charges incurred for a loss due to a covered Injury or Sickness up to a Maximum of $1,000 for each Injury or Sickness. After the initial $1,000 (and deductible if applicable), the company will pay 80% of additional Covered Medical Expenses incurred up to $5,000 then 100% up to the Major Medical Maximum of $50,000. For additional information on benefits, deductibles and co-insurance please refer to the Summary of Benefits located in the brochure.

Are Mental or Nervous Disorders covered?

Yes, when administered by an M.D. or licensed psychologist Ph.D., Psychotherapy Includes all related or ancillary charges incurred as a result of a mental or nervous disorder. For additional specifics, please refer to the Summary of Benefits located in the brochure.

What does the enhanced supplemental insurance do?

Enhanced supplemental insurance expands the maximum payment per condition from $50,000 to $250,000. It does not do anything for the $0 to $50,000 benefits.

How can I find a provider that speaks another language? I am an international student and I don’t understand English medical terms.

When you are in the “find a provider” field of the website, www.universityhealthplans.com, you can either put in the language as a search criteria, or you can look through the matches to your regular search and see if any providers speak another language.

Does the insurance cover check-ups, such as the TB test required of international students?

If you came to Lehigh and had a positive TB test, the Health Center probably would probably recommend you to get a chest X-ray done by St. Luke’s. The X-ray will be covered. Immunizations and vaccinations are usually not covered by the plan; they are requirements for your education so they are your responsibility. You can still turn in a claim, and you may receive some coverage, but expect to be responsible for some of the costs incurred.