Aetna Student Health is the claims administrator for the UMDNJ Student Health Insurance Plan. Aetna Student Health is responsible for answering questions about insurance benefits, claims, and providing lost ID cards. If you have any questions for Aetna Student Health, please call 800-466-3185.

University Health Plans (UHP) is the broker/plan manager who handles the enrollment and waiver process for the UMDNJ Health Insurance Plan. Please call UHP at 800-437-6448 if there are any questions about enrollment and waiver process or if there are customer service issues with Aetna Student Health.

What is a reasonable and customary charge and how does that charge affect me as a consumer?

Reasonable & Customary charges are guidelines developed by an independent source and used by insurance companies. These guidelines help to assure that the fees which providers are charging are reasonable for the service provided in their geographic area. Aetna utilizes the 90th percentile of Reasonable & Customary charges for most the UMDNJ student plan.

What is the negotiated charge?

The maximum charge a Preferred Care Provider has agreed to make as to any service or supply for the purpose of the benefits under this UMDNJ student plan.

Can I enroll in the insurance plan after the enrollment deadline?

You can enroll in the UMDNJ plan after the enrollment deadline should a qualifying event (loss of other coverage) occur. Examples of qualifying events are age limit under parent’s policy, marriage, etc.. You must supply written proof that your other coverage has terminated through a qualifying event. Once you have terminated from your current insurance carrier, you have 31 days after your termination to enroll in the UMDNJ student health insurance plan.

If I am in a car accident or I have an injury. What kind of documents will I need in order to submit a claim form for reimbursement?

You will be asked for a description of the accident, information on any other insurance coverage which you hold and perhaps a police report. A letter from Aetna Student Health will be sent to you requesting the pertinent information.

What are some of the reasons Aetna Student Health might not reimburse my medical provider for a claim I submitted?

Other insurance may be responsible for paying the claim; the services may not be covered according to the exclusions listed in your brochure or Plan Document; the claim may not have occurred while you were covered; or the charges may be over Reasonable and Customary. A letter or explanation of benefits from Aetna Student Health will accompany any denial of claim.

I have purchased coverage for myself, but can I also purchase coverage for my dependents (spouse, child)?

Yes, you can purchase coverage for your dependents. There are specific deadlines for enrolling your dependents. Please refer to your UMDNJ student health insurance brochure or at www.universityhealthplans.com. You can obtain a copy of the dependent enrollment form by logging on to UHP website or call UHP to enroll at 800-437-6448.

Which network of doctors and hospitals do I have access to?

You have access to the Aetna provider network. To find a list of participating doctors and hospitals in the Aetna network, please visit www.aetna.com/docfind (be sure to include your zip code and to select Open Choice PPO Plan as the health plan type).

Where can I get a directory/list of participating providers and can I find a provider in another state?

Please log onto the UHP webpage, click on UMDNJ and on the left hand side of the page, you should be able to see “Find a Provider” under Menu. Click on “Find a Provider” and you can do a search of providers in various states. If you cannot locate the provider in the directory, then it means that the provider is not part of preferred provider network and is consider out of network.

When scheduling an appointment, should I tell the provider's office that I have Aetna?

Yes. If you are scheduling an appointment with a provider, you should inform the office of that network and ask if they are participating with Aetna PPO Open Choice.

What if I go to a provider that does not participate with Aetna?

If you see provider that is not part of the Aetna network, then you may have to pay a little more out of your own pocket expense. It is to your advantage to see a preferred care provider to get maximum benefit. In general, the coverage for non-preferred care is payable at 60% in the UMDNJ student plan.

How can I check the status of a claim I submitted?

You can check the status of a claim that you or the provider have submitted by contacting Aetna Student Health at 800-466-3185.

What do I do if I am sick and need to go to the hospital?

Your student health insurance plan may require you to contact The Aetna Student Health Group when you are being admitted to the hospital on an inpatient basis. Outpatient services, including day surgery and emergency room visits, do not need to be pre-certified. Your specific pre-certification requirements are listed on the back side of your student health insurance identification card.

Am I covered for medical treatment while studying or traveling abroad?

Yes, no matter where you travel as a student, you are covered under the student health insurance medical plan 24 hours, worldwide. If you are enrolled in the student health insurance medical plan and received an Emergency Travel Assistance Identification card, you are automatically eligible for additional traveling services. The first part is a $10,000 Accidental Death and Dismemberment insurance coverage. The second part is unlimited medical evacuation and repatriation coverage.

Does my health insurance plan cover treatment for substance abuse and mental illness?

The UMDNJ student health insurance plan provides coverage for medically necessary treatment of substance abuse and mental illness conditions. Generally, the extent of coverage may depend on whether the treatment is provided on an inpatient or outpatient basis. Please refer to you student health insurance brochure for specific details or call the toll-free 800# on the front of your student identification card.

Does my health insurance plan cover pregnancy?

The UMDNJ student health insurance plan provides coverage for a pregnancy on the same basis as any other medical condition. Please refer to your UMDNJ student health insurance brochure for specific details or call the toll-free 800# on the front of your student identification card.

Is it my responsibility to file a medical claim?

If you visit an In-Network Aetna Preferred Provider, the provider should file a medical claim on your behalf. In the event that the provider does not submit a claim for you, see your plan brochure on how to file a medical claim.

Do I get an insurance card?

Yes. Once you are enrolled in the UMDNJ Student Health Insurance, an insurance card will be sent to your home. In the event that the card did not arrive on time, please see on the back of the student health insurance brochure for a temporary ID card that can be used until you receive your permanent ID card.

What if I lost my insurance card?

Please contact Aetna Student Health at 800-466-3185 to request another card or visit www.universityhealthplans, click on UMDNJ, select the student health insurance plan to view the option to request an ID card.

Who should I contact for updating my personal information such as a mailing address, name, etc.?

Please call UHP at 800-437-6448 to update your personal information.

If I have a benefit question about my policy, who should I ask?

First of all, please refer to all benefits in your student health insurance plan brochure. If you still need assistance, please contact Aetna Student Health and a claims administrator can help you with your benefit questions at 800-466-3185.

When do I have to fill out a claim form?

The only time that you would need to fill out a claim form is if you already paid in advance for your medical expenses or prescription.

Where can I find a medical claim form and a prescription claim form?

You can obtain a copy of the medical claim form by contacting UHP or visit www.universityhealthplans to download a copy of the prescription claim form.

What happens if I drop out of school while I am enrolled in your insurance plan? Will you refund my money? Will I still be covered?

You will not receive a refund after 31 days. However, you will continue to be insured through the period for which you paid.

Does UMDNJ student insurance plan cover prescription drugs?

Yes, most prescription drugs are covered. There is a $15 copay for Tier One, $20 copay for Tier Two, and $40 copay for Tier Three. For more information regarding your prescription tier, please contact Aetna Pharmacy Management at 800-238-6279 .

Which pharmacy can I go to get my prescription?

You can go to any participating pharmacy that is part of the Aetna Pharmacy Management network. If you need to get a provider listing, please contact Aetna Student Health at 800-466-3185.

Does UHP provide a voluntary dental plan for UMDNJ students?

Yes, a voluntary dental plan is available for the UMDNJ students and their dependents. If interested, please log onto UHP website to learn more about the plan’s benefits and to find the enrollment form.

Does this plan offer any vision benefits?

This plan provides vision discounts through Vision Once Discount Program. This Program allows you to purchase certain vision services and supplies, including Lasik Surgery, at discounted rates. You can obtain more detailed information regarding services, supplies, and discounts, as well as a list of Providers who provide services, supplies, and discounts by accessing Aetna’s DocFind at: www.aetna.com/docfind.