Lehigh University
STUDENT HEALTH INSURANCE PLAN

2016-2017 Academic Year

Are your physicians at the Health and Wellness 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 annual cost for the 2016-2017 Policy Year is $1,875. Please check the enrollment form on-line or in the plan brochure for details.


Can I be seen at the Student Health and Wellness 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 or sickness and submit it to Consolidated Health Plans (CHP) at the address on the form. The student or the medical provider must also submit the bills for the services.

Bills for medical services should be submitted to Cigna, PO Box 188061, Chattanooga, TN 37422-8061. Cigna cannot accept claims forwarded to them by CHP.


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 Enrollment Form or Brochure for the details of coverage periods.


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

Beginning in the 2016-17 Policy Year, a referral is not required to receive coverage, however, obtaining a referral for each service is the only way to waive the plan’s per policy year deductible ($50 In-Network and $50 Out-of-Network).


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

A TB test will not be covered by the plan unless you are showing symptoms and have the test done to determine your diagnosis.

If you came to Lehigh and had a positive TB test, the Health and Wellness Center would probably recommend you to get a chest X-ray done by St. Luke's. The X-ray will be covered.

Various immunizations and vaccinations will be covered by the plan when received from in-network providers. Those covered immunizations will be paid at 100% and will not be subject to a deductible. However, because they are requirements for your education, the cost for ineligible immunizations (if any) would be your responsibility. You should still turn in a claim to have eligible coverage determined.

Also, routine examinations will be covered at 100% when received from an in-network provider and will not be subject to a deductible. Routine examinations and preventative/wellness services received from an out-of-network provider are not eligible for coverage.


Are prescriptions covered?

Most prescriptions are covered, except preventative or those which are not medically necessary.


Do I need to pick up my prescriptions at a specific pharmacy?

Yes. Your prescriptions must be filled a pharmacy that participates in the Cigna pharmacy network. Only prescriptions filled at a Cigna participating pharmacy are eligible for coverage.


I need to pick up a prescription before I'm in the insurance plan systems. What do I do?

If you will be retroactively covered by the Student Health Insurance Plan on the day you need to fill a prescription, but are not yet in the insurance plan systems, you can pay out-of-pocket and submit for reimbursement later.

If you pay out of pocket for a prescription during a time when you will have coverage, you should keep the detailed prescription receipt that is attached to your prescription drug bag. After you are added to the insurance plan systems, you will receive an insurance card. Once you receive your insurance card, you may submit the detailed receipt along with a "Prescription Drug Reimbursement Form" to Cigna.


Does insurance cover pregnancy termination?

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


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.


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

Click "Find a Provider" on the left side of this webpage and follow the links to your network's website. Once you are on the search page of the network website, you will be given an option to indicate a language.


Is dental covered?

Members who are under the age of 19 at the time of their eligible dental service have access to various dental benefits. See brochure for details.

Otherwise, only accidental injuries to sound, natural teeth are covered. Typical dental treatment such as fillings and teeth cleaning are not covered unless eligible under Pediatric Dental.


Are eye doctors covered?

Members who are under the age of 20 at the time of their eligible vision service have access to various vision benefits. See brochure for details. 

Otherwise, only treatments for sicknesses of the eye are covered. Routine vision care is not covered unless you are under the age of 19. A voluntary plan called VSP Vision Care Plan is available. To learn about the voluntary plan (including plan details, provider search, costs, deadlines, and an enrollment form), go to www.universityhealthplans.com; select your school name, and click on the "Voluntary VSP Vision Care" link.