Lehigh University
STUDENT HEALTH INSURANCE PLAN
2023-2024 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 https://www.universityhealthplans.com/Lehigh or calling University Health Plans (877)-657-5030.
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 insurance cost can be found on-line at https://www.universityhealthplans.com/Lehigh under the Insurance Cost & Coverage Periods section or the Plan Brochure.
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 Wellfleet 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.
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?
Where available, the student should first use the resources of the Student Health Center (SHC) where Treatment will be administered or a referral issued. Covered services that receive prior approval or referral will not be subject to the Deductible. A referral issued by the SHC must accompany the claim when submitted.
- For an Emergency Medical Condition. The student must return to the SHC for necessary follow-up care;
- When the SHC is closed;
- For medical care received when the student is more than 20 miles from campus;
- For medical care obtained when a student is no longer able to use the SHC due to a change in student status.
- For maternity care;
- When service is rendered at another facility during break or vacation period;
- Medical care is obtained by a student who is not eligible to use the SHC;
- Mental Health Disorders.
Additionally, no authorization or referral requirement will apply to obstetrical or gynecological care provided by In-Network Providers. The applicable Deductible(s); Coinsurance and Copayment(s) shall apply to all of the exceptions to the referral requirement shown above.
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. To see the prescription formulary and out of pocket cost to fill the prescription, please visit https://www.universityhealthplans.com/Lehigh.
Do I need to pick up my prescriptions at a specific pharmacy?
Yes. Your prescriptions must be filled a pharmacy that participates in the Wellfleet Rx pharmacy network. Only prescriptions filled at a Wellfleet Rx 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 Wellfleet Rx.
Does insurance cover pregnancy termination?
Abortion is covered up to 95% of the Negotiated Charge after Deductible for Covered Medical Expenses Deductible Waived if Student Health Center Referred. Plan brochures detailing coverage is available on-line at https://www.universityhealthplans.com/Lehigh
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.
When using the “Provider Search” tool you can select “Additional Languages Spoken” to narrow down your search. Please contact Wellfleet at 877-657-5030 and ask for an interpreter if you need assistance.
Is dental covered?
Members (to the end of the month in which the Insured Person turns 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. 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 Student Dental Plan" link.
Are eye doctors covered?
Members (to the end of the month in which the Insured Person turns 19) 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.
