Student Health Plans
2009-2010
EASTERN WASHINGTON UNIVERSITY
STUDENT HEALTH INSURANCE PLAN
This optional insurance plan is exclusively contracted and provided for the students of Eastern Washington University. On campus, please contact Health, Wellness & Prevention Services, 509-359-4279 or visit University Recreation Center 201 for more detailed information.
| Offered by: |
Aetna Life Insurance Company
|
| Coverage Acceptance |
Guaranteed |
| Policy Period |
9/17/09 to 9/17/10 |
| Eligibility |
Minimum 6 credit hours Fall, Winter & Spring – Minimum 3 credits in Summer |
| MEDICAL |
| Maximum Benefit/Period |
$75,000 per condition |
| Deductible/Period |
$150 per benefit year |
| ADDITIONAL CO-PAYS |
| Emergency Room |
$100 - waived if admitted |
| Doctor Visits |
$20 CoPay within Network |
| Prescription Maximum |
$1,500 per benefit year |
| Co-Pays-Generic |
$10 |
| Brand Name |
$20 |
| Non-Formulary |
$20 |
| COINSURANCE - COMPANY PAYS |
| In-Network |
80% |
| Out of Network |
50% |
| Maximum Out of Pocket |
$3,150 per benefit year |
| Hospital In Patient |
80% in Network |
| Professional Services |
80% in Network |
| Preventive Care |
Covered expenses include an annual Pap screening for women ages 18 & older and one
baseline mammogram for women between ages of 35 & 40. Women 40 & older have
coverage for an annual mammogram per policy year, subject to Co-Pays. |
| PREMIUMS |
|
2009-10
Rates |
Annual
9-17-09 to
9-16-10 |
Fall
9-17-09 to
1-3-10 |
Winter
1-4-10 to
3-29-10 |
Spring
3-30-10 to
6-21-10 |
Spring/Summer
3-30-10 to
9-16-10 |
Summer
6-23-10 to
9-16-10 |
| Student |
$1,489 |
$456 |
$346 |
$338 |
$683 |
$338 |
| Spouse |
$3,626 |
$1,113 |
$844 |
$825 |
$1,669 |
$825 |
| Child |
$2,268 |
$696 |
$528 |
$516 |
$1,044 |
$516 |
| Children (2+) |
$2,268 |
$696 |
$528 |
$516 |
$1,044 |
$516 |
|
| Age Rated? |
Rates Same for All ages |
This is not a coverage certificate. For a full description
or brochure from the web site at www.fidelityins.com.
If you have questions, please call Fidelity at 509-462-7862 or 1-800-223-7954 and ask for Alan Wolfson.
To Apply for Aetna Coverage
CLICK HERE or on the logo below to apply for Aetna coverage.
Individual Medical Plans
CLICK HERE for optional plans through Asuris northwest Health and LifeWise Health Plan of Washington.
Definitions
| Deductible |
A deductible is an amount payable by the subscriber for health care before certain contractual benefits are available. Some benefits may be payable without a deductible. |
| Coinsurance |
Student percentage of cost share after the deductible has been met |
| Maximum Out-of-Pocket |
This is the maximum amount a student will pay per contract before the policy will pay 100% thereafter for covered services received. Copays do not apply |
| 
