Student Health Insurance Requirement for All Emory Students:
Waiver FAQs for New and Continuing Students (including Oxford College) for 2010-2011
Questions about Emory's reasoning behind the Student Health Insurance requirement:
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Q. Why did Emory institute a health insurance requirement for all students in Fall 2006?
Emory University has always strongly encouraged students to carry medical insurance. However, for several years we have been deeply concerned about our uninsured Emory students. When uninsured/underinsured students become seriously ill or injured, their academic careers are seriously threatened by substantial healthcare debt, disability or both. The University agrees, and now all Emory students across the university are required to have health insurance.
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Q. Why is Emory doing this when other universities are not?
Well, actually, Emory was the only university in the 2005 US News and World Report America's Best Colleges Top 20 without a health insurance requirement for all students. In addition, the American College Health Association recommends that all colleges and universities require students to provide evidence that they have appropriate health insurance coverage. As a result, there has been a very strong national movement towards required health insurance for all students over the past 5 years.
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Q. Why do Emory students need health insurance, when we can be seen for free at Student Health Services?
Yes, visits to Student Health Services are free, but thinking that this is enough is a common and dangerous misconception. While Student Health Services provides excellent out-patient care for enrolled Emory students, EUSHS provides only out-patient primary care, short-term (but not long-term) counseling and psychiatry services. If and when Emory students need specialist care, emergency services or hospitalization, the bills can run quickly into the tens of thousands of dollars. Such unexpected expenses can derail, or even end, a promising academic career.
Questions about the quality and cost of the Emory/Aetna Student Health Insurance Plan and Scope of Coverage:
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Q. Is the Emory student insurance plan any good?
We feel strongly that our student health insurance plan is among the best student plans in the nation. The 2010-11 Emory/Aetna plan features the following:
- Three-tiers of coverage, including an Emory Healthcare Core (100% coverage with no annual deductible after co-payment of $25 for specialist care and $50 for Emergency Room; co-payments are waived at Emory Student Health and Counseling Services), Preferred Care at Aetna PPO providers (80% coverage after co-payment and a $200 annual deductible) and Out-of-Network care (60% coverage after co-payment and a $400 annual deductible).
- An Aetna PPO national preferred provider network of over 610,000 providers and over 3,700 hospitals.
- Students do not have to personally complete and submit claim forms for care received. The provider submits bills directly to Aetna.
- There are no pre-existing condition exclusions under the Emory/Aetna student plan and no waiting period for coverage to begin.
- The plan covers 100% of covered medical expenses at Emory Student Health Services, including the on-site EUSHS Dermatology clinic (after specialist $25 co-payment), immunizations, TB skin tests, colposcopies and Travel Clinic.
- The plan covers 100% of covered medical expenses at all other Emory Healthcare facilities, with no annual deductible, after co-payment of $25 for specialist care and $50 for Emergency Room (waived if the patient is admitted to the hospital).
- The plan covers 80% of negotiated charges outside Emory University Student Health Services (EUSHS) and within the Aetna network. There is a $200 total annual deductible in-network and a $25 co-pay for physician visits outside EUSHS. Outside the Aetna network, coverage is 60% after co-payments with a $400 annual deductible.
- All non-emergency specialist care must first have a written referral from the Student Health Service, unless you are more than 50 miles away from Emory or the EUSHS is closed.
- The plan offers outpatient prescription pharmacy coverage up to $2,000 (after co-pays) and $500 of coverage at EUSHS (which includes oral contraceptives).
- Mental health outpatient and inpatient coverage has no cap on coverage, including treatment for alcohol and substance abuse.
- Coverage is also available for student's spouse, qualified domestic partner and children.
- Plan changes for 2010-11 include: Added coverage for allergy treatment (serum + shots) at EUSHS, coverage of sinus surgery, no referral requirement for chiropractic care or primary care for dependents ages 12-17 years, coverage of gastric bypass surgery, transgender medical and mental health treatment, o referral requirement at EUSHS and a $10 co-pay for outpatient mental health (applies to all tiers, Core/Participating PPO/Nonparticipating out-of-network).
We strongly encourage you to read the plan brochure before you draw conclusions about the quality of coverage.
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Q. What are the 2010-11 premium rates of the Emory/Aetna plan?
Despite the above policy enhancements and changes, the 2010-11 annual premium has actually been decreased by $11 to $2,147. This comes out to approximately $180 per month for students.
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Q. Why is this student insurance plan so expensive? My spouse/partner pays a lot less for his/her health insurance.
While it is possible that that is true, it is unlikely if the coverage is comparable. Many employers provide health insurance as an employee benefit, and provide a large subsidy toward the employee's premium. That being said, if you want lower rates, get your friends to sign up! The more students on the plan, the more widely the risk is spread, so the rates go lower.
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Q. Aren't there cheaper insurance policies available that meet the minimum waiver criteria?
Yes, there are. As noted earlier, the Emory/Aetna student policy far exceeds the waiver coverage minimums in several areas. However, you get what you pay for, and insurance companies are in business to make money. We implore you to read the summary of benefits (and the fine print) and compare and contrast insurance policies before you make your decision to purchase one plan over the other. You should particularly note the excellent coverage for care delivered within the Emory Healthcare Core. The time to determine whether your level of coverage is adequate is now, not when you are sitting in the emergency room or lying in a hospital bed.
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Q. Why should students who already have excellent insurance coverage via their parents' or spouse/partner's plans be forced to also pay for the Emory plan?
They won't be. Emory has a student health insurance requirement with a "hard waiver". Under this approach, students must either purchase the Emory Student Health Insurance Plan or show evidence of enrollment in a comparable health insurance plan. If the student has not waived out of the Emory plan by July 1, 2010, he/she will be automatically enrolled in the Emory plan and billed via Student Financial Services. However, the student will still have until the first day of Fall Semester classes (August 25, 2010) to complete the waiver through OPUS and get the insurance enrollment and charge reversed. Therefore, no student should find himself or herself in a situation where they have two insurance plans. . . . unless he/she ignores deadlines.
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Q .When I leave Emory, will I automatically lose my insurance coverage?
No, not necessarily. The Emory/Aetna is a student plan, and if you graduate in May 2011 your plan will continue until the end of your plan year in July or August. That should give you time to get settled at your new job, school or the like. If you want to extend your coverage beyond that, you will be eligible for the Continuation Plan, which can cover you for up to an additional 3, 6, or 9 months. That should give you time to get settled at your new job, school or the like. Arrangements for continuation coverage must be made while your current policy is still in effect. Please be aware that the continuation plan is significantly more expensive than coverage for enrolled students, which is true of all COBRA-type coverage.
If you graduate in December, or if you take a leave of absence and do not enroll for classes in the Spring, your insurance plan will terminate on January 7, 2011. However, if you want to extend your coverage beyond that, you will be eligible for the Continuation Plan, which can cover you for up to an additional 3, 6, or 9 months. Arrangements for continuation coverage must be made while your current policy is still in effect. Please be aware that the continuation plan is significantly more expensive than coverage for enrolled students, which is true of all COBRA-type coverage.
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Q. I will be going abroad in the Spring Semester. Will the Emory plan give me coverage while I am away from the United States?
Yes. The Emory/Aetna Student Plan gives coverage both in the United States and abroad.
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Q. Are there reasons that I might not want to enroll in the Emory student plan?
Yes, possibly. The Emory student plan is designed to meet the insurance needs of the vast majority of Emory students while keeping premium costs in mind (since cost is a big issue for many/most students). As a result, there are at least two features of the plan of which students should be aware:
- The Pharmacy Cap: The plan offers outpatient prescription pharmacy coverage up to $2,000 (after co-pays) and $500 of coverage at EUSHS (which includes oral contraceptives). If you have a condition that will require prescription medications that far exceed this cap, you may want to consider another insurance plan.
- The $250,000 Lifetime Aggregate Maximum: Although the plan has no pre-existing condition exclusion (which is great), it features a $250,000 aggregate lifetime maximum for each covered illness or injury. It also only provides coverage while you are a student at Emory. If you have a severe pre-existing illness (cancer, a complex cardiac condition, etc.) and your physician feels that your expenses for that condition could exceed $250,000 during the time you are a student at Emory, you should consider another insurance plan.
Questions about issues of importance to International Students:
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Q. I am an international student and I have always been required to have health insurance at Emory. However, I never heard about this 'United States-domiciled' insurance company requirement. Is this new? Can't I have insurance from my home country?
All international students at Emory have been required to have health insurance or to purchase the Emory student plan. However, the requirement that the insurance company be domiciled in the United States is a Fall 2005 change in the insurance requirement for international students. Emory has found that receiving health insurance benefits from international carriers for medical care in the United States can often be incomplete and problematic.
Under certain circumstances, we will allow students to have insurance with an international carrier if the insurance company has a claims-processing agreement with an American firm. Please contact our Student Health Services Insurance Office if you have questions about this situation.
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Q. Are there any additional insurance requirements for International Students that do not apply to domestic students?
Yes. In addition to the coverage requirements listed for all students, International Students must have insurance that meets the following additional requirements:
- Coverage for medical evacuation and repatriation of remains to the Insured Person's place of residence in his or her home country ($10,000 for evacuation, $7,500 for repatriation)
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For J-1 exchange visitors and their J-2 dependents, the U.S. Department of State regulations require that the health insurance plan must also meet one or more of the following criteria:
- Part of a group benefits program offered to enrolled students by a designated sponsor, or
- A health maintenance organization (HMO) that is federally qualified as determined by the Health Care Financing Administration (HFCA) of the U.S. Department of Health and Human services, or
- A Competitive Medical Plan (CMP) as determined by the Health Care Financing Administration (HFCA) of the U.S. Department of Health and Human services, or
- Underwritten by an insurance company having an AM Best rating of "A-" or above, an Insurance Solvency International, LTD. (ISI) rating of "A-" or above, a Standard and Poor's Claims-Paying Ability rating of "A-" or above, or a Weiss research, Inc. rating of "B+" or above.
The Emory University Student Health Insurance Plan, offered by Aetna Student Health, meets all additional insurance requirements for international students and dependants
Questions about enrollment in the Emory/Aetna Plan:Questions about enrollment in the Emory/Aetna Plan:
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Q. Can I waive insurance for the Spring, and then sign up for the Summer when my finances are in a little better shape?
Sorry, no. The Emory/Aetna insurance plan is an annual plan, with annual enrollment in the Fall. The only students eligible to enroll in the Spring or Summer are students new to Emory during that semester or students with a qualifying event.
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Q. What if I find out that I have a serious illness or suffer an injury after the enrollment deadline, can I sign up for the insurance plan then?
Sorry, no again. The Emory/Aetna insurance plan is an annual plan with no pre-existing condition exclusions. If the insurance company let students sign up at any time during the semester, after finding out that they have a serious, expensive medical problem or injury, then the rates of coverage would go way up for everybody else covered under the plan. That's why it is called an insurance plan, not a "wait until I need it and then sign up" plan.
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q. What if I lose my current insurance during the school year. Can I sign up for the Emory insurance plan then?
Yes, you can. After the enrollment deadline, students who have involuntarily lost health insurance coverage through a "Qualifying Life Event" (such as (1) removal from a parent's health insurance plan after achieving a landmark birthday that disqualifies them from a parent's health insurance plan, or (2) losing private insurance through loss of employment or divorce) may apply for late enrollment in the Emory University Student Health Insurance Plan. These students must provide proof that they have lost insurance through another group (certificate and letter of ineligibility) within 30 days of the qualifying event. The premium will be the same as it would have been at the beginning of that period, but the effective date would be the later of the date the student enrolls and pays the premium or the day after prior coverage ends. Premiums are not pro-rated, and the student will be responsible for paying the full premium for the term in which they enroll.
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Q. I would like to enroll my spouse and children in the Emory/Aetna plan. Can I do that?
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Q. Can I enroll my domestic partner in the plan?
Yes, qualified domestic partners are eligible for enrollment in the plan. To be considered a Domestic Partner, and eligible to be covered as a Dependent of an Insured Student under the Emory University Student Health Insurance Plan, you must meet the following criteria:
- The Domestic Partnership must have been in existence for a period of 12 consecutive months prior to the application for coverage under this Plan.
- The members of the Domestic Partnership are not legally married to anyone.
- The members of the Domestic Partnership must be 18 years of age or older.
- The members of the Domestic Partnership are not related by blood closer than would bar marriage in the State of Georgia and are mentally competent to consent to a contract.
- The members of the Domestic Partnership are each other's sole Domestic Partner, and intend to remain so indefinitely and are responsible for their common welfare.
Students who elect to enroll their Domestic Partner are required to complete an Affidavit for Domestic Partnership, which is available at the Student Health Services Insurance Office in the 1525 Clifton Road Building. Call 404-727-7560 if you have questions.
Questions about dates of coverage, including the continuation plan:Questions about dates of coverage, including the continuation plan:
Questions about primary care at Student Health Service and referrals for specialist care:
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Q. Where do I get my primary medical care under the Emory/Aetna student plan? At Student Health Services?
Yes. Emory Student Health Services is the primary care provider under the plan. Visits to EUSHS are free for enrolled students, and the insurance plan pays 100% of covered services at EUSHS (lab tests, medical supplies, medications, immunizations, Travel Clinic, etc.).
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Q. What if I don?t have the Emory/Aetna plan? Can I still go to Student Health Services?
Yes, absolutely! Your visits are still free (covered by your tuition).
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Q. What if I don't have the Emory/Aetna plan and I get billed for ancillary services at Student Health Services?
EUSHS accepts cash, checks, EmoryCard, Visa and MasterCard for ancillary services (lab, medications, etc.). Payment for deductibles and coinsurance is due at the time of service.
Although EUSHS participates in the Emory/Aetna student insurance plan, we are non-participants in many other plans. However, we will file any charges a student incurs at EUSHS with his/her primary insurance carrier. Since we are non-participants, it is possible that the carrier may not pay for these charges. We will also provide students with copies of all relevant paperwork they will need to resolve any payment issues with their carrier. Any account balance that is not paid in a timely manner, either by insurance or patient, will be transferred to Student Financial Services for inclusion on the student's university account. But please take note: if a student's account becomes past due, Emory may withhold transcripts, grades, registration or other University provided services or goods until all past due amounts are paid.
Please note that EUSHS does not participate in federal Medicare and state Medicaid programs and will be unable to bill for services under these plans.
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Q. I have heard that I have to have a referral to see a specialist under the Emory/Aetna student health insurance plan. Is that true?
Yes, it is. There is a referral requirement under the plan. Emory University Student Health Services (EUSHS) offers students comprehensive primary and specialty services coordinated by EUSHS. All covered students and covered dependents age 18 years or older in need of medical care should, except in the case of a medical emergency, first seek treatment and be evaluated at EUSHS. You may be referred to an outside medical provider if required specialist medical care is unavailable at EUSHS. If you are enrolled in the Student Health Insurance Plan, a referral is necessary to receive the maximum benefit under your Student Health Insurance Plan, except in the following instances:
- Treatment of an Emergency Medical Condition; or
- When EUSHS is closed; or
- When the service is rendered at another facility during breaks or vacation periods; or
- When medical care is received by a Covered Person who is more than 50 miles from campus; or
- When medical care is received by a Covered Person who is no longer able to use the EUSHS due to a change in student status; or
- Ob/Gyn services.
- Dermatological services.
- Chiropractic care
A new referral must be obtained if continuous treatment is being received from one Policy Year to the next. Please note that dependents under age 18 are not permitted to use EUSHS and therefore are exempt from the referral limitations and requirements.
Questions about other optional coverage, including the dental plan and the supplemental plan:
Questions about payment options under the Emory/Aetna plan, including financial aid:
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Q. How will I be billed for the Emory/Aetna insurance plan?
If you are enrolled into the Emory/Aetna insurance plan, you will be billed by Emory Student Financial Services via your student account. If you have the payment plan, the cost of the insurance will be divided into your individual Fall and Spring payments. You should see your first insurance charge with your July 2010 bill. If you are not on the payment plan, but would like to be, contact Student Financial Services at 404-727-6095.
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Q. Can I get financial aid to cover the Emory/Aetna insurance plan?
Because health insurance is now mandatory for all Emory students, if you are eligible for financial aid, you can request access to additional loans for the amount of the premium. Contact the Office of Student Financial Aid at 404-727-6039 or stop in at their offices at the B. Jones Center.
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Q. Can I charge the cost the Emory/Aetna insurance plan for my spouse, domestic partner or children to my Emory Bursar account?
Sorry, no. If you wish to enroll dependents in the plan, you must go to www.aetnastudenthealth.com. Emory Student Financial Services will only bill for student insurance, since students are required to have insurance. Spouses, partners and children are not.
Questions about the waiver process, including appeals:Questions about the waiver process, including appeals:
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Q. If I waived off the insurance plan 2010-11, then I am good for the next four years at Emory, right?
No! Every Emory degree-seeking and international student must complete the enrollment/waiver process once a year (each Fall Semester) every year.
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Q. What if I make a mistake while I am completing the waiver, or if my insurance situation changes between the day I complete the 2010-11 waiver and the August 25th deadline?
You may reenter the OPUS mandatory insurance waiver site as many times as you wish prior to August 25th and cancel or change your waiver.
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Q. Why does Emory have a requirement that the individual annual deductible on my plan must be $2,500 or less or I must have a certified Healthcare Savings Account (HSA)?
Emory has found that students avoid going to the doctor or the emergency room, refuse needed hospitalizations, or won't allow important tests, x-rays or scans to be done, if their deductible is very high (e.g. $5,000, $10,000). The whole point of the mandatory insurance requirement is to give Emory students insurance coverage that will allow them to get important, needed healthcare so that they can successfully complete their degrees. This waiver criterion helps us to achieve that goal.
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Q. What if I fail the waiver process or I miss the deadline and get charged for the Emory/Aetna insurance plan and I want to appeal the charge? Can I do that?
Yes. Emory will have a formal committee to review and vote on appeals. Each Fall, the deadline for this appeals process for the annual plan will be on or about September 15th. If you have questions or concerns about the student insurance requirement or your individual situation relative to the requirement, please contact the Student Health Services Insurance Office at 404-727-7560 or mandatoryinsurance@listserv.cc.emory.edu.
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Q. When can I complete my waiver for 2010-11?
The on line student insurance requirement waiver site for new and continuing Emory University students (including Oxford College) opens on April 21, 2010 and will close at 5:00 pm on the first day of classes, August 25, 2010. You will access this waiver site via your OPUS account at www.opus.emory.edu.
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Q. I already completed my insurance waiver for Summer 2010. Now I hear that I also have to do a waiver for 2010-11. Is that true?
Yes! At Emory, we say "Student Insurance Requirement: Every Student, Every Year." If you do not wish to enroll in the Emory Student Health Insurance Plan, the waiver process must be completed EACH year you are enrolled at Emory University for the upcoming academic year. If you have questions about the insurance waiver/enrollment process, you may contact our Insurance Office at mandatoryinsurance@listserv.cc.emory.edu , 404-727-7560.
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Q. I made a mistake on my waiver (or my insurance situation has changed) and I need to change the information I provided on the waiver site. Can I do that?
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Q. I waived the student insurance plan, but now I have changed my mind and want to enroll for 2010-11. Can I do that?
Yes. Students can change information on the waiver site as many times as necessary up to the time the site closes (August 25, 2010 at 5:00 pm), including canceling a waiver and deciding to enroll in the Emory Student Health Insurance Plan.
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Q. My waiver was rejected and I am very unhappy about it.
University policies (like laws) are made with an attempt to meet the needs of the majority, and if possible, the overwhelming majority. However, virtually never are they "one size fits all." The University did its best to create a series of minimum requirements that would insure that students were properly covered (otherwise, saying "you must have insurance" would lead to people purchasing $15 annual policies), but knew that there would be requests for exceptions and that many would be legitimate. Therefore, an Appeals Committee, consisting of students, faculty and staff, has been formed and will hear the written appeals requests of individual students. You can find information about the appeals process, and an appeals form for the current waiver/enrollment process by clicking here. If you appeal, we will ask Student Financial Services to not place any charges for insurance on your account pending your appeal. However, if you receive a bill in error prior to the completion of the appeals process, please contact us at mandatoryinsurance@listserv.cc.emory.edu, 404-727-7560.
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Q. I am an international student here for only one year and I will not be getting an Emory degree. Why am I still required to have insurance if I am non-degree seeking?
Our international students do need insurance while here, even if they are not degree-seeking. It is an Emory University requirement, and also may be a requirement of your visa.
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Q. I am a student in the Laney Graduate School of Arts and Sciences for 2010-11 and I am eligible to get a subsidy to help pay for insurance. I would like to enroll in the student insurance plan. Do I still need to go to the OPUS web site?
No, the waiver site is for waivers only, not insurance enrollment. GSAS will then post the subsidy to your Student Financial Services account for their portion of the premium. If this still does not make sense, contact the GSAS Student Affairs office.
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Q. I still don't understand this requirement, the waiver process, etc. Can you help me?
Questions about how to get help if you have a question or problem:
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Q. Where do I go if I have questions about Emory's health insurance requirement or the online enrollment/waiver process?
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Q. What if I want to talk to the main person in charge of all of this, the Student Health Executive Director himself?
To reach the Student Health Services Executive Director, please contact:
Michael Huey, MD
Executive Director
Emory University Student Health Services
1525 Clifton Road
Atlanta , GA 30322
404-712-8652
mhuey@emory.edu
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Q. Where do I go if I have questions about enrollment, insurance benefits or claims processing?
For answers to these questions, go to:
Aetna Student Health Claims Administrators, Inc.
P.O. Box 15708
Boston , MA 02215-0014
(877) 261-8403
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Q. What if I am more comfortable looking up answers to my questions and getting information on line?
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Q. What if I have questions about or problems with my Aetna insurance ID card?
Permanent ID cards will be issued as soon as possible after the enrollment/waiver on line site closes. If you need medical attention before your ID card is received, benefits will be payable in accordance with the Policy. You do not need an ID card to be eligible to receive benefits. If you need a temporary ID card, you can obtain one from the Aetna Student Health website or contact the EUSHS Insurance Office for assistance. Once you have received your ID card, present it to the provider to facilitate payment of your claims. You will receive a unique Aetna member ID number on your membership card. For lost ID cards, contact Aetna Student Health Administrators, Inc. at (877) 261-8403, or visit www.aetnastudenthealth.com, click on "Find Your School" and enter "Emory University".
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Q. How do I find a list of preferred providers under my Emory/Aetna student health insurance plan?
A complete list of preferred providers can be found at Emory University Student Health Services (EUSHS), or you can use Aetna's DocFind® Service located at www.aetnastudenthealth.com. Click on "Find Your School" and enter "Emory University". You can use DocFind to find out whether a specific provider belongs to Aetna's network or to find Preferred Providers practicing in your area.
Revised 04/29/2010
