2012-438-1 introductory flyer-v3_benefit summary

Student Injury and Sickness Insurance
Plan for
Cornish College of Arts
2012-2013
Cornish College of Arts is pleased to offer an Injury and Sickness Insurance Plan underwritten by UnitedHealthcare Insurance Company. All students taking 3 or more credit hours are eligible to enroll in the student insurance program. Eligible Dependents of those enrolled in theplan may participate in the plan on a voluntary basis.
2012-438-1.
* Policy terms and conditionssubject to regulatory approval.
Highlights of the Coverage and Services
offered by UnitedHealthcare StudentResources are:
Up to $100,000 Per Insured Person, Per Policy Year Maximum Benefit for Covered Medical enroll. The plan brochureprovides details of the $500 Deductible for Preferred Providers per Insured Person, per Policy Year, $1,000 Deductible per Insured Person, per Policy Year for Out of Network Providers.
Covered Medical Expenses for Preferred Providers are payable at 80% of Preferred Allowance and Out of Network benefits are payable at 60% of Usual and Customary charges (all benefits are subject to satisfaction of the Deductible, specific benefit limitations, maximums and copays as described in the policy).
Preferred Provider Out-of-Pocket Maximum of $5,000 Per Insured Person, Per Policy Year.
Out-of-Network Out-of-Pocket maximum of $10,000 Per Insured Person, Per Policy Year.
After the Out-of-Pocket Maximum has been satisfied, Covered Medical Expenses will be paid at 100% up to the policy Maximum Benefit subject to any applicable benefit maximums. Refer to the plan brochure for details about how the Out-of-Pocket Maximum applies.
Prescription Drug Benefits: $15 Copay for Tier 1 / $35 Copay for Tier 2 / $70 Copay for Tier 3 up to a 31-day supply per prescription filled at a UnitedHealthcare Network Pharmacy (UHPS). Mail order through UHPS at 2.5 times the retail copay up to a 90-day supply. Prescriptions must be filled at a UHPS network pharmacy.
Coverage available for eligible Dependents.
The Preferred Provider Network for this plan is UnitedHealthcare Choice Plus. PreferredProviders can be found using the following link, http://www.uhcsr.com/lookupredirect.aspx?delsys=52 Scholastic Emergency Services – Domestic Students are covered when 100 miles ormore away from their campus or home address. International Students are coveredworldwide except in their home country.
Your student health insurance coverage, offered by UnitedHealthcare Insurance
Company may not meet the minimum standards required by the healthcare reform law
for restrictions on annual dollar limits. The annual dollar limits ensure that consumers
have sufficient access to medical benefits throughout the annual term of the policy.
Restrictions for annual dollar limits for group and individual health insurance coverage
are $1.25 million for policy years before September 23, 2012; and $2 million for policy
years beginning on or after September 23, 2012 but before January 1, 2014. Restrictions
on annual dollar limits for student health insurance coverage are $100,000 for policy
years before September 23, 2012 and $500,000 for policy years beginning on or after
September 23, 2012, but before January 1, 2014. Your student health insurance coverage
puts a policy year limit of $100,000 that applies to the essential benefits provided in the
Schedule of Benefits unless otherwise specified. If you have any questions or concerns
about this notice, contact Customer Service at 1-800-767-0700. Be advised that you may
be eligible for coverage under a group health plan of a parent's employer or under a
parent’s individual health insurance policy if you are under the age of 26. Contact the
plan administrator of the parent’s employer plan or the parent’s individual health
insurance issuer for more information.
UnitedHealthcare StudentResources
8/28/12 - 8/27/13 8/28/12 - 1/16/13 1/17/13 - 8/27/13 Each Child
Pre-Existing Condition means 1) the existence of symptoms within the 3 3 months immediately prior to becoming an Insured under this policy.
months immediately prior to the Insured’s Effective Date under the policy; Credit will be given for the period of time an Insured was covered or, 2) any condition which is diagnosed, treated or recommended for under the immediately preceding health plan for periods less than the treatment within the 3 months immediately prior to the Insured’s Effective 3 month period (This exclusion will not be applied to an Insured Exclusions and Limitations
27. Prescription Drugs, services or supplies as follows, except as No benefits will be paid for: a) loss or expense caused by, contributed to, or resulting from; or b) treatment, services or supplies for, at, or Therapeutic devices or appliances, including: hypodermic needles, syringes, support garments and other non-medical Acne; acupuncture; allergy, including allergy testing; except as substances, regardless of intended use, except as specifically Drugs labeled, “Caution - limited by federal law to investigational Milieu therapy, learning disabilities, behavioral problems, parent-child problems, conceptual handicap, developmental delay or disorder or mental retardation, except as specifically provided in the policy; Drugs used to treat or cure baldness; anabolic steroids used for Anorectics - drugs used for the purpose of weight control; Congenital conditions; except as specifically provided for Newborn or Fertility agents or sexual enhancement drugs, such as Parlodel, Pergonal, Clomid, Profasi, Metrodin, Serophene, or Viagra; Cosmetic procedures, except cosmetic surgery required to correct an Injury for which benefits are otherwise payable under this policy or Refills in excess of the number specified or dispensed after one for newborn or adopted children; removal of warts, non-malignant (1) year of date of the prescription.
28. Reproductive/Infertility services including but not limited to: family Custodial care; care provided in: rest homes, health resorts, homes planning; fertility tests; infertility (male or female), including any for the aged, halfway houses, college infirmaries or places mainly for services or supplies rendered for the purpose or with the intent of domiciliary or custodial care; extended care in treatment or inducing conception; premarital examinations; impotence, organic or substance abuse facilities for domiciliary or custodial care; otherwise; tubal ligation; vasectomy; sexual reassignment surgery; Dental treatment, except for accidental Injury to Sound, Natural Teeth; 10. Elective Surgery or Elective Treatment; 29. Research or examinations relating to research studies, or any treatment for which the patient or the patient’s representative must 12. Eye examinations, eye refractions, eyeglasses, contact lenses, sign an informed consent document identifying the treatment in which prescriptions or fitting of eyeglasses or contact lenses, vision the patient is to participate as a research study or clinical research correction surgery, or other treatment for visual defects and problems; 30. Routine Newborn Infant Care, well-baby nursery and related 13. Foot care including: flat foot conditions, supportive devices for the Physician charges, except as specifically provided in the policy; foot, care of corns, bunions (except capsular or bone surgery), 31. Routine physical examinations and routine testing; preventive testing calluses, toenails, fallen arches, weak feet, chronic foot strain, and or treatment; screening exams or testing in the absence of Injury or Sickness; except as specifically provided in the policy; 14. Health spa or similar facilities; strengthening programs; 32. Services provided normally without charge by the Health Service of 15. Hearing examinations or hearing aids; or other treatment for hearing the Policyholder; or services covered or provided by the student defects and problems. "Hearing defects" means any physical defect of the ear which does or can impair normal hearing, apart from the 33. Skeletal irregularities of one or both jaws, including orthognathia and mandibular retrognathia; temporomandibular joint dysfunction; deviated nasal septum, including submucous resection and/or other surgical correction thereof; nasal and sinus surgery, except for 18. Immunizations, except as specifically provided in the policy; preventive medicines or vaccines, except where required for treatment of a 34. Bungee jumping or flight in any kind of aircraft, except while riding as covered Injury or as specifically provided in the policy; a passenger on a regularly scheduled flight of a commercial airline; 19. Injury or Sickness for which benefits are paid or payable under any Workers' Compensation or Occupational Disease Law or Act, or 36. Speech therapy; naturopathic services; 37. Suicide or attempted suicide while sane or insane (including drug 20. Injury or Sickness outside the United States and its possessions, overdose); or intentionally self-inflicted Injury except for Injury Canada or Mexico, except for a Medical Emergency when traveling sustained as a consequence of the Insured’s being intoxicated or for academic study abroad programs, business or pleasure; 21. Injury sustained while (a) participating in any intercollegiate or 38. Supplies, except as specifically provided in the policy; professional sport, contest or competition; (b) traveling to or from 39. Surgical breast reduction, breast augmentation, breast implants or such sport, contest or competition as a participant; or (c) while breast prosthetic devices, or gynecomastia; except as specifically participating in any practice or conditioning program for such sport, 40. Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment; 41. War or any act of war, declared or undeclared; or while in the armed 24. Outpatient Physiotherapy; except for a condition that required surgery forces of any country (a pro-rata premium will be refunded upon or Hospital Confinement: 1) within the 30 days immediately request for such period not covered); and preceding such Physiotherapy; or 2) within the 30 days immediately 42. Weight management, weight reduction, nutrition programs, treatment following the attending Physician's release for rehabilitation; or when for obesity, (except surgery for morbid obesity), surgery for removal of 25. Participation in a riot or civil disorder; commission of or attempt to 26. Pre-existing Conditions for a 3 month period, except for individuals who have been insured under another similar health plan for at least

Source: http://www.cornish.edu/content/docs/student_life/CornishHealthInsuranceBrochure2012-13.pdf