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by Tony Novak, CPA, MBA, MT,
Penn Student Insurance Plan is an Accident and Sickness Medical Expense policy underwritten by Aetna Life Insurance Company. The policy number is 724535. The complete policy brochure is available online. The information below is meant to be a brief summary of coverage and does not include all of the policy details. In the event of a discrepancy between the information below and the actual policy, the policy will prevail.
Annual premium per student: $2,642 for medical plus $205 for optional dental coverage (2010 school year)
Deductible: $250 in network / $1,500 out-of-network
Hospital deductible: $100 per admission
Surgical or Outpatient procedure Deductible: $150
Co-payments as a percentage of total charges: 30% for out-of-network hospital charges, 10% for dental injury or impacted wisdom teeth and vision care, 10% in network or 30% for out-of-network routine exams, 10% in-network or 40% out-of-network for immunizations, 30% of out-of-network mental health treatment, 30% of out-of-network alcohol or drug treatment.
Co-payments for outpatient office visits: $25 for walk-in clinic, outpatient therapy, routine exam, urgent care facility or outpatient drug or alcohol treatment, $75 for emergency room, $35 for lab expenses, $50 high cost procedures, $30 for name brand drug, $15 for generic prescriptions.
Maximum benefit: $2,000,000
Other limitations on coverage: maximum 30 days per year of hospitalization for each mental health condition, maximum $80 paid for out-of-network therapist, maximum 50 outpatient visits per year for mental health treatment, 120 maximum lifetime outpatient mental health visits.
Eligibility: full and part time students and their dependents
Referral: required from Student Health Services for treatment by a specialist within 25 miles of Philadelphia.
Pre-certification: for non-emergency medical procedures.
Emergency hospital admission: Notice must be provided within 48 hours of admission.
Maternity: covered subject to stated limits
Diabetic treatment: covered subject to stated limits
Prescriptions: covered subject to stated limits
Dental: available as an option
Pre-existing medical conditions: covered subject to stated limits
Waiver: A waiver form is required when substituting other coverage for the plan sold by Penn/Aetna. If you have other qualifying coverage, the form can be submitted by email to Onilneadviser@freedombenefits.net for validation by an officer of the insurance company. Effective September 2011, UnitedHealthcare companies will only sign waiver forms if the school is a member of "UnitedHealthcare Student Resources" program. University of Pennsylvania is not currently a member of this program so waivers are not available for the fall 2011 semester.
This web site is independently owned and managed by Tony Novak operating under the trademarks "Freedom Benefits", "OnlineAdviser" and "OnlineNavigator". Opinions expressed are the sole responsibility of the author and do not represent the opinion of any other person, company or entity mentioned. Tony Novak is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide uncompensated advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the other commercial companies listed on this site. Information is from sources believed to be reliable but cannot be guaranteed.