1. What is the plan year (effective dates)?
The Aetna Student Health Insurance plan effective dates, which indicate annual policy year, run from 1st August to 31st July the following year. In the current annual policy year, the effective dates run from 1st August 2016 to 31st July 2017 (Penn State, para 4). There are two enrollment deadlines within annual policy year whereby the deadlines fall in 31st August while the spring enrollment deadline is on 31st January of the year that follows.
2. Whether My Plan Is HMO, PPO or Traditional Indemnity Type
The Aetna Student Health Insurance plan is considered as HMO (Health Maintenance Organization). The reasons for considering Aetna Student Health Insurance plan as HMO is that it offers a wide range of healthcare services through an identified network of providers willing to supply their services to members (Lum 1198). HMO provides access to specified doctors and hospitals in identified network. The network consists of health providers who have agreed to meet the Aetna Student Health plan quality standards and lowering rates for the plan members.
3. My Various Levels of Co-Payments by Service
The various levels of co-payment depend on the services that are covered by Aetna Student Health plan. The Aetna Student Health plan covers dental and vision insurance plan, student term life insurance and prescription drug coverage. The payments made for visiting primary care physician range from $25 to $35 per visit and for specialty physician visit range from $35 to $40 per visit (Student Health Insurance Plan, para 8). The payment made for inpatient hospitalization and outpatient physical therapy depends on the complexity of health condition as identified by the physician.
4. What is your deductible?
The annual premium of Aetna Student Health plan is $ 2,014 for basic coverage cost and $ 2,782 for annual plus coverage cost (Student Health Insurance Plan, para 8). The students may opt to pay the annual premium once or into two deductible installments. The two deductible installments consist of Spring/Summer deductible of $ 1,891 and summer deductible that amount to $ 755 (Student Health Insurance Plan, para 8).
5. What Is Your Co-Insurance?
Aetna Student Health plan meets all the requirements of Affordable Care Act. ACA is considered as the co-insurance of Aetna Student Health plan.
6. Whether My Plan Fully Insured or Self-Funded
The Student Health plan is fully insured. All the students’ health insurance plan is fully insured by the school administration. The carrier is the university as students willing to take health insurance cover do it through school administration.
7. Whether I am Required to Identify a PCP in the Enrollment
When enrolling with Aetna Student Health plan, identified Primary Care Physicians (PCP) are required to manage most of the students’ medical issues. At university, the identified professionals Primary Care Providers (PCP) in health units are responsible for monitoring students’ health care needs. It is from Primary Care Physicians recommendation that students are referred to Aetna Student Health Plan supported hospitals network depending on healthcare complexity.
8. Whether Pre-Certification is Required?
The pre-certification from Primary Care Physician (PCP) is required when seeking health care services in Aetna Student Health Plan supported hospital network. The pre-certification from Primary Care Physician serves as referral certificate. As a member of Aetna Student Health Plan, students are supposed to produce the pre-certification from Primary Care Physician that indicates the health examinations and results. It is from the pre-certification that hospital network identifies students who are covered by Aetna Student Health Plan.
9. Whether Pharmacy (Prescription Drug) Coverage is Included in the Plan?
The pharmacy coverage is included in the Aetna Student Health Plan. Aetna drugs home delivery and specialty pharmacy are some of the benefits of Aetna Student Health Plan. Long-term conditions such as diabetes and high blood pressure use Aetna pharmacy services for drugs delivery (Pharmacy & Prescription Benefits, para 2). The cost for generic drugs is subsidized for health insurance plan to Aetna members. The formal benefit is on free standard drug shipping from Aetna pharmacy coverage to home or doctors’ office depending on Aetna members’ choice.
10. Wellness Benefits Covered in the Plan
The wellness benefits that are covered under my Aetna Student Health plan are healthy living and mindfulness programs (Wellness Programs, para 4). The healthy living program is essential in health assessment with personalized results. With personalized results, the Aetna members understand the risks that are involved in their actions and what they do. The healthy living program includes eating healthy, stress relieving and physical activities among others. The mindfulness program involves practices that help in paying attention without judgment (Wellness Programs, para 13). Mindfulness improves both mental and physical health. The mindfulness program helps in teaching people to reduce stress, obesity and metabolic syndrome risk factors and lifestyle behavioral changes. Mindfulness program provides appropriate health care mechanism to Aetna Student Health plan members. Lifestyle behavioral changes involve healthy eating, physical exercises and activities.
11. Description of My Plan’s Coverage for Services “Out Of Network” (Routine Services, Not Emergency Services.)
The Aetna Student Health Plan focuses on health wellbeing of its members on routine services. These services include programs guide to facilitate healthier life and mindfulness wellbeing of Aetna Students Health Plan. The routine services provide health care platform for Aetna members to enjoy variety of insured services. The insurance coverage plan services for in-patient and out-patient varies. Aetna Student Health plan has identified healthcare routine services procedure for both in-patient and out-patient insurance members. These routine services ensure that Aetna members get high-quality standards health care.
Works Cited
Lum, Doman. “The Health Maintenance Organization Delivery System. A National Study of Attitudes of HMO Project Directors on HMO Issues.” American Journal of Public Health, vol. 65, no. 11, 2011, pp. 1192–1202
Penn State University. Aetna Student Health - College Student Health Insurance, Dental and Life Insurance. https://www.aetnastudenthealth.com/students/student-connection.aspx?GroupID=846513. Accessed 17 Jan. 2017.
Pharmacy & Prescription Benefits. 2017, Aetna Rx Home Delivery https://www.aetna.com/individuals-families/pharmacy.html. Accessed 17 Jan. 2017.
Wellness Programs – Producers. Helping employees stay healthy 2001, https://www.aetna.com/insurance-producer/health-wellness/wellness-programs.html. Accessed 17 Jan. 2017.
