Portland State UniversityHard Waiver Mandatory

Student Health Insurance Plan 2012-13

What You Need to Know

Costs of Common Medical Procedures Emergency Room Visit: $600-$1500 MRI: $1,000 - $4,000 CT Scan: $900 - $1,300 Broken Arm: $4,000 - $16,000 Torn ACL: $12,800 Appendectomy: $12,000 - $18,750 90 day Alcoholism Treatment Program: $35,000 Treatment for Eating Disorder: $12K- $30K per month

Aetna Student Plan BenefitsPSU Student Health Insurance Plan 2012-13

Medical Max per Academic Year $100,000 ($3,500* out of pocket max)

Deductible $0*

Co-insurance 80% in-network

Co-pays $20 per visit

Prescriptions $20/$30/$40 copays

Emergency Room $150 copay, paid at 80%

Physician and Specialist Visits $20 copay, paid at 100%

Mental Health and Substance Abuse Expense (outpatient)

$15 copay, paid at 100%

Surgery $100 copay, paid at 80%

Physical Therapy/Chiropractic $20 copay, paid at 80% (12 visits)

Maternity $20 copay, paid at 80%

* If using Aetna in-network providers

Who is Eligible for the PSU Plan? All Domestic students taking 5 or more in-load

classes (online and self-support may not count towards eligibility and it is the student’s responsibility to verify).

All International students

HOWEVER, If you take a term off you will lose your insurance

unless it is a medical withdrawal.

How Much Does it Cost?

Fall Term (9/20/12–1/7/13) = $560 Winter Term (1/7/13–4/1/13) = $560 Spring/Summer (4/1/13–9/20/13) = $560(Summer coverage is included in Spring’s cost

regardless of graduating, traveling, or taking classes)

Dependent coverage is not available for domestic students’dependents due to high cost.

International Dependents must be insured to stay in the U.S.

Students with comparable coverage may waive out of the PSU Plan (once per academic year) Must have a plan with at least $100,000 of medical

benefits Must have deductible of $1,000 or less Must be able to receive primary services within 25

miles of PSU Must have Rx coverage Must have Mental Health benefits Oregon Health Plan is considered “comparable”***Students can get back on the student plan if they

lose health coverage and are above 5 credits.***

How Do I Waive Out of the PSU Plan?

You may wait at least 48 hours after you register for fall term.

Online waiver takes less than 10 minutes Have your insurance information nearby for

reference. Waive Out Link: https://wfis.wellsfargo.com/psu

Click “Domestic Student” or “International Student” to begin the waiver process

If waiver is denied, there is an instant online appeal process

Learn More:

Visit the Center for Student Health and Counseling website:

http://www.pdx.edu/shac/insurance

PSU SHAC Insurance Team

Contact Informationinsurancehelp@pdx.edu

503) 725-2800

Christi Ziegler, Licensed Agent and Student Insurance Coordinator

Nick Walden Poublon, Student Insurance Advocate

Jessica Cole, Assoc. Director of SHAC