2013-14 Insurance Summary

Important Saint Mary's College student negotiated insurance information for the current academic year (2013-14) will be provided by Anthem Blue Cross Insurance.

Anthem Blue Cross Insurance Plan

While this insurance plan may not cover all of your health care expenses, it does offer high quality coverage for the services students may need most.

- After a $200 deductible, covered expenses are payable as follows:

– 90% of the negotiated rate for preferred providers;

– 70% of the maximum allowable amount for non-preferred providers.

– There is a $10 prescription copay for generic drugs and a $20 prescription copay for brand-name drugs

– Access to travel assistance services and worldwide medical coverage while traveling or studying abroad

– 360 health wellness program which includes Anthem 24/7 nurseline

Who Is Eligible To Enroll?

All full-time registered undergraduate students will automatically be enrolled in the negotiated student health insurance plan unless you complete an online waiver to opt out of the plan. Please review the insurance waiver to see if your existing health insurance plan meets the minimum required coverage for SMC undergraduate students.

How Much Does It Cost?

The Saint Mary’s College Anthem Blue Cross Insurance Plan is an affordable plan for budget-conscious students. The annual premium will be $1,380 and you will be billed in 2 installments, July 2013 and December 2013.

Important Information

The online waiver process will begin on May 8, 2013 and will close September 11, 2013. After this date, there are no premium refunds. No refunds will be made after the closure of the waiver process. Once you are enrolled, the coverage can not be cancelled.

The Saint Mary’s College Health Insurance Plan may not cover all of your health care expenses. While this document tells you about some of the important features of the insurance plan, other features may be important to you and some further limit what the insurance plan will pay.

Please review the enclosed information for a brief policy summary and for more detailed information visit the HWC website or call Anthem Blue Cross, 800-888-2108, and talk to their dedicated student team.

BENEFITS	PPO Providers	Non-PPO Providers
Deductible	$200 per insured, per policy year
Annual out-of- pocket maximum	$5,000 per insured, per policy year
Lifetime maximum	Unlimited
After your deductible has been met, eligible expenses are payable as follows:
Inpatient Benefits
Hospital room and board expenses*	90% of the negotiated rate	$500 deductible, 70% of the maximum allowable amount
Intensive care / hospital expenses	90% of the negotiated rate	70% of the maximum allowable amount
Miscellaneous hospital expenses (Covered medical expenses include, but are not limited to: laboratory tests, X-rays, anesthesia, use of special equipment, medicines, and use of operating room.)	90% of the negotiated rate	70% of the maximum allowable amount
Physician’s hospital visit expenses	90% of the negotiated rate	70% of the maximum allowable amount
Surgical (inpatient and outpatient)
Surgical expenses	90% of the negotiated rate	70% of the maximum allowable amount
Anesthetist expense and assistant surgeon expense	90% of the negotiated rate	70% of the maximum allowable amount
Outpatient Benefits
Physician’s office visit expenses	90% of the negotiated rate	70% of the maximum allowable amount
Emergency care expenses	90% of the negotiated rate after $100 copay (waived if admitted)	90% of the maximum allowable amount after $100 copay (waived if admitted)
X-ray and lab	100% of the negotiated rate; deductible is waived	70% of the maximum allowable amount
Durable medical equipment	90% of the negotiated rate	70% of the maximum allowable amount
Behavioral Health Services
Outpatient mental health	90% of the negotiated rate	70% of the maximum allowable amount
Inpatient mental health*	90% of the negotiated rate	$500 deductible, 70% of the maximum allowable amount
Additional Benefits
Inpatient or outpatient substance abuse	90% of the negotiated rate	70% of the maximum allowable amount
Ambulance expenses	90% of the negotiated rate	90% of the maximum allowable amount
Prescription drug expenses	Generic drug copay: $10 Brand-name drug copay: $20	Applicable copay + 50% of the remaining prescription drug maximum allowed amount
*Deductible is waived for emergency admission. Additional out of network deductible applies if utilization review is not obtained. The above information is a summary only. Please refer to your Evidence of Coverage for complete details of plan benefits, limitations and exclusions.