University of Kentucky - Student Affairs, University Health Service

Student Health

Workers Care

Employee Health

University of Kentucky Injury and Illness Plan
Frequently Asked Questions

Click the links just below to see the information covered under those topics.

General Information
Eligibility
Enrollment
Coverage
ID Cards
Claims
UK On-campus Resources

General Information
Attention: The Chickering Group is now known as Aetna Student Health.
It is the intent of the University and the insurance company to provide the greatest benefits to the majority of students and to keep the premium cost at a level that all students, usually on a limited income, can still afford. Therefore, certain limitations and exclusions must be applied to the student insurance coverage as a means of cost containment. It is your responsibility to read and understand the insurance plan, its exclusions, limitations, and schedule of benefits.

Limitations apply: The student insurance plan is a preferred provider organization (PPO), and UK Hospital and UK College of Medicine physicians are the preferred providers (in-area). When receiving treatment away from UK, you may experience significantly higher out-of-pocket costs. Additionally, the plan is an illness and injury plan only; it does not provide for preventive care or coverage of treatment in the absence of illness or injury, except as specifically provided in the policy.

Where do I go to the doctor?
This plan is a PPO, this means that your choice of healthcare provider will have an impact on your out-of-pocket expenses. See “Which health care providers can I use with this insurance plan,” under Coverage, and in your plan brochure for details.

Did you pay your health fee?
See “What is the difference between the mandatory student health fee and student insurance,” under Coverage, for details.

Utilize University Health Service.
The University of Kentucky University Health Service (UHS) is a large outpatient clinic available to all UK students for their healthcare needs including primary care, gynecology, mental health, nutrition counseling and health education. Utilizing UHS is an excellent way to receive fast, efficient and high quality clinical care. During the fall and spring semesters, all full-time University of Kentucky students pay for access to the Health Service through their tuition and mandatory fees. In the summer or for part-time students, the Health Service may be accessed by voluntarily paying a health fee or by being seen on a fee-for-service basis. Claims for charges incurred at UHS for covered benefits will be filed with Aetna Student Health by the Health Service. Bluegrass Community and Technical College (BCTC) students may receive services through UHS. For BCTC eligibility information or specific instructions about how to pay the health fee, visit www.uky.edu/UK-eStore.

All visits are by appointment. For an appointment call (859) 323-APPT (2778)

University Health Service Clinic Hours:
Fall and spring while school is in session: Monday - Friday 8 a.m. to 6 p.m.
For follow-ups and urgent care: Saturday 9 a.m. to 11 a.m.
Summer and when class is not in session: Monday - Friday 8 a.m. to 4:30 p.m.

How do I get a Certificate of Coverage?
Contact the customer service department at 1-888-834-4690. Be sure to verify your mailing address with the representative. (back to the top)

Eligibility

Am I eligible to purchase this insurance plan online?
See this chart to identify your enrollment group: Where do I fit? (pdf)
The Plan may be purchased on a voluntary basis for all eligible University of Kentucky and BCTC undergraduate and University of Kentucky graduate students. Students must actively attend classes for at least the first 31 days after the date for which coverage is purchased. Home study, correspondence, Internet and television (TV) courses do not fulfill the Eligibility requirements that the student actively attend classes.

Eligibility requirements:
• Undergraduate students enrolled in 6 credit hours or more
• Graduate students enrolled at the University of Kentucky
• Dietetic Interns
• Dependent coverage available for enrolled students

The following groups may also enroll online:
• J-1 Visiting Scholars
• English as a Second Language (ESL) students
• Dependents of International Students/Scholars
• B-1 Visa holders

NOTE: International (F-1, J-1, and J-2 students) and Funded Graduate Students should not enroll in the plan online.

Can I enroll my spouse and/or children in this insurance plan?
Yes. You may choose to enroll your dependents in this health insurance plan by completing the online form. You will have the option of submitting a check or credit card payment online. If you have difficulty with the online dependent enrollment process, contact Aetna Student Health at (888) 834-4690.

Can I decline this insurance plan?
See the "Where do I fit" chart (pdf) to identify your enrollment group.

Domestic non-funded students: This plan is voluntary for you. If you do not wish to participate in this student health insurance plan, simply do not enroll.

Domestic funded graduate students: Yes. If you are a domestic Funded Graduate Student, you may decline coverage by completing a Health Insurance Declination Form. Return the form to the Funding Office, 203 Gillis Building, by the first day of class for the semester(s) for which you are declining coverage.

International funded graduate students: Health insurance coverage for international students is mandatory.

International non-funded students: Health insurance is mandatory at UK for international students. If you are an F1, J1, or J2 student, the insurance fee is automatically placed on your student bill when you register for a class. If you have another insurance policy which meets UK’s minimum criteria, you may be eligible to decline (waive) the policy. To decline (waive) the policy will remove the health insurance charge from your student bill. A listing of UK’s minimum criteria and the waiver procedure can be found at www.aetnastudenthealth.com. A student must complete the waiver process before their student billing deadline at the beginning of each semester. (back to the top)

Enrollment

How much does the insurance cost?

	1st Period 08/26/08-10/28/08	2nd Period 10/29/08-12/31/08	3rd Period 01/01/09-03/25/09	4th Period 03/26/09-06/10/09	5th Period 06/11/09-08/25/09
Student	$157	$157	$208	$186	$186
Spouse	$423	$423	$561	$502	$502
Child	$363	$363	$482	$431	$431
All Children	$627	$627	$833	$745	$745

What is an enrollment “period”?
The plan is broken into 5 periods, or windows of time. This allows students to enroll themselves and/or dependents throughout the plan year. You must purchase the entire period and the plan is effective, or active, on the date of purchase.

For example: A spouse who elects to enroll in the 2nd Period on 11/16/08 would pay $423 and the plan would be effective from 11/16/08 – 12/31/08.

Can I purchase the enrollment period early?
Yes. You may purchase the plan before the period start date and the plan will become effective on the first day of that period.

Can I purchase the enrollment period late?
Yes. You may purchase a period after it begins, but remember it will be effective on the date of purchase.

I will be on campus before the plan begins on 8/25/08, can my coverage start any earlier?
Contact DeeDee Gullette regarding the Early Arrival Coverage to see if you qualify to purchase coverage beginning 8/1/08.

I am having trouble enrolling online, where can I get help?
If you have trouble with the online system contact Aetna Student Health customer service at 1-888-834-4690 for assistance. A University Health Insurance Coordinator is available on-site to answer your questions about enrolling online in the new University Health Service location at 830 South Limestone.

Will Aetna Student Health automatically charge me for the next period?
No. Voluntary students and dependents are responsible for purchasing the periods to continue the coverage via the online enrollment system.

Can I stay on this plan after I am no longer a UK student?
Yes, you can enroll for a period up to 12 months after you no longer meet the eligibility requirements listed above.

Post Student Status Continuation Plan (PSS Plan) details:
Students presently enrolled in the University of Kentucky Student Insurance Plan are eligible to continue their coverage by enrolling in the University of Kentucky Post Student Status Continuation Plan. This Plan is only available to insured students who lose their eligibility for the University of Kentucky Student Health Insurance Plan through graduation or otherwise leaving school. This Plan will be available to terminating students and eligible dependents as long as they were enrolled in University of Kentucky Student Health Insurance Plan for the previous academic term. Newborn children born after the termination date of the 2008/09 Student Health Insurance Plan are not eligible for Continuation Coverage. Students eligible for the 2008/09 University of Kentucky Student Health Insurance Plan are not eligible to purchase this PSS Continuation Option. To enroll, print and complete the enrollment form and remit the appropriate premium prior to the stated deadline date. Coverage will be in effect the day after the termination date of your University of Kentucky Student Health Insurance to insure continuous coverage. Application and premium received after deadline date will not be accepted and premium will be refunded.

PSS Continuation Coverage may be purchased in three (3), six (6), nine (9) or (12) month increments, with a maximum coverage period not to exceed a period of 12 months.

PSS Continuation Coverage can not be completed through the online enrollment system. Contact DeeDee Gullette by email or in person at the University Health Service for details.

What is the refund policy?
Refunds are only available in the case of medical withdrawal from school during the first 31 days or to students or dependents entering into the armed forces. Written request must be submitted and received within 90 of withdrawal from school. See page 8 of the plan brochure for full details.

I am already enrolled in the plan and now I want to add my dependents. How do I enroll?
As a voluntary student, if you have previously enrolled via the online enrollment system and you want to add your dependents you will need to complete a paper form. Contact DeeDee Gullette in person at the University Health Service or by email for details and a copy of the form.

I am an international student, where do I enroll? Where do my dependents enroll?
Health insurance is mandatory at UK for international students. If you are an F1, J1, or J2 student, the insurance fee is automatically placed on your student bill when you register for a class. If you have another insurance policy which meets UK’s minimum criteria, you may be eligible to decline (waive) the policy. To decline (waive) the policy will remove the health insurance charge from your student bill. A listing of UK’s minimum criteria and the waiver procedure can be found at www.aetnastudenthealth.com. A student must complete the waiver process before their student billing deadline at the beginning of each semester.

I am a funded graduate student, where do I enroll? Where do my dependents enroll?
The enrollment process is designed to be completely hassle-free for qualified funded graduate students. There is no paperwork or enrollment form for you to complete. Students who meet the eligibility criteria do not need to take any action to enroll in the plan. Funded Graduate Students will be enrolled automatically.
Dependents of funded graduate students may enroll on the Aetna Website via the “Enroll” tab on the left. If you have trouble with the online system contact Aetna Student Health customer service at 1-888-834-4690 for assistance.

Why do I pay separately for vision and dental coverage or discounts?
This Injury and Illness plan is a health insurance plan only. Dental and vision insurance are separate products. As a UK or BCTC student you are not required to participate in any specific dental or vision insurance plans.

As a matter of convenience for our students Aetna Student Health has made their dental and vision products available for purchase on their Web site. Any questions about the Aetna Student Health vision or dental plans should be addressed by their customer service department at 1-888-834-4690. (back to the top)

Coverage

Which health care providers can I use with this insurance plan?

This plan is a three-tier preferred provider organization (PPO).

Preferred provider (in-area): UK Hospital and UK College of Medicine physicians (Kentucky Clinic) are the first tier of preferred providers. For both inpatient and outpatient services at UK Hospital and UK Clinic, the deductible is waived and there is 100% coverage of the negotiated charge for covered services to the benefit maximum. This tier offers the lowest out-of-pocket costs available.

Preferred provider (out-of-area): The second tier of coverage is with the Aetna preferred care network. This tier will extend preferred provider discounts for covered services when it is necessary for you to seek care away from UK. See for the DocFind feature to locate doctors in the Aetna preferred care network.

Non-Preferred provider: The third tier of coverage refers to services and physicians outside of both the UK and Aetna preferred care networks. Away from preferred providers you could experience significantly higher out-of-pocket costs.

Because I have student health insurance, are all my health care costs covered?
No. There are several areas for which you are responsible for payment, including, but not limited to, a deductible, a patient percentage of covered medical expenses, medical costs for services excluded by the plan, and amounts above the maximum benefits provided. (For example, the maximum for the “outpatient benefit” is $2,500 per sickness or injury per policy year.) Use of the preferred provider (UK Hospital/College of Medicine physicians) or an out-of-network provider will also affect your out-of-pocket expenses. The insurance plan includes benefits for sickness and injury; including both inpatient and outpatient care, as well as a prescription drug benefit.

How will I know if a particular medical expense will be covered on this insurance plan?
Consult the Plan Brochure via the “Benefit Details” tab on the Aetna Web site and be sure to read the Exclusions in the back of the brochure. Hard copies of the Plan Brochure are available from your insurance coordinator. If you need clarification on any information you read, contact the Aetna Student Health customer service department at 1-888-834-4690.

What is the difference between the mandatory student health fee and student insurance?
All full-time students pay a mandatory health fee in the fall and spring semesters that entitles them to most services at University Health Service (Student Health) at no cost. The health fee is voluntary for most students in the summer, as well as for all part-time students in the fall and spring semesters.

The student health insurance is an injury and sickness plan that includes hospitalization benefits. The plan is a preferred provider organization (PPO) and UK Hospital and UK College of Medicine physicians are the preferred providers (in area). When receiving treatment away from UK, you may experience significantly higher out-of-pocket costs. The insurance plan is underwritten by the Aetna Life Insurance Company.

Since UK is the preferred provider for the student health insurance plan, University Health Service and student health insurance work well together. For example, students who receive treatment at University Health Service for medical services not covered by the health fee may file their claims with the insurance company. For BCTC student eligibility information or specific instructions about how to pay the health fee, visit www.uky.edu/UK-eStore.

How does the prescription drug benefit work?
Your insurance identification card will double as your prescription identification card. The plan provides prescription benefits up to $1,000 (per policy year) when filled at the Kentucky Clinic Pharmacy and prescribed by a University clinician. The maximum annual benefit is $250 (per policy year) at all other pharmacies. Your total annual prescription benefit may not exceed $1,000. Eligible allergy prescriptions are covered only at the Kentucky Clinic Pharmacy. There is a $10.00 generic drug copay and a $30.00 brand name copay at Kentucky Clinic Pharmacy. There is a $15.00 generic drug copay and a $45.00 brand name copay at all other pharmacies. The copay will be due at the time of purchase at the Kentucky Clinic Pharmacy and participating Aetna Preferred Pharmacy. (See www.AetnaStudentHealth.com to locate Aetna Preferred Pharmacies) You will be required to pay the entire purchase price at a Non-Preferred Pharmacy.

	Kentucky Clinic Pharmacy	Aetna Preferred Pharmacy	Non-Preferred Pharmacy
Copay	$10 generic, $30 brand name	$15 generic, $45 brand name	$15 generic, $45 brand name
Annual benefit maximum	$1,000	$1,000	$1,000
Due at time of purchase	Copay only	Copay only	Full purchase price, then reimbursement process (see brochure for details)

Note: When purchasing prescriptions, always present your insurance identification card in order to receive the best prescription rate!

When will I receive my prescription card?
Your insurance identification card will double as your prescription identification card. You will receive the card at your home address one month after the first day of classes.

I am waiting to receive my insurance ID card, how can I get the prescriptions I need now?
Begin by contacting the Aetna Student Health customer service department at 1-888-834-4690. Ask the representative for your “W ID number.” Supplying the Kentucky Clinic Pharmacy with this number may assist them in processing your prescription claim more quickly.

Without your insurance ID card, you could be responsible for payment in full for your prescription. However, upon receipt of your ID card from Aetna Student Health, you should return to the Kentucky Clinic Pharmacy with your cash register receipt and ID card. You will be reimbursed the cost of the prescription drug minus the applicable copayments if submitted within 90 days.

Does this plan cover birth control prescriptions?
No, this insurance plan excludes birth control prescriptions as it does not include most routine or preventative care.

Does this plan include eye exams?
Yes, this health insurance plan only addresses claims for an eye exam. (See your plan brochure for details.) Other vision benefits are not built into this health insurance plan.

There are optional vision plans available for purchase through Aetna Student Health. This vision insurance or discount program is not administered by the University of Kentucky; all inquiries should be handled directly with Aetna Student Health.

Does this plan include Dental Benefits?

No; this health insurance plan only addresses claims “for the treatment of accidental injury to sound, natural teeth.” (See your plan brochure for details.) Dental benefits are not built into this insurance plan.

There is an optional dental plan available for purchase through Aetna Student Health. This dental insurance is not administered by the University of Kentucky; all inquiries should be handled directly with Aetna Student Health.

Is my student insurance valid outside of the United States?
Yes, though in some instances you may be required to make a payment to the provider and then submit your medical bills directly to the insurance company yourself. Remember, this policy is a PPO, so your out-of-pocket expenses could be affected.

Also see the 2008-2009 plan brochure regarding the Global Emergency Medical Assistance provided by On Call. This coverage is included with the Aetna Student Health policy with no additional premium cost. (back to the top)

ID Cards

I am enrolled in the plan, when will I receive my insurance card?
Please allow 15 days after the effective date for your insurance ID card to arrive in the mail.** If you have not received your insurance ID card within 3 weeks of enrolling, contact the Aetna Student Health customer service department at 1-888-834-4690.

**Funded graduate students will receive their ID card within one month of the first day of classes.
**International students will receive their ID card after paying their student account to a $0 balance.

I lost my insurance ID card, how do I get a replacement copy?
Contact the Aetna Student Health customer service department at 1-888-834-4690. Be sure to verify your mailing address with the representative.

If you need to see a doctor and you do not have time to receive your card in the mail before your appointment, contact the Aetna Student Health customer service department at 1-888-834-4690 and ask for your identification number. Supplying the doctor’s office with this number in the absence of an ID card may assist them in processing your claims more quickly. Ask the physician’s office if you will need to bring in your ID card when you receive your replacement in the mail.

Claims

What is the difference between an Explanation of Benefits (EOB) and a Bill?

After seeking medical care you should receive paperwork at your home address regarding your visit. In many cases you will receive a statement from your physician’s billing office first. This may even state “THIS IS NOT A BILL.” The purpose of this statement is to notify you of the charges and amounts submitted to the insurance company on your behalf. You can often find an estimation of the payments to be made by the insurance company.

You will also receive an Explanation of Benefits (EOB) from the insurance company. This is not a bill. This document is intended to notify of the payments made by the insurance company to your medical provider. Here you will find details about any denials of claims and their reason for denying the claim and any deductible and/or coinsurance payments you will be expected to pay. You will never pay money to the insurance company, you will always make any payments directly to your medical providers.

After the insurance company and your medical provider have communicated about what amounts the company will send to the provider’s office, you will receive an adjusted statement from your medical provider’s billing office. This will outline what amounts were paid by the insurance company and inform you of the amount you owe your healthcare provider.

All of the EOBs and bills you receive should reflect the information as written in your plan brochure.

What if I have difficulty with a claim?
The insurance company has a dedicated toll-free line for UK students. The number is (888) 834-4690. It is appropriate to contact the company directly at this number to resolve your claim. When speaking with someone from the insurance company, it is always recommended to ask for the name of the company representative and note the date and time of your call. In turn, this information may help both the insurance company and the University to resolve claim issues more efficiently.

If you are unable to resolve your insurance claim with the company, you may contact your insurance coordinator who will review the claim with you. Bring copies of all of paperwork you have received and any notes you have taken for reference to the coordinator’s office.

I received forms from the insurance company requesting additional information about my claims. What should I do?
It is not unusual for the insurance company to request additional information while they are processing a claim. Carefully read and complete the forms, then send them to the insurance company. If you have questions about completing the forms, contact your insurance coordinator.
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UK On-campus Resources
Who is my insurance coordinator? See "Where Do I Fit" (pdf)