Is the Deductible amount incurred for the calendar year beginning in January?
No. The Deductible amount is incurred for the Policy Year (August 16, 2008 ending at 12:01 a.m., August 16, 2009).
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If I want to get a routine physical, will the insurance cover it?
No. This insurance covers treatment of sickness
and injury. The insurance Policy covers one PAP smear and one STD test
each Policy Year without Deductible at HWS only. See the Schedule of Benefits
in Policy Brochure.
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What makes me eligible for the GSA Insurance?
| If you meet either of the following eligibility requirements
you are eligible: |
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1). Graduate Student Assistants who are paying tuition
and fees for 10 or more credit hours; who have an Assistantship
stipend of at least 50%; and who are eligible for a Qualified Tuition
Reduction or a Tuition Fee Waiver. |
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2). Full-time Graduate Research Fellows/Trainees who are paid
a stipend of at least $800 per month; who are engaged in research
similar to that of a Research Assistant; and who are eligible for
a Qualified Tuition Reduction or a Tuition Fee Waiver. |
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| See "Eligibility" section of Policy
Brochure. |
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Is birth control covered?
Yes, prescription birth control pills and prescription birth control devices (e.g. IUDs) are covered.
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Is there any coverage for allergy medications?
The student insurance policy will pay for
allergy medication up to a maximum per the policy year of $300.00. See
the Schedule of Benefits in Policy
Brochure.
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Are outpatient (not treated in the hospital) Mental Disorders covered under the Student Medical Insurance Plan?
Outpatient and Inpatient Mental or Nervous Disorder Expenses (combined) is paid as any other Sickness up to $3,000 maximum payment per Policy Year. Outpatient prescription drugs will be paid at 80% Generic / 60% Brand. See the Schedule of Benefits in Policy Brochure. For Dependents' benefits, see the Schedule of Benefits in Policy Brochure.
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Is pregnancy covered?
Yes, pregnancy is covered the same as any other sickness, subject to policy provisions.
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Is a newborn covered?
A child born to an Insured Student is automatically covered from the moment of birth until such child is 31 days old. Coverage for such child will be for Sickness and Injury, including medically diagnosed congenital defects, birth abnormalities, prematurity and nursery care. However, the Insured Student must enroll the child within 31 days of such birth and pay the required additional premium in order to have coverage for the newborn child continue beyond such 31 day period.
Well-Care for Children-Payment will be made at 90% of outpatient charges for routine physical examinations and scheduled immunizations, incurred from birth through age 7, when ordered by the attending Doctor. The maximum payment is $300 per Policy Year for each child. The Policy Year deductible is waived.
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Is there a death benefit to the plan?
Yes, the benefit for accidental loss of life is $10,000.
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Is there a PPO (Participating Provider Organization) network?
Yes. Covered Persons may choose to be
treated within or outside of the Beech Street PPO Network. This network
consists of hospitals, doctors and other health care providers organized
into a network for the purpose of delivering quality health care at
affordable rates. Therefore, when a Covered Person uses a Beech Street
Participating Provider, his or her fee may be reduced. A complete listing
of providers is available on the Beech
Street website link accessible at: http://www.maksin.com/wsu.shtml
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Is there a preferred provider listing for (students only) vision care?
Yes. If a Beech Street participating
provider is used, the Covered Student's fee may be reduced. You may
access the Beech Street PPO website
at: http://www.maksin.com/wsu.shtml
However, Covered Students may go to any ophthalmologist (MD) or optometrist (OD) that they prefer.
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If I have an existing condition prior to the effective date of the GSA Insurance, will the condition be covered?
There is no coverage for Pre-existing Conditions during the first 3 months following a Covered Person's effective date of coverage under the Policy. This limitation will not apply if, during the period immediately preceding the Covered Person's effective date of coverage under the Policy, the Covered Person was covered under prior Creditable Coverage for 3 consecutive months. Prior Creditable Coverage of less than 3 months will be credited toward satisfying the Pre-existing Condition Limitation. The Covered Person must provide proof of Creditable Coverage.
A Covered Person whose coverage under prior Creditable Coverage ended
no more than 63 days before the Covered Person's effective date under
the Policy, will have any applicable Pre-Existing Condition Limitation
reduced by the total number of days the Covered Person was covered by
such coverage. If there was a break in Creditable Coverage of more than
63 days, the Company will credit only the days of such coverage after
the break. See "Pre-Existing Condition Limitation" in Policy
Brochure for details.
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May I continue my coverage on a self-pay basis after my Graduate Appointment ends?
No. However, you may contact Health and Wellness
Services regarding temporary insurance plans or you may explore
other options with private insurance carriers.
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Is my Dental Policy carried by National Union Fire Insurance Company of Pittsburgh, Pa.?
No. The Dental Policy is carried by a different
insurance carrier. For details go to: www.hws.wsu.edu/Student_Info/Insurance-Dental-GA.htm
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