Student Health Insurance Plan

Healthcare Plan Definitions

To help you with understanding healthcare coverage, below are terms that often are used in describing healthcare plans.

Brand name drugs – drugs still under a patent. In the Student Health Plan, these are referred to as “Tier 2” drugs.

Co-insurance – a percentage that the student pays for healthcare services other than office visits after the deductible is met. (Example: 80/20 plan: The plan will pay 80 % and the student will pay 20 %.)

Copay – a fixed amount that the student pays for an office visit or a prescription drug. This does not count towards the deductible.

Deductible – an amount that you must pay before healthcare benefits will begin paying. 

Dental care / major services – dental services such as dental surgery, root canals, treatment for gum disease, crowns, bridges and dentures.

Dental care / preventive services – routine dental services such as cleanings, dentist exams and X-rays.

Generic drugs – drugs not under a patent. These are referred to as “Tier 1” drugs in the Student Health Plan.

Premium – the amount you pay for healthcare coverage. A fee paid to a health plan provider in exchange for healthcare coverage. This amount is outside of any applicable deductibles or coinsurance that is applicable to your plan.

Prior authorization / Pre-authorization – services that must be pre-approved through the company that provides your healthcare coverage before that care is provided to you. If pre-authorization is not obtained, the service may not be covered, and you could be charged for the entire amount. Therefore, be sure you understand your healthcare plan details, so you know if and when you need pre-authorization for specific healthcare services before you seek care. Otherwise, you may be required to pay for that care – sometimes amounting to thousands of dollars! – even though you have healthcare coverage.

Open enrollment – a set period every year when you elect benefits for the following term.

Qualifying event – a life event that allows you to change your benefit during the term (marriage; divorce; birth of a child; loss of other coverage because you’ve become unemployed, for instance; etc.).

Summary of Benefits and Coverage (SBC) – a brief, easy-to-understand summary of coverage. It is intended to be a uniform document that will allow the student to compare plans against each other.

Summary Plan Description (SPD) – a booklet explaining your benefits, eligibility requirements, pre-authorization requirements, plan exclusions and other pertinent information.

Last Updated: 10/14/20