Insurance: At a Glance, CUMC Student Health Service

	Insurance Overview
	At a Glance
	Aetna Navigator
	Cost of Coverage
	Customer Service
	Dental Coverage
	Dependents
	DocFind
	Enrollment Info
	Referrals
	Waive Coverage

Click here for Dependent Insurance details

Type of Service or Supply	Benefit Level
Lifetime Aggregate Maximum	$1,000,000

Plan Deductible
Preferred Providers	None
Non-Preferred Providers	$500 per Individual

Annual Out of Pocket Limit
Preferred Providers	$2,100
Non-Preferred Providers	$4,250

	Preferred Care	Non-Preferred Care
Physician Office Visit Expenses	Plan pays 100% after $20 per visit Copay	Plan pays 70% of reasonable charge (UCR) after a $500 deductible.
Inpatient Hospitalization Expenses	Plan pays 80% of Negotiated Charge	Plan pays 50% of Reasonable Charge after the deductible is met
Inpatient Mental Health Expenses*	Plan pays 80% of Negotiated Charge	Plan pays 50% of Reasonable Charge after the deductible is met
Emergency Room Expenses	Plan pays 100% after a $50 per visit Copay, waived if admitted	Plan pays 100% after a $50 deductible, waived if admitted
Prescription Drug Expenses**	Plan pays 100% after designated Copay (see below)	Plan pays 70% after designated Copay (see below)

*Covered Medical Expenses are payable up to a maximum of 30 days per Policy Year.
**Plan pays after a $15 copay/deductible (Preferred/Non-Preferred Care respectively) for each generic prescription and a $35 copay/deductible (Preferred/Non-Preferred Care respectively) for each brand-name prescription up to a maximum of $2,500 per Policy Year.

Additional Benefits

For more information about the benefits and programs, visit Aetna´s website and enter "812835" as your Policy Number.

Comparing Insurance Coverage

CUMC Mandated Criteria