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Columbia Univeristy Medical Center
     
  
        
  
  
Student Health Insurance Benefits
  

Click here for Dependent Insurance details

 

Effective August 17, 2014

Plan Features

In-Network

Out-of-Network

Deductible per individual

$0

$500

Annual Out-of-Pocket Max (Integrated maximum for Preferred Care only.  Includes Preferred $150 deductible, Preferred copays, Preferred coinsurance, Preferred Rx copays)

$3000 (In-Network only)

$3000 (Non- preferred only)

Coinsurance

0

30%

Maximum coverage per condition 

None

None

Lifetime Max

None

None

Office Visit

In-Network

Out-of-Network

Preventive

$0

30% after deductible

Physician

$20*

30% after deductible

Testing

In-Network

Out-of-Network

Lab/Diagnostic Test/preadmission testing

$0

30% after deductible

High Cost Imaging copay/coinsurance

$50

30% after deductible

ADD testing/treatment

$50

30% after deductible

Inpatient

In-Network

Out-of-Network

Inpatient Hospital Stay Facility fee

$250

30% after deductible

Inpatient Hospital Stay Physician fee

Included above

30% after deductible

Emergency/Urgent

In-Network

Out-of-Network

Emergency Room - inclusive of Facility and physician fees (copay waived if admitted to hospital)

$100

$100

Ambulance

$100

30% after deductible

Urgent care center

$20

30% after deductible

Outpatient/Other

In-Network

Out-of-Network

Outpatient surgery facility fee

$0

30% after deductible

Outpatient surgery physician fee

$100

30% after deductible

Acupuncture Outpatient

$20

30% after deductible

Acupuncture as anesthesia

$0

30% after deductible

Chiropractor

$20

30% after deductible

Physical Therapy Outpatient

$20

30% after deductible

Outpatient chemotherapy

$20

30% after deductible

Home Health

$20

30% after deductible

Rehabilitation/Habilitation - Inpatient

$250

30% after deductible

Rehabilitation/Habilitation - Outpatient

$20

30% after deductible

Skilled nursing

$250

30% after deductible

Durable medical equipment

10%

30% after deductible

Hospice

$250

30% after deductible

Termination of Pregnancy

0%

30% after deductible

ICU

$250

30% after deductible

Removal of Impacted Wisdom Teeth

$20

30% after deductible

Dental injury only

$20

30% after deductible

Behavioral Health

In-Network

Out-of-Network

Mental Health- Outpatient

$20

30% after deductible

Mental health- Inpatient

$250

30% after deductible

Mental Health Visits

No limit

None

Mental Health days

No limit

None

Substance abuse inpatient student

$250

30% after deductible

Substance abuse inpatient dependent 

n/a

n/a

Substance abuse outpatient student

$20

30% after deductible

Substance abuse outpatient dependent

n/a

n/a

Prescription Coverage

In-Network

Out-of-Network

Contraceptives: Generics and Brands without a generic equivalent or alternative

$0

$20, $35, $50/30%

Generic Drugs

$10

$10/30%

Preferred Brand drugs

$35

$35/30%

Non-Preferred Brand drugs

$50

$50/30%

Specialty Drugs copay/coinsurance

$75

$75/30%

*Does not apply to on-campus medical service visits.

*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 $45 copay/deductible (Preferred/Non-Preferred Care respectively).



Additional Benefits

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


Comparing Insurance Coverage

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