Student Insurance Basic Coverage
Outside the Student Health Center
The basic coverage of the Student Insurance Plan features a $150 Deductible per insured person, per policy year. There is also an additional $250 Inpatient copay/deductible per person, per policy year. The basic plan provides coverage at 100% for Preferred Provider Physician Visit (70% for Out-of-Network) with a $25 copay/deductible per visit (in lieu of the policy deductible), 100% for Preferred Provider Urgent Care Center visits (70% for Out-of-Network) with a $20 copay/deductible per visit and 100% for Emergency Room Visits with a $100 copay/deductible per visit (in addition to the policy deductible). Also,100% of the Preferred Provider Preventive Care Services with $0 copay/deductible per visit (see current policy brochure for detailed listing of this covered medical expense). After the policy deductible(s) has been met, other inpatient and outpatient benefits are typically covered at 80% for Preferred Providers and 50% for Out-of-Network Providers. Benefits will be paid the same as any other sickness for inpatient, outpatient and partial hospitalization for mental illness and substance abuse services. Finally, benefits are available for outpatient prescription drugs on our Prescription Drug List (PDL) when dispensed by a UnitedHealthcare Network Pharmacy (Optum Rx network). Benefits will be subject to varying copayments of $15 copay for each generic (Tier 1), $60 copay for each formulary (Tier 2) and 25% coinsurance (Tier 3) for each brand-name prescription (up to a 31 day supply).
At the Student Health Center
Covered medical expenses, including prescriptions drugs, will be paid at 100% at the Student Health Center (SHC) after applicable copayments. There is no copay for Physician/Provider Visits at the SHC. There is a $5 copay per prescription for generic and $15 copay per prescription for brand, up to a 31-day supply per perscription filled at the Student Health Center. The SHC is the only pharmacy authorized to dispense 90-day supplies of your prescription drugs. Benefits for laboratory services performed at the Student Health Center will be payable after a $10 copay. Laboratory services that are referred outside the SHC for processing will be billed to your insurance and subject to the policy deductible and coinsurance for outpatient healthcare services. See the Plan Brochure and other policy documents on the W&M's UHCSR page for complete details. Once you have reviewed the plan brochure, you can use the provider search to locate a UHC Options PPO network provider in your area.
