Insurance Basics

Setting: On Campus, open enrollment time

Jenny- Hey guys, what’s up?

Rena- We were just talking about the open enrollment for insurance, have you signed up yet?

Jenny- I did. Have you all?

J- I did since I’m an international student I signed up before I got to campus.

Rena- I just signed up last week.

J- Do you know what the premium covers? This is my first time having health insurance in the United States and I’m not quite sure how it works.

Jenny- The premium is the amount that must be paid for your health insurance or plan. You usually pay it monthly, quarterly, or yearly Then you have coverage and you can access care through the network. Your plan will also have a deductible which is the amount you have to pay before your insurance starts paying its share of your health-care costs. Each plan’s deductible is a bit different, you can check yours online at AetnaStudentHealth.com.

J- Oh ok that makes sense- so first I pay my premium to become eligible for coverage, and pay my health care costs until I reach my deductible and then the insurance plan will kick in.

Jenny- Exactly.

Rena- *coughs*

Jenny- Rena are you ok?

Rena- I think I have a cold and I need to go to the doctor tomorrow. Do you guys know if its free to see a doctor?

Jenny- Hmm maybe what’s your deductible?

Rena- What’s that?

Jenny- A deductible just means the amount you have to pay before your insurance starts paying its share of your health-care costs. Each plan’s deductible is a bit different so make sure you check before you go to the doctor. Usually the health care practitioner sends you a bill for the amount owed after your visit.

Rena- That’s good to know, so do I have to pay anything when I get to the doctor tomorrow?

Jenny- You might have to pay something tomorrow at the doctors office, it depends on what your copay is.

Rena- What’s a copay?

Jenny- Once you have reached your deductible, insurance pays for part or all of your treatment, depending on your plan and the type of treatment you receive. 

So for example, if your plan has a 20% co-pay for doctor’s visits, and the visit costs $50, you’d need to pay $10 at the doctor’s office.

Rena- How would I find out how much my co-pay is?

Jenny- You can call member services to check, go your school’s site on AetnaStudentHealth.com to find the phone number.

If you haven’t gotten your ID card yet make sure to download it when you visit AetnaStudentHealth.com you’ll need to bring it with you to the doctors office. Jenny- That’s right. And you may have to pay your copay at the doctor’s appointments as well.

Rena- Thanks for letting me know about that Jenny, now I’m less nervous for my doctors appointment tomorrow.

Jenny- Which doctor are you seeing at the health center tomorrow? I go to Dr. Smith.

Rena- I’m going to see Dr. Jones.

Jenny- Oh that’s great she will be in-network for your plan.

J- Wait what’s In -network?

Jenny- In-network is a doctor that has joined the Aetna health plan network so you can see them for a reduced cost. But if they are out of network you may not have coverage to see them and have to pay for the whole visit out of pocket.

Rena- Oh I had no idea, I’m glad that I am going to Dr. Jones so I can stay in-network. What if I need to go to a doctor outside of the health center, how do I find out if they are in- network?

Jenny- Just go to the Provider Search on AetnaStudentHealth.com and type in their name to check.

Rena- That’s really good to know. I have to head to work I’ll see you all later.

(Brendan enters the scene)

Brendan- Hi what are you all talking about?

J- We were just talking to Rena about her doctors appointment and the schools insurance plan.

Brendan- Oh. I haven’t signed up for insurance yet, which plan did you all go with? I’m on my parents’ plan right now.

J- Well since I’m an international student and I needed coverage I went with the Aetna Student Health plan because it really fits my needs. I don’t have a car so using the health center is really convenient and all of the doctors at the health center are in-network so it keeps my costs down.

Jenny- I was on my parents’ plan too but when my mom and I compared the two, the Aetna Student Health plan cost a lot less so it was much more affordable for me. Plus it has really great discounts so I can still see my acupuncturist and I even get a discount at the new gym they put up by campus.

Brendan- Really? I didn’t know I could get discounts on stuff like that from my insurance company. But can I only go to the student health center? I really like my doctor back home and would still like to get my checkups from her.

Jenny- As long as she’s in-network you can absolutely still go to her.

Brendan- That’s great how can I find out if she is in-network?

J- Well like Jenny told Rena you could go online but I like to use the Aetna Health app to check because its so much easier. I even have my ID card on the app so I can just show it on my phone at the doctors.

Brendan- That’s great. Does the Aetna Student Health plan cover visits with my therapist too or just my medical appointments?

J- The Aetna Student Health plan covers medical and behavioral health as well as your prescriptions.

Brendan- Very cool I need to check that out and figure out if I want to enroll in the Aetna Student Health plan.

Jenny- Make sure you do that before the open enrollment period ends. If you miss the deadline you won’t be able to sign up until next semester.

Brendan- Thanks for reminding me! I’ll take care of that after class today. I have to run to Chem lab I’ll see you all later. (Brendan exits)

Jenny- See you later Brendan.

LINK pops up- Sign up for Aetna Student Health Insurance today (vanity link unique URL https://aetna.quickbase.com/db/bpgp2fsdv)

END

Setting: Coffee Shop

J: (walks up to Jenny and Rena who are sitting having coffee)- Hey what’s up?

Jenny and Rena: Hi J!

Rena: How’s it going?

J: Good!  Jenny, I’ve been hoping to run into you. You really helped me understand my health insurance last time, and I’m trying to understand what a PCP is.  My plan says that I need to pick one and I’m not sure what that is or how to do that.

Jenny: That’s easy - “PCP” stands for Primary Care Provider. Do you have an in-network doctor that you like to go to?

J: Yes, I like Dr. Smith at the Health Center.   She’s a general practitioner.

Jenny: Great, she would be a good choice for a PCP. Otherwise you could go to Find a Doctor on AetnaStudentHealth.com to look for a PCP.

J: Ok I will put her name down. Why do I need a PCP anyway?

Jenny: A PCP is important because they are the doctor you know best and they can help coordinate care with specialists and mental health providers so that you have one person that can help you navigate the health care system.

J- Oh ok that makes sense, so they can work with my therapist to make sure I am getting the care I need?

Jenny: Exactly.

Rena: Its helpful to have a PCP who can refer you to a specialist when you need it. Last month I needed to see a dermatologist and my doctor was able to get me a referral to an in-network dermatologist since there wasn’t one at the health center.

J: Great. I’ve also been asked to bring a family health history with me. What is that?

Rena: When you go to the doctor in the US they request your family health history- asking questions about who in your family has had cancer, diabetes, high blood pressure, heart disease and other conditions. It helps them customize your care, understand risk factors you might have for future health issues, and ensure that you are getting the correct tests run when you need them.

J: That’s really good to know, I am going to email my parents tonight to get that information. I know my grandma had cancer but I can’t remember which type.

(Brendan walks up)

Jenny: Hi Brendan, what’s new?

Brendan: Hey everyone. (sneezes) I’m doing ok but I have a bit of a sinus infection. I felt really sick last night.

Jenny: Oh no that sounds painful.

Brendan: It is. Last night the health center was closed and I wasn’t sure what to do so I called the 24 hour nurses line from Aetna to find out if I needed care.

J- What did they say?

Brendan: they were able to evaluate my symptoms and suggested I seek treatment right away and not wait till the health center opened tomorrow.

Rena: Did you go to the ER?

Brendan: No, since it wasn’t a life threatening issue I decided to go to a CVS Minute Clinic since it was still open. I went online and was able to get an immediate appointment. I checked the online wait time before I went in too, which was helpful so I could make sure I wouldn’t have too long to wait.

J- Do they take insurance at CVS Minute Clinic’s?

Brendan- They do. It turns out it was a lot less expensive than going to the ER and I only had to wait about 20 minutes to see the nurse practitioner. The last time I went to the ER it was super expensive and I had to wait over 3 hours to see the doctor.

Rena: What is the 24 Hour Nurse Line I have never heard of that?

Brendan: oh its really cool, you can call 1-800-556-1555; and speak to a nurse 24/7  for no cost. They will assess your symptoms and let you know how you should proceed for care. Its really helpful when the health center is closed and you aren’t sure what to do.

Jenny: I used it last year, I felt really sick when I came home from my waitressing job but it was midnight and the health center was closed and I didn’t want to call and wake my mom up. The nurses were super knowledgeable and really helped me. I ended up going to urgent care since it was so late.

Rena: That’s awesome that there is no charge. I am going to put that number in my phone right now.

Brendan: I have to get my antibiotic prescription filled.  Do you know if can I do that at the health center?

Jenny: No they don’t have a pharmacy at the Health Center. But Aetna is now part of CVS, so CVS Pharmacies accept Aetna insurance and it’s walking distance from campus.

Brendan: Oh that’s great. If I have to fill a prescription away from campus can I only use CVS?

Jenny: No there are other pharmacies you can use – you can go to Aetna.com to search for locations near you. Or you can call the number on the back of your ID card 1-877-480-4161.  You can even get maintenance medications mailed to you on campus.

Brendan: Thanks Jenny. I’m going to walk over there now to get my prescription filled. See you all later.

J:  Bye Brendan!

Setting: Campus

RENA: Hey Jenny I was hoping I’d run into you. I got an email from my health plan about my doctor’s visit last week and I’m a bit confused.

JENNY: Ok can you show it to me?

RENA: Sure (brings up phone)

JENNY: This looks like the Plan Explanation of Benefits, some people call it the EOB or the claims statement. Your insurance company usually emails or mails them to you after a provider visit. It explains how your health benefits claim was processed.

RENA: Ok great. Is it a bill?

JENNY: No, but depending on your deductible and copay or co-insurance you may owe some payment to your provider. The EOB tells you want to expect – let me take a closer look.

Camera zooms in on the paper and the whole screen becomes the EOB

Ok so the EOB has:

the date that your service or doctors visit took place

your doctor’s name

what service was provided- in this case the visit was an exam

the claim amount- so the amount that the doctor charged your health plan- in this case $100

The contract amount - the agreed-upon amount based on the doctor’s contract with the insurance company – in this case $80, this is what the payment percent is based on

the portion of that amount that your insurance pays- in your case 80% of the agreed upon rate - so 80% of $80 or $64, and

the amount you are responsible for paying as your co-insurance.  For you, this will be the remaining 20% of $80 which is $16;.

RENA: Thanks Jenny I was worried I had to pay the whole $100!  But $16 is no problem.

BRENDAN- Rena how did you get this EOB? I don’t think I have received one yet for my therapist visits. I use telemedicine  - does that make a difference?

RENA: It shouldn’t. I got mine emailed to me after I registered with my plan’s website and gave them permission to email me.

JENNY- Brendan if you haven’t registered on AetnaStudentHealth.com yet they will mail the EOB to you. You might want to visit the website and sign up to have your EOB sent by email instead.  Also, if you’re curious about any of your claims or amounts you owe, you can find that information there, too.

J walks up

J- Hey what’s up?

JENNY- Hi J, we were just talking about the Explanation of Benefits form and how to find it online so Brendan can see what portion of his doctor visit bill he will need to pay.

J- Oh I just go on the Aetna app to find my claims information, it’s a lot easier and I can check it right on my phone.

BRENDAN- I didn’t know that I could do that from the app I really need to download that.

J- It’s been really helpful for me, I downloaded my ID card to the app too and so I never forget it for my medical appointments.

BRENDAN- I am going to do that today before my next therapy appointment so I have it. I wanted to check and see how much coverage I have for my treatment for this year.

RENA- What do you mean?

BRENDAN- Well I heard that there can be limits on some types of services and I wanted to check if our plan had that for annual or lifetime, or if there are no limits for the treatments I need.

JENNY- You can call the Member Services number on your ID card 1-877-480-4161 to confirm coverage with them. I usually call to check my coverage anytime I am having a new service just to make sure it’s covered and there aren’t any exclusions . I know every plan is different and it can change by state.

J- What’s an exclusion?

JENNY- It’s basically a service that isn’t covered under the insurance plan like acupuncture or certain experimental treatments. You can go online to our AetnaStudentHealth.com school site and read the Plan Benefit & Design doc too if you want to be sure and don’t have time to call member services.

J- Ok that’s good to know. What if  I discover a mistake on my bill,  how can I get that fixed?

JENNY- it’s a pretty easy fix, just call Member Services and they can help you  with the resolution process. But make sure you call as soon as you see it hasn’t been paid, sometimes you only have a limited amount of time to address errors.

J- That sounds pretty easy. Thanks Jenny, I have to head to class. See you all later!

J exits.

 End Scene

Coming to the United States for college is an exciting adventure.

Health care is a little different here. And there are some important things you should know.

Most people in the US are required to have health insurance coverage, including students…

But it’s not a public service here. People buy health insurance plans so they can afford great care if they ever need it.

Each school year, you’ll pay what’s known as a premium for your health insurance plan. Most plans also have a deductible, which is the amount you have to pay toward your health services before your insurer helps pay.

If you’re injured or become ill, you’ll only pay a copay after you’ve paid your deductible. And your insurance provider will pay your remaining bill, saving you money in the future.

Whether it’s flu season or you suffered a minor injury, you should always visit a health care provider that’s in network. Your network is a group of providers that partner with your insurance company, making their services more affordable.

The cost to see a doctor out of network is at least 50% higher .

You should also know about the different kinds of places where you can get care.

Your student health center or an off-campus urgent care clinic can treat most illnesses and injuries. And they’ll cost far less than a visit to a hospital emergency room.

You should go to the ER only when you experience a severe accident or suffer from intense pain – visit an ER immediately if your condition is life threatening, or if you need urgent care when other clinics are closed.

But there’s more to care than the cost. At Aetna Student Health, we understand that your needs are unique.

Our health plans give you the care you need, including reputable hospitals, doctors and specialists, and behavioral health care that helps you focus on your studies.

And we give you the support you need to make the health care process easier to understand …

We offer online tools and discount programs. And there are people you can talk to when you have to make important decisions, such as worldwide travel assistance.

Your Aetna Student Health plan is designed for you. And it meets the requirements of your school and your visa status, too.

We’ll make sure you can focus on making the grade in your next great adventure in the United States.