Health Insurance – FAQs
Health Insurance -- What is it and why is it provided by the University?
To understand how SHIP works, it is important to understand that your health plan at Auburn University consists of two parts:
- University Health Services (AUMC)
University Health Services is a complete outpatient health center for students, providing medical, mental health and preventive care. Our clinicians serve as your “family doctor” while you’re at Auburn University. All eligible registered students may use the services of UHS, regardless of what type of major medical insurance they have.
- Auburn University Student Health Insurance Plan (SHIP)
As voted in by students and passed by the Auburn University board, the University requires that all international student and grad students with assitantships have medical insurance, and provides the Auburn University Student Health Insurance Plan (SHIP) to meet this requirement. SHIP cover services at UHS including primary care and services outside UHS including hospitalization, off-campus or out-of-area care while traveling and some specialty services not available at UHS. Students are automatically enrolled in SHIP and the premium is charged on their e-bill.
Students can choose to keep SHIP or waive enrollment if they have comparable coverage. Most students keep their SHIP enrollment because it is a solid, comprehensive plan; it is convenient and provides coverage 12 months a year anywhere in the world, offers excellent benefits and is affordable. SHIP and AUMC work hand-in-hand.
How does the insurance work?
When you buy an insurance plan, you join a group of other people to combine your healthcare purchasing power. That way, everyone shares the cost of staying healthy. You also agree to pay a monthly fee in exchange for a variety of benefits.
Here’s an example of how insurance works:
Let’s say you develop a serious illness, need surgery, and a hospital stay. The costs of your covered medical expenses add up to $50,000.Without health insurance, you would be responsible for paying all $50,000. That’s a big financial hit! But with insurance, your financial responsibility is much smaller.
For this example, we’ll say these are the terms of your health insurance:
- Your deductible is $250.
- Your coinsurance is 20%.
- Your maximum out-of-pocket is $6,350.
In this case, you are responsible for the first $250 in charges. This is your deductible. After you’ve paid your deductible, there are $49,750 of expenses left. You are responsible for 20% coinsurance – that is 20% of the remaining cost, or $9,950. This is more than your maximum out-of-pocket of $6,350. So you pay $250 toward the deductible and only $6,100 of the coinsurance. Your insurance plan pays the rest of the covered expenses.
Here’s how it breaks out:
- Your payments come to $6,350.
- Your health insurance pays $43,650.
In addition, since you’ve reached your maximum out-of-pocket limit for the year, you won’t have to pay anything for the rest of the year for covered medical expenses.
I don’t know this insurance term-could you help me out?
Benefits are payments the plan makes to cover all or part of covered medical expenses. They vary according to the plan you choose and usually include a portion of the cost of doctors’ visits, prescription medicine, hospital charges, ER visits, and more.
These are the payments you make for your insurance. How do insurance companies figure out what your premium will be? Rates are affected by many things, including the cost of the various medical services they will cover and how likely their policyholders, or customers, are to need those services.
The Affordable Care Act introduced some changes in how premiums may be set: A premium can be based on your age (older adults can’t be charged more than three times what a younger person is charged), geography (insurers can charge more in areas where medical costs are high), family size (an individual versus an individual plus a spouse and/or children) and tobacco use (those using tobacco products can’t be charged more than 1.5 times what a non-tobacco user is charged). You can’t, however, be charged a higher premium based on your gender or if you’re sick or have a history of health problems.
This is the amount you’re responsible to pay for covered medical expenses (the medical services that are covered under your plan) before your insurance begins to pay each year. When you hear that someone has “met their deductible,” it means they have paid their part of their healthcare costs. Their plan will begin to pay its portion for healthcare costs; however, you may still have to pay a co-pay or a percentage of the cost of care, called coinsurance. Typically, anything you pay out of your own pocket, except for premiums, co-pays and some prescription drug costs, will go toward meeting your deductible.
Some plans include co-pays. These are set prices for various services you may need. For example, you may pay a $20 co-pay for a visit to your primary care physician, or a $100 co-pay for a visit to the emergency room.
Coinsurance means the costs of covered medical services are shared between you and your insurance company after the deductible has been met. For example, if a plan has 80/20 coinsurance, the plan would pay 80 percent of a covered medical expense, while you would pay 20 percent of the same covered medical expense.
This is the most money you will be required to pay in a year for deductibles, co-insurance and co-payments. It is a specific dollar amount that is part of the health insurance plan. After you’ve reached that amount, the insurance company may cover the cost of the rest of your covered medical expenses.
After you have a medical service, the doctor or facility that provided that service will file a claim with your insurance company. A claim is a formal request asking for payment based on the terms of the insurance plan. Your insurance company will review the claim to make sure it is valid. If so, the appropriate amount will be paid out to the insured person or to the doctor or facility that filed the claim.
When does SHIP coverage begin and end?
When does SHIP coverage begin and end?
Our coverage dates are as follows:
Can I waive the insurance?
Yes, if you have a policy that is equal to or greater than the policy we offer. The waiver is due by the 15th class meeting of the semester and will not be accepted after this date. Please contact the insurance office at firstname.lastname@example.org for any further questions.
Do I have to fill out a waiver every year?
Yes, a new waiver needs to be filled out every school year.
If I am enrolled in SHIP can I go to any doctor I want?
The AUMC is the primary care provider for students enrolled in SHIP. This means that you should see a AUMC clinician when you need medical attention, unless you are away from campus or need to visit an emergency room. We encourage students to see the same doctor or nurse practitioner for each visit, if possible. Knowing your clinician makes visits more comfortable and contributes to the most healthful outcome.
Should you need services not offered at the AUMC, your clinician will refer you to an off-campus health care provider (referral). Your AUMC clinician may suggest a specific provider or you can choose a provider. However, we strongly recommend that SHIP students see providers who belong to the UHC network. Use of the UHC network insures the least out-of-pocket costs to SHIP members.
Gentle reminder: Don’t get stuck with the bill! Please note that with the exception of emergency room , prescriptions, international services, and limited preventative and women’s health visits, all referrals for off-campus care must be authorized by the AUMC prior to receiving services or else the claim will be denied.
Are there deductibles with SHIP?
There is a $250 plan year deductible for some services provided outside AUMC and a $500 out of network deductible. SHIP members are responsible for the first $250 of qualified charges outside of the AUMC each plan year. Once the deductible has been satisfied, SHIP benefits begin.
What do I do if I have to go to the emergency room?
- No authorization from the AUMC is required for visits to an emergency room.
- Please provide the facility with the electronic version of your UHC card.
- All follow-up care must be authorized in advance by the AUMC.
Last modified: October 24, 2016