Frequently Asked Questions
Frequently asked questions about the 2011-2012 Wright State University Student Accident and Sickness Insurance Plan:
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What is the Wright State University Student Accident and Sickness Insurance Plan?
The Student Accident and Sickness Insurance Plan (the Student Insurance Plan) provides benefits worldwide for covered health care expenses, a limited accidental death and dismemberment benefit, benefits for medical evacuation of an ill or injured patient to the nearest suitable hospital or the insured's home country for care, and benefits for return of an insured's body to the insured's home country when death occurs outside his/her home country.
- Am I eligible for Student Insurance Plan coverage?
You are eligible for Student Insurance Plan coverage if you are an undergraduate or graduate student registered for six or more quarter credit hours, a student who participates in a cooperative education or other WSU-sponsored internship program, or a student who registers for classes at DAGSI (the Dayton Area Graduate Studies Institute), including those enrolled through the Air Force Institute of Technology.
Students who met the criteria of the preceding paragraph and purchased Plan coverage for the immediate prior quarter can purchase Student Insurance Plan coverage for one quarter without being enrolled for six quarter credit hours of classes for that quarter. A student who purchased coverage for the immediate prior quarter while meeting the eligibility criteria of the prior paragraph can purchase Student Insurance Plan coverage for one quarter without being enrolled for any classes at Wright State.
How do I enroll for Student Insurance Plan coverage?
If you are a student enrolled for six or more credit hours, you are automatically enrolled for student only coverage for the quarter of registration unless you request not to be enrolled during the registration process. If you do not enroll for coverage at the time you register for classes, you may enroll through Student Health Services in 051 Student Union until the quarterly Enrollment Deadline for coverage.
You can enroll for coverage on an annual basis for the period from September 6, 2011 through September 6, 2012 or for the remainder of the policy year beginning with Winter Quarter, 2012 or Spring Quarter, 2012 by contacting the Student Health Services staff in 051 Student Union. You cannot enroll for coverage on an annual basis or for the remaining two or three quarters of the policy year without contacting Student Health Services.
Can I enroll my dependents for coverage under the Student Insurance Plan?
Yes. You may enroll your dependents including a spouse, a child or children, and a qualified domestic partner by contacting the Student Health Services staff in 051 Student Union and paying the additional premium due for the dependent(s). Details are outlined in the brochure.
You may not insure your dependents unless you are also insured.
How am I charged for the premium for Student Insurance Plan coverage?
The quarterly premium for Student Insurance Plan coverage on a student only basis is assessed along with other fees billed to you. The charge is identified on your Billing Statement as "Student Health Insurance". The quarterly premium for student only coverage for the 2011-2012 plan year is $271.
If you enroll for dependent coverage, for coverage on an annual basis or for coverage for the remainder of the policy year beginning Winter or Spring Quarter, 2011, you will receive a fee slip from the Student Health Services staff for the premium due.
When does my coverage or coverage for my dependent(s) begin?
Coverage is effective on the Start Date of the quarter when enrollment and payment of the Insurance Fee are completed by the Enrollment Deadline for that quarter. Enrollment Deadline Dates and Start Dates are listed in the Student Insurance Plan brochure.
What are the Student Insurance Plan benefits?
Benefits are detailed in the Student Insurance Plan brochure. The Plan will pay benefits for Usual and Customary medical expenses actually incurred for the treatment of a covered illness or injury. Benefits are subject to the limitations of the Master Policy.
Are Student Insurance Plan benefits for a medical expense equal to 100% of the charge?
Generally, the answer is No. For example, Scheduled Benefits for outpatient doctor's visits for non-surgical cases are limited to expenses incurred up to $55 per visit. Scheduled Benefits for outpatient prescription medications are 80% of the cost. Major Medical Expense Benefits are paid at 80% of Usual and Customary expenses up to the limits of the policy.
Are there medical expenses for which the Student Insurance Plan does not pay benefits?
Yes. The Plan brochure lists those items for which no Student Insurance Plan benefits are payable.
The most common medical expense for which no benefits are payable is an expense for treatment of a pre-existing condition not subject to HIPAA portability limitations (a condition in the first 12 months of coverage which originated, was diagnosed, treated, or recommended for treatment within the six months immediately prior to the effective date of coverage).
Can I receive benefits for treatment provided by any doctor or hospital?
Yes. If you use a provider which is a member of the CCN network (a nationwide network of healthcare providers who have agreed to provide discounts on fees for medical services rendered), your share of the cost may be lower than for treatment with a provider who is not a member of the CCN network. You can find CCN network members at www.firsthealth.com.
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Yes. Benefits will not be denied under this policy for treatment of an illness or injury simply because benefits for the same illness or injury were paid during the policy year. To receive benefits for treatment in of an illness or injury, you must have been enrolled continuously for WSU Student Insurance Plan coverage from the date of the illness or injury.
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The Student Insurance Plan pays benefits on a secondary basis to other insurance and prepayment plans including medical benefits paid by an auto insurance coverage. You or your insured dependent(s) should file a claim with the primary carrier first. The Plan may pay additional benefits for covered expenses if the primary plan benefits are less than the cost of care. The sum of Student Insurance Plan benefits and benefits of other primary plan(s) will not exceed the Usual and Customary cost of the medical service.
Is there a maximum benefit payable under the Student Insurance Plan?
Benefits are paid on both a Scheduled Benefit basis and a Major Medical Benefit Expense basis. There are limits for each of these types of benefits detailed in the Student Insurance Plan brochure.
How do I file a claim for Student Insurance Plan benefits?
To file a claim for medical benefits, you must complete the claim form available from Student Health Services or from the Bollinger Insurance Solutions website. The student must submit a fully completed claim form within 90 days of an accident or sickness. Only one form is needed for each accident/sickness. An itemized bill from each provider including the name of the provider, the diagnosis, the date of medical services, a description of the medical services provided, and a listing of the charges must be included with the claim form. The completed claim form should be mailed or hand-delivered to:
Student Health Services
051 Student Union
Wright State University
3640 Colonel Glenn Highway
Dayton, OH 45435-
No. When you are not on campus or when Student Health Services is closed, you should consult any physician and follow the physician's directions.
If you are injured or become ill while on campus and while Student Health Services is open, you should report to Student Health Services for treatment or referral. If you are seeking treatment and/or referral for a mental or nervous condition, you should report to the Counseling and Wellness Service in the Student Union.
Your insured dependent should always consult a private physician and not Student Health Services for treatment.
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Yes. If you are a student, other than an international student or a student not living in campus housing, you can choose not to purchase Student Insurance Plan coverage whether or not you have other health insurance coverage.
Students living in campus housing are required to purchase the WSU Student Insurance Plan coverage or confirm existence of an equivalent coverage for themselves.
International students will be granted an exemption only if they have U.S.-based insurance coverage through the employer of a spouse or parent. This waiver must be obtained from the University Center for International Education office, 190E Student Union.
Can I cancel Student Insurance Plan coverage once it is in place?
Prior to the first day of classes for the quarter of coverage you may request cancellation of coverage with a full refund of the premium which has been paid.
A student may accept or decline the student health insurance in their WINGS Express account up until the 70% refund cut off date. Please check the brochure for further details.
Students who leave school after the beginning of classes will have continuous coverage after 31 days to the end of the period for which the premium was paid.
To request cancellation of coverage on an exception basis to this policy, you must present a written request which details the reason for the request to Leatha Ross.
If you enter the armed forces of any country during a period of coverage, you will receive a refund of your unearned prorata premium if you request the refund in writing.
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Yes. If you met the eligibility requirements described in the answer to Question #2 and purchased Student Insurance Plan coverage for the immediate prior quarter, you can purchase coverage for the next quarter without being enrolled at Wright State University (an "off quarter"). If you have been enrolled for the previous three quarters of coverage, you can purchase coverage for one "off quarter" and thus maintain year long coverage.
In addition, you may continue coverage (provided certain conditions are met) for 12 months after no longer meeting the eligibility requirements for Student Insurance Plan coverage. The conditions are (a) that you have maintained continuous Student Insurance Plan coverage for at least 12 months prior to the date you become ineligible for coverage, (b) that you have not received the Plan¹s maximum benefit for any one illness or injury, (c) that you are not eligible for any other insurance which would cover a condition for which a claim under this policy has been made, and (d) that Wright State University renews the Student Insurance Plan coverage for the policy year with the current insurance carrier.
- I have a specific question about coverage. Who should I contact?
You should contact Student Health Services staff members Joyce Smith at (937) 775-2553 or Nancy Caupp at (937) 775-2331.
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