If you’re taking five or more credits this term, listen up.

Unless you’ve opted out, you have already been enrolled in Portland State’s new major medical student health insurance plan.

The cost?

It’s $560 per term, charged three times a year—about $140 a month. And it’s already been charged to your student account.

If this is news to you, you’re probably wondering what you’ve got to do to opt out. How can you get that money back if you’ve already got health insurance?

To answer your questions about PSU’s switch from a basic health care plan to a more expensive and comprehensive plan, the Vanguard talked with the Center for Student Health and Counseling’s Executive Director Dana Tasson, SHAC Marketing and Communication Coordinator Angela Abel and Student Insurance Advocate Nick Walden Poublon—the folks on campus who helped make the decision and are now implementing the plan.

Five years ago, the university determined that its basic and supplemental health insurance plans were not sustainable and that rates would continue to increase substantially. PSU was faced with the choice of either eliminating insurance entirely or significantly changing its insurance program, a choice other institutions are facing in Oregon and across the country.

Chief among concerns about the basic plan was that nearly any serious medical problem would quickly empty the $10,000 pot of money each student could access.

“In the past, students were not receiving the coverage needed through the basic plan, and it was not enough to cover prescription costs, as well as being all too easy to max out coverage,”
Poublon said.

With the new plan’s $0 deductible, students get a much more comprehensive plan, they said.
“Unlike the current plan, opting out of the basic plan was not an option, even if you had other insurance,” Poublon added.

Starting this term, all students will be automatically enrolled in the Aetna Student Health Plan, so expect a medical ID card in the mail if you have not already gotten one.

“This new plan is not uncommon—all regional Oregon colleges, including OSU and UO, are committed to changing to a similar plan in the coming years, while Willamette and OIT have taken initiative and now offer the plan to students as well,” Poublon said.

Your Questions Answered

What is the cost?

The plan costs students $560 per term. Students will receive a medical ID card at the beginning of fall term, and the insurance charge will show up on your account three times per year—once per academic term.

It is important to note that the spring term charge covers you for the entire summer even if you are not taking classes. Students who have the PSU student health insurance plan during spring term of 2013 will automatically be covered through summer until Sept. 20, 2013, regardless of the student graduating, taking summer credits or traveling abroad.

What is the deductible?

The plan has no deductible and covers up to $100,000 in medical care per academic year, including emergency, hospital and surgery coverage. Outpatient physician benefits are covered 100 percent with a $20 copay. Outpatient counseling benefits are fully covered with $15 copay. Prescription drug coverage, including birth control, is now covered up to $100,000. Naturopathic care, physical therapy, chiropractic care and acupuncture are all included in the plan, and no referrals are required to see a specialist.

“We want students to know that this insurance is not only about treating the symptoms, and now the student’s overall health and wellbeing has been addressed,” Abel said.

Can I waive out of the program? What is the criteria? When is the deadline to waive?

To waive out of the plan, you must have comparable health insurance with a deductible that is no less than $1,000 annually. Medicare, Medicaid and Oregon Health Plan are automatic waivers, and you are guaranteed to be able to waive out if you have coverage from any of these three.
To find the waiver, visit pdx.edu/shac and click on the link provided. The short waiver application takes a couple of minutes to fill out. You will need to provide information about your health insurance and must know what your deductible is.

Once you submit the waiver, it will let you know whether you have been approved to opt out. It takes five to 10 business days for the insurance fee to be refunded to your account after you waive, and you must waive out before the deadline of Oct. 7, which is the add/drop deadline for fall term classes. The waive-out process is good for the entire academic year, and if you no longer have health insurance, you can reenroll in PSU insurance at any time.

If I applied for a waiver and was denied, what is the appeal process?

After you fill out the waiver, a text box will alert you if you are denied. Then a dialog box will allow you to explain if you feel that you have been denied although you do have comparable health insurance. Make sure you include that information in the dialog box so SHAC can work with you to figure out a solution.

“The insurance team is considering every appeal,” Abel said. Appeals must be filed by Oct. 7, she added.

Will it take up my financial aid?

Yes. “For the first time ever, the federal government is including insurance costs in cost of tuition, so depending on the level of your financial aid, it has been adjusted to offset the cost of insurance,” Poublon said. Because financial aid has been increased to include insurance costs, you might notice that your financial aid amount is reduced to balance out the costs if you waive out of the plan.

Can I opt out if I don’t have another insurance plan?

No, you must have comparable health insurance.

“Universities and colleges in Oregon had to decide whether to offer a comparable insurance plan or completely stop offering insurance, as basic plans as PSU had before have become essentially illegal, and it was apparent that students definitely needed more coverage,” Poublon said.

“Students such as me were spending thousands of dollars on prescription medication and had to pay upfront before hearing back from their insurance.” Therefore, PSU decided to introduce a plan with no deductible which covers all students regardless of medical history. “Opt-in plans have never been successful with universities, which is why PSU has made health insurance mandatory for students,” Poublon said.

If I waive out of PSU insurance, can I still go to SHAC?

“Absolutely. You will still have access to SHAC even if you opt out—doctor visits, nurse visits and counselor visits will still be free if you take five credits or more at PSU,” Tasson said. Students taking five or more in-load credit hours will continue to be eligible to utilize SHAC health, counseling, testing and dental services.

The only instance in which you are charged is if you need services such as blood work, X-rays or something that requires an outside laboratory. In that case, if you have waived out of PSU health insurance, SHAC will provide you with an annotated bill that will show you your charges and how to bill your insurance.

If I waive out of the health plan do I still pay a
health fee?

Yes. Most of the services at SHAC (such as seeing a doctor, nurse or counselor) are covered in student tuition. Dental clinic fees are 30–50 percent lower than other dental offices, and those charges get billed to the student account.

Does this plan cover vision and dental?

No, PSU insurance does not cover vision or dental. However, dental services at SHAC are 50–60 percent less than in the regular community. “As far as vision goes, SHAC has deals with local vision centers who give discounts to students,” Poublon said. The SHAC website will be updating information on these services through their website, and the center has flyers with this information available to students.

How many times a year can I waive out?

You only need to waive out once per academic year. The deadline to opt out for the 2012–13 academic year is Oct. 7 to avoid the insurance fee on your account. If you would like to opt into the plan at any time, you can do so.

If I drop my credit load below five credits, will I get a refund?

Students who drop below the five credit hour limit before the enrollment deadline, Oct. 7, will have their health fee refunded. If a student needs to drop for medical reasons and wishes to continue to have access to SHAC and insurance, they may appeal to do so by contacting Jessica Cole at 503-725-4426.

If I am a veteran, will I be covered?

Yes. PSU has gotten clearance from Veteran Affairs, and if you are here with the GI Bill, the government has agreed to pay for insurance as part of tuition costs. “That is something PSU is very proud to be able to offer, and has made more many happy veterans,” Poublon said.

If you have any other questions or concerns regarding PSU health insurance, feel free to contact SHAC at anytime or set up an appointment to speak with a representative. Call SHAC at 503-725-5301 or visit pdx.edu/shac.

Correction: The SHAC phone number is 503-725-2495.
Updated Sept. 26, 2012