Benefits
The health care services you will have payment for under your insurance plan
Claim
A written request for payment to the insurance company of medical expenses that are covered under the insurance policy
Co-Payment
A defined dollar amount a patient pays for medical
expenses. A co-payment is generally required at the time of service.
Deductible
The amount of money you must pay prior to any benefits being paid by the insurance company
Dependent
A person that the student has legal obligation to, such as a spouse, domestic partner (with certification) and/or children
Enrollment period
The time frame for which a student may enroll their
dependents into the medical plan, or, enroll in any optional plans, such as vision and dental insurance
Network provider
An insurance plan will pay more benefits (money) if you stay within a group of doctors, hospitals and other places. These networks have agreements with the insurance companies to provide care at a special rate. These providers will also do the paperwork on your behalf to get the benefits you are owed under your health insurance plan
Patient responsibility
Students have the responsibility to understand what the
plan will and will not pay for prior to seeking care. It is also an individual responsibility to understand the policy rules, such as the referral requirement. The insured individual is accountable for understanding their health care policy.
Examples of patient responsibility include Co-pay, Policy exclusions, Out-of- Pocket maximum.
Out of pocket maximum
The most an insured would pay for covered services in a
plan year
Policy
The written document that informs an individual of the agreement to pay benefits for the owner of the policy
Policy premium
The payment required for coverage under a specific insurance policy for a given period of time
Policy year
This is the period of time that the policy is in effect
Policy exclusions
Some medical care is not covered by the health insurance plan. This is considered a “policy exclusion.” All exclusions are specifically listed in the health insurance policy document. It is important to understand what the plan will not pay for.
Pre-approval
A provision in an insurance contract that the insured individual must seek prior approval from the insurance company before receiving certain treatments or
services in order for them to be covered under the policy
Premium
The amount of money an individual will pay for the health insurance plan. At WashU, all students are charged this amount of money on their student accounting bill. Any student wishing to enroll a dependent does this directly with the insurance company.
Referrals
The student health insurance plan states that any member on the plan is required to go to the Student Health Center prior to seeking any health care services while they are in the St. Louis area, unless they are seeking care for a medical emergency, OBGYN services, mental health services, or if they are 50 miles out of the St. Louis area.