2015-2016
STUDENT HEALTH BENEFIT PLAN
OHIO'S POLYTECHNIC UNIVERSITY
Plan issued & administered by: Student Educational Benefit Trust (hereinafter “Trust”)
33479 Lake Road • Avon Lake, OH 44012
Benefit Summary
Coverage / Claim Questions: 800-367-3762
For more information visit: www.uakronstudentbenefits.com
Eligibility
CampusFirstSM Domestic Plan - is a comprehensive plan for
matriculated Domestic Students. It is the intent of this plan to offer
coverage that meets or exceeds the Minimum Essential Coverage
requirements as set forth by the Federal Department of Health
and Human Services.
CampusFirstSM International Plan - is a comprehensive plan for
matriculated International Students. It is the intent of the plan to
offer coverage that meets or exceeds the J1 and F1 Visa
requirements, as set forth by the U.S. Department of State. Please
note J1 and F1 international students will be automatically enrolled
in the International Plan. These students may opt out of the
International Plan and purchase the Domestic Plan for greater
coverage.
CampusFirstSM Pre-Paid Student Health Center Plan
(Supplemental Only) - is a supplemental plan that is intended for
those students who have other coverage, but may want to prepay for primary care services at the Student Health Center. It also
includes a modest out-patient and Rx benefit to help off-set the
student’s out-of-pocket costs under a high deductible plan or a
plan with an insufficient network in your school area. As this is a
supplemental plan, please consult with your insurance agent or
human resource representative to understand any implications
that may result from electing this coverage in addition to your other
insurance policy.
Ohio Preferred
Providers
Student Educational Benefit Trust has arranged for you to
access the Medical Mutual of Ohio SuperMed Plus network
of local and state-wide providers. To confirm your physician
or provider is part of the SuperMed Plus network you may
call the Customer Service at 888-241-2583 or
visit www.uakronstudentbenefits.com.
The University of Akron is pleased to offer the University-sponsored Student Health Benefit Plan (SHBP) administered by the Student Educational Benefit Trust. The University
sponsored plan has no deductible and provides first dollar coverage. Many students find it is a better value and offers higher quality benefits than their parent, employer sponsored,
or individual health plan. We advise that you review your current health plan to determine if you could benefit by switching to the University-sponsored SHBP. This
brochure does not constitute a promise of benefits on behalf of the University of Akron, and is intended to provide an overview of the plan(s) benefits. A complete description
of benefits, limitations, exclusions and special provisions is provided in the Plan Document which is posted on the University of Akron's student website. Although many of the
program benefits meet or exceed requirements that would otherwise apply to group or individual plans, you may be eligible up to the age of twenty-six (26) for coverage under
a group health plan through your parent’s employer, or under an individual policy through an independent carrier or State Exchange. Contact the plan administrator for your
parent’s employer, an individual health insurance issuer or a State Exchange for more information.
Costs and Coverage
Effective Dates
ĂŵƉƵƐ&ŝƌƐƚ
ŽŵĞƐƚŝĐWůĂŶ
^D
^ƚƵĚĞŶƚ
^ƚƵĚĞŶƚн^ƉŽƵƐĞ
^ƚƵĚĞŶƚнŚŝůĚ;ƌĞŶͿ
^ƚƵĚĞŶƚн^ƉŽƵƐĞΘŚŝůĚƌĞŶ
ĂŵƉƵƐ&ŝƌƐƚ
/ŶƚĞƌŶĂƚŝŽŶĂůWůĂŶ
^D
^ƚƵĚĞŶƚ
^ƚƵĚĞŶƚн^ƉŽƵƐĞ
^ƚƵĚĞŶƚнŚŝůĚ;ƌĞŶͿ
^ƚƵĚĞŶƚн^ƉŽƵƐĞΘŚŝůĚƌĞŶ
ĂŵƉƵƐ&ŝƌƐƚ
WƌĞƉĂŝĚ^,WůĂŶ
^D
^ƚƵĚĞŶƚ
^ƚƵĚĞŶƚн^ƉŽƵƐĞ
^ƚƵĚĞŶƚнŚŝůĚ;ƌĞŶͿ
^ƚƵĚĞŶƚн^ƉŽƵƐĞΘŚŝůĚƌĞŶ
&Ăůů
ϬϴͬϭϯͬϮϬϭϱƚŽ
ϭϮͬϯϭͬϮϬϭϱ
^ƉƌŝŶŐͬ^ƵŵŵĞƌ
ϬϭͬϬϭͬϮϬϭ6ƚŽ
ϬϴͬϭϮͬϮϬϭϲ
^ƵŵŵĞƌ
ϬϱͬϭϲͬϮϬϭ6ƚŽ
ϬϴͬϭϮͬϮϬϭϲ
ŶŶƵĂů
ϬϴͬϭϯͬϮϬϭϱƚŽ
ϬϴͬϭϮͬϮϬϭϲ
Ψϱϭϱ͘ϯϯ
Ψϭ͕ϭϬϬ͘ϯϴ
ΨϲϮϲ͘ϲϯ
Ψϭ͕ϳϮϱ͘ϳϰ
Ψϳ11.67
Ψϭ͕519.62
Ψ865.37
ΨϮ͕383.26
ΨϯϵϮ͘ϲϰ
Ψϴϯϴ͘ϰϬ
Ψϰϳϳ͘ϰϰ
Ψϭ͕ϯϭϰ͘ϴϴ
ΨϭϮϮϳ͘ϬϬ
ΨϮϲϮϬ͘ϬϬ
ΨϭϰϵϮ͘ϬϬ
ΨϰϭϬϵ͘ϬϬ
&Ăůů
ϬϴͬϭϯͬϮϬϭϱƚŽ
ϭϮͬϯϭͬϮϬϭϱ
^ƉƌŝŶŐͬ^ƵŵŵĞƌ
ϬϭͬϬϭͬϮϬϭ6ƚŽ
ϬϴͬϭϮͬϮϬϭϲ
^ƵŵŵĞƌ
ϬϱͬϭϲͬϮϬϭ6ƚŽ
ϬϴͬϭϮͬϮϬϭϲ
ŶŶƵĂů
ϬϴͬϭϯͬϮϬϭϱƚŽ
ϬϴͬϭϮͬϮϬϭϲ
Ψϰϰϭ͘ϰϭ
ΨϵϰϮ͘Ϭϰ
Ψϱϯϲ͘ϳϱ
Ψϭϰϳϳ͘ϵϱ
Ψϲϰϲ͘ϯ2
Ψϭϯϳϵ͘ϯϴ
Ψϳϴϱ͘ϵϯ
ΨϮϭϲϰ͘Ϭϴ
Ψϯϯϲ͘ϯϮ
Ψϳϭϳ͘ϳϲ
ΨϰϬϴ͘ϵϲ
ΨϭϭϮϲ͘Ϭϴ
&Ăůů
ϬϴͬϭϯͬϮϬϭϱƚŽ
ϭϮͬϯϭͬϮϬϭϱ
^ƉƌŝŶŐͬ^ƵŵŵĞƌ
ϬϭͬϬϭͬϮϬϭ6ƚŽ
ϬϴͬϭϮͬϮϬϭϲ
^ƵŵŵĞƌ
ϬϱͬϭϲͬϮϬϭ6ƚŽ
ϬϴͬϭϮͬϮϬϭϲ
ŶŶƵĂů
ϬϴͬϭϯͬϮϬϭϱƚŽ
ϬϴͬϭϮͬϮϬϭϲ
ΨϭϮϮ͘ϮϮ
ΨϮϲϬ͘ϴϭ
Ψϭϰϴ͘ϲϴ
ΨϰϬϵ͘ϰϵ
Ψϭϳϴ͘ϵϲ
Ψϯϴϭ͘ϵϬ
ΨϮϭϳ͘ϳϬ
Ψϱϵϵ͘ϲϬ
Ψϵϯ͘ϭϮ
Ψϭϵϴ͘ϳϮ
Ψϭϭϯ͘Ϯϴ
ΨϯϭϮ͘ϬϬ
ΨϮϵϭ͘ϬϬ
ΨϲϮϭ͘ϬϬ
Ψϯϱϰ͘ϬϬ
Ψϵϳϱ͘ϬϬ
Cost for International students will be billed to your student account and can be waived with proof of comparable other health insurance. The student will need
to pay all fees charged by the University prior to coverage becoming active. If Title IV funds are being used to pay the student fees the student must authorize
the payment of allowable charges. Student’s coverage is not active until the student account has been paid and students will be responsible for any claims
incurred during the period. Costs for additional coverage, Dependents, Vision and Dental are the responsibility of the student and are accessible through logging
into www.uakronstudentbenefits.com to enroll and pay for the additional lines of coverage.
How to Waive Coverage
All Domestic Students attending the University of Akron taking six (6) credit hours or more are required to carry a benefit
plan that satisfies or exceeds the minimum essential benefit requirements under Health Care Reform. International J1 Visa
Students are automatically enrolled in the International Plan and do not need to complete an enrollment application.
International J1 Visa Students may opt into the Domestic Plan should they wish to take a greater benefit that still satisfies
the health insurance requirements under J1 or F1 Visa. Domestic students, through the Individual Mandate, are required to
have a benefit plan and can enroll through www.akronstudentbenefits.com. It is understood that neither the International Plan
or the Pre-Paid Student Health Center Plan meet the Individual Mandate for healthcare coverage and that the student
would be responsible for any potential tax consequence. Only the Domestic Plan will satisfy the Individual Mandate, as well
as the Minimum Essential Coverage requirements, as set forth by Health Care Reform. If you do have other insurance, it is
important to contact your Human Resource Manager or Agent to understand how these optional benefit plans could impact
your high deductible health plan or out-of-state HMO.
Cigna Global Health Benefits
Student Health – Anytime, Anywhere and from Any Device.
A personal health crisis can strike at any time, which is why
the Student Educational Benefit Trust (SEBT) is collaborating
with Cigna Global Health Benefits to offer customer service
that stretches beyond borders, across the globe and around
the clock. Cigna’s Global Customer Service Centre is open
24/7 to provide services on demand, so our model is always
there to help students with any situation that might arise. From
multilingual assistance with verification of benefits, payment
guarantees, physician and hospital referrals, to coordination with
emergency medical assistance providers.
range of convenient online services and resources both during
and prior to the departure. Your students will benefit from instant
access to their benefit information, claims status and healthcare
professional options—anytime, anywhere and from any device.
In most cases, Cigna’s Global Service Centre is a single point
of contact for students traveling abroad. Most calls are handled
entirely within the unit but, when coordination with other parties
is necessary, the Service Centre manages the process to ensure
that the call is properly transferred, introduced and briefed.
Download today from Google Play™ or the Apple App StoreSM
Cigna Envoy® at Your Service
Cigna Envoy provides parents, healthcare professionals and globally
mobile students with personalized information and access to a
Introducing the NEW Cigna Envoy Mobile App
At SEBT, we are dedicated to ensuring your globally mobile
students have quick and easy access to their benefits and services
anytime and anywhere they need them. That’s why we collaborated
with Cigna Global Health Benefits to offer the Cigna Envoy mobile
app. The Envoy Mobile App gives your students a quick and easy
way to access their health information on the go.
Enrollment: Students covered under a SEBT primary plan are
automatically enrolled into Cigna Global Health Benefit. To activate
coverage prior to departure, contact SEBT via your dedicated
toll-free number (1-888-204-5770) and push (7) at the telephone
prompt menu to be transferred to Cigna’s Global Service Center.
24 / 7 Phone Service
Voluntary Dental and Vision
Your University sponsored Student Health Benefit Plan offers
a quick, integrated, inexpensive, round-the-clock solution
to provide access to primary physician care when your Main
Campus Medical Center or HSC Student Health and Wellness
Clinic is not available to you or your dependents due to limited
hours of operation, time of day, or the nature of your medical
necessity. Access to this cross coverage services is available in
all fifty states. Please note this service is available at no additional
cost to you or your dependents for the actual consultation. The
intent of this service is to provide an integrated cross coverage
capability for your Main Campus or Health Science Campus
Medical Center and is not intended to replace an urgent care
or emergency room, but, when medically appropriate, is able to
provide treatments for common illness such as colds, flu, upper
respiratory and sinus infections, allergies, bronchitis, and urinary
tract infections. If appropriate, the board certified physician
may phone a prescription of a non-DEA controlled or
lifestyle modification substance into a local pharmacy.
As this service is integrated into your Main Campus
Medical Center, the on-campus medical professional
will receive a copy of all consultations performed
during the period of cross coverage. You
may be contacted by the same on-campus
medical professional to follow up with the
appropriate course of treatment.
All Students and Dependents may purchase voluntary
Delta Dental and Davis Vision plans at:
www.uakronstudentbenefits.com.
The 24/7 Physician Service
is available toll-free at:
1-877-233-5159
Delta Dental Plan of Ohio:
Customer Service 1-800-524-0149
Go to www.deltadentaloh.com
Davis Vision Plan of Ohio:
Customer Service 1-800-999-5431
Go to www.davisvision.com
Enroll today!
Enroll: www.uakronstudentbenefits.com
Enrollment Deadlines:
• Annual and Fall – 09/20/2015
• Spring/Summer – 01/31/2016
• Summer** – 06/5/2016
**Summer (New or Transfer Students only)