UNIVERSITY OF WASHINGTONSTUDENT HEALTH INSURANCE PLAN - SHIP

2013-2014 POLICY YEAR

9/20/13 - 9/19/14

SHIP HIGHLIGHTSMEDICAL COVERAGE• One Preventative Care Physical is free from deductible per year if received at or through Hall Health• Sickness, illness and injury at any participating care provider (subject to deductible and copay)• Mental Health visits (subject to deductible and copay – deductible waived at Hall Health)• Emergency Care (subject to deductible and copay)• Prescription medication (purchased at Rubenstein Pharmacy or UWMC/UWP with limited benefits at

other participating pharmacies)• Some services are not covered by this plan – see booklet on website

(http://www.washington.edu/ship/)• In-network care providers covered at 75% of allowable charges, Out-of-network care providers covered

at 60% of allowable charges (see student.lifewiseac.com for list of network providers)• $100 deductible per quarter, maximum of $400 deductible per year for student only

– How the math works: If you go to a network provider to be treated for the flu and the doctor charges you $200 for the visit. You would pay the first $100 deductible (once per quarter), the insurance would pay $75 and you would pay $25. This same example after the deductible has been met, the insurance would pay $150 and you would pay $50.

 

DENTAL COVERAGE• Preventative Care (maximum of 2 routine oral exams per year)• Restorative Care (such as fillings, crowns or root canals)• Maximum benefit is $300 per plan year• $25 copay per plan year

 

VISION COVERAGE• Routine eye exam no charge up to $150 per plan year

DATES OF COVERAGE

• AUTUMN QUARTER

SEPTEMBER 20, 2013-JANUARY 5, 2014• WINTER QUARTER

JANUARY 6, 2014-MARCH 30, 2014• SPRING QUARTER

MARCH 31, 2014-JUNE 22, 2014• SUMMER QUARTER

JUNE 23, 2014-SEPTEMBER 19, 2014

THE ANNUAL PLAN RUNS FROM AUTUMN THROUGH SUMMER QUARTER PROVIDING 4 QUARTERS OF COVERAGE (AUTUMN, WINTER, SPRING, & SUMMER QUARTERS)

SHIP PREMIUMS for 2013/2014

2013/14Plan Premiums

# of Quarters Student OnlySHIP

Student + Spouse

SHIP

FamilySHIP

Student + ChildSHIP

Annual at Autumn(2) 4 $2,748 $6,840 $10,308 $6,216

Annual at Winter(1) 3 $2,118 $5,223 $7,851 $4,746

Annual at Spring(1) 2 $1,412 $3,482 $5,234 $3,164

Per Autumn Quarter(1) 1 $673 $1,663 $2,497 $1,507

Per Win/Spr/Sum Quarter(1) 1 $706 $1,741 $2,617 $1,582

(1) Includes 2014 ACA Fees(2) Includes ACA required fee for the last 3 quarters in 2014

INSURANCE DEFINITIONS

• MAXIMUM BENEFIT: $500,000 PER CONDITION AGGREGATE (TOTAL) MAXIMUM

• DEDUCTIBLE: $100 PER QUARTER MEDICAL; $25 DENTAL PER POLICY YEAR

1. THE AMOUNT OF COVERED EXPENSES YOU HAVE TO PAY BEFORE THE PLAN PAYS ANY BENEFITS

2. DOES NOT APPLY TO PREVENTATIVE CARE VISITS, PHARMACY, HALL HEALTH UNLESS LAB WORK PERFORMED BY OUTSIDE LAB

• COINSURANCE: NETWORK PROVIDER PAYS 75% / YOU PAY 25%; NON-NETWORK PROVIDER PAYS 60% / YOU PAY 40%

• COPAYMENT: SPECIFIED DOLLAR AMOUNT YOU MUST PAY FOR SERVICES; COPAYMENT IS NOT PART OF DEDUCTIBLE OR COINSURANCE

• NETWORK PROVIDER: PROVIDERS WHO HAVE CONTRACTED WITH LIFEWISE TO PROVIDE CARE AT A DISCOUNT

STUDENT INSURANCE VIDEOS

CHECK OUT OUR WEBSITE TO VIEW THE FOLLOWING VIDEOS: http://www.washington.edu/ship/

1. SELECTING STUDENT INSURANCE

2. HOW UW SHIP WORKS

3. UNDERSTANDING IN-NETWORK & NON-NETWORK COVERAGE

4. UNDERSTANDING DEDUCTIBLES, CO-PAYS, INSURANCE, BILLING, & CLAIMS

5. WHAT TO EXPECT AT A TYPICAL DOCTOR’S VISIT

CONTACT US

Student Insurance Office:

206-543-6202

http://www.washington.edu/ship/

LifeWise Assurance Company

800-971-1491

www.student.lifewiseac.com

Graduate Appointee Insurance Plan – GAIP

206-543-2800

http://www.washington.edu/admin/hr/benefits/insure/gaip/