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Below you will find useful information about the

Harvey Mudd College
Student Health Insurance Plan (SHIP)

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Important Messages


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Use your insurance

Undergraduate students (domestic and international) will be enrolled in this plan automatically, unless you submit an approved waiver (see waiver FAQ, above).

Dependents

Students enrolled in SHIP may enroll their eligible dependents in the plan by completing a form below by the deadline date each term, or the annual deadline, if purchasing a full year of coverage. Once you have filled in the form, mail it, along with payment, to the address below:

Ascension
P.O. Box 240042
Los Angeles, CA 90024

 

Instructions for Involuntary Loss of Coverage

If you or your dependent(s) lose your other insurance coverage and wish to enroll in SHIP after the enrollment deadline date, you must enroll within 31 days of losing your other coverage, and you must pay for the full term in which you are enrolling (no pro-ration). You will need to provide proof of your expiring coverage.

 

Instructions for Optional Practical Training (OPT)

Students engaged in Optional Practical Training (OPT) through the College are eligible to enroll in the plan for up to one year (or the length of the OPT term, whichever is the lesser) beyond their regular course of study, provided they:

  1. Are enrolled in the coverage described in this brochure in the immediately preceding term; and
  2. Submit an enrollment form (link below) and payment by mail to Ascension within 30 days of the  termination date of the immediately preceding term; and
  3. Submit proof of Optional Practical Training (either a copy of their Employment Authorization Card or an official letter from the College stating their OPT dates).

The PPO Network for this plan has changed to AETNA.

This plan utilizes the Aetna Open Access Student MC Preferred Provider Network. To learn more about the network or find a provider, view the Aetna DocFind® online provider directory by visiting the link below. While you are allowed to visit any provider of your choosing, if you use an in-network PPO doctor or facility, you will pay less money out-of-pocket.

Contact the provider prior to your visit to confirm their membership in the network.

 

 

THE AETNA NAME AND LOGO ARE REGISTERED TRADEMARKS.

In some circumstances,  you may be asked to pay up-front. In this case, download a claim form (available below) and follow these instructions:

  1. Complete items one (1) through twenty-one (21) in full.
  2. Complete items twenty-two (22) through twenty-six (26) only if other medical coverage exists.
  3.  Be certain to sign the authorization to release information in block twenty-seven (27).
  4.  If you wish to have your benefits for this claim paid directly to your physician or supplier, sign block twenty-eight (28).
  5.  If you have submitted a request for benefits to another plan, including Medicare, attach a copy of the bills you submitted to the other plan and the explanation of
    benefits you received from the other plan.
  6. Attach itemized bills or ask your health care provider to complete the applicable section on the reverse side. The bills must include:
    – patient’s name – condition being treated – type of service(s) rendered – date(s) of service(s) – relationship to member
    If this information is missing, write it on the bill and sign your name.
  7. If prescription drugs are covered under your plan, submit receipts or a Prescription Drug Record form. This information can be copied from the prescription bottle or
    box. Receipt must contain:
    – drug name – purchase date – prescription number – pharmacy name/address – dose per/day – nature of illness or injury – quantity – charge – strength – physician’s name
  8.  Retain copies of your bills for your record.
  9. Send the completed benefits request and the bills to:

Aetna Life Insurance Company
PO Box 981106
El Paso, TX 79998

The Pharmacy Benefit Manager for this plan is Aetna (Aetna Premier Plus). Only prescriptions filled at Aetna pharmacies are covered.  To find a pharmacy, visit their website by clicking the link below.

Additionally, please see the Preferred Formulary list and a list of preferred drug exclusions related to this plan.

A mail order discount is available for maintenance medications (taken on a regular basis); pay two copays for each 90-day supply when using the mail order discount program. To sign up, go to the Express Scripts website (link below) and set up an online account. You can also download a mail order form through the link below that you can print out and mail in with a prescription.

Included in this plan are supplemental benefits, including a Health Line, Natural Health Discounts, and several other programs. View the links below for more information

View a glossary of commonly used insurance terms, provided by the Department of Health and Human Services.