1. Portland State University Hard Waiver Mandatory Student Health Insurance Plan 2012-13 What You Need to Know

2. Costs of Common Medical Procedures  Emergency Room Visit: $600-$1500  MRI: $1,000 - $4,000  CT Scan: $900 - $1,300  Broken Arm: $4,000 - $16,000  Torn ACL: $12,800  Appendectomy: $12,000 - $18,750  90 day Alcoholism Treatment Program: $35,000  Treatment for Eating Disorder: $12K- $30K per month

3. Aetna Student Plan Benefits PSU Student Health Insurance Plan 2012-13 Medical Max per Academic Year$100,000 ($3,500* out of pocket max) Deductible$0* Co-insurance80% in-network Co-pays$20 per visit Prescriptions$20/$30/$40 copays Emergency Room$150 copay, paid at 80% Physician and Specialist Visits$20 copay, paid at 100% Mental Health and Substance Abuse Expense (outpatient) $15 copay, paid at 100% Surgery$100 copay, paid at 80% Physical Therapy/Chiropractic$20 copay, paid at 80% (12 visits) Maternity$20 copay, paid at 80% * If using Aetna in-network providers

4. Who is Eligible for the PSU Plan?  All Domestic students taking 5 or more in-load classes (online and self-support may not count towards eligibility and it is the student’s responsibility to verify).  All International students HOWEVER,  If you take a term off you will lose your insurance unless it is a medical withdrawal.

5. How Much Does it Cost?  Fall Term (9/20/12–1/7/13) = $560  Winter Term (1/7/13–4/1/13) = $560  Spring/Summer (4/1/13–9/20/13) = $560 (Summer coverage is included in Spring’s cost regardless of graduating, traveling, or taking classes)  Dependent coverage is not available for domestic students’dependents due to high cost.  International Dependents must be insured to stay in the U.S.

6. Students with comparable coverage may waive out of the PSU Plan (once per academic year)  Must have a plan with at least $100,000 of medical benefits  Must have deductible of $1,000 or less  Must be able to receive primary services within 25 miles of PSU  Must have Rx coverage  Must have Mental Health benefits  Oregon Health Plan is considered “comparable” ***Students can get back on the student plan if they lose health coverage and are above 5 credits.***

7. How Do I Waive Out of the PSU Plan?  You may wait at least 48 hours after you register for fall term.  Online waiver takes less than 10 minutes  Have your insurance information nearby for reference. Waive Out Link: https://wfis.wellsfargo.com/psu https://wfis.wellsfargo.com/psu  Click “Domestic Student” or “International Student” to begin the waiver process  If waiver is denied, there is an instant online appeal process

8. Learn More: Visit the Center for Student Health and Counseling website: http://www.pdx.edu/shac/insurance

9. PSU SHAC Insurance Team Contact Information insurancehelp@pdx.edu 503) 725-2800  Christi Ziegler, Licensed Agent and Student Insurance Coordinator  Nick Walden Poublon, Student Insurance Advocate  Jessica Cole, Assoc. Director of SHAC