Who can enroll?
University City (Main Campus) and Center City Campus:
All full-time undergraduate international students holding a J-1 visa are
automatically enrolled in this insurance plan on a mandatory basis unless
other coverage is verified with another Embassy-sponsored Health Insurance
coverage.
All Visiting Faculty Scholars are required to purchase this insurance plan on a
mandatory basis.
International graduate students holding a F-1 visa are automatically enrolled in
this insurance plan unless proof of comparable coverage is furnished.
Enrolled full-time domestic undergraduate and full-time domestic graduate
students (including online students) are automatically enrolled in this
insurance plan unless proof of comparable coverage is furnished.
Currently enrolled domestic part-time undergraduate, domestic part-time
graduates, and online degree seeking students are eligible to enroll in this
insurance plan on a voluntary basis.
College of Medicine:
All full-time matriculated students are automatically enrolled in this insurance
plan unless proof of comparable is furnished.
All qualifying part-time students (undergraduate six or more credit hours) and
part-time graduate students (four and a half credit hours or more) who actively
attend classes for the first 31 days after the date when coverage becomes
effective are eligible to enroll in this insurance plan on a voluntary basis.
ndent children under 26 years
of age.
The student (Named Insured, as defined in the Certificate) must actively attend classes for at least the first 31 days after the date for which coverage is
purchased. Home study, correspondence, and online courses do not fulfill the eligibility requirements that the student actively attend classes. The Company
maintains its right to investigate eligibility or student status and attendance records to verify that the Policy eligibility requirements have been met. If and
whenever the Company discovers that the Policy eligibility requirements have not been met, its only obligation is refund of premium.
The eligibility date for Dependents of the Named Insured shall be determined in accordance with the following:
1. If a Named Insured has Dependents on the date he or she is eligible for insurance.
2. If a Named Insured has Dependents and is issued a court or administrative order to provide insurance for those Dependent(s), the
Dependents are eligible for insurance without enrollment restrictions:
a. On the date the Named Insured is ordered to provide insurance for said Dependent; and
b. We receive a copy of the order within 30 days of the date the court order or administrative order is issued.
3. If a Named Insured acquires a Dependent after the Effective Date, such Dependent becomes eligible:
a. On the date the Named Insured acquires a legal spouse.
b. On the date the Named Insured acquires a dependent child who is within the limits of a dependent child set forth in the Definitions
section of this Certificate.
Dependent eligibility expires concurrently with that of the Named Insured.
Coverage periods, plan cost and deadline dates
Rates
Annual
Winter
Spring
Summer
Waiver and Open Enrollment
Deadline
September 30, 2024
April 30, 2025
July 15, 2025
Coverage dates
09/01/24 - 08/31/25
03/31/25 - 08/31/25
06/23/25 - 08/31/25
Student
$3,030.00
$1,307.00
$622.00
Spouse
$2,980.00
$1,257.00
$572.00
One Child
$2,980.00
$1,257.00
$572.00
Two or More Children
$5,960.00
$2,514.00
$1,144.00
Spouse and Two or More
Children
$8,940.00
$3,771.00
$1,716.00
Rates are subject to regulatory approval and may change.
23COL4751-195-1
Plan resources at your fingertips
Enroll or Waive
coverage
https://studentcenter.uhcsr.com/drexel
View benefits,
submit a claim and
download your ID
card via My Account
uhcsr.com/myaccount
Find an in-network
provider
Choice Plus
Find a prescription
drug provider
Optum Rx
Value-added
benefits and
services
(Student Assist
1
,
HealthiestYou
2
, UHC
Global
3
)
uhcsr.com/myaccount
2024-2025
Student Health Insurance Plan:
Drexel University Quarter Students
Plan highlights
Metallic Level: Platinum with actuarial value of 88.410%
Student Health Center Benefits: The Deductible and Copays will be waived and benefits will be paid at 100% for Covered
Medical Expenses incurred when treatment is rendered at the Student Health Center for the following services: e.g., any
services listed in the schedule of benefits. Labs referred by the SHC to Quest/LabCorp will be paid at 80%. Policy Exclusions
and Limitations do not apply.
Benefits
Preferred Providers
Out-of-Network Providers
Overall Plan Maximum
There is no overall maximum dollar limit on the Policy
Plan Deductible
$100 Per Insured Person, per Policy Year
$350 Per Insured Person, per Policy Year
Out-of-Pocket Maximum
After the Out-of-Pocket Maximum has been satisfied,
Covered Medical Expenses will be paid at 100%
for the remainder of the Policy Year subject to any
applicable benefit maximums. Refer to the plan
certificate for details about how the Out-of-Pocket
Maximum applies.
$5,000 Per Insured Person, Per Policy Year
$10,000 For all insureds in a Family, Per
Policy Year
$10,000 Per Insured Person, Per Policy Year
$20,000 For all insureds in a Family, Per Policy
Year
Coinsurance
All benefits are subject to satisfaction of the Deductible,
specific benefit limitations, maximums and Copays as
described in the plan certificate.
80% of Allowed Amount for Covered Medical
Expenses
60% of Allowed Amount for Covered Medical
Expenses
Prescription Drugs
UHCP Mail Order Network Pharmacy or Preferred 90 Day
Retail Network Pharmacy at 2.5 times the retail Copay up
to a 90 day supply.
$15 Copay for Tier 1
$40 Copay for Tier 2
$75 Copay for Tier 3
Up to a 31-day supply per prescription filled at
a UnitedHealthcare Pharmacy (UHCP) Retail
Network Pharmacy
not subject to Deductible
$40 Copay per prescription generic drug
$75 Copay per prescription brand-name drug
100% of billed charge generic drug
100% of billed charge brand-name drug
up to a 31 day supply per prescription
not subject to Deductibles
Preventive Care Services
Including but not limited to: annual physicals, GYN exams,
routine screenings and immunizations. No Deductible,
Copays, or Coinsurance will be applied when the services
are received from a Preferred Provider. Please visit
www.healthcare.gov/preventive-care-benefits/ for a
complete list of the services provided for specific age and
risk groups.
100% of Allowed Amount
80% of Allowed Amount
after Deductible
The following services have per service
copays
This list is not all inclusive. Please read the plan
certificate for complete listing of copays.
0
not subject to Deductible
Medical Emergency: $150
not subject to Deductible
The Copay will be waived if admitted to the
Hospital.
Medical Emergency: $150
not subject to Deductible
The Copay will be waived if admitted to the
Hospital.
Contact Customer Service at 1-888-265-0117
or at customerservice@uhcsr.com
1
Student Assist services are provided through OptumHealth Behavioral Solutions and OptumHealth Care Solutions, UnitedHealth Group companies. The Student Assist is not a substitute for medical attention. If you have an
emergency medical condition, you should call 911 or your local emergency services number.
2
HealthiestYou and the HealthiestYou logo are trademarks of Teladoc Health, Inc., and may not be used without written
permission. HealthiestYou does not replace the primary care physician. HealthiestYou does not guarantee that a prescription will be written. HealthiestYou operates subject to state regulation and may not be available
in certain states. HealthiestYou does not prescribe DEA-controlled substances, non-therapeutic drugs and certain other drugs that may be harmful because of their potential for abuse. HealthiestYou physicians reserve
the right to deny care for potential misuse of services.
3
Non-Insurance Travel Assistance services are provided by or through United Healthcare Services, Inc., and affiliates under the UnitedHealthcare Global brand.
© 2024 United HealthCare Services, Inc. All Rights Reserved. The written materials contained in this document are a confidential property of UnitedHealth Group. Do not distribute or reproduce any materials without
the express written consent of UnitedHealth Group. This plan is underwritten by UnitedHealthcare Insurance Company and is based on policy 2024-195-1. For further details of the coverage including costs, benefits,
exclusions, any reductions or limitations and the terms under which the coverage may be continued in force, please refer to www.uhcsr.com. NOTE: The information contained herein is a summary of certain benefits
which are offered under a student health insurance Policy issued by UnitedHealthcare. This document is a summary only and does not contain a full or complete recitation of the benefits and restrictions/exclusions associated
with the relevant Policy of insurance. This document is not an insurance Policy document and your receipt of this document does not constitute the issuance or delivery of a Policy of insurance. Neither you nor UnitedHealthcare
has any rights or responsibilities associated with your receipt of this document. Changes in federal, state or other applicable legislation or regulation or changes in Plan design required by the applicable state regulatory
authority may result in differences between this summary and the actual Policy of insurance. Benefits and rates described herein are subject to regulatory approval and may change.
Questions about your plan?