Insurance for Domestic Students

Insurance Policy Details

The information below is a synopsis of the United Healthcare policy information, and is subject to change. For the most up-to-date information, view the online brochure at United Healthcare Student Resources.

$100,000 lifetime maximum for each injury or sickness
$300 deductible per insured person per policy year
80/20 payment for PPO Network services (excluding prescriptions)*
60/40 payment for Non-network services (excluding prescriptions)*

* After deductible is met, UHC pays 80% of remaining eligible costs that were accrued using medical staff and/or services listed with the United Healthcare Options PPO network. The student pays 20%. If the student uses staff and/or services not listed on the UHC network, the student pays a higher percentage of the bill, 40% of Usual and Customary charges plus 100% or any charges above Usual and Customary prices. It benefits you financially to stay within the assigned network.

A Primary Care Physician (PCP) can treat most illnesses. If the PCP decides that a specialist needs to be consulted, the PCP can issue a referral to you. In order for the insurance company to cover a consultation fee with a specialist, you must have a referral from your PCP or the Student Health Center (SHC). Without the referral, coverage for a specialist consultation fee will be denied by the insurance company. To obtain a referral from the SHC, call (972) 883-2747 and schedule an appointment.

Prescription Benefits

The maximum prescription benefit is $1,300.00 per academic year. You must purchase the prescription in full from a pharmacy of your choice. You may then file a claim for reimbursement through Medco Health Solutions. To get the most of out of your prescription benefit, ask your doctor if generic drugs are available. For more information about filing a claim, see claimes page.

Proof of Insurance Card

United Healthcare sends one card per school year to policyholders. In your first semester of coverage you should receive an insurance card 2-4 weeks after Census Day. (Because eligibility for the UT Dallas Student Health Insurance Plan is contingent upon enrollment at UT Dallas, insurance cards cannot be sent until all students are officially registered, which is Census Day.) You may also print a card from the United Healthcare website at that time. If you need to see a doctor between the start of the semester and Census Day, you may obtain an Interim Coverage letter from the insurance office.

Policy Cost and Coverage Dates

2011-2012 Academic Year

Student Health Insurance Coverage
Period name	Coverage dates	Student	Spouse	All children	Student, Spouse & All Children
Fall 2011	8/19/11-1/16/12	$472	$1,374	$742	$2,588
Spring 2012	1/17/12-5/29/12	$445	$1,296	$700	$2,441
Summer 2012	5/30/12-8/18/12	$287	$835	$451	$1,573

Exclusions and Limitations

Inform yourself about the Exclusions and Limitations of this policy at United Healthcare Student Resources (page 24-25).

Examples of Exclusions: ..more
Examples of Limitations: ..more

Optional Major Medical Coverage

This coverage covers up to $400,000 of additional eligible medical expenses over the basic benefit maximum of $100,000 and is only available for purchase at the time of initial enrollment in the SHI Plan. For more details, view the online brochure at UnitedHealthcare Student Resources.

Optional Major Medical Coverage
Period name	Coverage dates	Student	Spouse	Each Child	Student, Spouse & One Child
Annual 2011-2012*	8/19/11-8/18/12	$648	$648	$648	$1,944