(Includes: Undergraduate Students and Non-Supported The American College Student Association (ACSA) Student Health Insurance Plan underwritten by UnitedHealthcare Insurance Company and serviced by Gallagher Koster is available to all Undergraduate students taking a minimum of 6 credit hours and non-supported Graduate Students taking 3 credit hours are eligible to enrol in this insurance plan. Highlights of the Coverage and Services offered by UnitedHealthcare StudentResources are: Company and serviced by
 Maximum benefit of to $2,000,000 per Insured Person per Policy Year.  $250 deductible for Preferred Providers, $500 deductible for Out of Network Providers,  $7,500 Out-of-Pocket maximum per Insured Person per Policy Year.  A Preferred Provider is a member of the United HealthCare Choice Plus PPO network.  Covered Medical Expenses for Preferred Providers are payable at 80% of Preferred nd click on the UCF logo. Al owance and Out of Network benefits are payable at 60% of Usual and Customary charges (all benefits are subject to satisfaction of the deductible, specific benefit limitations, maximums and co-pays as described in the policy). Need More Information?
 Students under the age of 19 are immediately covered for pre-existing conditions. For students who are 19 and over, pre-existing conditions wil apply for the first 6 months Gal agher Koster
except for individuals who have been continuously insured under the school’s student insurance policy for at least 6 consecutive months.  Network Prescription Drug Benefit at UnitedHealthcare Network Pharmacies: $15 copay per prescription for Tier 1, $40 copay per prescription for Tier 2, $70 copay for Tier 3 up to a 31-day supply per prescription. Specific Contraceptive Drugs and Devices covered at 100%, no copays. Prescriptions are covered up to the policy maximum.  Preventive Services benefit which includes annual physicals, GYN exams, routine screenings and immunizations, covered at 100%, no copayments or deductibles to Preferred Providers only. Please sfor complete details of the services provided for specific age and risk groups.  Coverage available for eligible dependents. Dependent coverage must be purchased for the same time period as the student’s period of coverage.  FrontierMEDEX – Domestic Students are covered when 100 miles or more away from their campus or home address. International Students are covered worldwide except in This Student health insurance coverage, offered by UnitedHealthcare Insurance Company, may not meet the minimum standards required by the health care reform law for restrictions on annual dollar limits. The annual dollar limits ensure that consumers have sufficient access to medical benefits throughout the annual term of the policy. Restrictions for annual dollar limits for group and individual health insurance coverage are $1.25 million for policy years before September 23, 2012; and $2 million for policy years beginning on or after September 23, 2012 but before January 1, 2014. Restrictions on annual dollar limits for student health insurance coverage are $100,000 for policy years before September 23, 2012 and $500,000 for Each Injury or Sickness policy years beginning on or after September 23, 2012 but before January 1, 2014. This student health plan puts a policy year limit of $500,000 for each Injury or Sickness that applies to the essential benefits provided in the schedule of Benefits unless otherwise specified. If you have any questions or concerns about this notice, contact Customer Service at 1-866-948-8472. Be advised that an Insured Person may be eligible for coverage under a group health plan of a parent's employer or under a parent’s individual health insurance policy if you are under the age of 26. Contact the plan administrator of the parent’s employer plan or the parent’s individual health insurance issuer for more information. Monthly Rate
Quarterly Rate

Exclusions & Limitations:

No benefits wil be paid for: a) loss or expense caused by, contributed to, or resulting from; or b) treatment, services or supplies for, at, or related to: 3. Nicotine addiction, except as specifically provided in the policy 4. Milieu therapy, learning disabilities, behavioral problems, parent-child problems, attention deficit disorder, conceptual handicap, developmental delay or disorder or mental 8. Congenital conditions, except as specifically provided under Benefits for Newborn Infant, Adopted or Foster Child or Benefits for Cleft Lip and Cleft Palate; 9. Cosmetic procedures, except cosmetic surgery required to correct an Injury for which benefits are otherwise payable under this policy or for newborn or adopted children; 10. Custodial care; care provided in: rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places mainly for domiciliary or custodial care; extended care in treatment or substance abuse facilities for domiciliary or custodial care; 11. Dental treatment, except for Injury to Sound, Natural Teeth; 12. Elective Surgery or Elective Treatment, except cosmetic surgery made necessary as the result of a covered Injury or to correct a disorder of a normal bodily function; 14. Eye examinations, eye refractions, eyeglasses, contact lenses, prescriptions or fitting of eyeglasses or contact lenses, vision correction surgery, or other treatment for visual defects and problems; except when due to a Covered Injury or disease process; except as specifical y provided in the policy or under Benefits for Newborn Infant, Adopted or Foster Child or Benefits for 15. Flat foot conditions, supportive devices for the foot, subluxations of the foot, fallen arches, weak feet, chronic foot strain, symptomatic complaints of the feet and routine foot care including the care, cutting and removal of corns, cal uses, toenails, and bunions (except capsular or bone surgery); 16. Health spa or similar facilities; strengthening programs; 17. Hearing examinations; hearing aids; or other treatment for hearing defects and problems except as specifically provided under Benefits for Cleft Lip and Cleft Palate or Benefits for Newborn Infant, Adopted or Foster Child, or Benefits for Child Health Assurance. "Hearing defects" means any physical defect of the ear which does or can impair normal hearing, apart from the disease process; 20. Immunizations, except as specifically provided in the policy, preventive medicines or vaccines, except where required for treatment of a covered Injury or as specifically provided in the policy; 21. Injury or Sickness for which benefits are paid or payable under any Workers' Compensation or Occupational Disease Law or Act, or similar legislation. 22. Injury or Sickness outside the United States and its possessions, Canada or Mexico, except for a Medical Emergency when traveling for academic study abroad programs business or pleasure; 22. Injury sustained by reason of a motor vehicle accident to the extent that benefits are paid or payable by any other valid and collectible insurance; 23. Injury sustained while (a) participating in any intercollegiate or professional sport, contest or competition; (b) traveling to or from such sport, contest or competition as a participant; or (c) while participating in any practice or conditioning program for such sport, contest or competition; 26. Nuclear, chemical or biological Contamination, whether direct or indirect. “Contamination” means the contamination or poisoning of people by nuclear and/or chemical and/or biological substances which cause Sickness and/or death; 27. Outpatient Physiotherapy; except for a condition that required surgery or Hospital Confinement: 1) within the 30 days immediately preceding such Physiotherapy; or 2) within the 30 days immediately fol owing the attending Physician's release for rehabilitation; or except as specifically provided under Benefits For Habilitative Services For The Treatment of Congenital 28. Participation in a riot or civil disorder; commission of or attempt to commit a felony; or fighting, except in self-defense; 29. Pre-existing Conditions except for individuals who have been continuously insured under the school’s student insurance policy for at least 6 consecutive months. Credit will be given for the time the Insured was covered under a previous similar plan if the pervious coverage was continuous to a date not more than 63 days prior to the Insured’s Effective Date under this policy. This exclusion wil not apply to an Insured Person who is under age 19; 30. Prescription Drugs, services or supplies as follows: a) Therapeutic devices or appliances, including: hypodermic needles, syringes, support garments and other non-medical substances, regardless of intended use; except as specifically provided b) Immunization agents, biological sera, blood or blood products administered on an outpatient basis; c) Drugs labeled, “Caution - limited by federal law to investigational use” or experimental drugs; e) Drugs used to treat or cure baldness; anabolic steroids used for body building; f) Anorectics - drugs used for the purpose of weight control; g) Fertility agents or sexual enhancement drugs, such as Parlodel, Pergonal, Clomid, Profasi, Metrodin, Serophene, or Viagra; i) Refills in excess of the number specified or dispensed after one (1) year of date of the prescription. 31. Reproductive/Infertility services including but not limited to: family planning; fertility tests; infertility (male or female), including any services or supplies rendered for the purpose or with the intent of inducing conception; premarital examinations; impotence, organic or otherwise; tubal ligation; vasectomy; sexual reassignment surgery; reversal of sterilization procedures; 32. Research or examinations relating to research studies, or any treatment for which the patient or the patient’s representative must sign an informed consent document identifying the treatment in which the patient is to participate as a research study or clinical research study, except as specifical y provided in the policy; 33. Routine Newborn Infant Care, wel -baby nursery and related Physician charges; except as specifically provided in the policy 34. Preventive Care services; routine physical examinations and routine testing; preventive testing or treatment; screening exams or testing in the absence of Injury or Sickness; except as specifically provided in the policy; 35. Services provided normally without charge by the Health Service of the Policyholder; or services covered or provided by the student health fee; 36. Deviated nasal septum, including submucous resection and/or other surgical correction thereof; nasal and sinus surgery, except for treatment of chronic purulent sinusitis; 37. Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, bungee jumping, or flight in any kind of aircraft, except while riding as a passenger on a regularly scheduled flight of a commercial airline; 39. Speech therapy except as specifically provided in Benefits for Cleft Lip and Cleft Palate; naturopathic services; 40. Supplies, except as specifically provided in the policy; 41. Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, or gynecomastia; 42. Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment; 43. War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium wil be refunded upon request for such period not covered); and 44. Weight management, weight reduction, nutrition programs, treatment for obesity, surgery for removal of excess skin or fat

Source: http://www.hs.sdes.ucf.edu/forms/hc/13-14_Student_Health_Insurance_Benefit_Flyer_Voluntary.pdf


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