1. Boston University 2017-2018 Student Health Insurance Plan
Graduate School of Arts and Sciences
Fully insured student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna) and administered by Aetna Life Insurance Company (ALIC). Self insured plans are funded by the applicable school, with claims administration services provided by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company and their applicable affiliated companies (Aetna).

2. 2017-2018 Coverage Dates and Premiums
Boston University makes two plans available to students on the main campus. The Basic Plan provides benefits comparable to “Gold” plans offered through the public Marketplace (e.g. Healthcare.gov). The Plus plan provides a higher level of benefits, comparable to “Platinum” plans offered through the public Marketplace, at a higher premium than the Basic Plan:
Program
Coverage Dates
Annual Premium
Basic Plan
8/23/17 to 8/14/18
$2,045
Plus Plan
$2,813
For premium rates and benefit description available to eligible dependents, please visit

3. Basic Plan benefits Plan information Preferred Care Non-Preferred Care
Policy Year Maximum
Unlimited Medical & Prescription Drug
Policy Year Deductible
$150 per Covered Person
$500 per Covered Person
Out-of-Pocket Maximum
$5,500 per Covered Person
Physician Office Visits
$40 Copay, then 100% of Negotiated Charge
80% of Recognized Charge
Laboratory and X-ray
80% of Negotiated Charge
60% of Recognized Charge
Preventive Care
100% of Negotiated Charge
Emergency Room (Copay waived if admitted)
$150 Copay, then 80% of Negotiated Charge
$150 Deductible, then 80% of Recognized Charge
Inpatient Hospitalization
Prescription Drug
$10 Tier 1 Drug
$40 Tier 2 Drug
$60 Tier 3 Drug
The Plan will pay benefits in accordance with any applicable Massachusetts insurance law. The  Boston University plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the Boston University Plan Design and Benefits Summary carefully before deciding whether this plan is right for you.  While this document and the Boston University Plan Design and Benefits Summary tell you about some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look at the full plan description, which is contained in the Master Policy issued to Boston University, you may contact us at (800)   Additional plan maximums may also apply. Some illnesses may cost more to treat and health care providers may bill you for what the plan does not cover.

4. Plus Plan benefits Plan information Preferred Care Non-Preferred Care
Policy Year Maximum
Unlimited Medical & Prescription Drug
Policy Year Deductible
None
$250 per Covered Person
Out-of-Pocket Maximum
$3,000 per Covered Person
Physician Office Visits
$25 Copay, then 100% of Negotiated Charge
80% of Recognized Charge
Laboratory and X-ray
100% of Negotiated Charge
Preventive Care
Emergency Room (Copay waived if admitted)
$100 Copay, then 100% of Negotiated Charge
$100 Deductible, then 100% of Recognized Charge
Inpatient Hospitalization
$250 Copay, then 100% of Negotiated Charge
Prescription Drug
$10 Tier 1 Drug
$35 Tier 2 Drug
$50 Tier 3 Drug
The Plan will pay benefits in accordance with any applicable Massachusetts insurance law. The  Boston University plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the Boston University Plan Design and Benefits Summary carefully before deciding whether this plan is right for you.  While this document and the Boston University Plan Design and Benefits Summary tell you about some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look at the full plan description, which is contained in the Master Policy issued to Boston University, you may contact us at (800)   Additional plan maximums may also apply. Some illnesses may cost more to treat and health care providers may bill you for what the plan does not cover.

5. Student Connection www.aetnastudenthealth.com/bu

6. Aetna Mobile - available from App Store and Play Store

7. Aetna Student Health network
A national network of more than million providers* including:
More than
664,000 primary care doctors and specialists*
5,600 hospitals*
Access to the Aetna Preferred Provider Network.
Aetna has arranged for you to access a Preferred Provider Network in your local community (referrals from Student Health Services may be necessary). Acute care facilities and mental health networks are available nationally if you require hospitalization outside the immediate area of the Boston University campus.
To maximize your savings and reduce your out-of-pocket expenses, select a Preferred Provider. It is to your advantage to use a Preferred Provider because savings may be achieved from the Negotiated Charges these providers have agreed to accept as payment for their services.
To learn more about Preferred Providers, visit
Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.
* As of December 31, 2016.
Boston University
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8. Travel assistance services
Access to travel assistance services including emergency assistance – available 24/7.
24/7 emergency travel arrangements
Translation assistance
Emergency travel funds and lost travel documents assistance
Natural Disaster & Political Evacuation Services up to $100,000 in the event of either natural disaster making current location uninhabitable or governmental/social upheaval, placing student in imminent bodily harm
Unlimited emergency medical evacuation and medical repatriation
Medical/dental/pharmacy referral
Hospital deposit arrangements
Prescription drug replacement assistance
Dispatch of physician
Pre-trip plans
For more information visit

9. Value added programs
Aetna VisionSM discount program Informed Health® Line Aetna Natural Products and ServicesSM discount program Aetna Weight Management discount program Aetna FitnessSM discount program Oral Health Care discount program
These are not underwritten by Aetna and are NOT insurance.  The member is responsible for the full cost of the discounted services. Please note that these programs are subject to change without notice. To learn more about these additional services and search for providers visit,
Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Discount programs may be offered by vendors who are independent contractors and not employees or agents of Aetna or their affiliates. Aetna may receive a percentage of the fee you pay to the discount vendor.
These services, programs or benefits are offered by vendors who are independent contractors and not employees or agents of Aetna Life Insurance Company or its affiliates

10. Vital Savings by Aetna® on Dental*
An optional dental discount program helping you and your dependents save.
One low annual fee of $25 per student
In most instances, savings range from percent on services from general dentistry and cleanings to root canals, crowns, and orthodontia (braces)
No claims to file
Price: $25 Student only
$44 Student +1 Dependent
$63 Student +2or more Dependents
*Actual costs and savings vary by provider and geographic area.
The Vital Savings by Aetna® program (the “Program”) is not insurance. The Program does not meet the Minimum Creditable Coverage requirements in Massachusetts. It provides Members with access to discounted fees according to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna discount program. The range of discounts provided under the Program will vary depending on the type of provider and type of service received. The Program does not make payments directly to the participating providers. Each Member must pay for all services or products but will receive a discount from the providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, BeVital, is the Discount Medical Plan Organization.
Enroll online at

11. Contacts for assistance
We offer helpful tools and resources.
Aetna Student Health
Customer Service: (800)
Aetna Pharmacy Management: (888)
For assistance with waivers and enrollment:
Boston University Student Accounting Services
phone: (617)
Boston University
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12. Thank you
This material is for information only and is not an offer or invitation to contract. Health insurance plans contain exclusions, limitations and benefit maximums. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change. 
©2017 Aetna Inc.
(04/17)
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