1. UNIVERSITY OF WASHINGTON STUDENT HEALTH INSURANCE PLAN - SHIP
POLICY YEAR
9/20/13 - 9/19/14

2. SHIP HIGHLIGHTS MEDICAL COVERAGE
One Preventative Care Physical is free from deductible per year if received at or through Hall Health
Sickness, illness and injury at any participating care provider (subject to deductible and copay)
Mental Health visits (subject to deductible and copay – deductible waived at Hall Health)
Emergency Care (subject to deductible and copay)
Prescription medication (purchased at Rubenstein Pharmacy or UWMC/UWP with limited benefits at other participating pharmacies)
Some services are not covered by this plan – see booklet on website (
In-network care providers covered at 75% of allowable charges, Out-of-network care providers covered at 60% of allowable charges (see student.lifewiseac.com for list of network providers)
$100 deductible per quarter, maximum of $400 deductible per year for student only
How the math works: If you go to a network provider to be treated for the flu and the doctor charges you $200 for the visit. You would pay the first $100 deductible (once per quarter), the insurance would pay $75 and you would pay $25. This same example after the deductible has been met, the insurance would pay $150 and you would pay $50.
DENTAL COVERAGE
Preventative Care (maximum of 2 routine oral exams per year)
Restorative Care (such as fillings, crowns or root canals)
Maximum benefit is $300 per plan year
$25 copay per plan year
VISION COVERAGE
Routine eye exam no charge up to $150 per plan year

5. AUTUMN QUARTER SEPTEMBER 20, 2013-JANUARY 5, 2014 WINTER QUARTER
DATES OF COVERAGE
AUTUMN QUARTER
SEPTEMBER 20, 2013-JANUARY 5, 2014
WINTER QUARTER
JANUARY 6, 2014-MARCH 30, 2014
SPRING QUARTER
MARCH 31, 2014-JUNE 22, 2014
SUMMER QUARTER
JUNE 23, 2014-SEPTEMBER 19, 2014
THE ANNUAL PLAN RUNS FROM AUTUMN THROUGH SUMMER QUARTER PROVIDING 4 QUARTERS OF COVERAGE (AUTUMN, WINTER, SPRING, & SUMMER QUARTERS)

6. Per Win/Spr/Sum Quarter(1)
SHIP PREMIUMS for 2013/2014
2013/14
Plan Premiums
# of Quarters
Student Only
SHIP
Student + Spouse
Family
Student + Child
Annual at Autumn(2) 4
$2,748
$6,840
$10,308
$6,216
Annual at Winter(1) 3
$2,118
$5,223
$7,851
$4,746
Annual at Spring(1) 2
$1,412
$3,482
$5,234
$3,164
Per Autumn Quarter(1) 1
$673
$1,663
$2,497
$1,507
Per Win/Spr/Sum Quarter(1)
$706
$1,741
$2,617
$1,582
(1) Includes 2014 ACA Fees
(2) Includes ACA required fee for the last 3 quarters in 2014

7. INSURANCE DEFINITIONS
MAXIMUM BENEFIT: $500,000 PER CONDITION AGGREGATE (TOTAL) MAXIMUM
DEDUCTIBLE: $100 PER QUARTER MEDICAL; $25 DENTAL PER POLICY YEAR
THE AMOUNT OF COVERED EXPENSES YOU HAVE TO PAY BEFORE THE PLAN PAYS ANY BENEFITS
DOES NOT APPLY TO PREVENTATIVE CARE VISITS, PHARMACY, HALL HEALTH UNLESS LAB WORK PERFORMED BY OUTSIDE LAB
COINSURANCE: NETWORK PROVIDER PAYS 75% / YOU PAY 25%; NON-NETWORK PROVIDER PAYS 60% / YOU PAY 40%
COPAYMENT: SPECIFIED DOLLAR AMOUNT YOU MUST PAY FOR SERVICES; COPAYMENT IS NOT PART OF DEDUCTIBLE OR COINSURANCE
NETWORK PROVIDER: PROVIDERS WHO HAVE CONTRACTED WITH LIFEWISE TO PROVIDE CARE AT A DISCOUNT

8. STUDENT INSURANCE VIDEOS
CHECK OUT OUR WEBSITE TO VIEW THE FOLLOWING VIDEOS:
SELECTING STUDENT INSURANCE
HOW UW SHIP WORKS
UNDERSTANDING IN-NETWORK & NON-NETWORK COVERAGE
UNDERSTANDING DEDUCTIBLES, CO-PAYS, INSURANCE, BILLING, & CLAIMS
WHAT TO EXPECT AT A TYPICAL DOCTOR’S VISIT

9. CONTACT US
Student Insurance Office: LifeWise Assurance Company Graduate Appointee Insurance Plan – GAIP