Some general information on our health insurance plan is provided here. The brochure on our health plan, with further details, is available here.
When you need health services beyond those provided by the Student Health center, the Health Center physician may refer you to an outside private specialist. You may also go to an outside doctor or hospital as you wish. These are covered by the Student Health Insurance Plan. All registered Caltech graduate students are automatically enrolled in the Caltech Student Health Insurance Plan provided by Aetna, policy number 812843. A Student Connection resource page can be found at: www.chickering.com/stu_conn/student_connection.aspx?group_number=812843. The customer service phone line for our health insurance is (877) 261-8414.
Coverage
Caltech's medical insurance offers up to 50% discounts on eye exams and perscriptions when done by a participating VisionOne optometrist. To see the details of the VisionOne plan, visit http://www.chickering.com/schools/caltech/VisionOne.pdf. The medical insurance does not, however, cover
dental exams. The optional separate dental plan is described in the next section.
For other medical care, you can see any "preferred provider" (PPO) without a referral. You can find a PPO online at www.aetna.com/docfind/custom/chickering/, or by calling customer service at (877) 261-8414. When you visit a PPO, most Covered Medical Expenses are paid at 100%. Some services are paid at 80% (that means you pay 20%). Services covered at 80% include prescription drugs and medicines, anesthesiologists, ambulance service and services provided during travel outside the United States.
If you choose to use a non-preferred medical provider, Covered Medical Expenses will be payable at 70% of the Reasonable Charge allowance (this is what they determine to be a reasonable cost for a service in a particular geographical area). This means that you will be responsible for 30% of the covered expenses, plus any amount over the Reasonable Charge allowance, in addition to the annual deductible ($150 for our plan). If you plan to go to a hospital for treatment, call the customer service line at (877) 261-8414 for "pre-certification for hospital admission".
Refer to the brochure for details on what is and isn't covered.
Claims
Before you receive medical services at an outside facility, show your Aetna card
to identify yourself as a student covered by the Health Insurance Plan.
When you fill in the forms, have the medical expenses billed to the insurance company directly.
Even if you do that, sometimes the medical bills are sent to you. In that case or to
get prescription drugs reimbursed, you must file a claim form to get benefits paid. You can
obtain a claim form from the Health Center, complete the front side describing the injury
or sickness as simply as possible and mail the completed form together with all itemized bills
to Chickering Claims Administrators, Inc., P.O. Box 15708, Boston, MA 02215-0014.
If you need to check on the status of your claim, call customer service at (877) 261-8414.
Cost
The Student Health Insurance Plan is provided to students free of charge by Caltech.
For such a PPO plan, students are required to pay the first $150 of health care expenses each year
and the first $50 of emergency room costs, if any. This is referred to as the deductible.
Traveling
The Student Health Insurance Plan is in effect 24 hours a day, anywhere in the world. If
you need medical care when traveling, check the website
(www.chickering.com/stu_conn/student_connection.aspx?group_number=812843)
to find a hospital or doctor near you covered in the
PPO plan. If no PPO is available, just go to any doctor and then file a claim form. After you pay
the deductible (which can be reimbursed from the Health Center), the plan will cover 70% of
the cost of covered non-PPO services (see above section on coverage for details).
Continuing Coverage after Leaving Caltech
If you take a sabbatical, graduate or withdraw mid-term,
coverage will remain in force only for the balance of the
Insurance Term for which you last enrolled as a degreeseeking
student.
However, you and your covered dependents can still
receive benefits (except mail-order prescriptions) for up to
six months for the continued treatment of a covered
condition for which you were receiving treatment when
your coverage ended.You will not, however, be eligible to
receive benefits for any new conditions, unless you
purchase extended-coverage insurance.
If you wish to pay the full cost of the premium, you may
continue full coverage for up to a maximum of six consecutive
months following the end of the insurance term for which you
last enrolled as a degree-seeking student. Students on sabbatical
may elect to continue coverage for up to three consecutive
Insurance Terms. In either case, the election to continue
insurance should be made as soon as possible and not later
than 30 days following completion of the Insurance Term. For
information regarding continuation coverage, including rates,
contact the Shared Customer Service Unit at (626) 395-6443.
Benefits for Dependents
The cost each insurance term to cover your eligible
dependents through the Student Health Insurance Plan is:
Health Center involvement
The Health Center staff will be glad to help with forms and advice in processing
claims against the policy, but the basic relationship is between the student and the insurance
carrier. The Health Center cannot accept responsibility for health treatment costs which are
not reimbursed by the insurance carrier. For health costs not covered by the insurance,
some students may be covered by their parents' or spouse's health care plan and it is possible that
this plan could make up part of any unreimbursed costs.
All Caltech registered students are required to enroll in the CIGNA Dental Insurance Plan unless exempted because of existing coverage. For the 2004-5 school year, each student pays $60, which is about half of the annual premium. There is no cancellation refund. Spouses and children of students may also enroll in the dental plan for an additional fee. Covered services must be obtained from a selected participating dentist list. To select a dentist or to contact CIGNA for any other reason, call (800) 367-1037 or check out their webpage at www.cigna.com. Call the Shared Customer Service Unit (x6443) to obtain a brochure describing benefits of the plan.
Dentist selection is done when you join the program. Be careful with your choice: look up the Doctor and Dentist Reviews and talk to other students. Although you can change your dental care provider, a bad dentist can be very unpleasant and expensive. Most dental offices require reservations. Bring a credit card for additional charges not covered by the insurance.
The Health Insurance Plan provided by Caltech includes participation in the VisionOne program. This plan includes up to 50% off of scheduled exams when completed at a participating provider. There are also good discounts on perscription and non-perscription eyewear as well as Lasik surgery. To find a participating provider, visit the Chickering/Aetna website at http://www.chickering.com/stu_conn/student_connection.aspx?group_number=812843 and click "Docfind". More information about the VisionOne plan is given at http://www.chickering.com/schools/caltech/VisionOne.pdf.
If you would prefer to see an optometrist not covered by VisionOne, be aware that some nearby optometrists offer a 5%-10% discount to Caltech students. The discount will not be automatically applied to you. You need to ask for it! Make sure you bring your student ID. The Student Health Center maintains a list of vision care providers and other community health resources.
Medical and Dental Insurance
All postdocs are eligible for one of several health plans, including one insurance plan and
three prepaid (or HMO) plans. For more information about the specifics of each of these plans,
call the Employee Benefits Office at x6381. Additionally, postdocs on fellowships should
check with the funding agency to see if it provides a health care plan. There are two dental
plans available to postdocs, but enrollment is limited to the first month after arriving; contact
the Benefits Office for more information.