Student Health Insurance Plan
2024 – 2025
Underwritten by: Wellfleet New York Insurance Co. Group #: ST1263SH
We are pleased to provide you with this summary of the 2024 – 2025 Student Health Insurance
Plan (“Plan”), which is fully compliant with the Affordable Care Act. This is only a brief description
of the coverage(s) available under Certificate form NYSHIP Cert (2024). The Certificate will
contain reductions, limitations, exclusions, and termination provisions. Full details of
coverage are contained in the Certificate. If there are any conflicts between this document
and the Certificate, the Certificate shall govern in all cases.
This ACA-compliant plan includes:
• Coverage while at school and at home
• Comprehensive coverage both for emergency and non-emergency situations
• Access to the Cigna PPO network
This Plan is paired with the Cigna Network. Note that the benefits are not insured by Cigna or affiliates.
This Plan also offers the following Value-added services. These services are not part of the Student Health Insurance Plan underwritten by Wellfleet Insurance Co.:
• Vision Discount Program through Davis Vision
• Medical Travel Assistance Services
Manhattan University Insurance Requirements
All registered full-time undergraduate domestic and international students, all degree seeking international students, all students residing in the university dormitories and all Division 1 athletic participants are automatically enrolled and charged for the Manhattan University Student Health Insurance Plan on their Tuition bill.
If you have existing medical insurance you will have the opportunity to remove the fee you can complete the waiver request by providing details of your current insurance plan coverage. If you require assistance you may contact the plan administrator at 1-800-734-9326.
How to Waive Coverage:
If you have existing medical insurance coverage under another policy (self, parent, spouse, etc.) – you may have the charge for the Manhattan University Student Health Insurance Plan removed from your tuition bill.
Go to: manhattan.edu/studenthealthinsurance for the waiver instructions. Please note that to waive the insurance premium, the student must show proof of other health coverage.
The deadline to file a waiver is August 1, 2024
Health Insurance Benefit Summary
| Benefit item | Participating Provider Member Responsibility | Non-Participating Provider |
|---|---|---|
| Deductible | $250 Per Individual | $500 Per Individual |
| Out-of-Pocket Limit |
$7,900 Individual |
$15,800 Individual |
| Coinsurance | 30% Coinsurance | 40% Coinsurance |
| Preventive Care | Covered in full | 30% Coinsurance |
|
Inpatient Hospital Preauthorization required |
30% coinsurance after deductible | 40% coinsurance after deductible |
| Physician’s Office Visit |
$25 Copayment |
$25 Copayment 30% coinsurance not subject to deductible |
| Emergency Room Expense |
$200 copayment 30% coinsurance after deductible |
$200 copayment 30% coinsurance after deductible |
| Diagnostic Testing | 30% coinsurance after deductible | 40% coinsurance after deductible |
| Laboratory Procedures | 30% coinsurance after deductible | 40% coinsurance after deductible |
|
Prescription Drugs • 30-day Supply • Prescriptions should be filled at a Cigna Pharmacy Network |
0% Coinsurance Tier 1:$20 copay Tier 2:$50 copay Tier 3:$100 copay See Prescription Card |
0% coinsurance Tier 1:$20 copay Tier 2:$50 copay Tier 3:$100 copay Member submit |
|
*This summary is provided as a courtesy and is not meant to replace or override the terms and conditions detailed in the insurance policy/brochure. Please refer to the policy/brochure to verify medical coverage, eligibility, exclusions, limitations, and for more detailed information. |
||
| I need to: | Visit: |
|---|---|
| Waive the Insurance Plan | manhattan.edu/studenthealthinsurance |
| Ask Any General Questions on the Program |
Plan Administrator The Allen J. Flood Companies 1-800-734-9326 |
|
Learn about: • Insurance Benefits • Participating PPO Provider Listings • Claims Processing • ID card |
Wellfleet 1-877-657-5030 |
|
Find a PPO Provider:
|
Cigna PPO (PPO, Choice Fund PPO) or Wellfleet |
|
Find a Prescription Drug Provider: |
Wellfleet Rx/ESI |
Cost and Period of Coverage
| Coverage For | Annual Coverage* 8/1/24-7/31/25 |
Spring Coverage* 1/1/25-7/31/25 |
|---|---|---|
| Student Only | $2,359 | $1,370 |
| *Premiums include an Administrative Service Fee | ||
Accessible, Responsive, Flexible.
(877) 657-5030
2077 Roosevelt Ave.
Springfield, MA 01104
www.studentinsurance.com