Student Health Insurance Plan

2019 – 2020 

Underwritten by: Wellfleet Insurance Co. Group #: ST1263SH

Dear Student, Parent, or Guardian: We are pleased to provide you with this overview of the Manhattan College Student Health Insurance Plan (SHIP). This SHIP is underwritten by Wellfleet Insurance Co. and administered by The Allen J. Flood Company.

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 College Insurance Requirements

All registered full-time undergraduate domestic and international students, all degree seeking international students, all students residing in the college dormitories and all Division 1 athletic participants are automatically enrolled and charged for the Manhattan College 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 College 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, 2019

Health Insurance Benefit Summary

Benefit item Participating Provider Member Responsibility Non-Participating Provider
Deductible $500 Per Individual $1,000 Per Individual
Out-of-Pocket Limit

$7,900 Individual

$15,800 Family

$15,800 Individual

$31,600 Family

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

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

www.wellfleetstudent.com

1-877-657-5030

Find a PPO Provider: 

Cigna Logo

 

Cigna PPO

(PPO, Choice Fund PPO)

www.cigna.com

or

Wellfleet

www.wellfleetstudent.com

Find a Prescription Drug Provider:

Cigna Pharmacy Network

www.cigna.com

Cost and Period of Coverage

Coverage For Annual Coverage*
8/1/19-7/31/20
Spring Coverage*
1/1/20-7/31/20
Student Only $2,550 $1,484
*Premiums include an Administrative Service Fee

 

 Wellfleet Corporate Logo    Accessible, Responsive, Flexible. 

(877) 657-5030
2077 Roosevelt Ave.
Springfield, MA 01104
www.studentinsurance.com