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Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutionsAetna Student HealthSMPlan Design and Benefits SummaryPreferred Provider Organization (PPO)Marshall UniversityPolicy Year: 2020 – 2021Policy Number: 686202www.aetnastudenthealth.com/marshall(877) 626-2308The Marshall University Student Health Insurance Plan is underwritten by Aetna Life Insurance Company.Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Companyand its applicable affiliated companies (Aetna).15.02.928.1-WV
This is a brief description of the Student Health Plan. The plan is available for Marshall University students and theireligible dependents. The plan is insured by Aetna Life Insurance Company (Aetna). The exact provisions, includingdefinitions, governing this insurance are contained in the Certificate issued to you and may be viewed online atwww.aetnastudenthealth.com. If there is a difference between this Plan Summary and the Certificate, theCertificate will control.Marshall University Medical CenterMarshall University partners with the Marshall University Medical Center to provide on-campus health services forits students. Marshall University Medical Center is located beside Cabell Huntington Hospital. The Family Medicineclinic, located on the first floor of the Marshall University Medical Center, offers diagnosis and treatment for acuteand chronic illnesses and onsite lab, x-ray and pharmacy services.Marshall University Medical Center1600 Medical Center Drive, First FloorHuntington, WV 25701304-691-1100Monday-Friday, while classes are in session8 a.m. to 10:45 a.m. 1 p.m. to 4 p.m.Coverage Dates and RatesCoverage for all insured students will become effective at 12:01 AM on the Coverage Start Date indicated below andwill terminate at 11:59 PM on the Coverage End Date indicated.Coverage Start DateCoverage End 012/31/2020Spring/Summer01/01/202108/14/2021 1,720 655 1,065Who is eligible?You are eligible if you are a: Registered international student ELP StudentJ-1 Scholar Students participating in an OPT program that were previously insuredYou must actively attend classes for at least the first 31 days after the date your coverage becomes effective. Youcannot meet this eligibility requirement if you take courses through: Home study CorrespondenceThe internet Television (TV)Marshall University 2020-202115.02.928.1-WVPage 2
Enrollment and Waiver ProcessThe enrollment and waiver process is administered by Insurance for Students. To enroll in the MarshallUniversity-sponsored plan, or if you have any questions regarding the enrollment or waiver process, contactInsurance for Students at (800) 356-1235, or visit www.insuranceforstudents.com/marshall.If you need information or have general questions on dependent enrollment, contact Insurance for Students at(800) 356-1235, or visit www.insuranceforstudents.com/marshall.Medicare Eligibility NoticeYou are not eligible to enroll in the student health plan if you have Medicare at the time of enrollment in thisstudent plan. The plan does not provide coverage for people who have Medicare.In-network Provider NetworkAetna Student Health offers Aetna’s broad network of In-network Providers. You can save money by seeing Innetwork Providers because Aetna has negotiated special rates with them, and because the Plan’s benefits arebetter.If you need care that is covered under the Plan but not available from an In-network Provider, contact MemberServices for assistance at the toll-free number on the back of your ID card. In this situation, Aetna may issue a preapproval for you to receive the care from an Out-of-network Provider. When a pre-approval is issued by Aetna, thebenefit level is the same as for In-network Providers.PrecertificationYou need pre-approval from us for some eligible health services. Pre-approval is also called precertification. Your innetwork physician is responsible for obtaining any necessary precertification before you get the care.When you go to an out-of-network provider, it is your responsibility to obtain precertification from us for anyservices and supplies on the precertification list. If you do not precertify when required, there is a 500 penalty foreach type of eligible health service that was not precertified.For a current listing of the health services or prescription drugs that require precertification, contact MemberServices or go to www.aetnastudenthealth.com.Marshall University 2020-202115.02.928.1-WVPage 3
Precertification CallPrecertification should be secured within the timeframes specified below. To obtain precertification, call MemberServices at the toll-free number on your ID card. This call must be made:Non-emergency admissions:You, your physician or the facility will need to call and requestprecertification at least 14 days before the date you are scheduled to beadmitted.An emergency admission:You, your physician or the facility must call within 48 hours or as soon asreasonably possible after you have been admitted.An urgent admission:You, your physician or the facility will need to call before you arescheduled to be admitted. An urgent admission is a hospital admission bya physician due to the onset of or change in an illness, the diagnosis of anillness, or an injury.Outpatient non-emergency servicesrequiring precertification:You or your physician must call at least 14 days before the outpatientcare is provided, or the treatment or procedure is scheduled.We will provide a written notification to you and your physician of the precertification decision, where required bystate law. If your precertified services are approved, the approval is valid for 30 days as long as you remain enrolledin the plan.Coordination of Benefits (COB)Some people have health coverage under more than one health plan. If you do, we will work together with yourother plan(s) to decide how much each plan pays. This is called coordination of benefits (COB). A completedescription of the Coordination of Benefits provision is contained in the certificate issued to you.Marshall University 2020-202115.02.928.1-WVPage 4
Description of BenefitsThe Plan excludes coverage for certain services and has limitations on the amounts it will pay. While this PlanSummary document will tell you about some of the important features of the Plan, other features that may beimportant to you are defined in the Certificate. To look at the full Plan description, which is contained in theCertificate issued to you, go to www.aetnastudenthealth.com/marshall.This Plan will pay benefits in accordance with any applicable West Virginia Insurance Law(s).Policy year deductibleIn-network coverageOut-of-network coverageYou have to meet your policy year deductible before this plan pays for benefitsAnnual Individual Deductible 100 per policy year 500 per policy yearDeductibleThis is the amount you owe for in-network and out-of-network eligible health services each policy year beforethe plan begins to pay for eligible health services. This policy year deductible applies separately to you and eachof your covered dependents. After the amount you pay for eligible health services reaches the policy yeardeductible, this plan will begin to pay for eligible health services for the rest of the policy year.Eligible health services applied to the out-of-network policy year deductibles will not be applied to satisfy the innetwork policy year deductibles. Eligible health services applied to the in-network policy year deductibles willnot be applied to satisfy the out-of-network policy year deductibles.Policy year deductible waiverThe policy year deductible is waived for all of the following eligible health services: In-network care for Preventive care and wellness, Pediatric Dental Type A Services, Pediatric Vision Careservices, and Outpatient prescription drugs In-network care and out-of-network care for Well newborn nursery careMaximum out-of-pocket limit per policy yearStudent 5,000 per policy year 10,000 per policy yearSpouse 5,000 per policy year 10,000 per policy yearEach child 5,000 per policy year 10,000 per policy yearFamily 7,000 per policy year 14,000 per policy yearEligible health services applied to the out-of-network maximum out-of-pocket limit will not be applied to satisfythe in-network maximum out-of-pocket limit and eligible health services applied to the in-network maximumout-of-pocket limit will not be applied to satisfy the out-of-network maximum out-of-pocket limit.Marshall University 2020-202115.02.928.1-WVPage 5
Eligible health servicesIn-network coverageOut-of-network coverage100% (of the negotiated charge)per visitNot CoveredRoutine physical examsPerformed at a physician’sofficeNo copayment or policy yeardeductible appliesMaximum age and visit limitsper policy year through age 21Subject to any age and visit limits provided for in the comprehensive guidelinessupported by the American Academy of Pediatrics/Bright Futures//HealthResources and Services Administration guidelines for children and adolescents.Maximum visits per policyyear age 22 and over1 visitPreventive care immunizationsPerformed in a facility or at aphysician's office100% (of the negotiated charge)per visit.Not CoveredNo copayment or policy yeardeductible appliesMaximumsSubject to any age limits provided for in the comprehensive guidelinessupported by Advisory Committee on Immunization Practices of the Centers forDisease Control and Prevention.Routine gynecological exams (including Pap smears and cytology tests)Performed at a physician’s,obstetrician (OB), gynecologist(GYN) or OB/GYN office100% (of the negotiated charge)per visitNot CoveredNo copayment or policy yeardeductible appliesMaximum visits per policyyear1 visitPreventive screening and counseling servicesPreventive screening andcounseling services forObesity and/or healthy dietcounseling, Misuse of alcohol& drugs, Tobacco Products,Depression Screening,Sexually transmitted infectioncounseling & Genetic riskcounseling for breast andovarian cancer100% (of the negotiatedcharge) per visitObesity/Healthy Dietmaximum per policy year(Applies to covered personsage 22 and older)26 visits (10 visits will be allowed under the plan for healthy diet counselingprovided in connection with Hyperlipidemia (high cholesterol) and other knownrisk factors for cardiovascular and diet-related chronic disease)Marshall University 2020-202115.02.928.1-WVNot CoveredNo copayment or policy yeardeductible appliesPage 6
Eligible health servicesIn-network coverageOut-of-network coverageMisuse of Alcohol maximumper policy year5 visitsTobacco Products Counselingmaximum per policy year8 visitsDepression screeningmaximum per policy year1 visitSTI maximum per policy year2 visitsRoutine cancer screenings100% (of the negotiated charge)per visitNot CoveredNo copayment or policy yeardeductible appliesMaximumsSubject to any age; family history; and frequency guidelines as set forth in themost current: Evidence-based items that have in effect a rating of A or B in the currentrecommendations of the United States Preventive Services Task Force; and The comprehensive guidelines supported by the Health Resources andServices Administration.Lung cancer screeningmaximumsPrenatal care services(Preventive care services only)1 screenings every 12 months100% (of the negotiated charge)per visitNot CoveredNo copayment or policy yeardeductible appliesLactation counseling servicesmaximum per policy yearMarshall University 2020-202115.02.928.1-WV6 visitsPage 7
Eligible health servicesIn-network coverageOut-of-network coverageLactation support andcounseling services100% (of the negotiated charge)per visitNot CoveredNo copayment or policy yeardeductible appliesBreast pump supplies andaccessories100% (of the negotiated charge)per visitNot CoveredNo copayment or policy yeardeductible appliesFemale contraceptivecounseling services office visit100% (of the negotiated charge)per visitNot CoveredNo copayment or policy yeardeductible appliesContraceptive counselingservices maximum per policyyearFemale contraceptiveprescription drugs anddevices2 visits100% (of the negotiated charge)per visitNot CoveredNo copayment or policy yeardeductible appliesFemale voluntary sterilizationInpatient & Outpatientprovider services100% (of the negotiated charge)per visit70% (of the recognized charge)No copayment or policy yeardeductible appliesPhysicians and other health professionalsPhysician, specialist includingConsultants Officevisits (non-surgical/nonpreventive care by a physicianand specialist)(includes telemedicineconsultations) 20 copayment then the plan pays90% (of the balance of thenegotiated charge) per visitthereafterAllergy testing and treatmentCovered according to the type ofAllergy testing & Allergybenefit and the place where theinjections treatmentservice is received.performed at a physician’s or70% (of the recognized charge) per visitCovered according to the type of benefitand the place where the service is received.specialist’s officeMarshall University 2020-202115.02.928.1-WVPage 8
Eligible health servicesIn-network coverageOut-of-network coveragePhysician and specialist - surgical servicesInpatient surgery performedduring your stay in a hospitalor birthing center by asurgeon (includes anesthetistand surgical assistantexpenses)90% (of the negotiated charge)70% (of the recognized charge)Outpatient surgery performedat a physician’s or specialist’soffice or outpatientdepartment of a hospital orsurgery center by a surgeon(includes anesthetist andsurgical assistant expenses)90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitAlternatives to physician office visitsWalk-in clinic visits(non-emergency visit) 20 copayment then the plan pays90% (of the balance of thenegotiated charge) per visitthereafter70% (of the recognized charge) per visitHospital and other facility careInpatient hospital (room andboard) and othermiscellaneous services andsupplies)90% (of the negotiated charge) peradmission70% (of the recognized charge) peradmission90% (of the negotiated charge)per visit70% (of the recognized charge) per visitIncludes birthing centerfacility chargesIn-hospital non-surgicalphysician servicesAlternatives to hospital staysOutpatient surgery (facilitycharges) performed in theoutpatient department of ahospital or surgery center90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitHome health Care90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitHospice-Inpatient90% (of the negotiated charge)per admission70% (of the recognized charge) peradmissionHospice-Outpatient90% (of the negotiated charge)per visit70% (of the recognized charge) per visitHospice-Outpatient90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitOutpatient private dutynursing90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitMarshall University 2020-202115.02.928.1-WVPage 9
Eligible health servicesIn-network coverageOut-of-network coverageSkilled nursing facilityInpatient90% (of the negotiated charge) peradmission70% (of the recognized charge) peradmissionHospital emergency room 200 copayment then the planpays 90% (of the balance of thenegotiated charge) per visitPaid the same as in-network coverageNon-emergency care in ahospital emergency roomNot coveredNot coveredImportant note: As out-of-network providers do not have a contract with us the provider may not accept payment of yourcost share, (copayment/coinsurance), as payment in full. You may receive a bill for the differencebetween the amount billed by the provider and the amount paid by this plan. If the provider bills you foran amount above your cost share, you are not responsible for paying that amount. You should send thebill to the address listed on the back of your ID card, and we will resolve any payment dispute with theprovider over that amount. Make sure the ID card number is on the bill. A separate hospital emergency room copayment/coinsurance will apply for each visit to an emergencyroom. If you are admitted to a hospital as an inpatient right after a visit to an emergency room, youremergency room copayment/coinsurance will be waived, and your inpatient copayment/coinsurance willapply. Covered benefits that are applied to the hospital emergency room copayment/coinsurance cannot beapplied to any other copayment/coinsurance under the plan. Likewise, a copayment/coinsurance thatapplies to other covered benefits under the plan cannot be applied to the hospital emergency roomcopayment/coinsurance. Separate copayment/coinsurance amounts may apply for certain services given to you in the hospitalemergency room that are not part of the hospital emergency room benefit. Thesecopayment/coinsurance amounts may be different from the hospital emergency roomcopayment/coinsurance. They are based on the specific service given to you. Services given to you in the hospital emergency room that are not part of the hospital emergency roombenefit may be subject to copayment/coinsurance amounts that are different from the hospitalemergency room copayment/coinsurance amounts.Urgent Care 50 copayment then the plan pays90% (of the balance of thenegotiated charge) per visitthereafter 50 copayment then the plan pays 70%(of the balance of the recognized charge)per visit thereafterNon-urgent use of urgent careproviderNot coveredNot coveredMarshall University 2020-202115.02.928.1-WVPage 10
Eligible health servicesIn-network coverageOut-of-network coveragePediatric dental care (Limited to covered persons through the end of the month in which the person turnsage 19.)Type A services100% (of the negotiated charge)per visit70% (of the recognized charge) per visitNo copayment or deductibleappliesType B services90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitType C services50% (of the negotiated charge) pervisit50% (of the recognized charge) per visitOrthodontic services50% (of the negotiated charge) pervisit50% (of the recognized charge) per visitDental emergency treatmentCovered according to the type ofbenefit and the place where theservice is received.Covered according to the type of benefitand the place where the service isreceived.Diabetic services and supplies(including equipment andtraining)Covered according to the type ofbenefit and the place where theservice is received.Covered according to the type of benefitand the place where the service isreceived.Impacted wisdom teeth90% (of the negotiated charge)90% (of the recognized charge)Accidental injury to soundnatural teeth90% (of the negotiated charge)90% (of the recognized charge)Obesity bariatric SurgeryCovered according to the type ofbenefit and the place where theservice is received.Covered according to the type of benefitand the place where the service isreceived.Maternity care (includesdelivery and postpartum careservices in a hospital orbirthing center)Covered according to the type ofbenefit and the place where theservice is received.Covered according to the type of benefitand the place where the service isreceived.Well newborn nursery care ina hospital or birthing center90% (of the negotiated charge)70% (of the recognized charge)No policy year deductible appliesNo policy year deductible appliesSpecific ConditionsMaternity careFamily planning services – otherVoluntary sterilization formales-surgical services90% (of the negotiated charge)90% (of the recognized charge)Abortion physician orspecialist surgical services90% (of the negotiated charge)90% (of the recognized charge)Gender reassignment (sex change) treatmentSurgical, hormonereplacement therapy, andcounseling treatmentMarshall University 2020-202115.02.928.1-WVCovered according to the type ofbenefit and the place where theservice is received.Covered according to the type of benefitand the place where the service isreceived.Page 11
Eligible health servicesIn-network coverageOut-of-network coverageCovered according to the type ofbenefit and the place where theservice is received.Covered according to the type of benefitand the place where the service isreceived.Autism spectrum disorderAutism spectrum disordertreatment, diagnosis andtesting and Applied behavioranalysisMental Health & Substance Abuse TreatmentInpatient hospital(room and board and othermiscellaneous hospitalservices and supplies)90% (of the negotiated charge) peradmission70% (of the recognized charge) peradmissionOutpatient office visits(includes telemedicineconsultations) 20 copayment then the plan pays90% (of the balance of thenegotiated charge) per visitthereafter70% (of the recognized charge) per visitOther outpatient treatment(includes Partialhospitalization and IntensiveOutpatient Program)90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitEligible health servicesIn-network coverageNetwork (IOE facility)Transplant services Inpatientand outpatient facility servicesCovered according to the type of benefit and the place where the service isreceived.Transplant services Inpatientand outpatient physician andspecialist servicesCovered according to the type of benefit and the place where the service isreceived.Transplant services-travel andlodgingCoveredCoveredCoveredLifetime Maximum Travel andLodging Expenses for any onetransplant 10,000 10,000 10,000Maximum Lodging Expensesper IOE patient 50 per night 50 per night 50 per nightMaximum Lodging Expensesper companion 50 per night 50 per night 50 per nightMarshall University 2020-202115.02.928.1-WVIn-network coverageNetwork (Non-IOEfacility)Out-of-networkcoveragePage 12
Eligible health servicesIn-network coverageOut-of-network coverageBasic infertility servicesCovered according to the type ofbenefit and the place where theservice is received.Covered according to the type of benefitand the place where the service isreceived.Specific therapies and testsOutpatient diagnostic testingDiagnostic complex imagingservices performed in theoutpatient department of ahospital or other facility 200 copayment then the planpays 90% (of the balance of thenegotiated charge) per visitthereafter 200 copayment then the plan pays 70%(of the balance of the recognized charge)per visit thereafterDiagnostic lab work andradiological servicesperformed in a physician’soffice, the outpatientdepartment of a hospital orother facility90% (of the negotiated charge)per visit70% (of the recognized charge) per visitOutpatient Chemotherapy,Radiation & RespiratoryTherapy90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitOutpatient physical,occupational, speech, andcognitive therapies (includingCardiac and PulmonaryTherapy)90% (of the negotiated charge)per visit70% (of the recognized charge) per visit90% (of the negotiated charge) pervisit70% (of the recognized charge) per visitEmergency ground, air, andwater ambulance(includes non-emergencyambulance)90% (of the negotiated charge)per tripPaid the same as in-network coverageDurable medical and surgicalequipment90% (of the negotiated charge)per item70% (of the recognized charge) per itemEnteral formulas andnutritional supplements90% (of the negotiated charge) peritem70% (of the recognized charge) per itemProsthetic Devices & Orthotics90% (of the negotiated charge)per item70% (of the recognized charge) per itemCochlear implants90% (of the negotiated charge) peritem70% (of the recognized charge) per itemCombined for short-termrehabilitation services andhabilitation therapy servicesChiropractic servicesOther services and suppliesMarshall University 2020-202115.02.928.1-WVPage 13
Eligible health servicesIn-network coverageOut-of-network coveragePediatric vision care (Limited to covered persons through the end of the month in which the personturns age 19).Pediatric routine vision exams(including refraction)Performed by a legallyqualified ophthalmologist oroptometristIncludes comprehensive lowvision evaluations Includes100% (of the negotiated charge)per visit70% (of the recognized charge) per visitNo policy year deductible appliesvisit for fitting of contact lensesMaximum visits per policyyearLow vision Maximum1 visitOne comprehensive low vision evaluation every policy yearFitting of contact MaximumPediatric vision care services &supplies-Eyeglass frames,prescription lenses orprescription contact lenses1 visit100% (of the negotiated charge)per visit70% (of the recognized charge) per visitNo policy year deductible appliesMaximum number Per year:Eyeglass framesOne set of eyeglass framesPrescription lensesOne pair of prescription lensesContact lenses (includes nonconventional prescriptioncontact lenses & aphakiclenses prescribed aftercataract surgery)Daily disposables: up to 3-month supplyExtended wear disposable: up to 6-month supplyNon-disposable lenses: one set*Important note: Refer to the Vision care section in the certificate of coverage for the explanation of thesevision care supplies. As to coverage for prescription lenses in a policy year, this benefit will cover eitherprescription lenses for eyeglass frames or prescription contact lenses, but not both.Outpatient prescription drugsCoinsurance waiver for risk reducing breast cancerThe per prescription copayment/coinsurance will not apply to risk reducing breast cancer prescription drugswhen obtained at a retail in-network, pharmacy. This means that such risk reducing breast cancer prescriptiondrugs are paid at 100%.Copayment waiver for tobacco cessation prescription and over-the-counter drugsThe prescription drug copayment will not apply to the first two 90-day treatment regimens per policy year fortobacco cessation prescription drugs and OTC drugs when obtained at an in-network pharmacy. This meansthat such prescription drugs and OTC drugs are paid at 100%.Your prescription drug copayment will apply after those two regimens per policy year have been exhausted.Marshall University 2020-202115.02.928.1-WVPage 14
Eligible health servicesIn-network coverageOut-of-network coverageCopayment waiver for contraceptivesThe prescription drug copayment will not apply to female contraceptive methods when obtained at an innetwork pharmacy.This means that such contraceptive methods are paid at 100% for: Certain over-the-counter (OTC) and generic contraceptive prescription drugs and devices for each of themethods identified by the FDA. Related services and supplies needed to administer covered devices willalso be paid at 100%. If a generic prescription drug or device is not available for a certain method, you may obtain certainbrand-name prescription drug or device for that method paid at 100%.The prescription drug copayment continues to apply to prescription drugs that have a generic equivalent,biosimilar or generic alternative available within the same therapeutic drug class obtained at an in-networkpharmacy unless you are granted a medical exception. The certificate of coverage explains how to get a medicalexception.Preferred Generic prescription drugs (including specialty drugs)For each fill up to a 30-daysupply filled at a retailpharmacy 15 copayment per supply then theplan pays 100% (of the balance ofthe negotiated charge)Not CoveredNo policy year deductible appliesMore than a 30-day supply butless than a 90-day supply filledat a mail order pharmacy 37.50 copayment per supply thenthe plan pays 100% (of the balanceof the negotiated charge)Not CoveredNo policy year deductible appliesNon-Preferred generic name prescription drugs (including specialty drugs)For each fill up to a 30-daysupply filled at a retailpharmacy 60 copayment per supply then theplan pays 100% (of the balance ofthe negotiated charge)Not CoveredNo policy year deductible appliesMore than a 30-day supply butless than a 90-day supply filledat a mail order pharmacy 150 copayment per supply then theplan pays 100% (of the balance ofthe negotiated charge)Not CoveredNo policy year deductible appliesMarshall University 2020-202115.02.928.1-WVPage 15
Eligible health servicesIn-network coverageOut-of-network coveragePreferred brand name prescription drugs (including specialty drugs)For each fill up to a 30-daysupply filled at a retailpharmacy 30 copayment per supply then theplan pays 100% (of the balance ofthe negotiated charge)Not CoveredNo policy year deductible appliesMore than a 30-day supply butless than a 90-day supply filledat a mail order pharmacy 75 copayment per supply then theplan pays 100% (of the balance ofthe negotiated charge)No policy year deductible appliesNot CoveredNon-Preferred brand name prescription drugs (including specialty drugs)For each fill up to a 30-daysupply filled at a retailpharmacy 60 copayment per supply then theplan pays 100% (of the balance ofthe negotiated charge)Not CoveredNo policy year deductible appliesMore than a 30-day supply butless than a 90-day supply filledat a mail order pharmacy 150 copayment per supply then theplan pays 100% (of the balance ofthe negotiated charge)Not CoveredNo policy year deductible appliesOrally administered anticancer prescription drugs- Foreach fill up to a 30-day supplyfilled at a retail or mail orderpharmacy100% (of the negotiated charge)Preventive care drugs andsupplements filled at a retailor mail order pharmacy100% (of the negotiated charge perprescription or refillFor each 30-day supplyRisk reducing breast cancerprescription drugs filled at apharmacyFor each 30-day supplyMaximums:Tobacco cessationprescription drugs and OTCdrugs filled at a pharmacyFor each 30-day supplyMaximums:Marshall University 2020-202115.02.928.1-WVNot CoveredNo policy year deductible appliesNot CoveredNo copayment or policy yeardeductible applies100% (of the negotiated charge) perprescription or refillNot CoveredNo copayment or policy yeardeductible appliesCoverage will be subject to any sex, age, medical condition, family history, andfrequency guidelines in the recommendations of the Unit
Aetna Student Health offers Aetna's broad network of In-network Providers. You can save money by seeing In-network Providers because Aetna has negotiated special rates with them, and because the Plan's benefits are . state law. If your precertified services are approved, the approval is valid for 30 days as long as you remain enrolled .
