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Understanding insurance
You’ll learn so much on your college journey. Be sure to brush up on health insurance, too. From paying for care to what plans cover, knowing matters. Let’s make sense of it all so you can make great choices for a healthy future.
Already a member?
Navigate your health plan, find providers and take control of your wellness — all in one place.
Paying for care: Terms to know
Your plan covers many services. But covered doesn’t mean “free.” For most services, you pay a part of the cost out of pocket. Check your plan documents for your exact costs.
Ready to learn? Here are common insurance terms to describe what you pay, and what we pay.
Premium
This is a payment you make to an insurance plan in exchange for coverage. Most people pay a premium every month. Some pay up front for the whole year.
Tip: Sign up for autopay. It’s a simple way to ensure your coverage keeps going with you.
Deductible
This is the amount you pay before your health plan starts to pay for some or all of your costs.
Tip: You’re covered 100% for preventive care at a network provider without a deductible.
Copay
This is a fixed amount that you pay at the time you get care. Copays count toward your plan deductible.
Example: You pay $30 when you see your primary doctor. Or $50 for a specialist visit.
Coinsurance
This is a percentage that you pay after you’ve met your deductible. Coinsurance counts toward your plan deductible.
Example: If your plan covers 80% of the cost of service, you pay 20%. So if a service costs $1,000, you would pay $200.
Out-of-pocket maximum
This is the most you pay each year for covered expenses. Once you reach this amount, we pay 100% of covered expenses for the rest of the year.
Tip: Copays and deductibles may go toward your out-of-pocket maximum.
Know your limits
Not everything is included
Some services may not be covered by your plan. These might include:
- Cosmetic procedures
- Out-of-network care (unless it’s an emergency)
- Experimental or investigational treatments
Always check your plan documents or call us before getting care you’re unsure about. It could save you time and money.
Getting care: How it works
Before visiting your provider
Use our search tool to find a provider in our network. These doctors, labs and hospitals charge lower rates, so you pay less. And you don’t have to file claims.
Use your cost-of-care tools to compare costs before you get care.
During your visit with your provider
Visit a network doctor and show your member ID card. You can look up and share your ID card on the Aetna Health app. Don’t have a member account yet? Access your member ID card.
Pay nothing at your visit, unless you have a copay.
After your in-network visit
- Your doctor files your claim with us. A claim is a request for your plan to pay for services you receive.
- We pay your doctor based on the negotiated rate. This is an agreed-upon price between a doctor and a health plan.
- Your doctor bills you for any amount you owe.
- You pay what you owe directly to your doctor. Or use the “Pay Your Provider” link on each of your claims.
- You’ll get an explanation of benefits, or EOB. It’s a statement that shows a breakdown of how we process your claim. It’s not a bill. More like an FYI for you.
After an out-of-network visit
If your plan covers out-of-network care, you may need to file a claim yourself for your plan to pay for the services you received.
If your claim is denied
If your claim is denied, you can file an appeal. An appeal is where you ask us to take a second look at your claim because you think the services should have been covered by your plan.
Who to see for care
Know where to go — and when
Not sure where to go when you’re sick or hurt? You’re not alone. Here’s a quick guide to help you choose the right place for care — and avoid unnecessary costs or delays.
Primary care doctor
Your go-to for everyday health.
See your primary care doctor (PCP) for routine checkups, preventive care, and common illnesses like colds or allergies. They get to know your health history and can refer you to specialists if needed.
Tip: Many plans cover preventive visits at 100% when you stay in-network.
Urgent care
For things that can’t wait — but aren’t life-threatening.
Go to urgent care for issues like sprains, minor cuts, or a fever that won’t go away. It’s faster and less expensive than the ER — and many centers are open evenings and weekends.
Tip: Use your plan’s provider search to find an in-network urgent care near you.
Emergency room (ER)
For serious or life-threatening issues
Head to the ER for emergencies like chest pain, trouble breathing, or a serious injury. You’ll get immediate care — but it’s the most expensive option, so only use it when truly needed.
Tip: If you’re unsure, call the 24/7 nurse line to talk through your symptoms.
Specialist
For expert care in a specific area
Specialists treat specific conditions — like dermatologists for skin or cardiologists for heart issues. You usually need a referral from your PCP to see one.
Tip: Check your plan to see if a referral is required before booking.
What insurance covers
Your plan covers more than doctors’ visits
You’re covered for a range of programs and services to keep you feeling your best, mind and body. Benefits for the way you live, in and out of the classroom.
Special plan benefits include:
- A 24-hour nurse line to answer your health questions. Before class, after class, weekends and holidays.
- A choice of telehealth services and virtual care visits for your physical and mental health needs.
- A wealth of well-being resources for the whole you. Explore info for your physical, mental, sexual and financial journey.
- More extra benefits just for members, from wellness discounts and digital tools to MinuteClinic visits.
Looking for dental or vision?
Looking for dental or vision?
Here’s what you need to know
Your plan covers your dental and vision needs in certain situations, like trauma or injury. But many student health plans don’t include dental or vision benefits for everyday health needs.
We’ve got you covered
Good health is whole health, head to toe. So, we make it easy to add dental and vision to your student health plan if your school offers that option. You’ll get coverage for dental fillings, braces, routine exams, eyewear and more.
Questions? We’re here to help.
If you need help understanding your plan, get in touch with us. We can go through it together.
Legal notices
Student health insurance plans are insured by Aetna Life Insurance Company. Self-insured plans are funded by the school and administered by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.