Student Health Insurance
2024-2025 Student Health Insurance Plan: St. Lawrence University
Who can enroll?
All full time domestic undergraduate students taking 12 credit hours or more and international students are automatically enrolled in this insurance plan, unless proof of comparable coverage is furnished. All Full-time domestic graduate students taking six credit hours or more are eligible to enroll on a voluntary basis. Eligible students who do enroll may also insure the dependents. Students must actively attend classes for at least the first 31 days after the date for which coverage is purchased. Home study, correspondence and online courses do not fulfill the eligibility requirements that the student actively attends classes. Students who do enroll may insure their dependents.
Plan resources at your fingertips:
View benefits, submit a claim and download your ID care via My Account - uhcsr.com/ myaccount
Find an in network provider - Choice Plus
Find a prescription drug provider - Optum Rx
Value added benefits and services - uhcsr.com/ myaccount
Coverage Periods, Deadline Dates, Plan Cost and Premium Rates: The total cost of the plan noted below includes premium and fees.
| Total Plan Cost | Annual | Fall | Spring |
|---|---|---|---|
| Coverage Dates | 08/01/2024-07/31/2025 | 08/01/2024-12/31/2024 | 01/01/2025-07/31/2025 |
| Student | $2,274.00 | $953.22 | $1,320.78 |
| Spouse | $2,274.00 | $953.22 | $1,320.78 |
| One Child | $2,274.00 | $953.22 | $1,320.78 |
| Two or more Children | $4,548.00 | $1,906.44 | $2,641.56 |
| Spouse & two or more Children | $6,822.00 | $2,859.66 | $3,962.34 |
See information below for the breakdown of premium and fees.
| *Premium Rates | Annual Premium | Fall Premium | Spring Premium |
| Student | $2,205.62 | $924.55 | $1,281.07 |
| Spouse | $2,205.62 | $924.55 | $1,281.07 |
| One Child | $2,205.62 | $924.55 | $1,281.07 |
| Two or more Children | $4,411.24 | $1,849.10 | $2,562.14 |
| Spouse & two or more Children | $6,616.86 | $2,773.65 | $3,843.21 |
Rates are subject to regulatory approval and may change.
*The premium is for the insurance coverage underwritten by UnitedHealthcare Insurance Company of New york and does not include the following fees:
- Annual **Service fee of $2.38 for UHC Global administration of the Assistance and Evacuation Benefits.
- Annual **Service fee of $66.00 charged by or at the direction of the school you are receiving coverage through to cover the costs of services provided by a non-insurer vendor or consultant.
**Note: Fees are prorated for the coverage dates other than annual.
Plan highlights
Metallic Level: Platinum with actuarial value of 90.900%
| Benefits | In Network Participating Provider Member Cost-Share | Out of Network Non-Participating Provider Member Cost-Share |
|---|---|---|
| Overall Plan Maximum | There is no overall maximum dollar limit on the Policy | There is no overall maximum dollar limit on the Policy |
| Plan Deductible | $50 per member per plan year | $100 per member per plan year |
|
Out of Pocket Maximum: After the out of pocket maximum has been satisfied, covered medical expenses will be paid at 100% for the remainder of the policy year subject to any applicable benefit maximums. Refer to the plan certificate for details about how the out of pocket maximum applies. |
$6,350 per member per plan year $12,700 for all members in a family per plan year |
There is no out of pocket limit for out of network benefits |
|
Coinsurance All benefits are subject to satisfaction of the deductible, specific benefit limitations, maximums and copays as described in the plan certificate |
90% of allowed amount for covered medical expenses | 70% of allowed amount for covered medical expenses |
|
Prescription Drugs UHCP Mail Order Network Pharmacy or maintenance drugs from a designated retail pharmacy at 2.5 times the retail copay up to a 90-day supply |
$10 Copayment for Tier 1 $25 Copayment for Tier 2 $25 Copayment for Tier 3 Up to 30-day per prescription filled at a UnitedHealthcare Pharmacy (UHCP) not subject to Deductible |
70% Coinsurance for Generic Drugs 70% Coinsurance for Brand Name Drugs Up to a 30-day supply per prescription after Deductible |
|
Preventive Care Services Including but not limited to: annual physicals, GYN exams, routine screenings and immunizations. Please see https://www.healthcare.gov/preventative-care-benefits/ for complete details of the services provided for specific age and risk groups. |
Covered in full | 70% of allowed amount after Deductible |
| The following services have per service copays; this list is not all inclusive. Please read the plan certificate for complete listing of copayments |
Office Visits $15 after deductible Laboratory Procedures: $15 not subject to deductible Diagnostic X-rays: $15 not subject to deductible Emergency Care in an Emergency Department: $100 Copayment then 10% Coinsurance after deductible. Copayment/Coinsurance waived if admitted to the Hospital |
Emergency Care in an Emergency Department: $100 Copayment then 10% Coinsurance after deductible Copayment/Coinsurance waived if admitted to Hospital |
Questions about your plan? Contact Customer Service at 1-800-767-0700 or at customerservice@uhcsr.com