Carnegie Mellon University

Insurance Basics & Common Questions

What is health insurance and why do I need it?

The cost of healthcare in the United States is high, so insurance helps protect you from serious health and financial risks.

Health insurance is a contract between you and an insurance company.  You enroll in a plan and the company pays part of your medical costs when you get sick or hurt.  Many plans also cover preventive services. Learn more about why health insurance is important.

Premiums, Deductibles, Co-Pays, and Qualifying Events...

Health insurance terms are confusing.  Use the HealthCare.gov glossary to understand key terms.

Yes.  University policy requires students to apply each year that the student is in attendance at CMU.  Circumstances, policies, criteria, and benefits may change from year to year, so insurance re-enrollment is required for each coverage year.

Involuntary loss of medical coverage, including turning age 26, is considered a qualifying event to get enrolled into the CMU SHIP (outside of Open Enrollment; if you are enrolling during Open Enrollment, you do not need to notify the UHS insurance department).

To get you enrolled we will need:   

1) A loss of medical coverage letter from your insurance company.

2) A completed partial-year enrollment form.  Email shinsure@andrew.cmu.edu to request this form.

The coverage period of the CMU SHIP is from August 1 through July 31, each academic year.  For example, for the academic year 1999-2000, the coverage period is August 1, 1999 to July 31, 2000.

Aetna, the insurance carrier for the CMU SHIP, does not offer partial or monthly insurance plans. If you enroll during Fall Open Enrollment, you will be enrolled and charged for the full coverage period.

In certain cases, a student may need to enroll after Open Enrollment, for example due to a qualifying event. In this case, the insurance premium is pro-rated according to the month that the student is enrolled. The CMU SHIP is always effective at the beginning of a month and terminates at the end of a month.

UHS does not have a dentist on staff. A CMU dental insurance plan is offered during Fall Open Enrollment (coverage August 1 - July 31) and Spring Open Enrollment (coverage January 1 - July 31).

We offer a list of local dentists that accept the Aetna dental insurance plan. However, you should still verify with the dentist that the insurance is accepted.

The CMU SHIP can be used for pediatric dental care only through the end of the month in which you turn 19 years old. However, if you have impacted wisdom teeth, the medical insurance will cover at any age. You would need to see a dentist first to confirm that your wisdom teeth are impacted and if their office will accept the insurance. You and the dentist should contact Aetna Student Health about filing a claim and to determine to what extent it will be covered: 877-410-6560.

If you need to enroll a domestic partner, spouse and/or child/children during Open Enrollment, you can enroll the dependent(s) through your SIO account (no need to notify UHS). 

Outside of Open Enrollment, you will need to email shinsure@andrew.cmu.edu to request an enrollment change form.  Please note that your dependent(s) will need to have a qualifying event in order to be enrolled into your medical policy, and you will be asked to provide supporting documentation.

Turning 26 years old, getting married or entering a domestic partnership, and involuntarily losing medical coverage are examples of qualifying events. Review the full list of qualifying life events here.

Please note that a qualifying event allows for enrollment in the CMU SHIP outside of Open Enrollment. It cannot be used as a reason to cancel the CMU SHIP. To enroll in the CMU SHIP due to a qualifying event, please email shinsure@andrew.cmu.edu to request an enrollment change form.

Unless it is an emergency, students are strongly encouraged to see a provider at UHS first, before seeking out an outside provider. With the CMU SHIP, most visit and service fees are covered by the plan. 

To find in-network medical providers for the CMU SHIP, use Aetna's provider search tool and select Open Choice PPO under Student Health Medical Plans.

Depending on the treatment you received, you may have a co-pay or an amount not covered by your insurance plan. At the time of treatment, please provide your medical insurance information to your provider so that a claim can be made on your behalf to the insurance company.

You can expect a bill from the medical provider showing the charges for the treatment, what your insurance plan has paid and what you may owe. If the bill does not show that insurance was applied to your bill, please contact the medical provider and give them your insurance information.  

You can also expect an Explanation of Benefits (EOB) from your insurance plan. An EOB shows what the insurance company has paid on your behalf for a claim or what it is not covering and the explanation for it. An EOB is not a bill.

For details on covered services and associated co-pays for the CMU SHIP, see the plan guide.

 

 

You have the option to remain on the CMU SHIP until the coverage period ends on July 31 of the current academic year. Or, if you have been officially certified by your department and have other medical insurance, you have the option to cancel your CMU SHIP so long as no significant claims have been paid on your behalf.

Please note that even if you have employment, you are not required to cancel the CMU SHIP. You may tell your employer that you already have medical insurance in effect through July 31 (current year). They can then help you enroll in their plan effective August 1, because you would then have a loss of coverage, which is considered a qualifying event for enrollment in a medical insurance plan.

If you are traveling more than 100 miles from home, either in or outside of the United States, the CMU SHIP offers worldwide travel assistance through Aetna’s On Call Services. This includes 24 hour assistance finding medical services, making emergency travel arrangements, and replacing prescription drugs, plus medical evacuation and repatriation. Contact On Call Services at 1-866-525-1956 or collect 1-603-328-1956.
If you were enrolled in the CMU SHIP, Aetna will have mailed the 1095 form to the mailing address that Aetna has on file for you. If you need a new copy, call Aetna at 877-437-6535 or 877-410-6560 (or the number on the back of your insurance card).

Because everyone in the U.S. is required to have insurance or qualify for an exemption, health plans are required to send the federal Internal Revenue Service (IRS) information about their members, including social security or other tax identification numbers.  Learn more about this requirement.

If you do not have a social security or other tax identification number, you can disregard the request. However, please note that health plans are required to request the information three times. If no response is received after the third request, the plan can provide the member’s date of birth.