University of Nevada, Las Vegas

Learn More! 
2010-2011 Student Health Insurance Plan  

Aetna Student Health, in partnership with the University of

Nevada, Las Vegas and Wells Fargo Insurance Services, offers  
(800) 853‐5899  
a student-focused health insurance plan that helps protect https://wfis.wellsfargo.com/unlv 
students at school, at home, and while traveling or studying  
abroad. Brokered by:
Wells Fargo Insurance Services, Inc.
What is the Plan All About? Student Insurance Division
Please see the reverse side of this flyer for the Summary of Benefits.
Your school-endorsed Student Health Insurance Plan offers you:
ƒ Aetna’s nationwide network of doctors, hospitals, pharmacies and specialists Who is eligible?
throughout the country. Undergraduate and graduate students
ƒ An award-winning online secure member website, Aetna Navigator® may purchase this health insurance
ƒ Informed Health® Line – Our 24-hour toll-free number that puts you in touch through Wells Fargo Insurance
with experienced registered nurses and an audio library for information on Services USA, Inc. at (800) 853-5899.
thousands of health topics.
International students are automatically
ƒ Discounts on Vision, Fitness Program, Alternative Health Care Programs, enrolled in the Plan at registration and
Weight Management Discounts, Zagat Survey® Healthy Dining, eDiets® , the premium for coverage is added to
Mayo Clinic Bookstore.com and many more! their tuition billing.
ƒ Emergency Travel Services
Students who have comparable health
ƒ A Dental Insurance Plan is also available to all students. Visit insurance coverage may waive
www.aetnastudenthealth.com for more details.
coverage by completing a waiver form
How much does it cost? online.
Annual Fall Spring/Summer Summer
8/16/10- 8/16/10- 1/12/11-8/15/11 5/16/11-8/15/11
8/15/11 1/11/11
Undergraduate & $1,469 $600 $869 $370
Graduate Students

Fall Spring Spring/ Summer Summer Summer

Summer Session 1 Session 2 Session 3

8/16/10 - 1/12/11 - 1/12/11 - 5/16/11 - 6/6/11 - 7/11/11 -

1/12/11 5/15/11 5/15/11 8/16/11 8/16/11 8/16/11

International $600 $499 $869 $370 $245 $145

Students
Rates include premium payable to Aetna Life Insurance Company, as well as administrative fees payable to other
third parties.
For dependent rate and enrollment information please contact Wells Fargo Insurance Services at
(800) 853-5899.

This material is for information only. Health insurance plans contain exclusions and limitations. Discount programs provide access
to discounted rates and are NOT insured benefits. The member is responsible for the full cost of the discounted services.
Discounts are subject to change without notice. Discount programs may not be available in all states. Discount programs and
travel assistance services may be offered by vendors who are independent contractors and not employees or agents of Aetna.
Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or
other health care professionals. Preferred providers are independent contractors and are neither employees nor agents of Aetna
Life Insurance Company, Chickering Claims Administrators, Inc. or their affiliates.

The University of Nevada, Las Vegas Student Health Insurance Plan is underwritten by Aetna Life Insurance Company (ALIC) and
administered by Chickering Claims Administrators, Inc. Aetna Student HealthSM is the brand name for products and services
provided by these companies and their applicable affiliated companies.
Policy forms issued in OK include GR-96134.
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 University of Nevada, Las Vegas
2010-2011 Student Health Insurance Plan
Coverage Highlight Sheet
You can obtain a copy of the Student Health Insurance Plan brochure offered through the University of Nevada, Las Vegas at
www.aetnastudenthealth.com over the summer.
In addition to the Plan's Aggregate Maximum, the Policy may contain benefit level maximums. Please review the Summary of Benefits section
of the brochure for any additional benefit level maximums.

Aggregate Maximum $100,000 lifetime per Injury or Sickness

Deductible – Individual/Family $300 per person, per Policy Year
(Waived at the Student Health Center) $600 per family, per Policy Year

After the first $5,000 of covered medical expenses have been paid the
plan will then pay 100% of covered Negotiated or Reasonable charges
Annual (Stop Loss) Maximum
incurred for any additional medical expenses up to the $100,000
Aggregate Lifetime Maximum per Condition.

AFTER THE DEDUCTIBLE IS SATISFIED THE FIRST $5,000 OF COVERED MEDICAL EXPENSES ARE PAYABLE AS FOLLOWS:
INPATIENT BENEFITS
Hospital Room and Board Expenses Preferred Care: 80% of the Negotiated Charge
(Benefit limited to 30 days maximum per policy year.) Non-Preferred Care: 50% of the Reasonable Charge
Covered Medical Expenses include, but are not limited to:
laboratory tests, X-rays, anesthesia, use of special equipment, medicines and
Miscellaneous Hospital Expense use of operating room.
Preferred Care: 80% of the Negotiated Charge
Non-Preferred Care: 50% of the Reasonable Charge
Preferred Care: 80% of the Negotiated Charge after a $15 copay per visit,
Physician’s Hospital Visit Expenses limited to one visit per day.
Non-Preferred Care:50% of the Reasonable Charge after $15 deductible per
visit, limited to one visit per day.
SURGICAL (INPATIENT AND OUTPATIENT)
Preferred Care: 80% of the Negotiated Charge
Surgical Expenses
Non-Preferred Care: 50% of the Reasonable Charge
Preferred Care: 80% of the Negotiated Charge
Anesthetist Expense & Assistant Surgeon Expense
Non-Preferred Care: 50% of the Reasonable Charge
OUTPATIENT BENEFITS
Preferred Care: 80% of the Negotiated Charge after a $15 copay per visit.
Physician’s Office Visit Expenses Non-Preferred Care: 50% of the Reasonable Charge after a $15 copay per
visit.
Preferred Care: 80% of the Negotiated Charge after a $100 copay
Emergency Care Expenses
Non-Preferred Care: 50% of the Reasonable Charge after a $100 deductible
MENTAL HEALTH AND SUBSTANCE ABUSE BENEFITS
Inpatient Mental Health Expense Preferred Care: 80% of the Negotiated Charge
(*Preferred Care copay applies. Limited to a maximum of 40 days per Policy Non-Preferred Care: 50% of the Reasonable Charge
Year per condition for any one or related mental health condition.)
Preferred Care: 80% of the Negotiated Charge
Outpatient Mental Health Expense
Non-Preferred Care: 50% of the Reasonable Charge
(Benefit is limited to $75 per Visit, not to exceed 40 visits per Policy Year.)

Inpatient Substance Abuse Expense Preferred Care: 80% of the Negotiated Charge
(Benefit is limited to a maximum of $9,000 per Policy Year.) Non-Preferred Care: 50% of the Reasonable Charge
Outpatient Substance Abuse Expense Preferred Care: 80% of the Negotiated Charge
(Benefit is limited to a maximum $2,500 per Policy Year for counseling. Benefit is Non-Preferred Care: 50% of the Reasonable Charge
limited to a maximum $1,500 for treatment of withdrawal.)
ADDITIONAL BENEFITS
Ambulance Expenses
(Benefit is limited to a maximum of $1,000 for air Covered Medical Expenses are payable at 80% of the Actual Charge
ambulance and $500 for ground ambulance.)
At SHC Pharmacy:
Prescription Drug Expenses Generic Prescription Drug: $20 Copay
(The Company pays up to $3,000 maximum benefit per policy year, for pharmacy Brand Name Prescription Drug: $20 Copay
charges on Formulary (Student Health Center approved prescriptions). The Formulary Prescription Drug: $20 Copay
remaining charges after the co-pay are billed directly to the Insurance Company and
are limited to $3,000 per policy year.) Outside SHC Pharmacy:
25% of Negotiated or Reasonable Charges

The University of Nevada, Las Vegas Student Health Insurance Plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on
the amounts it will pay. Please read the University of Nevada, Las Vegas brochure carefully before deciding whether this plan is right for you. While this document and the University of
Nevada, Las Vegas brochure tell you about some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look
at the full plan description, which is contained in the Master Policy issued to the University of Nevada, Las Vegas you may view it at your University’s Business Office or you may contact us at
(800) 853-5899.

This plan will never pay more than $100,000 lifetime per Injury or Sickness. Additional plan maximums may also apply. Some illnesses may cost more to treat and health care providers may
bill you for what the plan does not cover.
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