Student Health Insurance Plan
For School Year Beginning August 16, 2003

Open Enrollment for the Student Health Insurance Plan

Old Dominion University is pleased to confirm the continuation of a Health Insurance Plan for students, their spouses and eligible children, now being offered by North Carolina Mutual Life Insurance Company. Old Dominion University strongly recommends that all students have adequate health insurance to defray any additional medical costs for services not available at the University Student Health Service. Our University-sponsored Student Health Insurance Plan is available to all students taking 7 or more credit hours per semester or degree-seeking students who have paid the Student Health Service fee of $48 per semester. The continuing service agent Collegiate Risk Management, Inc. will mail descriptive brochures and enrollment materials to those students taking 7 or more credit hours per semester. Those students registered prior to July 2 will be mailed brochures in July. For those registering after July 1st, brochures will be mailed in August. In July, you may visit the Collegiate Risk Management web site and access student insurance information by clicking on "Students" and then typing "olddominionuniversity". You will have the availability to print the enrollment form, download the brochure, email to get answers to frequently asked questions, search for PPO providers, and print claim forms or call 1-800-922-3420 for a complete enrollment packet to be mailed. Students may also stop by the University Student Health Service located in the Webb Center for a packet.

Medical Plan Highlights

• The Plan provides 24-hour coverage for medically necessary expenses resulting from accidents or illnesses, including maternity, mental health & substance abuse and prescription drugs.
  
  
• The medical plan is a Preferred Provider Organization (PPO) plan which uses the National Alliance PPO Network and MAPSI network for mental health services. You can check to see if your physician participates by accessing the internet site www.MAMSI.com, choose members, find a doctor, in step #4 select the Alliance PPO Network or for mental health providers choose MAPSI and continue. Or you may call toll free 1-800-342-3289 for assistance in finding a provider.
  
  
• To obtain the greatest reimbursement, all services received through the ODU Student Health Services, which are covered under the plan, are covered at 100%. You may file your ODU Student Health Services claim with Benefit Services, Inc.
  
  
• Services received from a provider who participates with the National Alliance PPO Network are reimbursed at 80% of covered charges. Services received by providers who do not participate in the National Alliance PPO Network are reimbursed at 60% of Usual & Customary Charges.
  
  
• We will continue to offer students the choice between two (2) plans. Each plan covers services at different levels. The Standard Plan limits total benefits payable during the policy year to $50,000 while the Deluxe Plan includes the Standard Plan and additional supplemental major medical program from $50,000 to $500,000 lifetime aggregate maximum (100% coverage) through Boston Mutual Insurance Company per student insured per condition and 100% coverage to $100,000 for each dependent.
  
  
• A referral is required from the Student Health Service or Counseling Center for non-emergency physician and diagnostic services rendered within 30 miles of campus.
  
  
• Prescription contraceptives are covered at 100% through the Student Health Service and as any other prescription through retail pharmacies in the network.
  
  
• $20 Prescription drug copayments are not subject to the deductible ($1,500 maximum policy year benefit)
  
  
• There is a $250 per person per policy year deductible.
  
  
• $400 in-patient per admission deductible
  
  
• Emergency Room copay of $200 per incident (waived if admitted to hospital - maximum of 3 per Policy Year).
  
  
• X-ray and Lab services rendered outside the Student Health Services are subject to the deductible, and covered at 80% when using a National Alliance PPO Network provider.
  
  
• International students with F-1, F-2, J-1 or J-2 immigration status, $7,500 repatriation and $10,000 medical evacuation to student home country is included in benefits. Domestic students may purchase this coverage, when studying abroad, for an additional $25 per year per student.
  
  
• North Carolina Mutual Life Insurance Company underwrites the Plan. Claims are administered by Benefit Services, Inc. Claims forms can be printed from the website at http://www.collegiateriskmanagement.com/Students/odu/odu.html.

Please read the plan summary material carefully for a full description of coverages. Exclusions and limitations may apply.

Premiums (annual)	Standard Plan ($50,000)	Deluxe Plan ($500,000 per insured student $100,000 maximum per dependent)
Student Only	$850	$959
Student & Spouse	$1,946	$2,302
Student, Spouse & Child(ren)	$2,623	$3,721
Student & Child	$1,559	$1,916
Student & Children	$1,940	$2,791

Premiums may be paid annually, by semester or bank draft (2 initial payments towards total premium (Deluxe plan initial payment includes major medical) and 7 equal payments - October 20th thru April 20th), by check, money order or credit card. If choosing the Deluxe Plan bank draft, the initial premium includes major medical. International Students must choose either the semester or annual options only. Open enrollment is available for 30 days at the beginning of each semester (August, January and May).