The Student Insurance Plan provides benefits both within the CSU Health Network (Campus Care) and when services are provided outside of the CSU Health Network (Off Campus Care).

View a list of plan benefits.

Colorado State University students, spouses, partners and dependent children up to age 26 are eligible for coverage under the plan. The following provides a summary of plan eligibility.

Domestic Students

• Admitted Colorado State University Undergraduate Students enrolled for 1 or more resident instruction credit hours.
• Admitted Colorado State University Graduate Students enrolled for 1 or more resident instruction credit hours. Graduate Students who are enrolled in 6 or more resident instruction credit hours are subject to the mandatory insurance requirement (see the Automatic Enrollment Tab below).
• Colorado State University Continuous Registration Students.
• Guest Students enrolled for 6 or more credit hours (excluding correspondence and distance learning courses).
• Division of Continuing Education (OnlinePlus) Students enrolled for 6 or more resident instruction credit hours (excluding correspondence and distance learning courses).

International Students

• International Students are subject to the mandatory insurance requirement (see the Automatic Enrollment Tab below).

Spouses/Partners & Dependent Children

• Spouses/Domestic Partners of Colorado State University students who are enrolled on the plan.
• Dependent Children (up to age 26) of Colorado State University students who are enrolled on the plan.
• Comprehensive information about plan eligibility requirements can be viewed in the 2011/2012 Insurance Brochure (PDF).

The following provides premium information for the 2011/2012 plan year. It should also be noted that because the plan is designed to work in conjunction with the fee funded services provided at the CSU Health Network, all students enrolled on the plan must also pay the semester health fee. Spouses, Partners and Dependent Children enrolled on the plan who choose to access care at the Hartshorn Clinic of the CSU Health Network can do so by paying the semester health fee or by paying for services rendered on a fee for service basis.

Schedule of Costs
	Fall	Spring/Summer	Summer Only
Student Only	$1,036	$1,059	$623
Spouse	$2,048*	$2,282*	$1,501*
All Children	$1,347*	$1,253*	$822*
* The cost for Spouse and/or Children is in addition to the Student Only cost.

Billing Information

All insurance premiums for students, spouses/partners and dependent children are billed directly to the student's University account and are payable in accordance with the established university e-billing procedures and billing deadlines. In addition, at the time of plan enrollment the semester health fee will also be billed to each student who has not already paid this fee for the semester.

Account Statements are provided to students via the University e-billing process. As a result, it is important that students monitor their applicable e-mail account regularly.

Enrollment/Cancellation Deadlines

Semester	Enrollment/Cancellation Deadline
Fall Semester	September 7, 2011
Spring/Summer Semester	February 1, 2012
Summer (12 Week Session)	May 14, 2012
Summer (8 Week Session)	June 11, 2012

Under the terms required by our insurance carrier, no enrollment or cancellations may be made after the published enrollment/cancellation date outlined above and therefore no refunds can be made after this date. It is the responsibility of the student to view your online Colorado State University Online Account statement at the beginning of each term (and prior to the enrollment cancellation deadline) to ensure that it reflects the intended level of student insurance enrollment.

The coverage dates for the 2011/2012 plan are outlined below.

Coverage Dates For 2011/2012 School Year
Semester
Fall	August 22, 2011 - January 16, 2012
Spring/Summer	January 17, 2012 - August 19, 2012
Summer Only	May 14, 2012 - August 19, 2012 June 11, 2012 - August 19, 2012

Specific detailed information about plan effective and termination dates and times is available in
the 2011/2012 Insurance Brochure (PDF).

Colorado State University embraces the rationale that financial risks - those that may impact a student's ability to complete his or her studies while attending the university - should be minimized. As a result, university policy requires mandatory demonstrated comparable health insurance for all full-fee paying, resident instruction Graduate Students and for all Graduate and Undergraduate International Students.

Graduate Student Enrollment
All graduate students (except graduate students with a status of continuous registration only) who are enrolled in at least one resident instruction credit hour are automatically enrolled in the CSU Student Accident and Sickness Plan each semester. Students who are enrolled in less than 6 credits may opt out of coverage by contacting the CSU Student Insurance Office (information in the Student Insurance Office Tab below) before the plan enrollment/cancellation deadline. If you do not opt out of the plan before this deadline you will be billed for the premium. Graduate students with a status of continuous registration only are not automatically enrolled in the plan and must enroll in the plan by contacting the student insurance office.

Students who are enrolled in 6 or more resident instruction credit hours are subject to the graduate student mandatory insurance requirement. In order to opt out of the plan these students must demonstrate proof of comparable coverage via the University waiver process (information in the Waiver Process Tab below) administered by the CSU Student Insurance Office. All waiver requests must be made no later than the plan enrollment/cancellation deadline. Students who have been granted a waiver in the fall semester will be automatically waived in the spring semester as well.

International Student Enrollment
International Students (both graduate and undergraduate) who are enrolled in at least one resident instruction credit hour are required to maintain health insurance and are automatically enrolled in the plan each semester. International Students may waive the insurance requirement and enrollment in the plan by demonstrating proof of comparable coverage via the University waiver process (information in the Waiver Process Tab below) administered by the CSU Student Insurance Office. All waiver requests must be made no later than the plan enrollment/cancellation deadline. Students who have been granted a waiver in the fall semester will be automatically waived in the spring semester as well.

Enrollment/Cancellation Deadlines
All waiver requests must be made no later than the plan enrollment/cancellation deadline.

Semester	Enrollment/Cancellation Deadline
Fall Semester	September 7, 2011
Spring/Summer Semester	February 1, 2012
Summer (12 Week Session)	May 14, 2012
Summer (8 Week Session)	June 11, 2012

Under the terms required by our insurance carrier, no enrollment or cancellations may be made after the published enrollment/cancellation date outlined above. It is the responsibility of the student to view your online Colorado State University Online Account Statement at the beginning of each term (and prior to the enrollment/cancellation deadline) to ensure that it reflects the intended level of Student Health Insurance enrollment.

Undergraduate Students
Domestic Undergraduate Students may purchase the insurance plan by making an on-line election to enroll in the plan during the Registration Ready Process or in person at the CSU Student Insurance Office (information in the Student Insurance Office Tab below) during the open enrollment period. Domestic Undergraduate students must re-enroll each semester to have continuous coverage. Re-enrollment is not automatic.

Domestic Undergraduate Students who do not wish to purchase the student insurance plan should indicate "no" when prompted about insurance enrollment during the Ready Registration Process.

Spouses, Partners and Dependents
Eligible students who enroll in the plan may also insure their spouse/domestic partner and/or Dependent Children (up to age 26) as of the date of the student's plan enrollment. This enrollment must be made in person at the CSU Student Insurance Office (information in the Student Insurance Office Tab below) during the open enrollment period. Any enrollments or cancellations must be made before the enrollment/cancellation deadline. Spouses/Domestic Partners and Dependent Children must be re-enrolled on the plan each semester. Re-enrollment is not automatic.

Enrollment/Cancellation Deadlines
All enrollment and cancellations for students, spouses, partners, and dependents must be made prior to the plan enrollment/cancellation deadline.

Semester	Enrollment/Cancellation Deadline
Fall Semester	September 7, 2011
Spring/Summer Semester	February 1, 2012
Summer (12 Week Session)	May 14, 2012
Summer (8 Week Session)	June 11, 2012

Under the terms required by our insurance carrier, no enrollment or cancellations may be made after the published enrollment/cancellation dates outlined above. It is the responsibility of the student to view your online account statement at the beginning of each term (and prior to the enrollment/cancellation deadline) to ensure that it reflects the intended level of Student Health Insurance enrollment.

Graduate and International students who are required to enroll in the Student Insurance Plan may request a waiver of this mandatory insurance requirement if they can demonstrate proof of comparable coverage under another insurance plan.

Students should do the following in order to request a plan waiver:

1. Complete the Student Insurance waiver request form. It is important that the plan name and policy number be included on the waiver request form.
2. Provide a copy of your current or proposed insurance policy that is being submitted for review.
3. Provide a copy of your current insurance card or proof of coverage under the policy submitted for review.
4. Under the terms required by our insurance carrier, no enrollment or cancellations may be made after the enrollment/cancellation deadline date.

Waiver Submission MethodsThe students

The Student Insurance Office is accepting waiver applications for the fall 2012 semester. Students may submit a waiver request package to the CSU Health Network Student Insurance Office in a variety of ways:

• Submit waiver request materials to the Student Insurance Office in the lower level of the Hartshorn Building which is west of the Morgan Library.
• Submit your waiver request materials via email to the Student Insurance Office at CSUHN_insurance@mail.colostate.edu.
• Fax your waiver request materials to the Student Insurance Office at (970) 491-6965.
• Mail your waiver request materials to the following address:
  
  CSU Health Network
  Student Insurance Office
  Campus Delivery 8031
  Fort Collins, CO 80523-8031

You will be notified by mail of the waiver decision no later than 5 days following receipt of the waiver request and all required supporting materials.

Appeals Process

In the event that a waiver request is denied and the student believes an error has been made, an appeal can be filed and the initial determination will be reviewed by the Insurance Appeals Committee. This committee is made up of members who are external to the CSU Health Network and who are knowledgeable about the University's comparable coverage requirements.

Additional information and forms pertaining to the appeals process can be located here.

Students

• Students who need health care should access the CSU Health Network first for treatment or to obtain a referral to an in-network provider.
• When referred or in the event of an emergency, benefits will be paid at a higher level if you obtain treatment or medical services from a provider in the First Health or Summit America Direct networks. Detailed information about emergency/emergent care procedures is available in the Emergency Care Tab below.

Spouses/Partners and Dependent Children

• Spouses/Partners and Dependent Children do not need a referral from the CSU Health Network in order to seek treatment from an outside provider.
• Benefits will be paid at a higher level if the plan participant obtains treatment or medical services from an in network provider. Detailed information about emergency/emergent care procedures is available in the Emergency Care Tab below.

In-Network Preferred Providers

The plan is structured so that benefits are paid at a higher level if you obtain treatment or medical services from a provider in the First Health or Summit America Direct networks. You are strongly encouraged to utilize these providers whenever possible given this can reduce your out-of-pocket expenses.

Detailed information about in-network providers is available by visiting Summit America, or by calling Summit America during their business hours at (877) 246-6997.

Network providers are subject to change. Whenever possible, please contact the provider prior to obtaining medical care/treatment in order to confirm their participation in the First Health or Summit Direct networks.

Non-Life-Threatening Emergent or Urgent Care

If during CSU Health Network clinic hours, seek care at the CSU Health Network first (no deductible, no co-pay).

If the CSU Health Network is closed or you are out of the Fort Collins area, seek care at the nearest in-network urgent care facility (subject to plan deductible and $50 co pay)

If an urgent care facility is not available, seek care at the nearest in-network hospital emergency room (subject to plan deductible and $100 co-pay).

If an in-network provider is not available, seek care at the nearest urgent care or hospital emergency room facility (subject to plan deductible, out-of-network reimbursement rate and a $ 100 co-pay).

Life-Threatening Emergencies

Dial 911 and seek care at the nearest hospital emergency room facility (subject to plan deductible, reimbursement rate based upon network status of provider and $100 co-pay which is waived if admitted.)

In-Network Providers

In-Network provider information is listed here and may be accessed 24/7. For Non-Life Threatening Emergent Care situations you can also call the CSU Health Network Referral Coordinator for assistance at (970) 491-3962 during the CSU Health network clinic hours.

Campus Care Benefits

Students do not need to submit a claim form for Campus Care benefits provided at the CSU Health Network. (Also note that while a spouse/domestic partner and/or dependent children may seek treatment at the Hartshorn Clinic at the CSU Health Network, they are not eligible for benefits under Campus Care.)

Campus Care benefits will be processed by the CSU Student Insurance Office and any ineligible expense not payable under the campus care benefits plan or by the student health fee will be charged to the student's University account.

Off-Campus Care Benefits

Individuals enrolled on the plan must initiate a claim form to submit medical charges for consideration of coverage under the Off-Campus Care benefit plan administered by Summit America.

Claims may be submitted in the following ways:

1. File a claim electronically via the Summit America on-line claim form.
2. Fill out a Summit America claim form (link to .pdf file attached) and mail it directly to Summit America for processing. The completed claim form, along with required documentation should be submitted to the following address:
   
   Summit America Insurance Services LC
   7400 College Blvd., Ste 100
   Overland Park, KS 66210

Claim information must be received as soon as possible and no later than 90 days after the date of accident or onset of illness.

Questions about benefits or claims should be directed to Summit America at (877) 246-6997.

The Colorado State University Health Network Student Insurance Office provides the following services to plan participants in support of the Student Insurance Plan:

• Provides general information about plan features benefits to prospective and current plan participants
• Facilitates plan enrollment and billing for students, spouses, partners, and dependent children
• Administers the University waiver request program
• Assists plan participants with procedures necessary to file Off-Campus Care claims to Summit America
• Assists with questions about the status or disposition of on-campus care claims
• Facilitates presentations designed to disseminate information about the plan

Location and Office Hours

The Student Insurance Office is located in the basement of the Hartshorn Building just west of the Morgan Library and is staffed during university business hours.

Academic Year Hours: Monday - Friday 7:45 a..m - 4:45 p.m.
Summer Hours: Monday - Friday 7:30 a.m. - 4:30 p.m.

Contact Information for the CSU Student Insurance Office

Phone:
(970) 491-5118
Due to the nature of the insurance open enrollment cycle this office experiences periods of high phone volume. If the line is busy when you call please leave a message and we will return your call as soon as possible.

Email:
CSUHN_Insurance@mail.colostate.edu

Web:
www.health.colostate.edu

Mailing Address:
CSU Health Network, Student Insurance Office
Colorado State University
Campus Delivery 8031
Fort Collins, CO 80523-8031

Summit America Insurance Services functions as the third party claims administrator for the Off-Campus Care benefits offered under the Student Accident and Sickness Insurance Plan. Summet America provides the following services to plan participants in support of the plan:

• Assists plan participants in identifying in-network providers by calling (877) 246-6997 or by visiting here.
• Provides information about Off-Campus Care plan benefits to prospective and current plan participants.
• Processes Off-Campus Care benefit claims submitted for processing. Plan participants must initiate claims. Specific information about submitting a claim is located here.
• Assists plan participants with questions about the status or disposition of Off-Campus Care claims.
• Assists with the preparation of written plan material and participates in presentations to campus designed to disseminate information about the plan.

Contact Information for Summit America:

Phone:
(877) 246-6997 from 8:30 am - 5:00 pm CST

Address:
7400 College Blvd. Suite 100
Overland Park, KS 66210

Web:
www.summitamerica-ins.com

Insurance Plan Information

2011/2012 Benefit Highlights

2011/2012 Insurance Brochure (PDF)

2011/2012 Plan Document (PDF)

Waiver Process

Request for Waiver (PDF)

Insurance Appeals Form (PDF)

Filing A Claim

Summit America Online Claim Form

Summit America Claim Form (PDF)

Other Forms

Replacement ID Card (PDF)

Affidavit of Domestic Partnership (PDF)

This glossary is to assist you in understanding the most used terms related to the insurance industry. It can also help in understanding the student insurance program; however, all of the terms are not specific to the program offered at Colorado State and therefore the glossary should only be used as an educational reference.

Accident/Injury
Bodily injury to the insured person resulting directly from an accident and independent of all other causes which occurs while the policy is in force and which is an injury covered by the policy.

Assigned Benefits
A statement allowing your insurance company to make (assign) payments for your medical treatment directly to the hospital or physician. Otherwise, the money will be paid to the insured when bills and claim forms are returned to the insurance office.

Carrier, Underwriter, Insurer
The company that insures you.

Claim Form
A document that an insured person must complete as a part of the filing process. The form will usually ask specific questions relating to the medical treatment, previous history, etc.

Coinsurance/Co-payment
A provision of the insurance by which the covered person and the insurance carrier share in a specified ratio the eligible hospital or medical expenses resulting from a sickness or accident, (e.g. 80%:20% the carrier paying 80%, the insured person paying 20%).

Coordination of Benefits/Anti-Duplication Provision
Provision of the insurance designed to eliminate duplicate payments and provide the sequence in which coverage will apply when a person is insured under two or more health plans. This provision assures that no more than 100% of all incurred expenses will be paid by all insurance companies combined.

Cosmetic Surgery
Surgery/treatment given to correct/reconstruct a defect caused from an injury or disease (See elective surgery/treatment).

Deductible
The amount of out-of-pocket expenses that must be paid by the insured for health services before benefits become payable by the insurance carrier.

Dependent
The insured student's spouse residing with the insured student; or the insured student's unmarried child or children over the age of fourteen(14) days (including step children if dependent on the insured student), and under the age of twenty-six (26) years, who are not self-supporting and who reside with the Insured student.

Doctor
A licensed practitioner of the healing arts acting within the scope of his or her license and practice.

Effective Date
Date the insurance coverage commences.

Elective Surgery and Elective Treatment
Surgery or medial treatment which is not necessitated by a pathological or traumatic change in the function or structure in any part of the body.

Eligible Expenses
Usual and customary expenses that may be used as the basis for a claim under the terms of the insurance.

Emergency Admission
A hospital admission for inpatient hospital confinement for a condition which, unless promptly treated on an inpatient bases, would (1) put the patient's life in danger; or (2) cause serious damage to a bodily function of the patient.

Exclusions
Specified conditions or circumstances for which a policy does not provide benefits.

Hospital
An institution operating under the supervision of a licensed physician primarily for the care and treatment of injured and sick persons confined as inpatients, having organized facilities on the premises for diagnosis, major surgery and 24 hour-a-day nursing services but not primarily a place for alcoholics or drug addicts, not a nursing, rest or convalescent home.

Hospital Stay
A medically necessary overnight confinement in a hospital when room and board and general nursing care are provided and a per diem charge is made by the hospital.

Illness
Sickness or disease for which no treatment or expense has been incurred for the six (6) month period immediately preceding the effective date of coverage of the insured person whose illness is the basis of the claim.

Loss
Medical expense or indemnity covered by the policy as the result of "injury" or "sickness".

Open Enrollment
Time period when students are eligible to enroll for coverage without having to prove insurability.

Out-of-Pocket
Includes the 20% coinsurance payable by the claimant and any co-payments paid by the claimant. Out of Pocket does not include any excluded amounts ( including but not limited to amounts over Reasonable and Customary or Usual and Customary and charges not covered by the policy) or amounts that exceed the maximum benefit allocation as listed in the Schedule of Benefits.

Pre-existing Condition
A pre-existing condition is a condition for which the person received medical treatment or advice, or which was diagnosed in the six months preceding the effective date of the person's coverage. An accidental injury sustained during the six months preceding the effective date of the persons coverage will also be considered a pre-existing condition.

Surgical Procedure
Cutting, suturing, treating burns, correcting fracture, reducing a dislocation, manipulating a joint under general anesthesia, electrocauterizing, tapping (paracentesis), applying plaster casts, administering pneumothorax, endoscopy or injecting, sclerosing solution.

Therapy Services (Medical)
Services used to treat or promote recovery from illness/injury.
A) radiation therapy is treatment using x-ray, radium, cobalt, or high energy particle sources. Radiation therapy includes rental or cost of radioactive materials. Diagnostic services requiring use of radioactive materials are not radiation therapy.
B) Chemotherapy is treatment of malignant disease by using chemical or biological antineoplastic agents.

Treatment
Medical care provided by means of consulting any medical provider about symptoms resulting from injury or sickness. Also includes, (but is not limited to) care by means of diagnostic procedures (i.e., x-rays, lab, surgery); the taking of medications; therapy (physical, mental health, etc.); or the use of any appliance (mental or dental).

Usual and Customary Charge/Reasonable and Customary
The charge for the offered service or supply usually made by the provider when there is no insurance, not to exceed the prevailing charge in the area for a service of the same nature and duration and performed by a person of similar training and experience, or for a substantially equivalent supply.

General Questions

How do I get an insurance card?

Insurance cards are mailed at the beginning of each semester with your plan materials. If you have lost your card you can request a new one at the Student Insurance Office or print one online by clicking here.

How do I provide input about suggested changes in plan benefits and coverage?

Your input about plan benefits and coverage is important! We welcome your comments and suggestions.

Eligibility

Why do I have to pay the student health fee to be enrolled on the student insurance plan?

The insurance plan is designed to work in conjunction with the student fee funded services provided at the CSU Health Network.

Can I use part of my $100 annual flex benefit to pay for the summer health fee?

Yes.

Premiums

Why do the premiums for students, spouses/domestic partners and dependent children vary?

Premium rates for students, spouses/domestic partners, and dependent children up to age 26 are calculated separately by the underwriter and are based on an actuarial analysis of claims history for each group.

Coverage Dates

I was enrolled in the plan during the spring semester. I will not be attending summer school. Do I have plan coverage during the summer?

Students who are enrolled in the plan in the spring have coverage that extends through the subsequent June, July and a portion of August. Refer to the coverage date information provided above for specific coverage dates for the specific plan year.

Automatic Enrollment - Graduate & International Students

I am a graduate student taking less than 6 credits so I am not subject to the mandatory insurance requirement. Why have I been automatically enrolled and billed for the Student Insurance Plan?

Because credit hours can vary during the open enrollment period, all graduate students who are enrolled in at least one credit hour (except continuous registration students) are automatically enrolled in the plan. Domestic Graduate Students who are enrolled in less than six credit hours are not subject to the mandatory insurance requirement and can contact the student insurance office at any time during the open enrollment period to change their enrollment status. Under the terms of our insurance provider, no changes can be made to enrollment status once the open enrollment period has ended and no changes or refunds from our insurance provider can be made after that time.

Plan Enrollment - Domestic Undergraduates, Partners and Dependents

I am an undergraduate student and I accidentally enrolled in the plan during the registration ready process. I am already covered by my parent's insurance plan. How do I get off the student insurance plan?

Domestic undergraduate students are not subject to the mandatory insurance requirement and can contact the student insurance office at any time during the open enrollment period to change their enrollment status. Under the terms of our insurance provider, no changes can be made to enrollment status once the open enrollment period has ended and no changes or refunds from our insurance provider can be made after that time.

Does my spouse or dependent children need to reenroll each semester?

Yes. Your spouse and dependents need to be reenrolled each semester. Coverage dates are dependent on the date of enrollment. Please refer to the insurance brochure regarding the effective date of coverage given the date of enrollment.

Waiver Process

Why are all International Students required to have a specified level of health insurance coverage?

The Board of Governors of the Colorado State University System has mandated that a specified level of health insurance coverage be required for all International Students so that student's educational success is not hindered by unforeseen medical problems or expenses. More information on this requirement is available at the Office of International Programs and can be accessed here.

Why does the University require Graduate Students who are enrolled in 6 or more resident instruction credits to have a specified level of health insurance coverage?

In order to minimize the health risks that may impact a student's ability to complete his or her graduate studies, the Board of Governors of the Colorado State University System has mandated that all CSU graduate students enrolled in 6 or more resident instruction units be covered by a comprehensive health insurance plan. More information about this requirement is available from the Graduate School and can be accessed here.

I am a graduate student and was waived from the mandatory insurance requirement in the fall because I was covered under another plan that was approved as comparable coverage by the CSU student insurance office. Do I need to submit another waiver request in the spring semester if I was approved for a waiver in the fall semester?

No.

I have the same plan and coverage this year as I did last year. Do I need to submit proof of coverage and plan documents again?

Yes. Because plan enrollment and plan benefits can vary from year to year proof of coverage and insurance plan documents outlining benefits must be submitted each year when applying for a waiver due to comparable coverage.

Finding A Provider

Should a student have a referral to use other providers?

Yes. Your first and primary source for medical care under the Student Insurance Plan is at the CSU Health Network as you will receive the most benefit from your plan by beginning here. Depending upon need, you may be referred to an outside provider for additional care. Using our referral system can assist you with finding in-network providers under the off campus care benefit which will maximize your benefits.

Plan Benefits

What's the difference between the Campus Care Prescription Drug Benefit vs. the Off-Campus care Prescription Drug Expense Benefit?

For the 2011/2012 plan year the Campus Care Prescription Drug Benefits provides students with up to $500 per plan year in benefits for most prescriptions filed at the CSU Health Network Pharmacy. Students are not required to pay a deductible or a co-pay for this benefit.

The Off-Campus care Prescription Drug Expense benefit provides enrolled individuals (including students, spouses/domestic partners and dependent children up to age 26) who are experiencing emergency or emergent care situations with up to $200 of eligible pharmacy benefits once applicable deductibles and copays are met. For specific information relating to this benefit refer to the insurance brochure.

Student Insurance Office

I am enrolling in an outside plan and need a letter of credible coverage or proof of prior coverage. How to I obtain such a letter?

The student insurance office can help you with this. See above tab titled Student Insurance Office.