FAQs About Insurance & Billing

lmu shs insurance billing faq

Listed below are Loyola Marymount University, Student Health Services' most frequently asked questions and answers regarding the school sponsored insurance plan.

  • Am I required to have health insurance?

    All full-time students including undergraduate, graduate, and law school, enrolled in seven (7) semester hours or more are required to have health insurance. Full-time students are automatically enrolled in the Student Health Insurance Plan. However, students may waive out of the Student Health Insurance Plan, if they have comparative health insurance coverage.

  • Who underwrites the University Endorsed Student Health Insurance Plan?

    The Aetna Student Health Plan is underwritten by Aetna Life Insurance Company and is administered by Chickering Claims Administrators, Inc.

  • Once I enroll, can I see any doctor and be covered by the plan?

    No, only services from in network preferred providers are covered. This means the plan pays benefits only when you see a provider who is part of the Aetna network of preferred providers. However, non-preferred provider services for emergencies, ambulance, and accidental dental injuries are covered.

    Providers include doctors, hospitals, laboratories and pharmacies.

    To find a preferred provider:

    1. Go to Aetna Student Health

    2. Select your school (Loyola Marymount University or Law School)

    3. Click “Find a doctor, hospital or pharmacy” in the orange box on the left

    4. Follow the remaining instructions

    If you’re reading this online, you can go directly to Aetna’s DocFind tool.

    What is the cost of the University Endorsed Student Health Insurance Plan cost?

    Accident and Sickness Plan Rates

    Coverage

    Annual
    8/1/18  - 7/31/19

    Spring
    1/1/18 – 7/31/19

    Student

    $2,420

    $1,411

    Source: Aetna Life Insurance Company Academic Year 2017-18 University Endorsed Student Health Insurance Plan LMU/LA Loyola Marymount University Policy Number 474945

  • What is the term for coverage for the university endorsed health insurance plan?

    The term coverage for insured students entering in the Fall Semester is from August 1, 2018 through July 31, 2019. For new students entering the university in the Spring Semester, the term coverage is from January 1, 2019 through July 31, 2019 or from dates that the insurance is purchased.

  • Is there a separate accident plan?

    Yes, there is a separate mandatory accident plan for full time students. Students cannot waive out of this plan, except for those students who have purchased the University endorsed student health plan. The mandatory accident plan is administered by A-G Administrators, Inc. Plan management and brokerage services are provided by Mercer Health & Benefits, LLC, and is underwritten by QBE Insurance Corporation. The Master Policy may be viewed by request at the Office of Risk Management, University Hall, 4900, during business hours.

  • Is there a deadline to waive out of the University Endorsed Student Health Insurance Plan?

    Yes, there is a deadline. Please see below:

    Category

    Waiver Deadline Date

    Students enrolling for the Fall Semester

    10/05/18

    Students enrolling for the Spring Semester

    02/01/19

     

  • How do I waive out of the University Endorsed Student Health Insurance Plan?

    To waive out of the University Endorsed Student Health Insurance Plan, please visit Aetna Student Health, select your school (Loyola Marymount University or Law School), select "enroll/waive" at the bottom of the page, select "enroll/waive" again on the next page, input your student I.D. number and date of birth, then follow the process to request a waiver. If you are not a full-time student (enrolled in 7 credit hours), you are not automatically enrolled in the student health insurance plan and therefore do not have to waive out. 

  • Can I enroll in the University Endorsed Student Health Insurance Plan if I am not a full-time student?

    Yes, part-time students (those enrolled in less than 7 credit hours), can enroll in the University Endorsed Student Health Insurance Plan, they just aren't automatically enrolled. To enroll, click on the link below, select "Loyola Marymount University" in the drop-down menu, select "waive/enroll" at the bottom of the page, select "enroll/waive" on the page that follows, and finally, you will be asked to input your university I.D. number and date of birth. Your information should be loaded and there will be an option to enroll. Click "enroll" and follow the directions given on the site.

    Click here to start:

    Aetna Student Health

  • How do I submit a claim under the University Endorsed Health Insurance Plan?

    Any services rendered at SHS will be billed to the patient's student account. It is the responsibility of the patient or patient guardian to submit documentation of SHS billing to Aetna. Student Health Services does NOT submit claims to insurance on behalf of patients.

    1. When submitting any bill or document to AETNA, include your name, University Identification number, and date of birth. Indicate that you are a LMU student.
     

    2. Make copies of all bills and correspondence before you submit them to AETNA. Keep a record of all phone conversations, including the name of the person with whom you spoke to, date, time and probable outcome.  If you need to correspond with AETNA over the phone, be prepared to refer to your documents and bills. 

    3. While a referral is not required, when you seek medical care outside Student Health Services, it is recommended.

    4. To maximize your savings and reduce out-of-the pocket-expenses, select an Aetna Network Preferred Provider. It is to your advantage to use a preferred provider because savings may be achieved from the Negotiated Charges these providers have agreed to accept as payment for their services. Preferred providers are independent contractors, and neither employees or agents of Loyola Marymount University, Aetna Student Health, or Aetna.

    5. Not all procedures and costs are covered 100%.  To verify your coverage type (injury or sickness), you may call AETNA (1-877-409-7356) and provide your name and UID (see #1). Some illnesses or injuries may cost more to treat and you may be billed for what the plan does not cover.

    6. Please review the section on Exclusions and Limitations in your insurance pamphlet.

    7. For more information on your specific plan's policies and benefits, please go to AETNA’s website: Aetna Student Health and go to “get started by searching your college or university,” and enter Loyola Marymount University in the field “find your school.”

    8. If sending claims through physical mail, please send all claims to:

    Aetna

    PO Box 981106

    El Paso, TX 79998

    Fax: 859-455-8650

     

    For information on how to submit claims online, go to How to Submit an Aetna Claim Online

  • How do I submit a claim if I don't have the University Endorsed Student Health Insurance Plan?
    1. When submitting any bill or document to your insurance plan, please include your name, date of birth, and insurance number.
    2. Make copies of all bills and correspondence before you submit them to your insurance plan. Keep records of all phone conversations, including the name of the person(s) with whom you spoke to, date, time and probable outcome. If you need to correspond with your insurance plan over the phone, be prepared to refer to your documents and bills. 
    3. When seeking a referral to an outside provider, please check to see that the new provider is part of your insurance plan’s network, and accepts your plan. For more information regarding referrals, please check your policy or your insurance plan’s web page.
    4. Not all procedures and costs are covered 100%. To verify your coverage type (injury or sickness), you may contact your insurance plan and provide your name and your plan and identification number. Some illnesses or injuries may cost more to treat and you may be billed for what the plan does not cover.
    5. Please review your insurance policy for the section on Exclusions and Limitations.
    6. Please check your insurance plan’s web page to obtain copies of blank insurance forms that will need to be completed for reimbursement.
    7. If you require an itemized billing statement from LMU, please contact Student Health Services in person and complete a copy of “Loyola Marymount University Student Health Center Authorization to Release Patient Medical Information.” Copies of Patient Release of Medical Information can also be found on line at Student Health Services - Forms and Resources under forms and brochures.

     

  • How do I know if I am enrolled in the University Endorsed Student Health Insurance Plan?

    If you are a full-time student (enrolled in more than 7 credit hours per semester), you are automatically enrolled in the University Endorsed Health Insurance Plan through Aetna.

    If you are a part-time student (enrolled in less than 7 credit hours per semester), you are not automatically enrolled but can if you so wish (See "Can I enroll in the University Health Plan if I am not a full-time student?" in FAQ)

     

    If you don't know whether you are enrolled in the University Endorsed Student Health Insurance Plan or not, you can find this out (2) ways:

    1. Go to Aetna Student Health, select "Loyola Marymount University" in the drop-down menu, click "enroll/waive" until you are directed to input your student I.D. and date of birth. Once you do, a page will load that will tell you whether you are or are not enrolled in the plan and give you the option to opt-out if you are enrolled or enroll if you are not.

    2. If you are enrolled in the University Endorsed Student Health Insurance Plan, the charge will be present on your student billing account through PROWL. If you do not see a charge, you are not enrolled, however, should confirm via doing what is listed above in point 1.

     

    Note to Freshman who are starting full-time at LMU:

    If you already have insurance through your parents, it is up to you to make sure you opt-out of the University Endorsed Student Health Insurance Plan. If you do not opt-out, your student account will be charged and you will then be paying for 2 insurance plans.

If you have questions about the benefit plan or about waivers, please contact Aetna Student Health or call (877) 409-7356.

If you have any questions regarding the Aetna Student Health Insurance Master Plan, please review the Office of Risk Management policy or contact Doug Moore, Risk Manager, at (310) 338-3071.