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Insurance Plan Comparison

In regard to doctoral students enrolled in the Graduate School: 

Feb 16, 2017 Comparison of the

Graduate Student Health Insurance Plan (SHIP)

Vs.

VU Employee Health Plan (PLUS)

 

2016-2017

Graduate SHIP Plan

2017 Employee Plan

Plus Option **

Annual Cost Paid by Ph.D. Student* or Employee for Individual Coverage

$0

$852 

Annual Cost Paid by Vanderbilt

For the Student: $3,064

For the Employee: $3858

Insurance Carriers

United Healthcare

Aetna

Provider Network

Preferred Provider: VUMC

In Network Provider: UHC

Options PPO

Tier 1: VHAN

Tier 2: Aetna Choice POS II

National Network

Claims Company

HeartSmart

Aetna

Plan Maximum

Unlimited

Unlimited

Deductible

In Network: $150

Out-of-Network: $500

Individual Deductible:
Tier 1: $750
Tier 2: $1,400
Out-of-Network: $2,600

Family Deductible:
Tier 1: $1,500
Tier 2: $2,800
Out-of-Network: $4,800

Coverage Levels

90% VUMC

85% In Network

65% Out-of-Network

80% VHAN

60% In Network

40% Out-of-Network

Out-of-Pocket Maximum

In Network:
$5,000 Individual
$10,000 Family

Out-of-Network: 
No Out-of-Pocket max

In Network:
$4,000 Individual
$7,500 Family

Out-of-Network:
$8,500 Individual
$16,500 Family

Primary Care or Specialist Doctor's Office Visit Patient Co-Insurance (non-preventive)

10% VUMC

15% In Network

35% Out-of-Network

Tier 1: $35 co-pay

Tier 2: $60 co-pay

Out-of-Network: 60% after deductible

Precentive/Routine Doctor's Office Visits Patient Co-Insurance

In Network: $0

Out-of-Network: Not Covered

Tier 1: $0

Tier 2: $0

Out-of-Network: Not Covered

Urgent Care Coverage Levels

90% VUMC

85% In Network

65% Out-of-Network

(no deductible if after hours)

Tier 1: $50 co-pay, then 80% after deductible

Tier 2: $75 co-pay, then 60% after deductible

Out-of-Network: $75 co-pay, then 40% after deductible

Emergency Room Patient Co-Pays (waived if admitted)

$100 and then:

10% VUMC

15% In Network

35% Out-of-Network

Tier 1: $250 co-pay, then 20% after deductible

Tier 2: $250 co-pay, then 40% after deductible

Out-of-Network: $250 co-pay, then 40% after deductible

Inpatient Hospital Coverage Levels

90% VUMC

85% In Network

65% Out of Network

Tier 1: 80% after deductible

Tier 2: 60% after deductible

Out-of-Network: 40% after deductible

Prescriptions

Student Health meds all <$15 (no deductible applies)

$15/$40/$60 for 30 day supply any retail pharmacy, after $100 deductible

$30/$80/$120 for 3 month supply mail order after $100 deductible

See Chart Below

 

Vanderbilt Employee Health Plan Pharmacy Co-Insurance Chart

 

Vanderbilt Pharmacy
(30 day supply)

Vanderbilt Pharmacy
(90 day supply)

Non-Vanderbilt Pharmacy
(30 day supply)
Out of Network

Maintenance
Generic

$1

$3

 $15 N/A

Level 1

$5

$15

 $15 N/A

Level 2

70% co-insurance
up to $50

70% co-insurance
up to $125

 50% co-insurance
up to $75
N/A

Level 3

50% co-insurance 
up to $75

50% co-insurance 
up to $225

 30% co-insurance 
up to $100
N/A

Specialty

90% co-insurance 
up to $100

N/A N/A N/A