Wellfleet Medical Plan
The Student Health Benefits Plan is administered by Wellfleet (formerly CHP), and is contracted with Cigna for the medical plan’s provider network of hospitals, physicians, and other health care providers.
| Benefit | In-Network | Out-Of-Network |
|---|---|---|
| Annual Deductible (Per Plan Year) | $150 individual/$450 family* | |
| Out-of-Pocket Maximum | $3,000 individual/$9,000 family | |
| Wellness/Preventive and Immunization Expenses | $0 copay | 16% coinsurance |
| Physician’s Office Visit | $20 copay | 36% coinsurance |
| Inpatient Mental Health Professional Fees | 20% coinsurance | 36% coinsurance |
| Outpatient Mental Health Professional Fees | 10% coinsurance | 36% coinsurance |
| Urgent Care Center | $50, then covered at 100% | |
| Emergency Room | $50, then covered at 100% | |
| Pharmacy Benefit | $15 for generic drugs $25 for brand name drugs |
$15 for generic drugs $25 for brand name drugs** |
* Your deductible may be reduced to $75 per condition with a referral for additional treatment from the Student Health & Wellness Center, Counseling Center, the Georgetown University Student Health Center, the University of Bologna Counseling Center or the Johns Hopkins Student Assistance Program. Referrals are only issued for covered students seeing a provider at one of these sites and will not be issued over the phone.
**You must pay out of pocket for prescriptions at out of network pharmacies and then submit your receipt of reimbursement.
Medical Plan Enrollment
Your time period for enrolling and/or waiving coverage in the student health plan may vary according to your program and division, however, the general plan enrollment/waiver deadline for the academic year is September 15. Waiver requests can be submitted through SIS self-service beginning on July 1st. From self-service, select Personal Info, then Health Insurance. You will need the plan details and health insurance ID card information in order to complete the waiver.