Student Health Insurance Enrollment Form

Description of Student Health Insurance Program

The RVU-Sponsored Student Health Insurance Plan is a Preferred Provider Plan that has been designed specifically for RVU students and is underwritten by Aetna Student Health. With an emphasis on wellness, the plan is designed to provide full coverage for medical care, including annual routine physicals and immunizations.  

Health Insurance Plan - Aetna Student Health Summary of Benefits and Costs 2022-2023
(policy plan year August 1 - July 31)

Plan Rates 2022-2023* Annual
Student Only $4,589.00

*Rates include the cost of medical and dental plans.

The Summary of Benefits for 2022/2023 is not available yet.  There are no changes to the plan design so you may refer to the 2021/2022 Summary of Benefits. For a detailed summary of benefits, please click on the following attachments.

RVU 2022-2023 Aetna Medical Plan Summary

To maximize your benefits, you may refer to the following links to locate in-network participating providers. For a general provider or facility search within the Aetna Student Health network, you may access DocFind. If you do not have your ID number available, you will identify your plan type as PPO.

The RVU-Sponsored Student Health Insurance Plan is a Preferred Provider Plan (PPO) that has been designed specifically for RVU students and is underwritten by Aetna Student Health (ASH). With an emphasis on wellness, the plan is designed to provide full coverage for medical care, including annual routine physicals and immunizations.  The RVU-Sponsored Student Health Insurance Plan offers both in-network and out-of-network benefits; it is an ACA-compliant Platinum level plan. 

All students will be charged for student-only coverage in the RVU-Sponsored Student Health Insurance Plan prior to the start of each academic year. The charge to the student's account will be removed if an approved waiver is granted.

The RVU-Sponsored Student Health Insurance Plan is a Preferred Provider Plan that has been designed specifically for RVU students and is underwritten by Aetna Student Health. With an emphasis on wellness, the plan is designed to provide full coverage for medical care, including annual routine physicals and immunizations.

All students will be charged for coverage in the RVU-Sponsored Student Health Insurance Plan prior to the start of each academic year. The charge to the student's account will be removed if an approved waiver is granted.

Dental Insurance Plan - Aetna Dental

All students enrolled in the RVU sponsored medical plan will also be enrolled in the dental plan.

The RVU sponsored dental plan is a PPO plan underwritten by Aetna that provides for an annual benefit of $1,000 with your preventative services such as periodic oral evaluation, cleanings, and x-rays covered at 100% and basic services such as fillings and simple extractions covered at 80% when utilizing a participating provider after a $50 per individual annual deductible.

*Dental premium for students enrolled in the medical plan is included in the health rate.

For additional information regarding the dental plan, please click on the following attachment.

RVU Dental Plan Summary

You may locate Preferred Dental Providers by clicking on DocFind and select Dental PPO options.

Discount Benefits - Aetna Student Health

In addition to the medical and dental benefits, those enrolled in the RVU-Sponsored Student Health Insurance Plan will have access to an Aetna discount program which will provide savings for vision, fitness clubs, and more at no additional cost.

Enrollment Process

All students are automatically enrolled in the RVU-Sponsored Student Health Insurance Plan, and the premium charge is added to the student billing unless a waiver request is submitted and approved. Enrollment and the insurance charge can be waived if proof of other acceptable health insurance is provided by submitting an online waiver.

  • To expedite enrollment in the RVU Sponsored Student Health Plan, please follow the Student Verification tab at the bottom of this page.
  • If you are having difficulty with the online enrollment process, please contact HSAC for assistance.
  • Students who lose coverage midterm are required to submit an enrollment request within 30 days of the date of loss of prior coverage for enrollment in the RVU - Sponsored Student Health Insurance Plan.  Please follow the  Student Verification tab at the bottom of this page and submit your request with proof of loss of prior coverage, which can be attached to your electronic enrollment.

To begin the enrollment process please enter your demographic information below and click the "next" button at the bottom to continue.

If you receive an error message when entering your information please contact HSAC at 888-978-8355. The deadline for Medical Students and continuing PA students to submit your annual waiver is July 31st. You MUST include a copy of your Health Insurance ID card with your waiver submission. The deadline for PA 1 Students to submit your annual waiver is August 31st. You MUST include a copy of your Health Insurance ID card with your waiver submission.

Please enter your information. Fields with * are required

HELPFUL TIPS:
* Student ID is not a required field.
* If you don't know your University Email address, you may enter your personal email address instead.

Please add any dependents (Spouse, Domestic Partner, Child):

  • Dependent 1

  • Dependent 2

  • Dependent 3

  • Dependent 4

  • Dependent 5

Add Dependent

Please choose your insurance coverage:

HELPFUL TIPS:
*For incoming students and continuing students enrolling during the Open Enrollment period (8/1/2017 - 8/31/2017), the requested effective date will be 08/01/2017.
*For continuing students enrolling outside of an Open Enrollment period, as a result of an involuntary loss of other coverage, the requested effective date will be the date you lost other coverage.

  • Dependents Also?

If you have any extra documents you would like us to have, please upload them here. Only .doc, .docx and .pdf files are accepted. Up to two documents may be uploaded. Each file may be no larger than 10 Megabytes.

Please Confirm the information you entered, then click submit.

Student Information

Last Name
Middle Initial
1
First Name
Gender
Social Security Number
Student ID
Home Address
Home Address 2
Home City
Home State
Home Country
Home Zip
Phone Number
Personal Email
University Email
Program
Date of Birth

Dependent 1

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 2

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 3

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 4

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 5

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Insurance Information

Medical
Medical For Dependents
Requested Enrollment Date

Documents

Document 1
Document 2

Digital Signature

** By typing your name in the Signature field, you hereby certify that the information entered into this form is true and correct to the best of your knowledge.

  • Comments

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