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Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutionsAetna Student HealthSMPlan Design and Benefits SummaryPreferred Provider Organization (PPO)Columbia UniversityPolicy Year: 2020 – 2021Policy Number: 704502www.aetnastudenthealth.com/columbia(800) 859-8471

This is a brief description of the Student Health Plan. The plan is available for Columbia University students andtheir eligible dependents. The plan is insured by Aetna Life Insurance Company (Aetna). The exact provisions,including definitions, governing this insurance are contained in the Certificate issued to you and may be viewedonline at www.aetnastudenthealth.com. If there is a difference between this Plan Summary and the Certificate,the Certificate will control.Columbia University Morningside CampusColumbia Health offers a wide array of services provided by Medical Services, Counseling and PsychologicalServices, Disability Services, Sexual Violence Response, and Alice! Health Promotion. Detailed information includinghours of operation, student insurance information, and department services can be found at health.columbia.edu.For more information, call Columbia Health at (212) 854-2284.Columbia University Irving Medical CenterColumbia University Irving Medical Center (CUIMC) Student Health Service (SHS) is CUIMC’s on-campus healthfacility for all students registered at CUIMC. SHS offers a wide array of services provided by Medical Services, theMental Health Service, and the Center for Student Wellness. Detailed information including hours of operation,student insurance information, and department services can be found at cumc.columbia.edu/student-health.For more information, call CUIMC Student Health Service at (212) 305-3400.Teachers College, Jewish Theological Seminary, & Union Theological SeminaryColumbia Health offers a wide array of services to students from the three affiliate institutions. Detailed informationincluding hours of operation and department services can be found at health.columbia.edu.For more information, call Columbia Health at (212) 854-2284.Coverage PeriodsCoverage will become effective at 12:00 AM on the Coverage Start Date indicated below and will terminate at 11:59PM on the Coverage End Date indicated.Coverage PeriodCoverage StartCoverage 0/2020Fall (Only applies to studentscompleting their degree programin December 2020)08/15/202012/31/202009/30/2020Spring/Summer (Only applies tostudents joining the university inthe Spring term)01/01/202108/14/202102/15/2021Summer (Only applies to studentsjoining the university in theSummer term)05/01/202108/14/202106/30/2021Columbia University 2020-2021Page 2

Morningside & CUIMC RatesThe rates below include both premiums for the student health plan underwritten by Aetna Life Insurance Company, as wellas 8 per year for the OnCall travel program and 29 per year (student) or 58 per year (student spouse) for ColumbiaUniversity fees for preventive dental services provided by the Columbia University College of Dental Medicine.Columbia University Student Health Insurance Plan – available to Morningside and CUIMC Campus studentsMorningside/ CUIMC StudentFall Semester 1,400.00Spring/Summer 2,276.00Summer* 1,070.00Morningside/CUIMC Student Spouse 2,800.00 4,552.00 2,140.00Morningside/CUIMC Student Child 2,789.00 4,534.00 2,129.00Morningside/CUIMC Student Children 4,178.00 6,792.00 3,188.00Morningside/CUIMC Student Spouse Child 4,189.00 6,810.00 3,199.00Morningside/CUIMC Student Spouse Children 5,577.00 9,069.00 4,258.00*Summer fees only apply to students enrolling for the first time in summer.Affiliate Campus RatesThe rates below include both premiums for the student health plan underwritten by Aetna Life Insurance Company, as wellas 8 per year for the OnCall travel program and 29 per year (student) or 58 per year (student spouse) for ColumbiaUniversity fees for preventive dental services provided by the Columbia University College of Dental Medicine.Columbia University Student Health Insurance Plan – available to TC, JTS, and UTS studentsFall SemesterSpring/SummerSummer*Affiliate Student 1,738.00 2,826.00 1,328.00Affiliate Student Spouse 3,476.00 5,652.00 2,656.00Affiliate Student Child 3,465.00 5,634.00 2,645.00Affiliate Student Children 5,192.00 8,442.00 3,962.00Affiliate Student Spouse Child 5,203.00 8,460.00 3,973.00Affiliate Student Spouse Children 6,930.00 11,268.00 5,290.00*Summer fees only apply to students enrolling for the first time in summer.Columbia University 2020-2021Page 3

Student CoverageEligibility (Columbia Morningside)Full-Time Domestic StudentsAll registered full-time domestic students at the Columbia University Morningside Campus are enrolled in theColumbia University Student Health Insurance Plan if no valid waiver request is submitted before the deadline.Full-time domestic students must confirm a specific insurance selection every year by actively enrolling in theColumbia University Student Health Insurance Plan through the insurance selection portion of the Student ServicesOnLine (SSOL) by the published deadline, or request a waiver from enrollment in the Columbia University StudentHealth Insurance Plan and demonstrating coverage under another comparable policy. Enrollment in the ColumbiaUniversity Student Health Insurance Plan, either by default enrollment or online selection, is effective only upon thestudent's registration for the term for which coverage will be active. Enrolling in the plan will also automaticallyinitiate enrollment in and payment of the Health and Related Service Fee, which is required. Please visithealth.columbia.edu for more information about Preferred Member Responsibility for Cost-Sharing and theHealth and Related Service Fee.Once the student’s insurance coverage decision has been determined for the Fall term, either by online selection,default enrollment, or waiver request, that decision will automatically be continued in the following Spring term aslong as the student remains registered at the University. For students who do not register for the Spring 2021 Term,their insurance coverage will terminate on December 31, 2020.Part-Time Domestic StudentsDuring the open enrollment period part-time domestic students may choose to enroll in the Columbia UniversityStudent Health Insurance Plan. Enrolling in the plan will also automatically initiate enrollment in and requiredpayment of the Health and Related Service Fee, which is required. Please visit health.columbia.edu for moreinformation about Preferred Member Responsibility for Cost-Sharing and the Health and Related Service Fee. Parttime students who have been insured under the plan in previous years and wish to enroll again must re-enroll bythe published deadline in order to avoid a break in coverage.International StudentsAll international students, regardless of the number of registered credits, are required to enroll in the ColumbiaUniversity Student Health Insurance Plan. Students will be enrolled in the Columbia University Student HealthInsurance Plan before the published enrollment deadline. International students are not eligible to waiveenrollment in the Columbia University Student Health Insurance Plan, except in very limited circumstances. Pleasevisit health.columbia.edu/content/international-students for more information. Enrolling in the plan will alsoautomatically initiate enrollment in and payment of the Health and Related Service Fee, which is required. Pleasevisit health.columbia.edu for more information about Preferred Member Responsibility for Cost-Sharing and theHealth and Related Service Fee.Funded Graduate StudentsPlease contact your departmental administrator, Financial Aid Office, or Fellowship Office for information aboutwhether your school provides funding to cover any portion of the Columbia University Student Health InsurancePlan premium.Columbia University 2020-2021Page 4

Student-VeteransStudent-veterans may be eligible for health care benefits through the Veterans Administration (VA) for illnesses andinjuries related to their service. Columbia Health recommends that Columbia student-veterans confirm their statuswith the VA and visit the Veterans Affairs website at sfs.columbia.edu/departments/veterans-service. All full-timestudents will be enrolled in the Columbia University Student Health Insurance Plan unless a waiver request issubmitted and approved by the waiver request deadline.Students Studying AbroadStudents expecting to participate in any Study Abroad program are encouraged to consult with an InsuranceSpecialist at the Columbia University Student Health Insurance Office (Morningside) about the type of insurancecoverage the student will rely on while traveling.Eligibility (Columbia University Irving Medical Center)Full-Time Domestic StudentsAll registered full-time domestic students at Columbia University Irving Medical Center (CUIMC) are enrolled in theColumbia University Student Health Insurance Plan if no valid waiver request is submitted. Students must confirm aspecific insurance selection every year by actively confirming their enrollment in the Columbia University StudentHealth Insurance Plan by indicating through the insurance selection portion of the Student Services OnLine (SSOL)by the published deadline. Enrolling in the plan will also automatically initiate enrollment in and payment of theCUIMC Health and Related Service Fee, which is required. Please visit cumc.columbia.edu/student-health formore information about Preferred Member Responsibility for Cost-Sharing and the Health and Related Service Fee.Waiver requests must be repeated annually and must demonstrate coverage under another comparable policy.Enrollment in the Columbia University Student Health Insurance Plan, either by default enrollment or onlineselection, is effective only upon the student's registration for the term for which coverage will be active.Once the student’s insurance coverage decision has been determined for the Fall term, either by online selection,default enrollment, or waiver request, that decision will automatically be continued in the following Spring term aslong as the student remains registered at the University. For students who do not register for the Spring 2021 Term,their insurance coverage will terminate on December 31, 2020.Part-Time Domestic StudentsDuring the open enrollment period, part-time domestic students may choose to enroll in the Columbia UniversityStudent Health Insurance Plan. Enrolling in the plan will automatically initiate payment of the CUIMC Health andRelated Service Fee, which is required. Please visit cumc.columbia.edu/student-health for more informationabout Preferred Member Responsibility for Cost-Sharing and the Health and Related Service Fee. Part-time studentswho have been insured under the plan in previous years and wish to enroll again must re-enroll by the publisheddeadline in order to avoid a break in coverage.International StudentsAll international students, regardless of the number of registered credits, are required to enroll in the ColumbiaUniversity Student Health Insurance Plan. Students will be enrolled in the Columbia University Student HealthInsurance Plan before the published enrollment deadline. International students are not eligible to waiveenrollment in the Columbia University Student Health Insurance Plan, except in very limited circumstances. Pleasevisit inistration/waiver for more information. Enrollingin the plan will also automatically initiate enrollment in and payment of the CUIMC Health and Related Service Fee,which is required. Please visit cumc.columbia.edu/student-health for more information about Preferred MemberResponsibility for Cost-Sharing and the Health and Related Service Fee.Columbia University 2020-2021Page 5

Funded Graduate StudentsPlease contact your departmental administrator, Financial Aid Office, or Fellowship Office for information aboutwhether your school provides funding to cover any portion of the Columbia University Student Health InsurancePlan premium.Student-VeteransStudent-veterans may be eligible for health care benefits through the Veterans Administration (VA) for illnesses andinjuries related to their service. CUIMC Student Health Service recommends that Columbia University studentveterans confirm their status with the VA and, if necessary, complete the VA paperwork needed to receive benefitsin the New York City area. All students will be enrolled in the Columbia University Student Health Insurance Planunless a waiver request is submitted and approved by the waiver request deadline.Eligibility (Teachers College)Full-time (12 billable credits or more) and residential domestic students are enrolled in the Columbia UniversityStudent Health Insurance Plan or request a waiver from the Columbia University Student Health Insurance Planbefore the published deadline. Part-time domestic students enrolled in degree-granting programs may electenrollment in the Columbia University Student Health Insurance Plan, which also initiates payment of the Healthand Related Service Fee.International StudentsAll international students, regardless of the number of registered credits, are required to enroll in the ColumbiaUniversity Student Health Insurance Plan. Students will be enrolled in the Columbia University Student HealthInsurance Plan before the published enrollment deadline. International students are not eligible to waiveenrollment in the Columbia University Student Health Insurance Plan, except in very limited circumstances. Pleasevisit lth-insurance/columbia-student-health-insurancefor more information.Eligibility (Jewish Theological Seminary)Full-time and residential domestic students are enrolled in Columbia University Student Health Insurance Plan if novalid waiver request is submitted by the enrollment/waiver deadlines. Part-time and exempt status domesticstudents may elect enrollment in the Columbia University Student Health Insurance Plan, which also initiatespayment of the Health and Related Service Fee.International StudentsAll international students, regardless of the number of registered credits, are required to enroll in the ColumbiaUniversity Student Health Insurance Plan. Students will be enrolled in the Columbia University Student HealthInsurance Plan before the published enrollment deadline. International students are not eligible to waiveenrollment in the Columbia University Student Health Insurance Plan, except in very limited circumstances. Pleasevisit jtsa.edu/health-services for more information. Enrolling in the plan will also automatically initiate enrollmentin and payment of the Health and Related Service Fee, which is required. Please visit health.columbia.edu formore information about Preferred Member Responsibility for Cost-Sharing and the Health and Related Service Fee.Eligibility (Union Theological Seminary)Full-time and residential domestic students are enrolled in the Columbia University Student Health Insurance Plan.Part- time domestic students may elect enrollment in the Columbia University Student Health Insurance Plan, whichalso initiates payment of the Health and Related Service Fee.Columbia University 2020-2021Page 6

International StudentsAll international students, regardless of the number of registered credits, are required to enroll in the ColumbiaUniversity Student Health Insurance Plan. Students will be enrolled in the Columbia University Student HealthInsurance Plan before the published enrollment deadline. International students are not eligible to waiveenrollment in the Columbia University Student Health Insurance Plan, except in very limited circumstances. Pleasevisit utsnyc.edu/life/student-affairs/health/insurance for more information. Enrolling in the plan will alsoautomatically initiate enrollment in and payment of the Health and Related Service Fee, which is required. Pleasevisit health.columbia.edu for more information about Preferred Member Responsibility for Cost-Sharing and theHealth and Related Service Fee.How to EnrollMorningside CampusEligible students will be enrolled in the Columbia University Student Health Insurance Plan unless the completedwaiver application has been received and approved by Columbia University by the published enrollment deadline.To confirm enrollment in the Columbia University Student Health Insurance Plan (full-time students) or to requestenrollment in the Columbia University Student Health Insurance Plan (part-time students), a student must enter theconfirmation or request by indicating their choice through the insurance selection of Student Services OnLine(SSOL).International students are not eligible to waive enrollment in the Columbia University Student Health InsurancePlan, except in very limited circumstances.CUIMC CampusEligible students will be enrolled in the Columbia University Student Health Insurance Plan unless the studentcompletes a waiver application that has been received and approved by Columbia University by the publishedenrollment deadline. All students should either confirm enrollment in the Columbia University Student HealthInsurance Plan or request a waiver by indicating their choice through the insurance selection of Student ServicesOnLine (SSOL).International students are not eligible to waive enrollment in the Columbia University Student Health InsurancePlan, except in very limited circumstances.Teachers CollegeEnrollment is coordinated by the TC Insurance and Immunization Records Office. For questions about ColumbiaHealth and the Columbia Student Health Insurance Plan, please visit tc.edu/health.International students are not eligible to waive enrollment in the Columbia University Student Health InsurancePlan, except in very limited circumstances.Jewish Theological SeminaryEnrollment for JTS students is coordinated by the JTS Office of Human Resources. Please note that student healthinsurance for Double Degree Barnard College students is administered through Barnard. For questions aboutColumbia Health and the Columbia Student Health Insurance Plan, refer to the JTS Office of Human Resources’Student Health Insurance website at jtsa.edu/Campus Life/Student Services/Student Health Insurance.xml.International students are not eligible to waive enrollment in the Columbia University Student Health InsurancePlan, except in very limited circumstances.Columbia University 2020-2021Page 7

Union Theological SeminaryEnrollment is coordinated by the UTS Office of Student Life. For questions about enrollment, please refer to the UTSOffice of Student Life. For questions about Columbia Health and the Columbia University Student Health InsurancePlan, please contact the UTS Office of Student Life.International students are not eligible to waive enrollment in the Columbia University Student Health InsurancePlan, except in very limited circumstances.Morningside Campus Dependent CoverageEligibilityCovered students may also enroll their lawful spouse, same-sex or opposite-sex domestic partner, and dependentchildren up to the age of 26.EnrollmentTo enroll the dependent(s) of a covered student, please complete the Enrollment Form on the Columbia Healthwebsite. The form, along with supporting documentation, should be submitted to the Columbia University StudentHealth Insurance Office. Please submit the form and supporting documentation via email tostudentinsurance@columbia.edu for processing before the published deadline.Dependent enrollment applications will not be accepted after the enrollment deadline unless there is a qualifyinglife change that directly affects their insurance coverage. An example of a qualifying life change would be loss ofhealth coverage under another health plan.Please contact the Columbia University Health Insurance Office at studentinsurance@columbia.

Columbia University Student Health Insurance Plan through the insurance selection portion of the Student Services OnLine (SSOL) by the published deadline, or request a waiver from enrollment in the Columbia University Student Health Insurance Plan and demonstrating coverage under another comparable policy. Enrollment in the Columbia

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