Health Insurance 101

Access the Vassar Student Health Insurance Plan Information. Enter Vassar as the school name and it will take you directly to the plan for Vassar Student Health.

How to get your Vassar Student Health Insurance ID Card: Visit ID Card Access to create an on-line account to access your health insurance card and benefits.

Below are a variety of short videos to help you understand health insurance:

Not on a Vassar Student Health Plan? Submit a question for Erika via the Ask Erika Form.

Lowering Prescription Costs Resources

GoodRx: allows you to compare costs of prescription medications, as well as provides coupons
Single Care

General Health Insurance Terms

There are some basic insurance terms that students should know and understand in order to best utilize their insurance benefits. These include:

Behavioral Health: term used interchangeably with mental health. Some insurers will use mental health, others will use behavioral health, to describe services.
Benefits: The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan’s coverage documents. In Medicaid plans (like OHP), covered benefits and excluded services are defined in state program rules.
Claim: A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.
Co-insurance: the percentage of a medical expense that you are responsible for paying. This usually applies after a deductible has been met. For example—if you have a 20% coinsurance, and the cost of services is $200, your cost would be $40.
Co-payment: a fixed amount paid for covered services like doctors visits. Some insurance companies have different co-payments for different types of service or doctors. Please note that mental health providers may be considered ‘specialists’ by some plans, and could have a higher co-payment.
Deductible: the amount you must pay before your insurance company starts to pay for covered services each year. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. This amount resets each year on January 1. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Your insurance company pays the rest.
Explanation of Benefits (EOB): Every time services are provided, doctors and other medical professionals will submit claims to patients’ insurance companies to receive payment. The insurance company will then sent out an EOB to the member, which provides details about a claim that has been processed and explains what portion was paid to the health care provider and what portion of the payment, if any, is the patient’s responsibility. The EOB is not a bill. Generally, EOBs are sent to the primary subscriber of the insurance plan.
Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list. Covered medications generally fall into three categories:
Generic: These drugs are copies of brand-name drugs that have been on the market for a number of years and are often offered at very cheap prices.
Preferred: These drugs are name brand but are available to you at a price below the retail price.
Non-Preferred: These drugs are name brand but are not offered at a very large discount.
Member: someone with insurance coverage from a particular company.
Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
‘In Network’ provider: providers whose services are contracted with/covered by your health plan
‘Out of Network’ provider: providers whose services are not contracted with your insurance plan. Some plans offer ‘out of network’ benefits, meaning that the plan will cover some of the cost of these providers. Please note that the initial payment for the full cost of services is the responsibility of the individual receiving services, and is paid at the time services are rendered. This can be a large expense. Out of network providers may offer a ‘super bill’ that can be submitted by the member for insurance reimbursement.
‘Out of pocket’ costs: expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and co-payments for covered services plus all costs for services that aren’t covered.
Pre-Authorization: depending on your insurance plan, you may need to obtain authorization—get approved—for services before starting treatment.
Premium: the amount paid for your insurance plan. This may be paid monthly, quarterly, or yearly.
Provider: these are the doctors, nurses, hospitals, treatment facilities and practices and that provide medical care.
Subscriber: If you have insurance through your parent’s, spouse’s, or registered domestic partner’s employer, the parent/spouse/ or domestic partner who is covering you as a dependent under his or her health insurance plan would be the primary subscriber, sometimes called primary enrollee.
Super Bill: an itemized form used by healthcare providers for reflecting rendered services. It is the main data source for creation of healthcare claim, which will be submitted to payers (insurances, funds, programs) for reimbursement.