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Students Away at School
If your child (age 5 to 26) goes away to school outside our service area, we go too. Most services will
be covered at the in-network level.
Emergency Care for Students Away at School
Emergency care is covered. There’s no need for authorization. If there’s a serious illness or injury, your
child should call 911 or go to the nearest emergency room. If admitted to the hospital, your child, or
someone chosen on his/her behalf, must report the admission. Call hospital admissions using the
number on the back of the ID card within 48 hours. Without proper notice, claims for these services
may be denied.
Urgent Care for Students Away at School
Urgent care, for treatment of minor injuries like a sprained ankle or treatment of the flu, is also
covered. This includes X-rays and lab tests following an illness or injury, done in an outpatient setting.
Looking for an urgent care center? Call Customer Service to find out if there is an affiliated urgent care
center nearby. If there isn’t, your child should go to the nearest urgent care center. College health care
centers can also help with urgent care services.
Follow-Up Care
Follow-up care must be authorized by your health plan before getting treatment. It may also need
review by our medical director. Call Customer Service to find out if authorization is needed for follow-up
covered care.
Coverage Criteria for Students Away at School Program
To be eligible for services, the following conditions must be met:
• The student attends an educational institution outside of our delivery system
• The student is between the ages of 5 and 26
Here is a list of some covered services for students away at school. See your plan documents for
details about the following:
1. Emergency and urgent care
2. Required maintenance visits for chronic conditions with the preapproval of our medical director
or designee
3. Follow-up office visit related to an acute illness or injury, only with the preapproval of our
medical director or designee
4. Imaging provided in the outpatient setting and related to an acute illness or injury
5. Laboratory tests provided in the outpatient setting and related to an acute illness or injury
6. Routine immunizations/vaccines, according to the recommendations from the Centers for
Disease Control and Prevention (CDC)
7. Allergy injections
8. Prescription coverage as allowed under the member’s Prescription Drug Rider
In the event of an inpatient emergency admission, your health plan’s admission department must be
notified within 48 hours. We reserve the right to transfer a member to an alternate facility if deemed
necessary for continued care.
The services identified as covered services for Students Away at School will be covered at the in-
network level.
The following services are not covered:
1. Routine complete physical examinations, including gynecological exams
2. All elective surgery or hospitalizations
3. Routine eye examinations and/or eyeglasses (optometry and optical services)
4. Routine OB/GYN services for pregnancy
5. Doctor visits or physical therapy, occupational therapy, or other therapies or treatments that are
not authorized beforehand by your plan
6. Vaccines administered for the sole purpose of travel
The Students Away at School policy does not cover dependent members permanently residing out of our
service area, even if the dependent is a student. Any services, other than those listed under “Covered
Services,” are not covered under the plan.
Your plan does not cover dependent children who live with a custodial parent outside of our
service area.