Using Private Health Insurance
What about Health Insurance?
Campus Health & Wellbeing strongly recommends carrying private health insurance for medical and surgical problems beyond the scope of Cal Poly's Health Services. Each student is encouraged to have their own coverage for major medical, surgical and emergency expenses. Cal Poly cannot pay for off-campus care. Therefore, an individual is responsible for those charges. We recommend consulting with an insurance broker to find the best available insurance coverage for you or CoveredCA.com to choose a plan.
What kind of insurance do I have? How does it work?
It is very important that you know what kind of insurance you have: HMO, PPO, or indemnity insurance. The most critical information is to know whether you need preapproval for a medical service in order to be reimbursed for your expenses by your insurance company. Call the customer service number on your insurance card to find out.
Health Maintenance Organizations (HMOs)
- Most medical services (other than care from your Primary Care Provider or emergency services) will require pre-approval from your HMO.
- Without pre-approval, your insurance company will refuse to pay your claim, and you will be responsible for the entire bill.
- Please call the phone number listed on your insurance card for pre-approval.
- If you plan on living in San Luis Obispo County for the school year or longer, you may want to consider changing your Primary Care Provider in this County, since his/her approval will be needed for a referral to a specialist. This will save you a visit to your Primary Care Provider (out of SLO) for that approval.
Indemnity Insurance Plans (Fee for Service)
Indemnity insurance plans simply pay a percentage of your medical expenses, after your deductible has been met (i.e. you have a $500 deductible plan and the insurance will not pay for the first $500 of the expenses you incur) . In most instances you will not have to submit bills for medical care, but you will probably have to submit bills for pharmacy items and medical supplies in order to be reimbursed.
Preferred Provider Organizations (PPOs)
Preferred Provider Organizations insurance are similar to Indemnity Insurance plans. PPOs create groups of providers that you can see at a discount. For example, they may pay 80% of your bill if you see someone from their preferred provider list, but may only pay 60% if you see someone who is not on their list. Frequently there is a deductible. If you have a $500 deductible plan, the insurance will not pay for the first $500 of your expenses.
Inpatient Hospital Care
Hospital care is extremely expensive. If you are going into the hospital, it is critical that you follow the correct procedures set by your insurance company. If you are covered by an HMO, your hospital stay must be pre-approved by the HMO or you stand a high probability that they will not pay for your care. The hospital admitting office should help with pre-authorization, but in order for them to do that effectively they need your insurance card. Be sure to carry it with you at all times.
When You Need to Use Private Insurance
- Emergency services
- Urgent services that occur after Health Center hours [see urgent care facilities in San Luis Obispo]
- Services of medical specialists, not seen at the Health Center
- Basic medical services away from campus [you can receive basic health services at any Cal State University campus if you are a currently enrolled Cal Poly student]
What are my insurance options after graduation?
As graduating seniors begin departing for the next chapter of their lives, we wanted to circulate this helpful one-pager on the affordable healthcare opportunities now available to graduates. This document lays out the options available including getting health insurance through employer based coverage, staying on parents' plan until the age of 26, as well as going to HealthCare.gov to choose a plan in the Health Insurance Marketplace. As you may know, graduation is a general mile marker for many significant life changes, such as expired student health insurance or moving from home, that trigger a "Special Enrollment Period" that allows a 60 day window for students to sign up for coverage in the marketplace even though the open enrollment period has ended. You can find more information from the College Grad Fact Sheet.
- IF YOU HAVE A MEDICAL EMERGENCY, CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM!
- Carry your health insurance card at all times.
- If you have HMO coverage, call for pre-approval of all non-emergency services.
- If you have PPO coverage, find the appropriate provider from your provider list for this area.
- If you have indemnity insurance, contact the provider of your choice.
- Keep all receipts for services, doctor’s costs, pharmacy items, and medical equipment. It may be necessary to submit these to your insurance company at a later date.
- Know which pharmacies accept your health plan. If there is no pharmacy in this area, check to see if the Health Center Pharmacy has the medication. Our prescription prices are generally the best in town.