Whether you’re managing your own health coverage for the first time, new to the US healthcare system, or you’ve been managing your own insurance for years, we’re here to help! Understanding your coverage is key to getting the most from your benefits.
The following are a few common terms and concepts important to understanding your coverage in SHP and other US-based health insurance plans. For a glossary of terms, please visit healthcare.gov.
As a Student Health Plan (SHP) member, when you receive care at an Aetna participating provider (including Cornell Health) within the United States, any claims that need to be submitted for reimbursement will be submitted directly to Aetna for you.
When a claim is submitted on your behalf, you will receive and Explanation of Benefits (EOB) electronically or in the mail after your visit that explains what your provider charged and what was covered under SHP. The EOB is not a bill.
If you receive care from a non-participating provider, or from a provider outside of the United States, you are responsible for submitting your claims for reimbursement. Log into the Aetna member site to submit a claim. Aetna will reimburse you for charges for covered benefits, minus any applicable co-payments, and will mail you a check directly.
Depending on the type of service you are receiving, you may be responsible for a copay and/or a portion of your total bill. A copay is a flat fee you pay at the time of service. Coinsurance is a percentage of the total claim amount. The coinsurance is paid to the provider by you.
To find out more about copays and cost-sharing in SHP, see our summary of benefits as well as the Glossary for definitions of common insurance terms. *For an accommodation for this PDF, please contact studentbenefits@cornell.edu.
If you are enrolled in SHP, your pharmacy claims are administered by OptumRX. Make sure to present your OptumRX ID card when picking up medications.
If you paid out of pocket for a prescription and need to be reimbursed for the prescription. Download and complete the OptumRX Claim Reimbursement form. *For an accommodation for this PDF, please contact studentbenefits@cornell.edu.
Send the completed form, along with your original receipt to:
OptumRx Claims Department, PO Box 650334, Dallas, TX 75265-0334
You should always carry your insurance ID cards. There are two ID cards, your Aetna card, which is used for visits to doctor’s offices and hospitals, and your OptumRX card, which is used when picking up prescriptions, including medications.
ID cards are not automatically mailed to you. You must take action to get your ID cards.
Please see our Plan Overview and Documents Page.
