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Understanding Insurance

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.

Aetna-Participating (In-Network) Providers

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.

Out-of-Network and International Providers

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.

Copays and Coinsurance

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.

Pharmacy and Prescription Coverage

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

ID Cards

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.

  • Download (and print) your Aetna ID – Download the AetnaHealthSM app to view your ID card on your mobile device after you have logged in. Through the website, select Cornell University as your school, enter your school ID number and your birthdate to view an image of your ID card (which you can print).
  • Download (and print) your OptumRx pharmacy ID card – After you download your Aetna ID card, create an account on OptumRx's website or mobile app to access your pharmacy card (you will need the W+ ID number from your Aetna card to do so). Please see the OptumRX welcome letter for more detail. *For an accommodation for this PDF, please contact studentbenefits@cornell.edu.

IRS 1095-b Forms

In compliance with the Affordable Care Act (ACA), all individuals covered under the Cornell Student Health Plan are required by law to furnish a taxpayer identification number to Cornell, either as a Social Security Number (SSN) or Individual Tax ID Number (ITIN). 

We use the taxpayer identification number when we submit completed 1095-B forms to the Internal Revenue Service (IRS) on behalf of all individuals who were enrolled in SHP or SHP+ during that year. This reporting requirement verifies that plan members had insurance that provides minimum essential coverage.

Please make sure that the University Registrar has your SSN or ITIN on record: Log in to your Student Essentials account to check that your SSN/ITIN number is listed correctly.

If you have not yet provided the Registrar with your SSN/ITIN, please do so by December 31 using one of the following methods:

  • In Person – Visit the Office of the University Registrar, located at B7 Day Hall, and bring a copy of your original social security card or taxpayer/ITIN letter and two forms of identification.
  • By Secure File Transfer – Take a picture of your SSN/ITIN card and login to Cornell’s SFTP system. Click “prepare upload” and select Go to https://sft.cornell.edu/login/, select univreg@cornell.edu as your recipient and upload an image of your card. Be sure to include a description of what you are sending in the notes section.

If you do not have an SSN or ITIN, please refer to this website for assistance.

International students: We understand that international students and their families who are not receiving fellowship payments or wages will not be eligible to apply for a SSN/ITIN, and therefore will not be able to supply this tax identification number to the university.

If you need a copy of your 1095-b form, please send an email to shp-finance@cornell.edu. Please include your full name, student ID number, and an address to which the form may be mailed. Include “1095-b” in the subject line.

Questions

If you have a medical claim question, you can log into your Aetna portal or call 1-800-859-8475.

If you have a pharmacy claim question, contact OptumRx by calling 1-866-868-1677.