Fully insured student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna) and administered by Aetna Life Insurance Company (ALIC). Self insured plans are funded by the applicable school, with claims administration services provided by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company and their applicable affiliated companies (Aetna).

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Boston University2015-16 Student Health Insurance Plan

August 31, 2015

Aetna Inc.Boston University 2Boston University

2015-2016 Coverage Dates and Premiums

For premium rates and benefit description available to eligible dependents, please visit www.aetnastudenthealth.com.

Program Coverage Dates Annual Premium

BASIC Plan 8/23/15 to 8/22/16 $1,945

PLUS Plan 8/23/15 to 8/22/16 $2,713

Boston University makes two plans available to students on the main campus. The BASIC Plan provides benefits comparable to “Gold” plans offered through the public Marketplace (e.g. Healthcare.gov). The PLUS plan provides a higher level of benefits, comparable to “Platinum” plans offered through the public Marketplace, at a higher premium than the BASIC Plan:

Aetna Inc.Boston University 3Boston University

BASIC Plan benefits

The Plan will pay benefits in accordance with any applicable Massachusetts insurance law. The Boston University plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the Boston University Plan Design and Benefits Summary carefully before deciding whether this plan is right for you. While this document and the Boston University Plan Design and Benefits Summary tell you about some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look at the full plan description, which is contained in the Master Policy issued to Boston University, you may contact us at (800) 966-7772. Additional plan maximums may also apply. Some illnesses may cost more to treat and health care providers may bill you for what the plan does not cover.

Plan information Preferred Care Non-Preferred Care

Policy Year Maximum Unlimited Medical & Prescription Drug

Policy Year Deductible $150 per Covered Person $500 per Covered Person

Out-of-Pocket Maximum $5,500 per Covered Person $5,500 per Covered Person

Physician Office Visits $40 Copay, then 100% of Negotiated Charge 80% of Recognized Charge

Preventive Care 100% of Negotiated Charge 80% of Recognized Charge

Emergency Room (Copay waived if admitted)$150 Copay, then 80% of

Negotiated Charge$150 Deductible, then 80% of

Recognized Charge

Inpatient Hospitalization 80% of Negotiated Charge 60% of Recognized Charge

Prescription Drug$10 Generic Drug/

$40 Preferred-Brand Name Drug/ $60 Non-Preferred Brand Name

Drug80% of Recognized Charge

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PLUS Plan benefits

The Plan will pay benefits in accordance with any applicable Massachusetts insurance law. The Boston University plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the Boston University Plan Design and Benefits Summary carefully before deciding whether this plan is right for you. While this document and the Boston University Plan Design and Benefits Summary tell you about some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look at the full plan description, which is contained in the Master Policy issued to Boston University, you may contact us at (800) 966-7772. Additional plan maximums may also apply. Some illnesses may cost more to treat and health care providers may bill you for what the plan does not cover.

Plan information Preferred Care Non-Preferred Care

Policy Year Maximum Unlimited Medical & Prescription Drug

Policy Year Deductible None $250 per Covered Person

Out-of-Pocket Maximum $3,000 per Covered Person $3,000 per Covered Person

Physician Office Visits $25 Copay, then 100% of Negotiated Charge 80% of Recognized Charge

Preventive Care 100% of Negotiated Charge 80% of Recognized Charge

Emergency Room (Copay waived if admitted)$100 Copay, then 100% of

Negotiated Charge$100 Deductible, then 100% of

Recognized Charge

Inpatient Hospitalization $250 Copay, then 100% of Negotiated Charge 80% of Recognized Charge

Prescription Drug$10 Generic Drug/

$35 Preferred-Brand Name Drug/ $50 Non-Preferred Brand Name

Drug80% of Recognized Charge

Aetna Inc.Boston UniversityBoston University

Aetna Student Health network

A national network of more than 1.1 million providers* including:

More than

664,000 primary care doctors and specialists*

More than

5,500 hospitals*

To learn more about Preferred Providers, visit www.aetnastudenthealth.comProviders are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.*http://www.aetna.com/about-aetna-insurance/aetna-corporate-profile/facts.html. As of September 30, 2014.

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Access to the Aetna Preferred Provider Network.Aetna Student Health has arranged for you to access a Preferred Provider Network in your local community. Acute care facilities and mental health networks are available nationally if you require hospitalization outside the immediate area of the Boston University campus.To maximize your savings and reduce your out-of-pocket expenses, select a Preferred Provider. It is to your advantage to use a Preferred Provider because savings may be achieved from the Negotiated Charges these providers have agreed to accept as payment for their services.

Boston University

Aetna Inc.Boston University 6Boston University

Travel assistance services

Access to travel assistance services including emergency assistance – available 24/7.

For more information visit www.aetnastudenthealth.com

• Unlimited emergency medical evacuation and medical repatriation

• Medical/dental/pharmacy referral• Hospital deposit arrangements• Prescription drug replacement

assistance• Dispatch of physician• Pre-trip plans

• 24/7 emergency travel arrangements• Translation assistance• Emergency travel funds and lost travel

documents assistance• Natural Disaster & Political Evacuation

Services up to $100,000 in the event of either natural disaster making current location uninhabitable or governmental/social upheaval, placing student in imminent bodily harm

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Vital Savings by Aetna® on Dental*

An optional dental discount program helping you and your dependents save.• One low annual fee of $25 per student • In most instances, savings range from 15-50

percent on services from general dentistry and cleanings to root canals, crowns, and orthodontia (braces)

• No claims to file• Price: $25 Student only

$44 Student +1 Dependent

$63 Student +2or more Dependents

*Actual costs and savings vary by provider and geographic area.

The Vital Savings by Aetna® program (the “Program”) is not insurance. The Program does not meet the Minimum Creditable Coverage requirements in Massachusetts. It provides Members with access to discounted fees according to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna discount program. The range of discounts provided under the Program will vary depending on the type of provider and type of service received. The Program does not make payments directly to the participating providers. Each Member must pay for all services or products but will receive a discount from the providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-888-BeVital, is the Discount Medical Plan Organization.Enroll online at www.aetnastudenthealth.com

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Value added programs

Aetna Weight Management discount program: Access to discounts on the CalorieKing® Program and products, eDiets® diet plans and products, Jenny® weight loss programs and Nutrisystem® weight loss meal plans.

Aetna FitnessSM discount program: Access to preferred rates on gym memberships and discounts on at-home weight loss programs, home fitness options and one-on-one health coaching services through GlobalFit®.

Oral Health Care discount program: Access to discounts on oral health care products. Save on xylitol mints, mouth rinses, gum, candies and toothpaste from Epic. Additionally, receive exclusive savings on Waterpik® dental water jets and sonic toothbrushes.

These are not underwritten by Aetna and are NOT insurance. The member is responsible for the full cost of the discounted services. Please note that these programs are subject to change without notice. To learn more about these additional services and search for providers visit, www.aetnastudenthealth.com.

Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Discount programs may be offered by vendors who are independent contractors and not employees or agents of Aetna or their affiliates. Aetna may receive a percentage of the fee you pay to the discount vendor.

These services, programs or benefits are offered by vendors who are independent contractors and not employees or agents of Chickering Claims Administrators, Inc., Aetna Life Insurance Company or their affiliates

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Value added programs (continued)

Aetna Natural Products and ServicesSM discount program: Access to savings on complementary health care products and services, including online consultations, not traditionally covered by their health benefits plan. All products and services are provided through the ChooseHealthy® program* and Vital Health Network (VHN).

Aetna VisionSM discount program: Access to discounts on vision exams, lenses and frames when a member utilizes a provider participating in the EyeMed Select Network.

*The ChooseHealthy program is made available through American Specialty Health Networks, Inc. (ASH Networks) and Healthyroads, Inc. subsidiaries of American Specialty Health Incorporated (ASH). ChooseHealthy is a federally registered trademark of ASH and used with permission herein.

These are not underwritten by Aetna and are NOT insurance. The member is responsible for the full cost of the discounted services. Please note that these programs are subject to change without notice. To learn more about these additional services and search for providers visit, www.aetnastudenthealth.com.

Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Discount programs may be offered by vendors who are independent contractors and not employees or agents of Aetna or their affiliates. Aetna may receive a percentage of the fee you pay to the discount vendor.

These services, programs or benefits are offered by vendors who are independent contractors and not employees or agents of Aetna Life Insurance Company or their affiliates

Aetna Inc.Boston UniversityClient name here, change on master page

Contacts for assistance

We offer helpful tools and resources.

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Aetna Student Health Customer Service: (800) 966-7772Aetna RX: (888) 792-3862www.aetnastudenthealth.com

For assistance with waivers and enrollment:

Boston University Student Accounting Servicesphone: (617) 353-2264email: studenta@bu.eduwww.bu.edu/studentlink

Boston University

Aetna Inc.Boston UniversityBoston University

Thank you

This material is for information only and is not an offer or invitation to contract. Health insurance plans contain exclusions, limitations and benefit maximums. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.

©2014 Aetna Inc.15.25.118.1 (12/14) 11Aetna Inc.