All full-time and dissertation-status students, and exchange students at Penn for a semester or more, must carry comprehensive health insurance as a condition of student enrollment at the University of Pennsylvania. If you have your own insurance coverage, you may waive enrollment in the Penn Student Insurance Plan. Learn more here.

**Please note** Insurance plans can vary greatly, including in terms of out-of-pocket costs, provider networks, and referral requirements. Be sure to review plans carefully and take advantage of the glossaries below to make sure you understand the potential costs and care covered in any plan you select.

Insurance Tips from Wellness at Penn

Tips for International Students

International Students residing in the US may be eligible for plans offered by PSI and ISO. While these plans are accepted by the University and meet the waiver requirements, they are not sponsored by the University of Pennsylvania, they are merely a suggestion of international private insurance plans that will meet the basic requirements of the University (whichever plan you choose it must cover your stay as a Student at UPenn):

- PSI Emerald, Platinum, and Presidential
- ISO Plans For UPenn

Tips for English Language Program (ELP) Students

If you receive your health insurance through the English Language Program (ELP), you will receive your card in your mail folder in the Student Center. You will also receive a second card in a few weeks that you can use to help pay for prescription medications at the pharmacy. You must Register your ELP insurance policy when you receive your card. You can also find information on this website about what services are covered by your insurance and how to request reimbursement

Health Insurance Terms & Definitions

Below is a list of common terms used in relation to health insurance with brief and general definitions. A more comprehensive glossary of health care terms can be found on the HealthCare.gov website here.

Allowed amount

The maximum amount an insurance plan will pay for a covered health care service. This may also be called an “eligible expense,” “payment allowance,” or “negotiated rate.” If your provider charges more than the plan’s allowed amount, you may have to pay the difference.

Annual limit

A cap or maximum on the benefits your insurance plan will pay in a given coverage year. Caps may be placed on specific services or prescriptions. Annual limits may be placed on the dollar amount of covered services or on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated health care costs for the rest of the year.

Authorization (or pre-authorization)

Obtaining approval from the primary care physician and/or health plan prior to receiving a specific service, such as visiting a specialist, obtaining a radiology scan or imaging, or undergoing surgical procedures.

The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan's coverage documents. In Medicaid or CHIP, covered benefits and excluded services are defined in state-specific program rules.

Claim
A request for payment for services and benefits you received.

Coinsurance

The share of health care services paid by the individual enrolled in a given plan. Coinsurance is generally found in conjunction with a deductible. Once the deductible is met, the enrollee is typically responsible for a specified percentage of the medical bill.

Co-payment (or co-pay)

A fixed fee ($20, for example) you are responsible for paying at the time of receiving service. Co-payments are generally charged by health maintenance organizations (HMOs), point-of-service plans (POS) and some preferred provider organization (PPO) plans. Learn more about how copayments work here.

Deductible

An annual amount paid by the enrolled individual for services before the insurance plan begins to pay. After the annual deductible is met, you may only need to pay a reduced copayment or coinsurance rate for covered services and your insurance plan will cover the remaining costs. Learn more about how deductibles work here.

Generic drugs

A prescription drug that has the same active-ingredient formula as a brand-name drug. The Food and Drug Administration (FDA) rates these drugs to be as safe and effective as brand-name drugs. Generic drugs usually cost less than brand-name drugs and may be required by some insurance plans, if available.

Exclusive Provider Organization (EPO)

A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). If specialty services are not authorized, the plan usually does not cover the services.

Health Insurance Discount Plan

A discount plan allows members to access health care providers, such as dentists or opticians, who have agreed to provide services to plan members at discounted rates. Such plans typically charge members a monthly membership fee. Discount plans are not a substitute for health insurance. Many providers do not accept this type of coverage.

Health Maintenance Organization (HMO)

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. Aside from a per-visit co-payment, the patient typically does not pay for services from an authorized physician or hospital, but they are responsible for the cost of services that are not covered benefits or the cost of any unauthorized services or visits.

Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) is a law passed in 1996 that expands your health care coverage if you lose your job or if you move from one job to another. It also mandates significant changes in the legal and regulatory environments governing the delivery and payment of healthcare services and the security and confidentiality of patient health information.

Indemnity

A traditional insurance medical plan that allows the enrollee to choose any provider and pays a portion of the medical bills. The enrollee pays a deductible and coinsurance.

In-network

This refers to doctors, hospitals, pharmacies and other health care providers that have agreed to provide members of a certain insurance plan with services and supplies at a discounted price. Under some insurance plans, your care is covered only if you get it from in-network providers.

Managed Care

Managed care refers to a variety of approaches to managing health care, from managed indemnity plans to health maintenance organizations. The focus of managed care is on controlling health care costs and utilization. This is accomplished in a number of ways, including contracts with specific providers, incentives to those providers to keep costs down and a review process to promote appropriate use of health services.

Medicaid

Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Medicaid eligibility, benefits, and program names, vary somewhat between states.

Medicare

A federally funded health insurance program for patients who are disabled or over age 65. The original Medicare plan has two parts — Part A is hospital insurance with coverage including hospitalization, hospice and skilled nursing facility services. Medicare Part B is medical insurance with coverage including physician services, medical supplies and clinic care.

Participating Medical Group (PMG)

A physician group (a primary care or multi-specialty group) that is a member of a health plan's network and therefore may provide services to members who are covered by that health plan.

Point-Of-Service (POS) plan

A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.

Precertification

Obtaining approval from a health plan for an elective hospital stay, prior to admission to the hospital. Expected length of stay is also determined during precertification.

Preferred Provider Organization (PPO)

Preferred provider organizations offer care through a network of specified physicians and hospitals. Generally, there is no gatekeeper. Many services, however, require prior authorization by the insurer or the patient may be held accountable for a larger portion of the bill. Some plans have an annual deductible that must be met before services are covered by the insurer. Other plans have a co-payment. If a non-participating provider is seen, the patient is responsible for a higher percentage of the bill.

Referral

A referral is when a physician sends a patient to another physician for a specific, usually complex problem.