USC Student Health Insurance Plan: Covered Benefits through USC Programs by University of Southern California

STUDENT HEALTH INSURANCE PLAN (SHIP)

provided through Aetna

Fall 2023 Covered Benefits Reminder September 2023 Dear USC Students: Please see the information attached from our USC campus partners that accept the SHIP/Aetna plan: • • • • • •

USC Pharmacies Herman Ostrow School of Dentistry of USC Faculty Practice (accepts Delta Dental plan) USC Chan Division of Occupational Science and Occupational Therapy Faculty Practice USC Physical Therapy Faculty Practice USC Psychiatry and Behavioral Health Services (PBHS, Engemann building 5 th floor) clinical practice USC Roski Eye Institute (USC Village)

Overview of SHIP/Aetna plan benefits Please visit the Aetna Student Health Insurance website for a summary of benefits: • •

students attending IN-PERSON programs (categorized as “on campus”); or students attending ONLINE-ONLY programs (categorized as “off campus”).

Additional information guides on the Aetna website may be helpful to you. Please remember to print your Aetna insurance card to present when using services outside of Student Health.

Recent Plan Updates Narcan, recently approved as an over-the counter medication (available without prescription) continues to be a covered benefit with $0 copay. Coverage has also been added for travel reimbursement for plan members who need domestic travel to obtain abortion care services when they are outside of the state of California. The coverage includes travel for the covered member and a travel companion. (See page 10 of the attachments for details.) The SHIP/Aetna plan also contracts with the "Hey Jane" service that provides telehealth care and FDA-approved medication abortion pills by mail, to plan members in CA, CO, CT, IL, NJ, NM, NY and WA. (See page 11 of the attachments). New clarification on the coverage of STI testing is included in the attachments, see page 13 for details. In the 2022-2023 plan year, new coverage was added for gender-affirming care including surgery, behavioral health services, hormone therapy, and fertility preservation (see page 14-20 of the attachments). A care navigator at Aetna can answer your questions, contact the Aetna Member Services line for USC students at 1-877-626-2299 (TTY: 711). USC Student Health Insurance Plan (SHIP) Office Call: 213-740-9355 (WELL) Email: studenthealth@usc.edu University of Southern California Los Angeles, California 90089-9034 • Tel: 213.740.9355 (WELL) • studenthealth.usc.edu

The Dental Faculty Practice, located on the University Park campus is a PPO Delta Dental Insurance option. At the USC Dental Faculty Practice, you will receive state-of-the-art treatment from among the finest dentists, specialists and dental hygienists in their fields. Our team is made up of faculty members from the Herman Ostrow School of Dentistry of USC, one of the nation’s top dental schools. From general and preventive dental care to the most advanced specialties and latest breakthroughs, the Dental Faculty Practice is here for students. We are located in the: Engemann Student Health Center, 4th floor 1031 West 34th Street Suite 401 Phone: (213) 740-2012 Los Angeles, CA 90089 Email: dentists@usc.edu https://dentalfacultypractice.usc.edu/ The Herman Ostrow School of Dentistry of USC provides urgent and regular dental care services to students. For information, visit: dentistry.usc.edu/dental-urgent-care-for-usc-students.

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Covered Benefits for USC Students The following services are covered benefits through your student health insurance plan (SHIP), provided through Aetna:

Flu Vaccines Hormonal Contraception (Birth Control) prescribed by USC pharmacists

pharmacies.usc.edu

USC International Travel Health Clinic consultations by appointment: Information, vaccines and medications to ensure safe and healthy travels Narcan / Naloxone ($0 copay) Smoking Cessation Services

Come in and meet your USC pharmacist!

USC HEALTH CENTER PHARMACY

USC MEDICAL PLAZA PHARMACY

USC VERDUGO HILLS PROFESSIONAL PHARMACY

Engemann Student Health Center USC University Park Campus 213-821-6100 Hours: M-Th: 9 am - 7 pm, Fri: 9 - 5 pm

Healthcare Consultation Center I USC Health Sciences Campus 323-442-5770 Hours: M-F: 8:30 am - 6 pm, Sat: 9 am - 3 pm

Verdugo Hills Professional Building 1808 Verdugo Blvd. #111, Glendale, CA 912818952-2223 Hours: M-F: 9 am - 5:30 pm

Experiencing muscle or joint pain? Sports-related injury? Difficulty studying or exercising due to stiffness, pain or movement related issues? Need help staying healthy? Student Health Center - Physical Therapy Appointments (1-2 visits only) studenthealth.usc.edu/myshr (select Medical, then Muscle Pain or Sports-Related Visit) In-person within ESHC, Eric Cohen, and Telehealth (available services using your Student Health Center fees)

USC Physical Therapy Clinic Appointments Email: uscptupc@med.usc.edu OR Call: 213-740-0215 Engemann Student Health Building, Suite 450 (UPC) and Health Research Association Building (HSC) Recovery/rehabilitation for all injuries and conditions, postoperative care, pelvic health In-person and Telehealth, 7am - 7pm Monday - Friday (available services using your health insurance benefits)

Complete Eye Care Near You The USC Roski Eye Institute clinic at USC Village serves the optical needs of Trojan students, faculty and staff and the greater Los Angeles community.

835 W. Jefferson Blvd. Suite 1720 Los Angeles, CA 90089 General Hours Mon - Fri: 8:30 a.m. - 5 p.m.

Whether you need an eye exam or are looking for prescription glasses, sunglasses or contact lenses, our experienced opticians can help. We carry a full selection of optical eyewear from top brands. Our on-site lab can make most prescription glasses in 24 hours or less. USC students and employees are eligible for discounted rates. Bring your valid prescription for purchase of contact lenses and same-day order of glasses. Please visit us for a free adjustment of your sunglasses or glasses. (You must obtain pre-authorization for all services.)

uscsthealth.info/eyecare

USC Psychiatry and Behavioral Health Services Clinic overview Some patients may be best served through an intermediate or longer-term treatment model utilizing their private health insurance or the USC Aetna Student Health Insurance Plan (SHIP). In 2019, to help meet the needs of our students who may require specialized or higher complexity care, USC established the Keck Medicine of USC Psychiatry and Behavioral Health Services (PBHS) on the USC University Park Campus. PBHS and USC Student Health Counseling and Mental Health (CMH) are both staffed with faculty members from the Keck School of Medicine of USC’s Department of Psychiatry and the Behavioral Sciences, who work in partnership to provide comprehensive and unified care across the USC campuses in order to meet the varied and unique needs of the USC student population. Our faculty are multilingual, multicultural and LGBTQ+ affirming.

Access to psychiatry and behavioral health services Patients using the USC Aetna Student Health Insurance Plan require an initial evaluation and referral from USC Student Health. All others may refer themselves to PBHS for review of health insurance benefits and scheduling. PBHS is not covered by Kaiser or MediCal at this time.

Care model While there is no limit to the number of sessions we can provide while you are a student at USC (barring any limit from certain insurance plans), the PBHS care model is designed to provide problemfocused, evidence-based treatment, which is generally 12-15 sessions or 3-6 months, on average. Some patients will need fewer visits, some more. Particularly for patients prescribed certain medications or with certain diagnoses, treatment at PBHS might continue through the entirety of matriculation at USC. We will work in partnership with you to create a care plan that fits your specific needs.

Location: Engemann Student Health Center Building 1031 West 34th Street 5th Floor Los Angeles, CA 90089

For more information, call:

(213) 764-2800

获取精神科及行为健对一些患者来说，使用其私人健康保险或南加州大学 Aetna 学生健康保险计划（SHIP）获取更全面的治疗模式，可能是最合适的。2019 年，为了应对学生可能需要的专门或更复杂护理的需求，南加州大学在 UPC 校区设立了南加州大学凯克医学精神科及行为健康服务（PBHS）。 PBHS 和南加州大学学生健康咨询及心理健康（CMH）均配备南加州大学凯克医学精神科及行为科学系的教职工，他们的合作为南加州大学各校区提供全面和统一的护理，以满足南加州大学生群体的各种独特需求。我们的教职工是多语言、多文化以及 LGBTQ+肯定的。

康服务使用南加州大学 Aetna 学生健康保险计划的患者，需要南加州大学学生健康中心的初步评估和转诊。如果有空位，所有其他患者都可以自我转诊到 PBHS，以检查其医疗保险福利并进行预约。目前，PBHS 不在 Kaiser 或 MediCal 的保险范围内。

PBHS 的护理模式旨在提供针对问题的循证治疗，治疗通常平均为 12-15 个疗程或 3-6 个月，但只要您是南加州大学的学生，我们可以提供的疗程次数是没有限制的（某些保险计划的限制除外）。有些患者需要的看诊次数较少，有些则需要较多。PBHS 的治疗可能会持续到学生从南加州大学毕业为止，特别是获得了某些药物处方或某些诊断的患者。我们将与您合作，制定符合您特定需求的护理计划。

Engemann 学生健康中心大楼 1031 West 34th Street 5th Floor Los Angeles, CA 90089

USC Psychiatry and Behavioral Health Services Time to first appointment timeline The time between referral to PBHS and your first visit may vary depending on your particular needs or preferences and clinician availability. We do our best to ensure your referral will be processed quickly so we can schedule your first appointment as soon as possible.

Referral from USC Student Health • 1-2 days CMH provider submits referral request to CMH care coordinator (CC) CC reviews and sends formal referral to PBHS Patient is registered at Keck Medicine of USC

Insurance verification • 1-3 days***

Cost of care

Insurance information shared with PBHS verifiers

As part of Keck Medicine of USC, PBHS is contracted with a number of insurers. After the insurance verification process, we consult directly with each patient to explain their expected cost of care.

Insurance company contacted for benefits/ deductible, etc.

Aetna Student Health Insurance: A copay of $20 per visit is required. Other Insurers: Not all plans are identical, even from the same insurer. During the verification process we will contact your insurer to help you estimate your cost of care. Please note this is only an estimate and may not match the actual cost of care.

Appointment scheduling • 1-5 days Patient contacted to discuss benefits Patient matched with provider Patient scheduled with provider

Patient seen at PBHS • 1-15 days

(depending on preferences and specializations)

First visit at PBHS

Total time Average time for referral process: 5-10 days Total process average time: 15-25 days

南加州大学精神科和行为健康服务从转诊至首次预约的时间线从转诊到 PBHS 至首次就诊之间的时长，可能会各有不同，影响因素包括您的特定需求或偏好，以及临床医生是否有空。我们会尽最大努力确保您的转诊得到快速处理，使我们能够尽快安排您的首次预约。

从南加州大学学生健康中心转诊 · 1-2 天 CMH 提供者向 CMH 护理协调员（CC）提交转诊请求 CC 进行审查，然后向 PBHS 发送正式转诊患者在南加州大学凯克医学注册

保险验证 · 1-3 天*** 与 PBHS 验证人员分享保险信息

护理费用作为凯克医学的一部分，PBHS 与多家保险公司签订了合同。在保险验证过程完成之后，我们会直接联系每位患者，向其说明预计的护理费用。

Aetna 学生健康保险：

联系保险公司核实赔付/免赔额等

预约安排 · 1-5 天联系患者讨论福利患者与医疗提供者匹配

每次就诊需要支付 10 美元的共付费。

患者与医疗提供者预约

其他保险公司：

患者到 PBHS 就诊 • 1-15 天

并非所有计划都是相同的，即使是来自同一家保险公司。在验

（取决于偏好和专科）

证过程中，我们会联系您的保险公司，帮助您估算护理费用。请注意，这只是一个预估，可能与实际护理费用不符。

首次到 PBHS 就诊

UPDATE TO SHIP/AETNA POLICY TRAVEL BENEFITS RELATED TO REPRODUCTIVE CARE SERVICES FOR STUDENTS (POST-DOBBS) We recognize that you may have questions about access to abortion services and related health coverage following the U.S. Supreme Court’s ruling in Dobbs. The Dobbs decision permits individual states to decide to set standards for abortion access,

Phone: 213-740-9355 (WELL) Email contact: studenthealth@usc.edu

including whether to ban or allow abortion. For individuals in California, comprehensive reproductive health care is available and protected by state law. Students participating in the Student Health Fee (SHF) while residing in California may see providers in USC Student Health for any of their reproductive care services, including in-person and telehealth visits and consultation for medication abortion, and referrals for

Information in this summary document is provided by the

procedures outside of ambulatory care.

Insurance Office of USC Student

Students on the USC Student Health Insurance Plan (SHIP, provided through Aetna) may be traveling

Health. For detailed questions

out of state during the plan year. The SHIP includes travel benefits for certain covered medical

regarding plan benefits, including

services, including abortion care services. This generally means that USC students on SHIP who

steps for filing claims, policyholders are directed to review

are outside of California and within the 48 contiguous statements and who must travel a certain

the plan documents and verify

distance (domestically) to obtain defined covered services may be entitled to reimbursement of

additional details that are

certain travel expenses for themselves and a travel companion. Additionally, the heyjane.com

available. You may access

medication abortion service by mail (available in CA, CO, CT, IL, NJ, NM, NY, WA) is available as

your Aetna plan online (www. aetnastudenthealth.com) or you may call the number listed on your insurance card. Benefit amounts are subject to maximum amounts permitted by Internal Revenue Service guidelines, per Federal Travel Limits outlined in IRS publication 502.

a covered benefit of this plan.

Who may use the plan benefits? All policyholders in the current USC Student Health Insurance Plan provided through Aetna (SHIP/Aetna) are eligible. The travel benefit may be used if you need to travel at least 100 miles to access health services for abortion.

Will anyone be informed if I have used these benefits? No. Your health insurance data is protected health information and is only accessible to you as the policyholder, and the insurance benefits processing teams.

Welcome to your safe space Hey Jane is a virtual clinic offering telemedicine abortion care that’s private, safe, supportive, accessible, and

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judgment, ever)

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clinician to answer any questions about treatment.

For now we’re serving patients who are: 8 years old

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ext us (

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STI Testing and SHIP/Aetna Health Insurance A Guide to Coverage

Phone: 213-740-9355 (WELL) Email contact: studenthealth@usc.edu

Check Yourself & Protect Yourself: Know your status. Test preventatively before sex with a new partner; and post, after potential exposure. Use condoms and dental dams. If you are at higher risk of infection, talk to your medical provider about medications for PrEP (pre-exposure prophylaxis).

Under USC SHIP (Student Health Insurance Plan, provided through Aetna), sexually transmitted infection (STI) testing is covered under preventive screening and as also as part of clinical care diagnosis. Tiers 1 & 2 are 100% coverage, no deductible applies. [USC Student Health and other Keck Medicine of USC entities are Tier 1 providers.] Tier 3 is 50% coverage, deductible applies. Students enrolled in USC SHIP can receive unlimited STI screenings without patient cost share. What this means for SHIP/Aetna policy members: 1) Routine screening STI testing that is recommended annually is covered, without cost to the patient. Tier designation of provider applies. [USC Student Health and other Keck Medicine of USC entities are Tier 1 providers.] 2) Additional frequency of testing as part of clinical care for potential exposure is covered, without cost to the patient, as this testing is part for diagnosis services (medical visit or consultation). Tier designation of provider applies. [USC Student Health and other Keck Medicine of USC entities are Tier 1 providers.] Exposure through unplanned unprotected sex, or as part of a prophylactic regimen for individuals in populations with higher risk of exposures, such as people on PrEP medications. Related information: If you are getting together with a new partner or had sex without using a barrier (condom/dental dam), it’s recommended that you test to know your status. You can order the right tests for yourself in MySHR and head to the lab without a clinical interview with a medical provider. Check out our quick guide to STI testing, (https://bit.ly/uscselfdirectedtesting). Note for students on all insurance plans: • Under the Affordable Care Act (ACA), all insurance plans must cover HIV testing for everyone ages 15-65. Coverage for other STIs such as syphilis, chlamydia, and gonorrhea, may vary, but these tests are often part of your preventive care benefits.

Information in this summary document is provided by the Insurance Office of USC Student Health. For detailed questions regarding plan benefits, including steps for filing claims, policyholders are directed to review the plan documents and verify additional details that are

Additional resources in LA County (including for partners who are non-students): • AHF Los Angeles is a leading nonprofit that offers STI testing and access to treatment; testing services are at no cost to patients, locations, including mobile testing vans, are available throughout Los Angeles and at locations nationally. (https//ahf.org) • Los Angeles County Dept. of Public Health provides an online pocket guide to free reproductive and sexual health hotlines and services. (https://pocketguidela.org)

available. You may access your Aetna plan online (www. aetnastudenthealth.com) or you may call the number listed on 11.2024

your insurance card.

Here for you Transgender services from Aetna® Helping you be you

Aetna.com

Live your best life Sometimes your gender identity doesn’t exactly match the gender you were born with. That’s called “gender dysphoria.” We’re here to support you every step of the way on your journey to expressing your gender identity. That’s why we’ve added a variety of transgender services to some of our plans. We want to help you choose the care that's right for you.

Connecting you to care Some of our plans offer transition assistance that will help you take care of your physical and behavioral health needs. We also offer benefits that will help you address your dailyliving needs after your transition. Your coverage for gender transition services depends on your health plan and on certain state and federal laws.

You may be able to get help with: • Behavioral health services • Hormone therapy and medications • Surgical services • Ongoing health and wellness support

We’re here for you You can call Aetna® Member Services for assistance at 1-877-bf^#b_d_ (TTY: 711). They can help you: • Understand and access your benefits • Get help with precertification for gender affirmation procedures • Find the doctors and facilities that work best for you

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Get the care that’s right for you Finding a provider It’s important to find a provider who understands your unique health care needs. You should feel comfortable with your provider so you can be honest and open with them and ask them any questions you have.

Getting the most from your plan Behavioral health services

Gender affirmation surgery

Your mental wellbeing is important, and we encourage everyone to visit a behavioral health provider. In fact, talking to a behavioral health provider before your gender affirmation surgery is a requirement for your transition planning. Before you can schedule a gender affirmation surgery, you will need:

If you decide to have a gender affirming surgery, we’ll be right here to help. You can call Member Services or ask your ÛÝÚáÔÏÐÝ to help you find an appropriate surgeon. (They often are not local.) Then we’ll work with your surgeon to get all of the precertifications you need. While you’re getting ready for your surgery, it’s important to stay in shape — that means eating healthy and exercising regularly.

• One letter from a behavioral health care provider for breast surgery • Two letters from behavioral health care providers for genital surgery

You may be covered for a variety of surgeries, including:

Your pÝÚáÔÏÐÝ can help you find the right behavioral health provider and services for your needs. Or you can call Member Services and ask for a list of behavioral health providers in your area.

• Removal of reproductive organs

Hormone therapy Hormone therapy can be a way to affirm your gender. You should talk to your ÛÝÚáÔÏÐÝ before starting hormone therapy. They’ll talk to you about any risks or side effects. And they'll help make sure you’re taking the right amount for your desired results. Alcohol and tobacco use raises the risk of side effects when taking hormones. Ask your provider how much alcohol is safe for you and about ways to quit smoking, especially if you are considering surgery.

• Breast reduction, removal or augmentation • Creation of exterior sexual organs You can find out which surgeries are covered or excluded and which services have limits by calling Member Services. The resources below will also give you more information about our gender affirmation policy and breast surgery providers. • Aetna standard gender affirmation clinical policy • Breast reduction and augmentation surgery providers (PDF)

Gender support services

Staying healthy after your surgery

Depending on your plan, you may be covered for a variety of other services, including:

We’ll help you take care of yourself after your surgery. You should talk to your ÛÝÚáÔÏÐÝ about safe sex and being screened for sexually transmitted diseases. You’re also covered for preventive health services based on your birth anatomy, including screenings for:

• Behavioral health services • Hormone therapy • Breast reduction, removal or augmentation • Genital surgery

• Breast cancer • Cervical cancer • Prostate cancer

We’re here with you every step of the way. To learn more about your benefits and options, just call Aetna® Member Services at 1-877-bf^#b_d_ (TTY: 711). Each benefits plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member’s benefits plan to determine if there are any applicable exclusions or other benefits limitations. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member’s plan of benefits, the benefits plan will govern.

Call out. Contact information, call X-XXX-XXX-XXXX or visit www.aetna.com

Here for you Transgender and gender-diverse people services from Aetna® Get the support you need As you begin your journey to transition your gender identity, know that we’re here to help, every step of the way. And that’s why we’ve added coverage for gender-affirming services to some of our plans. This will help you get the care that's right for you. Connecting you to care Some of our plans offer services and support that will help take care of your physical and behavioral health needs. We also offer benefits that help with daily living needs after your transition.

Based on your plan, we can help you with: • Behavioral health services • Hormone therapy and medications • Surgical services • Reproductive services • Ongoing health and wellness support, and more

Visit the Transgender & Gender Diverse Support Center at go.aetna.com/genderdiversity for helpful tools and resources.

Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Disclaimer. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Create your care team It’s important to find providers you’re comfortable with and who understand your unique needs. Keep in mind that your mental well-being is also a key part of your transition. You will have access to a transgender care personal navigator who has specialized training to provide you with dedicated support. They can also help you find doctors and explain your costs and benefits. Log in to your member website at Aetna.com or call us.

Know what’s covered Your coverage for services depends on your health plan and certain state and federal laws. So be sure to check your benefits plan, refer to the resources below or call us for help. • Aetna standard gender affirmation clinical policy • Breast (top), genital (bottom) and facial gender affirming provider (PDF)

Count on us every step of the way If you have questions or want to learn more, just call us at the number on your Aetna® member ID card.

Each benefits plan defines which services are covered, which are excluded and which are subject to dollar caps or other limits. Members and their providers will need to consult the member’s benefits plan to determine if there are any exclusions or other benefits limitations applicable. Some plans exclude coverage for services or supplies that Aetna® considers medically necessary. If there is a discrepancy between this policy and a member’s plan of benefits, the benefits plan will govern.