Health Insurance Basics
Health Insurance Terminology
The fee you pay for covered services, usually due at the time you receive care. For example, you might pay a $15 copay to see a primary care doctor or specialist.
The financial part of a medical service you’re responsible for. For example, you might pay 20% of the cost for a particular service, and the health insurance plan will pay the remaining 80%.
The amount you have to pay toward medical costs before your health insurance plan starts paying part of the bill.
An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm or death.
Out of pocket maximum
The maximum amount of money you’ll have to pay for health care in a year. After you meet the maximum, your health insurance plan covers 100% of all eligible costs for the rest of the plan year.
A group of healthcare providers and facilities—including doctors, hospitals, and labs—that contract with your healthcare plan to provide services at negotiated discount rates. You’ll usually pay less when you use a network healthcare provider. WPI SHIP contracts with United Healthcare/Student Resources to provide access to its extensive network of hospitals and providers. In-network options for students enrolled in the WPI student health insurance plan can be found here:
HealthiestYou virtual counseling is available to students that are enrolled in the WPI student health insurance plan. Please use the HealthiestYou app to request a virtual counseling appointment that fits your schedule.
Health care professionals, hospitals, clinics, and labs that do not belong to the United Healthcare network. You’ll typically pay more and may need to file a claim for payment.
Written authorization given by the student health center (SHC) to seek care outside of the SHC for medically necessary services.
Maximum Allowed Amount
The total reimbursement payable under your plan for covered services you receive in-network and out-of-network providers. It is the claims administrator’s payment toward the services billed by your provider, combined with any deductible or coinsurance you may owe. If you receive services from an out-of-network provider, the provider will bill you the different, if any, between their charges and the maximum allowed amount.
Health insurance tips
How does the US healthcare system work?
The following video is a great resource and teaches students how the U.S. healthcare system works, and how students should seek appropriate medical care if they become sick or injured.
HealthCare in the US can be very complex and confusing. We encourage students who have questions about their coverage or any billing to contact our representative at United Healthcare via e-mail at firstname.lastname@example.org.
Your insurance card
Always keep your health insurance card with you. You will need to present this card whenever you seek medical attention in the United States. If you have the WPI Student Health Insurance you can obtain a copy of your card through the UHC Student Resources App (Apple or Android).
Finding medical and mental health providers
To best utilize your student health insurance, you will need to search for local providers (medical providers and mental health providers) in the United Healthcare/Harvard Pilgrim Network to ensure that your insurance is accepted at their practice. It is also helpful to utilize the “My Account” feature of the student health insurance. Instructions on how to access this feature can be found here.
After your appointment
Following your appointment, you may receive an Explanation of Benefits (EOB). Always review your EOB for errors or uncovered expenses. An EOB is a description of payments issues by the insurance company after a claim has been processed. The EOB will also state the remaining amount that may be owed by the policyholder (you, the student) to the medical provider. Note: this is not a bill, but an explanation of covered expenses. You will likely receive a bill directly from your medical provider that you must pay.
Local physical and mental healthcare options
WPI Student Health Services
WPI Student Health Services provides medical care to WPI students; more information can be found here. All WPI undergraduate students pay the Health and Wellness Fee on an annual basis; Graduate students are not required to pay the health fee since many already have, and are, using outside medical providers of their own choosing.
If you are a graduate student and wish to be seen at WPI Student Health Services for medical care of acute illness or injury, please call the WPI Bursar’s Office and request to pay the Health and Wellness Fee, or you can complete the following online form.
Mental Health Resources
The Student Development & Counseling Center (SDCC) provides free and confidential counseling, guidance, and support––or just someone to talk to––24/7. Please visit the SDCC page for more mental health resources on the WPI campus and within the greater Worcester Community.
HealthiestYou virtual counseling is available to students that are enrolled in the WPI student health insurance plan. Please use the HealthiestYou app to request a virtual counseling appointment that fits your schedule. This informational video provides more information about how to access this service.
Urgent care offices provide a wide range of medical care with extended hours and on weekends. These offices can provide a higher level of care than WPI Student Health Services, but not as high a level of care as a hospital emergency department. Students can be seen at the local urgent care locations on a walk-in basis. Urgent care offices can provide x-ray and electrocardiogram (EKG) services as well.
Please explore the different urgent care locations below to see what they have to offer their patients.
- CVS Minute Clinic located at 44 West Boylston Street in Worcester
- ReadyMed Urgent Care at 366 Shrewsbury Street in Worcester
- AFC Urgent Care at 117 Stafford Street in Worcester
Urgent care offices may bill you or charge a copayment based on your health insurance plan. Please call your health insurance plan directly to determine the cost.
Virtual general medical visits are available to students that are enrolled in the WPI student health insurance plan. Please use the HealthiestYou app to request a virtual medical or counseling appointment that fits your schedule. This informational video provides more information about how to access this service.
Emergency departments and hospitals provide 24/7 care for emergent illnesses and injuries that cannot wait to be treated. You do not need an appointment to be seen at an emergency department, you can walk in at any time, but may have to wait.
If you are experiencing a medical emergency on campus and need an ambulance, please call campus police at 508-831-5555 or if you are off campus call 911.
The closest hospitals and emergency rooms to the WPI campus are:
- UMass Memorial Medical Center- Memorial Campus at 119 Belmont Street Worcester
- UMass Memorial Medical Center- University Campus at 55 Lake Avenue North Worcester
- Saint Vincent’s Hospital at 123 Summer Street Worcester.
Emergency departments may bill you or charge a copayment based on your health insurance plan. Please call your health insurance plan directly to determine the cost. Visits to the emergency department can be expensive but required for life threatening illnesses and injuries.
Several pharmacies are located within a short distance from campus and are available for all your medication needs, including over the counter and prescription medications.
The closest pharmacies to campus are:
- CVS at 44 West Boylston Street in Worcester (1.2 mile walk from the WPI Quad)
- CVS at 400 Park Avenue in Worcester (1.4 mile walk from the WPI Quad)
- Walgreens at 320 Park Avenue in Worcester (1.2 mile walk from the WPI Quad)
How to use your health insurance
I just enrolled with WPI's student health insurance plan. What do I do next?
- Download a copy of your insurance card to your phone, and keep another physical copy with you at all times.
- If you have any chronic health problems (including behavioral health diagnoses) and are hoping to seek care for these medical conditions while studying in the U.S., consider getting set up with a primary care medical provider.
- Familiarize yourself with your insurance card (please note, there may be slight differences in the insurance card’s appearance from academic year to academic year).
- “Insured” should have the name of the policy holder – in this case, it is your name.
- SR ID: This is your member ID, and is oftentimes requested by medical offices for billing purposes.
- Policy #: This is a number that an insurance company uses to identify benefits that an individual has. This is also oftentimes requested by medical offices for billing purposes.
- Copays: These are fixed amounts that you are responsible for paying for covered healthcare services. In this sample card, for covered office visits (OV), a member will pay $10 per visit. Similarly, if a member is evaluated at an emergency department, the member will pay $100 for this visit.
- DED IND/FAM: This is your deductible amount, which is the amount you owe for in- network healthcare services before your insurance company will begin to help pay. For example, if your deductible is $500, you will need to pay a total of $500 in associated covered healthcare services before Harvard Pilgrim will start paying.
- Please note, for the ’23-24 academic year, there is no deductible associated with the student health plan.
- OOPM IND/FAM: This is your out-of-pocket maximum, which is the maximal amount you will pay during the policy year (usually 1 year). For the sample card, the OOPM is $5,000 for individuals and $10,000 for any family (applies when dependents or spouses are enrolled on the plan).
- Please note, the OOPM does not include charges that the health insurance plan does not cover. For example, if you utilized an out-of-network provider for healthcare, and they bill you $1,250, this amount will not count towards the $5,000 OOPM previously outlined.
- The customer service phone number can be used if a student has questions about a recent bill they have received or with other questions regarding the health insurance plan.
I’m looking for more specific information regarding my insurance. Where should I look?
I’m sick/hurt and I want to be evaluated. What’s the difference between the hospital emergency room and an urgent care clinic?
Urgent care clinics are generally walk-in clinics that are equipped to deal with urgent, but non-life threatening medical conditions. Meanwhile, emergency rooms or emergency departments are walk-in, hospital-based locations that are equipped to deal with major and/or life-threatening medical conditions.
I have these symptoms. Where do I go next?
Emergency room/department **
Cold and flu-like symptoms (e.g. cough, congestion, sore throat, low grade fever, body aches, fatigue, mild headache)
Chest pain or feeling that the heart is beating irregularly or too fast
Ligament sprains and muscle strains
Shortness of breath or difficulty breathing
Mild abdominal pain
Severe abdominal pain
Urinary tract infection symptoms
Allergic reactions causing facial swelling, throat tightness, difficulty swallowing, shortness of breath or difficulty breathing
Minor wounds such as burns and small lacerations, abrasions, or cuts
Severe injuries (e.g. broken bones or dislocated joints, large or deep lacerations, persistent bleeding)
Vomiting and/or diarrhea
High, sustained fevers (>103F or >39.4C)
Severe head injuries with or without loss of consciousness
Sexually transmitted infection (STI) screening
Severe headaches or seizures
Ear pain or changes in hearing
Mental health crises, or intent of harming self or others
Concern for conjunctivitis (also commonly known as “pink eye”)
Weakness or numbness to one side of body or to one limb
Genitourinary symptoms (e.g. vaginal or penile itch, pain, discharge)
Sexual assault, physical assault, or injuries from car accidents
**Emergency room visits and being transported via an ambulance are oftentimes much more expensive than an urgent care visit. Please note, an urgent care clinic may still recommend you go to an emergency room/department if they deem your medical presentation requires a higher level of care than they can provide.
Where is the nearest urgent care clinic or emergency room?
- Urgent care clinics
- ReadyMed Plus on 366 Shrewsbury St, Worcester, MA 01604
- CareWell Urgent Care on 500 Lincoln St, Worcester, MA 01605
- AFC Urgent Care on 117 Stafford St, Worcester, MA 01603
- CVS Minute Clinic on 44 W. Boylston St, Worcester, MA 01605
- Limited services – please check above link to view available services
- Emergency rooms/departments
- UMass Memorial (Memorial campus) on 119 Belmont St, Worcester, MA 01605
- Saint Vincent Hospital on 123 Summer St, Worcester, MA 01608
- UMass Memorial (University campus) on 55 Lake Avenue North, Worcester, MA 01655
I am going to make a medical appointment but how will I give them my insurance information and what is the payment process like?
- When you schedule your appointment over the phone, the medical office staff will collect your insurance information ahead of time.
- If you do not provide your insurance information at the time of scheduling the appointment, you will likely need to provide that information when you arrive to check in for your appointment – so make sure to bring a copy of your insurance card with you.
- You will need to pay any copays if applicable.
- You will see your medical provider.
- Once your visit is over, your medical provider will bill the health insurance company for services that the provider rendered (performed) during the visit.
- Your insurance company will process this claim from this medical provider and will pay its share accordingly. You may need to then pay the remaining cost to the medical office depending on your insurance plan’s coinsurance amount.
Still have questions?
Feel free to call or email WPI Student Health Services (SHS) and we will do our best to answer those questions and help guide you in the right direction!
WPI Student Health Services
Daniels Hall, 84 Institute Rd, Worcester, MA 01609
Tel: 508-831-5520 | Fax: 508-831-5953 | Email: SHS@wpi.edu