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:
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 email@example.com.
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.
- About your medical benefits
Local 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.
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.
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
- CVS at 400 Park Avenue in Worcester
- Walgreens at 320 Park Avenue in Worcester.