UNIVERSITY OF WASHINGTON STUDENT HEALTH INSURANCE PLAN - SHIP

1. UNIVERSITY OF WASHINGTONSTUDENT HEALTH INSURANCE PLAN - SHIP 2013-2014 POLICY YEAR 9/20/13 - 9/19/14

2. SHIP HIGHLIGHTS MEDICAL COVERAGE • One Preventative Care Physical is free from deductible per year if received at or through Hall Health • Sickness, illness and injury at any participating care provider (subject to deductible and copay) • Mental Health visits (subject to deductible and copay – deductible waived at Hall Health) • Emergency Care (subject to deductible and copay) • Prescription medication (purchased at Rubenstein Pharmacy or UWMC/UWP with limited benefits at other participating pharmacies) • Some services are not covered by this plan – see booklet on website (http://www.washington.edu/ship/) • In-network care providers covered at 75% of allowable charges, Out-of-network care providers covered at 60% of allowable charges (see student.lifewiseac.com for list of network providers) • $100 deductible per quarter, maximum of $400 deductible per year for student only • How the math works: If you go to a network provider to be treated for the flu and the doctor charges you $200 for the visit. You would pay the first $100 deductible (once per quarter), the insurance would pay $75 and you would pay $25. This same example after the deductible has been met, the insurance would pay $150 and you would pay $50. DENTAL COVERAGE • Preventative Care (maximum of 2 routine oral exams per year) • Restorative Care (such as fillings, crowns or root canals) • Maximum benefit is $300 per plan year • $25 copay per plan year VISION COVERAGE • Routine eye exam no charge up to $150 per plan year

5. DATES OF COVERAGE • AUTUMN QUARTER SEPTEMBER 20, 2013-JANUARY 5, 2014 • WINTER QUARTER JANUARY 6, 2014-MARCH 30, 2014 • SPRING QUARTER MARCH 31, 2014-JUNE 22, 2014 • SUMMER QUARTER JUNE 23, 2014-SEPTEMBER 19, 2014 THE ANNUAL PLAN RUNS FROM AUTUMN THROUGH SUMMER QUARTER PROVIDING 4 QUARTERS OF COVERAGE (AUTUMN, WINTER, SPRING, & SUMMER QUARTERS)

6. SHIP PREMIUMS for 2013/2014 • (1) Includes 2014 ACA Fees • (2) Includes ACA required fee for the last 3 quarters in 2014

7. INSURANCE DEFINITIONS • MAXIMUM BENEFIT: $500,000 PER CONDITION AGGREGATE (TOTAL) MAXIMUM • DEDUCTIBLE: $100 PER QUARTER MEDICAL; $25 DENTAL PER POLICY YEAR • THE AMOUNT OF COVERED EXPENSES YOU HAVE TO PAY BEFORE THE PLAN PAYS ANY BENEFITS • DOES NOT APPLY TO PREVENTATIVE CARE VISITS, PHARMACY, HALL HEALTH UNLESS LAB WORK PERFORMED BY OUTSIDE LAB • COINSURANCE: NETWORK PROVIDER PAYS 75% / YOU PAY 25%; NON-NETWORK PROVIDER PAYS 60% / YOU PAY 40% • COPAYMENT: SPECIFIED DOLLAR AMOUNT YOU MUST PAY FOR SERVICES; COPAYMENT IS NOT PART OF DEDUCTIBLE OR COINSURANCE • NETWORK PROVIDER: PROVIDERS WHO HAVE CONTRACTED WITH LIFEWISE TO PROVIDE CARE AT A DISCOUNT

8. STUDENT INSURANCE VIDEOS CHECK OUT OUR WEBSITE TO VIEW THE FOLLOWING VIDEOS: http://www.washington.edu/ship/ • SELECTING STUDENT INSURANCE • HOW UW SHIP WORKS • UNDERSTANDING IN-NETWORK & NON-NETWORK COVERAGE • UNDERSTANDING DEDUCTIBLES, CO-PAYS, INSURANCE, BILLING, & CLAIMS • WHAT TO EXPECT AT A TYPICAL DOCTOR’S VISIT

9. CONTACT US Student Insurance Office: 206-543-6202 http://www.washington.edu/ship/ LifeWise Assurance Company 800-971-1491 www.student.lifewiseac.com Graduate Appointee Insurance Plan – GAIP 206-543-2800 http://www.washington.edu/admin/hr/benefits/insure/gaip/