Below you will find useful information about the

Harvey Mudd College
Student Health Insurance Plan (SHIP)

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Important Messages


Use your insurance

Undergraduate students (domestic and international) will be enrolled in this plan automatically, unless you submit an approved waiver (see waiver FAQ, above).


Students enrolled in SHIP may enroll their eligible dependents in the plan by completing a form below by the deadline date each term, or the annual deadline, if purchasing a full year of coverage. Once you have filled in the form, mail it, along with payment, to the address below:

P.O. Box 240042
Los Angeles, CA 90024


Involuntary Loss of Coverage

You may enroll in SHIP mid-year if you waived out but later lose your other coverage due to no fault of your own, such as cover age that terminates due to a loss of employment (by you, your spouse, or your parent) or by reaching an age limit set by the plan. This does not include coverage that has been voluntarily or inadvertently terminated by you, for example, by missing an enrollment deadline.

To enroll in the plan mid-year after an involuntary loss of coverage, you must notify the Student Services Office on campus and submit proof of loss of coverage within 31 days of termination of prior coverage. Premium costs will be prorated based on number of full months remaining in the term. Contact Ascension Customer Service at (800) 537-1777 for an enrollment form or additional information.


Instructions for Optional Practical Training (OPT)

Students engaged in Optional Practical Training (OPT) through the College are eligible to enroll in the plan for up to one year (or the length of the OPT term, whichever is the lesser) beyond their regular course of study, provided they:

  1. Are enrolled in the coverage described in this brochure in the immediately preceding term; and
  2. Submit an enrollment form (link below) and payment by mail to Ascension within 30 days of the  termination date of the immediately preceding term; and
  3. Submit proof of Optional Practical Training (either a copy of their Employment Authorization Card or an official letter from the College stating their OPT dates).

The PPO Network for this plan has changed to AETNA.

This plan utilizes the Aetna Open Access Student MC Preferred Provider Network. To learn more about the network or find a provider, view the Aetna DocFind® online provider directory by visiting the link below. While you are allowed to visit any provider of your choosing, if you use an in-network PPO doctor or facility, you will pay less money out-of-pocket.

Contact the provider prior to your visit to confirm their membership in the network.

Click the “How to get your Aetna Student Health ID Card” link below for instructions on how to visit your school specific web page and get your ID card.


Claim forms
If the Provider does not file the claim directly with Aetna Student Health, then you can file the claim by submitting an Aetna Claim Form along with an itemized bill and proof of payment (if you paid for the service) immediately after treatment to us. Always retain copies for your records.

For prescription drug claims, to receive reimbursement, you will need to submit a claim form and the prescription receipt to Aetna. Fax your completed Aetna Prescription Drug Claim Form and receipts to 1-888-472-1128 or mail it to:

Aetna Pharmacy Management
P.O. Box 52444
Phoenix, AZ 85072-2444

Personal health information requests
We need your permission to release your Personal Health Information. Print out the PHI Request 67902-5 form and fax it to (860) 907-3017 or mail it to:

Aetna Legal Support Services
151 Farmington Avenue, RT65
Hartford, CT 06156-9998

The Pharmacy Benefit Manager for this plan is Aetna (Aetna Premier Plus). Only prescriptions filled at Aetna pharmacies are covered.  To find a pharmacy, visit their website by clicking the link below.

Additionally, please see the Preferred Formulary list and a list of preferred drug exclusions related to this plan.

A mail order discount is available for maintenance medications (taken on a regular basis); pay two copays for each 90-day supply when using the mail order discount program. To sign up, go to the Express Scripts website (link below) and set up an online account. You can also download a mail order form through the link below that you can print out and mail in with a prescription.

Included in this plan are supplemental benefits, including a Health Line, Natural Health Discounts, and several other programs. View the links below for more information

View a glossary of commonly used insurance terms, provided by the Department of Health and Human Services.