Northwestern University Northwestern University

 

 

 

 

Northwestern University

 

 

 

Please Note: The Northwestern University Student Health Insurance Plan may not cover all of your healthcare expenses. The Plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the Northwestern University Student Health Insurance Plan Brochure carefully before deciding whether this Plan is right for you. While this document will tell you about some of the important features of the Plan, other features may be important to you and some may further limit what the Plan will pay. If you want to look at the full Plan description, which is contained in the Master Policy issued to
Northwestern University, you may view it at The Risk Management Office or you may contact Aetna Student Health at (877) 626-2314.
This Plan will never pay more than $500,000 in a Policy Year. Additional Plan maximums may also apply. Some illnesses may cost more to treat and health care providers may bill you for what the Plan does not cover.

 

 

 

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Full Time Students must use this form only for the following:
-You enrolled in the NU/Aetna Student Health Insurance plan (NU Plan) and wish to Waive or Cancel the insurance before the enrollment
deadline (see Deadline Dates below),
-You have Waived the NU plan at the beginning of the Academic Year and wish to Enroll in the NU Plan
-You have undergone a life changing event: Involuntary Loss of Insurance Coverage, marriage, etc. and wish to Enroll in the NU plan.
Important Information:
-Note Full Time International Students: You will be automatically enrolled in the NU plan & do not need to use this form. Complete this
form only if you have received an approved Waiver Exemption from the NU Office of Risk Management.
-Orthotic/Prosthetic and Physician Assistant students are required to complete a hard copy of this form. You can not complete the online
form via CAESAR.
-Continuing Education, Part Time and students on Medical Leave of Absence will need to complete a Part Time Application in the Insurance
Office located at: 633 Emerson Street (Searle Building) Evanston Campus or call (847) 491-4134 or 2113. Chicago Campus location:
357 East Chicago Ave #131 (Rubloff/Law School Administration Building) or call (312) 503-1242

 

 

 

 

 

J-1 .J-2 INSURANCE

 

 

To qualify for a waiver, supplied health insurance must, at a minimum, meet the following requirements:

  • Medical benefits of at least $100,000 per accident or illness
  • Coverage for repatriation of remains in the amount of $7,500
  • $10,000 for expenses associated with medical evacuation
  • Deductible not to exceed $250 per accident or illness
  • Co-insurance provision can be no greater than 25%
  • Out-of-pocket expenses not to exceed $2,000 per year
  • Pre-existing conditions must be covered (no exclusions, no waiting period)

 

 

 

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https://www.aetnastudenthealth.com/schools/northwestern/brochure1112.pdf

 

 

 

ENROLLMENT/WAIVER DEADLINES

Waiver Deadline Dates:


Annual/Fall Quarter October 3, 2011


Winter Quarter* February 13, 2012


Spring Quarter* April 9, 2012


Summer Quarter* July 9, 2012


*Only students whose programs begin during the Winter, Spring or Summer quarter are eligible to submit a
coverage selection form to accept or decline the Northwestern Student Health Insurance Plan

 

         

 

 

        

     

 

       

      

 

 

 

 

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Evanston Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Hospital - Rehabilitation, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery - Transplant, Surgery Center
Estimated Distance: 0.9 miles
2650 Ridge Ave
Evanston, IL 60201-1718
847-570-2000

 
St Francis Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 2.1 miles
355 Ridge Ave
Evanston, IL 60202-3328
847-316-4000
 
North Shore University Health System-Skokie Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Obstetrics, Occupational Therapy, Outpatient Facility, Physical Therapy, Psychiatry, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 3.3 miles
9600 Gross Point Rd
Skokie, IL 60076-1214
847-677-9600
 
Kindred Chicago Lakeshore
Specialty: Hospital - General
Estimated Distance: 4.3 miles
6130 N Sheridan Rd
Chicago, IL 60660-2830
773-381-1222
 
Swedish Covenant Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Hospital - Rehabilitation, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Pediatric Psychiatry, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 5.5 miles
5145 N California Ave
Chicago, IL 60625-3661
773-878-8200
 
Chicago Lakeshore Hospital
Specialties: Hospital - Chemical Dependency, Hospital - Psychiatric, Substance Abuse
Estimated Distance: 5.8 miles
4840 N Marine Dr
Chicago, IL 60640-7860
773-878-9700
 
Kindred Hospital Chicago North
Specialty: Hospital - General
Estimated Distance: 6.4 miles
2544 W Montrose Ave
Chicago, IL 60618-1537
773-267-2622
 
Kindred Hospital Chicago North
Specialty: Hospital - General
Estimated Distance: 6.4 miles
2544 W Montrose Ave
Chicago, IL 60618-1537
773-267-2622
 
Thorek Memorial Hospital
Specialty: Hospital - General
Estimated Distance: 6.9 miles
850 W Irving Park Rd
Chicago, IL 60613-3077
773-525-6780
 
Advocate Illinois Masonic Center
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Outpatient Facility, Physical Therapy, Psychiatry, Radiology, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 8.2 miles
836 W Wellington Ave
Chicago, IL 60657-5147
773-975-1600
 
Kindred Chicago Central Hospital
Specialty: Hospital - General
Estimated Distance: 8.3 miles
4058 W Melrose St
Chicago, IL 60641-4799
773-736-7000
 
Kindred Chicago Central Hospital
Specialty: Hospital - General
Estimated Distance: 8.3 miles
4058 W Melrose St
Chicago, IL 60641-4799
773-736-7000
 
Resurrection Medical Center
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 8.4 miles
7435 W Talcott Ave
Chicago, IL 60631-3707
773-774-8000
 
St Joseph Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Outpatient Facility, Physical Therapy, Rehabilitation, Occupational & Physical Therapy, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 8.4 miles
2900 N Lakeshore Dr
Chicago, IL 60657-5640
773-665-3000
 
Our Lady of the Resurrection Medical Center
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Laboratory, Occupational Medicine, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 8.8 miles
5645 W Addison St
Chicago, IL 60634-4403
773-282-7000
 
Advocate Lutheran General Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Emergency Medicine, Hospital - General, Hospital - Psychiatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Outpatient Facility, Pediatric Psychiatry, Physical Therapy, Psychiatry, Radiology, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 9 miles
1775 Dempster St
Park Ridge, IL 60068-1143
847-723-2210
 
Childrens Memorial Hospital
Specialty: Hospital - Pediatric
Estimated Distance: 9 miles
2300 N Childrens Plz
Chicago, IL 60614-3363
773-880-4000
 
Glenbrook Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Home Health, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Hospital - Rehabilitation, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Skilled Nursing Facility, Substance Abuse, Surgery - Cardiovascular, Surgery - Transplant, Surgery Center
Estimated Distance: 9.4 miles
2100 Pfingsten Rd
Glenview, IL 60026-1301
847-657-5800
 
Saints Mary and Elizabeth Medical Center, Division Street
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Obstetrics, Occupational Therapy, Outpatient Facility, Pediatric Psychiatry, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 10.4 miles
2233 W Division St
Chicago, IL 60622-8151
312-770-2000
 
Holy Family Medical Center
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Physical Therapy, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 11 miles
100 N River Rd
Des Plaines, IL 60016-1209
847-297-1800

 

 

Northwestern Memorial Hospital
Specialty: Hospital - General
Estimated Distance: 11.3 miles
251 E Huron St
Chicago, IL 60611-2908
312-926-2000

 
Rehabilitation Institute of Chicago
Specialties: Hospital - Rehabilitation, Outpatient Facility, Physical Therapy, Rehabilitation, Occupational & Physical Therapy
Estimated Distance: 11.3 miles
345 E Superior St
Chicago, IL 60611-2654
312-238-1000
 
Rehabilitation Institute of Chicago
Specialties: Hospital - Rehabilitation, Outpatient Facility, Pathology - Speech, Physical Therapy, Rehabilitation, Occupational & Physical Therapy
Estimated Distance: 11.3 miles
345 E Superior St
Chicago, IL 60611-2654
312-238-1000
 
Highland Park Hospital (Nuhs)
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Obstetrics, Occupational Therapy, Outpatient Facility, Pediatric Psychiatry, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery - Transplant, Surgery Center
Estimated Distance: 11.6 miles
777 Park Ave W
Highland Park, IL 60035-2433
847-432-8000
 
Rush University Medical Center
Specialty: Hospital - General
Estimated Distance: 12.3 miles
1653 W Congress Pkwy
Chicago, IL 60612-3833
312-942-5000
 
West Suburban Medical Center
Specialties: Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Neonatal and Perinatal Medicine, Obstetrics, Occupational Therapy, Physical Therapy, Rehabilitation, Occupational & Physical Therapy, Surgery - Cardiovascular
Estimated Distance: 12.3 miles
3 Erie Ct
Oak Park, IL 60302-2519
708-383-6200
 
Advocate Bethany Hospital
Specialties: Ambulatory Surgical Center, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Neonatal and Perinatal Medicine, Obstetrics, Occupational Therapy, Outpatient Facility, Physical Therapy, Rehabilitation, Occupational & Physical Therapy, Skilled Nursing Facility, Substance Abuse, Surgery Center
Estimated Distance: 12.4 miles
3435 W Van Buren St
Chicago, IL 60624-3312
773-265-7700
 
University of Illinois Medical Center at Chicago
Specialty: Hospital - General
Estimated Distance: 12.7 miles
1740 W Taylor St
Chicago, IL 60612-7232
866-600-2273
 
Gottlieb Memorial Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 13.2 miles
701 W North Ave
Melrose Park, IL 60160-1612
708-681-3200
 
Gottlieb Memorial Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 13.2 miles
701 W North Ave
Melrose Park, IL 60160-1612
708-681-3200
 
Rush Oak Park Hospital
Specialty: Hospital - General
Estimated Distance: 13.7 miles
520 S Maple Ave
Oak Park, IL 60304-1022
708-383-9300
 
St Anthony Hospital
Specialty: Hospital - General
Estimated Distance: 13.7 miles
2875 W 19th St
Chicago, IL 60623-3501
773-521-1710
 
Hartgrove Hospital
Specialties: Hospital - Chemical Dependency, Hospital - Psychiatric
Estimated Distance: 13.8 miles
5730 W Roosevelt Road
Chicago, IL 60644-1226
773-413-1700
 
Westlake Hospital
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery Center
Estimated Distance: 14.3 miles
1225 W Lake St
Melrose Park, IL 60160-4039
708-681-3000

 

 

 

 

 

 
Mercy Hospital and Medical Center
Specialties: Ambulatory Surgical Center, Cardiac Rehabilitation, Critical Care Medicine, Emergency Medicine, Hospital - General, Hospital - Pediatric, Hospital - Psychiatric, Laboratory, Neonatal and Perinatal Medicine, Obstetrics, Occupational Medicine, Occupational Therapy, Outpatient Facility, Pediatric Psychiatry, Physical Therapy, Psychiatry, Rehabilitation, Occupational & Physical Therapy, Substance Abuse, Surgery - Cardiovascular, Surgery - Transplant, Surgery Center
Estimated Distance: 14.5 miles
2525 S Michigan Ave
Chicago, IL 60616-2333
312-567-2000

 

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