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2013-2014 Student Health Insurance Plan Overview
Contact Information Ascension Benefits and Insurance Solutions (Plan Administrator) For CIGNA PPO information, brochures, FAQs, ID cards, or eligibility questions – Hours: 8:00 am- 5:00 pm, Monday-Friday – Phone: (800) 537-1777 – Fax: (310) 394-0142 – Website: www.4studenthealth.com/touro Personal Insurance Administrators (Claims Payer) For questions about eligibility, benefits, or claims – Hours: 8:00 am- 5:00 pm Monday; Thursday, 8:00 am- 4:00 pm Friday – Phone: (877) 358-3727 – Website: http://www.piaclaims.com – Claims Mailing Address: GWH-Cigna, 1000 Great-West Drive, Kennett, MO 63857-3749
Terms to Know • Claim – The total bill to the insurance company for a covered illness or injury • Co-pay – The fixed amount that you are responsible for paying at the time of service each time you see a doctor or go to the hospital. • Coinsurance – The sharing of the cost of the medical services between the insurance company and you. • Deductible – The amount that you may have to pay before the insurance company begins to pay benefits. • Exclusions – Specific conditions or situations that are not covered by the plan. • Preferred Provider Organization (PPO) – The network of providers who have contracted with the insurance company to provide discounted rates for services. • Premium – The cost of the insurance coverage. Note: You must maintain coverage the entire time you are enrolled in school. • Provider – A doctor, hospital, medical facility or ambulance that is licensed to provide medical care. • Usual, Reasonable & Customary (URC) or Reasonable & Customary (R&C) – The most common charge for similar medical services or treatment within the same geographical area.
How does PPO insurance work? In health insurance, a preferred provider organization (PPO) is a network of medical doctors, hospitals, and other health care providers who have contracted with an insurer to provide health care at reduced rates. Your PPO network is CIGNA, and your coinsurance when you use CIGNA providers (also known as in network providers) is 0% for covered expenses, meaning that the insurance will pay for 100% of covered charges. If you go to a medical doctor, hospital, or other health care provider that is not in the CIGNA PPO network (also described as out of network), your coinsurance is 20% for covered charges, meaning that the insurance will only pay for 80% of covered charges. You are responsible for paying for what your insurance does not cover.
How to I obtain an ID card? Your ID cards will be sent to you after the first week of the Fall term (or Spring if you are newly enrolled). If you have enrolled dependents, they should use your card. You will receive a separate ID card for prescriptions from Express Scripts, but you may use your SHIP ID card to get prescriptions in the meantime. Keep your IDs card for the full academic year. Do not throw away your cards until you receive new ones the next academic year. If you lose your cards, download a temporary ID card from www.4studenthealth.com/touro and call Ascension at (800) 537-1777 to request replacements.
It is very important to have proof of insurance coverage in order to receive prompt medical treatment! Keep your ID card with you at all times!
What is covered by this insurance? 2013-14 Plan Benefits • $500,000 plan maximum per policy year for all conditions • Coverage of preventive services (as defined by the Affordable Care Act) at 100% in network (deductible and co-pays waived) and 80% out of network (deductible and co-pays apply) • Outpatient prescription drug benefit paid up to $500,000 per policy year under the Express Scripts Network • Policy year deductible of $250 in network/$500 out of network • Office visit co-pay of $20 in network/$40 out of network • Emergency room co-pay of $150 per visit, waived if admitted • Outpatient physical therapy/chiropractic/OMM benefit maximum of 20 visits per policy year • Coverage for routine Antibody Titers testing incorporated, paid at 100% innetwork, 80% out-of-network (deductibles and copays waived)
What is covered by this insurance? This plan does NOT cover: • Dental or vision care, including eye examination or routine dental examinations (dental treatment due to injury is covered, at $100 per tooth maximum) • Cosmetic procedures, unless due to an injury or sickness • Pre-Existing Conditions*, for the first 6 months of the policy, unless you had continuous coverage under other insurance for at least a full 6 months immediately preceding this plan. *A Pre-Existing Condition is a Sickness or Injury for which medical care, treatment, diagnosis or advice was received or recommended within the six (6) consecutive months prior to the Covered Person’s Effective Date of coverage under the Policy.
How do I get medical treatment? Go to the Emergency Room only in the event of a life-threatening injury or illness. For injuries that are not life-threatening but that require immediate attention, visit an Urgent Care Center. You can find Urgent Care locations near you by visiting www.cigna.com.
For injuries and illnesses that are not life-threatening or urgent, you can either visit the student health center on campus or you can schedule an appointment with a doctor. To find a provider that is in network, check the CIGNA PPO listing for preferred doctors and hospitals at www.cigna.com. When you go to the doctor, show them your ID card and pay the co-pay. Remember, you do not have to go to a PPO network provider, but you will save a lot of money if you do.
What do I do when I receive a bill? After you receive treatment at a PPO provider, your provider will submit a claim to the insurance company. In some circumstances, such as using a non-PPO provider, you may be asked to pay up-front. In this case, submit a claim for reimbursement by sending all itemized hospital and medical bills, along with a copy of your health insurance ID card to the address below: GWH-Cigna 1000 Great-West Drive Kennett, MO 63857-3749 • Claims are usually processed in 7-10 days. If you have questions about the status of your claim after it has been submitted, please call Personal Insurance Administrators (PIA) at (877) 358-3727 or visit www.piaclaims.com. • Be sure to keep copies of all documents submitted to CIGNA.
The truth about medical bills Medical bills are not automatically paid. Providers typically submit claims electronically. However, please keep in mind that ultimately it is your responsibility to send the insurance company the documentation they need to promptly process your claim. The insurance does not necessarily cover everything, so check the brochure or call Personal Insurance Administrators (PIA), the claims administrator, before you have a procedure to make sure it will be covered. You are ultimately responsible for any charges not covered by the insurance.
How do I Prescriptions Filled? To locate a network pharmacy and to manage your medications (including refills and home delivery), contact Express Scripts, Inc. at 1-800-447-9638 or by visiting www.express-scripts.com. Only prescriptions filled at an express scripts pharmacy will be covered.
Student Health Services Touro University California- Student Health Services is located at 1310 Club Drive, Wilderman Hall, Room 114 Business Hours: Monday-Thursday 8am-5pm; Friday 8am-3pm. Extended Business Hours*: 1st & 3rd Tuesday of the Month: 8:00am-6:30pm * Students and visitors are strongly encouraged to verify availability of extended hours prior to arrival as this schedule may be impacted by holidays, illness, vacations or periods when classes are not in session.
Please contact the SHS for services offered. Telephone: (707) 638-5220 Fax: (707) 638-5261
Please call us if you have questions about this presentation or the brochure. We are happy to assist you!