Student Health Insurance for
Florida A&M University

Check back next week
for the 2014-2015 plans.

Many students and their dependents will require health care at some time during the school year. 

You should consider this insurance if you:

currently do not have any health insurance.

have health insurance but it has a deductible and/or co-payments that will leave you paying out-of-pocket expenses.

you have health insurance but it is a PPO, HMO or other insurance plan that has coverage restrictions.

Check your current policy concerning ....

need for medical care away from your local network, such as when you are at school and 

the maximum age for coverage

 



This insurance policy is endorsed by Florida A&M University for the Eligible Students and their Eligible Dependents. Many students and their dependents will require health care at some time during the school year. The University recommends that you take a look at this plan and give it serious consideration.

Brochure

Enrollment Form

50+ Most Frequently Asked Questions

FAQ: Benefits

FAQ: Coverage

FAQ: Cost

FAQ: Enrollment Process

FAQ: How to Use

 

 

 

 

    

50+ Frequently Asked Questions

Benefits of the Plan

 

What does the plan cover and is there a deductible?

 

 

check back next week for the 2012- 2013 plan
2011-12 FAMU Plan

Maximum Benefit

Student

$50,000 for each Injury or Sickness.

Dependents

$50,000 for each Injury or Sickness.

Deductible

In Network

$100 for Each Injury or Sickness

Out of Network

$200 for Each Injury or Sickness

Coinsurance

In Network

80% except as noted in the Schedule of Benefits

Out of Network

60% except as noted in the Schedule of Benefits

 

Please see brochure for more details.

Does the plan provide maternity benefits?

Yes. Maternity is treated as any other illness. Conception must occur after the Insured’s effective date of coverage. Maternity is treated as any other illness. Conception must occur after the Insured’s effective date of coverage.

 

Does the plan cover pre-existing conditions?

PRE-EXISTING CONDITION means any condition which manifested itself in such a manner as would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment or for which medical advice, diagnosis, care or treatment was recommended or received within the 12 months immediately prior to the Insured's Effective Date under this policy. Routine follow-up care to determine whether a breast cancer has recurred in a person who has been previously determined to be free of breast cancer does not constitute medical advice, diagnosis, care, or treatment for purposes of determining preexisting conditions unless evidence of breast cancer is found during or as a result of the follow-up care.

 

Pre-existing Conditions will apply for the first 12 months, except for individuals who have been continuously insured under the school's student insurance policy for at least 12 consecutive months. Credit will be given for the time the Insured was covered under s similar plan if the previous coverage was continuous to a date not more than 63 days prior to the Insured's Effective Date under this policy

 

Does the plan pay for prescriptions?

Yes. When you require prescribed medicines, the Plan pays the 80% of Usual & Customary Charges up to a maximum benefit of $500 per policy year. The deductible is $20 per prescription.

 

Does the plan cover health related conditions when I am out of the country?

Yes. The plan provides coverage 24-hour a day anywhere in the world.

 

If you are a student insured with this insurance plan, you and your insured spouse and minor child(ren) are eligible for Scholastic Emergency Services (SES). The requirements to receive these services are as follows:

 

Domestic Students, insured spouse and insured minor child(ren): You are eligible for SES when 100 miles or more away from your campus address and 100 miles or more away fromyour permanent home address or while participating in a Study Abroad program. 

 

SES includes Emergency Medical Evacuation and Return of Mortal Remains that meet the US State Department requirements. The Emergency Medical Evacuation services are not meant to be used in lieu of or replace local emergency services such as an ambulance requested through emergency 911 telephone assistance. All SES services must be arranged and provided by SES, Inc., any services not arranged by SES, Inc. will not be considered for payment.

Please visit your school's insurance coverage page at www.firststudent.com for the SES Global Emergency Assistance Services brochure which includes service descriptions and program exclusions and limitations

           

            To access services please call:

            (877) 488-9833 Toll-free within the United States

            (609) 452-8570 Collect outside the United States

 

Does the plan include a Preferred Provider Organization Network?

Yes, the plan uses the United Healthcare Option PPO network. A list of physicians and hospitals is available at:

 

                         www.firststudent.com –click on Find Doctor or Hospital,

                         or by calling 1-800-505-4160

 

Does the insurance plan include an Emergency Room Expense Benefit?

            Yes. The Emergency Room Expense Benefit is paid:

            Preferred Provider: 80%; $250 maximum

            Out of Network:  60% under the Outpatient Miscellaneous Benefit

 

Does the insurance plan include a dental benefit and Discount Prescription, Dental & Vision Plans?

Yes, the plan includes a dental benefit for injury to sound natural teeth in the amount of the usual & customary charge up to $500 maximum.

 

The plan includes the United Health Allies Discount Plan. For more information please click on:

www.firststudent.com

 

            UnitedHealth Allies Discount Card includes:

 
Dental Care:
Save from 10% to 35% on a range of dental services including routine cleaning, x-rays, even cosmetic dentistry, such as teeth whitening.
 
Vision Care:
Pay no more than $40 for an annual eye exam, save 10% to 20% on eyeglasses from participating eye care professionals and retail vision chains and fittings for contact lenses (not included in annual eye exams).
 
Wellness products and services:
Be healthier and save money with discounts of 10% to 50% on weight management, fitness memberships and equipment, relaxation resources, natural products and vitamins and supplements.

 
Prescription drugs:
Save at the pharmacy or through the mail. Not available on plans that utilize the United Healthcare Network Pharmacy Program (Medco).

 

Your UnitedHealth Allies ID card will be delivered along with your student health insurance ID card. Once received, log onto www.sr.unitedhealthallies.com, and register to begin using the program immediately.

 

 

 

Coverage Periods

 

What coverage periods are available? How long of a time period am I covered?

The plan may be purchased for the following coverage periods during the 2011-12 policy periods:

 

           

2011-12

Coverage Periods

Annual

09/15/11 to 09/14/12

Fall

09/15/11 to 01/02/12

Spring/Summer

01/03/12 to 09/14/12

Summer

05/07/11 to 09/14/12

 

If I elect not to purchase the annual coverage, will I receive notification to re-enroll for continuous coverage?

No. It is the Insured’s responsibility for timely payments during the 14 day grace period to re-enroll and maintain continuous coverage.

 

Can I purchase this plan for one or two semesters?

Yes. Please see for coverage periods.

 

If I purchase the annual coverage and graduate in December 2011 or May 2012, will I be covered through September 14, 2012?

Yes. Coverage will terminate on the last day of the period for which premium has been paid, (September 14, 2012)

 

Cost/Payment

 

How much does the plan cost?

The premiums depend upon the length of coverage and the number of Insureds. The premiums are affordable and your acceptance is guaranteed.

 

2011-12

Annual

9/15/11

to

9/14/12

Fall

9/15/11

to

1/2/12

Spring/Summer

1/3/11

to

9/14/12

Summer

5/7/12

to

9/14/12

Student

$856

$263

$610

$313

Spouse

$2,353

$723

$1,677

$861

Each Child

$1,498

$460

$1,067

$548

 


How do I pay?

On-line Enrollment:      www.firststudent.com

By Mail: Print Enrollment Form:

Payment Instructions: Make check or money order payable to UnitedHealthcare - Student Resources in US dollars. Mail this enrollment card along with premium payment to:

 

            First Risk Advisors

                        67 W Court Street

                        Doylestown, PA 18901

 

Your cancelled check is your only receipt and notification of coverage. The student is responsible for timely premium payments whether or not a premium notice is received

 

Has the company received my premium payment?

            Receipt of premium can be verified by contacting First Student:

            Toll-free:           800-505-4160

            Website:           www.firststudent.com

 

 

Enrollment Process

 

Am I eligible to enroll in the plan?

All registered undergraduate students taking 9 or more credit hours and graduate students taking 6 or more credit hours are eligible to enroll this insurance Plan.

 

Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the spouse and their children under 25 years of age who are not self-supporting; who live with the Insured or who are a full-time or part-time student.

 

How do I enroll in the plan?

On-line Enrollment:        www.firststudent.com

The brochure and enrollment form may be obtained from the agent by contacting:

            Health Benefit Concepts, Inc.

Telephone: 800-463-2317

E-mail: al@hbcstudent.com or clicking brochure  and enrollment

 

           

 

What happens if I do not re-enroll during the 14 day grace period?

If the premium is not paid within the 14 day grace period, coverage will lapse at the end of the coverage period. If premium is subsequently paid, a new effective date of coverage will be established.

 

Can I enroll after the Effective Date and are the premiums pro-rated?

Yes, including:

1) Adding a new spouse or dependent child (within 31 days of marriage, birth or adoption)

2) Loss of coverage under another plan due to ineligibility (within 31 days of loss of eligibility)

3) New or Transfer Student (within 31 days of date of enrollment at FAMU)

 

Premiums are not pro-rated. Please note the premiums are charged by coverage period. If you enroll after a coverage period has begun, you must still pay the full premium. There is no provision in the policy for "pro-rating" of premiums

            More information is available by contacting First Student:

            Toll-free:           800-505-4160

            Website:           www.firststudent.com

 

Will I receive a receipt?

No. Your canceled check is your receipt and proof of coverage.

 

Will I receive an identification card?

Yes. The identification card is attached to the brochure. Identification  Cards may be printed and mailed to the student

            More information is available by contacting First Student:

            Toll-free:           800-505-4160

            Website:           www.firststudent.com

 

Will I receive a copy of the policy?

No. The Master Policy is on file at the FAMU Student Health Center. No individual policies will be issued. In the event of a claim dispute, the Master Policy will prevail. Please retain the brochure as it outlines the provisions of coverage.

 

Can I get a refund?

No. The only situations that allow for a refund is if the Insured enters or becomes active in the armed services of any country.

 

How do I know that the company received my premium payment?

Receipt of premium can be verified by contacting:

First Student by:

Toll-free: 800-505-4160

Website: www.firststudent.com

 

Your canceled check or credit card statement is your receipt and proof of coverage.

 

If I elect not to purchase the annual coverage, will I receive notification to re-enroll for continuous coverage?

No. It is the Insured’s responsibility for timely payments during the 14 day grace period to re-enroll and maintain continuous coverage.

 

Using the insurance

 

How do I get another identification card?

          

An identification card is attached to the brochure and may be obtained by contacting First Student:

                        Toll-free:           800-505-4160

                        Website:           www.firststudent.com

 

What should I do if my student health center is closed or I am away from school?

You are covered anywhere in the word, 24-hours a day. You should consult a medical professional and follow his or her advice and contact First Student

           

                        Toll-free:           800-505-4160

                        Website:           www.firststudent.com

 

Can I choose any physician and hospital?

 Yes. You are able to choose any physician and hospital. However, the plan utilizes the United Healthcare Option PPO

 

 Does the plan include deductibles?

Yes.

 

Deductible

In Network

$100 for Each Injury or Sickness

Out of Network

$200 for Each Injury or Sickness

 

Does the plan cover health related conditions when I am out of the country?

 Yes. The plan provides coverage 24-hour a day anywhere in the world.

If you are a student insured with this insurance plan, you and your insured spouse and minor child(ren) are eligible for Scholastic Emergency Services (SES). The requirements to receive these services are as follows:

 

Domestic Students, insured spouse and insured minor child(ren): You are eligible for SES when 100 miles or more away from your campus address and 100 miles or more away from your permanent home address or while participating in a Study Abroad program.

           

SES includes Emergency Medical Evacuation and Return of Mortal Remains that meet the US State Department requirements. The Emergency Medical Evacuation services are not meant to be used in lieu of or replace local emergency services such as an ambulance requested through emergency 911 telephone assistance. All SES services must be           arranged and provided by SES, Inc., any services not arranged by SES, Inc. will not be considered for payment.

Please visit your school's insurance coverage page at www.firststudent.com for the SES Global Emergency Assistance Services brochure which includes service descriptions and program exclusions and limitations

           To access services please call:

            (877) 488-9833 Toll-free within the United States

            (609) 452-8570 Collect outside the United States

 

 

How do I know if my illness or injury is covered?

Refer to the Medical Benefits Schedule in your brochure to determine covered and Covered Service. You should also review the Exclusions section of the brochure and the definitions of Pre existing conditions and Elective Surgery & Elective Treatment to understand what conditions are not covered.

If you have any questions, please contact First Student:

                        Toll-free:           800-505-4160

                        Website:           www.firststudent.com

 

Is Pre-Admission Notification of hospital admissions required?

           

      UMR Care Management should be notified of all Hospital Confinements prior to admission.


1. Pre-Notification of Medical Non-Emergency Hospitalizations: The patient, Physician or Hospital should telephone 1-877-295-0720 at least five working days prior to the planned admission.

2. Notification of Medical Emergency Admissions: The patient, patient’s representative, Physician or Hospital should telephone 1-877-295-0720 within two working days of the admission to provide notification of any admission due to Medical Emergency.

 

UMR Care Management is open for Pre-Admission Notification calls from 8:00 a.m. to 6:00 p.m. C.S.T., Monday through Friday. Calls may be left on the Customer Service Department’s voice mail after hours by calling 1-877-295-0720.

 

IMPORTANT: Failure to follow the notification procedures will not affect benefits otherwise payable under the policy; however, pre-notification is not a guarantee that benefits will be paid

     

How do I verify coverage?

Verification of coverage may be obtained by contacting First Student:

            Toll-free:           800-505-4160

            Website:           www.firststudent.com

 

How do I file a claim?

           In the event of Injury or Sickness, student should:

1.Report to the Student Health Service or Infirmary for treatment, or when not in school, to their Physician or Hospital. 

 

2. Mail to the address below all medical and hospital bills along with the patient's name and insured student's name, address, social security number and the name of the university under which the student is insured. A company claim form is not required for filing a claim.

3. File claim within 30 days of Injury or first treatment for a Sickness. Bills should be received by the company within 90 days of service. Bill submitted after one year will not be considered for payment except in the absence of legal capacity

 

                        Direct all Claim and/or Customer Service Inquiries to:

                        First Student

                        PO Box 809025

                        Dallas, TX  75380-9025

                        Telephone:        800-505-4160

                        Website:           www.firststudent.com

 

How do I check the status of my claim?

            Status of the claim may be obtained by contacting First Student:

                        Toll-free:           800-505-4160

                        Website:           www.firststudent.com

 

Does the plan include a 24/7 Nurse line?

Insured Students have access to nurse advice, health information, and counseling support 24 hours a day, 7 days a week by dialing the number indicated on the permanent ID card. Collegiate Assistance Program is staffed by Registered Nurses and Licensed Clinicians who can help students determine if they need to seek medical care, need legal/financial advice or may need to talk to someone about everyday issues that can be overwhelming.

Telephone: 1-800-525-4160

 

The Master Policy on file at the University contains all of the provisions, limitations, exclusions and qualification of your insurance benefits, some of which may not be included in this Frequently Asked Questions. If any discrepancy exists between this Frequently Asked Questions and the Master Policy, the Master Policy will govern and control the payments of benefits. Master Policy 2011-653-76.

 

 

 

Need additional assistance?

 call Al at 1.800.463.2317   or email Al