University Sponsored Student Health Insurance for
Florida A&M University


According to Florida A&M University...

Beginning with the 2016-2017 academic year, ALL FAMU students are required to have health insurance. Students must provide proof of health insurance coverage that meets benefit requirements set by the Affordable Care Act for a Gold level plan. We recommend that the insurance provide access to routine and preventative care to providers in Tallahassee for students on the main campus and providers in the Orlando Area for Law School students.

Students that do not have health insurance coverage may purchase the University sponsored student health insurance plan. Students that already have appropriate insurance coverage will need to provide documentation prior to class registration via an online waiver.  The waiver portal will become available the first week of August 2016.  Students that fail to provide documentation or that do not have appropriate coverage will have a registration hold placed on their account.

The Student Health Insurance Plan (SHIP) will be effective August 15, 2016 - August 14, 2017. ENROLLMENT for 2016-17 will be available after August 1, 2016.

 

 

 



 



The University sponsored student health insurance plan


30+ Most Frequently Asked Questions

FAQ: Benefits

FAQ: Coverage

FAQ: Cost

FAQ: Enrollment Process

FAQ: How to Use

BROCHURE

 

 

    

the Most Frequently Asked Questions     

Florida A&M University
2016-17 Frequently Asked Questions

Benefits of the Plan

Does the plan include deductibles?

What are the maximum benefit and coverage?

Does the plan have an Out of Pocket expense limit?

Does the plan provide for maternity benefits?

Does the plan cover pre-existing conditions?

Does the plan pay for prescriptions?

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

Does the plan include a Preferred Provider Organization (PPO)?

Does the plan include dental and vision benefits?

Coverage Periods

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

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

Can I purchase this plan for one or two semesters?

If I elect to purchase the annual coverage and graduate in May 2017, will I be covered through the August 14, 2017 termination date?

Cost Payment

How much does it cost?

How do I pay?

Enrollment Process

How do I enroll in the plan? How do I pay?

Can I enroll my spouse or child?

Will I receive an identification card?

Will I receive a copy of the policy?

Can I get a refund?

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

Can I enroll late after the coverage begins (Qualified Late Enrollment)?

Using the Insurance

How do I get another identification card?

What should I do of the student health center is closed or I am away from school?

Can I choose any physician and hospital?

Does the plan include deductibles?

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

Does the plan include a 24/7 Nurse Line?

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

How do I verify coverage?

How do I file a claim?

How do I check on the status of my claim?

How do I understand the Explanation of Benefits (EOB) for a paid claim?

How do I appeal my claim payment?

Waiving the FAMU student insurance plan

How do I waive the FAMU student insurance plan?

 

                                    Benefits of Plan

Does the plan include deductibles?

Yes. The deductible are $350 per year for Network Providers and $500 for Non-Network providers

Deductible means the dollar amount of Covered Medical Expenses which must be paid by each Insured Person before benefits are payable under the Policy. The amount of the Deductible and the frequency (annual or per occurrence) will be shown in the Schedule of Benefits.

What are the maximum benefit and coverage? 

Maximum Benefit: unlimited

Coinsurance:  Network:  80% PA (PPO Allowance) and Non-Network: 60% of U&R of Covered Medical Expense

Network Providers are Physicians, Hospitals and other healthcare providers who have contracted with us to provide specific medical care at negotiated prices.

Non-Network Providers have not agreed to any pre-arranged fee schedules.

Coinsurance means the ratio by which We and the Insured Person share in the payment of Usual and Reasonable expenses for treatment. The Coinsurance percentage that We will pay is stated in the Schedule of Benefits.

PPO Allowance means the amount a Network Provider will accept as payment in full for Covered Medical Expenses.

Usual and Reasonable (U & R) means the normal charge, in the absence of insurance, of the provider for a service or supply, but not more than the prevailing charge in the area for a: 1) Like service by a provider with similar training or experience; or 2) Supply that is identical or substantially equivalent.

Does the plan have an Out of Pocket expense limit?

Yes. After the Out of Pocket limit has been met, benefits will be paid at 100% of PA (PPO Allowance) in Network and no limit for U&R (Usual & Reasonable) for Non-Network.

Out of Pocket Expense Limit: Network: $6,850 and Non-Network: No Maximum

Out-of-Pocket Expense Limit: The Out-of-Pocket Expense Limit is shown in the Schedule of Benefits. It provides a cap on the amount of Covered Medical Expenses an Insured Person has to pay. Copayments and amounts above any Maximum Benefit do not apply toward the Out-of-Pocket Expense Limit. However, the Insured Person’s Coinsurance amounts will apply toward the Out-of-Pocket Expense Limit.

Out-of-pocket Expense Limit means the amount of Usual and Reasonable expenses that an Insured Person is responsible for paying.

Does the plan provide for maternity benefits?

Yes. Maternity is treated as any other illness.

Does the plan cover pre-existing conditions?

Yes.

Does the plan pay for prescriptions?

Yes. Prescriptions are covered under the Catamaran pharmacies. Plan deductible does not apply to co-pays.

Prescriptions must be filled at a Catamaran participating pharmacy and you are able to locate a pharmacy by:

Web site:  https://consolidatedhealthplan.com/files/pdf/Pharmacy+Network+Listing+flyer.pdf

Web Site: https://mycatamaranrx.com/PortalCentral/

Telephone: 800-248-1062

In Network:

Generic Co-pay: $15

Brand Co-pay: $30

Preferred Brand Co-pay: $50

Generic Contraceptives Co-pay: $0

 

Out of Network: no coverage

 

Visit https://mycatamaranrx.com/PortalCentral/ for a comprehensive listing of network pharmacies or call member services with the phone number located on your pharmacy ID card.

 

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

Yes. Frontier MedEx Travel Assistance:

For general inquiries regarding the travel access assistance services coverage, please call Consolidated Health Plans at 1-800-633-7867 or visit https://consolidatedhealthplan.com/products/medex

If you have a medical, security, or travel problem, simply call Frontier MEDEX for assistance and provide your name, school name, the group number shown on your ID card, and a description of your situation. If you are in North America, call the Assistance Center toll-free at: 1-800-527-0218 or if you are in a foreign country, call collect at: 1-410-453-6330.

Does the plan include a Preferred Provider Organization (PPO)?

Yes. You are able to choose any physician and hospital. However, the plan includes the First Health PPO network with Physicians, Hospitals and other health care providers who have contracted to provide specific medical care at negotiated prices.

You are able to locate a participating provider by:

First Health Website:  http://firsthealth.coventryhealthcare.com/locate-a-provider/index.htm

 

Telephone CHP:  800-633-7867

 

Website: https://chpstudent.com

 

Does the plan include dental and vision benefits?

No. Dental and vision coverage is not included in the plan. However, you are able to enroll in a dental insurance or discount dental plan and vision discount plan.

Visit the FAMU web page at chpstudent.com for more information and click on Student for Davis Vision Discount Plan and Other Discount and Insurance Products for Careington Discount Dental Plan and Other Dental Insurance Plans.

 

Coverage Periods

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

The Florida A&M University Student Health Insurance Plan provides coverage to students for a twelve (12) month period from 12:01 a.m. on the following dates:

FAMU

Coverage Periods

Student Premium

Annual

08/15/16 to 08/14/17

$2,035

Fall

08/15/16 to 12/31/17

$   775

Spring & Summer

01/01/17 to 08/14/17

$1,260

Summer:  (new student only)

05/06/17 to 08/14/17

$   546

 

 

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 to maintain continuous coverage.

Can I purchase this plan for one or two semesters?

Yes. Please see above coverage periods.

If I elect to purchase the annual coverage and graduate in May 2017, will I be covered through the August 14, 2017 termination date?

Yes. Coverage will terminate on the last day of the period premium has been paid (08/14/17)

 

Cost Payment

How much does it cost?

Coverage Period

Student Premium

Annual: 08/15/16 to 08/14/17

$2,035

Fall: 08/15/16 to 12/31/16

$   775

Spring & Summer:
01/01/17 to 08/14/17

$1,260

Summer: 05/06/17 to 08/14/17

(new student only)

$   546

 

How do I pay?

Students that do not have health insurance coverage may purchase the University sponsored student health insurance plan. The ENROLLMENT portal for 2016-17 will be available August 10, 2016, witht the deadline being September 10, 2016.

Enrollment Portal at FAMU Student Health Services: http://www.famu.edu/index.cfm?shs&HealthInsurance

                                        Enrollment Process

How do I enroll in the plan? How do I pay?

Students that do not have health insurance coverage may purchase the University sponsored student health insurance plan. The ENROLLMENT portal for 2016-17 will be available August 10, 2016, witht the deadline being September 10, 2016.

Enrollment Portal at FAMU Student Health Services: http://www.famu.edu/index.cfm?shs&HealthInsurance

Can I enroll my spouse or child?

No. The plan is for student only.

Will I receive an identification card?

Yes. You will receive an identification card in approximately six weeks. If you need access services prior to receiving your identification card, your provider can contact Consolidated Health Plans by:

Toll-free Telephone: (800) 633-7867

E-mail: customerservice@consolidatedhealthplan.com

https://www.chpstudent.com

Will I receive a copy of the policy?

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

Can I get a refund?

Should a student graduate or leave College for any reason, except to enter military service, the coverage will continue in effect to the end of the Policy Term for which premium has been paid. If the student enters military service, coverage will terminate immediately and a prorated premium refund will be made on request.

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 to maintain continuous coverage.

Can I enroll late after the coverage begins (Qualified Late Enrollment)?

Yes, a student is able to enroll after the effective date of coverage.

The student seeking the Qualified Late Enrollment should follow the following instructions:

1.  Complete the 2016-2017 Qualified Late Enrollment Form and,

2. Email to: mblomberg@consolidatedhealthplan.com (Mary Jo Blomberg)
or call 1-800-633-7867 extension 129  to obtain the prorated premium for the desired coverage period.

Person to enroll: student only

Reason for Late Enrollment: Termination of Prior Coverage

A copy of the following documentation is required: Insurance document showing the Date of Termination

CHP must receive the completed enrollment form and appropriate documentation within: 31 days of following prior coverage termination

The effective date of the new coverage will be: The date of prior coverage termination


Using the Insurance

How do I get another identification card?

If you need another identification card, you can contact Consolidated Health Plans by:

Toll-free Telephone: (800) 633-7867

E-mail: customerservice@consolidatedhealthplan.com

Website: http://chpstudent.com

What should I do of the student health center is closed or I am away from school?

You are covered anywhere in the world, 24 hours a day. You should consult a medical professional and follow his or her advice.

Can I choose any physician and hospital?

Yes. You are able to choose any physician and hospital. However, the plan includes the First Health PPO network with Physicians, Hospitals and other health care providers who have contracted to provide specific medical care at negotiated prices.

You are able to locate a participating provider by:

First Health Website:  http://firsthealth.coventryhealthcare.com/locate-a-provider/index.htm

 

Telephone CHP:  800-633-7867

 

Website: http://chpstudent.com

 

Does the plan include deductibles?

Yes. The deductible are $350 per year for Network Providers and $500 for Non-Network providers

Deductible means the dollar amount of Covered Medical Expenses which must be paid by each Insured Person before benefits are payable under the Policy. The amount of the Deductible and the frequency (annual or per occurrence) will be shown in the Schedule of Benefits.

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

Yes. Frontier MedEx Travel Assistance:

For general inquiries regarding the travel access assistance services coverage, please call Consolidated Health Plans at 1-800-633-7867 or visit https://consolidatedhealthplan.com/products/medex

If you have a medical, security, or travel problem, simply call FrontierMEDEX for assistance and provide your name, school name, the group number shown on your ID card, and a description of your situation. If you are in North America, call the Assistance Center toll-free at: 1-800-527-0218 or if you are in a foreign country, call collect at: 1-410-453-6330.

Does the plan include a 24/7 Nurse Line?

Yes. Call the toll-free Nurse Hotline at 800-557-0309. Note: if you are experiencing a life-threatening medical emergency, call 911.

Registered Nurses (RN) provide information based on physician approved guidelines 24 hours a day / 365 days per year. The information is completely confidential.

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

Refer to the Medical Benefits Schedule in your brochure to determine coverage and covered services. You should review the Exclusions and Definition sections of the brochure to understand what conditions are not covered.

If you have any questions, please contact Consolidated Health Plan by:

Toll-free Telephone: (800) 633-7867

E-mail: customerservice@consolidatedhealthplan.com

Website: http://chpstudent.com

 

How do I verify coverage?

You are able to verify coverage by contacting Consolidated Health Plans by:

Toll-free Telephone: (800) 633-7867

Email: customerservice@consolidatedhealthplan.com

Website: http://chpstudent.com

 

How do I file a claim?

Most students do not have to file their own claims. However, if a claim needs to be submitted by a student, you can download a student claim form from the Consolidated Health Plan website and attach the claim (itemized bill) to the claim for and mail to their office. 

In the event of Accident or Sickness the student should:

1. If at the College, report immediately to Health Services so that proper treatment can be prescribed or approved.

2. If away from the College, consult a doctor and follow his or her advice.  Notify Florida A&M University within 90 days after the date of the Covered Injury or commencement of the Covered Sickness or as soon thereafter as is reasonably possible.

3. Secure a claim form from Consolidated Health Plans at  http://chpstudent.com


4. Complete the form.

5. Submit the claim form, complete with bills and receipts, to the Claims Administrator:

Claims Administrator:

Consolidated Health Plans

2077 Roosevelt Avenue

Springfield, MA 01104


Toll Free: 800-633-7867

 

6. Submit only one claim form for each Accident or Sickness

 

How do I check on the status of my claim?

You are able to check claim status by contacting Consolidated Health Plans by:

Toll-free: 800-633-7867

Email: customerservice@consolidatedhealthplan.com

Website: http://chpstudent.com

 

How do I understand the Explanation of Benefits (EOB) for a paid claim?

The Explanation of Benefits (EOB) is a summary of how your paid claim was processed. It includes any co-pay, deductible, coinsurance (%) or non-covered amounts that you may owe to the provider(s) of service. Use this EOB to verify the accuracy and validity of any bill you may receive from the provider(s).

Please see sample Explanation of Benefits (EOB)

How do I appeal my claim payment?

You have the right to appeal any decision or action taken by Us to deny, reduce, or terminate the provision of or payment for health care services requested or received under this Certificate of Insurance. You have the right to have Our decision reviewed by an independent review organization. We must provide you with certain written information, including the specific reason for Our decision and a description of Your appeals rights and procedures every time We make an determination to deny, reduce, or terminate the provision of or payment for health care services requested or received under the Certificate of Insurance.

You have 180 calendar days to submit your written appeal to Consolidated Health Plans Appeal Department 2077 Roosevelt Avenue Springfield, MA 01104. Once your appeal is received a decision will be made in 30 to 60 calendar days (depending on your state requirements), or within 72 hours in the case of an expedited appeal.

Does the plan include dental and vision benefits?

No. Dental and vision coverage is not included in the plan. However, you are able to enroll in a dental insurance or discount dental plan and vision discount plan.

Visit the FAMU web page at http://chpstudent.com for more information and click on Student for Davis Vision Discount Plan and Other Discount and Insurance Products for Careington Discount Dental Plan and Other Dental Insurance Plans.

 

Waiving the FAMU student insurance plan

How do I waive the FAMU student insurance plan?

You are able to waive the FAMU student insurance plan.
Please visit the Consolidated Health Plan site and follow the waiver instructions.

Website: https://consolidatedhealthplan.com/group/197/waiver/1

The following information will be required to complete the waiver:

Insurance Company Information

Insurance Carrier

Insurance Carrier Street Address or P.O. Box

Insurance Carrier City

Insurance Carrier State

Insurance Carrier Country

Insurance Carrier Phone

Insurance ID# or Member ID#

Insurance Group Number

 

The following information about the Insurance Subscriber (primary insured) will be required:

Insurance Subscriber (primary insured)

Student’s relationship to insurance subscriber

Subscriber Address

Subscriber City

Subscriber State

Subscriber Zip Code

Subscriber Country

 

If insurance coverage is provided by employer sponsored plan the following information is required:

Employer Name

Employer City

Employer State

Employer Zip Code

Employer Country

 

Additionally the following questions will require yes/no answers:

Yes or No: My current plan offers an unlimited plan maximum in coverage.

 

Yes or No: My plan provides in-patient care in the Florida A&M University campus area (including mental health care).

 

Yes or No: My plan provides out-patient care in the Florida A&M University campus area (including office visit, out-patient mental health care and ancillary procedures). Coverage for emergency-only care does not satisfy this requirement.

 

Yes or No: This coverage will remain in force throughout the 2016-2017 academic year.

 

Yes or No: My plan provides coverage for pre-existing conditions.

 

Yes or No: My plan provides coverage for prescription drugs.

 

Yes or No: I acknowledge that I am responsible for payment of all fees for medical and mental treatment not covered not by my health insurance plan (including but not limited to deductibles, copays, coinsurance and the expenses above my policy maximums and benefit limits). I understand that some health facilities, including the Student Health Center, may require payment at the time the treatment is provided.

 

I agree that all of the information is correct and I confirm that I have chosen to waive coverage.

 

 

 

 

 

The Master Policy on File at Florida A&M University Student Health Center contains all of the provisions, limitations, exclusions and qualification of your insurance benefits, some which may not be included in the Frequently Ask 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.

Underwritten by:

National Guardian Life Insurance Company
Madison, WI

As Policy form: NBH-280 (2014) FL

Policy Number: 2016I5B15

Group Number: S210608

Effective: 8/15/16 – 8/14/17