Student Health Insurance for
St Augustine University
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 St. Augustine 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
50+ Most Frequently Asked Questions
FAQ: Benefits
FAQ: Coverage
FAQ: Cost
FAQ: Enrollment Process
FAQ: How to Use
50+ of the Most Frequently Asked Questions
Benefits of the Plan
Does the plan include deductibles?
Does the plan have an Out-of-Pocket Maximum?
Does the plan provide maternity benefits?
Does the plan cover pre-existing conditions?
Does the plan pay for prescriptions?
Does this plan cover health related conditions when I am out of the country?
Does the plan include a Preferred Provider Organization (PPO)?
Coverage Periods
What coverage periods are available? How long of a time period 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 purchase the annual coverage and graduate in December 2012 or April 2013, will I be covered through the August 26, 2013 Termination date?
Cost/Payment
How much does it cost?
How do I pay?
How do I know that the company received my premium payment?
Enrollment Process
How do I enroll in the Plan?
How do I pay?
Will I receive a receipt?
Will I receive an identification card?
Will I receive a copy of the policy?
Can I get a refund?
How do I know that the company has received my payment?
If I elect not to purchase the annual coverage, will I receive notification to re-enroll for continuous coverage?
Using the insurance
How do I get another identification card?
What should I do if 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 this plan cover health related conditions when I am out of the country?
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 the status of my claim?
Does the plan include a 24/7 Nurse line?
Benefits of the Plan
Does the plan include deductibles?
Yes. The deductible is $250 per Policy Year for Preferred Provider Network and $500 per Policy Year for Out of Network.
Does the plan have an Out-of-Pocket Maximum?
Yes, Out-of-Pocket Maximum, after the Out-of-Pocket maximum has been met, benefits will be paid at 100% of PA for in-network and 100% of R&C out-of-network.
In Network Providers: $3,500
Out of Network: $7,000
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: 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.
Note: The Pre-existing Conditions Limitation does not apply to Insured Persons under age nineteen (19).
Pre existing Conditions are not covered for the first six (6) months following the Covered Person's Effective Date of Coverage under the Policy. There is no Coverage for Pre-existing Conditions unless the Covered Person has had twelve (12) months of Continuous Coverage. The Covered Person must provide us proof of prior Creditable Coverage. This waiver of Pre-existing Conditions will apply only if the Covered Person becomes eligible and applies for Coverage within sixty-three (63) days of termination of his or her prior Coverage.
Continuous Coverage: The period of time that a Covered Person is continuously Insured under this Policy and/or any prior Creditable Coverage with no greater than a sixty-three (63) day lapse between the Effective Date of Coverage under this Policy and the termination of prior Creditable Coverage.
Does the plan pay for prescriptions?
Yes. Prescription Drugs
• The Rx maximum is a component of the Overall Plan Maximum and is not a separate Benefit Maximum;
• Co-pays do not apply to preventive/wellness prescriptions;
• Co-pays apply to 31 day supply; and
• Plan deductible does not apply to prescriptions.
In Network
$15 Co-pay for Generic Drugs
$0 Co-pay for Generic Contraceptives
$35 Co-pay for Brand Name Drugs
$70 Non-Formulary Brand Drugs
Out of Network: Not Covered
Does this plan cover health related conditions when I am out of the country?
Yes. FrontierMEDEX ACCESS services is a comprehensive program providing You with 24/7 emergency medical and travel assistance services including emergency security or political evacuation, repatriation services and other travel assistance services when you are outside Your home country or 100 or more miles away from your permanent residence. FrontierMEDEX is your key to travel security.
For general inquiries regarding the travel access assistance services coverage, please call Consolidated Health Plans at 1-800-633-7867.
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.
If the condition is an emergency, you should go immediately to the nearest physician or hospital without delay and then contact the 24-hour Assistance Center. FrontierMEDEX will then take the appropriate action to assist You and monitor Your care until the situation is resolved.
Does the plan include a Preferred Provider Organization (PPO)?
Yes. The Insured is able to choose any physician and hospital.
Name: First Health
Telephone: 1-630-737-7900
Link: www.firsthealth.com
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.
Coverage Period |
|
Annual |
08-27-12 to 08-27-13 |
Fall |
08-27-12 to 12-31-13 |
Spring |
12-31-12 to 04-25-13 |
Summer |
04-25-13 to 08-27-13 |
Click for brochure click for enrollment form
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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 coverage periods.
Yes. Coverage will terminate on the last day of the period premium has been paid (August 26, 2013).
Cost/Payment
The premiums depend upon the length of coverage and the number of Insureds. The premiums are affordable and your acceptance is guaranteed.
08-27-12 |
08-27-12 |
12-31-12 |
04-25-13 |
|
Student Only |
$1,697 |
$ 599 |
$ 546 |
$ 585 |
Spouse |
$5,636 |
$1,990 |
$1,815 |
$1,942 |
Each Child |
$2,463 |
$ 869 |
$ 794 |
$ 849 |
Payment is on-line and by credit card. Click here.
How do I know that the company received my premium payment?
Receipt of premium can be verified by contacting:
Consolidated Health Plans by:
Toll Free: (800) 633-7867
Website: customerservice@consolidatedhealthplan.com
Coverage may be purchased prior to the effective date with coverage beginning on the effective date of coverage purchased.
Payment is on-line and by credit card. click here
No. Your credit card payment is your receipt and proof of coverage.
Will I receive an identification card?
Yes. If you need to access services before you receive your ID card, your provider can contact:
Consolidated Health Plans by:
Toll Free: (800) 633-7867
Website: customerservice@consolidatedhealthplan.com
Will I receive a copy of the policy?
No. The Master Policy is on file at the University of St. Augustine-Registrar's office. 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.
Yes. The date a Covered Person enters full time active military service. Upon written request sixty (60) days of leaving school, We will refund any unearned pro-rata Premium with respect to such person. We will refund the unearned pro-rata Premium to such person upon request. NO OTHER REFUND WILL BE MADE
How do I know that the company received my premium payment?
Receipt of premium can be verified by contacting:
Consolidated Health Plans by:
Toll Free: (800) 633-7867
Website: customerservice@consolidatedhealthplan.com
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.
How do I get another identification card?
An identification card may be obtained by contacting:
Consolidated Health Plans by:
Toll Free: (800) 633-7867
Website: customerservice@consolidatedhealthplan.com
What should I do if the 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.
Can I choose any physician and hospital?
Yes. The Insured is able to choose any physician and hospital.
Name: First Health
Telephone: 1-630-737-7900
Web: www.firsthealth.com
Does the plan include deductibles?
Yes. The deductible is $250 per Policy Year for Preferred Provider Network and $500 per Policy Year for Out of Network
Does this plan cover health related conditions when I am out of the country?
Yes. FrontierMEDEX ACCESS services is a comprehensive program providing You with 24/7 emergency medical and travel assistance services including emergency security or political evacuation, repatriation services and other travel assistance services when you are outside Your home country or 100 or more miles away from your permanent residence. FrontierMEDEX is your key to travel security.
For general inquiries regarding the travel access assistance services coverage, please call Consolidated Health Plans at 1-800-633-7867.
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.
If the condition is an emergency, you should go immediately to the nearest physician or hospital without delay and then contact the 24-hour Assistance Center. FrontierMEDEX will then take the appropriate action to assist You and monitor Your care until the situation is resolved.
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:
Consolidated Health Plans by:
Toll Free: (800) 633-7867
Website: customerservice@consolidatedhealthplan.com
Verification of coverage may be obtained by contacting
Consolidated Health Plans by:
Toll Free: (800) 633-7867
Website: customerservice@consolidatedhealthplan.com
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 our website and attach the claim (itemized bill) to the claim form and mail it to our office.
In the event of Covered Accident or Sickness
1. Report to your Physician or a Hospital.
2. Notification of injury or sickness must be provided within thirty (30) days after the date of accident or the commencement of sickness. Itemized billings (Written Proof of Loss) should be submitted by Your health care provider or the Covered Person within ninety (90) days of treatment, or as soon as reasonably possible.
All itemized bills should be submitted to the Claims Administrator shown below:
For a copy of the Company’s privacy notice, go to:
Claims Administrator:
CONSOLIDATED HEALTH PLANS
2077 Roosevelt Avenue
Springfield, MA 01104
(413) 733-4540
Or
Toll Free (800) 633-7867
How do I check the status of my claim?
Status of the claim may be obtained by contacting:
Consolidated Health Plans by:
Toll Free: (800) 633-7867
Website: customerservice@consolidatedhealthplan.com
Does the plan include a 24/7 Nurse line?
Call the toll-free Nurse Hotline at 800-557-0309. Note: If you are experiencing a life-threatening medical emergency, please call 911.
24 hours a day, 365 days per year
Registered Nurses (RNs) provide information based on physician-approved guidelines
Completely confidential
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. Policy Number: 302-001-0910
Need additional assistance?
call Al at 1.800.463.2317 or email Al