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International Student Health Insurance
Frequently Asked Questions
Colleges and Universities
 

Home       International Student Health Insurance     BUY TODAY        About Our Company       call 1.800.463.2317             

 

For many international students, decisions about student health insurance in the U.S. are complicated. To simplify your decision we have provided the responses to 50+ of the Most Frequently Asked Questions concerning our international student health insurance plan. Please contact us if you do not find the information that you need.

Call us 1.800.463.2317 or email.

FAQ: Plan Comparisons

FAQ: Coverage Periods
FAQ: Cost    
FAQ: Waiver Process   
FAQ: How to buy       
FAQ: How to Use        
FAQ: Benefits and Coverage

 

Definitions of Health  Insurance Terms 

Brochure

 

 

 

 

 

Plan Comparisons

What are the advantages of purchasing the Premier International Student Insurance Plan?


International Students on an F-1 student visa are required by federal law to have health insurance and must provide proof of insurance coverage to their respective schools. This plan is designed specifically to meet this requirment for international students.

For most schools international students are not required to buy a specific policy. We make it easy to compare plans, buy, confirm enrollment and provide the school with the information needed for enrollment. This international student health insurance plan has been designed to meet the requirements of most schools.

 

This International Student Insurance Plan provides affordable premiums and benefits for protection of unexpected medical costs.


The Plan provides Student Injury and Sickness Insurance coverage for International Students attending any university or community college.


Who do I contact with questions?

Please contact:

            Health Benefit Concepts by:

            Telephone:      800.463.2317

            Email:              premierinfo@hbcstudent.com.

 

            Seven Corners by:

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or
                                    collect 0-317-575-2656

 

Where can I view the Plan (program) Summary?

click here to view plan

 

 Am I required to purchase the school’s plan?

No. You are not required to buy a specific plan. Your school has a process for accepting other lower cost plans that meet the school's requirements. Contact the appropriate office at your school to obtain information concerning the waiver process.

 

International Students on an F-1 student visa are required by federal law to have health insurance and must provide proof of insurance coverage to their respective schools. International students should verify with their respective schools to determine their eligibility to provide comparable coverage and the deadlines to submit proof of comparable coverage.

 

How does the school accept this plan?

 

Your school has a process for you to purchase other insurance plans. Contact the appropriate office at your school to obtain the waiver form. Seven Corners will assist in the completion of the school waiver form and return this form to you or your school.

 

You must fax or email the waiver form to Seven Corners by:

            Email: assist@sevencorners.com

            Fax: 317.575.2870   

 

Important.  You must sign the form prior to scanning and sending or faxing to Seven Corners. The company is not allowed to complete and return the form without your signature.

 

If the form is sent without a signature, the company will return the form by email or fax requesting your signature. This will delay the completion process.

 

Please contact Seven Corners for assistance:

            Email:             assist@sevencorners.com

            Telephone:      1-800-335-0477 or
                                    collect 0-317-575-2656

For additional assistance contact.  
  Health Benefit Concepts
by:

            Telephone:      800.463.2317

            Email:              premierinfo@hbcstudent.com.

 

 

Will I receive verification of enrollment in the Premier International Student Health Insurance Plan to waive out of the school’s plan?

Yes. Seven Corners will email policy confirmation and electronic Virtual ID Card upon completion of the enrollment process, and will assist in the completion of the school waiver process.

 

My school requires the insurance company to complete and return a Compliance/Waiver Form as proof of comparable insurance coverage. What should I do?

 

Contact the approriate office at your school to obtain the waiver form. Fax or email the waiver form to Seven Corners by:

            Email: assist@sevencorners.com

            Fax: 317.575.2870   

 

Important.  You must sign the waiver form prior to scanning and sending or faxing to Seven Corners. The company is not allowed to complete and return the form without your signature.

 

If the form is sent without a signature, the company will return the form by email or fax requesting your signature. This will delay the completion process.

 

Seven Corners will assist in the completion of the school waiver form and return this form to the student or school.


Please contact Seven Corners for assistance:

            Email:            assist@sevencorners.com

                

            Telephone:      1-800-335-0477 or
                                    collect 0-317-575-2656

For additional assistance contact.  
Health Benefit Concepts
by:

            Telephone:      800.463.2317

            Email:              premierinfo@hbcstudent.com.

 

Are school administrators able to contact Seven Corners to confirm my enrollment in the plan?

Yes. Seven Corners will provide the capability to electronically verify enrollment.

 

Process for Enrolling

Am I eligible for this plan? 

International Students, under the age of 66, who are temporarily residing outside their Home Country. The Insured must remain engaged in educational activities outside their Home Country during the Period of Coverage Education or research activities shall mean the Insured: 1) is enrolled and participating in an educational, vocational, cultural exchange, or training programs; and 2) has a valid J-1, H-3, F, M, or Q Visa.

 

Are my dependents eligible for this plan?

YES!  Eligible dependents are allowed  to enroll in the Premier International Plan. Just click for enrollment!

However, if the student is not enrolled in the Premier International Plan dependents are not able to enroll in the Plan.

Dependents are able to enroll in the Liaison Majestic Plan without the student enrolled in the Liaison Majestic Plan. The premiums are based on the maximum benefit, deductible and coverage period. Click for Liason Majestic Plan Brochure  

Enroll in the Liason Majestic Plan by clicking: https://hybrid.sevencorners.com/insurance/liaisonmajestic_hybrid/HW3PRY4

How do I enroll and pay for the Premier International plan?

Eligible students are able to enroll and pay by clicking here.

 

Will I receive a receipt upon enrollment? 

No. Your canceled check or credit card statement is your receipt and proof of coverage.

 

Will I receive an identification card upon enrollment?  

Yes. Seven Corners will provide identification cards electronically. Please contact Seven Corners should you have any questions by:

            Email:              policy@sevencorners.com

            Telephone:      1-800-335-0611 or

                                     collect 0-317-575-2652

 

Will I receive a copy of the policy? 

No. Individual policies will be not issued. In the event of a claim dispute, the Master Policy will prevail. Please keep this brochure as a general summary of the insurance.

 

When can I get a refund? 

 Certain Underwriters at Lloyds, London realizes that there is uncertainty in international travel. Premium refunds will be considered only for school withdrawal. If you withdraw from school the unused portion of the Plan cost may be refunded minus cancellation fee, provided no claim has been submitted to the Administrator for reimbursement. Refund of total plan cost will only be considered if written request is received by the Adminstrator prior to the Effective Date of Coverage.

 

Will I receive notification to re-enroll for continuous coverage?  

Yes. Seven Corners will provide notification to enroll electronically. Please contact Seven Corners should you have any questions by:

            Email:              policy@sevencorners.com

            Telephone:      1-800-335-0611 or

                                     collect  0-317-575-2652

 

Does the plan have a grace period to enroll without a lapse of coverage?

No. Seven Corners will provide notification to enroll electronically. It is the Covered Person’s responsibility to maintain continuous coverage.

 

How do I verify enrollment in the plan?

Receipt of premium can be verified by contacting Seven Corners by:

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                      collect 0-317-575-2656

 

 

Plan Coverage Periods

The plan is based on daily payments. You are able to purchase a combination of daily periods (coverage) to meet your school’s required enrollment periods (Fall, Spring and Summer Semesters). Please check with your school to verify the required coverage periods to enroll in the plan to become eligible to enroll in school.

           

How long of a time period am I covered?

Policy Period cannot exceed 12 months.

 

Renewability: Any one policy period may not exceed (12) months. This plan may be renewed up to a maximum total of (48) forty-eight continuous months. If there is a lapse in coverage for any reason, coverage may not be renewed. Coverage must be separately rewritten under a new certificate.

 

Period of Coverage

For each Insured Person benefits will begin on the latest of the following:

1. The Plan Effective Date;or

2. The moment you depart your Home Country; or

3. 12:01 am Standard Time on the date indicated on the Application; or

4. 12:01 am Standard Time on the date of receipt of premium by Seven Corners; or

5. The date requested on the Application.

 

For each Insured Person benefits will terminate on the earlier of the following:

1. Your return to your Home Country; or

2. 12:01 am Standard Time on the date shown on the ID Card, for which plan premium has been paid; or

3. 12:01 am Standard Time on the date you are no longer an eligible Participant under this Plan; or

4. The date the Plan is cancelled.

Home Country shall mean the country where an Insured Person has his or her true, fixed and permanent home and principal establishment.

 

Will I receive notification to re-enroll for continuous coverage?

Yes. Seven Corners will provide notification to enroll electronically. Please contact Seven Corners should you have any questions by:

            Email:              policy@sevencorners.com

            Telephone:      1-800-335-0611 or

                                      collect 0-317-575-2652

 

Cost/Payment

How much does the plan cost?

The premiums depend upon the length of coverage.

 

Premier International

Per Person
per Day

$250,000 Medical
Maximum

$500,000 Medical

Maximum

Student:
Age 12-24

$1.90

$1.98

Student
Age 25-29

$2.77

$2.90

Student
Age 30-34

$3.52

$3.69

Student
Age 35-39

$4.94

$5.18

Student
Age 40-44

$6.24

$6.55

Student
Age 45-49

$6.76

$7.08

Student
Age 50-54

$12.54

$13.13

Student
Age 55-65

$15.05

$15.78

Spouse
Age 12-65

$25.69

$26.92

Child
Age 0 - 18

$5.16

$5.40

 

How do I pay?

Eligible students are able to enroll and pay by credit card by clicking here.

Eligible dependents are allowed  to enroll in the Premier International Plan or Laison Majestic Plan (see Are my dependents eligible for this plan?)

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

Receipt of premium can be verified by contacting Seven Corners by:

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                     collect 0-317-575-2656

 

Benefits of the Plan

 

Where can I view the Plan (program) Summary? 

Click here for brochure

 

What are the plan’s deductibles?

 The plan includes the following deductibles per Injury or Sickness:

 

Premier International

Deductible (per Injury or Illness)

$250 maximum per Policy Year

Student Health Center

$0

Preferred Provider Organization (PPO)

$50 if not first treated by the Student Health Center (or if there is not Student Health Center)

Out of Network

$100

 

 

What are the maximum benefits and coverage?

 

SCHEDULE OF BENEFITS

All Coverage and Benefits are in U.S. Dollar Amounts

Accident and Sickness Medical Maximums Per Accident or Sickness and Annual Maximum

Student
Option 1: $250,000
Option 2: $500,000

 

Spouse/Dependent Child

Option 1: $50,000
Option 2: $50,000

 

Deductible – Per Injury or Illness

In Network or Outside the U.S.: $50 if not first treated by the Student Health Center (of if there is no Student Health Center)

Outside Network: $100 $0 if first treated by the Student Health Center $250 Maximum per Policy Year

Prescription of Medicine Co-Pay

$10 for Generic and $20 for Brand Name

Coinsurance

In Network or Outside the U.S. 80% to $25,000, then 100% to plan Maximum.

Outside Network: 70% to plan Maximum.

Benefit Period

Covered Expenses incurred during the Period of Coverage

Maternity

Covered as any other illness. Conception must occur after the Effective Date of the Covered Person’s coverage.

Therapeutic Termination of Pregnancy

$500

Mental Illness and Alcohol & Drug Abuse

 

Students studying in the U.S.: $10,000

Lesser of U.R.C. for the first 30 days of hospital confinement per Policy Year or 90% of U.R.C. up to limit of $10,000 in the U.S.

Dental (Emergency)

$250 per tooth to a maximum of $1,000

Emergency Medical Evacuation

$500,000

Repatriation of Mortal Remains

$100,000

Emergency Reunion

$2,500

Accidental Death & Dismemberment

$5,000 per Insured

$250 per spouse / dependent child

Chiropractic

$1,000 per Policy Year, $35.00 per visit up to 3 visits per week.

Assistance

24 hours – Worldwide

Unless otherwise mentioned, deductibles, co-pays, coinsurance and benefits are considered on a Per Injury/Sickness basis.

 

What are the plan’s maternity benefits?

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

 

What are pre-existing conditions?

Pre-existing Condition(s) shall mean any Injury or Illness which meets the following criteria: 1) a condition that would have caused a person to seek medical advice, diagnosis, care or treatment during the six (6) months prior to the Effective Date of coverage under this Policy; 2) a condition for which manifestation, medical advice, diagnosis, care or treatment was recommended, received, or noticed during the six (6) months prior to the Effective Date of coverage under this Polcy. If the Insured Person is covered under the Policy for six (6) consecutive months, the Pre-existing Condition exclusion will no longer apply and any eligible expenses incurred thereafter will be considered for remimbursement.

 

Does the plan cover pre-existing conditions?

No. Pre-existing Conditions are not covered for the first six months following a Covered Person's effective date of coverage under the Policy.

 

Are pre-existing conditions covered after the Covered Person has been covered under the Premier International Plan for more than six consecutive months?

Yes. Pre-existing conditions will be covered after the Covered Person has been covered under the Premier International Plan for more than six consecutive months.

 

Does the plan pay for outpatient prescriptions?

Yes. After the deductible has been satisfied, outpatient prescription drugs for a covered Injury or Sickness are payable $10 co-payment for generic and $20 co-payment for brand name.

 

Does the insurance plan include vision and dental benefits?

Vision: The plan does not include vision benefits.

 

Emergency Dental Treatment: (Injury only Benefits are paid for Reasonable and Customary expenses in excess of the Deductible and Coinsurance of $250 per tooth up to a maximum of $1,000, for the emergency repair or replacement to sound, natural teeth damaged as the result of a Covered Accident.

 

Does the insurance plan include Medical Emergency Expense benefits?

Yes. Expenses for a covered medical expense include use of the emergency room and supplies.

 

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

Yes. For a list of participating facilities and doctors in Seven Corners' International Network, access our exclusive Wellabroad.com website.

 

            WellAbroad/A Service of Seven Corners, Inc.

            303 Congressional Blvd

            Carmel, IN 46032 USA

 

            Web Sites:       www.wellabroad.com 

                                  

            Telephone:      800-335-0611 or 317-575-2652

            Fax:                 317-575-2659

 

WellAbroad offers medical, political and cultural information and includes many benefits and educational resources, such as: text messaging alerts, provider network directory and online forums.

 

What benefits and limitations are excluded from Coverage?

A list of benefits and limitations excluded from Coverage is listed in the brochure. See brochure for complete list.

 

Does the plan provide chiropractic benefits?

Yes. Benefits shall be paid for Spinal Manipulation which is prescribed, performed, or ordered by a licensed chiropractor for the relief of pain. $1,000 per Policy Year, $35.00 per visit up to 3 visits per week.

 

Does the plan provide medical evacuation, repatriation and emergency medical reunion benefits? 

Yes.

Medical Evacuation: $500,000

Repatriation: $100,000

Emergency Medical Reunion: When the Assistance Company and your attending Physician determine that it is necessary and prudent for you to have an Emergency Medical Evacuation or Repatriation, this Plan will arrange

to bring an individual of your choice, from your current Home Country, to be at your side while you are hospitalized and then accompany you during your return to your current Home Country. Benefits will be paid up to $2,500 for a round-trip economy airfare ticket as well as for reasonable travel and accommodation expenses up to a maximum of ten (10) days, as preapproved and arranged by the Assistance Company.

 

Using the insurance


Who do I contact with questions and customer service?

Please contact:

            Health Benefit Concepts by:

            Telephone:      800.463.2317

            Email:             premierinfo@hbcstudent.com

 

            Seven Corners Customer Service by:

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                      collect 0-317-575-2656

 

            The Customer Service Center is available at
           
877-444-5012 (8:00 am to 5:00 pm EST).

Seven Corners has a well-trained, multi-lingual dedicated customer team that provides helpful support to students 24/7 for emergency assistance.

How do I get another identification card?

 Seven Corners will provide replacement identification cards by mail. Please contact Seven Corners should you have any questions by:

            Email:              policy@sevencorners.com

            Telephone:      1-800-335-0611 or

                                    collect 0-317-575-2652

 

Does the Plan require a Student Health Center referral for services rendered outside the Student Health Center?

No.

 

What should I do if 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. You should seek out a Seven Corners PPO Provider p if you are traveling in the United States by contacting:

           

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                      collect 0-317-575-2656

 

            PPO Web site:http://www2.sevencorners.com/ppo/

 

Can I choose any physician and hospital?

 

Yes: Persons insured under this plan may choose to be treated within or outside of the Seven Corners PPO Network. Reimbursement rates will vary according to the source of care as described under the Plan Schedule of Benefits herein. Assignment of a Network Provider does not guarantee eligibility or right to student health benefits. Please be aware that if a Covered Person is treated at a PPO Hospital, it does not mean that all providers at the Hospital are PPO providers.

 

In addition, if a Covered Person is referred by a PPO provider to another provider or facility, it does not mean that the provider or the facility to which the Covered Person is referred is also a PPO. For the most current list of network providers, check the Seven Corners website at http://www2.sevencorners.com/ppo/

It is the Covered Person’s responsibility to verify that a provider is a Participating Provider prior to services being rendered.

 

Is my physician and hospital in the Plan’s PPO networks?

Preferred Providers in your local school area are Seven Corners PPO Hospitals and Physicians. The availability of specific providers is subject to change without notice. You should always confirm that a Preferred Provider is participating at the time services are required by contacting:

 

            Web site:         sevencorners.com

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                    collect 0-317-575-2656

            PPO Web site:http://www2.sevencorners.com/ppo/

 

How do I fill and pay for prescriptions?

You are able to fill you prescription at the student health center (if available) or any pharmacy. After the deductible has been satisfied, outpatient prescription drugs for a covered Injury or Sickness are payable $10 co-payment for generic and $20 co-payment for brand name.

 

Does the plan include deductibles?

The plan includes the following deductibles per Injury or Sickness:

 

Premier International

Deductible (per Injury or Illness)

$250 maximum per Policy Year

Student Health Center

$0

Preferred Provider Organization (PPO)

$50 if not first treated by the Student Health Center (or if there is not Student Health Center)

Out of Network

$100

 

 

Do I have to pay when I visit the doctor?

Hygeia providers should file the claim. However, each provider has their own specific payment policy. You should always confirm that a Preferred Provider is participating at the time services and inquire on payments.  

            PPO Web site http://www2.sevencorners.com/ppo/

 

What do I do if I am out of the country?

You are covered anywhere in the world, 24-hours a day. You should consult a medical professional and follow his or her advice. You should seek out a PPO provider if you are traveling outside the United States by contacting:

           

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                    collect 0-317-575-2656

 

 

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

Coverage can be verified by contacting Seven Corners by:

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                   collect 0-317-575-2656

 

Is Pre-Notification of hospital admissions required?

Yes. Seven Corners should be notified of all Hospital Confinement prior to admission.

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                     collect 0-317-575-2656

 

Pre-Notification: For each scheduled hospital admission, emergency hospital confinement, or Outpatient Treatment, you or someone on your behalf must contact the Assistance Company for pre-notification as soon as possible, but no later than forty-eight (48) hours prior to the admission to a the hospital, hospital confinement or Outpatient Treatment. For Emergency hospital Confinement, you or someone on your behalf must notify the Assistance Company as soon as possible, but not later than forty-eight (48) hours after the date of admission. If you fail to pre-notify with the Assistance Company, Covered Expenses will be reduced to and payable at 50% after the Deductible. Pre-Notification does not guarantee or confirm benefits or the payment of said benefits

 

How do I obtain a Certificate of Coverage?

Certification of Coverage request should be direct to Seven Corners by:

Coverage can be verified by contacting Seven Corners by:

            Email:              assist@sevencorners.com

            Telephone:      1-800-335-0477 or

                                      collect 0-317-575-2656

 

 

How do I file a claim?

Claims Services:        

Important Note: Claim forms and receipts for medical expenses must be sent to Seven Corners quickly.

 

Claim submissions must be made within ninety (90) days after the Date of Service. If claims are received after ninety (90) days, they may be considered ineligible.

 

To report claims or verify eligibility, send the original bills and claim forms to Seven Corners, or call or fax to the numbers below. Be certain to include your ID# shown on the ID Card with all correspondences:

 

            Seven Corners, Inc.

            303 Congressional Blvd.

            Carmel, IN 46032

           

            Email:              claims@sevencorners.com

            Telephone:      800-335-0477 or 317-575-2256

                                    Fax: 317-575-2659

 

How do I check the status of my claim?

Status of claim is available by contacting Seven Corners by:

            Email:              claims@sevencorners.com

            Telephone:      800-335-0477 or 317-575-2256

                                    Fax: 317-575-2659

 

 

How do I understand the Explanation of Benefits received for payment of claim?

Assistance with understanding the Explanation of Benefits is available by contact Seven Corners by:

            Email:              claims@sevencorners.com

            Telephone:      800-335-0477 or 317-575-2256

                                    Fax: 317-575-2659

 

How do I appeal my claim?
Claims Appeals must be received in writing with supporting medical information. Appeals are addressed within 30 days after receipt. You may submit your written appeal to:

 

Seven Corners, Inc.

Attn: Claims

303 Congressional Boulevard

Carmel, IN 46032 USA

Fax: (+01) 317-575-2256

 

Email:  claims@sevencorners.com

                                   

Does the Plan provide Travel Assistance services?

Yes. To receive assistance worldwide, call Seven Corners Assist at the numbers below and provide them with

your ID Number.

 

For Emergency Medical Evacuation, Return of Remains, Emergency Reunion, Assistance Services, call:

If in the United States or Canada: 1-800-690-6295; or

If outside the United States or Canada: 1-317-818-2808 (collect)

 

 

Certain Underwriters at Lloyd's, London Certificate contains all of the Certificate Provisions, Eligibility, Period of Coverage, Schedule of Benefits, Description of Benefits, Plan Definitions, Exclusions and Limitations and Policy Provisions 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 Certain Underwriters at Lloyd's London Certificate, the Certain Underwriters at Lloyds Certificate will govern and control the payments of benefits. Lloyds Certificate Premier International ATR15-151111-01LS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 Definitions

Accident or Accidental shall mean an event, independent of Illness or self inflicted means, which is the direct cause of bodily Injury to an Insured Person.

 

Airworthiness Certificate shall mean the “Standard” Airworthiness Certificate issued by the Federal Aviation Agency of the United States or its foreign equivalent issued by the government authority having jurisdiction over civil aviation in the country of its registry.

 

Benefit Period shall mean the allowable time period you have to receive Treatment for a Covered Injury or Illness.

 

Company shall mean The Insurance Company of the State of Pennsylvania.

 

Coinsurance shall mean the percentage amount of eligible Covered Expenses, after the Deductible, which is your responsibility to pay.

 

Common Carrier shall mean any public air conveyance operating under a valid license providing for the transportation of passengers for hire.

 

Deductible shall mean the amount of eligible Covered Expenses which are the responsibility of each Insured Person and must be paid by each Insured Person before benefits under the Policy are payable by the Company.

 

Disablement as used with respect to medical expenses shall mean an Illness or an Accidental bodily Injury necessitating medical treatment by a Physician as defined in this Policy.

 

Eligible Benefit(s) shall mean benefits payable by the Company to reimburse expenses which are for Medically Necessary services, supplies, care, or treatment; due to Illness or Injury; prescribed, performed or ordered by a Physician; Reasonable and Customary charges; incurred while insured under this program and which do not exceed the maximum benefit.

 

Emergency shall mean a medical condition manifesting itself by acute signs or symptoms which could reasonably result in placing the Insured Person’s life or limb in danger if medical attention is not provided within 24 hours.

 

Hospital as used in this Policy shall mean except as may otherwise be provided, a Hospital (other than an institution for the aged, chronically ill or convalescent, resting or nursing homes) operated pursuant to law for the care and treatment of sick or Injured persons with organized facilities for diagnosis and Surgery and having 24-hour nursing service and medical supervision.

 

Illness wherever used in this Policy shall mean sickness or disease of any kind.

 

Injury wherever used in this Policy shall mean bodily Injury caused solely and directly by violent, Accidental, external, and visible means occurring while this Policy is in force and resulting directly and independently of all other causes in Disablement covered by this Policy.

 

Insured or Insured Person shall mean a person eligible for benefits under the Policy who has applied for coverage and is named on the application and for whom the company has accepted premium.

 

Medical Necessary shall mean services and supplies received while insured that are determined by the Company to be: (1) appropriate and necessary for the symptoms, diagnosis, or direct care and treatment of the Insured Person’s medical conditions; (2) within the standards the organized medical community deems good medical practice for the Insured Person’s condition; (3) not primarily for the convenience of the Insured Person, the Insured Person’s Physician or another Service Provider or person; (4) not Experimental/Investigational or unproven, as recognized by the organized medical community, or which are used for any type of research program or protocol; and (5) not excessive in scope, duration, or intensity to provide safe and adequate, and appropriate treatment. For Hospital stays, this means that acute care as an Inpatient is necessary due to the kinds of services the Insured Person is receiving or the severity of the Insured Person’s condition, in that safe and adequate care cannot be received as an Outpatient or in a less intensified medical setting. The fact that any particular Physician may prescribe, order, recommend, or approve a service, supply, or level of care does not, of itself, make such treatment Medically Necessary or make the charge of a Covered Expense under this Policy.

 

Pre-existing Condition shall mean Any Injury or Illness which meets the following criteria: a) condition(s), including any associated complications or consequences, which manifest during the 6 months prior to the Effective Date of coverage under this policy; (b) condition(s) that would have caused a person to seek medical advice, diagnosis, care or treatment, including any associated complications or consequences, during the 6 months prior to the Effective Date of coverage under this Policy; (c) condition(s) for which medical advice, diagnosis, care or treatment was recommended, received, or noticed, including any associated complications or consequences, during the 6 months prior to the Effective Date of coverage under this Policy.

 

Reasonable and Customary(R&C) shall mean the maximum amount that the Company determines is Reasonable and Customary for Covered Expenses the Insured Person receives, up to but not to exceed charges actually billed. The Company’s determination considers: (1) amounts charged by other Service Providers for the same or similar service in the locality where received, considering the nature and severity of the bodily Injury or Illness in connection with which such services and supplies are received; (2) any usual medical circumstances requiring additional time, skill or experience; and (3) other factors the Company determines are relevant, including but not limited to, a resource based relative value scale. For a Service Provider who has a reimbursement agreement, the Reasonable and Customary charge is equal to the amount that constitutes payment in full under any reimbursement agreement with the Company.

 

Spinal Manipulation shall mean outpatient treatment in connection with the detection or correction by manual or mechanical means of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference as a result of or related to distortion, misalignment or subluxation of or in the vertebral column.

 

Treatment means a specific in-office or hospital physical examination of or care rendered to you, consultation, diagnostic

procedures and services, Surgery, medical services and supplies including medication prescribed or provided by a Service Provider.

 

 

 

HBC has compiled this information from public information as a resource for students seeking alternate coverage to the school’s sponsored plan. HBC specifically does not intend to imply a sponsorship or endorsement between the school and our website or company. Since Premier International is an alternative to the school’s student health insurance plan, it is advisable for the student to contact the school to ensure the Premier International meets the school’s requirement for alternate comparable coverage.