Transcript Document

International Student
Health Insurance
for the students of
Providing Student Health Insurance Solutions for Over 30 Years
Topics for Discussion
Contact Information
Health Insurance Basics
• Why do I need health insurance?
• How does health insurance work?
• Who is eligible?
How to Enroll in the Plan
• How do I enroll?
• What if I want to pay by check?
Using Your Health Insurance
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Your insurance brochure
What is covered by this insurance?
Where is the Health and Wellness Center?
How do I obtain an ID card?
How do I get medical treatment?
Why should I use a PPO?
How do I find a participating provider?
What if I have an emergency?
Paying for Health Care
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How are medical bills paid?
Where can I find a claim form?
How do I submit a claim?
How to complete a claim form
How do I find out about my claim?
Prescription Medication
• How do I get my prescriptions filled?
• Prescription drug claim form
Other Important Information
• Terms to know
• Summary
Contact Information
Renaissance Agencies, Inc.
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Phone: (800) 537-1777
Fax: (310) 394-0142
Website: www.renstudent.com/ivc
– Visit the website for PPO information, brochures, FAQs, claim instructions, ID cards,
and much more!
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Hours: 8:00 a.m.–5:00 p.m. Monday-Friday
IVC Health and Wellness Center
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Phone: (949) 451-5221
Website: www.ivc.edu/wellness
Hours: 9:00 a.m.–7:00 p.m. Monday-Thursday
9:00 a.m.–1:00 p.m. Friday
Health Insurance
Basics
Why do I need health insurance?
• Health care in the U.S. is different than in any
other country:
– No free medical care
– Privately funded and run
– Average cost to visit a doctor: $150
– Average cost to stay in a hospital: $1,800
• And that’s just room and board! Doctor’s fees,
lab charges, x-rays, surgery, etc. all cost extra.
Your final bill can be thousands of dollars!
How does health insurance work?
• Your insurance is there to help
with the cost in case you get
sick or injured. It will cover a
certain percentage of the cost if
you go to a doctor or hospital.
• You are responsible for paying
what the insurance doesn’t
cover.
• Even if you don’t go to a doctor
or hospital all year, you still
have to pay the insurance
premium and you will not get a
refund at the end of the term.
Who is eligible for IVC’s International
Student Health Insurance Plan?
• You are required to be insured under the
policy offered by Irvine Valley College if you
are a full-time student with an F-1, J-1 or M-1
visa.
• Dependents of full-time students are eligible
for this coverage.
How to Enroll in the
Health Insurance Plan
How do I enroll?
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Go to www.renstudent.com/ivc and click on “Enroll Online.”
Click on “Purchase Plan Online.” A major credit card or debit card
is required.
Click on “Purchase a Plan Online”
to proceed.
What if I want to pay by check?
• If you do not have a credit card or
prefer to pay by check or money
order you can fill out and mail in an
enrollment form instead.
• Submit the form, along with your
check or money order, to:
Renaissance Agencies, Inc.
P.O. Box 2300
Santa Monica, CA 90407
• Enrollment forms are available
from the Student Heath and
Wellness Center, SC 150, or online
at www.renstudent.com.
Using Your
Health Insurance
Your health insurance brochure
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The brochure contains important
information about your
insurance benefits, as well as
important contact information.
Keep it handy and use it for
future reference.
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You can download the brochure
by visiting
www.rensutdent.com/ivc.
What is covered by this insurance?
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Medical costs up to $250,000 per Accident or Sickness for students and $100,000
for dependents.
Most charges at 100% when you use a PPO provider; most charges at 75% when
you use a non-PPO provider.
There is a $100 deductible unless you go to the Health and Wellness Center first.
You will need to pay a $10 copay when you go to a Doctor’s office.
Medical evacuation and repatriation through MEDEX.
Generic medicines paid at 100% if you use an Express Scripts Pharmacy, brandname medications paid at 50%.
Treatment for Mental and Nervous disorders.
Women’s wellness examinations (see the Health and Wellness Center for more
information).
This plan does NOT cover:
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Dental or vision care, including eye examination or
routine dental examinations (except to repair injury).
Pre-existing conditions, for the first 6 months
of the policy.
Additional information on benefits
is located on pages 10-11 of your
insurance brochure
Where is the
Health and Wellness Center?
The Health and Wellness Center id
located at SC 150.
How do I obtain an ID card?
• Your insurance ID cards will be sent to you within about two weeks
from the first day of school. You will receive two ID cards at the
beginning of the school year. Keep your cards for one year. Do not
throw away your cards until you receive new ones (next year).
• If you lose your ID card:
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Get a temporary ID card from the Campus Health Center or
download a temporary ID card from www.renstudent.com/ivc.
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Call Renaissance at (800) 537-1777 to request a replacement card.
• 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!
How do I get medical treatment?
1. Visit the Health and Wellness Center (HWC) before you go
to any other doctor (unless it’s an emergency!).
2. Check PPO listing for preferred doctors and hospitals. List
is available at the Health and Wellness Center, online at
www.myfirsthealth.com or by calling (800) 226-5116.
3. Call your doctor to schedule an appointment.
IMPORTANT NOTE:
If you don’t visit the Health and Wellness Center before
seeing another doctor, you will be required to pay a $100
deductible for treatment received before the insurance
will pay any benefits.
Why should I use a PPO?
• A PPO means a Preferred Provider Organization,
which is a group of doctors and medical facilities
that has been authorized by the insurance
company and has negotiated rates with the
insurance company.
• If you get a referral for medical care, you can
choose any doctor or hospital, but choosing one
that is part of the First Health Preferred Provider
Network may decrease your costs. Visit
www.myfirsthealth.com or call (800) 226-5116 to
find a PPO provider.
How do I find a participating provider?
Log on to www.myfirsthealth.com.
Click “Find a doctor” to
begin
Finding a PPO provider (cont’d)
Enter your search criteria and click
“Find a Doctor.”
Finding a PPO provider (cont’d)
Providers will be listed by distance from the
address you entered. You may contact any
provider from this list.
What if I have an emergency?
In the event of an
emergency, go directly
to the nearest hospital
for treatment or call
9-1-1 if you need an
ambulance.
Paying for Health Care
How are medical bills paid?
If you see a doctor or are treated in a hospital, there are
two ways in which payment can be handled:
1. If the provider requires full payment at the time of
treatment, pay the fee and then submit a claim form (a
written request to the insurance company for payment
of covered expenses) along with a copy of your bill(s) to
Personal Insurance Administrators (PIA). The company
will reimburse you for the amount they are responsible
for paying (100% of Allowable Charges for PPO, 75% for
non-PPO).
2. If the provider submits the bill directly to the PIA, you
will be billed later for any charges that your insurance
does not cover.
Where can I find a claim form?
• You can find claim forms
at the HWC, by calling
(800) 468-4343, or by
visiting
www.renstudent.com/ivc.
• Be sure to fill out the
claim form completely!
Go to the Health and
Wellness Center if you
need help or have
questions.
Claim Form
How do I submit the claim form?
• You must submit a claim in order to have your medical
bills paid!
• Send all claim forms, referrals, prescriptions, lab test
charges, and any other bills for medical treatment to:
Personal Insurance Administrators
P.O. Box 6040
Agoura Hills, CA 91376
• Keep copies of all the documents you submit for claims.
• Claims are usually processed in 7-10 days if all the
paperwork is complete.
• Make sure you fill out the form completely to ensure your
claim will be processed promptly.
How to complete a claim form
Fill out your school
Information.
Irvine Valley College
Part I
302-082-0407
Holly Smith
Include your current
information.
12546
123 Any Street
Anytown, CA
2/21/85
85236
Part II
09/01/2008
09/01/2008
broken arm
Playing basketball at the park
This section relates
directly to the injury
or sickness for
which you’ve been
treated and wish to
be reimbursed for.
x
Part III
x
Recreational game with friends
x
x
How to complete a claim form
x
Only fill in this
section if you
currently have
other insurance
covering injury or
sickness.
Part IV
x
Be sure to specify
who and where
payment should
be reimbursed to.
Part V
Remember to sign
and date the claim
form.
Part VI
Holly Smith
123 Any Street
Irvine, CA 85236
Holy Smith
10/01/2009
How do I find out about my claim?
• Contact Personal Insurance Administrators for
help with claims, including filling out the form
and information on a claim that has been
submitted.
• To check the status of a claim you submitted
call PIA at (800) 468-4343.
Prescription
Medications
How do I get my prescriptions filled?
• You will receive a special ID card from Express Scripts for
prescriptions in the mail. You may use your insurance ID card in the
meantime.
• You should use an Express Scripts pharmacy; otherwise you will be
responsible for paying 100% of the prescription cost. Most major
chains are Express Scripts pharmacies (CVS, Walgreens, etc.). To find
pharmacies near you, visit www.express-scripts.com.
• Most pharmacies will only charge you the copay. If they require you
to pay the full amount, you can complete a claim form (available
from www.express-scripts.com) for reimbursement. You only need
to complete a claim form if the pharmacy requires payment at the
time of pick-up.
• If you must complete a claim form. Be sure to attach receipts from
the pharmacy and to keep a copy of all documents submitted for
claims.
Prescription drug claim form
Instructions
Claim Form
Other Important
Information
Terms to know
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Amount Charged – The amount charged by the provider for their service.
Copay – A definite amount that you are responsible for each time a specified service is rendered
regardless of the deductible or co-insurance.
Co-insurance – The sharing of the cost of the medical services between the insurance company
and you. Example: Your plan covers 100% of the in-network charges, but if you do not see a First
Health PPO Network doctor the plan covers only 75% of your expenses.
Deductible – The amount that you may have to pay before the policy begins to pay benefits.
Disallowed – Those charges that are either not covered by the plan or have exceeded the plan
benefit.
Exclusions – Specific conditions or instances that are not covered by the plan.
Limitations – Specifications that apply and must be met in order for services to be covered.
Out-of-pocket – The amount that you are responsible for paying after the plan has paid its
portion. This includes deductibles, co-payments and co-insurance.
Patient Liability – The amount of the charge you are responsible for. The provider will bill you
directly for the balance due.
Preferred Provider Organization (PPO) – The network of providers contracted to charge
discounted rates.
Provider – The doctor, hospital, medical facility or ambulance that is licensed to provide medical
or dental 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.
Summary
• Always visit the Health and Wellness Center first. The $100
deductible is waived if you first utilize the center, and receive a
referral for any outside care.
• Providers in the First Health PPO Network will lower your out-ofpocket costs. Use a First Health provider!
• Remember to always submit a claim form after receiving medical
treatment outside of the campus Health and Wellness Center.
• Use Express Scripts pharmacies to avoid paying full price for
prescription medications.
• Call PIA for help with claims: (800) 468-4343.
We are here to help you!
Our job is to help you
understand your insurance
benefits. Please call us if you
have any questions.
Renaissance Agencies, Inc.
1437 Seventh Street, Suite 400
Santa Monica, CA 90401
Phone: (800) 537-1777
Fax:
(310) 394-0142
Website: www.renstudent.com
THANK YOU!
Renaissance Agencies, Inc.
1437 7th St, Suite 400
Santa Monica, CA 90401
(800) 537-1777
www.renstudent.com