You are eligible for coverage if you are a student enrolled at Florida A & M University and:

1. Are an Domestic Undergraduate or Graduate Student taking 6 or more credit hours, or

2. Eligible Dependents of Insured students can also purchase coverage.

See brochure for more details.

Complete the enrollment form and mail for each coverage period. Coverage may be purchased prior to the effective date with coverage beginning on the effective date of coverage purchased.

Students may initially enroll themselves and their dependents for coverage up to 14 days after the start of the Fall, Spring, or Summer coverage periods to avoid a lapse of coverage.

The brochure and enrollment form may be obtained from the University or by contacting the Servicing Agency by:

Basic Plan: The Basic Plan provides benefits for 80% of the Usual & Customary Charges incurred by an Insured Person for a loss due to a covered Injury or Sickness up to the maximum of $50,000 for each covered Injury or Sickness. There is a $50 deductible for each Injury or Sickness

See Schedule of Benefits for Covered Medical Expenses and Limitations

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

The brochure and enrollment form may be obtained from the Florida A&M University Student Health services or by contacting the agent by:

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Make check or money order payable to Nationwide Life Insurance Company in US dollars or refer to the Charge Card Authorization to charge your premiums to Visa or Master Card. Mail the enrollment card along with premium payment to:

5. What coverage periods are available?

The plan may be purchased for the following coverage periods during the 2008-09 policy period:

No. See number 5 for coverage period options.

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

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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.

 

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

Yes. The identification card is attached to the brochure.

Identification Cards may be printed www.gmsouthwest.com or contact:

GM-Southwest by:

            Toll-free:          800-550-4870 option 2

            Website:         www.gmsouthwest.com

 

12. Will I receive a copy of the policy?

No. The Master Policy is on file at the University. 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.

 

No. The only situations that allow for a refund are if the insured enters or becomes active in the armed services of any country. Then the company will issue a pro-rata refund for the period not covered by the policy. No refunds are available if a claim has been paid.

Yes. Maternity is treated as any other illness.

 

Pre-existing Conditions means any condition which manifested itself in such a manner as would cause an ordinary prudent person to seek medical advice, diagnosis, care or treatment for which medical advice, diagnosis, care or treatment was recommended or received within 12 months immediately prior to the Insured's Effective Date under this policy.

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.

 

You are able to chose any physician or hospital. The plan requires a Student Health Center Referral for services outside the FAMU Student Health Services.

The Plan Deductible is $50 for Each Injury or Sickness

There are some limitations as outlined under the Schedule of Medical Expense Benefits

Please see brochure for more details..

 

Yes. When you require prescribed medicines, We pay the 50% of Usual & Customary Charges up to a maximum benefit of $500 per policy year.

18. Can I choose any physician and hospital?

Yes. You are able to choose any physician and hospital.

 

     Yes, the plan uses the Beech Street PPO network. A list of physicians and hospitals is available at www.beechstreet.com  or by calling 1-800-877-1444

    Receipt of premium can be verified by contacting: 

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21. How do I verify coverage?

22. How do I file a claim?

Yes. Coverage will terminate on the last day of the period for which premium has been paid, (August 16, 2009)

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

.                        Consolidated Health Plans by:

            Toll-free:          800-633-7867

            Website:        www.consolidatedhealthplan.com    

28. How do I know if a particular illness or injury is covered?

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.

The plan includes a dental benefit only for injury to sound natural teeth in the amount of the Usual & Customary charge at $200 maximum.

The WellDyneRx Family Best Price Program is included in the plan.

WellDyneRx FAMILY BEST PRICE

PROGRAM     Prescriptions – Dental – Vision

Prescription Discount Plan

The WellDyneRx Best Price Card is an easy way to help your members receive all their prescription drug needs with no monthly fees or administrative charges. WellDyneRx participants and their family can obtain savings of up to 60% on drug prices through our nationwide network of over 50,000 pharmacies, including major chains and community pharmacies. In addition your members can receive savings up to 10 to 50% on all their dental and visions needs. Actual savings may vary depending on the type of service and the provider used.

 See our list of Pharmacies, save more and enjoy the convenience of home delivery on your medications by enrolling at www.welldynerx.com

 Dental Discount Plan

The dental discount plan offers significantly reduced fees saving members an average of 20% to 50% off of almost all General Dentists’ and Specialists’ standard fees. Members get access to nearly 70,000 credentialed DenteMax dentists nationwide. The dental discount plan is not insurance, which keeps it simple and more convenient.

 To find a provider please go to www.dentemax.com or call 800-752-1547, then simply present your card at a participating provider to receive your discount.

 Vision Discount Plan

The vision discount plan offers members a 10% to 50% savings when purchasing eyewear or receiving eye care at participating OUTLOOK Vision providers. Discounts are offered on eye exams, prescription glasses, sun glasses, contact lenses (mail order program available) and on surgical procedures (including PRK and LASIK) where available. Members receive the discounts at over 11,000 national and regional vision care centers. Our vision care provider network is one of the most comprehensive in the United States and includes ophthalmologists, optometrists, independent optical centers and national chain locations.

 To find a provider please go online to www.outlookvision.com  or call 800-342-7188, then simply present your card at a participating provider to receive your discount.

 

Yes. The Emergency Room Expense Benefit is paid under the Outpatient Miscellaneous Benefit of $1,500 maximum benefit.

Servicing Agency: Health Benefit Concepts, Inc.

E-mail: al@hbcstudent.com

Telephone: 1-800-463-2317     If the lines are busy, your call will be routed to voice mail. Please leave your name, telephone number and brief message. All calls will be returned in the order received, so please do not call repeatedly.

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