Florida A&M University
2009 - 2010 Accident and Sickness Insurance Plan

 

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

 you have 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 policy concerning ...

(1) need for medical care away from your local network, such as when you are at school and 

(2) the maximum age for coverage

 

This insurance policy is endorsed by Florida A & M 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.

31 Most Frequently Asked Questions

brochure and enrollment form

 

 

 

 

 

          

Frequently Asked Questions

1. How do I enroll in the plan...

   as an undergraduate?     

   as a Graduate Student?
2. What does the plan cover and is there a deductible?
3. How much does the plan cost?
4. How do I pay?
5. What coverage periods are available?
6. Can I enroll after the Effective Date and are the premiums pro-rated?
7. Can I purchase this plan for the spring semester only?
8. If I elect to enroll by Fall and Spring/Summer semesters, will I receive notification to re- enroll for continuous coverage?
9. What happens if I do not re-enroll during the 14 day grace period?
10. Will I receive a receipt?
11. Will I receive an identification card?
12. Will I receive a copy of the policy?
13. Can I get a refund?
14. Does the plan provide maternity benefits?
15. Does the plan cover pre-existing conditions?
16. Where to go for medical care and does the plan include deductibles and co-pays?
17. Does the plan pay for prescriptions?
18. Can I choose any physician and hospital?
19. Does the plan include a Preferred Provider Organization Network?
20. Has the company received my premium payment?
21. How do I verify coverage?
22. How do I file a claim?
23. How do I check the status of my claim?
24. How do I get another identification card?
25. If I purchase the annual coverage and graduate in December 2008 or May 2009, will I be covered through the August 16, 2009?
26. What should I do if my student health center is closed or I am away from school?
27. Does the plan cover health related conditions when I am out of the country?
28. How do I know if my particular illness or injuries covered?
29. Is pre-certification of hospital admissions required?
30.Does the insurance plan include a dental benefit and Discount Prescription, Dental & Vision Discount  Plan?
31. Does the insurance plan include an Emergency Room Expense Benefit?
 

Need additional assistance?

 

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,

You have health insurance but it has a deducible 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 policy concerning ....

(1) need for medical care away from your local network, such as when you are at school and 

(2) the maximum age for coverage

 

This insurance policy is endorsed by Florida A & M 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.

 

 

Information for Florida A & M University students concerning the 2009- 2010

Student Insurance Plan

2009 - 2010 Student Health Insurance Plan

　

         How do I enroll in the plan as an undergraduate student?

          Undergraduate

All registered undergraduate students taking 9 or more credit hours are eligible to enroll in this insurance Plan.

Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the spouse and their children under 25 years of age who are not self-supporting; who live with the Insured or who are a full-time or part time student.

How do I enroll in the plan as a Graduate student?

Graduate

All registered graduate students taking 6 or more hours are eligible to enroll in this insurance plan.

In order to be eligible for university-funded insurance graduate students must:

  • Be US Citizen or permanent resident

  • Have signed a graduate assistant contract with an appointment of at least a .25 FTE (10 hours a week)

  • Be enrolled as a regular full-time student

  • Have signed up for a FAMU e-mail address

However, if a graduate student does not meet the eligibility requirements for payment by the University, they can purchase the health insurance coverage on their own by completing the United Healthcare Insurance Company Enrollment Form and send directly to the insurance company. Students eligible for University funded insurance do not have to complete this form. Additional information on applying for health insurance can be found on the School of Graduate Studies website at:

         www.famu.edu/graduatestudies/healthcare

Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the spouse and their children under 25 years of age who are not self-supporting; who live with the Insured or who are a full-time or part time student.
 

2. What does the plan cover and is there a deductible?

The Policy provides benefits for the Usual and Customary Charges incurred by an Insured Person for loss due to a covered Injury or Sickness up to the Maximum Benefit of $50,000 for each Injury or Sickness.

The Preferred Provider for this plan is UnitedHealthCare Options PPO.

Preferred Provider: 80% except as noted in the Schedule of Benefits

Out of Network: 60% except as noted in the Schedule of Benefits

            Deductibles:

Preferred Provider: $100 for Each Injury or Sickness

Out of Network: $200 for Each Injury or Sickness

 

3. How much does the plan cost?

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




Basic Plan

Annual

9-15-09
to
9-14-10

Fall

9-15-09
to
1-2-10

Spring/Summer

1-3-10
to
9-14-10

Summer

5-7-10
to
9-14-10

Student

      $856

$263

$610

$313

Spouse

    $2,353

$723

$1,677

$861

Each Child

    $1,498

$460

$1,067

$548

 

The brochure and enrollment form may be obtained from the agent by:

Servicing Agency: Health Benefit Concepts, Inc.    Telephone: 800- 463- 2317

E-mail: al@hbcstudent.com     On-line Enrollment www.firststudent.com

Or click for brochure          enrollment form  

4. How do I pay?

Make check or money order payable to United Healthcare Student Resources  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:

            First Risk Advisor

            10 S. Clinton Street –Suite 10

            Doylestown, PA  18901

 

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5. What coverage periods are available?

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

2009 -10

Coverage Period

 Annual

09-15-09 to 09-14-10

Fall

09-15-09 to 01-02-10

Spring/Summer

01-03-10 to 09-14-10

Summer

05-07-10 to 09-14-10

 

6. Can I enroll after the Effective Date and are the premiums pro-rated?

Yes, including:

1) Adding a new spouse or dependent child (within 31 days of marriage, birth or adoption)

2) Loss of coverage under another plan due to ineligibility (within 31 days of loss of eligibility)

3) New or Transfer Student (within 31 days of date of enrollment at FAMU)

Premiums are not pro-rated. Please note the premiums are charged by coverage period. If you enroll after a coverage period has begun, you must still pay the full premium. There is no provision in the policy for "pro-rating" of premiums.

  More information is available by contacting: 

First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

 

7. Can I purchase this plan for the spring semester only?

No. See number 5 for coverage period options.

 

8. If I elect to enroll by Fall and Spring/Summer semesters, will I receive notification to re-enroll for continuous coverage?

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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9. What happens if I do not re-enroll during the 14 day grace period?

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.

 

10. Will I receive a receipt?

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

 

11. Will I receive an identification card?

Yes. The identification card is attached to the brochure.

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

First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

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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.

 

13. Can I get a refund?

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.

 

14. Does the plan provide maternity benefits?

Yes. Maternity is treated as any other illness.

 

15. Does the plan cover pre-existing conditions?

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. Routine follow-up care to determine whether a breast cancer has reoccurred in a person who has been previously determined to be free of breast cancer does not constitute medical advice, diagnosis, care, or treatment for purposes of determining pre-existing conditions unless evidence of breast cancer is found during or as a result of the follow-up care.

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

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16. Where to go for Medical Care and does the plan include deductibles and co-pays?

You are able to choose any physician or hospital. The Plan Deductibles are:

Preferred Providers: $100 for Each Injury or Sickness

Out of Network: $200 for Each Injury or Sickness

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

Please see brochure for more details.

 

17. Does the plan pay for prescriptions?

Yes. When you require prescribed medicines, the Plan pays the 80% of Usual & Customary Charges up to a maximum benefit of $500 per policy year. The deductible is $20 per prescription.

 

18. Can I choose any physician and hospital?

Yes. You are able to choose any physician and hospital. However, the plan utilizes the United Healthcare Option PPO

 

19. Does the plan include a Preferred Provider Organization Network?

Yes, the plan uses the United Healthcare Option PPO network. A list of physicians and hospitals is available at:

 www.firststudent.com – click on Find Doctor or Hospital,

 or by calling 1-800-767-0700

The Plan provides benefits for a $50,000 for Each Injury or Sickness If care is received from a Preferred Provider any Covered Medical Expense will be paid at the Preferred Provider level of benefits. In all other situations, reduced or lower benefits will be provided when an out of Network provider is used.

Preferred Provider: 80% except as noted in the Schedule of Benefits

Out of Network: 60% except as noted in the Schedule of Benefits

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20. Has the company received my premium payment?

    Receipt of premium can be verified by contacting: 

First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

21. How do I verify coverage?

Verification of coverage may be obtained by contacting

             First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

 

 

22. How do I file a claim?

In the event of Injury or Sickness, student should:

1.  Report to the Student Health Service or Infirmary for treatment, or when not in school, to their Physician or Hospital. 

2. Mail to the address below all medical and hospital bills along with the patient's name and insured student's name, address, social security number and the name of the university under which the student is insured.

A company claim form is not required for filing a claim.

3. File claim within 30 days of Injury or first treatment for a Sickness. Bills should be received by the company within 90 days of service. Bill submitted after one year will not be considered for payment except in the absence of legal capacity.

            Direct all Claim and/or Customer Service Inquiries to:

             First Student
            PO Box 809025
            Dallas, TX  75380-9025

            Telephone:    800-505-4160

            Website:         www.firststudent.com

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23. How do I check the status of my claim?

Status of the claim may be obtained by contacting:

             First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

 

24. How do I get another identification card?

An identification card is attached to the brochure and may be obtained by contacting:    

           

First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

 

 

25. If I purchase the annual coverage and graduate in December 2009 or May 2010, will I be covered through September 14, 2010?

Yes. Coverage will terminate on the last day of the period for which premium has been paid, (September 14, 2010)

 

26. What should I do if my 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.

Contact  First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

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

Yes. The plan provides coverage 24-hours a day anywhere in the world.

Through participation in the Florida A&M University insurance plan, each Insured Person is eligible for emergency medical assistance services when traveling 100 miles or more from his/her permanent home or campus address or abroad. Services are available 24 hours a day, 365 days a year and are provided by Scholastic Emergency Services (SES)

Please refer to www.firststudent.com for service description.

877.488.9833 toll-free within the United States

609.452.8570 collect outside the United States

 

 

28. How do I know if a particular 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:

                        First Student by:

            Toll-free:        800-505-4160

            Website:         www.firststudent.com

 

29. Is pre-certification of hospital admissions required?

Yes. Avidyn should be notified for All Hospital Confinements prior to admission.

1. Pre-Notification of Medical non-Emergency Hospitalization: The patient, Physician or Hospital should telephone
1-877-295-0720 at least five working days prior to the planned admission.

2. Notification of Medical Emergency Admission: The patient, patient's representative, Physician or Hospital should telephone 1-877-295-0720 within two working days of the admission to provide notification of any admission due to Medical Emergency.

Avidyn is open for Pre-Admission Notification calls from 8:00 am to 6:00 pm CST. Monday through Friday. Calls may be left on the Customer Service Department's voice mail after hours by calling 1-877-295-0720

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.

 

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30. Does the insurance plan include a dental benefit and Discount Prescription, Dental & Vision Plans?

 Yes, the plan includes a dental benefit for injury to sound natural teeth in the amount of the usual & customary charge up to $500 maximum. 

The plan includes the United Health Allies Discount Plan. For more information please click on:

http://firststudent.com/html/unitedhealth_allies.htm

 

UnitedHealth Allies Discount Card includes:

Dental Care:
Save from 10% to 35% on a range of dental services
including routine cleaning, x-rays, even cosmetic dentistry, such as teeth whitening.

Vision Care:
Pay no more than $40 for an annual eye exam, save 10% to 20% on eyeglasses
from participating eye care professionals and retail vision chains and fittings for
contact lenses (not included in annual eye exams).

Wellness products and services:
Be healthier and save money with discounts of 10% to 50% on weight management,
fitness memberships and equipment, relaxation resources, natural products and
vitamins and supplements.

 Prescription drugs:
Save at the pharmacy or through the mail. Not available on plans that utilize the
United Healthcare Network Pharmacy Program (Medco).

 

31. Does the insurance plan include an Emergency Room Expense Benefit?

Yes. The Emergency Room Expense Benefit is paid:

Preferred Provider: 80%; $250 maximum

Out of Network:  60% under the Outpatient Miscellaneous Benefit

 

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. Master Policy 2009-653-76.

      　

　

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If you are unable to find your question and answer, assistance with other inquiries may be obtained by contacting the servicing agency:

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.

back to FAQ

Complete the following form:

Name:               

E-mail:   

If you prefer to be contacted by phone -telephone with area code:

                         Type of Assistance needed: 

If you are requesting a brochure or enrollment form, please provide your address:
Street or Post Office Box:

City:   State: Zip Code:

Message:

 

 

 

 

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. Master Policy #903108.