TBR International FAQ

Why should I have this student health insurance?

If you are an International Student on an F-1 student visa, you are required by federal law to have health insurance. International students must provide proof of insurance coverage to their respective schools. Some schools require the international students to purchase the State University and Community College System of Tennessee International Student Plan.

Tennessee Board of Regents has selected a student health insurance plan to offer to you. The rates are affordable and your acceptance is guaranteed.

This information is provided for the convenience of students and other interested parties. Any discrepancies between this document and the Master Policy shall be found in favor of the Master Policy on file at the Tennessee Board of Regents.

The information provided should not be considered as legal advice or opinion.

What does ---- mean? Definitions

INSURANCE DEFINITIONS

Allowable Charge: “Allowable Charge” has a different meaning according to the type of provider used. For

Preferred Provider Organization (PPO) Network Providers, an allowable charge is the contracted amount those providers have agreed to accept as payment in full for covered services. For a non-network (Non-PPO) provider, an allowable charge is based on the Usual and Customary (U&C) charge.

No payment will be made under this policy for any expenses incurred which are in excess of the UC charge for that service.

Co-payment: A per occurrence payment

Covered Expense: A medical procedure or service deemed payable by the insurance plan.

Deductible: A set dollar amount which must be satisfied within a specific time frame before the health plan begins making payments on claims

Exclusions: Those items or medical services that are not covered by the health plan.

In-patient: Those services provided by the hospital requiring an over-night stay.

Out-patient: Those services provided by the hospital not requiring an over-night stay.

PPO: Preferred Provider Organization - a physician or other medical provider who has agreed to accept a set fee for services provided under this plan. They are deemed to be "in-network".

Pre-Existing: A medical condition which originates, diagnosed, recommended for treatment or the existence of symptoms 12 months prior to the effective date of the insurance plan.

Benefits of the Plan

Does the plan include deductibles?

Yes. The plan includes the following deductibles per Injury or Sickness:

2007-08 International Plan	Deductible
Deductible	$50 per Insured for each Injury or Sickness
Student Health Center	$0 - deductible waived

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What are the maximum benefits?

International Insurance Plan	2008-09
Maximum Benefit:	Student: $250,000 per Injury or Sickness Spouse/Child: $100,000 per Injury or Sickness

Deductible:	$50 per Insured Person per Injury or Sickness; Deductible waived at Student Health Center

Deductible: Inpatient or Outpatient Hospitalization	No Deductible

Preferred Provider Organization (PPO) Coverage:	Student: 80% of Allowable Charge to $250,000 Spouse/Child: 80% of Allowable Charge to $100,000

Out of Network Coverage (Non-PP0):	Student: 80% of Allowable Charge to $250,000 Spouse/Child: 80% of Allowable Charge to $100,000

Preferred Provider Organization Network	Humana/Choice Care Network

Coverage outside the US	Yes

Student Health Center Referral Requirement	No

Eligibility	Enrolled for at least 6 credit hours

Benefit Period	Expires on Termination Date - 90 days extension if hospital confined

Pre-existing Conditions (waiting period)	12 months

INPATIENT
Room & Board (R&B)	PPO: 80% Non PPO: 80%
Hospital Miscellaneous (HM)	PPO: 80% Non PPO: 80%
Intensive Care	Paid under Room & Board
Physiotherapy	$5,000 maximum; PPO: 80% Non-PPO 80%
Surgeon's Fees	PPO: 80% Non PPO: 80%
Assistant Surgeon	PPO: 80% Non PPO: 80%
Anesthetist	PPO: 80% Non PPO: 80%
Registered Nurse's Services	PPO: 80% Non PPO: 80%
Physician's Visit	PPO: 80% Non PPO: 80%
Pre-Admission Testing (HM)	Paid under Hospital Miscellaneous
Psychotherapy/Drug Abuse	PPO: 100% Non PPO: 80%; Mental & Nervous: 45 days maximum; Alcoholism/Drug: 28 days maximum

OUTPATIENT
Surgeon's Fees	PPO: 80% Non PPO: 80%
Day Surgery Miscellaneous	PPO: 80% Non PPO: 80%
Anesthetist	PPO: 80% Non PPO: 80%
Assistant Surgeon	PPO: 80% Non PPO: 80%
Physician's Visits	PPO: 80% Non PPO: 80%
Physiotherapy	$1,000 maximum; PPO 80% Non-PPO 80%
Medical Emergency Expenses	PPO: 80% Non PPO: 80%;
Outpatient Miscellaneous Benefit (OM)	PPO: 80% Non PPO: 60% $2,500 maximum
Diagnostic X-ray & Laboratory	Paid under Outpatient Miscellaneous
Injections	Paid under Outpatient Miscellaneous
Radiation Therapy & Chemotherapy	Paid under Outpatient Miscellaneous
Test & Procedures	Paid under Outpatient Miscellaneous
Prescription Drugs	80%; $2000 maximum for covered Injury or Sickness
STD Testing	80%
Psychotherapy	Mental & Nervous:75% for the first 40 visits then 60% Alcoholism/Drug: 30 visits per year; PPO 100% Non-PPO 80%
OTHER
Ambulance Service	80% Usual & Customary
Braces & Appliances	80% Usual & Customary
Consultant Physician's Fees	PPO: 80% Non PPO: 80%
Dental Treatment – injury only	$100 maximum per tooth; $500 maximum
Elective Abortion	No Benefit
Maternity & Complications of Pregnancy	Paid as any other sickness
Routine Well-Baby Care	Paid as any other sickness; 4 days max. confinement
Detoxification - 12 days max./year	PPO: 80% Non PPO: 60%
Rectal & Prostate Exam; deductible waived	$20 co-pay; PPO: 80% Non PPO: 80%
Pap Smear; deductible waived	$20 co-pay; PPO: 80% Non PPO: 80%
Motor Vehicle Injury	Paid as any other injury
Blood & Body Fluid Exposure/Needle Stick	PPO: 80% Non PPO: 80%
Tennessee Department of Insurance Mandated Benefits	Yes

Optional Dental Benefit – non-injury	$500 maximum

Annual Premiums Under Age 40
Student	$ 765
Spouse	$1844
Each Child	$ 921
Annual Premiums Age 40 & Over
Student	$ 816
Spouse	$1968
Each Child	$ 921

Optional Dental Benefit	$ 159

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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 Benefits will be covered on the same basis as any other Sickness, after the Insured’s expiration date of coverage for an Insured’s pregnancy which commenced while insured under the Policy.

Does the plan cover pre-existing conditions?

Pre-existing conditions are excluded, except for individuals who have been continuously insured under the school's student insurance policy for at least twelve months.

Pre-existing conditions are excluded, except for congenital conditions, and as specifically provided for Newborn and Adopted Infants.

Pre-existing Conditions means: 1) the existence of symptoms within the 12 months immediately prior to the Insured’s Effective Date under the policy; or 2) any condition which originates, is diagnosed, treated or recommended for treatment within the 12 months immediately prior to the Insured’s Effective Date under the policy.
Coverage under a prior non-school’s student insurance policy does not satisfy the 12 month pre-existing condition waiting period.

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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 for Usual & Customary Charges (U&C) at 80% of Usual & Customary Charge.

Does the insurance plan include a prescription drug card?

No. The student insurance plans do not include a prescription drug card. The insured must pay for the prescription then file a claim with GM-Southwest for reimbursement of a covered injury or sickness.

The plan includes the Welldyne Discount Prescription Plan. 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.

See list of participating members at www.welldynerx.com

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Does the insurance plan included vision and dental benefits?

Vision Benefits:

The insurance plan does not provide vision benefits as part of the Student Injury and Sickness Insurance Plan.

The plan includes the WellDyne Vision – Outlook Vision Providers 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, including:

● Pearle Vision ● JC Penney Optical

● Sears Optical ● LensCrafters

● EyeMasters

See list of participating members at www.outlookvision.com

Dental Benefits – Injury Only:

The insurance plan includes a dental benefit for injury to sound natural teeth in the amount of $100 maximum per tooth up to a maximum benefit of $500.

Optional Dental Benefit: additional premium required

The optional dental plan is available on an annual or semester basis and only to Policyholders enrolled in the Student Health Insurance Plan. The Dental Plan provides a Policy Year Maximum Benefit of $500.00 with a policy year deductible of $50.00.

If a student experiences a break in coverage or terminates the medical plan, the dental plan is

Also terminated. There will be no refund of premium when the dental plan is terminated.

Optional dental is available on a annual premium basis. Students initially enrolling in the Spring can purchase the dental coverage. However, the premiums are not prorated

	State University and Community College System of Tennessee
International Student Accident & Sickness Insurance Plan Most Frequently Asked Questions about.....
Brochure Enrollment form				Plan Benefits	Coverage Time	Cost/Payment	Definition of Terms
			Process for Enrollment			Using the Insurance
						Why should I buy this insurance? Need additional assistance? click here

		Health Benefit Concepts, Inc. Your Partner in Student Health Insurance This information is provided for the convenience of students and other interested parties. Any discrepancies between this document and the Master Policy shall be found in favor of the Master Policy on file at the Tennessee Board of Regents. The information provided should not be considered as legal advice or opinion. The State University and Community College System of Tennessee Student Accident & Sickness Insurance Plan click for brochure enrollment form These are pdf files which have been created by Adobe. All downloadable information on this site is in the Adobe PDF File format. To view this file you will need to have the Adobe Acrobat Reader Plug-in installed on your computer. Get the free Adobe Acrobat Reader Plug-in here: www.adobe.com/products/acrobat/readstep.htm