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.

 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.

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

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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.

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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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.

 

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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      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