University of St. Augustine
Health Insurance Designed Just for Students

Why should I have this insurance?

Health
Benefit
Concepts,  Inc

 Your Partner in Student Health Insurance

Accidents
and Illness

 Do Happen!      

 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.

Why should I have this student health insurance?

Every year, a number of uninsured students incur unexpected medical bills. These students often drop out of school to work in order to pay the medical bills or stay in school and obtain student loans/a payment plan to pay the bills. The University of St. Augustine does not want unexpected medical expenses to become a hardship. This insurance plan is endorsed by the University of St. Augustine for the Eligible Students and their Eligible Dependents.

Many students and their dependents will require health care at some time during the school year. 

You should consider this insurance if:

 è you currently do not have any
health insurance

  èyou have health insurance but it has a deductible and/or co-payments that will 
leave you paying out-of-pocket expenses

èyou have health insurance but it is a PPO,
HMO or other insurance plan that has coverage restrictions.

Check your policy concerning ....

P need for medical care away from your local network, such as when you are at school and 
P the maximum age for coverage

 Benefits of the Plan

Does the plan include deductibles?

Yes. $50 deductible per Injury or Sickness.

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 is treated as any other illness. Conception must occur after the Insured’s effective date of coverage.

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 6 months immediately prior to the Insured's Effective Date under this policy.

Pre-existing Conditions will apply for the first 6 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. 

Does the plan pay for prescriptions?

Yes. Yes. Outpatient prescription drugs for a covered injury or sickness.

Injury Only Plan: 90% of usual & customary charges

Injury & Sickness Plan: 90% of usual & customary charges; $300 maximum benefit

Does this 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 University of St. Augustine insurance plan, each Insured* is eligible for global emergency assistance services when traveling 100 miles or more form his/her permanent home or campus address or abroad. Services are accessible 24 hours a day, 365 days a year and are provided by Assist America, Inc..

Please refer to www.assistamerica.com

           for service descriptions. To access services please call:

          877-488-9833 Toll free within the United States

          609-452-8570 Collect outside the United States

Does the plan include a Preferred Provider Organization (PPO)?

No.

Coverage time of the Plan

What coverage periods are available? How long of a time period am I covered?

The plan may be purchased for the following coverage periods.

Click for   brochure                click for 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

If I elect not to purchase the annual coverage, 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.

Can I purchase this plan for one or two semesters?

Yes.  Please see for coverage periods.

If I purchase the annual coverage and graduate in December 2009 or May 2010, will I be covered through the August 26, 2010 expiration date?

Yes. Coverage will terminate on the last day of the period for premium has been paid (August 26, 2010).

If I elect not to purchase the annual coverage, 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.

Cost/Payment

How much does it cost?

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

How do I pay?

Make check or money order payable to United Health Care/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 Advisors, Inc.      
      
            10  S. Clinton St.     Suite 10

                Doylestown, PA 18901

Only the above office is authorized to accept and process your completed enrollment form; do not send it elsewhere.   Your cancelled check or credit card billing is your only receipt and notification of coverage. It is the student’s responsibility for timely renewal payment whether or not a renewal notice is received.

How do I know that 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

Your canceled check is your receipt and proof of coverage.

Enrollment Process

How do I enroll in the Plan?

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

Click for   brochure                click for 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

The enrollment forms may be obtained from the Registrar's Office or 
by contacting agent

On-line enrollment at www.firststudent.com

How do I pay?

Make check or money order payable to United Health Care/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 Advisors, Inc.      
      
            10  S. Clinton St.     Suite 10

                Doylestown, PA 18901

Only the above office is authorized to accept and process your completed enrollment form; do not send it elsewhere.   Your cancelled check or credit card billing is your only receipt and notification of coverage. It is the student’s responsibility for timely renewal payment whether or not a renewal notice is received.

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.

Can I enroll after the effective date and are the premiums pro-rated?

Yes. You can purchase insurance coverage at any time. However, your coverage may vary depending in the timing of your enrollment:

·    If you were covered by the 2008-2009 student health insurance plan and you enroll in the 14 day grace period, you will qualify for continuous coverage. This means that the pre-existing condition exclusion will not apply for any conditions that were covered claims in the previous school year.

·    If you were covered by the 2008-2009 student health insurance plan and you do not enroll within the 14 day grace period, the pre-existing condition exclusion will apply for claims that are submitted for payment.

·    If you are a new student or enrolling due to an involuntary loss of coverage from another source, you may enroll at anytime, and the pre-existing condition exclusion will apply.

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. 

Will I receive a receipt?

No. No. Your canceled check is your receipt and proof of coverage.

Will I receive an identification card?

Yes. If you need to access services before you receive your ID card, your provider can contact:

            First Student by:

            Toll-free:        800-505-4160

            Website:        www.firststudent.com

Will I receive a copy of the policy?

No. The Master Policy is on file at the University of St. Augustine-Registrar's office. 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.

Can I get a refund?

No. The only situations that allow for a refund if the insured enters or becomes active in the armed services of any country.

Using the insurance

How do I get another identification card?

An identification card may be obtained by contacting:    

            First Student by:

            Toll-free:        800-505-4160

            Website:        www.firststudent.com

What should I do if the 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.
 

Can I choose any physician and hospital?

Yes. You can choose any physician or hospital.

Does the plan include deductibles?

Yes. $50 deductible per Injury or Sickness.

Does this 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 University of St. Augustine insurance plan, each Insured* is eligible for global emergency assistance services when traveling 100 miles or more form his/her permanent home or campus address or abroad. Services are accessible 24 hours a day, 365 days a year and are provided by Assist America, Inc..

Please refer to www.assistamerica.com

           for service descriptions. To access services please call:

          877-488-9833 Toll free within the United States

          609-452-8570 Collect outside the United States

How do I know if my 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

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 nay 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.

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

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

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

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 nay 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.

           Does the plan include a 24/7 Nurse line?

 Insured Students have access to nurse advice and health information 24 hours a day, 7 days a week by dialing 1-877-643-5130. The Collegiate Assistance

 

Need additional assistance? You may phone 1.800.463.2317   ask for Al with Health Benefit Concepts   or email al@hbcstudent.com or You may complete this form:              Your Name:                              Your preference for our response: email:  telephone with area code:  Please provide your address if you require a brochure. street address or P.O. Box  city: State/Province   zip/postal code Please assist me concerning: