Health Insurance. To reach the Healthcare Advocates, students should use the following contact information:

Transcription

1 Health Insurance The College requires that all students have health insurance. To make sure that all students are covered, the College automatically includes the cost of a health insurance policy provided through A-G Administrators Inc. (AG) in their tuition bills. Students must either document that they are already properly insured with personal medical insurance, or they must purchase the plan offered by the College. The exception is international students, who are required to carry insurance and are automatically enrolled in this plan and may not waive out of the plan. Insured students that want to waive out of the AG plan must log on to and complete the waiver, which requires them to provide key information about their personal medical insurance. Your log on information is: ID: Last Name First Initial entered without any spaces Example: Enter Jane Smith as smithj Password: Last 5 digits of your Moore College of Art and Design Student ID Once students have documented that they are properly insured with personal medical insurance, the charge will be taken off their bills. Students are asked to log on to the website and process their waiver information by September 10, 2010; the deadline for waiving without any financial penalty is September 30, For students who aren t insured and must purchase the plan, the cost of the AG plan is $ , which includes all premiums and administration fees. The cost will be included in determining students financial aid packages. All students have access to our Health Services, headed by Diane Azuma, RN, free of charge. The College also has an ongoing relationship with a group of physicians to whom we refer students for primary care. Whether they are insured by the College s AG plan or by their own insurance, all students will use their insurance for visits to PennCare. The College will reimburse up to a maximum of $20 of a student s co-pay if she uses PennCare for primary care. (For more specifics on this policy, see the Student Handbook.) The AG plan also covers visits to specialists, prescriptions, x-rays, etc. which aren t part of PennCare s services. A summary of AG s benefits is included in this section of the New Student Guide. Brochures explaining in greater detail exactly what the AG insurance covers will be mailed to students who are enrolled in the plan. Brochures can also be picked up in the Health Services Office on the first floor of Stahl Hall. Any charges for these services beyond what the insurance covers are the student s responsibility. The College does NOT provide any reimbursement for these co-pays. The College has also retained Hulse/QM as Healthcare Advocates to assist students using the AG plan in the processing of claims. If a student suspects her claim is not being handled correctly, she should call the Advocates who can assist her in understanding the coverage and make certain the insurance company is administering the claim correctly. As Healthcare Advocates, Hulse/QM is separate from the insurance company. To reach the Healthcare Advocates, students should use the following contact information: Hulse/QM Healthcare Advocates 5 East Main Street Mechanicsburg, PA Phone: Fax: university@hulseqm.com Part-time, non-degree, and post-baccalaureate students, carrying a minimum of six (6) credit hours are encouraged to enroll in the College s AG plan with the submission of an Enrollment From, which may be obtained in the Business Office. The Enrollment Form must be returned with a check for $ to the Business Office on or before September 10, 2010, in order for the student to be eligible for coverage. Students with questions regarding this policy and its terms should contact the Hulse/QM Healthcare Advocates at the numbers listed above.

2 Moore College of Art & Design Student Blanket Accident and Health Plan Summary of Benefits Eligibility: All Moore College of Art and Design students are required to be enrolled in a health insurance plan with benefits equal to or better than the plan detailed below. Student will be automatically enrolled in the school-sponsored plan, unless they provide evidence of acceptable, personal, medical insurance. Effective Dates: August 14, August 14, 2011 Cost of Insurance: Student- $1,331; Dependent Spouse- $2,789.00; Dependent Child- $1, (Annual Rates) Rates include all administrative fees. Networks: The Devon Health Network is available to students and dependents. Use of a network provider reduces out-of-pocket expenses as network providers have agreed to accept lower fees as payment for healthcare services. You can review a list of in-network providers, by visiting accessing the Provider Finder, and searching by zip code. In-Network Out-of-Network Per Condition Maximum - combined total for in- and out-of-network. $50,000 Usual, Reasonable and Customary (URC) is the charges and/or fees for medical services, treatments or supplies that are the lesser of the usual charge by the provider for the service or supply given or the average charged for the service or supply in the area where the service/supply is given or received and that are reasonable in relationship to the severity of the condition. INPATIENT BENEFITS Anesthetist URC URC Assistant Surgeon 25% of Surgeon's URC 25% of Surgeon's URC Hospital Expense Daily semi-private room rate and Hospital Miscellaneous Expenses which includes pre-admission testing, anesthesia, operating room, laboratory tests, x-rays, oxygen, $50 copay/day 80% URC medicines, drugs (excluding take home drugs), dressings, and other medically necessary non-room and board expenses. $3,000 aggregate per day. Inhalation Therapy 100% after $20 copay 80% URC Intensive Care - $6,000 aggregate per day. $100 copay/day 80% URC Mental and Nervous Disorders - Limited to 30 Inpatient days per policy year. 100% after $50 copay/day 80% URC Physician s Visits 100% after $20 copay 80% URC Rehabilitation Services - Limited to 10 visits per policy year- (expanded to 30 visits with a Physicians prescription) 100% after a $10 copay 80% URC Surgeon s - Up to $3,000 per condition $50 copay 80% URC OUTPATIENT BENEFITS In-Network Out-of-Network Outpatient Hospital - When related to a scheduled surgery includes the cost of the operating room, anesthesia, drugs (excluding take home drugs), medicines and supplies. $3,000 per condition maximum. $50 copay 80% URC Outpatient Miscellaneous - Includes but not limited to benefits designated as Paid under Outpatient Miscellaneous. Up to $2,000 per condition. $20 copay 80% URC Anesthetist - Professional services administered in connection with outpatient surgery. Assistant Surgeon Laboratory Services URC URC Paid under Outpatient Miscellaneous URC URC Paid under Outpatient Miscellaneous Medical Emergency Expenses - Includes use of Emergency Room and supplies. Up to $2,500 per condition. $150 copay $150 copay Physician s Visits 100% after a $20 copay 80% URC This summary of benefits will introduce students to the accident and health benefits offered by the Moore College of Art and Design sponsored plan. This is only a summary and does not replace or supersede the full plan document which is available through the College. IT DOES NOT PROVIDE FULL DETAILS FOR ALL BENEFITS. This summary highlights the most common areas of interest when comparing health plans. For additional information, please call the Healthcare Advocate at Hulse/QM at (800) MCAD Page 1

3 OUTPATIENT BENEFITS (continued) In-Network Out-of-Network Mental and Nervous Disorders - Limited to 60 Outpatient days per policy year. 100% after a $40 copay 100% after a $40 copay Radiology, Diagnostic, and Treatment Services Paid under Medical Emergency Expense or Outpatient Miscellaneous Paid under Medical Emergency Expense or Outpatient Miscellaneous Rehabilitation Services - Limited to 10 visits per policy year- (expanded to 30 visits with a Physicians prescription) 100% after $10 copay 80% URC Surgeon s - Up to $3,000 per condition. $50 copay 80% URC Termination of Pregnancy 100% after $50 copay 100% after $100 copay OTHER BENEFITS In-Network Out-of-Network Alcoholism/Drug Abuse - Inpatient and Non-hospital resident limit of 7 days per admission, 4 admissions per policy year; Up to 8 admissions per lifetime for both inand out-of-network. Outpatient limited to 60 visits per policy year. Inpatient: 100% after $40 copay/day; Outpatient: 100% after $20 copay/visit In-/Outpatient: 80% URC Allergy Antigen and Serum 100% after $20 copay 80% URC Allergy Testing and Treatment 100% after $20 copay 80% URC Ambulance 100% after $50 copay 100% after $50 copay Dental and Oral Surgical Services - Coverage is limited to injury to teeth, dental abscesses, or impacted wisdom teeth, $750 max per tooth, up to $1,000 maximum benefit. $20 copay 80% URC Diabetic Care Benefits 100% after $20 copay 80% URC Durable Medical Equipment & Corrective Appliances - Up to a $1,000 annual maximum benefit for both in- and out-of-network combined. Family Planning - Includes Diaphragm fittings, IUDs, insertion and removal of implanted time-release capsules and injectable contraceptive aids. $30 copay 80% URC 100% after a $10 copay 50% URC Immunizations Children: As required by law Adults: Coverage limited to Hepatitis A and B, Tetanus, (Td), Rabies, Flu Vaccine, Meningitis, TB Testing, and Gardasil Children: 100% Adults: 100% after $10 copay Children s: 100% URC Adults: 80% URC Maternity and Complications of Pregnancy Paid as any other sickness Paid as any other sickness Nutritional Counseling Prescription Drugs - Mandatory Generic, if available; No coverage for Nonformulary Brand Name Drugs; Limited to $2,500 per policy year. Preventive Women s Care - Annual Gynecological Exam and Pap Smear. Mammogram for qualified women age 40 or over. 100% after $10 copay if provided by Physician; $20 copay if provided by a Registered Dietician $15 copay - Generic $25 copay - Brand Name 2 Retail Copayments - Mail Order 100% after a $10 copay for each individual service 80% URC if provided by a physician; $40 copay if provided by a Registered Dietician No Coverage 80% URC One annual Routine Physical Examination 100% after $20 copay 80% URC Repatriation of Remains and/or Medical Evacuation 100% up to $40,000 lifetime maximum for both in- and out-of-network combined BENEFIT MAXIMUMS Annual Maximum Comprehensive Benefit $100,000 Annual Maximum Supplemental Benefit $50,000 Healthcare Advocacy Provided by the Healthcare Advocates at Hulse/QM (800) Maximum Number of days, Comprehensive Benefit and Supplemental Benefit amounts indicated represent both in- and out-of-network eligible charges combined. Claims Administered by: A-G Administrators, Inc. P.O. Box 979 Valley Forge, PA (800) Fax: (610) Coverage is Underwritten by: United States Fire Insurance Company Eatontown, New Jersey This summary of benefits will introduce students to the accident and health benefits offered by the Moore College of Art and Design sponsored plan. This is only a summary and does not replace or supersede the full plan document which is available through the College. IT DOES NOT PROVIDE FULL DETAILS FOR ALL BENEFITS. This summary highlights the most common areas of interest when comparing health plans. For additional information, please call the Healthcare Advocate at Hulse/QM at (800) MCAD Page 2

4 Exclusions (See Insurance Plan s Policy for complete list) 1. Injury of the primary insured covered under any student accident insurance policy underwritten by us. 2. Services and supplies furnished normally without charge by the participating institution s infirmary, its employees, or doctors who work for the participating institution 3. Services covered or provided by the student health fee. 4. Normal health checkups, preventive testing or treatment, screening exams or testing in the absence of injury or illness. 5. Eye examinations, prescriptions or fitting of eyeglasses and contact lenses, or other treatment for visual defects and problems, unless payable as a covered expense associated with a sickness or injury covered by the policy. 6. Hearing examinations or hearing aids, or other treatment for hearing defects and problems, unless payable as a covered expense associated with an injury covered by the policy. 7. Dental treatment, except as specifically provided for in the Schedule. 8. War or any act of war, declared or undeclared, or while in the armed forces of any country. 9. Participation in a riot or civil disorder, commission of or attempt to commit a felony, or fighting, except in self-defense; 10. Injury caused by, contributed to, or resulting from suicide, attempted suicide or intentionally self-inflicted Injury, except as a result of a mental disorder that is currently under the care of a mental health professional; 11. Injury of any covered person sustained while: Participating in any school, professional or organized sports contest or competition, unless specifically list in the Schedule; Traveling to or from such sport, contest or competition as a participant; or During participation in any practice or conditioning program for such sport, contest or competition. 12. Skydiving; parachuting or bungi-cord jumping, hang gliding, glider flying, snowmobiling, parasailing, sail plaining, or flight in any kind of aircraft, except while riding as passenger on a regularly scheduled flight of a commercial airline. 13. Treatment in a military or Veterans Hospital or a hospital contracted for or operated by a national government or its agency unless: The services are rendered on a medical emergency basis; and A legal liability exists for the charges made on behalf of a covered person for the services given in the absence of insurance. 14. Injury caused by, or resulting from, the use of alcohol, controlled substance, illegal drugs, or any drugs or medicines that are not taken in the dosage or for the purpose prescribed by the person s doctor. This exclusion will not apply to an insured under the care of a mental health professional. 15. Elective surgery and elective treatment, except as required to correct an injury for which benefits are otherwise payable under the policy. 16. Any loss covered by state or federal worker's compensation law, employers liability law, occupational disease law, or similar laws or act. 17. Braces and appliances, except as specifically provided for in the Schedule. 18. Replacement braces and appliances. 19. Expense incurred within your home country or country of regular domicile. 20. Services rendered for detection and correction by manual or mechanical means (including x-rays incidental 21. thereto) of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column. 22. That part of medical expense payable by any automobile insurance policy without regard to fault. 23. Nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained within 180 days of the initial incident and:the loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear energy; and The covered person is within a 25-mile radius of the site of the release either:at the time of the release; orwithin 24 hours of the start of the release. 24. Preventive medicines, serums, vaccines. 25. Blood or blood plasma, except for charges by a hospital for the processing or administration of blood; 26. Rest cures or custodial care. 27. Personal services such as television and telephone or transportation. 28. Any service or supply that is not Medically Necessary 29. Any charges in excess of a Benefit Maximum, Annual Comprehensive Maximum, Supplemental Maximum, or any other maximum or limit set forth in Insurance Plan s Policy; 30. Services and or supplies rendered as a result of injuries sustained during the commission of an illegal act or engagement in an illegal occupation 31. Treatment provided in a governmental Hospital unless the Insured is legally obligated to pay such charges 32. Equipment or services primarily used for use in altering air quality or temperature 33. Alternative health care, including but not limited to, acupuncture, except as specifically provided, acupressure, biofeedback, reflexology, and rolfing type services; 34. Acne 35. Foot care, except for foot care required to treat manifestations of systemic disease causing circulatory problems, such as diabetes or peripheral vascular disease. Foot care that is excluded from Coverage under the Insurance Plan s Policy includes, but is not limited to removal or reduction of warts; removal of toenails (except Medically Necessary surgery for ingrown toenails); treatment of corns, calluses, fallen arches, flat feet, weak feet, chronic foot strain, symptomatic complaints of the feet, or bunions (except as Medically Necessary for bunions); 36. Corrective Appliances that do not require prescription specifications and/or are used primarily for recreational sports 37. Cosmetic Services and Surgery and the complications incurred as a result of those services and surgeries 38. Exams for employment, school, camp, sports, licensing, insurance, adoption, marriage, driver s license, foreign travel, passports, or those ordered by a third party 39. Marriage or relationship counseling, family counseling, vocational or employment counseling, and sex therapy; 40. Sex transformation procedures, treatments, or studies or expenses incurred for any service, treatment or supply for the diagnosis or treatment of sexual dysfunction 41. Sterilization and reversal of voluntary sterilization 42. Work related injuries or illnesses when covered by workers compensation 43. Spinal manipulations and/or chiropractic care 44. Inpatient or outpatient radiation and chemotherapy benefits, unless specifically provided in the Schedule of Covered Services This summary of benefits will introduce students to the accident and health benefits offered by the Moore College of Art and Design sponsored plan. This is only a summary and does not replace or supersede the full plan document which is available through the College. IT DOES NOT PROVIDE FULL DETAILS FOR ALL BENEFITS. This summary highlights the most common areas of interest when comparing health plans. For additional information, please call the Healthcare Advocate at Hulse/QM at (800) MCAD Page 3

5 ONLINE ENROLLMENT/WAIVER INSTRUCTIONS To use the Hulse/QM My Insurance page to ENROLL in the Moore College-sponsored health insurance plan, or WAIVE coverage, by providing verifiable proof of accident and sickness insurance coverage, please log on to To LOG ON, you will need the following information: ID = The student s last name first initial entered without spaces Example: Enter Jane Smith as smithj Password = The last 5 digits of your Moore College Student ID To ENROLL in the Moore College-sponsored health insurance plans.: 1. Point your web browser to This will automatically take you to the Hulse/QM myinsurance page. 2. Enter the required information. Press the log in button. 3. Read Moore College s policy for student health insurance. Check the Please enroll me in the school-sponsored accident and sickness insurance plan option. Press the continue button. Select and verify the preferred address for ALL health insurance mailings, including your ID card and benefit statements. Complete all required fields. Verify all information is correct. Read the Responsibility statement. Press the submit button. 4. Print a copy of the Thank You/Confirmation page. Keep with your records. You have completed the enrollment process. If you need to update any information, please call the Hulse/QM Health Advocates at (800) To WAIVE enrollment, by providing verifiable proof of accident and sickness coverage. You will need your health insurance card to complete this process.: 1. Point your web browser to This will automatically take you to the Hulse/QM myinsurance page. 2. Enter the required information. Press the log in button. 3. Read Moore College s policy for student health insurance. Check the I am covered under a private insurance policy and I will provide the required information option. Press the continue button. 4. Complete all required fields. Verify all information is correct. Read the responsibility statement. Press the submit button. 5. Print a copy of the Thank You/Confirmation page. Keep with your records. You have completed the waiver process. If you need to update any information, please call the Hulse/QM Healthcare Advocates at (800) If you have questions about this process or experience problems with the website, please contact the Hulse/QM Healthcare Advocates at (800) TO PROTECT YOUR INFORMATION, YOUR UNIQUE PASSWORD WILL EXPIRE AFTER YOU SUBMIT YOUR ENROLLMENT OR WAIVER. You can log on as many times as necessary to complete your transaction, but once you have completed the process your password will be deactivated. Please review each entry for accuracy before moving to the next screen. Changes to your enrollment/waiver entry can be made at any time by calling the Hulse/QM Healthcare Advocates at (800)

6 Important Information Regarding Student Health Care Private Insurance or I already have insurance. I don t need the school policy. OR DO I? The Moore College sponsored student health insurance plan was designed to maximize student access to healthcare while in the Philadelphia area, and also to provide a comprehensive, national network of coverage while at home, on vacation or abroad. If you are covered under a qualified private insurance, we strongly urge you to contact your health insurance company and ask them the following questions. 1. Is there an age limit on coverage for full-time or part-time college students? What if you leave college? 2. Is there network coverage in Philadelphia, Pennsylvania? Are there penalties for being out of network? 3. If you plan to study abroad during the 2010/2011 year, is there coverage for you while outside the United States? If your insurance company has provided satisfactory answers to the questions above and you feel you have adequate coverage, then you should waive participation in the school-sponsored plan. Instructions for waiving are included at the end of this letter. Obtaining Care and Using Healthcare Networks The College has put in place a system for health care that begins with the students. You should be familiar with your health insurance benefits and do a little investigation as to what network providers are available to you in the Philadelphia area. Using network providers can increase the dollar amounts that your carrier will pay for services and could decrease your out-of-pocket expense. All students are encouraged to begin with the College s Health Center at the first sign of an illness or to properly begin treatment for an injury. The trained medical staff at the Health Center is the first line of defense in determining the best course of action for medical treatment and for finding medical care that is in your insurance company network. Anytime you have an illness or injury that is life threatening, seek emergency medical care. The Moore-sponsored plan does have a network. You can review the network of providers at Responsibility Statement Insurance fraud is a crime and is subject to criminal and civil penalties. Any person who knowingly and with intent to defraud, files an application for insurance or statement of claim against an insurance policy, any insurance company or other person, is committing insurance fraud. Providing statements during the application and/or claims process that contain any materially false information, or concealing information for the purpose of misleading, including omitting any materials facts, is considered a fraudulent insurance act.