STUDENT Health Internation ent HEALTH Assistance

Transcription

1 STUDENT Health Internation ent HEALTH Assistance YOUR USER-FRIENDLY INSURANCE GUIDE Welcome to SWitzerland!

2 Your SEG insurance plan 3 Table of benefits 4 Manage your medical policy online 7 Benefit claims procedure 8 Direct Cashless settlement of hospital expenses 10 Looking after your health, every step of the way 12 2

3 Medical plan : Worldwide cover (excl. USA): you are free to choose your healthcare provider or hospital anywhere in the world in the event of illness & accident. (Only emergency treatment is covered in the USA). A comprehensive package of assistance and travel services Insurer: Allianz Worldwide Care Multilingual helpline & emergency assistance 24/7 Fully completed medical claim form processed in 72H Direct «cashless» settlement of hospital costs Online services & personal secured account in 6 languages Easy way to access your health insurance with MyHealth App A personal membership insurance card Freedom to choose your medical provider Direct payment of prescribed drugs Private civil liability plan : Coverage for personal injury or material damages to a Third Party for up to CHF 3 million per event Worldwide cover excluding USA and Canada CHF 200 deductible by claim Insurer: Generali 3

4 All benefit amounts are per person, per year of cover, unless otherwise indicated. CORE PLAN - ILLNESS & ACCIDENT SEG Maximum plan benefit CHF per illness/accident CHF Hospital accommodation Prescription drugs and materials (in-patient and day care treatment only) Surgical fees, including anaesthesia and theatre charges Physician and therapist fees (in-patient and day care treatment only) Surgical appliances and prosthesis Diagnosis tests (in-patient and day care treatment only) Organ transplant Emergency in-patient dental treatment Day-care treatment Out-patient surgery Nursing at home or in convalescent home (immediately after or instead of hospitalization) Rehabilitation treatment (immediately after acute medical treatment ceases) Local ambulance Emergency treatment outside area of cover (i.e. in the USA) (for trips of a maximum period of 6 weeks) CT scans (in-patient and out-patient treatment) MRI, PET and CT-PET scans (in-patient and out-patient treatment) Oncology (in-patient and out-patient treatment) Routine maternity (in-patient and out-patient treatment) Complications of pregnancy and childbirth Home delivery Legal abortion Emergency out-patient treatment Emergency out-patient dental treatment Palliative care and long term care Prescribed stay in a spa General Ward 80% refund CHF 20 per day Max. 100 days Max. 90 days Max. 42 days 80% refund, Max. 30 days per lifetime CHF 10 per day Max. 21 days 4

5 OUT-PATIENT PLAN Maximum plan benefit Medical practitioner fees and prescription drugs Specialist fees Diagnostic tests Alternative medicine: chiropractic treatment, osteopathy, homeopathy, Chinese herbal medecine and acupuncture HIV/AIDS test Annual gynecological exam Psychiatry and psychotherapy Prescribed medical aids No limit 50% refund CHF 150 Prescribed glasses and contact lenses CHF 200 Prescribed physiotherapy and speech therapy Prescribed vaccination CHF 100 SEG DENTAL PLAN SEG Dental prosthesis (in case of accident only) CHF 100 ASSISTANCE PLAN Search and rescue CHF Medical repatriation Repatriation of mortal remains Parental presence in case of hospitalization over 7 days (Benefit only applies to events outside of Switzerland) Theft of ID documents (Benefit only applies to events outside of Switzerland) Emergency message transmission (Benefit only applies to events outside of Switzerland) CHF CHF Return flight postponement due to exam rescheduling CHF 150 SEG PRIVATE CIVIL LIABILITY Material damage and personal injury caused to third parties SEG CHF 3,000,000 per event / Treatment Guarantee/Pre-authorisation Treatment Guarantee (pre-authorisation) may be required for some benefits as indicated by a or a. These treatments/benefits require pre-authorisation through submission of a Treatment Guarantee Form. Please refer to page 10 for full details. 5

6 Student HEALTH Internat Assistance Note on the table of benefits This summary of benefits provides an outline of the cover Allianz Worldwide Care and Generali offer. Medical cover is subject to the detailed Table of benefits and the policy terms and conditions, which are issued to members upon policy inception. Private civil liability cover is subject to the policy terms and conditions. Special note on emergency dental benefits Emergency in-patient dental treatment up to 80% This benefit provides a refund for emergency dental treatment due to a serious accident requiring hospitalization. Emergency out-patient dental treatment up to 80% This cover includes treatment received in a dental surgery or hospital emergency room for the immediate relief of dental pain. Cover includes temporary fillings, limited to three fillings per insurance year, and/or the repair of damage caused in an accident. The treatment must be received within 24 hours of the emergency event. What your health care plan does not pay for * Self inflicted injury (including suicide attempt) and treatments related to drug addiction or alcoholism. No show penalty: Doctors and dentists can legally charge patients a no show fee for not keeping a scheduled appointment. The no show penalty is excluded from your medical policy. * Please refer to the ScoreStudies Terms & Conditions to read the complete list of exclusions. 6

7 My Health App A simple, easy way to access your health insurance with MyHealth App: Submit your claims Simply use the app to provide a few key details, photograph your invoices and you re done. Any claims information entered will be preserved until submitted. Emergency contact numbers Immediate access to local emergency services telephone numbers even Policy documents in your pocket Leave your paperwork at home and still be able to access your most recent policy documents and membership card on the go. Health Assistant Find local equivalents of brand named drugs and translate common ailments into one of 17 languages. Find a hospital Get directions to your nearest hospital or search our database of hospitals around the globe. Secure and simple access For fast and easy access, you can login with an easy to remember 5 digit PIN code. MyHealth app is available in 5 languages Free download by searching for Allianz MyHealth in the App Store or Google play Your personal online account: You can manage your medical and assistance policy 24/7 in 6 different languages.... Stay connected Change your personal details Download your insurance certificate, table of benefits, and electronic version of your Membership card Complete and print your forms Check claims status and amounts reimbursed Retrieve your login details 1. Connect to 2. Choose «Members», 3. Click on Your account : enter the secured username and password details you received by in your Membership Pack at inception. 7

8 Within Switzerland For out-patient treatment, please follow the steps below : 1. Show your Allianz Worldwide Care membership card to the medical practitioner. 2. Upon receipt of the invoice, the fully completed claim will be processed and payment issued to the medical provider. 3. An will automatically be sent to you notifying receipt of the claims and confirming payment of the bill to the practitioner. You consult a healthcare provider Show your Allianz Worldwide Care card to the practitioner The fully completed claim is processed For prescribed drugs: You will be provided shortly your personal Covercard pharmacy benefit card. This card allows you to avail of direct settlement for prescribed LAMal Basic drugs in approximately 80% of all pharmacies in Switzerland. Simply present this card together with your prescription in any participating pharmacy and the pharmacist will settle the bill directly with Allianz Worldwide Care. Your pharmacy benefit card is valid in Switzerland only. USEFUL TIPS With MyHealth app, you can access your membership card on the go and show it to the medical practitioner. 8

9 Outside Switzerland For out-patient or emergency dental treatment, when you visit a medical provider, dentist, physician or specialist on an out-patient basis, please follow the steps below: 1. You will need to get an invoice from the doctor/medical provider stating the diagnosis or medical condition treated, the nature of the treatment and the fees charged. Pay your bill. 2. You can simply use MyHealth App to provide a few key details, photograph your invoices and you re done. Alternatively, please post or scan & to customercare@antae.ch: a. Your medical bills, receipts and prescriptions if applicable b. Please provide us also with your personal bank details (IBAN - SWIFT/BIC code - Bank name and address) You consult a healthcare provider Pay your bills to the healthcare provider, send us your claim The fully completed claim is processed within 72H For prescribed drugs: You pay your prescribed drugs and claim for reimbursment. Just follow the same procedure as medical expenses. 9

10 In case of planned hospitalization Contact us at least 5 working days before the hospitalization. 1. Download a Treatment Guarantee Form from or your online account. 2. Please ensure that you complete sections 1, 2, 3 and 5, and that your doctor completes all questions in section Once fully completed, please send the Treatment Guarantee Form at least 5 working days prior to treatment so that we can ensure there will be no delay at the time of admission. You can submit it the following ways directly to Allianz Worldwide Care : Scan and to medical.services@allianzworldwidecare.com or Fax to Allianz Worldwide Care at Treatment Guarantee ensures that you get cashless access to hospitals for inpatient treatment in Switzerland and abroad, where possible. There is also the added advantage of treatment being overseen by AWC s Medical Team, making sure that the proposed treatment is appropriate. Download a treatment guarantee form Complete and ask your healthcare provider to complete the form Send the fully completed treatment guarantee form to Allianz Worldwide Care at least 5 days prior treatment We arrange direct settlement of your medical bills USEFUL TIPS Please note that AWC Helpline can accept Treatment Guarantee requests over the phone if treatment is due to take place within 72H. Please have as many details as possible ready to give over the phone, including the contact details of your doctor. 10

11 In case of emergency Treatment Guarantee is not required in advance of emergency treatment, however either you, your physician, one of your dependants or a friend need to inform us about the hospital admission within 48 hours of the event. You can either call Allianz Worldwide Care (AWC) who can take Treatment Guarantee details over the phone: From Switzerland: (Toll free number) From abroad: Or you can at: medical.services@allianzworldwidecare.com This gives us the opportunity to arrange direct settlement of your hospital bills, where possible, and will ensure that your treatment can be processed without delay and is medically appropriate. Contact Allianz Worldwide Care within 48H of the event You can the OR completed form to Allianz Worldwide Care You can contact Allianz Worldwide Care by phone We arrange direct settlement of your medical bills In case of claim for private civil liability: Contact us at as soon as possible after the event occurs. We will assist you to process your claim. Upon receipt of your completed claim, it will be processed within 7 working days. 11

12 Allianz Worldwide Care and Swiss Education Group understand that your health is of paramount importance to you. As your health insurer, we want to make it easy for you to look after yourself and encourage you to develop a responsible attitude toward your health insurance plan. Here are few tips to get you started. Manage your stress Stress happens when you are under too much emotional or mental pressure and you are unable to cope with this pressure. Stress could have various causes such as exams, being far away from home etc. Stress may impact your thought and feelings. This can also change your behavior. This may result in increased tobacco and alcohol consumption. This may also cause you to lose your temper more easily. This is important that you recognize how stress can affect you so that you can take the necessary steps to minimise its effect. Common stress-busting techniques include going for a walk, doing something you enjoy and connecting with others at school or at home. Sexually Transmitted Infections Sexual health is an important part of overall health. It means in the first place the absence of disease and infections but also covers well-being, the ability to control fertility and to have children later and the ability to enjoy fulfilling relationships free from discrimination. Worldwide, one in four college students has a sexually transmitted infection (STI) - this may be higher than you expected. STIs are infections transmitted by intimate sexual contact. Moreover, 80% of individuals with an STI experience no noticeable symptoms, so you or your partner could be transmitting an infection without even knowing it! Although treatment is available for all STIs, not all are curable. General signs of STI s include: sores/blisters, rash, penile or vaginal discharge, painful urination, abdominal pain, or even none at all. Practicing safe sex can cut down on the spread of STIs but not totally prevent them. To decrease risk: Use condoms - Birth control pills do not protect from disease Don t drink alcohol if there is a chance of unintended or unwanted sexual activity Get vaccinated for hepatitis A and B Kindly note that HIV testing is included in your SEG health benefits up to 150 CHF per year. Emergency Contraception/ Morning-after contraception Emergency Contraception (EC) can prevent pregnancy after unprotected sex. It is also called «morning-after» contraception. EC must be started up to 120 hours (five days) after unprotected intercourse to reduce the risk of pregnancy. The sooner it is started, the more effective it is. EC reduces the risk of pregnancy by 75-89% when started within 72 hours. It does not protect against HIV or STIs. 12

13 Alcohol, Drugs and Narcotics Note that the treatments relating to the following cases will be subject to the decision of SEG and Allianz Worldwide Care to charge fully or partially the cost to the student: Treatments related to drug addiction or alcoholism. Accidents which are caused by the effect of alcohol, or the use of drugs and narcotics, beyond legally authorised limits for driving in the country where the accident took place. Responsible attitude toward your healthcare plan The following are ways to develop a responsible attitude toward your health benefits while adding value to the quality of your health. Take good care of yourself. 8 out of 10 health problems are treated at home. By doing a good job of self-care you can reduce your visits to the Doctor. Do not hesitate to consult your nurse at school at any time. Become aware of the health risks of different lifestyle choices like alcohol and drug use, home and driver safety, and eating habits. The riskier your lifestyle the more likely you are to have health problems. Know what your S.E.G medical benefits cover. You need to know what your benefits are before you can use them appropriately. Take an active role in health care decision-making. Take the time to build a good relationship with your doctor. Making sure that your doctor understands your expectations and needs can result in a more effective treatment plan. Ask your doctor about generic drugs instead of branded drugs. They are safe and efficient and they cost less. Save the ambulance for true emergencies. The ambulance transport is required for an emergency or due to medical necessity, to the nearest available and appropriate hospital or licensed medical facility. Note that in case of inappropriate use of ambulance, it will be subject to the decision of SEG to charge fully or partially the cost to the student. For more information on the above topics, please visit our webpage dedicated to Health and Wellbeing: 13

14 Your Customer Care contact and claims coordinator: Antaé Voie du Chariot 3 CH Lausanne Office hours: Monday to Friday, 8:30AM - 5:30PM Tel: + 41 (0) Fax: + 41 (0) customercare@antae.ch 24/7 Medical emergency or repatriation assistance: Allianz Worldwide Care s in-house team of professional, multilingual staff is available 24/7 to handle your urgent medical policy enquiries. You can contact them by phone, fax or . Toll-free number from Switzerland: English: German: French: Spanish: Italian: Portuguese: Fax: client.services@allianzworldwidecare.com