Florida Memorial University s Student Insurance Plan. Frequently Asked Questions

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1 Florida Memorial University s Student Insurance Plan Frequently Asked Questions Did you know college students have several choices for health coverage? Did you know there is no special college student exemption from paying the tax penalty for individuals without coverage beginning January 1, 2014? What are my health plan options? The following options qualifies as minimum essential coverage under the ACA individual mandate: 1. Extended dependent coverage under a parent s insurance plan until age 26; 2. Expanded eligibility for Medicaid in some states; All adults at or below 133 percent of the federal poverty level (FPL) about $15,000 for a single individual or $31,000 for a family of four could qualify for health insurance coverage through Medicaid. 3. Refundable, up-front tax credits to buy insurance on the new health insurance marketplace, and subsidies to help pay for out-of-pocket costs; 4. A student health insurance plans; and 5. Catastrophic plans. What other type of plans qualify as minimum essential coverage under the Affordable Care Act s Individual Health Insurance Mandate? Minimum essential coverage includes the following: Employer-sponsored coverage (including COBRA coverage and retiree coverage) Coverage purchased in the individual market, including a qualified health plan offered by the Health Insurance Marketplace (also known as an Affordable Insurance Exchange) Most Medicaid coverage Children s Health Insurance Program (CHIP) coverage Certain types of veterans health coverage administered by the Veterans Administration TRICARE Coverage provided to Peace Corps volunteers Coverage under the Non-appropriated Fund Health Benefit Program Refugee Medical Assistance supported by the Administration for Children and Families Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these programs may apply to HHS to be recognized as minimum essential coverage) State high risk pools for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these program may apply to HHS to be recognized as minimum essential coverage) What is the tax penalty I will have to pay if I do not obtain insurance coverage that meets the minimum essential coverage?

2 Do international students in the U.S. need to meet the ACA s individual mandate? Under regulations published by the U.S. Internal Revenue Service, which enforces the mandate, international students with valid student visas are exempt from the individual mandate and do not need to enroll in an ACA-compliant plan. Why do we pay for insurance if we cannot go to the hospital if we are sick? Plan I covers all full time Florida Memorial University students and the cost of this plan is part of your tuition cost. This plan provides a limited sickness benefits when treated at the clinic on campus, accident coverage and athletic injury coverage. This plan also provides 24/7 access to a Physician Telemedicine service. What is the difference between a regular student accident insurance and that of an athlete? A regular student accident plan will cover you for an injury that is not related to an intercollegiate sport. I am an American student with Blue Cross-Blue Shield Insurance, why do I still have to pay for insurance here when there is no doctor in the clinic when I am sick? All full time students are covered under Plan I only and the cost is built into your tuition. Plan II is optional and recommended if you do not have other major medical coverage i.e. Blue Cross that includes inpatient and outpatient benefits that are unlimited for all medical essential benefits. What is the process for getting reimbursed if I spend my money to buy medications?

3 You will need to pay for the medication and send in a claim form with copies of your receipts to be reimbursed under the plan benefits. Is Birth Control medications covered under the insurance? Yes, but coverage is limited under both plan options. How long do I have to send my claim to your office and how long do you take to pay the Bill? A claim form must be submitted and received by the insurance company within 30 days of from the date of injury. Actual medical bills must be submitted and received by the company within 90 days from the date of injury. Claims will be paid by the company within 5-10 days once the claim form, medical bills and other insurance information and copies of the other insurance plan s explanation of benefits is received by the company. Students complain that their bills are sent to the collections agency and ruin their credit rating. Can you help to fix this problem? If not, how do we go about fixing the problem? As long as you submit a claim form, medical bills, other insurance information (that includes the Explanation of Benefits from the other insurance plan) to the student insurance company within 90 days from the date of injury your claims will be processed. If you do not provide this information or any additional information they request from you then the claims will be put in a pending status and subsequently the medical providers will send unpaid medical expenses to a collection agency if they are not paid within a timely manner on their end. It is very important to keep a copy of all medical bills and any paperwork related to your medical expenses. Copies must be sent to the insurance companies, including copies of the bills or they cannot process your claim. Be sure your mailing address on file with your doctor s office and the insurance company is up to date. If you receive a PAYMENT DUE or notice from a collection agency, it is your responsibility to contact the insurance company to see why the claim has not been paid. If I have a mental health issue, how do I access care? Plan I provides a limited outpatient only benefit for psychotherapy visits and medication with a referral from the Student Health Center Only. Plan II provides inpatient and outpatient coverage for mental health visits and medication without a referral. What are the services that I can get at the clinic on campus? Can I get a Physical Examination or a Pap Smear under the current insurance? Plan I provides limited acute care only medical treatment at the clinic on campus with no preventative wellness benefits. When referred by the clinic, you will receive a limited medical expense benefits to coverage a routine physical, pap smear, labs and some medications to treat a sickness on an outpatient basis only. Again this is a very limited plan.

4 Plan II provides enhanced primary care from the clinic and health insurance coverage outside of the clinic for inpatient hospitalization, outpatient treatment, emergency care, prescription medication, an annual physical exam, pap smear and coverage for labs and x-rays. Why do I have to pay for blood work done at the clinic? Labs done at the clinic are sent to an outside lab company that is not part of Jessie Trice or the student health clinic on campus. Plan I has a very limited benefit for labs sent from the clinic and will not cover most labs that are considered routine. Why is the insurance cost so high? Does other universities charge so much? The average annual premium for a student insurance plan in 2014 is between $1,200 to $2,800. The student insurance plan offered by Florida Memorial University is $750 for annual coverage under Plan I and $420 under Plan II. Please explain the services offered by DocLogic? You have access to a physician via telephone conference 24 hours a day/7 days a week. Please visit the website for instructions on how to use this free service. How long does it take for students who purchase the buy-up plan to get their insurance cards? It should not take more than 10 days after the open enrollment period ends for you to receive an insurance card in the mail. If I use the Buy-up insurance plan to access medical care, how do I file my claim or know if the bill is paid? Mail all medical bills along with a completed claim form to the address below for reimbursement according to the plan benefits: HealthSmart Preferred, P.O. Box 53010, Lubbock, TX What is the Explanation of Benefits and why does it say THIS IS NOT A BILL? This is a statement by the insurance company that explains the amount they paid toward your medical bills that they received and processed. This Explanation of Benefits also provides information on why a claim may not have been paid, if additional information is needed by you or the medical provider in order to process the claim and what you are expected to owe the medical provider. It is not a bill. You then need to wait for an updated bill from the medical provider to make a payment. If I purchase Obamacare in another state, can I use those benefits in Florida? If the plan is consider Medicaid, you will need to verify with the state of Florida s Medicaid office that your plan is transferable. If it is not Medicaid, then you will need to verify with that plan administrator if the plan provides adequate coverage in the state of Florida and not just for a medical emergency. What are the health insurance requirements for international students?

5 The U.S. Department of State requires J-1 Exchange Visitors to hold primary insurance and medical evacuation and repatriation insurance for the duration of the J exchange visitor program. Minimum levels of health insurance coverage must provide: 1. medical benefits of at least $50,000 per illness or accident; 2. deductible not to exceed $500 per accident or illness; 3. expenses associated with medical evacuation in the amount of $10, repatriation of remains in the event of death in the amount of $7, Coverage of pre-existing conditions after a reasonable waiting period 6. Co-payments that do not exceed 25 percent Government regulations require that J programs be terminated if a scholar or their J-2 dependent willfully fails to comply with this insurance requirements. Unfortunately, if a scholar's program is terminated due to lack of insurance coverage for the J-1/J-2, the scholar is not eligible to apply for reinstatement. Please explain the vision and dental policy? The vision and dental plans are optional and not included in the student insurance plans. You may purchase these separately by going to the website. What do I have to do to get my old bills from Evolutions insurance paid? If you did not submit a claim form or medical bills to Evolutions within 90 days from the date of injury or sickness, they will not be covered. If you submitted all of the required information to process a claim, please [email protected] with your name, date of service, name of the provider and amount of the claim so we can follow up on your claims for you.