Mills College International Student Group June 2, 2015

Transcription

1 Mills College International Student Group June 2,

2 Table of Contents I. Overview 3 II. Internet Resources and Toll-free Customer Service 4 III. mpassport 6 IV. Preferred Provider Network 7 VI. Plan Administration 8 VIII. GGH Benefits Insurance Plans 10 This proposal is a summary of the terms, conditions and benefits of the policy and services offered by GGH Benefits. 2

3 I. Overview GGH Benefits is a leader in helping international students access quality healthcare services all around the globe. GGH combines ongoing research, a contracted global community of physicians and hospitals, advanced Internet and mobile applications, and wide experience in international health insurance to ensure customers health, safety and peace of mind. GGH offers a full range of individual and group specialty health insurance programs, all of which include Global Health and Safety Services available online, through our 24/7 medical assistance call center and via mobile device. Welcome to Peace of Mind Worldwide One of the most important considerations to address before international students start a study abroad program is staying healthy. This proposal describes a comprehensive program of insurance benefits and services designed to empower your students to access quality medical care when they need it even when they re far from home. This includes managing chronic conditions and preparing for the unexpected. This package also highlights the many convenient administrative services GGH Benefits offers to you and your students. We are the leading provider of health insurance for international students at U.S. universities, and an innovator in mobile and online healthcare information, medical assistance and insurance services. Each year, hundreds of thousands of international students and scholars, as well as leisure and business travelers, protect themselves and their families with GGH Benefits plans. Highest Standards of Service Our health plans are administered to meet the highest expectations. GGH has set new standards for international assistance services and for applying stringent criteria when contracting with doctors and hospitals. GGH has unsurpassed commitment and capabilities to assist members with medical questions and treatment alternatives. A Recognized Leader GGH Benefits is a recognized leader in international health insurance and medical assistance services. We have earned a reputation as an innovator in promoting access to quality healthcare and streamlining insurance services. Strength of a U.S. Underwriter GGH plans are underwritten by Anthem Blue Cross Life and Health Insurance Company (Anthem). Anthem has earned an A rating from A.M. Best Company, the oldest and most recognized insurance rating organization. Anthem is a subsidiary of Anthem, Inc., the fifth largest publicly traded health benefits company in the United States. GGH Benefits - Apart from the Competition Service. Our mission is to provide the international education community with quality health insurance programs designed to meet the highest expectations for integrity and service. Each group is personally supported by a dedicated Account Manager and a group of industry experienced Customer Service Representatives who are available by phone or 24/7. Additional support is accessible through our unique online tools and databases designed to be user-friendly and informative. 3

4 II. Internet Resources and Toll Free Customer Service Website, Mobile and Toll-Free Customer Service for the Students gghstudents.com GGH Benefits s powerful online healthcare tools are easy to access. The homepage is organized to display your custom message to the participants on the left, quick access to tools in the center and current articles of interest on the right. Access to users personal information and tools is controlled by the navigation bars at the top of the page. To access the tools on the student site, your program participants go to gghstudents.com. Advisors can also access these tools. On gghstudents.com, you and your participants can: Check the status of a pending claim Download claims forms Search for a doctor in the U.S. and overseas Use the medical drug, term and phrase translation guides Read important health and security news View health and security profiles for cities worldwide GGH Benefits s unique medical information and assistance services give students and scholars the Interactive Resources they need to stay healthy. Search for Doctors GGH provides members within the U.S. access to providers in the Blue Cross of CA network which represents a large number of medical providers, specialists and hospitals. 4

5 Translate Medications Brand Name Drug Translation Guides yield the country-specific brand name under which common prescription and over-the-counter medications are sold. Currently this database includes the names, availability and preparation of 350 brand names drugs in 25 countries. Translate Medical Terminology Medical Phrase and Term Translation Guides capture idiomatic healthcare terms ( hay fever, CAT scan ) and critical healthcare phrases ( When can I travel? ) in six common languages. Find Quality Healthcare in Your Destination CityHealth Profiles encapsulate critical information about healthcare services in the world s most popular destinations; including emergency phone numbers, high quality hospitals, vaccination requirements, pharmacy information and more. Personalized Member Services GGH Benefits s Global Health and Safety online databases encourage students to consider plan for their medical needs before embarking on a study abroad program. These personalized web pages address potential health issues and chronic conditions and enable arrange doctor appointments for members, set up direct pay for services received and treatment alternatives as necessary. and GGH to suggest Toll Free Customer Service and Multi-Lingual Staff GGH Benefits s toll-free, concierge-level, multi-lingual customer service supports our online capabilities. To access GGH s toll-free, multi-lingual customer service center, call during our business hours: Monday Friday, from 8:00 am 7:00 pm Eastern Time. We are available around the clock for emergencies by dialing and selecting the option for emergency assistance. III. mpassport All GGH Benefits insurance plans include convenient access to GGH s Global Health and Safety Services online and via handheld mobile devices. Members can use GGH Benefits s mpassport SM service to translate medical terms, phrases and brand-name medications right from their handheld mobile device. mpassport also assists in finding emergency services and qualified doctors all around the world. IV. Preferred Provider Network GGH Benefits provides students with access to the Blue Cross provider network in the United States. From gghstudents.com (including via gghadvisors.com), users can search the Blue Cross network for providers by location, doctor name, facility name and more. Blue Cross s network is searchable online. 5

6 VI. Plan Administration As the plan administrator, GGH Benefits is responsible for: Enrollment Enrollment Fulfillment Invoicing Member services Claims processing Online rosters are processed the same business day. GGH Benefits has full capability to enroll members and deliver fulfillment materials. GGH has developed online administrative capabilities to streamline work flows and enhance reliability. Most of GGH s group customer members are enrolled online. GGH creates and delivers a wide variety of fulfillment materials in print or online. Fulfillment ID cards are available on the web immediately following processing of rosters. Documents are also sent through the mail to the destination of your choice. Option 1: GGH can mail a complete fulfillment package (ID card, certificate, claim forms and privacy policy) to each student individually. Option 2: GGH can provide the school s plan administrator with the fulfillment package for the administrator to distribute. Option 3: GGH can send partial fulfillment packages such as the certificate, claim forms and privacy policy to the administrator. The ID cards are sent to each individual enrollee. When GGH pre-prints your ID cards, each card is attached to a welcome letter, which highlights the valuable benefits of the program and includes an invitation to the student to register online at gghstudents.com. After registering, the student has access to all of the interactive tools. Member Services GGH serves its members through our unique, self service web portal, gghstudents.com, or by calling our toll-free customer call center. On the web site, members can review their plan benefits, print or re-print ID cards, review the status of their claims and access GGH s Global Health and Safety Resources. Self directed tours of our on-line tools and other Global Health and Safety Resources are available by visiting and clicking on the Demos icon in the lower left corner. Claims Processing All claims are processed by GGH Benefits Insurance Services. Claims for reimbursement of medical expenses, if not directly billed or for AD&D benefits, would be accompanied by a claim form, which is available for download from gghadvisors.com and gghstudents.com or by calling the Customer Service Center. 6

7 2015 International Student Health PPO PLUS COVERAGES Medical Benefits Period of Coverage Maximum Benefits $250,000 Maximum Benefit per Injury or Sicknesses $250,000 Maximum Out-of-Pocket Limit for any one Injury or Sickness Out-of-Pocket Limit means the amount of Reasonable Expenses for which the Covered Person is responsible after which the Insurer pays 100% of the Reasonable Expenses, subject to the limits and provisions of the Policy. Deductible Physician Office Visits 1 Inpatient Hospital Services Hospital and Physician Outpatient Services Emergency Hospital Services LIMITS ELIGIBLE PARTICIPANT After the Covered Person reaches a $2,500 Out-of-Pocket Limit per Policy Year, the Insurer pays the Reasonable Expenses at 100% and up to the applicable maximums listed below. Copayments and amounts above the maximums do not apply toward the Out-of-Pocket Limit. $0 per Injury or Sickness Prudent Buyer Plan Participating Provider Limits 100% of the Negotiated Rate after $20 Copayment per visit 100% of the Negotiated Rate after $50 Copayment per visit 100% of the Negotiated Rate after $50 Copayment per visit 100% of the Negotiated Rate after $50 Copayment per visit Non-Participating Provider Limits 75% of Reasonable Expenses 75% of Reasonable Expenses 75% of Reasonable Expenses 75% of Reasonable Expenses Benefits listed below are subject to Period of Coverage Maximum, Maximums per Injury and Sickness, Co-Insurance, Out-of Pocket Maximum and the above listed PPO Plan type limits Medical Benefit Limitations Maternity Care for a Covered Pregnancy Inpatient treatment of mental and nervous disorders including drug or alcohol abuse Outpatient treatment of mental and nervous disorders including drug or alcohol abuse Severe Mental Disorder Outpatient back and spine treatment (including modalities) Same as any illness Reasonable Expenses up to $10,000 Maximum per Period of Coverage Reasonable Expenses up to $5,000 Maximum per Period of Coverage Same as any illness Reasonable Expenses up to $1,000 Maximum per Period of Coverage with a $50 per visit Maximum and a Maximum of 3 visits per week 7

8 Medical Benefit Limitations Treatment of Specified therapies, including acupuncture and Physiotherapy Elective termination of pregnancy Routine nursery care of a newborn child of a covered pregnancy Annual cervical cytology screening for women 18 and older Low dose mammography screening, one baseline mammogram and one mammogram per year Medical treatment arising from participation in intercollegiate, interscholastic or club sports Repairs to sound, natural teeth required due to an Injury Outpatient prescription drugs including oral and Norplant contraceptives Home Health Care Skilled Nursing Facility Transgender Travel Expense for all travel expenses authorized by us in connection with authorized transgender surgery or surgeries Medical treatment received in the Home Country, if NOT covered by Other Plan Reasonable Expenses up to $1,000 Maximum per Period of Coverage on an Inpatient basis. Reasonable Expenses up to $50 Maximum per visit subject to a Maximum of 20 visits on an Outpatient basis. This benefit is per Period of Coverage Reasonable Expenses up to $500 Maximum per Period of Coverage Reasonable Expenses up to $750 Maximum per Period of Coverage Same as any illness Same as any illness Reasonable Expenses up to $10,000 Maximum per Period of Coverage. Injuries from participation in intramural sports are covered as any other Injury. 100% of Reasonable Expenses up to $500 Maximum per Period of Coverage 50% of actual charge 120 visits per Period of Coverage 120 days per Period of Coverage $3,000 per surgery or series of surgeries 100% of Reasonable Expenses up to $1,000 Maximum per Period of Coverage 1 All Physician Visit Copayments for an Injury or Sickness are waived if treatment is received at Recognized Student Health Center or if the initial treatment for an Injury or Sickness is received at Recognized Student Health Center. If there is a charge for visits to, or medical services, treatments and supplies received from, a Recognized Student Health Center for an Injury or a Sickness, benefits for those visits, medical services, treatments and supplies will be paid at 100% of Reasonable Expenses with no Copayment or Deductible. If the Recognized Student Health Center is not able to treat the Covered Person, it will refer the Covered Person to a Preferred Provider. If the Covered Person uses the Preferred Provider, medical benefits are paid according to the Inside PPO schedule. If the Covered Person chooses not to use the Preferred Provider, medical benefits are paid according to the Outside PPO schedule. 8

9 OTHER COVERAGES Accidental Death & Dismemberment Maximum Benefit: Principal Sum up to $10,000 Repatriation of Remains Maximum Benefit up to $25,000 Medical Evacuation Maximum Lifetime Benefit for all Evacuations up to $50,000 Bedside Visit OTHER INCLUDED SERVICES Global Assistance Services Pharmacy Discount Card PRE-EXISTING CONDITION LIMITATION Up to a maximum benefit of $1,000 for the cost of one economy round-trip air fare ticket to, and the hotel accommodations in, the place of the Hospital Confinement for one (1) person Emergency Medical and Travel Assistance services provided, including coordination of all evacuations and repatriations if needed Prescription drug discounts through a leading pharmacy benefit company with an extensive, nationwide, pharmacy network that offers discounts on prescriptions. Covered same as any illness 9

10 GENERAL POLICY EXCLUSIONS Unless specifically provided for elsewhere under the Policy, the Policy does not cover loss caused by or resulting from, nor is any premium charged for, any of the following: 1. Preventive medicines, routine physical examinations, or any other examination where there are no objective indications of impairment in normal health, unless otherwise noted. 2. Services and supplies not Medically Necessary for the diagnosis or treatment of a Sickness or Injury. 3. Cosmetic surgery or other services performed solely for beautification or to alter or reshape normal (including aged) structures or tissues of the body to improve appearance. This exclusion does not apply to reconstructive surgery (that is, surgery performed to correct deformities caused by congenital or developmental abnormalities, illness, or injury for the purpose of improving bodily function or symptomatology or to create a normal appearance), including surgery performed to restore symmetry following mastectomy. Cosmetic surgery does not become reconstructive surgery because of psychological or psychiatric reasons. 4. Surgery for the correction of refractive error and services and prescriptions for eye examinations, eye glasses or contact lenses or hearing aids, except when Medically Necessary for the Treatment of an Injury. 5. For diagnostic investigation or medical treatment for infertility, fertility, or birth control. 6. Expenses incurred in excess of Reasonable Expenses. 7. Organ or tissue transplant. 8. Participating in an illegal occupation or committing or attempting to commit a felony. 9. For treatment, services, supplies, or Confinement in a Hospital owned or operated by a national government or its agencies. (This does not apply to charges the law requires the Covered Person to pay.) 10. The diagnosis or treatment of Congenital Conditions, except for a newborn child insured under the Policy. 11. Treatment to the teeth, gums, jaw or structures directly supporting the teeth, including surgical extraction s of teeth. except as specifically stated under Repairs to teeth due to an Injury benefit. 12. Expenses incurred in connection with weak, strained or flat feet, corns or calluses. 13. Diagnosis and treatment of acne and sebaceous cyst. 14. Deviated nasal septum, including submucous resection and/or surgical correction, unless treatment is due to or arises from an Injury. 15. Loss due to war, declared or undeclared; service in the armed forces of any country or international authority; riot; or civil commotion. 16. Riding in any aircraft, except as a passenger on a regularly scheduled airline or charter flight. 17. Loss arising from participation in professional sports, scuba diving, hang gliding, parachuting or bungee jumping. 18. Under the Accidental Death and Dismemberment provision, for loss of life or dismemberment for or arising from an Accident in the Covered Person s Home Country. 19. Transgender Services. Services and supplies in connection with transgender services, except as specifically stated in the Transgender Services provision under Section 2 - Description of Coverages. 20. Food or Dietary Supplements. Nutritional and/or dietary supplements, except as provided in this plan or as required by law. This exclusion includes, but is not limited to, those nutritional formulas and dietary supplements that can be purchased over the counter, which by law do not require either a written prescription or dispensing by a licensed pharmacist. 21. Educational or Academic Services. This plan does not cover: a. Educational or academic counseling, remediation, or other services that are designed to increase academic knowledge or skills. b. Educational or academic counseling, remediation, or other services that are designed to increase socialization, adaptive, or communication skills. c. Academic or educational testing. d. Teaching skills for employment or vocational purposes. e. Teaching art, dance, horseback riding, music, play, swimming, or any similar activities. f. Teaching manners and etiquette or any other social skills. g. Teaching and support services to develop planning and organizational skills such as daily activity planning and project or task planning. This exclusion does not apply to the medically necessary treatment of pervasive developmental disorder or autism, to the extent stated in the Behavioral health treatment for pervasive developmental disorder or autism provision of MEDICAL CARE THAT IS COVERED. 22. Orthopedic Supplies. Orthopedic shoes (other than shoes joined to braces) or non-custom molded and cast shoe inserts, except for therapeutic shoes and inserts for the prevention and treatment of diabetes-related foot complications as specifically stated in the Prosthetic Devices provision of MEDICAL CARE THAT IS COVERED. 23. Surrogate Mother Services. For any services or supplies provided to a person not covered under the plan in connection with a surrogate pregnancy (including, but not limited to, the bearing of a child by another woman for an infertile couple). International Student HealthCare PLUS $250,000 Yearly Rate Student Spouse Child Children $1,704 $6,816 $2,556 $5,112 Rates shown here are for 12-months, you are billed at half the annual amount for each term. Separate summer term rates will be available for Summer