Transcript for a Rotary Insurance Overview

Overview of CISI Benefits &
Procedures
For the Participants of Rotary
International
2012
What we will be covering:
• Policies and benefits Plan A and Plan B
• Primary Exclusions
• Travel Assistance Center
• First Health Network
• HIPAA Laws
• Claim Handling, Procedures & Examples
• Questions and answers
Policies and Benefits
• The medical policy options:
Plan A (available for STEP & Short Term)
Plan A+
Plan B
Quick Overview
Accident & Sickness Benefits
For Students Traveling Outside of the USA (non US exchanges):
• Plan B: covered expenses paid at 100%
• Plan A: covered expenses paid at 80/20 with a one time $100
deductible .
For Students Traveling Into the USA:
• Plan B: covered expenses paid 80/20 of the first $5000, 100%
thereafter, with a one time $100 deductible.
• Plan A: covered expenses paid 80/20 with a one time $100
deductible.
Overview Continued
• Chiropractic services covered to $500
• Mental/Nervous covered to $1000 on an outpatient basis and $25,000 on
an inpatient basis. These benefits are not subject to the deductible
• Pre-existing conditions are covered to $500
• Emergency Medical Evacuation benefit of $100,000
• Repatriation of Remains benefit of $50,000
• Emergency Family Reunion benefit of $5000 if insured is hospitalized in
excess of four days
• Round trip flight benefit of $3000 if insured must return home due to the
death or serious illness of grandparent, parent or sibling.
Primary Exclusions
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Routine Physicals and Immunizations
Including Sports Physicals
Routine Dental care
Driving a vehicle
Alcohol related illness/injuries
Vision exams and eye glasses/contact lenses
Pre-existing Definition
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– Pre-Existing conditions, defined as any condition for which a licensed Physician
was consulted, or for which treatment or medication was prescribed, or for
which manifestations of symptoms would have caused a person to seek medical
advice in the 6 months prior to the Effective Date of coverage under the Policy,
except as specified:
If the Insured Person does not receive medical care or services, including prescription
drugs or other medical supplies and is not under the care of a Physician with respect
to the Pre-Existing Condition or related condition(s), for a period of 6 consecutive
months beginning on or after the first day of coverage, the preexisting condition
exclusion will no longer apply and any eligible charges incurred after the treatment
free. Please note that this policy allows up to $500 for treatment of a pre-existing
condition.
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Please note that this exclusion does not apply to Emergency Medical
Evacuation/Repatriation and Return of Mortal Remains
24-Hour Assistance Center (Team Assist):
Facts:
• 24-hours, 7 days a week. Anyone can open a case on behalf of the
student if there is a medical emergency.
• Legal Assistance available (Dick Atkins)
• Multi-lingual services are available
• Passport/Lost Luggage Assistance if applicable
• Keeps CISI staff informed (if appropriate) regarding clients
Medical Assistance:
• Referral to a First Health Network Preferred Provider (PPO) (They
can look someone up if needed)
• Prescription Drug replacement/shipment
Liability Coverage
Personal Liability –
Limit per claim $100,000
Deductible per claim $250
Medical Payments - $5000 per coverage period
Additional Living Expense - $5000 per coverage period
Unscheduled Personal Property –with replacement cost up to
$2500
First Health Network:
• PPO Network available to inbound students only
• To search for a network provider go to:
www.culturalinsurance.com.
• If provider participates, payment is based on a fee
schedule, not on usual and customary guidelines.
• Insured is always responsible for deductible.
• If a provider knows we are in their network, they are
more willing to accept our insurance.
• CISI works with PHX to negotiate discounts.
HIPAA Laws
HIPAA-Health Insurance Portability and Accountability ACT
Law that prevents the release of protected medical information.
The physician by law, cannot release medical information to anyone but the
insured without their written permission. In some cases, CISI may need
additional information from the physician. The insured must sign a release
of information in order for the physician to share private medical
information with CISI.
Claim Forms
• If additional claim forms are needed, please go to our
website:
www.cisi-bolduc.com
Claim Procedures
• Ideal submission is from the Doctor or facility directly to CISI.
• Submit your first medical bills within 60 days after occurrence.
• Claim form should be completed in full, have original bills and
receipts attached. (Itemized bills, no generic store receipts).
• Claims should have the most up-to-date contact details & addresses.
• Neat handwriting is key!
Payment on Claims
• Participants MUST pay their deductible.
• The Claims department will subtract the deductible from
the Doctor bill if the bill shows that the deductible has
not been paid and the insured has not filed a claim for
reimbursement.
• Deductibles are the responsibility of the participant.
Prescriptions
• Must be prescribed by a doctor or hospital
• Pay for medication and submit for reimbursement with
completed claim form.
• Claim form must be accompanied by a prescription
receipt. (Sorry, cash register receipts not acceptable).
• Receipt must include: Insured’s name, Physician’s name,
name of medication and cost.