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A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Academic Exchange Grantees in the United States.

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Presentation on theme: "A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Academic Exchange Grantees in the United States."— Presentation transcript:

1 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Academic Exchange Grantees in the United States

2 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Health Benefit Plan  ASPE is not an insurance policy  Limited health benefits plan  Self-funded through US Dept of State

3 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Health Benefit Plan  Administered by Seven Corners, Inc.  Seven Corners administers the program based on ASPE’s policies and procedures in benefit guide

4 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES ASPE Guide Version 1/2011

5 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Eligibility  Dates on ID card  24/7 coverage in your “host” country  ASPE will not cover you outside of your host country on personal leave/vacation  Example: Grantees host country is the United States, the grantee will not be covered by ASPE for personal leave, vacation/holiday outside the United States to include Canada and Mexico.

6 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES ID Card Exchange Grantee Name ID number 01/01/2010 to 12/31/2010 Citizen Country Exchange Grantee Name Unique ID number 06/01/2011 to 05/31/2012 Citizen Country

7 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Back of ID Card Exchange Grantee Name Unique ID number 06/01/2011 to 05/31/2012 Citizen Country

8 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Coverage  $100, maximum per covered sickness or per injury  Medevac Coverage  Repatriation Coverage

9 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Co-pay  ASPE requires all exchange grantees to pay a $15.00 co-pay. The co-pay is printed on the your ID card and will be due at the time-of-service for:  Office visits  Emergency Rooms  Urgent Care  Hospitalizations $15.00 co-pay for office visits*

10 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Benefit Limitations  ASPE has a lifetime pre-existing clause for medical conditions  Had its origins (condition) prior to your start date.  Consulted a physician prior to start date.  Treatment or medication received prior to start date.  Condition would have caused a “prudent” person to seek treatment prior to start date.

11 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Exceptions to Pre-ex  Pregnancy  Prescription Medications  Prescription medications are not subject to the pre-existing clause, only medical conditions.  Diabetes would be pre-ex, the medication, i.e. insulin, and syringes would be covered

12 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Benefit Limitations  ASPE does not cover the following  Dental Care—all dental care including routine*  Vision Care—routine eye exams or glasses/contacts not covered*  Routine Examinations—any type of routine medical care is not covered  Immunizations/vaccinations*

13 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Exceptions  Dental exception  Only treatment for the emergency alleviation of pain will be paid and the maximum allowed is $ per benefit year.  Call Seven Corners customer service for help in finding a dentist.

14 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Exceptions  Vision exception (eyes)  If you are in an accident and your eyeglasses/contacts are damaged, ASPE will replace or repair your eyeglasses or contacts the maximum limit is $

15 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Exceptions  Immunizations/vaccinations  Vaccinations that follow the guidelines set by the American College Health Association (ACHA) which include:  Measles, Mumps, Rubella (MMR), Polio, Varicella, Tetanus, Diphtheria, Pertussis, Quadrivalent Human Papillomavirus Vaccine (HPV), Hepatitis A Vaccine, Hepatitis B Vaccine, Meningococcal Tetravalent (Meningitis), Influenza, Pneumococcal Polysaccharide Vaccine and Tetanus booster—only if booster is required by the University. In addition, Hepatitis C and Tuberculosis skin test (PPD) are also covered.

16 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Seven Corners  Administers ASPE plan  Process claims  Customer service  Eligibility—enrollment  Prescriptions   MyPlan (secure website)

17 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES

18 https://myplan.sevencorners.com

19 Customer Service  Staffed 24/7  Call toll free   Find a doctor or hospital  Questions about ASPE or medical bills  Need forms  For hospitalization/surgery  For treatment of dental pain

20 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Provider Networks  ASPE uses a preferred provider network for medical care  ChoiceCare Network—www.choicecare.com  48 states excluding New Jersey and New York  Beechstreet Network—www.beechstreet.com  Only in New Jersey and New York

21 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES

22 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Provider Search

23 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES

24 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Provider Search

25 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Claim Form  If you use a provider network—you do not have to file a claim form, the provider will bill Seven Corners

26 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Claim Form  If you do not use a provider network—payment might be required upfront or the provider will bill you. You will need to file a claim form and you will be responsible for the difference in costs for using an out-of-network provider.  Claim form in back of guide or online

27 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Primary or Secondary  If ASPE is your only coverage—ASPE is primary  If you are covered by a University Insurance Policy— ASPE is secondary

28 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Pharmacy Network  BeneScript   Paid prescriptions—show your ID card with written prescription at the pharmacy  Start date on ID card is the start of your ASPE coverage and your prescription coverage  If you are not in the prescription system please contact Seven Corners customer service  Exclusions to the prescription program on page 19

29 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES  Start date on ID card is the start of your ASPE coverage and your prescription coverage  Give your ID card to the pharmacy the information to fill your prescription is on the back. To Fill a Prescription

30 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Reimbursement  If you are not in the system you can pay for your prescription out-of-pocket and get reimbursed  Use claim form in back of guide or download a copy from  BeneScript Prescription Reimbursement Form BeneScript Prescription Reimbursement Form

31 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Medical Care  Primary Care Provider  Urgent Care Center  Emergency Room

32 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Medical Care  Primary Care Provider  Unless you are experiencing a life-threatening emergency, primary care centers are the best places to start.  Primary care providers are physicians who deliver basic care for common illnesses. They are your first stop for most undiagnosed health concerns.  When to go  You should visit a primary care center for illnesses such as colds, flu, and sore throats; minor injuries, aches, and pains.  You can schedule appointments with primary care providers during the week.

33 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Urgent Care  Urgent Care Center  If your primary care physician is not available and you need quick medical attention for a non-life-threatening problem, visit an urgent care center.  Urgent care centers have similar resources to primary care facilities, but they provide comprehensive quality care on a walk-in basis with extended hours.  When to go  Go to an urgent care center when you need immediate medical attention or have non-emergency health concerns after hours. Examples include ear infections, sprains, simple cuts and burns, and eye injuries.

34 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Hospital Emergency Rooms  Emergency Room  Life-threatening emergencies and late-night trauma require an immediate visit to the hospital.  Emergency rooms offer inpatient care, emergency services, trauma services, and more. Emergency clinicians are able to recognize, diagnose, and make recommendations for a wide array of medical issues.  When to go  Call 911 or drive to the emergency department at your nearest hospital whenever conditions cause severe symptoms and/or put your health at serious risk. Examples include heart attacks, poisoning, severe bleeding, and broken bones.

35 A CCIDENT AND S ICKNESS P ROGRAM FOR E XCHANGES Dependents  ASPE only covers the grantee  Grantees with dependents are required to purchase a health insurance policy  Suggested websites for information and quotes  (commercial side) 

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