2013-2014
Student Health Insurance Plan Overview
Presented by
Contact Information
Ascension Benefits and Insurance Solutions (Plan Administrator)
For CIGNA PPO information, brochures, FAQs, ID cards, or eligibility questions
– Hours: 8:00 am- 5:00 pm, Monday-Friday
– Phone: (800) 537-1777
– Fax: (310) 394-0142
– Website: www.4studenthealth.com/touro
Personal Insurance Administrators (Claims Payer)
For questions about eligibility, benefits, or claims
– Hours: 8:00 am- 5:00 pm Monday; Thursday, 8:00 am- 4:00 pm Friday
– Phone: (877) 358-3727
– Website: http://www.piaclaims.com
– Claims Mailing Address: GWH-Cigna, 1000 Great-West Drive, Kennett,
MO 63857-3749
Terms to Know
• Claim – The total bill to the insurance company for a covered illness or injury
• Co-pay – The fixed amount that you are responsible for paying at the time of service each
time you see a doctor or go to the hospital.
• Coinsurance – The sharing of the cost of the medical services between the insurance
company and you.
• Deductible – The amount that you may have to pay before the insurance company begins to
pay benefits.
• Exclusions – Specific conditions or situations that are not covered by the plan.
• Preferred Provider Organization (PPO) – The network of providers who have contracted with
the insurance company to provide discounted rates for services.
• Premium – The cost of the insurance coverage. Note: You must maintain coverage the entire
time you are enrolled in school.
• Provider – A doctor, hospital, medical facility or ambulance that is licensed to provide
medical care.
• Usual, Reasonable & Customary (URC) or Reasonable & Customary (R&C) – The most
common charge for similar medical services or treatment within the same geographical area.
How does PPO insurance work?
In health insurance, a preferred provider organization (PPO) is a network of
medical doctors, hospitals, and other health care providers who have
contracted with an insurer to provide health care at reduced rates.
Your PPO network is CIGNA, and your coinsurance when you use CIGNA
providers (also known as in network providers) is 0% for covered expenses,
meaning that the insurance will pay for 100% of covered charges.
If you go to a medical doctor, hospital, or other health care provider that is not
in the CIGNA PPO network (also described as out of network), your coinsurance
is 20% for covered charges, meaning that the insurance will only pay for 80% of
covered charges.
You are responsible for paying for what your insurance does not cover.
How to I obtain an ID card?
Your ID cards will be sent to you after the first week of the Fall term (or Spring
if you are newly enrolled). If you have enrolled dependents, they should use
your card. You will receive a separate ID card for prescriptions from Express
Scripts, but you may use your SHIP ID card to get prescriptions in the
meantime.
Keep your IDs card for the full academic year. Do not throw away your cards
until you receive new ones the next academic year.
If you lose your cards, download a temporary ID card from
www.4studenthealth.com/touro and call Ascension at (800) 537-1777 to
request replacements.
It is very important to have proof of insurance coverage in order to receive
prompt medical treatment! Keep your ID card with you at all times!
What is covered by this insurance?
2013-14 Plan Benefits
• $500,000 plan maximum per policy year for all conditions
• Coverage of preventive services (as defined by the Affordable Care Act) at
100% in network (deductible and co-pays waived) and 80% out of network
(deductible and co-pays apply)
• Outpatient prescription drug benefit paid up to $500,000 per policy year
under the Express Scripts Network
• Policy year deductible of $250 in network/$500 out of network
• Office visit co-pay of $20 in network/$40 out of network
• Emergency room co-pay of $150 per visit, waived if admitted
• Outpatient physical therapy/chiropractic/OMM benefit maximum of 20
visits per policy year
• Coverage for routine Antibody Titers testing incorporated, paid at 100% innetwork, 80% out-of-network (deductibles and copays waived)
What is covered by this insurance?
This plan does NOT cover:
• Dental or vision care, including eye examination or routine dental
examinations (dental treatment due to injury is covered, at $100 per
tooth maximum)
• Cosmetic procedures, unless due to an injury or sickness
• Pre-Existing Conditions*, for the first 6 months of the policy, unless you
had continuous coverage under other insurance for at least a full 6 months
immediately preceding this plan.
*A Pre-Existing Condition is a Sickness or Injury for which medical care,
treatment, diagnosis or advice was received or recommended within the six
(6) consecutive months prior to the Covered Person’s Effective Date of
coverage under the Policy.
How do I get medical treatment?
Go to the Emergency Room only in the event of a life-threatening injury or
illness.
For injuries that are not life-threatening but that require immediate attention,
visit an Urgent Care Center. You can find Urgent Care locations near you by
visiting www.cigna.com.
For injuries and illnesses that are not life-threatening or urgent, you can either
visit the student health center on campus or you can schedule an appointment
with a doctor. To find a provider that is in network, check the CIGNA PPO listing
for preferred doctors and hospitals at www.cigna.com. When you go to the
doctor, show them your ID card and pay the co-pay.
Remember, you do not have to go to a PPO network provider, but you will
save a lot of money if you do.
What do I do when I receive a bill?
After you receive treatment at a PPO provider, your provider will submit a
claim to the insurance company.
In some circumstances, such as using a non-PPO provider, you may be asked to
pay up-front. In this case, submit a claim for reimbursement by sending all
itemized hospital and medical bills, along with a copy of your health insurance
ID card to the address below:
GWH-Cigna
1000 Great-West Drive
Kennett, MO 63857-3749
• Claims are usually processed in 7-10 days. If you have questions about the
status of your claim after it has been submitted, please call Personal
Insurance Administrators (PIA) at (877) 358-3727 or visit
www.piaclaims.com.
• Be sure to keep copies of all documents submitted to CIGNA.
The truth about medical bills
Medical bills are not automatically paid. Providers typically submit claims
electronically. However, please keep in mind that ultimately it is your
responsibility to send the insurance company the documentation they need to
promptly process your claim.
The insurance does not necessarily cover everything, so check the brochure or
call Personal Insurance Administrators (PIA), the claims administrator, before
you have a procedure to make sure it will be covered.
You are ultimately responsible for any charges not covered by the insurance.
How do I Prescriptions Filled?
To locate a network pharmacy and to manage your medications (including
refills and home delivery), contact Express Scripts, Inc. at 1-800-447-9638 or by
visiting www.express-scripts.com.
Only prescriptions filled at an express scripts pharmacy will be covered.
Student Health Services
Touro University California- Student Health Services is located at 1310 Club
Drive, Wilderman Hall, Room 114
Business Hours: Monday-Thursday 8am-5pm; Friday 8am-3pm.
Extended Business Hours*: 1st & 3rd Tuesday of the Month: 8:00am-6:30pm
* Students and visitors are strongly encouraged to verify availability of
extended hours prior to arrival as this schedule may be impacted by holidays,
illness, vacations or periods when classes are not in session.
Please contact the SHS for services offered.
Telephone: (707) 638-5220
Fax: (707) 638-5261
THANK YOU!
Please call us if you have questions about this presentation or the
brochure. We are happy to assist you!