PIA insurance ppt - Santa Monica College

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INTERNATIONAL STUDENT INSURANCE
INFORMATION
PERSONAL INSURANCE ADMINISTRATORS
(PIA)
SANTA MONICA COLLEGE HEALTH SERVICES
by
FAUZIA HASSAN OLIN RN
EDUCATE
ADVOCATE
EMPOWER
PIA
Personal Insurance Administrators
What does my insurance cover?
Eligibility
OPT (practical training)
Dependents
Refunds
Terms of coverage and Coverage schedule
What is a referral?
What is a claim and the process of filing a claim?
PPO (preferred provider network)
What is an emergency and what do I do in an emergency?
Is there a co-pay for my Doctors visit?
Who do I contact if I have any questions pertaining to my health
insurance?
What Your Policy Covers
Medical fees up to $250 000 per accident or sickness
Covers 100% payment of all charges in PPO network (non PPO provider
covered at 70% with a $100 deductible).
Contains 50% reimbursement of prescription drug charges.
Emergency conditions e.g. heart attack, a cut requiring stitches etc.
All Doctor visits are subject to a $25 co-pay
For the entire list or schedule of benefits please pick up a brochure from the
Student Health Services or down load it from www.renstudent.com/smc
Please visit www.renstudent.com/smc to down load ID cards and or claim
forms.
This Plan Does Not Cover:
Dental or Vision
Immunizations
STD screening
Pre-Existing Conditions or Illnesses (for first six months of policy term)
Treatment of a non-emergency medical condition in an Emergency Care
facility
ELIGIBILITY
Eligibility:
– International students, visiting faculty, scholars or other persons
with a current passport or student visa (F-1, J-1 or M-1 visa)
– Students who have paid their required premium (insurance fee)
and their name, student number and date of birth must have
been included in the declaration made by the college or the
Administrative Agent to the insurer.
– Covered students must actively attend classes for at least the
first 31 days of the period for which coverage is purchased,
except in the case of medical withdrawal.
– For questions, please contact Renaissance Insurance Agency,
Inc. at 1-800-537-1777
PRACTICAL TRAINING STUDENTS
OPT STUDENTS (PRACTICAL TRAINING)
– Must submit to Renaissance Insurance Agency, Inc. the
following:
An enrollment form and payment (by mail) within 30 days of the
termination date of the immediately preceding term; and
Proof of Practical Training (either a copy of their Employment
Authorization Card or an official letter from the college stating their
OPT dates).
Please note, students engaged in OPT are not eligible to use the
Students Health Services, therefore, the Deductible can not be
waived under any circumstances.
For questions please call Renaissance Insurance Agency, Inc. at 1800-537-1777
DEPENDENTS
DEPENDENTS:
– Spouse (husband or wife) living with the covered student; or unmarried
children under the age of 26 years.
– Eligible dependents must be enrolled by the Deadline Date or within 31
days of birth, adoption, marriage, or arrival in the U.S. or termination of
other insurance coverage. Coverage for eligible dependents will not be
effective prior to that of the covered student or extend beyond that of the
covered student.
– A newly acquired dependent child will be covered under Policy for the
first 31 days after birth; or the earlier of: effective date of adoption of the
child; or the date of placement of the child for adoption. Benefits will be
the same as any other covered person who is the child’s parent.
– To continue the coverage the covered student must within 31 days after
the birth, adoption or placement for adoption:
Apply to the company in writing
Pay the required additional premium. If not coverage ends at day
31.
REFUNDS
REFUNDS:
– No refunds for insurance will be permitted unless:
You are withdrawing from Santa Monica College and
returning to your home country---airline ticket must be
presented
You are transferring to a different U.S. university or college---documentation may be requested
You are a covered student entering the armed forces.
Refunds will be pro rated and issued upon request from the
school.
No refunds will be given if you purchase other insurance after
the semester begins.
TERMS OF COVERAGE
TERMS OF COVERAGE:
– Coverage begins at 12:01 a.m. if the eligibility
requirements are met.
The effective date of the policy
The effective date of the term of coverage for which premium
has been paid.
The day immediately following the date that full premium is
received by the Administrative Agent or the College
Please note: (PIA) Personal Insurance Administrators does not
send termination or renewal notices. It is the covered
persons responsibility to renew coverage in a timely manner,
subject to continuing eligibility.
COVERAGE SCHEDULE
BEGIN
END
DEPENDENT
ENROLLMENT
DEADLINE
FALL
08-25-11
02-12-12
09-25-11
WINTER
01-02-12
02-12-12
02-02-12
SPRING
02-12-12
08-25-12
03-12-12
SUMMER
06-16-12
08-25-12
07-16-12
STUDENT HEALTH SERVICES REFERRAL
REQUIREMENT
STUDENT
HEALTH
SERVICES
ACU
PHYSIO
DOCTORS
PUNCTURE THERAPIST
OFFICE
OFFICE
OFFICE
Students covered by the
insurance must first get a
referral/claim form from
the Student Health
Services.
The covered student
must visit the Student
Health Services for care
prior to seeing a Doctor
or receiving care offcampus unless its an
Emergency.
Referral and Claim forms
REFERRAL’S WAIVED UNDER THESE
CIRCUMSTANCES/SITUATIONS
REFERRAL WAIVED DUE TO:
– Medical emergency. The covered student
must return to Student Health Services for
referral and follow up care.
– When Student Health Services is closed.
– When service is given at another facility
during school break or vacation periods.
– Medical care received when the covered
student is more than 50 miles from campus.
PREFERRED PROVIDER ORGANIZATION
PPO: Preferred Provider Organization
– This is a network of Doctors and hospitals approved by the
covered student’s insurance to provide care to the covered
student.
– Covered student using the PPO network/panel of Medical
Professionals will only be responsible for any deductibles, copays or co-insurance as shown in the schedule of benefits.
– Covered students not using the PPO provider network will be
responsible for 30% of the eligible expenses. However, if
treatment is received in a non PPO facility due to an emergency
medical condition, benefits for eligible expenses are payable at
the PPO level.
– For a complete listing of PPO provider network Hospital and
Doctor facilities visit www.cfmcnet.org or call 1-800-334-7341
OBTAINING/GETTING MEDICAL
TREATMENT.
Get the Referral and Claim form from the RN in the Student Health
Services. Please bring your student ID card to receive service.
Select a Doctor within the PPO network by either calling 1-800-3347341 or going to the website www.cfmcnet.org
Call the Doctor and make an appointment.
Verify coverage with the doctor or primary care provider and with
your insurance company by calling 1-800-334-7341.
When going to the Doctor’s office present your insurance card, $25
and the dual sided referral/claim form.
Make sure to get the referral form/claim form back from the Doctor’s
office when the visit it done.
It is mandatory that the referral/claim form is mailed by the covered
student to the claims department for the Doctor to be paid and for
the expenses incurred to be covered.
Filing A Claim After Receiving Treatment
After receiving treatment complete the claim form
side by:
– Answering all the questions, sign and date the form prior to
submitting it.
– Attach medication bill’s, lab fees etc to this form.
– Make copies of all forms and receipts and keep for your own
records.
– Submit all copies of forms as one package.
– If you need help feeling informs contact International Student
Center.
– Have all your bills and the forms sent as one package to:
Personal Insurance Administrators, Inc. P O Box 6040, Agoura
Hills, CA 91376
IMPORTANT NOTICE
For More In depth and Up To Date Information check out PIA’s website at:
www.renstudent.com or call Denise, Sharif or Elaine at 1 310 394 0440.
You can down load claim forms, ID cards and or brochures from
www.renstudent.com if needed.
For questions regarding eligibility, benefits or claims:
Personal Insurance Administrators, Inc.
P.O.Box 6040
Agoura Hills, CA 91376
1-800-468-4343
www.piaclaims.com
Plan Underwritten by:
National Union Fire Insurance Company of Pittsburgh, Pa.
Policy Number CHH0058772
NO COST LANGUAGE ASSISTANCE SERVICES
You can get an interpreter and get documents read to you in your language. For
help call the number listed on your insurance card or 1-800-468-4343
SMC STUDENT HEALTH SERVICES
SMC Student Health Services
Office Hours (subject to change):
–
–
–
–
8:00am-7:00pm Monday–Thursday
8:00am-2:00pm Friday
Telephone 1 310 434 4262
To Receive service at the health office you need to have paid
your health fee of $16 spring and Fall, $13 summer and
winter; and have your student ID card.
ADMINISTRATIVE AGENT:
Renaissance Insurance Agency, Inc.
Phone: 1-800-537-1777
Available on campus at International Education Counseling by
appointment.
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