ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
A ca d e m i c E xc h a n ge G ra nte e s
i n t h e U n i te d S tate s
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Health Benefit Plan
 ASPE is not an insurance policy
 Limited health benefits plan
 Self-funded through US Dept of State
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Health Benefit Plan
 Administered by Seven Corners, Inc.
 Seven Corners administers the program based on
ASPE’s policies and procedures in benefit guide
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
ASPE Guide
Version 1/2011
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
ID Card
Exchange
Grantee
Name
Exchange
Grantee
Name
ID number
IDUnique
number
06/01/2011
to 05/31/2012
01/01/2010
to 12/31/2010
Citizen
Country
Citizen
Country
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Back of ID Card
Exchange Grantee Name
Unique ID number
06/01/2011 to 05/31/2012
Citizen Country
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Coverage
 $100,000.00 maximum per covered sickness
or per injury
 Medevac Coverage
 Repatriation Coverage
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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*
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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*
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Exceptions
 Dental exception
 Only treatment for the emergency alleviation of
pain will be paid and the maximum allowed is
$1000.00 per benefit year.
 Call Seven Corners customer service for help in
finding a dentist.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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 $300.00.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Seven Corners
 Administers ASPE plan
 Process claims
 Customer service
 Eligibility—enrollment
 Prescriptions
 www.usdos.sevencorners.com
 MyPlan (secure website)
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
www.usdos.sevencorners.com
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
https://myplan.sevencorners.com
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Customer Service
 Staffed 24/7
 Call toll free 1-800-461-0430
 E-mail: usdosinfo@sevencorners.com
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Find a doctor or hospital
Questions about ASPE or medical bills
Need forms
For hospitalization/surgery
For treatment of dental pain
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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
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www.choicecarenetwork.com
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Provider Search
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
www.beechstreet.com
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Provider Search
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Claim Form
 If you use a provider network—you do not
have to file a claim form, the provider will bill
Seven Corners
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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
www.usdos.sevencorners.com
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Primary or Secondary
 If ASPE is your only coverage—ASPE is primary
 If you are covered by a University Insurance Policy—
ASPE is secondary
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Pharmacy Network
 BeneScript
http://bsi.lc.healthtrans.com
 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
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To Fill a Prescription
 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.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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 www.usdsos.sevencorners.com
 BeneScript Prescription Reimbursement Form
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Medical Care
 Primary Care Provider
 Urgent Care Center
 Emergency Room
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
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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.
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Dependents
 ASPE only covers the grantee
 Grantees with dependents are required to
purchase a health insurance policy
 Suggested websites for information and quotes
 www.sevencorners.com (commercial side)
 www.insubuy.com
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
QUESTIONS