2013-201883-1 benefit summary flyer-v4_benefit summary

Student Injury and Sickness Insurance
Plan for
Chamberlain College of Nursing
2013-2014
Chamberlain College of Nursing is pleased to offer an Injury and Sickness Insurance Plan underwritten by UnitedHealthcare Insurance Company. All registered full-time students are eligible and must be enrolled in the plan on a hard waiver basis. All registered part-time students taking at least 6 credit hours are eligible to enroll in the plan on a voluntary basis.
Highlights of the Coverage and Services
offered by UnitedHealthcare StudentResources are:
● Up to $500,000 Per Insured Person, Per Policy Year Maximum Benefit for Covered Medical ● $5,000 Deductible Per Insured Person, Per Policy Year.
● The Company will pay Covered Medical Expenses incurred at 80% for Preferred Providers and 50% for Out-of-Network Providers up to $2,500 before the Insured Person is responsible for satisfaction of the $5,000 Deductible. After the Company pays $2,500, the Deductible must be satisfied by the Insured Person before additional benefits will be paid. Once the Deductible has been satisfied, the Company will pay Covered Medical Expenses incurred at 100% for PreferredProviders and 50% for Out-of-Network Providers not to exceed the Maximum Benefit of ● Prescription Drug Benefits: $20 Copay for Tier 1 / $35 Copay for Tier 2 / $70 Copay for Tier 3 up to a 31-day supply per prescription for prescriptions filled at a UnitedHealthcarePharmacy (UHCP).
be viewed and downloaded atwww.UHCSR.com/chamberlain.
● Preventive Care Services which include, but are not limited to, annual physicals, GYN exams, routine screenings and immunizations are covered at 100% with no Copay or deductible only when the services are received from a Preferred Provider. Please see www.healthcare.gov for complete details of the services provided for specific age and risk ● Coverage available for eligible Dependents.
● The Preferred Provider Network for this plan is UnitedHealthcare Options PPO. Preferred Providers can be found using the following link,http://www.uhcsr.com/lookupredirect.aspx?delsys=01 ● FrontierMEDEX – Domestic Students are eligible for FrontierMEDEX services when 100 miles or more away from your campus address and 100 miles or more away from yourpermanent home address. International Students are covered worldwide except in theirhome country.
● Online Services: UnitedHealthcare StudentResources Insureds have online access to their claims status, EOBs, ID Cards, network providers, correspondence and coverage accountinformation by logging in to My Account at www.uhcsr.com/myaccount. To create an onlineaccount, select the “create My Account Now” link and follow the simple, onscreen directions.
All you need is your 7-digit Insurance ID number or the email address on file. Insureds can alsovisit our mobile site at my.uhcsr.com to access an electronic ID card.
Your student health insurance coverage, offered by UnitedHealthcare Insurance Company
may not meet the minimum standards required by the healthcare reform law for
restrictions on annual dollar limits. The annual dollar limits ensure that consumers have
sufficient access to medical benefits throughout the annual term of the policy. Restrictions
for annual dollar limits for group and individual health insurance coverage are $1.25
million for policy years before September 23, 2012; and $2 million for policy years
beginning on or after September 23, 2012 but before January 1, 2014. Restrictions on
annual dollar limits for student health insurance coverage are $100,000 for policy years
before September 23, 2012 and $500,000 for policy years beginning on or after September
23, 2012, but before January 1, 2014. Your student health insurance coverage puts a policy
year limit of $500,000 that applies to the essential benefits provided in the Schedule of
Benefits unless otherwise specified. If you have any questions or concerns about this
notice, contact Customer Service at 1-866-808-8298. Be advised that you may be eligible
for coverage under a group health plan of a parent's employer or under a parent’s
individual health insurance policy if you are under the age of 26. Contact the plan
administrator of the parent’s employer plan or the parent’s individual health insurance
issuer for more information.
UnitedHealthcare StudentResources
NOTE: The amounts stated above include certain fees charged by the school you are receiving coverage through. Such fees include amounts which are paid to certain non-insurer vendors or consultants by, or at the direction, of your school.
PRE-EXISTING CONDITION means: 1) the existence of symptoms which would 27. Outpatient Physiotherapy; except for a condition that required surgery or Hospital cause an ordinarily prudent person to seek diagnosis, care or treatment within the 12 Confinement: 1) within the 30 days immediately preceding such Physiotherapy; months immediately prior to the Insured's Effective Date under the policy; or, 2) any or 2) within the 30 days immediately following the attending Physician's release condition which originates, is diagnosed, treated or recommended for treatment within the 12 months immediately prior to the Insured's Effective Date under the policy.
28. Participation in a riot or civil disorder; commission of or attempt to commit a No benefits will be paid for: a) loss or expense caused by or resulting from; or b) 29. Pre-existing Conditions, except for individuals who have been continuously treatment, services or supplies for, at, or related to any of the following: insured under the school's student insurance policy for at least 12 consecutivemonths; The Pre-existing Condition exclusionary period will be reduced by the total number of months that the Insured provides documentation of continuous coverage under a prior health insurance policy which provided benefits similar to this policy; as follows: in the event of a lapse in coverage or if coverage is waived 4. Nicotine addiction, except as specifically provided in the policy; and the individual purchases coverage under this policy during open enrollment, 5. Milieu therapy, learning disabilities, behavioral problems, parent-child problems, benefits will not be payable for Pre-existing Conditions for 12 consecutive conceptual handicap, developmental delay or disorder or mental retardation; months from the Insured’s Effective Date of the new coverage under this policy.
This exclusion will not be applied to an Insured Person who is under age 19; 7. Circumcision, except if medically necessary due to injury, illness, disease or 30. Prescription Drugs, services or supplies as follows: a. Therapeutic devices or appliances, including: hypodermic needles, syringes, 8. Congenital conditions, except: 1) for individuals who have been continuously support garments and other non-medical substances, regardless of intended insured under the school's student insurance policy for at least 12 consecutive use except as specifically provided in the policy; months or; 2) as specifically provided for Newborn or adopted Infants; b. Immunization agents, except as specifically provided in the policy, biological 9. Cosmetic procedures, except cosmetic surgery required to correct an Injury for sera, blood or blood products administered on an outpatient basis; which benefits are otherwise payable under this policy or for newborn or adopted c. Drugs labeled, “Caution - limited by federal law to investigational use” or 10. Custodial care; care provided in: rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places mainly for domiciliary or custodial e. Drugs used to treat or cure baldness; anabolic steroids used for body building; care; extended care in treatment or substance abuse facilities for domiciliary or f. Anorectics - drugs used for the purpose of weight control; g. Fertility agents or sexual enhancement drugs, such as Parlodel, Pergonal, 11. Dental treatment, except for accidental Injury to Sound, Natural Teeth; Clomid, Profasi, Metrodin, Serophene, or Viagra; 12. Elective Surgery or Elective Treatment; h. Growth hormones, except when a Medical Necessity; or i. Refills in excess of the number specified or dispensed after one (1) year of 14. Eye examinations, eye refractions, eyeglasses, contact lenses, prescriptions or fitting of eyeglasses or contact lenses, vision correction surgery, or other 31. Reproductive/Infertility services including but not limited to: family planning; treatment for visual defects and problems; except when due to a covered Injury fertility tests; infertility (male or female), including any services or supplies rendered for the purpose or with the intent of inducing conception; premarital 15. Flat foot conditions; supportive devices for the foot, subluxations of the foot; examinations; impotence, organic or otherwise; female sterilization procedures, fallen arches; weak feet; chronic foot strain; symptomatic complaints of the feet; except as specifically provided in the policy; vasectomy; sexual reassignment and routine foot care including the care, cutting and removal of corns, calluses, surgery; reversal of sterilization procedures; toenails and bunions (except capsular or bone surgery); 32. Research or examinations relating to research studies, or any treatment for which 16. Health spa or similar facilities; strengthening programs; the patient or the patient’s representative must sign an informed consent 17. Hearing examinations; hearing aids; or cochlear implants; or other treatment for document identifying the treatment in which the patient is to participate as a hearing defects and problems, except as a result of an infection or trauma.
research study or clinical research study; "Hearing defects" means any physical defect of the ear which does or can impair 33. Routine Newborn Infant Care, well-baby nursery and related Physician charges; normal hearing, apart from the disease process; except as specifically provided in the policy; 34. Preventive care services; routine physical examinations and routine testing; preventive testing or treatment; screening exams or testing in the absence of 20. Immunizations, except as specifically provided in the policy; preventive medicines Injury or Sickness; except as specifically provided in the policy; or vaccines, except where required for treatment of a covered Injury or as 35. Services provided normally without charge by the Health Service of the Policyholder; or services covered or provided by the student health fee; 21. Injury caused by or resulting from the addiction to or use of alcohol, intoxicants, 36. Skeletal irregularities of one or both jaws, including orthognathia and mandibular hallucinogenics, illegal drugs, or any drugs or medicines that are not taken in the retrognathia; temporomandibular joint dysfunction; deviated nasal septum, recommended dosage or for the purpose prescribed by the Insured Person’s including submucous resection and/or other surgical correction thereof; nasal Physician; Intoxication is defined and determined by the laws of the state where and sinus surgery, except for treatment of chronic purulent sinusitis; the loss or cause of loss was incurred.
22. Injury or Sickness for which benefits are paid or payable under any Workers' 38. Speech therapy, except when a Medical Necessity due to Injury or Sickness; Compensation or Occupational Disease Law or Act, or similar legislation; 23. Injury or Sickness outside the United States and its possessions, Canada or 39. Suicide or attempted suicide while sane or insane (including drug overdose); or Mexico, except for a Medical Emergency when traveling for academic study 40. Supplies, except as specifically provided in the policy; 24. Injury sustained while (a) participating in any intercollegiate or professional sport, 41. Surgical breast reduction, breast augmentation, breast implants or breast contest or competition; (b) traveling to or from such sport, contest or competition prosthetic devices, or gynecomastia; except as specifically provided in the policy; as a participant; or (c) while participating in any practice or conditioning program 42. Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment; 43. War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will be refunded upon request for such period notcovered); and 44. Weight management, weight reduction, nutrition programs, treatment for obesity, (except surgery for morbid obesity), surgery for removal of excess skin or fat.

Source: http://www.chamberlain.edu/docs/academics-admissions/clinical-uhcbrochure.pdf