VISIT® Travel & Medical Insuranc

VISIT^® International Health Insurance
Contact Us at epi@visitinsurance.com or 1-703-660-9062

Educational Partners International
DEPENDENT
Health Insurance Plan from VISIT^® Insurance
Plan E Plus 2023-2024
Effective August 1, 2023

What IS Covered by VISIT® Plan E Plus?

Medical Expenses - $100,000 per each accident or illness

Plan E Plus provides coverage for Accidents & Illness and medical emergencies. Your Plan will cover visits to a Doctor, Specialist, Minute Clinic, Urgent Care, Emergency Room and Hospital, as well as associated X-rays, Lab work and Prescriptions.

VISIT^® Plan E Plus uses the UnitedHealthcare Medical Provider Network. Be sure to have your doctor notify UnitedHealthcare in the event of any scheduled Hospitalization, Surgery and MRI/CAT Scans.

An Emergency Room should only be used in the event of a life-threatening Medical Emergency.

Home Country Coverage - A maximum of 14 days per year.

Dental - The plan will pay up to $300 for repair to a tooth due to an accident. Coverage is for accidents only.

Repatriation and Medical Evacuation are included in your Plan E Plus

Click Here to request a copy of the EPI DEPENDENT Health Insurance USER GUIDE

Each Box is a subject, click on each box for more information on that subject
EPI J2 Health Insurance Enrollment	COVERAGE Overview for EPI DEPENDENTS	What is NOT Covered Preventive Care Maternity Pre-existing Conditions Mental Health
How to Find a Doctor	How to Set-up and Use your MyIMG	TELADOC
How to File a CLAIM	How to Purchase PRESCRIPTIONS	Precertification
COVID-19	Dental & Vision Plans & Discounts	Additional Health Insurance Plans

EPI J2 Dependent Enrollment

J2 Dependent Rates per month (starting August 1, 2022)

$100,000 Medical / $100 Deductible

Age	Monthly Rate
0-29	$61.69
30-39	$81.68
40-49	$128.89
50-59	$193.34
60-64	$241.93
65-69	$294.94
70-79	$304.70

DEPENDENT Health Insurance Enrollment Process

All Dependents with a J-2 visa MUST ENROLL in the EPI AUTOMATIC MONTHLY PAYMENT (AMP) PLAN for their Health Insurance, which is now mandatory for all Dependents.

Please complete the EPI AUTOMATIC MONTHLY PAYMENT (AMP) PLAN Enrollment Form and return it to epi@visitinsurance.com or fax it to 703-991-9164, to enroll your dependents. Be sure to submit the AMP Enrollment Form prior to your Dependent's arrival into the USA.

What should I put as the Start Date of the Policy?
If your Dependent(s) are New to the USA, the START DATE should be the date they arrived in the USA.
If you previously had a policy, the START DATE should be the date your old policy renews (i.e. if your Dependent's policy ends on July 31, the Start Date should be August 1.)

What is my Monthly Withdrawal Date?
MONTHLY PAYMENT WITHDRAWAL DATE: Your credit/debit card will be charged on the same day each month as the Start Date of the policy. (As an example, if the policy starts on August 1, your monthly payment will be charged to your credit/debit card on the 1st of each month.)

Who do I contact if I need to change my credit card information?
Please submit an AMP Change of Information Form at least 10 days prior to your next Withdrawal Date. Please email the updated form to epi@visitinsurance.com. If you do not receive a confirmation that your form has been received, please contact VISIT at 703-660-9062.

VISIT^® PLAN E Plus Overview

Coverages - Plan E Plus	Benefits
Accident & Sickness Medical Illnesses (examples of illnesses typically covered: cold, flu, pneumonia, infection, new allergies, bronchitis, urinary tract infection, conjunctivitis, pelvic pain, cyst, rash, eye swelling, nausea/vomiting, animal bites, ear infection, sinus pain, cuts, heart attack, stroke, high fever, sudden/severe stomach pains, etc.) Accidents (examples of injuries typically covered by the Plan: medical expenses related to a car accident (max $50,000), broken bone, back injury due to a fall, injury from recreational sports, twisted or sprained ankle or wrist, etc.)	$100,000 per accident or illness Plan E Plus provides coverage for Accidents & Sickness and medical emergencies. Your Plan will cover visits to a Doctor, Specialist, Minute Clinic, Urgent Care, Emergency Room and Hospital as well as associated X-rays, Lab work and Prescriptions. Be sure to notify the UnitedHealthcare in the event of Hospitalization, Surgery and MRI/CAT Scans for a pre-certification. Physical Therapy treatment requires a referral from a licensed doctor. An Emergency Room should only be used in the event of a life threatening Medical Emergency. PRE-CERTIFICATION: 50% reduction of eligible medical expenses if pre-certification provisions are not met The following must always be pre-certified for medical necessity before admission or receiving treatments and/or supplies: Any treatment requiring inpatient hospitalization, Surgery or surgical procedure, including outpatient surgery, CAT scans or MRI's, Care in an extended care facility, Home nursing care, Chemotherapy, Radiation Therapy, Interfacility Ambulance Transfer.
Preventive Care (Annual Wellness Exams, school wellness exam and vaccinations) NOT COVERED FOR DEPENDENTS	Preventive care and vaccinations are NOT covered by Plan E Plus. However, EPI teachers will receive a separate Crescent Health Solutions insurance card that *will be used for Preventive care and Vaccines. This coverage is for EPI Teachers ONLY. When you are visiting the doctor for these services, please present the Crescent Health Solutions* insurance card, rather than then the VISIT^® Plan E Plus UnitedHealthcare ID Card. (When visiting the doctor for an accident and/or illness, then you will present the VISIT^® Plan E Plus UnitedHealthcare ID card.) If you have any questions regarding the Preventive Care coverage, please contact Crescent Health Solutions at 1-828-670-9145 and enter extension 104 directly. IMPORTANT: Routine physical exams and vaccinations are not covered on the J2 Plan. We recommend that you look for a local Community Clinic or go to a local Pharmacy to have these procedures as they can offer these services for a lower cost than going to a doctor's office.
COVID-19	COVID-19, the disease caused by the novel coronavirus, generally WILL be covered as would any other illness under the EPI VISIT Health Plan, including testing and treatment up to the policy limit. For testing to be covered by the Insurance, you must be symptomatic. Please be sure your Doctor’s Office submits your test as a SICK visit. If the test is submitted as a Preventive Care visit the claim will be denied.
TELADOC Common issues treated through Teladoc includes: allergies, bronchitis, cold and flu symptoms, respiratory infections, skin problems, sinus problems, and much more. Click here to Get Started	Call 1-800-TELADOC (835-2362) or visit www.teladoc.com to access the TELADOC services – Service is FREE! With TELADOC you can be connected with a licensed physician in minutes, not hours or days like you would at the ER, Urgent Care, or with your Doctor. And, you can get care from wherever you are home, work or traveling.
Prescription Drugs Reimbursed at 80%	In addition to your VISIT^® Plan E Plus Health Insurance ID card, you will receive two Discount Drug Cards (Universal Rx and WellCard) for your Prescriptions. When going to the pharmacy, please present both Discount Drug Cards. If the prescription is eligible for either discount, it will be applied at the time of your purchase. If there is a remaining cost due after the discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible and co-insurance apply. Click Here to register your WellCard. Click here to download a copy of the Discount card to be used at your local pharmacy. Click here to compare prices for your prescription.
Deductible The deductible is the portion of your medical bill that is your responsibility.	$250 Annual Deductible (New August 1, 2023) Your policy has a $250 ANNUAL DEDUCTIBLE. This means you are responsible for the first $100 of medical expenses each year. The deductible is paid to the doctor's office or the Medical Facility that has provided you treatment. Emergency Room: $500 (New August 1, 2023) (For Illness only, if not admitted Injuries not subject to ER Deductible)
Copayment Coinsurance applies after the copay	Walk In Clinic: $15 Urgent Care: $25
Coinsurance Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service.	Coinsurance The percentage of costs of a covered health care service you pay after you have paid your Deductible and Copays. NEW - In-Network – 90/10 (Maximum Out-of-Pocket $500, NOT including the Deductible and Copays) In-Network you are responsible for paying 10% of the first $5,000 in medical expenses. The Insurance company will pay 90%. After $5,000 in medical expenses, the Insurance company will pay 100% of covered medical expenses. Out-of-Network – 80/20 (Maximum Out-of-Pocket $1,000, NOT including the Deductible and Copays) expenses, the Insurance company will pay 100% of covered medical expenses.
Local Ambulance Injury Illness resulting in Inpatient Hospital admission	100% up to maximum limit
Chiropractor Care Physical Therapy Medical Order required from a Doctor	100% In-Network
Emergency Medical Evacuation	up to $1,000,000
Repatriation of mortal remains (Must be approved in advance by the company)	Up to the maximum limit for return of mortal remains or ashes to country of residence, or $5,000 maximum limit for cremation or local burial at the place of death. Not subject to deductible
Pre-existing condition coverage	No coverage for any medical condition, sickness, Injury, Illness, disease that existed at the time of application or any time during the 36 months prior to the effective date of coverage under this policy. Click here to review the upgrade options. Contact VISIT^® for more information.
AD&D - Accidental Death & Dismemberment	$25,000 per Insured/Spouse $5,000 per Dependent Child
Maternity coverage (including prenatal and miscarriage)	No coverage Click here to review the upgrade options. Contact VISIT^® for more information.
Home Country coverage	14 Days Your plan includes coverage for Incidental Trips to your Home Country: Up to $50,000.
Dental (Accident Coverage only)	To a maximum of $300 (available only if purchased for 1 month or more)
Dental	Discounts are available on some dental procedures through WellCard. For more information, visit the WellCard website. Use Group# SC001600 to register
Emergency Eye Exam Loss or Damage to prescription corrective lenses due to an accident	$150 Maximum Limit $50 Deductible Discounts are also available on eye exams and corrective lenses through the WellCard. For more information, visit the WellCard website. Use Group# SC001600 to register
Personal Liability	$100,000
Team Sports (Traveling Team Sports for Middle School, High School and College)	Click here to review the upgrade options. Contact VISIT^® for more information.
Trip Interruption	up to $5,000
Return of minor child	up to $100,000
Lost baggage	up to $250
Assistance Services	Included - 1-800-628-4664 / 1-317-655-4500 Press 0 between 7am-6pm (EST) OR Press 9 between 6pm-7am (EST)
Click here to request a copy of the Policy Details

What is NOT Covered by VISIT^® Plan E Plus?

Preventive Care - Preventive care and vaccinations are NOT covered by Plan E Plus. However, EPI teachers will receive a separate Crescent Health Solutions insurance card that will be used for Preventive care and Vaccines. This coverage is for EPI Teachers ONLY. When you are visiting the doctor for these services, please present the Crescent Health Solutions insurance card, rather than then the VISIT^® Plan E Plus UnitedHealthcare ID Card. (When visiting the doctor for an accident and/or illness, then you will present the VISIT^® Plan E Plus UnitedHealthcare ID card.) If you have any questions regarding the Preventive Care coverage, please contact Crescent Health Solutions at 828-670-9145 and enter extension 3 directly.

Pre-existing conditions - Any medical condition, sickness, injury, illness, disease that existed at the time of application or any time during the 36 months prior to the effective date of coverage under this policy is NOT covered. Click here to review the upgrade options. Please contact VISIT^® at 703-660-9062 for more information.

Mental Health - Any mental and nervous disorders or rest cures are NOT covered. This includes treatment for anxiety, depression, and stress related conditions. Treatments by a Psychologist, Psychiatrist, Counselor or Medical Physician that has diagnosed a mental/nervous condition are not covered. Click here to review the upgrade options. Contact VISIT^® for more information. coverage for Mental Health. Please contact VISIT^® at 703-660-9062 for more information.

Maternity - Maternity including Pregnancy or Illness resulting from Pregnancy, childbirth, or miscarriage is NOT covered by Plan E Plus. The SHA Plan provides coverage for maternity, however, you MUST be on the plan prior to conception. The GEO BLUE Plan is available for coverage if you are already pregnant. Click here to review the upgrade options. Please contact VISIT^® at 703-660-9062 for more information.
Dental - Regular dental care, treatment for cavities, root canals, and any other dental condition is not covered. Damage to a tooth due to an accident is covered to a maximum of $500. Discounts are also available on eye exams and corrective lenses through the WellCard. For more information, visit the WellCard website.
Use Group# SC001600 to register

Vision - Glasses and Eye Exams are not covered. Infections and medical conditions like Pink Eye may be covered. Please contact the Claims Office with any specific medical condition questions. Discounts are also available on eye exams and corrective lenses through the WellCard. For more information, visit the WellCard website.
Use Group# SC001600 to register

Team Sports - Injury due to competitive team sports is not covered. Recreational sports injuries are covered under the medical coverage on the policy.

TELADOC - Call 1-800-TELADOC (835-2362) or visit www.teladoc.com to access the TELADOC services –
Service is FREE!

TELADOC Service is FREE! With TELADOC you can be connected with a licensed physician in minutes, not hours or days like you would at the ER, Urgent Care, or with your Doctor. And, you can get care from wherever you are home, work or traveling. Common issues treated through Teladoc includes allergies, bronchitis, cold and flu symptoms, respiratory infections, skin problems, sinus problems, and much more. Click here to Get Started

TELADOC should be used for NON-EMERGENCY health issues ONLY! To set-up your account, please go to www.teladoc.com or download the APP. When setting up your account, please use the IMG Insured ID Number listed on the attached ID card and Zip Code 46208.

P. When setting up your account, please use the IMG Insured ID Number listed on the attached ID card and Zip Code 46208.

COVID-19 Coverage

COVID-19, the disease caused by the novel coronavirus, generally WILL be covered as would any other illness under the TPG Health Insurance policy, including testing and treatment up to the policy limit. If you have Dependents, please be sure their policy is paid-to-date to avoid any lapse in coverage!

COVID-19 TESTING - COVID-19 Testing is only covered if you are symptomatic. The test will not be covered for travel or non-illness related testing. Your doctor must submit the COVID-19 test as a “sick visit” and provide the medical records when submitting your claim. You should also submit a Patient Claim Form through your MyIMG Account explaining your symptoms.
COVID-19 VACCINES - Vaccines are currently being offered for FREE at most facilities. An administrative fee may apply. The COVID-19 vaccine is NOT covered on your VISIT^® Plan E PLUS Health Insurance.
COVID-19 TREATMENT - If you test positive for COVID-19, your medical expense will be covered by the UnitedHealthcare Plan up to the policy maximum of $100,000.

If you are experiencing symptoms related to COVID-19, it is important that you first contact your doctor or urgent care facility by phone to review the proper protocol to receive a test and treatment for COVID-19. Be sure to follow the current CDC Guidelines. When going to the doctor, please be sure to take your UnitedHealthcare Insurance card.

Where Can I Find a Doctor or Hospital?

(If you have an emergency medical condition, please call 911 or your local emergency services number)

To obtain a list of Providers in your area (Doctors, Urgent Care, ER, Hospitals and Labs), go to: UNITEDHEALTHCARE NETWORK

Urgent Care

Hospitals

Primary Care Doctors

When calling your medical provider or presenting your ID card say: “My healthcare coverage uses the UnitedHealthcare Network and I found your name on the directory."

DO NOT SAY: “I have VISIT or IMG Insurance” or “I use IMG Network or VISIT” or “I have the E Plus insurance.” Providers WILL NOT recognize this language, and your coverage may not be accepted.

Prescription Reimbursement

Prescriptions are covered at 80%, after your $100 Deductible for covered illnesses and injuries.

In addition to your Health Insurance ID card, you will receive two Discount Drug Cards (Universal Rx and WellCard) for your Prescriptions. Click Here to download a copy of the card to be used at your local pharmacy.
Where can I Use It? You may use your Discount Prescription card at most major Pharmacies, click here for more information.

When going to the pharmacy, please present both Discount Drug Cards. If the prescription is eligible for a discount, it will be applied at the time of your purchase. If there is a remaining cost due after the discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible and co-insurance apply.

Prescriptions can be filled at ANY Pharmacy.

In addition to your VISIT® Health Insurance ID card, you have two Discount Drug Cards for your Prescriptions. Please present both Discount Drug Cards at the Pharmacy. If the prescription is eligible for a discount, it will be applied when you purchase your prescription.

(The Universal Rx Discount information is now located on your VISIT® Plan Health Insurance ID card or you can download a copy of the card by going to https://imgpoc.com.

Please pay any remaining pharmacy costs due after the discount and keep the receipt and a copy of the prescription.

Steps for submitting your CLAIM for REIMBURSEMENT

Complete and submit a PATIENT Claim Form (include your Doctor visit and prescriptions on the same PATIENT CLAIM FORM)
Include a copy of the Receipt.
Include a copy of the Prescription (this can be the Prescription Information that is typically stapled to the prescription bag)
The Claim can be submitted online through your MyIMG Account
Reimbursements are only for covered medical expenses, not for pre-existing conditions. Additional discounts may be available through the pharmaceutical company that manufactures your prescription.)

Immediate Assistance - Assist 24/7: 1-800-628-4664 (Toll-free)

Assist must be contacted for the following reasons:

As soon as non-emergency hospitalization is recommended.
Within 48 hours of the first working day following an emergency admission.
When your physician recommends any surgery including outpatient.
For emergency evacuation, repatriation, and assistance services.

1-800-628-4664 / 1-317-655-4500 Press 0 between 7am-6pm ( EST )Press 9 between 6pm-7am (EST)

For non-life threatening illnesses, please make an appointment with a doctor or use a local non-emergency clinic like Minute Clinic or Urgent Care - Walk-in Clinics. A list of local providers are located below.

In Case of an Emergency

If an emergency:
• Go directly to the hospital, or call 911 for emergency response
• Call the 24-hour assistance service center at 1-800-628-4664 to alert the center of your situation.

A Medical Emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health.

Some examples of medical emergencies are:

Chest pain accompanied by sweating, nausea, vomiting, shortness of breath, radiating pain that moves to the arm or neck, dizziness, or feeling that your heart is beating irregularly or too fast
Choking
Severe bleeding that doesn't stop after 15 minutes of direct pressure
Fainting
Broken or displaced bones
Swallowing poison
Burns
Suddenly not being able to walk, speak, or move a portion of your body
Shortness of breath or difficulty in breathing

Minute Clinics

For minor illnesses, the following treatments are available at your local Minute Clinic located inside CVS Pharmacy:

Diagnose, treat and write prescriptions for common family illnesses such as strep throat, bladder infections, pink eye, and infections of the ears, nose and throat
Provide common vaccinations for flu, pneumonia, pertussis and hepatitis, among others
Treat minor wounds, abrasions, joint sprains, and skin conditions such as poison ivy, ringworm, lice and acne
Provide a wide range of wellness services including TB testing, sports and camp physicals, and lifestyle programs such as smoking cessation and a medically based weight loss program
Offer routine lab tests, instant results and education for those with diabetes, high cholesterol or high blood pressure
Provide care to adults and children 18 months and older for most services

North Carolina - North Carolina Minute Clinics

South Carolina - South Carolina Minute Clinics

Virginia - Virginia Minute Clinics

PRE-CERTIFICATION

Precertification is a requirement under your certificate for certain medical services. Pre-certification is a general determination of medical necessity only, not an assurance of coverage, verification of benefits or a guarantee of payment.

The following must always be pre-certified for medical necessity before admission or receiving the treatments and/or supplies:

Any treatment requiring inpatient hospitalization
Surgery or surgical procedure, including outpatient surgery
CAT scans or MRI's
Care in an extended care facility
Home nursing care
Chemotherapy
Radiation Therapy
Interfacility Ambulance Transfer

During the pre-certification process, medical professionals review the planned medical services against standard medical criteria to ensure that the services are within accepted medical standards and are medically necessary.
Precertification may be initiated by you, your representative or your medical provider. This can be done through MyIMG, www.imglobal.com/member or by phone at 1-800-628-4664 (within the U.S.) or 1-317-655-4500.

Most U.S. hospitals and physicians are familiar with the precertification process and will make the phone call for you, though they are not required to do this. You are responsible for ensuring the precertification process is done five days before you are hospitalized or within 48 hours after an emergency admission to the hospital.

Click here to submit a Precertification online I Need To Submit A Claim Form?

How To Set-up Your MYIMG Account

Service at your fingertips anytime, anywhere - that’s what MyIMG provides. MyIMG is our proprietary online service that allows you to access information and manage your IMG accounts, 24 hours a day, seven days a week, from anywhere in the world. Our service centers in the U.S. and Europe are always available to help or handle emergencies 24 hours a day, but through MyIMG you have immediate access to a wealth of information about your account and can manage routine areas to help you save time when you may need it most. Some features include:

Get explanation of benefits

Initiate precertification

Obtain certificate documents

Locate a provider

Recommend a provider/facility

Request or print ID cards

Submit a Claim online

Check the status of a Claim

Don't have an account? Create an account

You will need to put in your Health Insurance ID Number and Date of Birth to set-up an account. If you do not have your Health Insurance ID Number, please contact our office at 703-660-9062.

IMG Privacy Policy - www.imglobal.com/legal/privacy-policy

How To File A Claim

DOCTOR Claim Form

Be sure your Doctor files your claim through UnitedHealthcare using the information found on your VISIT^® Plan E Plus ID Card. This will allow your doctor to file your claim electronically which will help expedite the claims process. Your ID card includes a Member ID Number and a Group Number your Doctor must use to file the claim properly. Improperly filed claims may be delayed or denied.

UnitedHealthcare Member ID: xxxxx
(This number is found on your ID Card and is unique for each person)

Your Doctor may contact UnitedHealthcare at 1-800-628-4664 with any questions on how to submit a claim.

PATIENT Claim Form

You must also complete a PATIENT Claim Form. This is a separate form than the Claim information provided by your Doctor. Click here for a PATIENT Claim Form for you or your dependents. You must submit the completed PATIENT Claim Forms to VISIT® within 90 days of your visit to the doctor or hospital. SUBMIT YOUR PATIENT Claim Form Online: MyIMG By email: epi@visitinsurance.com Fax: 703-991-9164

How can I be reimbursed for medical payments I paid?
Any medical expense you have paid may be submitted to the claims office for reimbursement. Please complete and submit a PATIENT Claim Form and include all receipts for expenses you have paid.

How do I Pay for My Prescriptions?
In addition to your VISIT^® Plan E Plus Health Insurance ID card, you will receive two Discount Drug Cards (Universal Rx and AllyHealth) for your Prescriptions. Be sure to Register your WellCard online at www.wellcardhealth.com. When going to the pharmacy, please present both Discount Drug Cards. If the prescription is eligible for either discount, it will be applied at the time of your purchase. If there is a remaining cost due after the discount, please pay the remaining balance to the pharmacy and keep the receipt. To be reimbursed for the remaining balance of the prescription, please submit a PATIENT Claim Form with your receipt and a copy of your prescription. The deductible and co-insurance apply.

If you have lost your ID CARD, please email us at epi@visitinsurance.com to request a replacement or you can download a copy from you MyIMG Account.

If you are filing for a reimbursement, you will need to file a Claim Form, please submit the original, itemized bills and payment receipts to us along with a Claim Form below. Claims must be filed within 90 days of your medical pro

cedure.

CLAIM FORMS
VISIT^® E Plus Plans - Medical Claim Form - English

How do I check my Claim Status?

How do I check on the status of my Claim?
For claims and benefits questions contact VISIT^® at 1-800-628-4664 or you can check your MyIMG Account

If your Claim is showing as PENDING, please be sure to check the status of the claim on your MyIMG Account to see what information is needed to finalize your claim.

There is no record of my claim
Contact your doctor's office and ask them to submit the claim to IMG. If they say they have already submitted the claim, be sure to verify the address they sent the claim to and the date it was sent. Email this information to insurance@imglobal.com and ask the Claims Office to research their records to see if the claim is in their system. If the Claims Office is unable to locate the claim, please contact your doctor's office and ask them to resubmit the claim. Claims can be mailed to:

International Medical Group, Inc.
Claims Department
PO BOX 88500
Indianapolis, IN 46208-0500 USA

Patient to submit a completed IMG Claim Form
You must complete a PATIENT IMG Claim Form to process your claim. This form can be completed online through your MyIMG Account or you can download the IMG Claim Form and mail it or fax it to the claims office.

Charges pending receipt of medical records requested from provider
To process your claim, your doctor must provide the medical records to IMG for your treatment. Please contact your doctor's office and ask them to submit your medical records to the IMG. Medical records can be mailed to:

International Medical Group, Inc.
Claims Department
PO BOX 88500
Indianapolis, IN 46208-0500 USA

Your file has been closed due to a lack of response
This means that additional information has been requested but the Claims Office has not received the information. The file can be reopened once the information is received.

In order to process these charges, please submit on a HCFA/UB Form Indicating Standardized procedure (CPT) and Diagnosis (ICD) codes.
These forms are standard forms that doctors use to file a claim with an insurance company. Your doctor should have these forms available. If they are not sure what to file or have questions, please have the them call IMG at 1-800-628-4664.

How long do I have to file a claim?
Your IMG PATIENT Claim Form must be submitted to the IMG Claims Office within 90 days of your visit to the doctor, urgent care, emergency room and/or hospital. You and your doctor, hospital and other healthcare and medical service providers and suppliers shall have one hundred eighty (180) days from the date a claim is incurred to submit a complete Proof of Claim, medical records and any additional information needed to process your claim.

Click Here to request a copy of the EPI DEPENDENT User Manual for Answers to Frequently Asked CLAIMS Questions

For Members

For Providers

VISIT^® Insurance: 703-660-9062
Monday - Friday 9am to 6pm, available by email after hours.
Email: epi@visitinsurance.com

For emergency and other assistance services Assist 24/7:
1-800-628-4664 (toll free) or
0-317-655-4500 (collect)

Click Here for 2022-2023 Plan Information

To a Report a Claim, Verify Eligibility or Check on the Status of a Claim Contact:
International Medical Group, Inc.
Claims Department
PO BOX 88500
Indianapolis, IN 46208-0500 USA
Phone: 1-800-628-4664
Fax: 1.317.655.4505
Email: insurance@imglobal.com
24-Hour Worldwide Assistance Services:
1-800-628-4664 / 1-317-655-4500

Important Insurance Terms

What is a Deductible?
For a covered medical expense, the deductible is the portion of your medical bill that is your responsibility. The Deductible will first be subtracted from the total medical bill and you will need to pay this portion directly to the doctor or hospital. Your Annual Deductible is $250 per year.
What is Co-insurance?
In-Network - 100%
Out-of-Network: After You pay the Deductible, the plan pays 80% of the next $5,000 of eligible expenses, then 100% to the selected Medical maximum.
How do I Pay for My Prescriptions?
Prescriptions are a reimbursable expense. You will need to pay for your prescription and then complete a claim form to be reimbursed. If you need to apply for a reimbursement, download a Claim Form.
VISIT^® E Plus Plans - Medical Claim Form - English
What is a pre-existing condition?
A Pre-existing condition means any medical condition, sickness, Injury, Illness, disease, Mental Illness or Mental Nervous Disorder, regardless of the cause including any congenital, chronic, subsequent, or recurring complications or consequences related thereto or resulting there from that with reasonable medical certainty existed at the time of application or any time during the 36 months prior to the effective date of coverage under this policy , whether or not previously manifested , symptomatic, known, diagnosed , treated or disclosed. This specifically includes but is not limited to any medical condition, sickness, Injury , Illness, disease, Mental Illness or Mental Nervous Disorder , for which medical advice , diagnosis , care or treatment was recommended or received or for which a reasonably prudent person would have sought treatment during the 36 month period immediately preceding the effective date of coverage under this policy.

What is Pre-certification?
Emergency Pre-certification: In the event of an Emergency Hospital admission, Pre-certification must be made within 48 hours after the admission, or as soon as is reasonably possible.

Pre-certification Does Not Guarantee Benefits – The fact that expenses are Pre-certified does not guarantee either payment of benefits or the amount of benefits. Eligibility for and payment of benefits are subject to all the terms, conditions, provisions and exclusions herein.

Concurrent Review – For Inpatient stays of any kind, the Plan Administrator will Pre-certify a limited number of days of confinement. Additional days of Inpatient confinement may later be Pre-certified if a Member receives prior approval.

What is a Reasonable & Customary charge?
Reasonable and Customary charge is the amount normally charged by medical service providers for similar services and supplies in your area of living. Doctor's not in the Multiplan Network are not required to charge the Reasonable and Customary charge. Please note: Going to a doctor or hospital outside the UnitedHealthcare Network may result in higher payments for your medical procedure and a higher out-of-pocket expense for you and your family.
What is Medical Evacuation?
Medical Evacuation means transferring the insured person to the nearest hospital or medical facility in case of an emergency injury or sickness or back to his/her home country. It can be done by any necessary means of transportation.
What is Repatriation?
In case of death, the Repatriation benefit covers the transportation of your remains back to your family and your home country.
Are Injuries from Sports Covered?
Recreational sports are covered through the regular medical coverage. Injuries from intercollegiate, interscholastic, intramural or club sports are not covered.
Is there Dental Coverage?
There is limited coverage injury to natural teeth on your policy.
Discounts are available on some dental procedures through WellCard. For more information, visit the WellCard website at www.wellcardhealth.com/Public/DentalCare.aspx
Use Group# SC001801 to register
Do I need a referral to go to a Specialist?
A doctor’s referral typically is not required. Please be sure to check with the Claims Office prior to seeing a Specialist.

Important Contact Information

Contact VISIT^®

VISIT^® International Health Insurance Programs
P.O. Box 210
Mount Vernon, VA 22121
Phone: 1-703-660-9062 / 1-800-247-5575
Fax: 1-703-991-9164
Email: epi@visitinsurance.com
Hours: Monday - Friday 9:00 am to 6:00 pm.
Available by email after hours!

VISIT^® International Health Insurance Program
www.visitinsurance.com/epi.html
Correspondence: P.O. Box 210, Mount Vernon, VA 22121 (703) 660-9062/ (800) 247-5575/ (703) 991-9164 fax
email: epi@visitinsurance.com