VISIT® International Health Insurance
for International Students, Scholars, Spouses, Families & Visitors

1-800-247-5575 or 1-703-660-9062
The Trusted Name in International Travel and Medical Insurance for over 35 Years!


Welcome Lewis-Clark State College International Students

Lewis-Clark State College - International Student Medical Insurance Coverage
Eligibility Requirements:  Lewis-Clark State College International Students

VISIT® INTERCOLLEGIATE SPORTS PLUS Quote & Buy VISIT Sports Plus  Plan

Attention Students:  You Must purchase coverage from August 15, 2017 to June 15, 2018 for the full school year.
AGE VISIT® Intercollegiate Sports PLUS Monthly Rate 2017-2018
(3 month minimum purchase)
Student 24 and Under $109.80
Student 25-30 $157.20
Student 31-40 $346.50
Student 41+ $741.60

 
Coverages Benefits
Accident and Sickness Medical Maximums per Injury or Illness
Unlimited Medical Maximum per injury or illness

Deductible per Period of Coverage
*For a covered medical expense, the Deductible is the portion of your medical bill that is your responsibility to pay to the doctor or hospital. 

$100 Deductible for Preferred Providers Per Insured Person, Per Policy Year that is waived at the Student Health Center.
Co-Pays

Physician Visits: $25
Medical Emergency: $200

Coinsurance

After You pay the Deductible, Preferred Providers are payable at 80% of Preferred Allowance and Out of Network benefits are payable at 70% of Usual and Customary charges.

Pre-existing Conditions No waiting period
Preventive Care Preventive Care Services which include, but are not limited to, annual physicals, GYN exams, routine screenings and immunizations are covered at 100% with no co-pay or deductible only when the services are received from a Preferred Provider.
Outpatient Prescription Drugs $15 co-pay for Tier 1
20% Coinsurance for Tier 2
30% Coinsurance for Tier 3
Up to a 31-day supply per prescription filled at a UHC Pharmacy
Hospital Room and Board Preferred Allowance
Local Ambulance Preferred Allowance
Intensive Care Unit Preferred Allowance
Outpatient Treatment Preferred Allowance

Mental Health Disorders
(including Drug Abuse and Alcohol Abuse)

Paid as any other medical expense.

Maternity Care for a Covered Pregnancy

Paid as any other sicness

Routine Nursery Care of Newborn Paid as any other sickness
Physiotherapy Preferred Allowance
Intercollegiate, interscholastic, intramural or club sports PGH Global Intercollegiate Sports Plus Plan - $10,000 per injury.
Dental Treatment due to Accident Dental treatment for accidental Injury to Sound, Natural Teeth. 90% of Usual and Customary Charges.($250 maximum per tooth) ($1000 maximum Per Policy Year)
Emergency Medical Evacuation

Unlimited

Repatriation of Remains Unlimited
Accidental Death & Dismemberment $5000
Emergency Reunion If you are traveling alone and are or will be hospitalized for more than three (3) consecutive days due to a covered illness or injury, we will coordinate and pay for economy round-trip airfare for a person of your choice to join you.
Travel Assistance 24-hour Worldwide Assistance
Click here to download the full policy
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 deductible is $100 annually.

What is Co-insurance?
For the Certificate Period, the Insurance Company will pay 80% of Eligible Expenses after the Deductible, up to the out-of-pocket maximum.  After the out-of-pocket maximum has been met, the Insurance Company will pay 100%.

How do I Pay for My Prescriptions?
Your plan includes a Prescription Rx Card.   $15 Copay for Tier 1 / $30 Copay for Tier 2 / $50 Copay for Tier 3 up to a 31-day supply per prescription filled at a UnitedHealthcare Network Pharmacy (UCHP). Prescriptions must be filled at a UnitedHealthcare Pharmacy (UHCP).

If you need to apply for a reimbursement, please click here to download a Claim Form.


What is a pre-existing condition?

Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 12 months immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 12 months immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 12 months immediately preceding the Certificate Effective Date.

What is Precertification?
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.

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.  Click here for more information.

What is Repatriation?
In case of death, the Repatriation benefit covers the transportation of your remains back to your family and your home country.  Click here for more information.

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.

Do I need a referral to go to a Specialist?
A doctor’s referral typically is not required.  If you have a special medical condition, we recommend that you check with the Customer Service (888) 251-6253 , prior to making an appointment with a Specialist.

A Nurse 24-Hour Hotline is also available to assist you with medical questions.  To access Nurseline, please locate the number on your Insurance ID card. If you do not have an ID card, you can print one by accessing MyAccount.

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

 

Where Can I Find a Doctor or Hospital?
How To File A Claim
How to Use Your Insurance
In the event you need medical attention, present the identification card to your attending physician. The physician is welcome to submit bills directly to us.  If you doctor or the hospital submits the claim for you, you do not need to provide any additional paperwork to start the claims process.  If additional information is needed, the Claims Office will contact you.

If you have paid the doctor or hospital directly or the provider will not submit the claim on your behalf, please complete a Claim Form and submit it to the Claims Office.  To download a Claim Form, Click here.  For more information on submitting a claim, please Click here

To file a claim, please submit the original, itemized bills and payment receipts to us along with a Claimant’s Statement and Authorization form. You may obtain a Claimant's Statement Click here. Claims must be filed within 60 days of the termination date of your policy.


Who can my Provider (Doctor, Urgent Care, Minute Clinic, Hospital) contact to verify eligibility and coverages?
Providers can contact UnitedHealthcare Student Resources at
1-888-251-6253

How do I check on the status of my Claim?
Please visit our My Account Center to log in to an existing account or to create a new one.  Updates on your claims will be posted on your My Account Center.

Where do I find my Insurance ID Number?
Your ID Number is located on your Insurance Card.  You can also view your account information by going to My Account Center.

What do I do if I lose my ID Card?
Please contact VISIT at 1-800-247-5575 or by email at info@visitinsurance.com.  Be sure to let us know that you are in the Lewis-Clark State College Plan.


If an emergency: 
• Go directly to the hospital, or call 911 for emergency response
• Call the 24-hour assistance service center at the number listed on your ID card to alert the center of your situation.


 

Important Contact Information
   
Contact VISIT CLAIMS OFFICE
   

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: info@visitinsurance.com

UnitedHealthcare
Student Resources
P.O. Box 809025
Dallas, TX 75380-9025
To verify eligibility and benefits call 1-888-251-6253
Fax: 469-229-5625
Click Here to download a Claim Form

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

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