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

PLAN EPLUS  Quote & Buy Plan E Plus

  $100,000 Medical $250,000 Medical
AGE $500
Deductible		 $250
Deductible		 $100
Deductible		 $0
Deductible		 $500
Deductible		 $250
Deductible		 $100
Deductible		 $0
Deductible
0-29 $42.30 $47.40 $52.20 $61.50 $48.00 $53.40 $59.10 $69.60
30-39 $56.70 $62.70 $69.00 $81.30 $63.90 $70.80 $78.00 $92.10
40-49 $89.10 $99.00 $108.90 $128.70 $100.50 $111.30 $122.40 $144.90
50-59 $133.50 $148.80 $163.50 $193.50 $151.20 $167.70 $184.20 $218.10
60-64 $167.40 $186.00 $204.60 $241.80 $188.70 $209.70 $230.70 $272.70
     
  $500,000 Medical $1,000,000 Medical
AGE $500
Deductible		 $250
Deductible		 $100
Deductible		 $0
Deductible		 $500
Deductible		 $250
Deductible		 $100
Deductible		 $0
Deductible
0-29 $52.80 $59.10 $64.80 $76.50 $57.60 $63.90 $69.90 $83.10
30-39 $70.50 $78.00 $85.50 $101.40 $76.20 $84.90 $93.60 $110.40
40-49 $110.40 $122.40 $135.00 $159.30 $120.90 $133.80 $147.30 $174.30
50-59 $165.90 $184.20 $202.50 $239.70 $180.90 $201.00 $221.40 $261.60
60-64 $207.30 $230.70 $253.80 $299.70 $226.20 $251.40 $276.30 $326.70
             
Coverages Benefits
Accident & Sickness Medical
 Routine physical exams and vaccinations are not covered		 Choose $100,000, $250,000, $500,000 OR $1,000,000 Medical Maximum per injury or illness
Age 0-69
Deductible 
The deductible is the portion of your medical bill that is your responsibility.		 Choose $0, $100, $250 or $500 Deductible per policy period
Co-insurance
 Co-insurance: Your share of the costs of a covered health care service, calculated as a percent (20%) of the allowed amount for the service.

After You pay the Deductible, the plan pays 80% of the next $5,000 of eligible expenses, then 100% to the selected Medical maximum
Emergency Medical Evacuation up to $100,000
Repatriation of mortal remains up to $25,000
Pre-existing condition coverage no coverage
AD&D - Accidental Death & Dismemberment $25,000 per Insured/Spouse $5000 per Dependent Child
Maternity coverage no coverage
Home Country coverage 60 days per 12 months of coverage up to $50,000
Dental (Accident Coverage only) To a maximum of $500 (available only if purchased for 1 month or more)
Personal Liability $100,000 / $25,000 Property Damage
Trip Interruption up to $5000
Return of minor child up to $10,000
Lost baggage up to $250
Assistance Services Included
View Policy Details E Plus Plan
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 the amount you choose when you purchased the plan ($0, $100, $250 or $500).

What is Co-insurance?
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
VISIT® E Plus Plans - Medical Claim Form - Chinese
VISIT® E Plus Plans - Medical Claim Form - Spanish


What is a pre-existing condition?
Pre-existing Conditions shall mean 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 therefrom 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 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. 

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.

Do I need a referral to go to a Specialist?
 A doctor’s referral typically is not required. 

 
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. You will need to submit a Claimant's Statement.  To download a Claim Form, 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.


Claim Form
VISIT® E Plus Plans - Medical Claim Form - English
VISIT® E Plus Plans - Medical Claim Form - Chinese
VISIT® E Plus Plans - Medical Claim Form - Spanish

How do I check on the status of my Claim?
Where do I find my Insurance ID Number?
 Your ID Number is located on your Insurance Card. 

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

Seven Corners, Inc. 
For EMERGENCY evacuation and medical assistance, or travel assistance ONLY, call Seven Corners Assist 24/7/365:
U.S., Canada & Caribbean: 1-800-690-6295 (Toll Free)
International: Toll Free Country Access Codes +1 800-690-6295
Collect Calls: 0-317-818-2808
For claims and benefits questions (Open M-F 8am-6pm EST):
U.S., Canada & Caribbean: 1-800-335-0477 (Toll Free)
International: Toll Free Country Access Codes +1 800-335-0477
Collect Calls: 0-317-575-2656
Email: assist@sevencorners.com

 

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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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