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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. 

If the deductible is “per accident or illness,” not per visit to the doctor.  This means if you have to go to the doctor more than once for the same illness, you will only need to pay the deductible one time for that illness. 

What is Co-insurance?  You pay coinsurance plus any deductibles you owe. For example, if the health insurance allowed amount for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

How do I Pay for My Prescriptions?  Most plans require that you pay for your prescription first and be reimbursed.  Be sure to complete a claim form and include your receipt and prescription.

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.

Some Plan cover pre-existing condition immediately (PGH Global Plus and Preferred), some require a waiting period (Student Secure and Student Health Advantage) and some have restrictions on coverage for pre-existing conditions (Plan E Plus).

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.

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.  If you are a member of an intercollegiate, interscholastic, intramural or club sports, there is $5000 per injury coverage for injuries sustained while participating in a team sports on the Student Secure and Student Health Advantage Plans.  The VISIT Sports PLUS Plan covers athletic injuries at $10,000 per injury.  Additional coverage may be available through the Athletic Department for some sports.

Is there Dental Coverage?
There is limited coverage for dental pain and injury to natural teeth on your policy.

Student Secure includes Relief of sudden and unexpected pain to sound, natural teeth, including but not limited to fillings will be covered up to $100 maximum.  Injury due to an accident will be covered up to $500 per Accident maximum. 

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 Claims Office