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.
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.
Your deductible is $100 per accident or
illness for PPO and Student Health Center visits. The
Emergency Room deductible is $250 per ER visit.
What is Co-insurance?
Coinsurance is the term used by health insurance companies to
refer to the amount that you are required to pay for a medical
claim, apart from the deductible. Coinsurance will be
waived if
Eligible Expenses are incurred within the PPO Network or
at a Student Health Center.
However, if you choose to use a provider outside the PPO
Network or Student Health Center, the Plan will pay 80%
(you will pay 20%) of the next $5,000 of Eligible Expenses after
the Deductible, then 100% to the Certificate Period Maximum.
How do I Pay
for My Prescriptions?
Your Plan includes a Discount Prescription Drug (Rx) Benefit
through Universal Rx.
Please use your Universal Rx card when visiting the
pharmacy.
Important Information:
Universal Rx Pharmacy Help Desk:
1-800-742-0504 or
www.imgpoc.com
What is a pre-existing condition?
Charges resulting directly or indirectly from or relating to any
Pre-existing Condition that existed within thirty-six (36)
months prior to the Effective Date are excluded until the
Insured Person has maintained twelve (12) months of continuous
coverage under this insurance.
What is Precertification?
Precertification is a requirement under your certificate for
certain medical services. You must call to be
pre-certified for any of the following conditions: any treatment
requiring hospitalization, outpatient surgery, CAT scans, MRI’s,
within 48-hours after an emergency admission to the hospital,
care in an extended care facility, home nursing care, and
durable medical equipment.
During the precertification 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, through
the Client Resources page of
www.IMGLOBAL.com
or by calling IMG 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 of
an accident or emergency illness.
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 maximum coverage on
your policy for injuries sustained while participating in a team
sports. 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.
Relief of
sudden and unexpected pain to sound, natural teeth, including
but not limited to fillings will be covered up to $350 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
1-800-628-4664, prior
to making an appointment with a Specialist.
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