MERCER GROUP STUDENT INSURANCE PLAN County Community College. Underwritten by BCS Insurance Company

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GROUP STUDENT INSURANCE PLAN MERCER County Community College 2008-2009 Underwritten by BCS Insurance

1 GROUP STUDENT INSURANCE PLAN MERCER County Community College Underwritten by BCS Insurance Company Accident Expense Benefit - Policy No. BSA Medical and Hospitalization Benefit - Policy No. BSA 00010

2 INTRODUCTION New Jersey state law requires that all full-time college students have medical and hospitalization insurance. This brochure is a brief description of the Group Student Insurance Plan for students at Mercer County Community College. The exact provisions governing this insurance are contained in the Master Policies issued to the College. The Master Policies shall control in the event of any conflict between the Policies and this brochure. Any provision of the Policies or the brochure which is in conflict with the statutes of the state in which the Policies are issued will be administered to conform with the requirements of such state statutes. The Group Student Insurance Plan is composed of two different policies: 1) Accident Expense Benefit - Policy No. BSA (page 3) This policy covers all registered students of Mercer County Community College. Benefits are for Injury incurred during school time activities. 2) Medical and Hospitalization Benefit - Policy No. BSA (page 4). This policy covers full-time students not waiving coverage. Benefits are for hospital care rendered for Injury or Sickness. POLICY TERM The insurance coverage under the Mercer County Community College Group Student Insurance Plan becomes effective for fall semester at 12:01 a.m. on August 31, 2008 and continues until 12:01 a.m. on January 19, Coverage becomes effective for spring semester at 12:01 a.m. on January 19, 2009 and continues until 12:01 a.m. on August 31, For students enrolling directly with Collegiate Insurance Resources, an eligible student s coverage becomes effective on the semester start date or the day after the postmark date of the payment, whichever is later. COVERAGE COST The cost of the Medical and Hospitalization Benefit is $22.00 per semester, which includes an administrative fee. 1

3 OTHER COVERAGE OPTIONS Students not eligible to re-enroll in the Student Accident and Sickness Insurance Plan after coverage under the Plan expires due to graduation or discontinuation of studies at the College and students in need of specialized coverage (International Travel) should contact Collegiate Insurance Resources for possible options prior to the expiration of coverage under your student plan. ELIGIBILITY I. Accident Expense Benefit A registered student of Mercer County Community College is automatically provided the Accident Expense Benefit (Page 3, Section I) for the semester for which he/she is attending classes. II. Medical & Hospitalization Benefit Full-time Students All full-time (12 credit hours or more) Mercer County Community College students, while enrolled at the College, are required to have insurance comparable to, or enroll in the Medical and Hospitalization Benefit (Page 4, Section II) of the Group Student Insurance Plan. The insurance charge will automatically appear on the bill given to each full-time student at the time of registration. Those who have coverage under a family policy may waive enrollment in the Medical and Hospitalization Benefit of the Group Student Insurance Plan by completing the enclosed Waiver Form. The Waiver Form must be returned to the Mercer County Community College Cashier's Office at the time you make payment for your courses. Students who lose family coverage during the school year should contact the Mercer County Community College Cashier's Office. Part-time Students Voluntary enrollment is available to part-time students taking a minimum of 1 credit hour. To enroll, follow the instructions on the Enrollment Form (available from Collegiate Insurance Resources. Please see address on page 8). The last date for voluntary open enrollment is October 15, 2008 for fall semester and February 27, 2009 for spring semester. 2 I. ACCIDENT EXPENSE BENEFIT BENEFIT SCHEDULE Benefits are provided up to $25,000 for covered medical expenses incurred as the result of a covered accidental injury occurring to the Covered Person while: (1) on College premises; (2) away from College premises (other than traveling) while the Covered Person is participating in or attending any one-day College activity sponsored by and under the direct and immediate supervision of the College; and (3) traveling directly to or from residence and College to participate in College Activities. The initial treatment for an accidental injury must be rendered within 30 days of the accident. Benefits for a covered injury are limited to treatment received within 104 weeks of the date of the accident. The Accident Expense Benefit does not cover treatment of Sickness, condition, disease, ailment or infections (except pyogenic infections or bacterial infections which result from the accidental ingestion of contaminated sustances). Plastic, reconstructive or reimplantation, transplantation and experimental surgery and/or treatment for cosmetic purposes will not exceed a maximum benefit of $1,000 in the aggregate for all medical, surgical, hospital and dental expenses incurred as a result of any one (1) Covered Accident. Excess Provision - The Accident Expense Benefit of the Group Student Insurance Plan does not cover loss nor provide benefits for expense resulting from injury in excess of $200 which is covered by any other valid and collectible group medical, health, or Accident insurance to the extent that benefits are payable under other valid and collectible insurance whether or not a claim is made for such benefits. The company will pay for the medically necessary services in accordance with the usual, reasonable, and customary charge normally made for such services as follows below: INPATIENT Room/Board/ICU... Hospital Misc....; $400 / day Surgery... Anesthetist Services... Registered Nurses' Services... Physician's Visits... Consultant Physician Fees... Physiotherapy...; $200 Max. Pre-admission Testing... OUTPATIENT Hospital Day Surgery...; $400 Max. Surgery Misc.... Anesthetist Services... Physician's Visits... Consultant Physician Fees... Physiotherapy...; $200 Max. Medical Emergency... Diagnostic X-ray and Laboratory... Injections... Prescription Drugs... Braces and Appliances... OTHER Ambulance Services... Dental Treatment...; $10,000 Max. Accidental Death...$ 2,000 Max. Accidental Dismemberment...$10,000 Max. Replacement of Eyeglasses (due to covered Injury)...; $ 200 Max. Air Travel Coverage: For students participating in the Flight Training Program, benefits under the policy will include coverage while flying in any aircraft... 3

4 II. MEDICAL AND HOSPITALIZATION BENEFIT MEDICAL EXPENSE BENEFIT SCHEDULE The Basic benefit provides benefits for up to $1,000 of covered, hospital billed medical expenses incurred, inpatient or outpatient, as the result of a covered accidental injury or sickness. The initial treatment for an accidental injury must be rendered within 30 days of the accident. Benefits for a covered injury or sickness are limited to treatment received within 52 weeks of the date of the accident or first treatment for sickness. The company will pay for the medically necessary services in accordance with the usual, reasonable, and customary charge normally made for such services as follows: For Accidents For Sickness Inpatient Hospital Billed Services Room/Board/ICU Hospital Misc. Physician's Visits Physiotherapy Surgery Semi-private ; $200 Max. Semi-private ; $200 Max. Outpatient Hospital Billed Services Day Surgery Misc. Outpatient Misc. Emergency Room X-rays/Lab Tests Misc. Supplies Other Hospital Billed Services Home Health Care Extended Care Dental Alcoholism Treatment Treatment of Diabetes, Equipment/Supplies/Education Treatment of Wilm's Tumor Reconstructive Breast Surgery Maternity Assistant Surgeon Fees, Basic Benefit only Included in Outpatient Misc., Basic Benefit only II. MEDICAL AND HOSPITALIZATION BENEFIT Other Services Outpatient Physician s Visit Outpatient Prescription Drugs Wellness Testing... Air Travel Coverage: For students participating in the Flight Training Program, benefits under the policy will include coverage while flying in any aircraft. MAJOR MEDICAL SUPPLEMENT $20 Benefit per visit, beginning with the first visit per condition, limited to five visits per condition. 70% of Reasonable and Customary Cost, limited to $200 per Policy year. Scheduled (see Policy) After paying $1,000 in basic benefits under either the accident or sickness provision of the Medical and Hospitalization Benefit for any one accident or sickness, this Plan will pay 80% of any additional expenses incurred in excess of $1,000 up to, but not exceeding $29,000 (for a total Medical and Hospitalization Benefit maximum of $30,000) for Covered Medical Expenses for any one accident or sickness. Expenses must be incurred within one year from the date of accident or sickness. Dental Care or Treatment due to a covered accident is not payable under the Major Medical Supplement. 4

5 DEFINITIONS Accident means a sudden, unexpected and unintended incident. "Covered Accident" means an Accident which occurs while coverage is in force with respect to the Covered Person and which results in Injury or loss covered by the Policy. Activities sponsored and under the direct and immediate supervision of the School means any activity which the College requires the Covered Person to attend, or any activity of the School which is under the sole control and supervision of School authorities, but not including activities which are under joint sponsorship or supervision arrangement with any non College group. Hospital means a legally constituted institution having organized facilities for the care and Treatment of sick or injured persons on a registered inpatient basis, including facilities for diagnosis and surgery under the supervision of a staff or one or more licensed Physicians and provides 24-hour nursing service by Registered Nurses on duty or call. Injury means accidental bodily harm sustained by the Covered Person which resulted directly and independently of all other causes from an Accident and occurs while coverage under the Policy is in force. Inpatient means confinement for which the Covered Person is charged at least one full day's room and board. Medically Necessary or Medical Necessity means the services or supplies provided by a Hospital, Physician, or other provider that are required to identify or treat an Injury or Sickness and which, as determined by the Company, are: (1) consistent with the symptom or diagnosis and Treatment of the Injury or Sickness; (2) appropriate with regard to standards of good medical practice; (3) not solely for the convenience of the Covered Person; (4) the most appropriate supply or level of service which can be safely provided. When applied to the care of an Inpatient, it further means that the Covered Person's medical symptoms or condition requires that the services cannot be safely provided as an Outpatient. Physician means a practitioner of the healing arts who is duly licensed in the state where he is practicing and who is treating within the scope and limitation of that license. The term Physician will not include the Covered person or his spouse, children, brothers, sisters, or parents, or any person residing in his household. Sickness means illness or disease causing loss commencing while the Policy is in force as to the Covered Person whose Sickness is the basis of claim. Any complications or any condition arising out of a Sickness for which the Covered person is being treated or has received Treatment will be considered as part of the original Sickness. Usual, Customary, and Reasonable () Charges "Usual" means those charges made by a provider for services and supplies rendered to all patients for the same or similar Injury or Sickness; "Customary" means those charges made by the majority of providers in the area for the same or similar services or supplies. "Reasonable" means those charges which do not exceed the majority of prevailing fees in the area for the same or similar services or supplies. Area means a county or larger geographically significant area as determined by the Company. PRE-EXISTING CONDITION The Company will not pay benefits for a condition for which a Covered Person received medical treatment, care or advice within 6 months before being insured under the Policy. This does not apply if he has been insured under the Policy for 12 months. The Pre-existing condition limitation will be reduced by the total number of days a person was covered by prior creditable coverage, provided coverage under the prior health insurance policy ended no more than 63 days before coverage became effective under this plan. CERTIFICATION OF CREDITABLE COVERAGE State regulations may define this plan to be Creditable Coverage. This means that the time you are covered under this plan may be eligible for crediting toward satisfaction of a pre-existing conditions limitation in an employer-sponsored plan under which you subsequently become covered. When your coverage terminates, you are eligible to receive a certification regarding your coverage under this plan. If you want such a certification after your coverage terminates, please contact Collegiate Insurance Resources at that time. Pre-existing Condition means an Injury or Sickness for which a Covered Person received medical treatment, care or advice within 6 months before being insured under the Policy. 5 6

6 EXCLUSIONS Except as otherwise indicated, the Plan does not cover loss nor provide benefits for: 1. Eye examinations; prescriptions or fitting of eyeglasses and contact lenses; or other Treatment for visual defects and problems, except as required as a result of a covered injury. "Visual defects" means any physical defect of the eye which does or can impair normal vision; 2. Hearing examinations or hearing defects and problems, except as required as a result of a covered injury. "Hearing defects" means any physical defect of the ear which does or can impair normal hearing; 3. Dental care or Treatment other than care of sound, natural teeth and gums required due to an Injury resulting from an Accident while the Covered Person is insured under the Policy, and rendered within 12 months of the Accident; 4. Participation in a riot or civil disorder; fighting or brawling, except in self-defense; commission of or attempt to commit a felony; 5. Suicide, attempted suicide or intentionally self-inflicted Injury while sane or insane; 6. War or any act of war, declared or undeclared; or while serving in the armed forces of any country (a pro-rata premium will be refunded for such period of service); 7. Participation in, practice for, or orthopedic equipment and appliances used for: intercollegiate tackle football; intercollegiate sports; interscholastic sports; club sports; semi-professional sports; professional sports; contest or competition; 8. Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, or flight in any type of aircraft, except while riding as a fare-paying passenger on a regularly-scheduled airline; 9. Treatment, services, or supplies provided by a Hospital or facility owned or run by the United States Government, unless a charge is made for such services in the absence of insurance; or in a Hospital which does not unconditionally require payment; 10. Cosmetic surgery, except cosmetic surgery which the Covered Person needs as the result of an Accident which happens while he is insured under the Policy; 11. Charges used to meet any deductible, or in excess of the coinsurance level, or in excess of those considered Usual, Customary, and Reasonable Charges; 12. Treatment or services provided by any member of the Covered Person's immediate family; or for which no charge is normally made; 13. Treatment, services or supplies provided by the School's infirmary or its employees, or Physicians who work for the School; 14. Treatment, services or supplies provided or paid for by any governmental program or law, except Medicaid; 15. Mental or nervous disorder, except as otherwise provided by the Policy or mandate; 16. Outpatient treatment for Physiotherapy; 17. Organ Transplants; 18. Expense for Injury sustained as a result of riding in or on a two or three wheeled motor vehicle, or riding in or on a snowmobile; 19. Elective abortion; 20. Injury, Sickness or death, sustained or contracted as a consequence of the Covered Person s intoxication or being under the influence of any narcotic unless administered by a Physician; 21. Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, other than as provided by the Policy. CLAIM PROCEDURE In the event of an Injury or Sickness the Insured Person should: Report to the Student Activities Office at the College at once for full instructions. If the Student Activities Office is not available, report to the security office at the College. The physicians and hospitals may submit itemized bills directly to ACI electronically using Payor # or mailing them to the address below. Complete a claim form and mail it to ACI within 30 days of the date of the Injury or commencement of the Sickness, or as soon thereafter as possible. Mail the claim form to Administrative Concepts, Inc., 994 Old Eagle School Road, Suite 1005, Wayne, PA Claim forms are available on line at or by calling If the providers have given you bills, attach them to the claim form. Direct all questions regarding benefits available under this Plan, claim procedures, status of a submitted claim or payment of a claim to ACI. On line claim status is available at or by calling Select option 2 for Customer Service Itemized medical bills must be attached to the claim form at the time of submission. Subsequent medical bills received after the initial claim form has been submitted should be mailed promptly to ACI. No additional claim forms are needed as long as the Insured Person s name and identification number are included on the bill. Claim Administrator ADMINISTRATIVE CONCEPTS, INC. 994 Old Eagle School Road, Suite 1005 Wayne, PA Toll free telephone: Website: For enrollment information, contact the Plan Manager COLLEGIATE INSURANCE RESOURCES 172 Bechtel Road, Collegeville, PA Website: 7 8

Student Accident Insurance Plan Accident Policy #BSA Student Insurance Information Site: Insurance.

Student Accident Insurance Plan 2013-2014 SAINT AUGUSTINE S UNIVERSITY Saint Augustine s University Accident Policy #BSA-00179 Student Insurance Information Site: www.saustudent Insurance.com This brochure