Dear Parents, Our Local Doctor s Offices and Healthcare Providers: Medical Center Emergency Room Other Providers - Visiting the Doctor: Outpatient

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1 Dear Parents, This coming school year we have adopted a required insurance program for international students. We have selected a company which we believe fits our school and students needs. We realize many of our families have already purchased insurance policies for their child this past year, either through traveler s insurance providers or otherwise. However, we have often found these options to be inadequate and are generally not recognized by our local doctor s offices and healthcare facilities. In order to provide your child with the best availability to and level of medical care during their study at our school, we realize a need for a more suitable option. Therefore, we have selected a policy from a student insurance provider called LewerMark. This plan comes with a very high degree of financial coverage, (in most cases 100% up to the benefit maximums) and low co-pay amounts. Perhaps best of all, this option will take the worry and hassle out of your hands and allow the school to coordinate directly with the insurance company on your child s behalf. This letter offers you more information about the American medical and insurance systems as well as what LewerMark Student Insurance means and includes. For more specific policy details, including maximum policy amounts, please review LewerMark s PDF file attached to this letter. Our Local Doctor s Offices and Healthcare Providers: Medical Center - An outpatient clinic. The team of family doctors here provide care for all routine illnesses and injuries. Emergency Room - An Emergency Room meant for serious issues. The ER is staffed 24 hours a day, 7 days a week. Patients who need care are seen immediately. Other Providers - There are a vast number of more specialized healthcare providers. If your child needs additional specialized care then we can help him/her find a suitable doctor. Visiting the Doctor: Outpatient - If your child is sick, injured or otherwise needs to see a doctor, the host parent/school advisor/or program advisor will schedule them an appointment at our local clinic. Someone will accompany them into the doctor s office, and make sure they get any medicines which they are prescribed. This type of visit and necessary medications will be 100% covered up to the benefit maximums (excluding a small co-pay fee, see next section). Emergency Room - If your child experiences a medical situation requiring emergency care, (severe illness late at night, broken bones, severe injury, etc.) the host parent/school advisor/or program advisor will immediately take him/her to the Emergency Room, where they can receive emergency care. Visits here are also 100% covered up to the benefit maximums (excluding a small co-pay fee, see next section). Co-Pay: In the United States, even with full insurance coverage, the patient (your child) will still need to pay a small payment after seeing a doctor. This is called the co-pay. For a routine outpatient visit, this co-pay will be

2 about $20. For Emergency Room visits, needed in emergency situations, the co-pay will be about $100. In most cases, we will use cash from your child s allowance fund for co-pays. In-Network vs. Out-of-Network: LewerMark recognizes certain doctor s offices or health care providers that are in their preferred network. They cover 100% of all visits In-Network, (up to the annual policy maximum of $500,000). If your child needs to see another doctor for more specialized reasons, and that doctor s office happens to be Outof-Network, then LewerMark covers 80% of the care required. The remaining 20% of the cost of visit will be your responsibility. We will always communicate with you to the best of our ability whether or not a provider is In- Network or Out-of-Network. Pre-Existing Conditions: If your child has been diagnosed with a pre-existing condition, (like diabetes, asthma, etc.) LewerMark has a required six month waiting period before providing coverage. So, if your child has such a condition, and needs to see a doctor within the first six month to address a medical issue related to that condition, LewerMark will not cover this cost. You or your child will instead need to pay for the full cost of that visit. After the six month waiting period has past, your child will be covered for additional doctor s visits and medical costs related to their condition subject to the in-network/out-of-network percentages, the benefit maximums, and all applicable policy terms. However, even if your child has a pre-existing condition, they are still covered for medical needs not related to their condition. Ex: If they break a bone, an injury totally unrelated to their diabetes for example, then the cost of the broken bone will be covered under their LewerMark policy regardless of the six month waiting period. Enrollment and Payment: Enrollment and Registration: The school and the Diocese of Davenport International Student Office will be responsible for enrolling your child with a LewerMark Student Insurance policy. In most cases, you will not need to communicate with LewerMark directly. Your child will be covered from the first day they arrive to our campus. Payment: Similarly, the school will collect the insurance fees from you, the parent, at the same time that we collect tuition and registration fees. This should remove for you any hassle, worry, or language translation concerns from the enrollment process. Coverage Duration and Gaps in Coverage: We will arrange for insurance to cover students for the entire school year. If your child enrolls at our school midway through the year, insurance fees will be prorated for the amount of months remaining in the school year. If you would like the insurance coverage to continue throughout the summer months, you can request this and we can bill you accordingly (for the two additional months). If your child has a pre-existing condition, (as detailed above), then he/she is required purchase the full 12 months of coverage. This is because if your child has a gap in coverage then they will have the required six month waiting

3 period again when they re-enroll the following school year. If coverage is continuous throughout their entire stay at our school, however, then this waiting period only applies once. Citizenship Regulations: Consistent with all international student insurance policies, LewerMark only insures students who are foreign citizens. If a child is a dual citizen, having both an American and one other passport they can be fully covered, provided the child s parents live outside the United States. However, if one or both of the child s parents are in the US military, the case may be more complicated, and he/she likely cannot be covered under this plan. Finally, if the child is only a US citizen, even if the parents live outside the US, then he/she likely cannot be covered under this plan. LewerMark, however, has some other options under the Affordable Care Act. They have experts on staff who will be able to help families find coverage even with more unique cases. Simply let us know and we can help facilitate that process. International Coverage: Included in the LewerMark Student Insurance Policy is coverage at all international healthcare providers. Therefore, if your child is traveling outside the United States during school holidays, then they will still be covered, (most likely via reimbursements after they receive care). 10 month - Clause If a student/parents opt(s) for 10 months, then the pre-existing condition clause will come back in play upon return. It is in the student s best interest to pay the extra $200 cost in case the students are injured over the summer and need follow up here. Adding More Months to 10 month plan: If in spring the student would like to add the 2 months, we can also extend coverage and bill for that if needed. Website for more information: Each school has their own website via LewerMark. You can click on the link, then the state, and then the school for more information about coverage, hospitals, clinics, ID card, or ask questions. We thank you sincerely for your continued trust and support of our school. We consider your child s health and safety to be our single most important concern. That is why we have chosen a very well respected company with a comprehensive insurance plan. We hope this change will ensure that all of our students have hassle-free access to top healthcare while studying with us. As always if you should have any concerns or questions, please let us know. Sincerely, The Diocese of Davenport, Regina Education, Assumption High School, Prince of Peace School, Holy Trinity Catholic School, and Notre Dame Catholic School.

4 Health Insurance Duration Preference From Please complete and submit with your Enrollment Agreement Print Name of Student Grade Level Options: 10 Months: My child does not need health insurance coverage for the summer months, the coverage period will be between August 1st to May 31st. Cost - $1, Months: I request my child to have LewerMark Student Insurance coverage for the entire year (including the summer months) from August 1st until July 31st. Cost - $1, Pre-Existing Conditions: My child has a pre-existing condition, and therefore I need my child to have coverage for the entire year. Cost $1, In-keeping with our Parent Enrollment Agreement you must disclose medical conditions to the school. Please write in your child s pre-existing condition on the line here: Signed: Print Name of Parent/Guardian Parent/Guardian Signature Date DISCLAIMER: If we do not receive this form back from you before the start of the school year, we will assume you have selected the first option above or signed the waiver form. Changes in policy duration can also be made after the school year begins. However please note that we will not be able to refund any insurance payments, even if your child does not finish their intended length of study at our school.

5 Insurance Waiver Request Form The Diocese of Davenport International Student Program requires all F-1 international students to have health insurance valid in the United States. In an effort to contain costs, the Diocese has developed an international health insurance plan for F-1 international students through LewerMark Student Insurance; a nationally recognized innovator in the international student health insurance field. Information on the coverage and policy is found at Please inform all international students of this policy during the application process. International students studying in schools within the Diocese must demonstrate they have health insurance coverage for the United States and may petition to waive out of the LewerMark insurance program by demonstrating they have access to equivalent health insurance coverage for the United States. To petition for a waiver, students must follow the procedures outlined below. The deadline to submit a waiver for the fall 2018 term is August 15, The waiver is valid for the academic year only. Any adjustments to alternative plans or the purchase of a different plan require a new waiver to be completed. Individual plans purchased in the United States. For questions, please contact school advisor or Virginia Trujillo in the Diocesan Office at Waiver Procedure: The school advisor will review (1) completed Waiver Request Form, (2) copy of alternative insurance card, (3) written proof of alternative insurance. The Diocese and Davenport requires a student to have medical insurance at time of registration for the duration of their studies at our schools. We have a group rate plan and feel it is very inexpensive and great coverage for all students. This is a 12 month coverage. PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION I am requesting a waiver from the Diocese of Davenport International Student Program, I have provided the intended school with other insurance coverage and insurance card. Fall 2018 and Spring 2019 waiver request Fall 2018, Spring 2019, and Summer 2019 waiver request Student s Last Name: First Name: Student Address: Local Phone Number:

6 Reason for waiver request (select one): My parent or legal guardian is legally living/working in the United States and has medical insurance coverage for me as a dependent. I am a sponsored student (F1) and have medical insurance coverage from my sponsoring agency. I have paid insurance coverage from my home government, an NGO, or Embassy level scholarship plan. I have alternative insurance coverage through my placement program. I understand that: I have been given the option of having the Diocese of Davenport International Student Program student insurance plan, but I am choosing to use an alternative plan. Any medical expenses I incur in excess of my insurance coverage are my responsibility. The Diocese and school assume no liability. If my insurance coverage ends for any reason, it is my responsibility to notify the school. Name of Student Date Signature (or signature of parent/guardian if student is less than 18): _