Florida Memorial University believes it is important that all students maintain health care coverage to help ensure academic success and well-being. The University is pleased to offer our students a Health Plan that provides excellent levels of health coverage, with low out-of-pocket costs when compared to plans offered commercially or through the individual marketplace.
IMPORTANT NOTICE: We regret to inform you that the Student Educational Benefit Trust (“SEBT”) will no longer be operating effective December 31, 2018, and as such, will not be able to provide services to its students under the Comprehensive Student Health & Wellness Benefit Program as of this date.
Effective January 1, 2019, this plan will be administered by PayerFusion Holding, LLC and students will have access to Aetna’s Passport to Healthcare Primary PPO Network.
All registered full-time undergraduate, international students, and athletes are automatically enrolled in the Supplemental (Plan A) and Comprehensive (Plan B) Student Health and Accident, effective August 1, 2018 to July 31, 2019. The cost is included in your tuition and billed to your student account each academic semester.
Students who have adequate health care coverage may elect to waive out of Plan B only by completing the online waiver request. If you do not complete a waiver request by the semester deadline, you will automatically be enrolled for the full academic year and the cost of this plan will be charged to your student account. There are no refunds or cancellations (unless you are no longer a student) after the deadline.
Students may not waive out of Plan A.
The deadline to waive out of Plan B, for spring/summer 2019 is by December 31, 2018.
Students who have an approved waiver for fall do not need to waive out again for the spring semester. Your waiver is good for the full academic year.
MEDICAID: This plan may cancel your Medicaid benefits. Be sure to verify with your state plan if benefits are transferable or if having this Plan will cancel your coverage. Students who have Medicaid in the state of Florida should waive out of this Plan B.
APPROVED WAIVERS: If you have an approved waiver, a credit for the cost of Plan B will be placed on your student account each semester. To find out the status of this credit, please contact FMU Student Accounts at (305) 626-3737 or send an email to firstname.lastname@example.org.
Students who have other health insurance and do not want the Comprehensive Student Health Plan may complete this waiver request form. You will need a valid Florida Memorial University Student ID number to login and proceed to the waiver application request.
Your plan must meet the following criteria to receive an approved waiver:
- You will need to complete this waiver form if you are on a Medicaid plan that provides full health care benefits in the state of Florida. If you are on an out of state Medicaid plan or HMO that will not cover you in the state of Florida your waiver form will not be accepted.
- The claims administrator of the plan is based in the United States and has a U.S. telephone number and address for submission of claims.
- Is not a high deductible plan (over $5,000).
- Is not an international travel only policy.
- Provides both emergency and non-emergency health care and mental health benefits.
- Includes the minimum essential benefits as defined under the Affordable Care Act.
- Provides in-network coverage for hospitalization, outpatient physician visits, urgent care, emergency room, labs, x-rays and preventative wellness visits.
Out-of-state Medicaid and state Children’s Health Insurance Plans, HMOs, and Kaiser Permanente plans may not cover non-emergency care in this area. If this is the case, you will not qualify for a waiver. Please contact your medical insurance carrier to confirm that your insurance covers non-emergency care and that you have a deductible small enough to allow you to afford your portion of the bill.
International travel insurance or medical insurance policies issued from your country of origin or outside the U.S. is not adequate health care coverage under the University's insurance requirement unless it meets the above criteria.
All waiver requests will be reviewed by the University and/or is plan administrator.
If the waiver submitted does not meet the waiver criteria, you will be enrolled in this plan for the full academic year.
NEW INCOMING SPRING STUDENTS ONLY
The deadline to waive out of Plan B for Spring/Summer is January 31, 2019.
If you completed a waiver for the fall then you DO NOT need to complete another waiver. This waiver application is for new incoming students for spring only.
If you lose your health insurance plan mid-year, you may elect to enroll in Plan B at any time throughout the year due to a qualifying event. For more information, contact Academic Insurance Solutions to enroll at (888) 776-9920.
HEALTH & ACCIDENT COVERAGE
Plan A Supplemental (Outpatient Only) Student Health and Accident Coverage
- Services rendered at the Jesse Trice Student Health Center (on campus) are covered at 100%, with no plan deductible or copays.
- Has a limited outpatient medical and pharmacy benefit that will supplement your primary health care plan’s deductible or coinsurance.
- 24 Hour Accident Coverage (Non-Intercollegiate Sports related) up to $10,000 Per Injury.
- Prescription medication cost reimbursed up to $350 per academic year. This includes contraceptive medications.
Plan B Comprehensive (Inpatient & Outpatient) Major Medical Health Coverage
- This plan is mandatory for full-time undergraduate students who do not have other health insurance or an approved waiver while attending FMU.
- Plan B is to serve as a student’s primary health care plan and provides comprehensive inpatient, outpatient and pharmacy benefits.
- Services rendered at the Jesse Trice Student Health Center are covered at 100%, no copay or deductible applies.
- Unlimited lifetime maximum on all essential health benefits. In-network medical expenses covered at 80% after the $150 plan year deductible has been satisfied.
- Coverage for preventative care and routine well visits at 100%, no copay or deductible applies.
- 24/7 access to speak with a registered nurses or telemedicine physician services.
- Worldwide medical coverage and travel assistance services while studying abroad.
Need assistance? Contact Academic Insurance Solutions at 888-776-9920. Please read the Florida Memorial University Summary of Benefits located online at www.FMUstudentinsurance.net carefully before enrolling.
PLAN A is intended to cover 100% of acute medical care when treated at the Jesse Trice Student Health Center, located on the FMU campus. Full-time undergraduate students, international students, and athletes are automatically enrolled in this plan at the time of registration. The cost of this coverage is billed to your student account in two equal semester payments. Students may not waive out of Plan A.
This plan DOES NOT include coverage for inpatient hospitalization or any other specialty care.
This plan includes:
- • A limited outpatient medical and pharmacy benefit that will help supplement your out of pocket cost under your primary health care plan, i.e. deductibles, co-insurance and copayments.
- • Accident Coverage up to $10,000 per Injury (Non-Sports related injuries).
- • Accident Coverage up to $25,000 per Injury (Intercollegiate Sports related injuries).
- • 24 hour, 7 days a week access to a registered nurse and physician services.
PLAN B is to serve as a student’s primary health care plan and provides more comprehensive inpatient hospital, outpatient primary and specialty coverage, and pharmacy benefits. Students who do not have other adequate health insurance while attending Florida Memorial University are required to have Plan B.
Students with an approved waiver will receive a credit for the cost of this plan of $322.50 per semester that will be applied to your student account after the September 10th waiver deadline. If you have questions about this, please send an email to email@example.com.
This plan includes:
- • The cost for medical services rendered at the Jesse Trice Student Health Center.
- • In-network medical expenses are covered at 80% after the $150.00 plan year deductible has been satisfied.
- • Coverage for preventative and wellness benefits at 100%, no copay or deductible applies.
- • 24 hour, 7 days a week access to a registered nurse and telemedicine physician services.
- • Worldwide coverage and travel assistance services while traveling or studying abroad.
The Student Health Services health forms include a Statement of Health Insurance Coverage Form, Meningitis Information/Declination, Physical Examination, and Immunization Documentation forms.
The Jesse Trice Student Health Clinic provides minimal healthcare services to full-time students. Students can be evaluated and treated for acute and chronic medical conditions as well as guidance on practices that promote good health and disease prevention. You are advised and encouraged to visit the clinic for information on the services offered before you get sick. The clinic staff includes a Nurse Practitioner, Registered Nurse, Medical Assistant and a Customer Service Representative.
Location & Hours
The on-site clinic is located in Building 3. Business hours are Monday to Friday from 8.00 am to 5.00pm
Appointments may be made by calling 305-626-3110. Walk-ins are seen on a "first come, first, serve basis." Students are evaluated by the nurse and based upon the severity of illness may be immediately seen by a provider, given an appointment for a later time, or referred to a specialist or hospital. Students with scheduled appointments have priority over walk-ins unless there is a life-threatening emergency.
ATHLETIC INJURY COVERAGE
Florida Memorial University provides an excess medical athletic injury policy for all (full or part-time) of its intercollegiate athletes to cover injuries sustained during official intercollegiate athletic activities.
Excess Provision. No benefit under this Plan is payable for any expense incurred for Injury or Sickness which is paid or payable by other valid and collectible insurance or under an automobile insurance policy. Covered medical expenses exclude amounts not covered by the primary insurer due to penalties imposed on the Covered person for not complying with plan provisions or requirements.
BASIC PLAN SUMMARY - MEDICAL EXPENSES INCURRED UP TO $25,000 (Per Injury)
CATASTROPHIC PLAN SUMMARY - MEDICAL EXPENSES FROM $25,000 (Per Injury) to $5,000,000 (Per Injury)
Florida Memorial University provides an excess medical athletic injury policy for all of its intercollegiate athletes to cover injuries sustained during official intercollegiate athletic activities. This policy, at no cost to the athlete, provides secondary coverage; that is, it pays after the primary insurance carrier has paid their portion.
PLEASE BE SURE TO FOLLOWING THESE INSTRUCTIONS TO HAVE YOUR CLAIMS PAID PROPERLY:
ALL CLAIMS MUST BE FILED WITHIN 180 DAYS OF INJURY IN ORDER FOR VALID CLAIMS TO BE PAID.
- This claim form must be signed by you and a school official.
- All athletes must file claims with any other primary insurance that you are insured under (if applicable). This means that any claims for athletic injury must first be filed with the student, parent or guardian’s insurance plan or any other valid and collectible medical insurance coverage. Not following this step will delay the claim process.
- Be sure to submit a copy of this form to the claims address listed below along with copies of all itemized bills and any Explanation of Benefits (EOB) from any other insurance company that has processed your bills. The FMU student insurance WILL NOT pay your claims if you have other insurance and the other insurance company has not processed your claims.
- The FMU student insurance will pay the charges for eligible injuries which the other primary coverage has not covered or fully paid, up to the usual and customary charge in our area.
- In order to meet filing guidelines, all primary insurance carriers’ explanation of benefits (EOBs) must be mailed to the FMU student insurance claims office within one year of the date of service or your claims will be denied.
- The Claim's Department will coordinate all other aspects of the claim with the athlete/parent/guardian.
Medical Expenses that EXCEED - $25,000
Students must complete the Catastrophic Intercollegiate Sports Accident Claim Form if medical expenses exceed $25,000. Please complete the claim form and fax it to 1-913-327-7520.
For information about filing a claim or for claim status, please contact the Student Educational Benefit Trust (SEBT), the plan administrator, by phone (877) 233-5159 or email firstname.lastname@example.org.
For general questions, please contact the school's agent Academic Insurance Solutions at (888) 776-9920 or send an email with your questions to email@example.com.
If you need further assistance with your claims, please complete the Personal Authorization Form and take this form to the athletic department on campus.
For verification of benefits and coverage, please call Member Services at (866) 662-4097.
Comprehensive Plan B ONLY
Students who are covered under the Comprehensive Plan B may print an ID card by clicking on the link below. Students on the supplemental Plan A, do not receive an ID card.
This card is not a guarantee of coverage or benefit payment. The provider will verify coverage at the time of your visit with the information provided on this card.
- Fill in your name and FMU student ID number (Omit the "P" and leading zeros. Only print the 6 digits after the zeros.).
Create a member account as insured subscriber to view your 2018-19 claim information.
If you have already created an account,
If they have any questions on how to register, please call member services at (888) 479-2000.
As of January 1, 2019, the Aetna Passport to Health will be the new PPO Network of Preferred Providers.
The Plan has arranged for you to access the Aetna Preferred Provider Network in your local campus community. Using our Participating Provider Network you may access in-network savings for services rendered nationally if you require treatment or hospitalization outside the immediate area of the University campus.
To maximize your savings and reduce your out-of-pocket expenses, select a provider that is participating in the Aetna Preferred Provider Network. It is to your advantage to utilize an In-Network Provider because significant savings can be achieved from the substantially lower rates these providers have agreed to accept as payment for their services. In-Network providers are independent contractors and are neither employees nor agents of the University or PayerFusion Holding, LLC.
Passport to Healthcare®
To submit an Online Claim Form
Submit itemized claims to:
Evolutions Healthcare Systems, Inc.
PO Box 5001
New Port Richey, FL 34656
Payer ID# 59313
Group Name: Student Education Benefit Trust SEBT
As of January 1, 2019, the prescription drug network for this plan will be with EHIM.
Below is the information your pharmacy will need to process your prescription under this plan. This information is printed on your ID card as well.
Pharmacy Information Call +1 (800) 311-3446
Group #: See group specific ID Card for the group number.
Your prescription copay for:
- Tier 1 medications is $5 + 20% coinsurance;
- Tier 2 medications is $15 + 20% coinsurance; and
- Tier 3 medications is $30 + 20% coinsurance.
If for some reason you have to get your prescription filled at a pharmacy that does not participate with EHIM, and have to incur an out-of-pocket expense for the entire amount, you may be eligible for partial reimbursement. If you would like to be considered for reimbursement, submit this form, along with the pharmacy receipt (copies are acceptable) to EHIM. The form should be printed, filled out and then faxed or mailed to EHIM. EHIM's fax number is 248-948-9904.
Walgreens Mail Order
To place a mail order through the Walgreens processing center, please download the form using the link above and fill out all required information before submitting it via mail.
Search for drugs by different criteria – name, dosage, etc. and return results that include a full description, generic and brand information, available and recommended dosages, and images if available.
For questions about this plan, please call Academic Insurance Solutions at: 888-776-9920 or send an email to firstname.lastname@example.org.
Member Services: 866-662-4097
To locate a provider: 866-945-2292
Inpatient Pre-certification: 833-247-8916
INDIVIDUAL INTERNATIONAL STUDENT HEALTH, ACCIDENT AND ATHLETIC INJURY
Long-term coverage from one month up to five years for educational programs. Plans include coverage for an intercollegiate sports injury up to $5,000 per injury.
All full-time international students, cultural exchange students, scholars, students studying abroad and their families who desire an annually renewable comprehensive medical health and accident insurance plan may purchase this coverage. This plan meets student visa requirements and includes benefits for intramural and intercollegiate sports, mental health, international emergency care, medical and political evacuation, repatriation, and a choice of optional coverage enhancements.
If you would like to purchase dental coverage on a voluntary basis for you and/or your family, complete the form below to obtain plan information and cost.
To view all vision plan options, costs and to enroll, complete the form below.
For students who need coverage and are no longer on the student health plan, students who have graduated and need temporary coverage until employed, or new students who need coverage prior to being on the student health plan.
- Access to a nationwide network
- Per term or per cause deductible for premium flexibility
- Supplemental Accident optional benefit
For domestic individuals who needs coverage and would also like to insure their dependent spouse and child(ren). Several plans to choose from with monthly payment option.