Florida Memorial University Student Health Plan

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 at (866) 752-8881.


COVERAGE REQUIREMENT

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. 


WAIVER PROCESS

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 katrenia.blue@fmuniv.edu.


WAIVER PROCESS

Waiver Requirement

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.

Waiver Request Form

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.

Click Here To Waive Plan B

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.

Request Waiver Status

HEALTH & ACCIDENT COVERAGE

Plan Information

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.

View Plan Guide

Spring/Summer Brochure

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 - Limited Supplemental Limited Health and Injury Benefits

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 - Comprehensive Primary Medical Health and Injury Benefits

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.

Summary of Benefits

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 info@aisstudentinsurance.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.
Florida Memorial University's Student Health Center

The Student Health Services health forms include a Statement of Health Insurance Coverage Form, Meningitis Information/Declination, Physical Examination, and Immunization Documentation forms.

Download the Health 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.

Click Here For More Information

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
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.

Locate Off-Campus Providers


ATHLETIC INJURY COVERAGE

Plan Information

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.

CLICK HERE TO LEARN MORE ABOUT THE COST AND UNDERSTANDING YOUR COVERAGE

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)

Plan Benefit Summary (coverage up to $25,000)


CATASTROPHIC PLAN SUMMARY - MEDICAL EXPENSES FROM $25,000 (Per Injury) to $5,000,000 (Per Injury)

Plan Summary (from $25,000 to $5,000,000)

How To File A Claim

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.

COMPLETE AND PRINT THIS PAPER CLAIM FORM

 


How To File A Claim

Benefits under this Plan shall be paid only if the Plan Administrator decides in its discretion that a Covered Person is entitled to them.  When a Covered Person has a Claim to submit for payment that person must:

  • Have this claim form 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.
  • Send the above to PayerFusion Holding, LLC

Submission of Claims

In-network providers automatically submit your claim (bill) to PayerFusion.

If you must use an out-of-network provider, make sure to ask how your claim will be handled. If the provider will not submit the claim directly to PayerFusion, you may have to pay the provider immediately. In this case, you must send us the itemized bill and all other required documentation.   Make sure to write your name and ID number on all the medical bills, and keep a copy for your own records.

Payment

The expenses covered under your plan will be paid directly to the medical provider unless you send proof of payment that you paid the provider directly. If you request to be reimbursed, send the proof (receipt, etc.) to PayerFusion.

Ways we pay back (Reimbursments)

  • Electronic direct deposit.
  • Check can be sent to member and provider where electronic payment is not possible.

Once a claim has been processed, an EOB will be mailed to you indicating payments to your medical provider. If you have an outstanding balance, your medical provider will send you a separate statement indicating any  payment due.


Submit Electronic Medical Claims to: Payer ID - 27048

Submit Paper Medical Claims and Correspondence to:

COMPLETE AND PRINT THIS PAPER CLAIM FORM

PayerFusion Holdings, LLC
5200 Blue Lagoon Drive,  Suite 100
Miami, Florida 33126

Email: universityprograms@payerfusion.com

Claim Questions: 
(866) 752-8881

Pre-certifications:  (866) 752-8881

Please review the Pre-Certification Requirement for prior claims approval on in-patient hospital admissions, surgery, physical therapy, CAT Scans, MRIs, High-Cost Procedures, Durable Medical Equipment and Other Devices.


When Claims Should Be Filed

Claims should be filed with the Claims Administrator within 180 days of the date charges for the service were incurred. Benefits are based on the Plan's provisions at the time the charges were incurred. Claims filed later than that date may be declined or reduced unless:

(a) it's not reasonably possible to submit the claim in that time; and
(b) the claim is submitted within one year from the date incurred. This one year period will not apply when the person is not legally capable of submitting the claim.

The Claims Administrator will determine if enough information has been submitted to enable proper consideration of the claim. If not, more information may be requested from the claimant. The Plan reserves the right to have a Plan Participant seek a second medical opinion.


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.

Catastrophic Plan Claim Form

Coordination of Benefits

Coordination of Benefits (COB)

A Coordination of Benefits provision applies to the Plan when you have medical and/or dental coverage under more than one Plan. Your other Plan will ALWAYS be the primary plan and must pay first.

PayerFusion will only pay after the primary plan; and may reduce the benefits it pays; so that payments from all group plans do not exceed 100% of the total allowable expense.

For more information about the Coordination of Benefits procedure, including the Order of Benefits Determination Rules, you may call the Member Services telephone number shown on your ID card. A complete description of the Coordination of Benefits procedure is contained in the Plan Document issued to your University, and may be viewed on-line under plan information.

Referral & Pre-certification Requirement

Services requiring Pre-Certification include:

Inpatient admissions, outpatient surgeries, rehabilitative physical therapy, occupational therapy, speech and language therapy, CAT Scans and MRIs.

All of the above services must be pre-certified in advance by calling (866) 752-8881.

The patient, physician, or hospital must telephone at least 3 business days prior to the planned admission.

If you do not secure Pre-Certification for the above mentioned services, your covered medical expenses will be subject to an out-of-network penalty.

Pre-certification does not guarantee the payment of benefits. Each claim is subject to medical plan review in accordance with the exclusions and limitations contained in the Plan, as well as a review of eligibility, adherence to notification guidelines, and coverage under the Student Health Plan.

If you do not secure Pre-certification for non-emergency inpatient admissions or provide notification for emergency admissions, your covered medical expenses will be subject to an out-of-network penalty.

Notification of Emergency Admissions
The patient, patient’s representative, physician, or hospital must telephone PayerFusion Holdings, LLC at 1-866-752-8881 within 1 business day following admission.

Pre-Certification simply means calling PayerFusion Holdings, LLC prior to treatment to obtain approval for a medical procedure or service.

Pre-Certification may be done by you, your doctor, a hospital administrator, or one of your relatives.


ONCE ENROLLED

For verification of benefits and coverage, please call Member Services at (866) 752-8881.

IMPORTANT ID Card Information

Comprehensive Student Health Plan ID Cards


VERY IMPORTANT INFORMATION - PLEASE READ CAREFULLY.

  • All students will receive a new ID card for the 2019 Spring/Summer term.
  • Your ID card that you received in the fall from SEBT/NCAS is no longer valid as of January 1, 2019.

Students who are covered under the Comprehensive Student Health Plan will receive an electronic ID card that will be sent secured to your FMU email address.  Please check your spam or junk mail as well for this electronic ID card.  The secured email will be password protected.

You may request a copy of your ID card by sending an email to info@aisstudentinsurance.com.

For general information, waivers and enrollment, call (888) 776-9920

For claims information, verification of coverage, call (866) 752-8881

Find an In-Network Provider

Begin Search Here

For assistance in finding a provider call (866) 752-8881 or via email at universityprograms@payerfusion.com.

Your Student Health Plan allows you to choose whether to receive care from a Network provider, or a provider outside the Network. Using a network provider saves you money and provides better coordinated care.

The Jesse Trice Student Health Center (SHC) serves as your Primary Care Provider (PCP).  Please contact PayerFusion for a referral to any other provider.


NEED HELP FINDING A PROVIDER?

Step One - You’re not alone, call Customer Service at (866) 752-8881, powered by PayerFusion. We do the work for you. Reach out to our experienced customer support team. We are standing by to find the right provider who has been vetted to give you the care and service you deserve, while keeping your expenses low.

Step Two - Along with your Customer Service representative, choose your provider. Your representative will lead you through your choices. There are pros and cons to every healthcare provider. There are many metrics involved in this decision.

Step Three - We set it, fill it, and complete it.  Customer Service will set the appointment and along with you,
complete any required paperwork.

For non-emergency appointments and sessions, most cases are completed, and a date is assigned within less than 72 hours. During this time, they are set to help you with the full scope of services offered by  PayerFusion’s Customer Service.

To Find a Provider call (866) 752-8881 or email universityprograms@payerfusion.com.

Submitting a Claim

How To File A Claim

Benefits under this Plan shall be paid only if the Plan Administrator decides in its discretion that a Covered Person is entitled to them.  When a Covered Person has a Claim to submit for payment that person must:

Click Here To Complete The Claim Form

(1)   Complete a claim form.

(2)   Complete the Student portion of the form.

(3)   For Plan reimbursements, attach bills for services rendered.

(4)   If you don't have a copy of the bills to attach with the claim form, then you will need to have the Physician      complete the provider's portion of the form.

(5)   Send the above to PayerFusion Holding, LLC


Submission of Claims

In-network providers automatically submit your claim (bill) to PayerFusion.

If you must use an out-of-network provider, make sure to ask how your claim will be handled. If the provider will not submit the claim directly to PayerFusion, you may have to pay the provider immediately. In this case, you must send us the itemized bill and all other required documentation.   Make sure to write your name and ID number on all the medical bills, and keep a copy for your own records.

Payment

The expenses covered under your plan will be paid directly to the medical provider unless you send proof of payment that you paid the provider directly. If you request to be reimbursed, send the proof (receipt, etc.) to PayerFusion.

Ways we pay back (Reimbursements)

  • Electronic direct deposit.
  • Check can be sent to member and provider where electronic payment is not possible.

Once a claim has been processed, an EOB will be mailed to you indicating payments to your medical provider. If you have an outstanding balance, your medical provider will send you a separate statement indicating any  payment due.

 


Submit Electronic Medical Claims to: Payer ID - 27048

Submit Paper Medical Claims and Correspondence to:

COMPLETE AND PRINT THIS PAPER CLAIM FORM

PayerFusion Holdings, LLC
5200 Blue Lagoon Drive,  Suite 100
Miami, Florida 33126

Email: universityprograms@payerfusion.com

Claim Questions: 
(866) 752-8881

Pre-certifications:  (866) 752-8881

Please review the Pre-Certification Requirement for prior claims approval on in-patient hospital admissions, surgery, physical therapy, CAT Scans, MRIs, High-Cost Procedures, Durable Medical Equipment and Other Devices.


When Claims Should Be Filed

Claims should be filed with the Claims Administrator within 180 days of the date charges for the service were incurred. Benefits are based on the Plan's provisions at the time the charges were incurred. Claims filed later than that date may be declined or reduced unless:

(a) it's not reasonably possible to submit the claim in that time; and
(b) the claim is submitted within one year from the date incurred. This one year period will not apply when the person is not legally capable of submitting the claim.

The Claims Administrator will determine if enough information has been submitted to enable proper consideration of the claim. If not, more information may be requested from the claimant. The Plan reserves the right to have a Plan Participant seek a second medical opinion.

Prescription Medications

EHIM Logo

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.
BIN: 005285
PCN: ACB

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.

Search for a Pharmacy near you

Prescription Reimbursement

Download the Form

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

Download the Form

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.

Drug Search

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.

  1. Drugs.com
  2. Healthline
  3. Medline Plus
  4. RXList.com
  5. WebMD
Contact Information

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 .  For claims information, verification of coverage, call (866) 752-8881.

  • For general information, waivers and enrollment, call (888) 776-9920
  • For claims information, verification of coverage, call (866) 752-8881

Plan and Claims Administrator: 

PayerFusion Holding, LLC

5200 Blue Lagoon Drive, Suite 100
Miami, FL 33126
Email: universityprograms@payerfusion.com
www.payerfusion.com
1.866.752.8881

Broker of Record:  

Academic Insurance Solutions, LLC

Email:  info@aisstudentinsurance.com
www.aisstudentinsurance.com
1.888.776.9920

Referral & Pre-certification Requirement

Services requiring Pre-Certification include:

Inpatient admissions, outpatient surgeries, rehabilitative physical therapy, occupational therapy, speech and language therapy, CAT Scans and MRIs.

All of the above services must be pre-certified in advance by calling (866) 752-8881.

The patient, physician, or hospital must telephone at least 3 business days prior to the planned admission.

If you do not secure Pre-Certification for the above mentioned services, your covered medical expenses will be subject to an out-of-network penalty.

Pre-certification does not guarantee the payment of benefits. Each claim is subject to medical plan review in accordance with the exclusions and limitations contained in the Plan, as well as a review of eligibility, adherence to notification guidelines, and coverage under the Student Health Plan.

If you do not secure Pre-certification for non-emergency inpatient admissions or provide notification for emergency admissions, your covered medical expenses will be subject to an out-of-network penalty.

Notification of Emergency Admissions
The patient, patient’s representative, physician, or hospital must telephone PayerFusion Holdings, LLC at 1-866-752-8881 within 1 business day following admission.

Pre-Certification simply means calling PayerFusion Holdings, LLC prior to treatment to obtain approval for a medical procedure or service.

Pre-Certification may be done by you, your doctor, a hospital administrator, or one of your relatives.

VOLUNTARY COVERAGE

International Graduate Students

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.

Click Here To View Plan Options, Rates & to Enroll

Dental Coverage

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.

Vision Coverage

To view all vision plan options, costs and to enroll, complete the form below.

Short Term Coverage After Graduation

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

 

View Plans, Rates & Enroll Nowl

Individual and Family Plans

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.

 

Click Here For A Quote