Florida Memorial University 2017-2018 Student Health Plan

2017-2018 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 ACA marketplace.

COVERAGE REQUIREMENT

All registered full-time undergraduate, international students, and athletes are automatically enrolled in the new 2017-2018 Student Health Plan A and B, effective August 1, 2017 to July 31, 2018. 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 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.International Students may not waive out of Plan A or B. Graduate and part-time students may elect to purchase this plan on a voluntary basis.

ABOUT THE PLANS

Plan Information
Plan A - Limited Supplemental Limited Health and Injury Benefits

Click Here To View Plan 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

Click Here To View Plan 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.

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 while traveling or studying abroad.

 

Florida Memorial University's Student Health Center

FMU Student Health Center Clinic Website

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
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.


WAIVER PROCESS

The waiver site for Fall, 2017-18 will open on July 1, 2017.  The deadline to waive out of the FMU Student Health Plan B, for Fall 2017-18, is September 6, 2017.

Waiver Requirement

Students may request to waive out of Plan B if the following criteria below are met:
1. You will be required to upload a copy (front and back) of your health insurance plan ID card when completing the online waiver request.
2.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 and the insurance policy has not been issued outside the U.S.
3. The plan provides in-network coverage for non-emergency health care, hospitalization, physician visits, specialty visits and mental health benefits within 50 miles from campus.
4. The plan provides coverage for prescription medication.
5. The annual plan deductible does not exceed $1,000.

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 students holding an F1 or J1 visa may not waive out of Plan A or Plan B.

If the waiver submitted does not meet the waiver criteria, you will be enrolled in Plan A and Plan B.

Waiver Request Form

The deadline to waive out of the FMU Student Health Plan for fall, 2017 is September 6, 2017.

Click Here To Waive Coverage

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

ATHLETIC INJURY COVERAGE

Sports Coverage Information

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.

BENEFIT DESCRIPTION AND PLAN SUMMARY - For medical expenses incurred up to $25,000 (per Injury)

What to do when an athletic injury occurs and filing 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.

STEP 1.    CLICK HERE TO FILE AN ONLINE CLAIM FORM

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.

The mailing address to send your claims is:

Evolutions Network (PayerID 59313)

P.O. Box 5001

New Port Richey, FL 34656

To check on your claim status call (800) 367-3762 or login to your online member service account.

 

ONCE ENROLLED IN THE PLAN

Important Student Health Forms

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

Click Here To Download the Health Forms

Find an In-Network Preferred Provider

FOR ASSISTANCE, CALL OUR CUSTOMER SERVICE NUMBER AT 1-800-308-2749. We will personally verify your Provider’s status and information.

EVOLUTIONS PROVIDER SEARCH INSTRUCTIONS

  1. Click on the orange arrow on the “PATIENTS” box to begin your search.
  2. Click on the arrow in the orange “FIND A PROVIDER” Box.
  3. Type the first few letters of your school’s name, (Florida) or your group number (PS 101) in the appropriate box and click “Continue”.
  4. Choose YOUR SCHOOL NAME and click “Continue”.
  5. Review the Special instructions provided on the WELCOME screen.

Now begin your search by clicking on the round button next to the type of search you want to perform:

  • Location
  • Physician Name
  • Physician Group
  • Hospital or Facility Name
  • County Name
  • National Supplies and Equipment

You can also search by the provider type by clicking one of the following buttons:

  • Physician or Group Specialties
  • Hospital or Facility Specialties

**IMPORTANT**

You are responsible for discussing Network participation with your Provider. The provider Website is updated as we become aware of Provider changes. However, to ensure your Provider is still in Network and has not moved to a New Location or if your provider is NOT listed

Print an ID Card

Type in your full name and FMU student ID number next to FMU, i.e. FMU1345324, save, then print.

ID cards will not be mailed to you.

IF YOU NEED AN ID CARD IMMEDIATELY OR WOULD LIKE ONE MAILED TO YOU:

Please click on the button below and complete the online form to request an ID card.

CLICK HERE TO REQUEST AN ID CARD

AFTER THE WAIVER DEADLINE - YOU CAN PRINT YOUR ID CARD ONLINE

To print your electronic ID card, go to the "Create Your Online Member Account" tab below and register as a new user.  SELECT "Employee" as the student.

  • For User Type select Employee.
  • Type in Group Number:  SEBT006
  • Write the characters in the image
  • Type in your Student ID Number: Start with three zeros and the six numbers, no spaces (for example  000157263)

Login to your Member Account

First Time User - Create Member Account

File a Claim
Online Member Services

New users must register first to access your health plan benefit information.  You cannot log in until you have registered on this site.

  • REGISTER AS NEW USER
    • For User Type select Employee.
    • Type in Group Number:  SEBT006
    • Write the characters in the image
    • Type in your Student ID Number: Start with three zeros and the six numbers, no spaces (for example  000157263)
How to read my EOB (Explanation of Benefits)?
Optional Dental and Vision

Click on the links below if you are interested in purchasing optional dental or vision coverage.

Contact Information

PLAN COVERAGE, HOW TO WAIVE, WAIVER STATUS, STUDENT ACCOUNT CREDIT, ENROLLMENT OR ID CARD REQUESTS:
Toll-Free (888) 776-9920
Email info@aisstudentinsurance.com

FOR BENEFIT VERIFICATION AND CLAIMS INFORMATION:
Toll-Free (888) 237-5556

FOR IN-NETWORK PROVIDERS:
Toll-Free (800) 308-2749
Local (727) 938-2222
When traveling and receiving care outside of Florida or the Evolutions network area, please contact our Medical Help Desk at 1‐866‐807‐6193.

PRESCRIPTION DRUG INFORMATION:
RXBIN: 017449
RXPCN: 6792000
RXGRP: PRXSEB
MEMBER RX INQUIRIES: 1‐800‐424‐5828

PRE-CERTIFICATION IS REQUIRED
Call (888) 237-5556 ext. 2 for Pre-certification
Pre-certification must be made prior to an inpatient hospital admission (or within 48 hours if an emergency).
Failure to pre-certify may result in reduced benefits.

SUBMIT ITEMIZED CLAIMS TO:
Evolutions HealthCare
PO Box 5001
New Port Richey, FL 34656
Payer ID # 59313

TRAVEL ABROAD COVERAGE

Cigna Health when Traveling Abroad Student Health – Anytime, Anywhere and from Any Device. A personal health crisis can strike at any time, which is why the Student Educational Benefit Trust (SEBT) is collaborating with Cigna Global Health Benefits to offer customer service that stretches beyond borders, across the globe and around the clock. Cigna’s Global Customer Service Centre is open 24/7 to provide services on demand, so our model is always there to help students with any situation that might arise. From multilingual assistance with verification of benefits, payment guarantees, physician and hospital referrals, to coordination with emergency medical assistance providers. Students covered under a SEBT primary plan are automatically enrolled into Cigna Global Health Benefit. To activate coverage prior to departure, contact Cigna’s Global Service Centre at 800-243-1348