College Student Accident Medical Expense and Health Insurance

 

Please note   if your college will base its decision on a request for price quotation or other RFP-type document, please send it to us by facsimile using 206.292.6692. If you prefer, please mail it to American Health Administrators, Inc. PO Box 4586, Seattle, Washington 98194.

---

Disclaimer

The information on this page is based on a general concept of college student accident medical expense and health insurance plans, and is not meant to constitute advice, or represent any provisions of any policy. These details come from standard shelf-type plans. This information will serve as a guide to the main points, but is not a plan itself nor a contract or part of one. All complete and specific terms are set forth in your policy.

The information in this site should not be used or relied upon as a substitute for the relevant insurance policy wording or relevant policy documents.

This brief description of the benefits of the accident and sickness insurance plan is a proposed outline only. It is expected that the exact provisions governing coverage are in the master policy, once it is issued, which may be inspected during business hours at the college or university business office.

Note that some policies can also include medical evacuation and repatriation benefit as an option. In addition there may be an optional extension of coverage that essentially doubles the dollar amount of coverage.

---

[ top ]

 

Eligibility

All domestic and international students are eligible for coverage on a voluntary basis. An insured student may also enroll his or her eligible dependents in the plan by completing the enrollment form and remitting the appropriate premium.

An eligible dependent is the insured student’s spouse or unmarried dependent children from 31 days to 19 years of age, residing with the insured student.

If an insured student or an insured spouse gives birth to a child while the policy is in force, that child will automatically be covered under the policy for accident and sickness benefits for the first 31 days from the moment of birth. To continue coverage beyond this 31-day period, the company must be notified of the birth of such child and any additional premium required must be paid to the company prior to the expiration of this 31-day period. If notification and premium are not received within 31 days from birth, a lapse in coverage will occur and any new effective date will be the date premium is received by the company.

With compulsory coverage all students are covered and the premium is paid by the school.

[ top ]

 

Term of Coverage

Coverage is effective the date your premium payment is received for fall semester or for spring semester, whichever you select as your starting semester. Please refer to the enrollment form for specific effective and termination dates for the specific college or university that you are attending. Coverage will not begin nor extend beyond the dates noted on the enrollment form.

[ top ]

 

Basic Benefits

When hospital or medical care is required for a “sickness” first manifesting itself during the term insured, or when an “injury” requirements treatment, payment will be made for the reasonable and customary charges as allocated in the policy for those covered medical expenses incurred while insured. Amounts vary by policy, and generally cover these areas:

• Hospital room and board
• Miscellaneous hospital expense
• Surgical operations
• Physician’s fees
• Consultant’s fees
• Ambulance expense
• Dental expense
• Diagnostic x-ray and laboratory/emergency room expenses
• Outpatient prescription drug benefit

Injury means accidental bodily injury which is the sole cause of the loss and is sustained while the policy is in force as to the insured person whose injury is the basis of the claim.

Sickness means sickness or disease resulting in loss covered by the policy which is the sole cause of the loss and first manifests itself while the policy is in force as to the insured person whose sickness is the basis of the claim.

[ top ]

 

Major Medical Benefit

When covered medical expenses under the basic benefit exceed the amount payable, the company will pay such reasonable and customary expenses subject to the policy exclusions at the rate of 80% of eligible charges incurred to the maximum benefit per each sickness or injury listed in the policy. Covered medical expenses are those expenses for physicians and surgeons, hospital confinement, x-rays, laboratory tests, nurses, prescribed medicines, plaster casts, surgical dressings, use of ambulance and other usual and customary medical expenses incurred while the policy is in force as to the insured person whose injury or sickness is the basis of claim.

[ top ]

 

Maternity Expense

Benefits for pregnancy expenses are payable to the insured student or insured spouse on the same basis as a sickness. Voluntary or elective abortions are not covered.

[ top ]

 

Termination of Insurance

The termination date of the master policy is reflected on the specific enrollment form for the college or university you are attending. Individual coverage will terminate on that date, or the end of the period for which premium was paid, if earlier.

Benefits are payable only for those covered expenses incurred while the policy is in effect as to the insured person. Expenses incurred after the insured’s termination of the insurance are not covered except as shown under Extension of Benefits.

Except for medical withdrawal due to a covered injury or sickness, any student withdrawing from school during the first 31 days of the period for which coverage is purchased shall not be covered under the policy and a full refund of the premium will be made. Students withdrawing after such 31 days will remain covered under the policy for the full period for which premium has been paid and no refund will be available.

Should a student enter military service, his or her insurance is automatically terminated at the date immediately preceding the date on which he or she enters service. A refund of the unearned premium will be made provided written request is received by the company within three months. There will be no refund of premiums except as stated as above.

[ top ]

 

Extension of Benefits

If a covered person is hospitalized on his or her expiration date of coverage, benefits will continue to be paid until the completion of his or her hospital stay but not to exceed a period of 31 days from the expiration date of his or her coverage or the maximum policy benefit, whichever occurs first.

[ top ]