SUNY MANDATORY HEALTH AND ACCIDENT INSURANCE FOR INTERNATIONAL STUDENTS AND SCHOLARS
2009-2010 INFORMATION
WHY MANDATORY INSURANCE?
In 1985, the SUNY Board of Trustees passed a resolution mandating that all individuals participating in SUNY programs of international exchange possess health and accident insurance through a policy contracted by the University. This was to protect international students from the exceptionally high cost of medical care in the United States, and to fulfill U.S. federal government regulatory requirements. The insurance program commenced with the fall 1986 semester.
IF I HAVE OTHER HEALTH AND ACCIDENT INSURANCE WILL THE SUNY HEALTH AND ACCIDENT INSURANCE BE WAIVED?
Waivers can be given only if your current insurance is comparable to the SUNY policy. This means that your insurance must, at minimum, cover pre‑existing conditions, maternity, repatriation, and medical evacuation, as well as carry a $0 deductible per illness/accident/injury and a $200,000.00 maximum reimbursement rate per illness, accident or injury. Very few policies fulfill these requirements. Health insurance policies that are NOT comparable are policies offered by LASPAU, AAI, AmidEast, the Chinese (People's Republic) government, U.N. Blue Cross/Blue Shield, and IIE (including Fulbright). If you think you are eligible for a waiver, you must present a copy of your policy, in English, and proof of current dates of coverage to the International Health Insurance Coordinator, at the Office of International Student and Scholar Services.
HOW MUCH DOES THE SUNY POLICY COST?
The annual fee for the SUNY health insurance policy is $994.75 for the 2009-2010 academic year. The payment is made through two semester tuition payments: $414.50 for the fall semester (August 15, 2009 to January 14, 2010) and $580.50 for the spring semester and summer (January 15, 2010 to August 14, 2010). The payment is made, along with your tuition and other fees, to the Student Accounts Office at Binghamton University.
IS COVERAGE ALSO AVAILABLE FOR MY SPOUSE AND/OR CHILDREN?
Yes. Students in J-1 status should note that the US government REQUIRES that J-1 sponsored dependents have insurance. Printed material describing the health insurance policy benefits, the cost and enrollment information for dependent health insurance coverage is available from Diane Sliwinski at the Office of International Student and Scholar Services.
HOW DO I GET MY HEALth INSURANCE ID CARD?
HTH Worldwide Insurance Services, your health insurance company, will send your health insurance ID card to you by email to your Binghamton University email account.
WHO CAN I TALK TO IF I HAVE ANY QUESTIONS REGARDING MY INSURANCE, OR IF I NEED CLAIMS ASSISTANCE?
Any questions, concerns or problems regarding insurance should be directed to the International Health Insurance Coordinator at the Office of International Student and Scholar Services. You may also contact HTH Worldwide Insurance Services, Inc. in Tampa, FL for questions about coverage and claims. The toll free number is (888) 350-2002.
IS THERE A DEDUCTIBLE WHICH I MUST PAY BEFORE THE INSURANCE COMPANY WILL PAY MY MEDICAL BILLS?
There is no deductible for health care as long as you visit University Health Service first. However, you will pay a deductible of $50.00 per illness/accident/injury if you fail to use University Health Service first when their services are available. The $50.00 deductible is waived if University Health Services is closed when you need emergency medical care.
WHAT IF THE HEALTH SERVICE IS CLOSED?
If your situation is such that you cannot wait until University Health Services re‑opens (e.g., acute illness, severe injury, extreme pain), you have the option of going to a doctor, a “walk-in clinic” or an Emergency Room* in the community. When you file a claim with the insurance company for payment of your care, you are responsible for obtaining a stamped claim form (called a Health Center Authorization & Referral Form) from the University Health Service so that you will not be charged the $50.00 deductible. The stamped claim form verifies that you sought medical care when University Health Service was closed.
*Please note: Emergency Room services are very expensive. You should allow a minimum of as least 2 to 4 hours to be seen and treated. For non-emergencies, we recommend that you use one of the numerous “walk-in” clinics in the area that offer comparable, faster and not as cost prohibitive care.
WHAT IF THE HEALTH SERVICE IS OPEN, BUT I WOULD PREFER TO BE SEEN BY A DOCTOR IN THE COMMUNITY?
Go to the University Health Service first anyway for an evaluation. Have University Health Service stamp your claim form so that your doctor visit will be considered to be a referral. With a referral from University Health Services to an off‑campus health provider, you will not have to pay the $50.00 deductible.
WHY SHOULD I VISIT THE UNIVERSITY HEALTH SERVICE FIRST?
By visiting the University Health Service first, you will not be required to pay the $50.00 deductible per “event” (illness/accident/injury). All basic services offered by University Health Services, including office visits, medication, and common medical supplies, are pre‑paid by the separate Health Fee that is included in the tuition bill that you pay at the beginning of each semester. Using University Health Services offers you the convenience of receiving health care and medications right here on campus, rather than having to go off campus to a doctor or pharmacy. Also, you will not need to submit claim forms or wait for reimbursement of your medication expenses when you use University Health Services.
WHAT IS THE PROCEDURE FOR FILING A CLAIM?
If you are referred by University Health Services for off-campus health care, are hospitalized or use an Emergency Room, request a stamped international student “Authorization and Referral Claim Form” (claim form) from University Health Service to send to the health insurance company (HTH Worldwide) after your visit. If HTH Worldwide Insurance Services receives your claim form without the University Health Services stamp, you will be responsible for the $50.00 deductible.
Directions for filing a claim are on the back of the “Authorization and Referral Claim Form” (claim form). Answer all of the questions on the front page of the “Authorization and Referral Form” (claim form) that pertain to your situation and sign your name and the date at the bottom of the “Authorization and Referral Claim Form”. Remember: make copies of your completed “Authorization and Referral Claim Form” (claim form) and all of your medical bills and/or receipts for payments already made by you for your personal records.
Where to mail the “Authorization and Referral Claim Form” (claim form):
Medical bills:
HTH Worldwide
PO Box 30259
Tampa, FL 33630.
Prescription Drug receipts:
HTH Worldwide Insurance Services
PO Box 968
Horsham, PA 19044.
If you require follow-up care for your illness, accident or injury, do not send another claim form for the same “event” (illness/accident/injury). Submit all or any additional bills for the same “event” without a new claim form.
Note: the insurance company will make payment to the provider (doctor/lab/hospital), NOT to you. However, if you paid for your medical care, to receive reimbursement, you must include a paid receipt or statement when you submit your “Authorization and Referral Claim Form” (claim form) to the health insurance company. If you receive new bills and/or receipts for the same “event” (illness, accident or injury) after you have submitted your initial claim form to HTH Worldwide, make copies of the bills and/or receipts for your records and mail the originals to HTH Worldwide Claims Department (address above). REMEMBER: do not send another claim form for the same event. Send only one claim form per illness/accident/injury.
Processing for payment of claims and reimbursement takes approximately three to four weeks.
HOW DO I KNOW WHAT HEALTH CARE PROVIDERS TO USE IF I AM REFERRED OFF CAMPUS?
If you are referred off-campus for health care, be sure to use a provider who participates in the Aetna US Network System. Aetna is a private company that negotiates reduced health care rates between hospitals, physicians, health care providers and numerous health insurance companies around the world to offer patients more affordable health care. University Health Services will give you names of off-campus providers, but you do not have to use them those providers because they may not be participating Aetna providers.
To use a “preferred or participating provider” off-campus, go to Aetna’s website (http://www.aetna.com) and on the rights side of the screen under “shortcuts” click on “Find a Doctor.” On next screen, click on “Go to Doc Find”, then “standard search” and go to “Open Choice PPO” which is the location of providers who participate with your policy. By using a “preferred or participating provider”, you will avoid having to pay any cost difference between what a “non-participating provider” charges (e.g., $200.00) and what the insurance company contracts to pay a “participating provider” (e.g. $150.00). In this example, you would be responsible for the $50.00 difference in cost.
SINCE THIS INSURANCE POLICY DOES NOT COVER DENTAL CARE, WHERE CAN I GO FOR INEXPENSIVE DENTAL TREATMENT?
Broome Community College, on upper Front Street in Binghamton, operates a Dental Hygiene Clinic through their Dental Hygiene Program, 607-778-5015, that is open to the public by appointment during the academic year. The hygienists at the clinic are students who are supervised by a dentist and professional hygienists. Services offered include fluoride treatments, plaque control, X‑rays, teeth cleaning, and pit and fissure sealants. Please call 778-5015 for information and/or an appointment. Please note: The clinic cannot diagnose a dental condition, only a dentist can do that.
AM I STILL COVERED BY THE INSURANCE EVEN WHEN I TRAVEL?
Yes, you are covered everywhere in the world except in your country of citizenship where you are covered for a maximum of $5,000.00 per enrollment year.
May 2009