Overview of CISI Benefits & Procedures

For the Participants of Rotary International

2012

What we will be covering:• Policies and benefits Plan A and Plan B• Primary Exclusions• Travel Assistance Center• First Health Network• HIPAA Laws• Claim Handling, Procedures &

Examples• Questions and answers

Policies and Benefits

• The medical policy options: Plan A (available for STEP & Short

Term) Plan A+ Plan B

Quick Overview

Accident & Sickness Benefits

For Students Traveling Outside of the USA (non US exchanges):• Plan B: covered expenses paid at 100%• Plan A: covered expenses paid at 80/20 with a one time $100

deductible .

For Students Traveling Into the USA:• Plan B: covered expenses paid 80/20 of the first $5000, 100%

thereafter, with a one time $100 deductible.• Plan A: covered expenses paid 80/20 with a one time $100

deductible.

Overview Continued

• Chiropractic services covered to $500• Mental/Nervous covered to $1000 on an outpatient basis

and $25,000 on an inpatient basis. These benefits are not subject to the deductible

• Pre-existing conditions are covered to $500• Emergency Medical Evacuation benefit of $100,000• Repatriation of Remains benefit of $50,000• Emergency Family Reunion benefit of $5000 if insured is

hospitalized in excess of four days• Round trip flight benefit of $3000 if insured must return

home due to the death or serious illness of grandparent, parent or sibling.

Primary Exclusions

• Routine Physicals and Immunizations • Including Sports Physicals • Routine Dental care• Driving a vehicle• Alcohol related illness/injuries• Vision exams and eye glasses/contact lenses

Pre-existing Definition– Pre-Existing conditions, defined as any condition for which a licensed

Physician was consulted, or for which treatment or medication was prescribed, or for which manifestations of symptoms would have caused a person to seek medical advice in the 6 months prior to the Effective Date of coverage under the Policy, except as specified:

• If the Insured Person does not receive medical care or services, including prescription drugs or other medical supplies and is not under the care of a Physician with respect to the Pre-Existing Condition or related condition(s), for a period of 6 consecutive months beginning on or after the first day of coverage, the preexisting condition exclusion will no longer apply and any eligible charges incurred after the treatment free. Please note that this policy allows up to $500 for treatment of a pre-existing condition.

• Please note that this exclusion does not apply to Emergency Medical Evacuation/Repatriation and Return of Mortal Remains

24-Hour Assistance Center (Team Assist):

Facts:• 24-hours, 7 days a week. Anyone can open a case on

behalf of the student if there is a medical emergency. • Legal Assistance available (Dick Atkins)• Multi-lingual services are available • Passport/Lost Luggage Assistance if applicable• Keeps CISI staff informed (if appropriate) regarding clients

Medical Assistance:• Referral to a First Health Network Preferred Provider

(PPO) (They can look someone up if needed)• Prescription Drug replacement/shipment

Liability Coverage

Personal Liability – Limit per claim $100,000

Deductible per claim $250

Medical Payments - $5000 per coverage period

Additional Living Expense - $5000 per coverage period

Unscheduled Personal Property –with replacement cost up to $2500

First Health Network:

• PPO Network available to inbound students only• To search for a network provider go to:

www.culturalinsurance.com. • If provider participates, payment is based on a fee

schedule, not on usual and customary guidelines. • Insured is always responsible for deductible.• If a provider knows we are in their network, they

are more willing to accept our insurance.• CISI works with PHX to negotiate discounts.

HIPAA Laws

HIPAA-Health Insurance Portability and Accountability ACT

Law that prevents the release of protected medical information.

The physician by law, cannot release medical information to anyone but the insured without their written permission. In some cases, CISI may need additional information from the physician. The insured must sign a release of information in order for the physician to share private medical information with CISI.

Claim Forms

• If additional claim forms are needed, please go to our website:

www.cisi-bolduc.com

Claim Procedures

• Ideal submission is from the Doctor or facility directly to CISI.

• Submit your first medical bills within 60 days after occurrence.

• Claim form should be completed in full, have original bills and receipts attached. (Itemized bills, no generic store receipts).

• Claims should have the most up-to-date contact details & addresses.

• Neat handwriting is key!

Payment on Claims

• Participants MUST pay their deductible.• The Claims department will subtract the

deductible from the Doctor bill if the bill shows that the deductible has not been paid and the insured has not filed a claim for reimbursement.

• Deductibles are the responsibility of the participant.

Prescriptions

• Must be prescribed by a doctor or hospital• Pay for medication and submit for

reimbursement with completed claim form. • Claim form must be accompanied by a

prescription receipt. (Sorry, cash register receipts not acceptable).

• Receipt must include: Insured’s name, Physician’s name, name of medication and cost.