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This information should
be used in conjunction with the Student Medical
Insurance Brochure.
If you need a copy of the Student Medical Insurance
Plan brochure, please
contact Koster Insurance Agency at 800-457-5599 or
email Studentcare@kosterins.com. Koster's customer service is available Monday through Thursday: 8:30am to 7:00pm,
Friday: 8:30 to 6:00pm Eastern Time.
How do I know if I
am eligible to enroll in the Injury and Sickness Plan?
Massachusetts State Law
requires that you have some form of health insurance while attending college.
It does not have to be the Student Medical Insurance Plan if you will be
covered by other comparable coverage (i.e. your parent’s plan) while attending
Smith College. If you do not want to enroll, you have to prove comparable
coverage by completing the Waiver Form and submitting it by the posted
deadline.
What’s covered under
the Student Medical Insurance Plan?
The Student Medical Insurance
Plan is offered through the college to provide basic medical coverage to
eligible students who are sick or injured. The plan covers accident
and sickness expense including hospital room and board, prescription drugs,
emergency outpatient care, lab
and x-rays, inpatient and outpatient surgical procedures, and physician
office visits. Coverage varies from 80% to 100% depending on whether
or not you seek benefits through an in-network or out-of-network provider.
Coverage is subject to the limitations and provisions of the policy.
Please refer to the brochure for exclusions and limitations. This
coverage is separate and in addition to the services provided at the Student
Health Services.
Can I go to any health
care provider?
You can, but there is
a financial benefit to receiving care through an in-network or Preferred
Provider. When students see an in-network or Preferred Provider,
the insurance will cover 100% of a Preferred Allowance for covered expenses.
Services rendered by an Out of Network Provider are covered at 80% of Usual
and Customary charges. Preferred providers have agreed to accept
as payment in full for covered expenses, a prearranged amount or Preferred
Allowance. An Out of Network provider has not agreed to any prearranged
fee schedule, and any charges in excess of the insurance payment will be
your responsibility.
How do I find a preferred
provider?
A Preferred Provider
is a provider that is part of the PlanVista Solutions (formerly NPPN/HCVM)
or the Pioneer Health PPO. The easiest and most efficient way to
check if a provider or facility is part of the NPPN/HCVM network is to
call 1-800-557-1656 or go online at
www.planvista.com. To check on a provider in the Pioneer Health
PPO call 877-868-9060 or go on line at www.pioneerhealth.com.
Do I have to get a
referral before going to a doctor outside of the Student Health Service or
the hospital?
You need to obtain a
referral from the Student Health Service before seeking treatment from
either an in-network or out-of-network provider. If you seek medical
treatment from an in-network provider, the plan will cover most covered
expenses at 100%. If you are treated by an out-of-network provider,
the plan will cover most covered expenses at 80%. There are
exceptions to the referral
process: when the Student Health Service is closed, during term breaks,
when you’re more than 50 miles from campus, in the case of an emergency,
and for outpatient mental and nervous conditions.
Am I covered for a
Pre-Existing Condition?
There is a six-month
waiting period before your pre-existing condition is covered if you are
newly enrolled in the plan. However, if you were previously covered
by another insurance plan for at least six months, and there was not a
break in coverage of more than 30 days between your previous coverage and
the Student Medical Insurance Plan, your pre-existing condition will be
covered. If you had previous coverage but it was for less than six
months, the number of months you were covered will be applied to the waiting
period. If you didn't have previous coverage or you had a break in
coverage for more than 30 days, then your pre-existing coverage will be
covered up to $2,500 for the first six months under the Student Medical
Insurance Plan. After 6 months of coverage under the Student Medical
Insurance Plan, your condition will be covered.
How are prescriptions
filled?
The Prescription Program
is available through Express Scripts Pharmacy Network. There is a
$5 co-payment for a generic drug and a $15 co-payment for a brand name
drug for each 30-day supply. After the co-payment, the prescription
will be covered at 100% up to a maximum of $1000 per policy year.
Present your ID card to the pharmacist when purchasing your prescription.
To locate a participating pharmacy, call Pioneer Management Systems at
877-868-9060. Not all prescription drugs are covered. Please
refer to the brochure for more details.
When I receive services,
how and where do I submit my bill?
You do not need a claim
form to submit a bill. Physicians can bill the administrator, Pioneer
Management Systems directly. If you receive a bill or need reimbursement,
you can also forward your bill or your request for reimbursement to Pioneer
Management Systems at the address below. Make sure your name, ID
number, address and the College’s name are on the bill. All provider
bills must be sent to:
Pioneer Management Systems
330 Whitney Avenue
Holyoke, MA 01401-6600
Email: student@pioneerhealth.com
Where and when will
ID Cards be distributed?
Each student purchasing
the Student Medical Insurance Plan will receive and insurance ID Card in
her mailbox. Please carry the ID card at all times and you must present
it whenever receiving medical care or filling a prescription. If
you need to see a doctor before you receive your ID card, tell the provider
that you covered under the Smith College student insurance program.
Your provider can always call Koster Insurance to verify eligibility at
800-457-5599.
What if I leave Smith
College, will I get a refund?
Once you attend classes
for 31 days, your coverage will be in effect for the full period for
which premiums were paid and you will not be given a
refund.
Does the Student Medical
Insurance Plan cover me if I decide to study abroad?
Yes, the Student Medical
Insurance Plan provides worldwide coverage, whether studying or traveling
abroad. The plan provides the same benefits as if you were at Smith College.
What other services
are available to me as an enrolled student in the Student Medical Insurance
Plan?
If you are an enrolled
student in the Student Accident and Sickness Insurance Plan, you have the
option to purchase an Optional Supplemental Medical Insurance Plan.
This plan increases the plan’s aggregate maximum to $500,000 lifetime aggregate
maximum. The enrollment deadline for the Optional Supplemental Medical
Insurance Plan is September 15, 2001.
All students, even if
they are not enrolled in the Student Medical Insurance Plan, are eligible
to enroll in either the Dental Insurance Plan or a vision program.
With the dental plan, you can choose any licensed dentist. Routine
examinations, cleaning and x-rays are covered immediately. The enrollment
deadlines for the Dental Insurance Plan and the Optional Supplemental Medical
Insurance Plan are September 15th for annual coverage and January 15th
for newly enrolled students for spring term coverage.
Also available to all
students is an optional vision program offered through Eye Care Plan of
America. This plan includes discounts on prescription eyeglasses,
contact lenses or even non-prescription sunglasses. Also, some of
the nation’s most highly qualified laser vision correction surgeons offer
savings of 20% off the Usual & Customary charges. There is no
enrollment deadline. If you are interested in any of these plans,
contact Koster Insurance Agency at 800-457-5599.
Who do I call if I
have questions about enrollment, eligibility, coverage or other service
issues?
Koster Insurance
500 Victory Road
Quincy, MA 02171
800-457-5599 or email:
Studentcare@kosterins.com
Who do I call if I have
questions about a specific claim or claims payment?
Pioneer Management Systems
330 Whitney Avenue
Holyoke, MA 01040
1-877-868-9060 or email: student@pioneerhealth.com
Who do I call if I
need help in finding an in-network or Preferred Provider?
You can contact Plan
Vista Solutions (formerly NPPN/HCVM) at www.planvista.com or by telephone
at 800-557-1656 or to find a Pioneer PPO provider, contact Pioneer Management
Systems at 877-868-9060 or www.pioneerhealth.com
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