Information about http://cafnr.missouri.edu/study-abroad/forms/hthinsurance.pdf
WHAT IS NOT COVERED? The Policy does pay benefits for loss due to a…
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Created: Mon Oct 29 14:31:44 2007
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WHAT IS NOT COVERED?
The Policy does pay benefits for loss due to a Pre-Existing Condition. ENROLL ONLINE! (credit card only) at
hthstudents.com
Unless specifically provided for elsewhere under the Policy, the Policy does not cover loss caused by or
by entering the access code CBK 2348 in the box on
resulting from, nor is any premium charged for, any of the following:
the left hand side for the University of Missouri,
1. Preventative medicines, routine physical examinations, or any other examination where there are no Columbia Study Abroad plan
objective indications of impairment in normal health.
2. Services and supplies not Medically Necessary for the diagnosis or treatment of a Sickness or Injury.
3. Surgery for the correction of refractive error and services and prescriptions for eye examinations, eye
4.
glasses or contact lenses or hearing aids, except when Medically Necessary for the Treatment of an
Injury.
Plastic or cosmetic surgery, unless they result directly from an Injury which necessitated medical
University of Missouri
5.
6.
treatment within 24 hours of the Accident.
For diagnostic investigation or medical treatment for infertility, fertility, or birth control.
Expenses incurred in excess of Reasonable Expenses.
Columbia
7. Voluntarily using any drug, narcotic or controlled substance, unless as prescribed by a Physician. This Study Abroad
exclusion does not apply to the Medical Evacuation Benefit, to the Repatriation of Remains Benefit and
to the Bedside Visit Benefit.
8. Organ or tissue transplant. 2007 2008
9. Participating in an illegal occupation or committing or attempting to commit a felony.
10. For treatment, services, supplies, or Confinement in a Hospital owned or operated by a national
Blanket Student Accident and Sickness Insurance
government or its agencies. (This does not apply to charges the law requires the Covered Person to
pay.)
11. While traveling against the advice of a Physician, while on a waiting list for a specific treatment, or
when traveling for the purpose of obtaining medical treatment.
12. The diagnosis or treatment of Congenital Conditions, except for a newborn child insured under the
Policy.
13. Expenses incurred within the Covered Person's Home Country.
14. Treatment to the teeth, gums, jaw or structures directly supporting the teeth, including surgical
extraction's of teeth, TMJ dysfunction or skeletal irregularities of one or both jaws including
orthognathia and mandibular retrognathia.
15. Expenses incurred in connection with weak, strained or flat feet, corns or calluses. Administered by:
16. Diagnosis and treatment of acne and sebaceous cyst.
17. Outpatient treatment for specified therapies including, but not limited to, Physiotherapy and
acupuncture which does not follow a covered Hospital Confinement or surgery. One Radnor Corporate Center, Suite 100
18. Deviated nasal septum, including submucous resection and/or surgical correction, unless treatment is Radnor, PA 19087
due to or arises from an Injury. 1.866.281.1668
19. Loss due to war, declared or undeclared; service in the armed forces of any country or international hthstudents.com
authority; riot; or civil commotion.
20. Riding in any aircraft, except as a passenger on a regularly scheduled airline or charter flight. Underwritten by:
21. Elective termination of pregnancy.
22. Loss arising from participation in professional sports, scuba diving for recreational purposes, hang
gliding, parachuting or bungee jumping.
23. Medical Treatment Benefits provision for loss due to or arising from a motor vehicle Accident if the This blanket accident and sickness policy is underwritten by
UniCare Life & Health Insurance Company
Covered Person operated the vehicle without a proper license in the jurisdiction where the Accident NAIC # 842-80314
occurred. ® Registered mark of WellPoint , Inc.
24. Under the Accidental Death and Dismemberment provision, for loss of life or dismemberment for or
arising from an Accident in the Covered Person's Home Country. This pamphlet contains a brief summary of the features and benefits for insured participants covered
25. Expenses incurred as a result of pregnancy that is not covered. under Policy No. U-1048-A-06. This policy complies with state mandated benefits for Missouri and
therefore, Participants may be entitled to additional benefits. Please see the Certificate of Insurance on
file with the school for more information. Any provisions of this certificate that may be in conflict with the
laws of the state where the purchaser is located will be administered to conform with the requirements of
that state's laws, including mandated benefits. If there is a difference between this program description
and the certificate wording, the certificate controls.
.
WHAT IS THE COST OF THE INSURANCE PROGRAM?
The cost of this program is $37.45 per Eligible Participant per month and is available in whole months only,
for a maximum of 12 months from the date of enrollment.
WHAT IS COVERED BY THE PLAN?
WHO IS ELIGIBLE FOR COVERAGE?
Schedule of Benefits Table 1
All regular, full-time Eligible Participants of the educational organization or institution who: 1. Are engaged in
international educational activities; and 2. Are temporarily located outside his/her Home Country as a Limits Covered Person
non-resident alien; and 3. Have not obtained permanent residency status. Lifetime Maximum Benefit $1,000,000
WHEN DOES COVERAGE START? Policy Year Maximum Benefits $100,000
Maximum Benefit per Injury or Sicknesses $100,000
Coverage for an Eligible Participant begins at 12:00:01 a.m. on the latest of the following: 1. The effective
Basic Medical Expense Benefit per Injury or Up to $100,000 Maximum: 100% of Reasonable
date of the Policy; or 2. The Participating Organization's or Institution's Effective Date; 3. The effective date
Sickness Expenses
shown on the Insurance Identification Card, if any; 4. The date the premium and completed enrollment form,
Deductible $0 per Injury or Sickness
if any, are received by the Insurer or the Administrator.
Accidental Death & Dismemberment Maximum Benefit: Principal Sum up to $10,000
Thereafter, the insurance is effective 24 hours a day, worldwide except whenever the Covered Person is in Repatriation of Remains Maximum Benefit up to $25,000
his/her Home Country. In no event, however, will insurance start prior to the date the premium is received by Maximum Lifetime Benefit for all Evacuations up to
the Insurer. Medical Evacuation
$100,000
WHEN DOES COVERAGE END? Bedside Visit Up to a maximum benefit of $1,500
Coverage for an Eligible Participant will automatically terminate on the earliest of the following dates: Schedule of Benefits Table 2 Medical Expenses
1. The date the Policy terminates; 2.The Participating Organization's or Institution's Termination Date; Indemnity Plan Limits
3. The date of which the Eligible Participant ceases to meet the Individual Eligibility Requirements; 4. The end
Physician Office Visits, Hospital and Physician
of the term of coverage specified in the Eligible Participant's enrollment form, if any, including any requested For Basic 100% of Reasonable Expenses.
Outpatient Services, Inpatient Hospital Services
extension; 5. The date the Eligible Participant leaves the Country of Assignment for his/her or her Home
Country; 6. The date the Eligible Participant requests cancellation of coverage (the request must be in writing); Schedule of Benefits Medical Expense Benefits
or 7. The premium due date for which the required premium has not been paid, subject to the Grace Period Benefits listed below are subject to Lifetime Maximums, Annual Maximums, Maximums per Injury and
provision. Sickness, Co-Insurance, Deductibles, Out-of-Pocket Maximums; and Table 2 Plan Type Limits
WHAT TO DO IN THE EVENT OF AN EMERGENCY MEDICAL EXPENSE Limits Covered Person
All Eligible Participants are entitled to Global Assistance Services while traveling outside of the United Maternity Care for a Covered
Reasonable Expenses
States. In the event of an emergency, they should go immediately to the nearest physician or hospital Pregnancy
without delay and then contact HTH Worldwide. HTH Worldwide will then take the appropriate action to Inpatient treatment of mental and
Reasonable Expenses up to $2,500 Maximum per lifetime
assist and monitor the medical care until the situation is resolved. To contact HTH Worldwide in the event of nervous disorders including drug or
for a maximum period of 30 days per lifetime
an emergency, call 1.800.257.4823 or collect to +1.610.254.8771. alcohol abuse
Outpatient treatment of mental and
EXCESS COVERAGE nervous disorders including drug or Reasonable Expenses up to $500 Maximum per lifetime
The Insurer will reduce the amount payable under the Policy to the extent expenses are covered under any alcohol abuse
Other Plan. The Insurer will determine the amount of benefits provided by Other Plans without reference to Reasonable Expenses up to $5,000 Maximum combined
any coordination of benefits, non-duplication of benefits, or other similar provisions. The amount from Other Treatment of specified therapies, total for Inpatient and Outpatient care, up to 30 days
Plans includes any amount to which the Covered Person is entitled, whether or not a claim is made for the including acupuncture and immediately following the attending Physician's release for
benefits. The Policy is secondary coverage to all other policies. Physiotherapy rehabilitation following a covered Hospital confinement or
surgery per Policy Year
hthstudents.com Therapeutic termination of pregnancy Reasonable Expenses up to $500 Maximum per Policy Year
Once Eligible Participants receive their Medical Insurance ID card from HTH Worldwide, they should visit Routine nursery care of a newborn
Reasonable Expenses up to $500 Maximum per Policy Year
hthstudents.com, and using the certificate number on the front of the card, sign in to the site for child of a covered pregnancy
comprehensive information and services relating to this plan. Participants can track claims, search for a Repairs to sound, natural teeth 100% of Reasonable Expenses up to $500 per Policy Year
doctor, view plan information, download claim forms and read health and security information. required due to an Injury maximum
Outpatient prescription drugs including
CLAIMS SUBMISSION 80% of actual charge
oral and Norplant contraceptives
Claims are to be submitted to HTH Worldwide, Attn: International Claims, One Radnor Corporate Center,
Suite 100, Radnor, PA 19087 USA. See the hthstudents.com website for claim forms and instructions on
how to file.