INTERNATIONAL STUDENT INSURANCE INTERNATIONAL STUDENT INSURANCE INFORMATION INFORMATION

PERSONAL INSURANCE ADMINISTRATORS PERSONAL INSURANCE ADMINISTRATORS (PIA)(PIA)

SANTA MONICA COLLEGE HEALTH SERVICESSANTA MONICA COLLEGE HEALTH SERVICESbyby

FAUZIA HASSAN OLIN RN FAUZIA HASSAN OLIN RN

EDUCATEEDUCATE

ADVOCATE ADVOCATE

EMPOWEREMPOWER

PIA PIA Personal Insurance AdministratorsPersonal Insurance Administrators

What does my insurance cover? What does my insurance cover? EligibilityEligibilityOPT (practical training)OPT (practical training)DependentsDependentsRefundsRefundsTerms of coverage and Coverage scheduleTerms of coverage and Coverage scheduleWhat is a referral?What is a referral?What is a claim and the process of filing a claim?What is a claim and the process of filing a claim?PPO (preferred provider network)PPO (preferred provider network)What is an emergency and what do I do in an emergency?What is an emergency and what do I do in an emergency?Is there a co-pay for my Doctors visit?Is there a co-pay for my Doctors visit?Who do I contact if I have any questions pertaining to my health Who do I contact if I have any questions pertaining to my health insurance?insurance?

What Your Policy CoversWhat Your Policy Covers

Medical fees up to $250 000 per accident or sicknessMedical fees up to $250 000 per accident or sicknessCovers 100% payment of all charges in PPO network (non PPO provider Covers 100% payment of all charges in PPO network (non PPO provider covered at 70% with a $100 deductible).covered at 70% with a $100 deductible).Contains 50% reimbursement of prescription drug charges.Contains 50% reimbursement of prescription drug charges.Emergency conditions e.g. heart attack, a cut requiring stitches etc.Emergency conditions e.g. heart attack, a cut requiring stitches etc.All Doctor visits are subject to a $25 co-payAll Doctor visits are subject to a $25 co-payFor the entire list or schedule of benefits please pick up a brochure from the For the entire list or schedule of benefits please pick up a brochure from the Student Health Services or down load it from www.renstudent.com/smcStudent Health Services or down load it from www.renstudent.com/smcPlease visit www.renstudent.com/smc to down load ID cards and or claim Please visit www.renstudent.com/smc to down load ID cards and or claim forms.forms.

This Plan Does Not CoverThis Plan Does Not Cover::Dental or VisionDental or VisionImmunizationsImmunizationsSTD screening STD screening Pre-Existing Conditions or Illnesses (for first six months of policy term)Pre-Existing Conditions or Illnesses (for first six months of policy term)Treatment of a non-emergency medical condition in an Emergency Care Treatment of a non-emergency medical condition in an Emergency Care facilityfacility

ELIGIBILITYELIGIBILITY

Eligibility: Eligibility: – International students, visiting faculty, scholars or other persons International students, visiting faculty, scholars or other persons

with a current passport or student visa (F-1, J-1 or M-1 visa)with a current passport or student visa (F-1, J-1 or M-1 visa)– Students who have paid their required premium (insurance fee) Students who have paid their required premium (insurance fee)

and their name, student number and date of birth must have and their name, student number and date of birth must have been included in the declaration made by the college or the been included in the declaration made by the college or the Administrative Agent to the insurer.Administrative Agent to the insurer.

– Covered students must actively attend classes for at least the Covered students must actively attend classes for at least the first 31 days of the period for which coverage is purchased, first 31 days of the period for which coverage is purchased, except in the case of medical withdrawal.except in the case of medical withdrawal.

– For questions, please contact Renaissance Insurance Agency, For questions, please contact Renaissance Insurance Agency, Inc. at 1-800-537-1777Inc. at 1-800-537-1777

PRACTICAL TRAINING STUDENTSPRACTICAL TRAINING STUDENTS

OPT STUDENTS (PRACTICAL TRAINING)OPT STUDENTS (PRACTICAL TRAINING)– Must submit to Renaissance Insurance Agency, Inc. the Must submit to Renaissance Insurance Agency, Inc. the

following:following:An enrollment form and payment (by mail) within 30 days of the An enrollment form and payment (by mail) within 30 days of the termination date of the immediately preceding term; andtermination date of the immediately preceding term; and

Proof of Practical Training (either a copy of their Employment Proof of Practical Training (either a copy of their Employment Authorization Card or an official letter from the college stating their Authorization Card or an official letter from the college stating their OPT dates).OPT dates).

Please note, students engaged in OPT are not eligible to use the Please note, students engaged in OPT are not eligible to use the Students Health Services, therefore, the Deductible can not be Students Health Services, therefore, the Deductible can not be waived under any circumstances.waived under any circumstances.

For questions please call Renaissance Insurance Agency, Inc. at 1-For questions please call Renaissance Insurance Agency, Inc. at 1-800-537-1777800-537-1777

DEPENDENTSDEPENDENTS

DEPENDENTS:DEPENDENTS:– Spouse (husband or wife) living with the covered student; or unmarried Spouse (husband or wife) living with the covered student; or unmarried

children under the age of 26 years.children under the age of 26 years.– Eligible dependents must be enrolled by the Deadline Date or within 31 Eligible dependents must be enrolled by the Deadline Date or within 31

days of birth, adoption, marriage, or arrival in the U.S. or termination of days of birth, adoption, marriage, or arrival in the U.S. or termination of other insurance coverage. Coverage for eligible dependents will not be other insurance coverage. Coverage for eligible dependents will not be effective prior to that of the covered student or extend beyond that of the effective prior to that of the covered student or extend beyond that of the covered student.covered student.

– A newly acquired dependent child will be covered under Policy for the A newly acquired dependent child will be covered under Policy for the first 31 days after birth; or the earlier of: effective date of adoption of the first 31 days after birth; or the earlier of: effective date of adoption of the child; or the date of placement of the child for adoption. Benefits will be child; or the date of placement of the child for adoption. Benefits will be the same as any other covered person who is the child’s parent.the same as any other covered person who is the child’s parent.

– To continue the coverage the covered student must within 31 days after To continue the coverage the covered student must within 31 days after the birth, adoption or placement for adoption: the birth, adoption or placement for adoption:

Apply to the company in writingApply to the company in writingPay the required additional premium. If not coverage ends at day Pay the required additional premium. If not coverage ends at day 31.31.

REFUNDSREFUNDS

REFUNDS:REFUNDS:– No refunds for insurance will be permitted unless:No refunds for insurance will be permitted unless:

You are withdrawing from Santa Monica College and You are withdrawing from Santa Monica College and returning to your home country---airline ticket must be returning to your home country---airline ticket must be presentedpresented

You are transferring to a different U.S. university or You are transferring to a different U.S. university or college----documentation may be requestedcollege----documentation may be requested

You are a covered student entering the armed forces.You are a covered student entering the armed forces.

Refunds will be pro rated and issued upon request from the Refunds will be pro rated and issued upon request from the school.school.

No refunds will be given if you purchase other insurance No refunds will be given if you purchase other insurance after the semester begins.after the semester begins.

TERMS OF COVERAGETERMS OF COVERAGE

TERMS OF COVERAGE:TERMS OF COVERAGE:– Coverage begins at 12:01 a.m. if the eligibility Coverage begins at 12:01 a.m. if the eligibility

requirements are met.requirements are met.The effective date of the policyThe effective date of the policy

The effective date of the term of coverage for which premium The effective date of the term of coverage for which premium has been paid.has been paid.

The day immediately following the date that full premium is The day immediately following the date that full premium is received by the Administrative Agent or the Collegereceived by the Administrative Agent or the College

Please note: (PIA) Personal Insurance Administrators does Please note: (PIA) Personal Insurance Administrators does not send termination or renewal notices. It is the covered not send termination or renewal notices. It is the covered persons responsibility to renew coverage in a timely manner, persons responsibility to renew coverage in a timely manner, subject to continuing eligibility.subject to continuing eligibility.

COVERAGE SCHEDULECOVERAGE SCHEDULE

BEGINBEGIN ENDEND DEPENDENT DEPENDENT ENROLLMENT ENROLLMENT DEADLINEDEADLINE

FALLFALL 08-25-1108-25-11 02-12-1202-12-12 09-25-1109-25-11

WINTERWINTER 01-02-1201-02-12 02-12-1202-12-12 02-02-1202-02-12

SPRINGSPRING 02-12-1202-12-12 08-25-1208-25-12 03-12-1203-12-12

SUMMERSUMMER 06-16-1206-16-12 08-25-1208-25-12 07-16-1207-16-12

STUDENT HEALTH SERVICES REFERRAL STUDENT HEALTH SERVICES REFERRAL REQUIREMENTREQUIREMENT

STUDENTHEALTH

SERVICES

DOCTORSOFFICE

ACUPUNCTURE

OFFICE

PHYSIOTHERAPIST

OFFICE

Students covered by the Students covered by the insurance must first get a insurance must first get a referral/claim form from referral/claim form from the Student Health the Student Health Services.Services.

The covered student The covered student must visit the Student must visit the Student Health Services for care Health Services for care prior to seeing a Doctor prior to seeing a Doctor or receiving care off-or receiving care off-campus unless its an campus unless its an Emergency.Emergency.

Referral and Claim formsReferral and Claim forms

REFERRAL’S WAIVED UNDER THESE REFERRAL’S WAIVED UNDER THESE CIRCUMSTANCES/SITUATIONSCIRCUMSTANCES/SITUATIONS

REFERRAL WAIVED DUE TO:REFERRAL WAIVED DUE TO:

– Medical emergency. The covered student Medical emergency. The covered student must return to Student Health Services for must return to Student Health Services for referral and follow up care.referral and follow up care.

– When Student Health Services is closed.When Student Health Services is closed.– When service is given at another facility When service is given at another facility

during school break or vacation periods.during school break or vacation periods.– Medical care received when the covered Medical care received when the covered

student is more than 50 miles from campus.student is more than 50 miles from campus.

PREFERRED PROVIDER ORGANIZATIONPREFERRED PROVIDER ORGANIZATION

PPO: Preferred Provider OrganizationPPO: Preferred Provider Organization– This is a network of Doctors and hospitals approved by the This is a network of Doctors and hospitals approved by the

covered student’s insurance to provide care to the covered covered student’s insurance to provide care to the covered student.student.

– Covered student using the PPO network/panel of Medical Covered student using the PPO network/panel of Medical Professionals will only be responsible for any deductibles, co-Professionals will only be responsible for any deductibles, co-pays or co-insurance as shown in the schedule of benefits.pays or co-insurance as shown in the schedule of benefits.

– Covered students Covered students not using the PPO provider network will be not using the PPO provider network will be responsible for 30% of the eligible expenses.responsible for 30% of the eligible expenses. However, if However, if treatment is received in a non PPO facility due to an emergency treatment is received in a non PPO facility due to an emergency medical condition, benefits for eligible expenses are payable at medical condition, benefits for eligible expenses are payable at the PPO level.the PPO level.

– For a complete listing of PPO provider network Hospital and For a complete listing of PPO provider network Hospital and Doctor facilities visit www.cfmcnet.org or call 1-800-334-7341 Doctor facilities visit www.cfmcnet.org or call 1-800-334-7341

OBTAINING/GETTING MEDICAL OBTAINING/GETTING MEDICAL TREATMENT.TREATMENT.

Get the Referral and Claim form from the RN in the Student Health Get the Referral and Claim form from the RN in the Student Health Services. Services. Please bring your student ID card to receive service.Please bring your student ID card to receive service.Select a Doctor within the PPO network by either calling 1-800-334-Select a Doctor within the PPO network by either calling 1-800-334-7341 or going to the website www.cfmcnet.org7341 or going to the website www.cfmcnet.orgCall the Doctor and make an appointment.Call the Doctor and make an appointment.Verify coverage with the doctor or primary care provider and with Verify coverage with the doctor or primary care provider and with your insurance company by calling 1-800-334-7341.your insurance company by calling 1-800-334-7341.When going to the Doctor’s office present your insurance card, $25 When going to the Doctor’s office present your insurance card, $25 and the dual sided referral/claim form.and the dual sided referral/claim form.Make sure to get the referral form/claim form back from the Doctor’s Make sure to get the referral form/claim form back from the Doctor’s office when the visit it done. office when the visit it done. It is mandatory that the referral/claim form is mailed by the covered It is mandatory that the referral/claim form is mailed by the covered student to the claims department for the Doctor to be paid and for student to the claims department for the Doctor to be paid and for the expenses incurred to be covered.the expenses incurred to be covered.

Filing A Claim After Receiving TreatmentFiling A Claim After Receiving Treatment

After receiving treatment complete the claim form After receiving treatment complete the claim form side by:side by:– Answering all the questions, Answering all the questions, signsign and and datedate the form prior to the form prior to

submitting it.submitting it.– Attach medication bill’s, lab fees etc to this form.Attach medication bill’s, lab fees etc to this form.– Make Make copiescopies of all forms and receipts and keep for your own of all forms and receipts and keep for your own

records.records.– Submit all copies of forms as one package.Submit all copies of forms as one package.– If you need help feeling informs contact International Student If you need help feeling informs contact International Student

Center.Center.– Have all your bills and the forms sent as one package to:Have all your bills and the forms sent as one package to:

Personal Insurance Administrators, Inc. P O Box 6040, Personal Insurance Administrators, Inc. P O Box 6040, Agoura Hills, CA 91376Agoura Hills, CA 91376

IMPORTANT NOTICEIMPORTANT NOTICEFor More In depth and Up To Date Information check out PIA’s website at: For More In depth and Up To Date Information check out PIA’s website at:

www.renstudent.com or call www.renstudent.com or call Denise, Sharif or Elaine at 1 310 394 0440.Denise, Sharif or Elaine at 1 310 394 0440.

You can down load claim forms, ID cards and or brochures from You can down load claim forms, ID cards and or brochures from www.renstudent.com if needed.www.renstudent.com if needed.

For questions regarding eligibility, benefits or claims:For questions regarding eligibility, benefits or claims:Personal Insurance Administrators, Inc.Personal Insurance Administrators, Inc.

P.O.Box 6040P.O.Box 6040Agoura Hills, CA 91376Agoura Hills, CA 91376

1-800-468-43431-800-468-4343www.piaclaims.comwww.piaclaims.com

Plan Underwritten by:Plan Underwritten by:National Union Fire Insurance Company of Pittsburgh, Pa.National Union Fire Insurance Company of Pittsburgh, Pa.

Policy Number CHH0058772 Policy Number CHH0058772

NO COST LANGUAGE ASSISTANCE SERVICESNO COST LANGUAGE ASSISTANCE SERVICESYou can get an interpreter and get documents read to you in your language. For You can get an interpreter and get documents read to you in your language. For

help call the number listed on your insurance card or 1-800-468-4343help call the number listed on your insurance card or 1-800-468-4343

SMC STUDENT HEALTH SERVICESSMC STUDENT HEALTH SERVICES

SMC Student Health ServicesSMC Student Health Services

Office Hours (subject to change): Office Hours (subject to change): – 8:00am-7:00pm Monday–Thursday8:00am-7:00pm Monday–Thursday– 8:00am-2:00pm Friday8:00am-2:00pm Friday– Telephone 1 310 434 4262Telephone 1 310 434 4262– To Receive service at the health office you need to have paid To Receive service at the health office you need to have paid

your your health fee of $16health fee of $16 spring and Fall, $13 summer and spring and Fall, $13 summer and winter; and have your student ID card.winter; and have your student ID card.

ADMINISTRATIVE AGENT:ADMINISTRATIVE AGENT:Renaissance Insurance Agency, Inc.Renaissance Insurance Agency, Inc.

Phone: 1-800-537-1777Phone: 1-800-537-1777Available on campus at International Education Counseling by Available on campus at International Education Counseling by

appointment.appointment.