International Insurance

This video teaches international students how to prepare for their arrival in the US, how the US healthcare system works and how students should seek medical care appropriately if they become sick or injured.

For more information: International Insurance

INTERNATIONAL STUDENT & SCHOLAR HEALTH INSURANCE PLAN

This is a brief description of the Student Health Insurance Plan available for International Students & Scholars of Valparaiso University..

ELIGIBILITY

All International Students and Scholars of Valparaiso University are enrolled in the Student Health Insurance Plan, if comparable insurance coverage cannot be documented to the University’s satisfaction.

POLICY TERM

The insurance coverage under the Student Health Insurance Plan is effective August 11, 2014 -August 11, 2015.

Coverage is in effect only during the period for which premium is paid and will end on the termination date.

The coverage will end when the Insured Person departs for their home country.

DEPENDENT COVERAGE

International Students/Scholars are covered under the Student Health Insurance Plan and may also enroll their dependent children under age 26 or spouses who reside with the Insured Student/Scholar. Newborn children will also be covered for Injury or Sickness, including necessary care or treatment of congenital defects, birth abnormalities, or premature birth. Such coverage will automatically continue for 31 days after the date of birth. To continue the coverage beyond the 31 day period, the Insured must complete and return the Dependent Enrollment Form with payment to the Plan Administrator. You may secure an enrollment form from the Office of International Student Affairs.

SCHEDULE OF BENEFITS

We will pay benefits for Covered Medical Expenses that are incurred by the Insured Person for Loss due to Covered Injury or Covered Sickness. Benefits payable are subject to any specified benefit maximum, deductible, coinsurance or copayment amounts.

Deductible - $50 per Policy Year, per insured person

Benefit Period - August 11, 2014 - August 11, 2015

Medical Maximum - Unlimited

Out-of-Pocket Maximum - Individual: $6,350

Family:  $12,700

COINSURANCE*

Tier 1: 90% Usual and Reasonable - From $0 to $5,000

The plan will pay the first $5000.00 at 90% (excludes $50 deductible). You are responsible for 10% of the cost.

Tier 2: 80% Usual and Reasonable - From $5,000 to $500,000

For cost over $5000.00 in the benefit period the plan will pay 80%. You are responsible for 20% of the cost.

BENEFITS

There is a 90 visit maximum for outpatient care

Prescription Drugs (Rx Card) - 100% of Usual and Reasonable with copays of $10 for generic, $30 for preferred brand and $60 for brand

OTHER BENEFITS

Pediatric Vision Care - 100% Usual and Reasonable for Preventive, 1 visit per policy year

Pediatric Dental Care - 100% Usual and Reasonable for Preventive, 2 visits per policy year

Preventive Services - 100% Usual and Reasonable (Not subject to coinsurance or deductible)

Medical Treatment Received in Home Country (International Students Only) - No Benefit

Accidental Injury Dental Treatment - $200 per tooth, $600 maximum

Medical Evacuation – Usual and Reasonable, not to exceed $50,000

Repatriation– Usual and Reasonable, not to exceed $25,000

Accidental Death & Dismemberment - Principal Sum: $10,000

ESSENTIAL HEALTH BENEFITS

The plan will include coverage for Essential Health Benefits in the following general categories and the items and services covered within the categories: Ambulatory patient services; Emergency services, Hospitalization, Maternity and newborn care; Mental health and substance use disorder services, including behavioral health treatment; Prescription drugs; Rehabilitative and habilitative services and devices; Laboratory services; Preventive and wellness services and chronic disease management; and Pediatric services, including oral and vision care. Essential Health Benefits are not subject to annual or lifetime dollar limits. If additional care, treatment or services are added to the list of Essential Health

Benefits by a governing authority, the policy benefits will be amended to comply with such change. Please refer to www.studentplanscenter.com for an updated copy of this brochure when additional care, treatment or services are added to your Student Health Insurance Plan.

MANDATED BENEFITS

The following benefits are mandated in the state of Indiana. They will be included in all plans issued under the Policy. Unless specified otherwise, all such coverage will be subject to any deductible, copayment and co-insurance conditions of the Policy as well as all other terms and conditions applicable to any other covered sickness. If any Preventive Services Benefit is subject to the mandated benefits required by state law, they will be administered under the federal or state guideline, whichever is more favorable to the student. Mandated benefits as required by the state which the policy is issued include but are not limited to: Mastectomy, Reconstructive Surgery and Prosthetic Devices; Diabetes Equipment, Supplies, Service and Self-Management; Mental Illness; and Dental Anesthesia. See the Policy on file with the school for further details on these benefits.

EXCLUSIONS

Any exclusion in conflict with the Patient Protection and Affordable Care Act will be administered to comply with the requirements of that Act. The Policy does not cover loss nor provide benefits for any of the following, except as otherwise provided by the benefits of the Policy as shown in the Schedule of Benefits.

Expenses incurred within the Insured Person’s Home Country or country of regular domicile, that exceeds the benefit amount shown in the Schedule of Benefits.

Preventive medicines, serums or vaccines of any kind except as specifically provided under the Policy.

Routine physical or other examinations where there are no objective indications of impairment of normal health or except as specifically provided under the Policy.

Well baby care other than as shown in the Schedule of Benefits.

Services or supplies in connection with eye examinations, eyeglasses or contact lenses or hearing aids, except those resulting from a covered accidental Injury.

Birth control, including elective surgical procedures or devices, except as specifically provided in the Schedule of Benefits.

Expenses covered under any Workers’ Compensation, occupational benefits plan, mandatory automobile no-fault plan, public assistance program or government plan, except Medicaid.

Loss incurred as the result of riding as a passenger or otherwise (including skydiving) in a vehicle or device for aerial navigation, except as a fare paying passenger in an aircraft operated by a scheduled airline maintaining regular published schedules on a regularly established route anywhere in the world.

Loss resulting from war or any act of war, whether declared or not, or loss sustained while in the armed forces of any country or international authority, unless indicated otherwise on the Schedule of Benefits.

Loss resulting from playing, practicing, traveling to or from, or participating in, or conditioning for, any Intercollegiate or club sports.

Loss resulting from playing, practicing, traveling to or from, or participating in, or conditioning for, any professional sport.

Expenses incurred after: a) The date insurance terminates as to the Insured Person; b) The Maximum Benefit for each Covered Injury or Covered Sickness has been attained.

Elective Surgery or Treatment unless such coverage is otherwise specifically covered under the policy.

Charges incurred for chiropractic care, acupuncture, physical therapy, heat treatment, diathermy, manipulation or massage, in any form, except to the extent provided in the Schedule of Benefits.

Expenses incurred for Plastic or Cosmetic Surgery, unless they result directly from a Covered Injury that necessitates medical treatment within 24 hours of the Accident or results from Reconstructive Surgery. For the purposes of this provision, Reconstructive Surgery means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors normal appearance, to the extent possible. For the purposes of this provision, Plastic or Cosmetic Surgery means surgery that is performed to alter or reshape normal structures of the body in order to improve the patient’s appearance).

Professional services rendered by an Immediate Family Member or any who lives with the Insured Person 

Services or supplies not necessary for the medical care of the Insured Person’s Injury or Sickness.

Services or supplies in connection with eye examinations, eyeglasses or contact lenses or hearing aids, except those resulting from a covered accidental Injury.

Weak, strained or flat feet, corns, calluses or ingrown toenails.

Diagnostic or surgical procedures in connection with infertility unless such infertility is a result of a Covered Injury or Covered Sickness.

Charges of an institution, health service or infirmary for whose services payment is not required in the absence of insurance or services provided by Student Health Fees.

Any expenses in excess of Usual and Reasonable charges.

Treatment, services, supplies or facilities in a Hospital owned or operated by the Veterans Administration or a national government or any of its agencies, except when a charge is made which the Insured Person is required to pay.

COORDINATION OF BENEFITS

The Policy will coordinate benefits for expenses covered by any other valid and collectible medical, health or accident insurance or pre-payment plan as stated in the Policy. Payments from such coverage and from this Plan will not be in excess of the total eligible expenses incurred.

CLAIM PROCEDURE

In the event of accident or illness the Student should:

If at School report immediately to the Valparaiso University Health Center so that proper treatment can be prescribed or approved. Note: If the scholar does not report to the VU Health Center, a scholar should proceed to a physician’s office, an off-hours clinic or an emergency facility. 

Claims may be filed with the Valparaiso University Health Center at 55 University Drive, Suite 102, Valparaiso, IN 46383 or sent directly to Special Risk Claims, Commercial Travelers Mutual Insurance Company, 70 Genesee Street, Utica, NY 13502. 

Student Insurance Medical Claim Form must be submitted for all claims within 30 days after the date of accident or commencement of sickness. All Student Insurance Medical Claim Forms must be processed at Valparaiso University Health Center. Bills for which benefits are to be paid must be submitted within 90 days of the date of treatment.

If away from School (including foreign travel) consult a doctor and follow his/her instructions. Pay the bill and obtain a receipt. Notify the Claims Administrator, Special Risk Claims, Commercial Travelers Mutual Insurance Company, as soon as possible, or the International Studies Office.

This is not the Policy. Rather it is a brief description of the benefits and other provisions of the Policy. The Policy is governed by the laws and regulations of the state in which it is issued. Any provisions of the Policy, stated on this page that may be in conflict with the laws of the state where the school is located will be administered to conform with the requirements of that state’s laws, including those relating to mandated benefits.