For all questions please call (219) 464-5400

Coverage

Benefits become effective at 12:01 a.m. on August 11, 2012 and continue during the period for which the premium has been paid. The Master Policy expires at 12:01 a.m. on August 11, 2013.

Coverage is automatically cancelled when a student terminates his/her association as a full-time student with Valparaiso University.

Protection is in effect during all interim vacation periods.

STUDENT HEALTH CENTER REFERRAL

The Student Accident and Sickness Insurance Plan is a supplemental plan. When available, the student must first use the resources of the Health Center where treatment will be administered or a referral issued.

Expenses incurred for medical treatment rendered outside of the Health Center for which no prior approval or referral is obtained may be excluded from coverage. A referral issued by the Health Center must accompany the claim when submitted.

Health Center referral for outside care is not necessary ONLY under the following conditions:

1. For a Medical Emergency. The student must return to the SHC for necessary follow-up care.
2. When the Health Center is closed.
3. When service is rendered at another facility during break or vacation period.

BASIC BENEFITS

When hospital or medical care is necessary on account of injury sustained or sickness contracted and treated during the period for which the Student is covered, the Company will pay the usual and reasonable medical expense up to $500 per covered accident or sickness incurred. Such payment is subject to the following provisions:

HOSPITAL ROOM AND BOARD: Accommodation in a semi-private room not to exceed $70 per day.

HOSPITAL MISCELLANEOUS EXPENSE: While the student is confined as a bed patient in a hospital: Up to $100 for x-ray examinations, laboratory tests, plaster casts, use of operating room, hospital rendered medicines, and temporary surgical appliances.

OUTPATIENT SURGERY MISCELLANEOUS: For surgery performed in a hospital emergency room, trauma center, physician’s office, outpatient surgical center or clinic, up to $100 for x-ray examinations, laboratory tests, plaster casts, use of operating room, drugs and medicines (excluding take home drugs and temporary surgical appliances).

SURGERY (In or Out of Hospital): Benefits for injuries and operations are in accordance with a graduated schedule ranging from $7.50 up to a maximum of $300 for the surgeon’s fee. A copy of this Schedule may be seen at the Student Affairs Office.

ANESTHETIST SERVICES: In the event anesthesia fee is not charged (in conjunction with surgery) by the hospital but by an outside anesthesiologist, the Plan will pay the expense actually incurred but not to exceed $35.

IN-HOSPITAL PHYSICIANS’ EXPENSES: While the student is confined as a bed patient in the hospital on account of any sickness: Up to $20 for the first visit, then $10 per visit, up to a maximum of $150.

CONSULTANTS’ FEES: $100 when referred by the Health Center Staff or the attending physician for diagnosis or treatment while in residence at the University.

PRIVATE REGISTERED NURSES: Up to $8 per 12-hour day up to a maximum of $100.

ACCIDENTAL DENTAL EXPENSE: Up to $100 for treatment resulting from injury to sound, natural teeth.

AMBULANCE: Up to $75 for a community or hospital ambulance.

MEDICAL EMERGENCY EXPENSE: When charges are incurred at a hospital emergency room, surgical center or clinic as a result of emergency sickness or injury, the plan will pay up to $200.

DIAGNOSTIC LABORATORY AND X-RAY: Up to $200 per claim for outpatient x-rays and lab tests, not including those administered during a hospital emergency room visit, when the student is referred by the Health Center.

For coverage details you may pick up an insurance brochure at the Health Center or on line at: www.studentplanscenter.com/school.asp   You must maintain full time status of at least 12 credit hours for the coverage to be effective.    Titers that check for immunity to communicable diseases i.e. (MMR, Rubella, Hepatitis, etc.) are not covered.

You are responsible for any portion of the bill not covered by the student insurance plan. Screening services/wellness labs are not covered by the student insurance plan. Certain cancer screening services are covered, for example routine pap smears.  It is important that you take care of the bill in a timely fashion. If the bill for lab services is in danger of going to collections for “non-payment”, we will attempt to notify you. As the bill is generated by “Working Well” and Alverno labs, the Health Center is unable to prevent an unpaid balance from going to collection.

When completing the claim form please write legibly and give as much information as possible. Missed information may cause an interruption in the claims process. Turn in your insurance claim to the Health Center front office.