Moraine Valley Community College || International Student Affairs || Community Orientation || Health Care and Medical Insurance

Health Care and Medical Insurance


International Student Group Medical Insurance Policy

A brochure which includes a complete description of the medical insurance policy is available in the Office of International Student Affairs.

The information below includes a Summary of Insurance Inclusions and a Summary of Insurance Exclusions. Be advised the primary purpose of the group medical insurance policy is to protect students in the case of unexpected illness, accident or emergency. It is not primarily intended to provide routine or preventive medical or health care.

SUMMARY OF INCLUSIONS

The medical insurance policy generally provides the following benefits:

  • Doctor's Visit: For an unexpected injury or sickness, the medical insurance will reimburse the usual and customary cost for a doctor visit, less $20 student deductible per visit. See attached list of recommended doctors or visit any doctor of your choice.
  • Hospital Emergency Room: For visits to an emergency room at a hospital, the student pays $100 deductible per visit. The insurance company will pay 90% of other costs associated with the emergency room.
  • Hospitalization: In most cases, the insurance company will pay 90% of reasonable costs.
  • Medication/Prescription Drugs: $1000 Maximum benefit per policy year when prescribed by the attending physician. Prescriptions must be filled at a Walgreen Heal Initiatives participating pharmacy. Per prescription co-payments: $10 for Generic Drugs;$15 for Brand Names Drugs;$30 for Multi-Source Drugs
  • Chiropractic: When caused by an injury or sickness, student pays $20 deductible per visit. The insurance company will pay up to $50 per visit for three visits per week, up to a maximum of $1,000 per year.
  • Ambulance: If an ambulance is needed for a medical emergency, the insurance company will pay 100% of covered charges incurred.
  • Mental Health (outpatient services): Student pays $20 per visit. The insurance company will pay up to $3,000 per policy year for treatment for a mental health and nervous condition, and/or psychological services.
  • Evacuation: Up to $50,000 will be paid to cover costs of home country return in extreme medical emergency situations, upon approval of the insurance company. Up to $20,000 will be paid to cover the cost to return the insured person's body to the home country in the event of death. The insurance company will pay up to $1,000 for expenses incurred for the emergency reunion under certain conditions.

Moraine Valley Community College requires all international students to have medical insurance during their entire stay in the U.S. The cost is $1,044 per year ($418 each semester and $209 during the summer.) International students are automatically enrolled in a group insurance plan when they register for classes. The fee is added under "OTHER" fees payable.

Maximum Coverage per Insured Student is $250,000.

Note: This is a summary of benefits only. For a complete description, see official group policy brochure.

SUMMARY OF INSURANCE EXCLUSIONS

The group medical policy does NOT include coverage for the following:

  • Any pre-existing injury or sickness that was treated by a doctor or for which medication was prescribed within six months prior to your enrollment in the insurance plan.
  • Testing, treatment, or services for any condition in the absence of sickness or injury except as specifically provided.
  • Expenses incurred for routine physical examinations and routine chest x-rays.
  • Preventive medications, serums, immunizations or vaccines, except as specifically provided.
  • Cosmetic surgery, except as the result of a (covered) injury.
  • Acne treatments, moles, non-malignant warts or lesions, vitamins or food supplements, smoking deterrents, drugs to promote or stimulate hair growth, experimental drugs.
  • Alternative health care, including (but not limited to) acupuncture, except as specifically provided, acupressure, biofeedback, reflexology, and rolfing type services.
  • Treatment of any injury or sickness while committing or attempting to commit a felony or a crime.
    Illness or accident while participating in dangerous sports, such as hang gliding, skydiving, parasailing, speed contests, parachuting, bungee cord jumping, riding without a helmet on a motor vehicle or riding on a snowmobile.
  • Injuries incurred while intoxicated or under the influence of any drug (unless prescribed by a doctor).
  • Voluntary sterilization or any sterilization reversal process.
  • Dental treatment, except for an accidental injury to sound, natural teeth up to a maximum of $200 per tooth, $600 per occurrence. Routine dental exams, filling cavities, root canals, etc. are not covered.
  • Foot care only to improve comfort or appearance, such as care for flat feet, subluxation, corns, calluses, routine care of toenails, and the like.
  • Eye examinations, eyeglasses, and contact lenses (except for sclera shells which are intended for use of corneal bandages), including eye refractions, multiphasic testing, radial keratotomy, hearing aids or supplies related thereto, except as required for repair caused by a covered injury.

Note: This is a summary of benefit exclusions. For a complete description, see official group policy brochure.


Information for Using Your Medical Insurance

  • A list of doctors and hospitals that more easily accepts the group medical insurance is available in our office. You may choose to use one of these, or any doctor or hospital of your choice.
  • Consult a doctor for an injury or sickness, or visit the nearest hospital for emergencies. Follow the doctor's advice.
  • Be sure to bring your insurance card when you visit a doctor or hospital. Carry your insurance card with you in your wallet.
  • During a doctor's visit, you will usually have to pay the entire medical bill. If your doctor is on the preferred doctors list, they may allow you to pay your $20 co-payment rather than the entire bill.
  • Request an ITEMIZED bill from the doctor's office.
  • Complete the claim form in full with all the related information requested. Make sure to sign and date the claim form.
  • Submit your claim form and itemized bill to the insurance company within 30 days, by fax or mail. The insurance company will send you a refund.
  • If you receive additional medical bills for the same visit, send to the insurance company immediately. No additional claim form is needed.

Before mailing, be sure to make photocopies of all medical bills and the claim form, for your own records.

Mail Claim Form with all bills and receipts to:
AMA Associates
P.O. Box 659570
San Antonio, Texas 78265-9570
Telephone: 1-800-456-7480

Fax Claim to:
1-210-822-4113
The local office representative may be able to answer specific questions regarding your claim, but wait a few weeks after submission to be sure there is sufficient processing time.

Local Office:
Westpoint Insurance Company
5625 West 79th Street
Burbank, IL 60459
(800) 318-7709
Fax (708) 636-1915
terri@westpointinsurance.com


Medical Claim Procedures

To request reimbursement for expenses, you will need a copy of the medical insurance claim form. This claim form must be completed in full, and submitted to the claim office with complete documentation. On the top of the form, you must include the group insurance company name and policy number listed below: Combined Insurance Company of America. The policy number is GLB 9709600 (0810-2539) (06).

Claim Procedures

In the event of an injury or sickness, the insured person should:

  1. Consult a doctor and follow his/her advice.
  2. Submit your insurance claim form within 30 days of the accident or illness.
  3. Complete the claim form in full with all the related information requested regarding your illness. Make sure to sign and date the claim form.
  4. Attach all bills from the accident or illness, and any paperwork from your doctor, the hospital and/or other insurance companies.

For prescription drug claims, attach the itemized doctor/hospital bill along with the receipt from the pharmacy for the drug, along with the name/description of drug.

Mail Claim Form to:
AMA and Associates
P.O. Box 659570
San Antonio, Texas 78265-9570
Telephone: 1-800-456-7480
Fax: 1-210-822-4113

Local Office:
Westpoint Insurance Company
5625 West 79th Street
Burbank, IL 60459
(800) 318-7709
Fax (708) 636-3915
terri@westpointinsurance.com