STUDENT ACCIDENT AND SICKNESS INSURANCE PROGRAM


Valley
Preferred

Underwritten by:
National Union Fire Insurance
Company of Pittsburgh, PA

Insurance Check

VALLEY PREFERRED

The Cedar Crest College Student Accident and Sickness Insurance Program is utilizing the Valley Preferred PPO network. Valley Preferred is a local preferred provider organization with 20 hospitals and over 3,200 physicians. When an insured seeks treatment from a Valley Preferred provider or facility, they can maximize their savings.

Cedar Crest College requires basic accident/sickness insurance coverage for all full time students. If you have no other coverage, you will be charged for and will be covered by this Plan.

In the event you have your own coverage, please complete the Insurance Waiver/Election Form and return it to the Student Accounts Office. Without a completed waiver form, you will be billed $371 on your fall invoice, and will be covered by this Plan. If you begin your studies in spring, you will be billed $245 for coverage from January 12, 2007; expiring August 12, 2007. Call (610) 606-4602 with any questions you may have.

DEFINITIONS

Injury: Means bodily harm caused by an Accident occurring while the Policy is in force and which results directly and independently of all other causes in loss covered by the Policy.

Sickness: Illness, disease or pregnancy, which occurs and causes loss commencing while the Insured Person is covered under the Policy.

Reasonable & Customary Expenses: For any necessary services and supplies required for treatment. The lesser of (a) the charge regularly made for it and accepted as payment in full by the provider who furnishes it, and (b) the charge ordinarily made for it by the majority of providers of such service where the service is received, as determined by the Company.

Physician: Means any person who is licensed under the laws of the Commonwealth of Pennsylvania for the practice of Medicine, Osteopathy, Dentistry, Chiropractic or Podiatry.

Insured Person: Means any student or dependent (if eligible) who is insured under this policy.

HOME HEALTH CARE BENEFIT

If the insured has been confined to a hospital for at least three days as a result of a covered sickness or injury, subsequent, Home Health Care Expenses will be covered as set forth in the Policy.

PAP TEST AND MAMMOGRAPHY

Coverage will be provided as mandated by the Common- wealth of Pennsylvania Insurance Laws. Abnormal PAP: Treatment is limited to Usual and Customary charges to a maximum of $500 in anyone policy year.

IMMUNIZATIONS

Covered at the College Health Office, subject to Usual and Customary. Hepatitis vaccines are specifically covered at one per year/per student to a maximum benefit of $50, subject to Usual and Customary.

IMPACTED WISDOM TEETH

Expenses for the removal of impacted wisdom teeth are covered to a combined $400 Maximum for all charges.

MEDICAL BENEFIT PLAN COVERAGE

Coverage is in effect 24 hours a day starting August 12, 2006, at 12:01 AM, local time, or the date of application, whichever is later. The Plan covers injuries sustained and sickness contracted and causing loss, commencing during the plan period. The Plan expires August 12, 2007 at 11:59 PM, local time: (This Plan cannot establish physician fees, and therefore, cannot guarantee that payments made by the insurance company will cover all physician and surgeon charges in full.)

ACCIDENT EXPENSE BENEFIT

The Company will pay benefits, for the Reasonable and Customary Expense for treatment of an Accidental Injury, which occurs while this Policy is in force as to an Insured Person, to a maximum aggregate benefit of $4,000 for anyone Injury. Included are expenses incurred due to: (a) medical treatment by a physician, surgeon, dentist or registered nurse; (b) hospital services; (c) X-Ray's; or (d) use of an ambulance. The initial treatment must be rendered within thirty (30) days of the Accident and benefits are limited to treatment received within 52 weeks of the date of the accident. Treatment for injury to Sound Natural Teeth is limited to $500 maximum. Prescription drug expense is limited to $50.

ACCIDENTAL DEATH

$1,000 payable when injury results in loss of life.

ACCIDENTAL DISMEMBERMENT

$1,000 payable per plan schedule if dismemberment occurs within 180 days of the Accident.

SICKNESS BENEFITS

Benefits will be paid for expense incurred within 52 weeks from the date of first treatment to a maximum of $4,000 per anyone sickness, subject to the following schedule:

  • Hospital Room and Board: Semi Private room rate to $125 per day.
  • Hospital Miscellaneous Expenses (during hospital confinement): up to $1,100 for all charges combined including X-rays, tests, anesthesia, operating room, medication and dressings.
  • Ambulance Expense: $350
  • Hospital Out-patient Miscellaneous Medical Expenses: $350
  • Surgical Allowance: up to 80% of the Usual and Customary Charge not to exceed $1,500.
  • Physician's Visits: starting with the first visit will be paid up to $30 per visit, limited to one visit per day, not to exceed $400 for anyone sickness.
  • Psychotherapy: starting with the first visit, up to $45 per visit. Maximum of $250.
    Ambulance: expense incurred up to $50 for any one sickness.
  • Prescription Drug Expense: $50 per sickness.
  • Alcohol Treatment Benefit: Expense for the treatment of alcoholism as prescribed by a doctor of medicine will be covered to the same extent as any other sickness, except that confinement is limited to 30 days.

SUPPLEMENTAL MEDICAL EXPENSES

After paying $4,000 in basic benefits under either the accident of sickness provision of the Plan for anyone Accident or Sickness, the Plan will pay 80% of the expenses incurred in excess of $4,000, up to but not exceeding $21,000 for a physician's services, hospital confinement, nursing services, X-rays, operating room, emergency room, anesthesia, laboratory services, dressing prescription medicines, casts, use of wheel chair, crutches, or ambulance for anyone accident or sickness. Expenses must be incurred within one year from the date of accident or first treatment of sickness.

EXCLUSIONS

This plan does not cover:

  1. Health services which are furnished by the Policyholder except as provided herein.
  2. Health treatment or examinations where no injury or sickness is involved, except PAP test and mammogram as outlined in the Policy.
  3. Injury or sickness for which the Insured Person is entitled to benefits under any Worker's Compensation Act or Law or similar legislation, or medical expenses covered under any Automobile Reparations Reform act, or Automobile No-Fault Law, or similar legislation.
  4. Injuries resulting from air travel except as a fare paying passenger on a scheduled airline.
  5. Eyeglasses, eye examinations or fitting of glasses.
  6. Dental treatment except for Injury to sound, natural teeth except as otherwise provided herein.
  7. Elective surgery: treatment or preventative medicines; cosmetic surgery unless performed in conjunction with a covered loss.
  8. Tackle football in any form.
  9. Intentional self-inflicted injuries, suicide, or attempt thereat whether sane or insane.
  10. Loss sustained or contracted as a direct result of being under the influence of any narcotic, hallucinogenic agent or drug, unless administered on the advice of a physician.
  11. Injuries sustained as a result of snow skiing of any kind.
  12. Injury resultant from excess or illegal consumption of alcohol.
  13. Injuries sustained during the play or practice of inter- collegiate athletics or travel connected therewith.
  14. Treatment in any Veterans Administration or Federal Hospital except if there is a legal obligation to pay; service in the armed forces of any country, and war or any act thereof, declared or undeclared.
  15. Any expenses for:
    • services rendered by employees or physicians retained by the Policyholder;
    • use of the Policyholder's facilities;
    • service or treatment rendered by a physician or nurse who is the insured person or a member of his or her immediate family.

GENERAL PROVISIONS

Benefits under this Plan are payable in addition to those paid under any personal policy, with the exception of benefits for which the Insured Person is entitled under any Worker's Compensation Act or Law or similar legislation or under any Automobile Reparations Reform Act or Auto- mobile No-Fault Law or similar Legislation.

CLAIM PROCEDURES

In the event of injury or illness, students should contact the College Health Office at once for full instructions. All claim payments are made from Diversified Group Administrators, Inc. Proof of loss must be submitted within 90 days following the date of accident or start of sickness.

PREMIUM

STUDENT ONLY………$371

Direct all Claim Inquires to:

Diversified Group Administrators
P.O. Box 6540
Harrisburg, PA 17112
(800) 427 -9308

Marketed by:

T.L. Groseclose Associates, Inc.
190 Tamarack Circle
Skillman, NJ 08558
(609) 279-1500

Underwritten by:

National Union Fire Insurance Company of Pittsburgh, PA

 


This brochure describes the features of the plan in general terms and is subject to the provisions of the Master Policy, which is subject to the approval of the State Insurance Department. Any state statute, state mandated benefit, policy provision or exclusion which is in conflict with the laws of the state in which this brochure is utilized is automatically amended to conform with the laws of that state.