STUDENT ACCIDENT AND SICKNESS INSURANCE PROGRAM
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.
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.
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.
$1,000 payable when injury results in loss of life.
$1,000 payable per plan schedule if dismemberment occurs within 180 days of the Accident.
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:
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.
This plan does not cover:
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.
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.
Direct all Claim Inquires to:
Diversified Group Administrators
T.L. Groseclose Associates, Inc.
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.