Student Insurance

◊ Go to the Campus Student Health Services first. Go to their website at www.cerritos.edu/shs to find out their hours of operation and further information.

◊ If the Health Center cannot treat you, refer to the Student Insurance Company website @ www.studentinsuranceusa.com to locate a Medical Provider in the PPO Network. You may be referred to one of the designated medical facilities below by the Student Health Services.

◊ You must tell your doctor to mail all medical (HCFA 1500 form) and hospital (UB 92 form) bills along with

your: Name, address, social security number or school I.D. number and the name of your college to the claims address below.

◊ A CLAIM FORM IS NOT REQUIRED FOR FILING A CLAIM.

IF THE HEALTH CENTER IS CLOSED:

◊ Locate a PPO Medical Provider at: www.studentinsuranceusa.com, click on INTERNATIONAL PLANS, click on the State of CALIFORNIA, then click on FIND A DOCTOR.

◊ Go to one of the designated medical facilities below.

◊ Tell the doctor’s office or hospital to include with the medical bills (HCFA-1500 form/UB 92 form) and send to:

STUDENT INSURANCE

P.O. Box 809025

Dallas, TX 75380-9025

(800) 767-0700

claims@studentinsurance.net

◊ Be sure to file claims within 30 days of Injury or first treatment for a Sickness. Bills must be received by the Company within 90 days of service. Bills submitted after one year will not be considered for payment.

◊ Please make copies of all documents for your records.

◊ If you have any questions or receive bills or any other correspondence at your address, bring them into the International Student Center for information.

DESIGNATED FACILITIES:

PIONEER MEDICAL GROUP

16510 Bloomfield Ave

Cerritos, CA 90703

(562) 229-0902

HOURS: Mon-Tues-Wed: 8am-7pm

Thurs-Fri: 8am-6pm

PIONEER MEDICAL GROUP

2220 Clark Avenue

Long Beach, CA 90815

(562) 597-4181

HOURS: Mon-Tues-Thurs: 8am-8pm

Wed-Fri: 8am-6pm

PIONEER MEDICAL GROUP

11480 Brookshire Avenue

Downey, CA 90241

(562) 862-2775

HOURS: M-TH: 8am-8 pm

Fri: 8am-6pm

PIONEER MEDICAL GROUP

10251 Artesia Boulevard

Bellflower, CA 90706

(562) 867-8681

HOURS: Mon-Wed-Fri: 8am-7pm

Tues-Thurs: 8am-5:30 pm

POLICY #2007-200473-4

Coinsurance: 100% in-network / 80% out of network

Co-pays: $20 doctor office visit (waived with Health Center referral) / $20 specialist visit / $20 Lab & X-ray

$20 Test & Procedures / $20 Radiation & Chemotherapy / $20 Consultation office visit

ER visits: $50 co-pay / waived if admitted

Prescription Drugs: $10 co-pay – Tier 1 / $25 co-pay – Tier 2 / 50% - Tier 3

Deductibles: In-Network: $0 Student / $100.00 Dependent / Out of Network: $200.00 per insured

Cerritos College

ISC