Student Insurance

Student Insurance

(310) 826-5688   ■   (800) 367-5830   ■   FAX (310) 826-1601

E-mail:  international@studentinsuranceusa.com

Website: www.studentinsuranceusa.com

Lic # 0386216

How to pay health insurance

CERRITOS COLLEGE-International Students

2012-2013

International Accident & Sickness Insurance Information

WHEN YOU NEED TO SEEK MEDICAL ATTENTION FOLLOW THE STEPS BELOW: 

◊  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. 

BEFORE MAKING AN APPOINTMENT OR BEFORE YOU ARE REFERRED OUT, ALWAYS CHECK WITH THE DOCTOR, FACILITY, LAB OR X-RAY FACILITY THAT THEY ARE CONTRACTED WITH UNITED HEALTHCARE OPTIONS PPO.

◊  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: 

◊  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. 

BEFORE MAKING AN APPOINTMENT OR BEFORE YOU ARE REFERRED OUT, ALWAYS CHECK WITH THE DOCTOR, FACILITY, LAB OR X-RAY FACILITY THAT THEY ARE CONTRACTED WITH UNITED HEALTHCARE OPTIONS PPO.  

DESIGNATED FACILITIES:

POLICY #2010-200472-4                    

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

Co-pays:  $25.00 doctor office visit (waived with Student Health Center referral)

ER visits:  $100.00 Co-pay / waived if admitted (Student Health Center referral does not apply to ER visits)

Prescription Drugs:  $15.00 Co-pay – Tier 1 / $30.00 Co-pay – Tier 2 / 50% - Tier 3

Deductibles:  In-Network: $75.00 Student (waived with SHC referral)/ $100.00 Dependent / Out-of-Network: $200.00 Student/ $200.00 Dependent, per Insured