Cerritos College
Student Insurance
(310) 826-5688 ■ (800) 367-5830 ■ FAX (310) 826-1601
E-mail: international@studentinsuranceusa.com
Lic # 0386216
CERRITOS COLLEGE-International Students
2010-2011
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:
United Healthcare Student Resources P.O. Box 809025 Dallas, TX 75380-9025 (800) 767-0700 | Student Insurance For eligibility & benefits call: Linda Salazar For Claims call: Teresa Banuelos M-F 7:30 am - 4:30 pm (800) 367-5830or United Healthcare Student Resources 24 hours a day/7 days a week (800) 767-0700 |
◊ 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:
Santa Fe Springs Urgent Care 11460 Telegraph Rd. Santa Fe Springs, CA 90670 (562) 864-1000 M-F: 9 am - 10 pm Sat: 9 am - 3 pm CLOSED SUNDAY | Pioneer Medical Group 11480 Brookshire Ave Downey, CA 90241 (562) 862-2775 Urgent Care Hours: M-F: 6 pm - 9 pm Sat: 9 am - 5 pm Sun: 9 am - 1 pm | Pioneer Medical Group 2220 Clark Avenue Long Beach, CA 90815 (562) 597-4181 Urgent Care Hours: M-F: 6 pm - 9 pm Sat: 9 am - 5 pm Sun. & Holidays: 9 am - 1 pm | Healthfirst Medical Group 11817 Telegraph Rd. Santa Fe Springs, CA 90670 (562) 949-9328 M-F: 7:30 am - 5 pm CLOSED SAT & SUN
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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
