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St. Cloud State University

St. Cloud State University

Student Health Services

Student Insurance Information - Frequently Asked Questions

This is a composition of the Mega Life Insurance FAQs. Created and distributed by Heather Oehrlein, Student Insurance Advocate. The purpose of the Student Insurance Advocate is to educate students and staff throughout MnSCU about the insurance and help students with questions, problems, and concerns with the insurance. This information is to be used only as a resource, not as a guarantee for payment.

  1. Why do we need health insurance?
  2. Why was Mega Life Insurance selected as the Insurance carrier?
  3. Why has the insurance costs gone up?
  4. Where to go for medical care?
  5. Services the insurance will NOT pay for.
  6. Additional, optional coverage.
  7. Preferred Allowance and Usual & Customary (U&C) Charges
  8. How to read your bills and EOB (Explanation of Benefits).
  9. Pre-existing conditions.
  10. How to reduce out-of-pocket expenses
  11. International student's Residency Application Medical Exams (International Students ONLY)

1. Why do we need health insurance?

  • There is high quality health care in the US; however, it can be very expensive at times.
  • Health insurance offers some protection against these high prices.
  • If you were to get seriously ill or hurt you could seek medical attention with less worry of excessive financial strain.

2. Why was Mega Life Insurance selected as the Insurance carrier?

There are three main reasons why Mega Life was selected:

  • Cost. MnSCU has a committee that screens different insurance companies to ensure that you receive the best coverage for the lowest price. We understand that money is very tight for students; however, it is very important that students receive proper medical care.
  • Repatriation. In the unlikely event of a student’s death, repatriation will ship the student’s remains back to their home country.
  • Medical Evacuation. Medical Evacuation is when a student is critically ill and needs medical transportation back to their home country.

Repatriation and Medical Evacuation are crucial pieces of this insurance because they are not readily available in other insurances that students could purchase individually. Due to many regulations both of these are very expensive. If these were not covered by the insurance you the student, your family or the school you attend may be held liable for these costs. Therefore the insurance is another form of protection for you.

3. Why has the insurance costs gone up?

Students have requested more benefits; because of this demand additional benefits have been added to your insurance. The more benefits students receive the higher the premium price. Along with the additional benefits, the cost of health care (in general) has gone up, this also increases the cost of insurance.

“ New” Additional Benefits for the Health Insurance - Effective 2003/2004 policy

  • One Physical per year (available only at the on campus Health Services)
  • STD Screening: Chlamydia, HIV, and HPV ONLY (available only at the on campus Health Services)
  • Acne treatment: there will be a pharmacy cap on this (available only at the on campus Health Services)
  • More clinic choices (Network changing from ProAmerica to ProNet)
  • Student Insurance Advocate: to help with any problems, questions, or concerns with the insurance

Changes to the existing plan:

There will be a $50 deductible (both international and domestic plans) anytime you are seen outside of the campus Health Services without a referral from the Health Services. With a campus Health Services referral the deductible will only be $25 for covered services.

4. Where to go for medical care?

  • If you have a Student Health center on your campus always go there first for care and prescriptions. The insurance will pay 100% of the bill if it is a covered service (covered service- most injury and illness services, specified in insurance policy).
  • If there is no Student Health Center on your campus you can go online to www.medica.com/C10/SelectCare/default.aspx to find a provider near you.  Click the "find a doctor" (left side) - Network select option (drop down list)- Select Care PPO.  When you use any clinic or pharmacy other than the Student Health Center you will be charged a $50 deductible (Deductible- amount of money that must be paid by you, the student, before any bills will be paid by the insurance company). You will also be responsible for 20% of the total bill.
  • GOOD NEWS! New this year Metro Area Community/Technical College students can use the Boynton Health Center (U of M campus) for$10 co-pay (for covered services).
  • The reason students without a Health Center are charged more is that students who attend Universities with a Health Center, pay student activity fees that help fund the Student health Center.

5. Services the insurance will NOT pay for:

  • The insurance will not pay for anything preventative including:
  • Vaccines
  • Dental (Unless an injury to natural teeth)
  • Eye exams

The reason the above are not covered is because the insurance plan is Accident & Illness only. Preventative care is very expensive and the insurance would cost more if it were included in the policy. If you are unsure if something will be covered under the insurance ask. You can contact me directly (hloehrlein@stcloudstate.edu) with these questions and if I don’t know the answer I will find out for you.

6. Additional, optional coverage:

  1. Dental insurance is available as an optional add-on. Additional information is available at http://www.studentresources.net/college/DentalPlan.aspx and click on the dental insurance (left hand side).
  2. Vision insurance information is available as an optional add-on. Additional information is available at: http://www.srvisionplan.com/. For both of the above policies (Dental & Vision) please read the policy carefully, make sure to check out where the nearest providers are located. If you have any problems with either of these policies please contact the companies directly. I will not be able to help if any billing problems come up.
  3. You are able to purchase insurance for your children or spouses. Keep in mind that this is the same Injury & Illness plan that you have (no preventative).

7. Preferred Allowance and Usual & Customary (U&C) Charges:

Q. Why doesn't the insurance company give us exact prices in the brochure instead of Preferred Allowance or U & C?
A. There is really no way to put the Preferred Allowance or U&C amounts in the brochure. These brochures are printed for all of MnSCU (MN State Colleges & Universities). There are so many different CPT codes (numbers used for coding a procedure), and zip codes (zip codes are needed because the U&C charges are different throughout Minnesota) it cannot be done.

Q. How can I find out ahead of time if an expensive procedure will be covered?
A. Get the CPT code from the doctor along with the doctor's tax ID # or the zip code and call the insurance company 1-888-251-6243, they will give you a pre-treatment estimate.

About Preferred Allowance:
When you go to a network provider (www.providernetworks.com or 1-800-462-7554) the network and insurance company have already pre-arranged the allowable charges (how much the provider can charge or what discount percentage they will take). Because this is pre-arranged you, almost always, save money when you use a network provider. The $50 deductible and 20% of the total bill does still apply.

Please keep in mind that this is not a guarantee of payment. The doctor could change something during the procedure, which would make the original estimate null and void. There are also exclusions like pre-existing conditions, congenital, etc. that may apply. Unfortunately with Insurance you, almost, never know exactly what will be paid, until after the procedure and billing are done.

8. How to read your bills and EOB (Explanation of Benefits).

Q. Why do I receive a bill right after my visit with the provider and they have not sent it to my insurance?
A. For the most part providers usually send patients a bill showing what the charges were for the procedure. On this bill it should say something about billing this to insurance; if there is nothing like that you should contact the clinic's billing department and give them your insurance information found on your card. Keep this bill for your records.

Q. Why am I getting a bill from the insurance company?
A. The insurance never sends you a bill. What you are receiving is an EOB (explanation of benefits). This tells you what the provider billed for a service, how much the service was, any discount that is applied, how much the insurance company paid, and what your remaining balance is.

Q. Should I send in payment when I receive my EOB?
A. Usually the provider will re-bill you for the remaining balance after the insurance has paid. If you have not received another bill within a month of receiving your EOB you should call the provider and ask if a bill has been sent or will be soon.

Please keep in mind that sometimes when you are seen at a clinic or hospital there may be more than one bill even though you are only seen once. The separate bills could be from x-rays (Radiology), lab work, physician's fee, supplies/equipment, anesthesia, etc. With these bills you will also receive a corresponding EOB from the insurance company.

9. Pre-existing conditions.

Pre-existing condition- Any condition which originates, is diagnosed, treated or recommended for treatment within the 6 months immediately prior to signing up for the insurance. What this means in “non-insurance terms” is that if you have any kind of injury or illness that has been going on six months before you sign up for the insurance, even if you’ve never seen a doctor for this reason, it may be considered a pre-existing condition.

There is NO COVERAGE for pre-existing conditions under the Domestic policy for the first 6 months of the plan. For the International plan the insurance company will pay a maximum benefit of $500 for pre-existing conditions for the first 6 months of the plan. After the six months has passed, pre-existing limitations are dropped and the insurance should pay according to the insurance policy. The insurance will not go back and pay on any previous charges for these conditions.

10. How to reduce out-of-pocket expenses

  • When you decide to go to the doctor keep in mind that not all conditions will be covered under the MnSCU accident/illness insurance plan.
    There is NO preventative coverage, such as: sleep disorders, hair loss, immunizations, screenings, etc.
  • If you are unsure of what is going to be paid, CHECK AHEAD OF TIME! This can be done by emailing Heather at hloehrlein@stcloudstate.edu or calling Student Resources Insurance at 1-888-251-6243.
    It is much easier to get an explanation than to try and fix a problem later.
  • When selecting a clinic, the most cost effective would be Boynton Health Services at the U of M. When you use Boynton there will be a $10 co-pay (co-pay: the amount of money that must be paid by the patient. The insurance company will not pay this amount).
    (In an emergency use a hospital/clinic near you).
  • If you are being referred to another doctor, find out what you are being sent for and contact Student Resources Insurance at 1-888-251-6243 to find out if this is a covered service and how much they will pay. If you are confused by their answer please feel free to contact Heather at hloehrlein@stcloudstate.edu.
  • NEVER throw away a bill and assume the insurance will take care of it. Always check with the clinic that sends you the statement to make sure they have your insurance information. Usually there will be some out-of-pocket expense, however, if the bill seems to be quite a bit larger than what you expected to pay, contact Student Resources Insurance at 1-888-251-6243 or Heather at hloehrlein@stcloudstate.edu.

Keep in mind that Health Insurance should be thought of as similar to Car Insurance: both will cover in the event of accident; however there will still be some out of pocket expenses. In the Webster’s Dictionary the definition for insurance is: a means of guaranteeing protection or safety. That is exactly what this insurance was designed to do. It will not cover everything; however, it will cover when you absolutely need it. The price of your insurance reflects this; an example of this would be the all-inclusive insurance plans (available through employers). These plans would cover just about everything (including preventative), however, they would cost you around $5,000. You can see that there is quite a bit of difference between the costs and coverage of the all-inclusive plans versus the MnSCU accident/illness plan.

11. International student's Residency Application Medical Exams (International Students ONLY)
Green Card or U.S. Residency application medical exams or any medical exam that is required by the BCIS will not be covered by the mandatory Student Insurance.  In most cases the medical exam has to be done by a Civil Surgeon (Campus Health Services is NOT a Civil Surgeon provider), please check online http://uscis.gov/graphics/services to find the specific requirements.

Thank you
If you have any questions or concerns about this please feel free to email me at hloehrlein@stcloudstate.edu

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