EDUCATE ADVOCATE EMPOWER INTERNATIONAL STUDENT INSURANCE INFORMATION Relation insurance administrators SANTA MONICA COLLEGE HEALTH SERVICES by FAUZIA HASSAN RN,bsn,phn EDUCATE ADVOCATE EMPOWER

Relation insurance administrators Access to care Eligibility OPT (practical training) Dependents Refunds referral claim and filing a claim PPO (preferred provider network) Urgent care facilities emergency and what do Is there a co-pay for my Doctors visit? Who do I contact if I have any questions pertaining to my health insurance?

Access to Care Student Health Services Center (SHSC) For illness and injuries and to obtain a referral. Center for Wellness and Wellbeing (CWW) For mental health concerns and referral. Doctor’s office For illness, health concerns with a referral. Urgent Care For an urgent issue with a referral. Hospital For surgery or medical emergency’s only. Please visit www.renstudent.com/smc to down load ID cards and or claim forms.

ELIGIBILITY International students, visiting faculty, scholars or other persons with a current passport or student visa (F-1, J-1 or M-1 visa) Students who have paid their required premium (insurance fee) and their name, student number and date of birth must have been included in the declaration made by the college or the Administrative Agent to the insurer. Covered students must actively attend classes for at least the first 31 days of the period for which coverage is purchased, except in the case of medical withdrawal. For questions, please contact Relation at 1-800-537- 1777

PRACTICAL TRAINING STUDENTS (OPT) Must submit to Relation the following: An enrollment form and payment (by mail) within 30 days of the termination date of the immediately preceding term. Proof of Practical Training (either a copy of their Employment Authorization Card or an official letter from the college stating their OPT dates). Please note, students engaged in OPT are not eligible to use the Students Health Services, therefore, the Deductible can not be waived under any circumstances. For questions please call Relation at 1-800-537-1777

DEPENDENTS Spouse (husband or wife) living with the covered student; or unmarried children under the age of 26 years. Eligible dependents must be enrolled by the Deadline Date or within 31 days of birth, adoption, marriage, or arrival in the U.S. or termination of other insurance coverage. A newly acquired dependent child will be covered under Policy for the first 31 days after birth; or the earlier of: effective date of adoption of the child; or the date of placement of the child for adoption. Benefits will be the same as any other covered person who is the child’s parent. To continue the coverage the covered student must within 31 days after the birth, adoption or placement for adoption: Apply to the company in writing Pay the required additional premium. If not coverage ends at day 31.

REFUNDS No refunds for insurance will be permitted unless: You are withdrawing from Santa Monica College and returning to your home country---airline ticket must be presented. You are transferring to a different U.S. university or college---- documentation may be requested. You are a covered student entering the armed forces. Refunds will be pro rated and issued upon request from the school. No refunds will be given if you purchase other insurance after the semester begins.

COVERAGE SCHEDULE BEGIN END DEPENDENT ENROLLMENT DEADLINE FALL 08-24-2018 02-10-19 Check with insurance WINTER 01-02-19 SPRING 02-11-19 08-26-19 SUMMER 06-17-19

STUDENT HEALTH SERVICES REFERRAL REQUIREMENT DOCTOR’S OFFICE ACU PUNCTURE URGENT CARE Students covered by the insurance must first get a referral form from the Student Health Services. The covered student must visit the Student Health Services for care prior to seeing a Doctor or receiving care off-campus unless its an Emergency.

Referral and Claim forms This is a sheet of paper documenting medical need that you the individual will take with you to see the doctor. It is obtained by visiting the student health office. Claim form: This is a sheet of paper that can be downloaded from www.4studenthealt h.com Use a claim form for out of network providers if needed.

REFERRAL’S WAIVED UNDER THESE CIRCUMSTANCES/SITUATIONS REFERRAL WAIVED DUE TO: Medical emergency. The covered student must return to Student Health Services for follow up care. When Student Health Services is closed. When service is given at another facility during school break or vacation periods. Medical care received when the covered student is more than 50 miles from campus.

PREFERRED PROVIDER ORGANIZATION PPO: Preferred Provider Organization This is a network of Doctors and hospitals approved by the covered student’s insurance to provide care to the covered student. Covered students not using the PPO provider network will be responsible for 30% of the eligible expenses. However, if treatment is received in a non PPO facility due to an emergency medical condition, benefits for eligible expenses are payable at the PPO level. For a complete listing of PPO provider network Hospital and Doctor facilities visit www.myfirsthealth.com or call 1-800-226-5116

OBTAINING/GETTING MEDICAL TREATMENT. Get the Referral form from SHS Select a provider within the PPO network by either calling 1-800-226- 5116 or going to the website www.myfirsthealth.com. Call provider to make an appointment. Verify coverage with the provider and with your insurance company by calling 1-800-226-5116. At the provider’s office present your insurance card, $25 and the referral.

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Send forms/paperwork to: Filing A Claim After receiving treatment complete the claim form: Answering all the questions, sign and date the form. Attach medication bill’s/receipts. Keep copies for your own records. Submit forms/papers as one package. For help contact International Student Counseling Center. Send forms/paperwork to: Personal Insurance Administrators, Inc. P O Box 6040, Agoura Hills, CA 91376

IMPORTANT NOTICE For More In depth and Up To Date Information check out PIA’s website at: www.4studenthealth.com/smc or call Denise or Sharif at 1 310 394 0440. You can down load claim forms, ID cards and or brochures from www.4studenthealth.com/smc if needed. For questions regarding eligibility, benefits or claims: Personal Insurance Administrators, Inc. P.O.Box 6040 Agoura Hills, CA 91376 1-800-468-4343 www.piaclaims.com Plan Underwritten by: National Union Fire Insurance Company of Pittsburgh, Pa. Policy Number CHH0058772 NO COST LANGUAGE ASSISTANCE SERVICES You can get an interpreter and get documents read to you in your language. For help call the number listed on your insurance card or 1- 800-468-4343

SMC STUDENT HEALTH SERVICES Fall Hours: 7:30am-6:00pm Monday–Thursday 7:30am-3:00pm Friday Telephone 1 310 434 4262 To Receive service at the health office you need to have paid your health fee of $19 spring and Fall, $16 summer and winter; and have your student ID card. ADMINISTRATIVE AGENT: Relations Phone: 1-800-537-1777 Monday-Friday, 8:00 a.m. to 5:00 p.m. Available on campus at International Education Counseling by appointment.