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

2. 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?

3. 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 to down load ID cards and or claim forms.

4. 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

5. 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

6. 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.

7. 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.

8. COVERAGE SCHEDULE BEGIN END DEPENDENT ENROLLMENT DEADLINE FALL
Check with insurance
WINTER
SPRING
SUMMER

9. 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.

10. 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 h.com
Use a claim form for out of network providers if needed.

11. 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.

12. 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 or call

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

14. Urgent care facilities
Venice urgent care
2006 Lincoln boulevard, venice, ca 90291
West la urgent care
11600 venice boulevard, los angeles, ca, 90066
Playa vista medical center
6020 seabluff drive, suite 1, playa vista, ca 90094

15. 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

16. IMPORTANT NOTICE
For More In depth and Up To Date Information check out PIA’s website at: or call Denise or Sharif at You can down load claim forms, ID cards and or brochures from if needed. For questions regarding eligibility, benefits or claims: Personal Insurance Administrators, Inc. P.O.Box 6040 Agoura Hills, CA Plan Underwritten by: National Union Fire Insurance Company of Pittsburgh, Pa. Policy Number CHH 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

17. SMC STUDENT HEALTH SERVICES
Fall Hours:
7:30am-6:00pm Monday–Thursday
7:30am-3:00pm Friday
Telephone
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:
Monday-Friday, 8:00 a.m. to 5:00 p.m.
Available on campus at International Education Counseling by appointment.