| 
The ELCA National Health Insurance Plan
Frequently Asked Questions (2004-2005 Policy)
What is the ELCA National Health Insurance Plan and how
does it work?
The ELCA National Health Insurance Plan is an insurance plan designed
specifically for ELCA Seminarian students and their dependents. The
plan pays benefits for treatment relating to covered diagnosed sicknesses
and accidents. A benefit of $100,000 is paid per sickness and accident
for insured students. A benefit of $50,000 is paid per sickness and
accident for insured dependents
What is my Deductible?
The ELCA National Health Insurance Plan has a policy year deductible
of $300 for seminarian students. The dependent deductible is a per
diagnosis deductible of $100. These deductibles are applicable from
September to September of each academic year and do not apply to
prescription drugs.
Do I have to use certain doctors or hospitals?
The seminarian health plan utilizes the PPO’s CoalitionAmerica
and BeechStreet. Students can access their websites, which are: www.coalitionamerica.com
(using PIN# 3083) and www.beechstreet.com. (No PIN# needed) to secure
provider listings. By receiving medical care from an in-network provider
or hospital it will save the student out-of-pocket expense.
Please give an example of how my claim would be paid. For instance,
if I have to go to the doctor, how will the office visit be paid?
Office visits are payable after your deductible at 80% if you are
using an in-network provider, 60% if you are using a non-network
provider. If there are additional ex-ray and lab charges, they will
likely be billed separately and covered at the 80% benefit.
Are tests like a CAT Scan or MRI covered?
Yes, when prescribed by a physician.
What if I need to be hospitalized?
The ELCA National Health Insurance Plan will pay the semi-private
Room & Board rate across the country. Other benefits are payable
for surgeries, anesthetist, etc.
Can I go to the Emergency Room?
Yes, you may receive benefits for the emergency room. However,
there must be a diagnosed sickness or accident and it must be considered
an emergency (life-threatening).
Are benefits for psychotherapy available?
Yes. The ELCA National Health Insurance plan pays 50% of usual
and reasonable expenses incurred for counseling up to a policy year
maximum of $2500. Prescription drugs associated with this benefit
will be covered under the Walgreen’s drug card and it’s
co-pays.
Does my plan cover prescription drugs?
The plan will pay for prescription drugs when prescribed by the
attending physician and the prescription is filled through a Walgreen’s
Health Initiatives pharmacy. The prescriptions will be subject to
a per prescription co-pay: $10.00 co-pay for Generic/$40.00 co-pay
for Brand Name/$60.00 co-pay for Single Source Drugs.
Are pre-existing conditions covered in this Plan?
Yes, with the following rules: The pre-existing condition must
be an eligible benefit to the Plan. In order to receive benefits
you must provide a certificate of credible coverage from your current
insurance company and attach this to your first claim form that you
file. The certificate of credible coverage must be from a group insurance
plan. Other student plans and individual plans do not constitute
comparable coverage.
I am planning on studying abroad while I am in Seminary, will this
insurance plan cover me?
Yes, this Plan provides worldwide coverage.
How do I file a claim?
Obtain a claim form from our website which is www.specrick.com or
the www.BOP.org website. Print a Boston Mutual claim form that you
should complete, sign and date. If you have received a bill for your
medical treatment, attach that to the claim form and mail to the
Claims Administrator, Diversified Group Administrators, PO Box 6540,
Harrisburg, PA 17112
|
