ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES A CCIDENTAND

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES A CCIDENTAND S ICKNESS P ROGRAM FOR E XCHANGES( ASPE ) H EALTH B ENEFITS P LAN Academic Exchange Grantees in the United States

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Health Benefit Plan Ø ASPE is not an insurance policy § Limited health benefits plan Ø Self-funded through U. S. Dept of State Ø Administered by Seven Corners, Inc.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Eligibility Ø Dates on ID card § 24/7 coverage in your “host” country § ASPE will not cover you outside of your host country on personal leave/vacation § Example: Grantees host country is the United States, the grantee will not be covered by ASPE for personal leave, vacation/holiday outside the United States to include Canada and Mexico.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Eligibility Ø Leave of Absence § Not covered by ASPE Ø Travel outside “host country” § Covered if approved by ECA and IIE/LASPAU/AMIDEAST as part of your academic program

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Primary or Secondary Ø If ASPE is your only coverage—ASPE is primary § Contact Seven Corners for any questions related to your ASPE coverage Ø If you are covered by a University Insurance Policy— ASPE is secondary § Use your insurance policy for all medical treatment. § Medical bills not paid by your insurance policy can be submitted to Seven Corners for processing as long as the medical treatment is not for a pre-ex condition. § Call Seven Corners customer service if you need help.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Coverage Ø $100, 000. 00 maximum per covered sickness or per injury Ø Medevac coverage Ø Repatriation coverage

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Co-pay Ø ASPE requires all exchange grantees to pay a $25. 00 co-pay for office visits and a $75. 00 copay for emergency room visits. The co-pay is printed on your ID card and will be due at the time-of-service for: § § Office visits Emergency rooms Urgent care Hospitalizations $25. 00 co-pay for office visits

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Pre-existing clause Ø The condition originated prior to your grant start date. Ø You consulted a physician about the condition before your start date. Ø You received treatment or medication for the condition before your start date. Ø The medical condition would have caused a prudent person to seek advice or treatment before the start date.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Exceptions to Pre-ex Ø Pregnancy Ø Prescription Medications § Prescription medications are not subject to the pre-existing clause; only medical conditions § Diabetes § office visit, blood tests would not be covered § medication such as Insulin, and syringes are covered § the Insulin pump is an exclusion and would be covered

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Benefit Limitations Ø ASPE does not cover the following: § Dental care—all dental care including routine* § Vision care—routine eye exams or glasses/contacts not covered* § Routine examinations—any type of routine medical care is not covered § Immunizations/vaccinations*

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Exceptions Ø Dental exception § Only treatment for the emergency alleviation of pain will be paid and the maximum allowed is $1000. 00 per benefit year. § Call Seven Corners customer service for help in finding a dentist.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Exceptions Ø Vision (eyes) exception § If you are in an accident and your eyeglasses/contacts are damaged, ASPE will replace or repair your eyeglasses or contacts; the maximum limit is $300.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Exceptions Ø Covered immunizations/vaccinations: § Measles, Mumps, Rubella (MMR), Polio, Varicella, Tetanus, Diphtheria, Pertussis, Quadrivalent Human Papillomavirus Vaccine (HPV), Hepatitis A Vaccine, Hepatitis B Vaccine, Meningococcal Tetravalent (Meningitis), Influenza, Pneumococcal Polysaccharide Vaccine and Tetanus booster—only if booster is required by the University. In addition, Hepatitis C and Tuberculosis skin tests (PPD) are also covered.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Perilous Activity—not covered Sky diving Bungee jumping Scuba diving Rock climbing

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Seven Corners Ø Administers ASPE plan § Download a copy of the Benefit Guide § Process claims § Customer service § Eligibility—enrollment § Prescriptions § www. usdos. sevencorners. com § My. Plan (secure website)

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES www. usdos. sevencorners. com

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES https: //myplan. sevencorners. com

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES https: //myplan. sevencorners. com Click on Setup New Account

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES https: //myplan. sevencorners. com Enter your ID number you received from IIE Enter your Date of Birth, you must use the format shown mm=month dd=day yyyy=year

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Virtual ID Card—pdf file

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Customer Service Ø Staffed 24/7 § Call toll free 1 -800 -461 -0430 § E-mail: usdosinfo@sevencorners. com § § § Find a doctor or hospital Questions about ASPE or medical bills Need forms For hospitalization/surgery For treatment of dental pain

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Provider Networks Ø ASPE uses a preferred provider network for medical care § First Health Network— http: //firsthealth. coventryhealthcare. com/locatea-provider/index. htm

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Provider Search

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Claim Form Ø If you use a provider network you do not have to file a claim form; the provider will bill Seven Corners directly. § The address for Seven Corners is on the back of your ID card

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Claim Form Ø If you do not use a provider network payment might be required upfront or the provider will bill you. You will need to file a claim form and you will be responsible for the difference in costs for using an out-of-network provider. § Claim form may be found in back of Benefit guide or online at: www. usdos. sevencorners. com

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Pharmacy Network Ø Catamaran Ø www. catamaranrx. com § Paid prescriptions—show your ID card with a written prescription at the pharmacy § Start date on ID card is the start of your ASPE coverage and your prescription coverage § If you are not in the prescription system please contact Seven Corners customer service Ø To find a pharmacy: § Go to www. usdos. sevencorners. com or go directly to www. catamaranrx. com to register and access a list of in network pharmacies Ø Call Pharmacy Member Services at 1. 800. 531. 6351 § Exclusions to the prescription program are on page 22 of ASPE Benefit Guide

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES To Fill a Prescription § Start date on ID card is the start of your ASPE coverage and your prescription coverage § Give your ID card to the pharmacy; the information to fill your prescription is on the back. Exchange Grantee Name Unique ID number 06/01/2012 to 05/31/2013 Citizen Country

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Prescription or OTC Pharmacist Over the Counter (OTC)

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES OTC=Over the Counter Ø ASPE does not cover OTC medications § OTC are items such as: aspirin, ibuprofen, cough suppressants, band-aids, topical ointments; anything you can pick up off the shelf.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Reimbursement Ø If you are not in the system you can pay for your prescription out-of-pocket and get reimbursed § Download a copy from www. usdsos. sevencorners. com § Catamaran Prescription Drug Claim Form

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Medical Care ØCampus health center ØPrimary Care Provider ØCVS Minute clinics, Walmart Clinics, Target Clinics ØUrgent Care Center ØEmergency Room

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Primary Care Provider Ø Primary Care Providers are physicians who deliver basic care for common illnesses. They are your first stop for most undiagnosed health concerns. § Physicians Assistants (PA) can also treat and diagnose your symptoms Ø When to go § You should visit a primary doctor or PA for illnesses such as colds, flu, and sore throats; minor injuries, aches, and pains. § Check the network for doctors nearest you

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Urgent Care Ø Urgent Care Center § If your primary care physician is not available and you need quick medical attention for a non-life-threatening problem, visit an urgent care center. § Urgent care centers have comprehensive quality care on a walk-in basis with extended hours. Ø When to go § Go to an urgent care center when you need immediate medical attention or have non-emergency health concerns after hours. Examples include ear infections, sprains, simple cuts and burns, and eye injuries.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Emergency Rooms Ø Life-threatening emergencies and late-night trauma require an immediate visit to the ER. § Triage—life threatening cases first… Ø When to go § Call 911 whenever conditions cause severe symptoms and/or put your health at serious risk. Examples include heart attacks, poisoning, severe bleeding, unable to breathe, and broken bones.

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES Dependents Ø ASPE only covers the grantee! § Grantees with dependents are required to purchase a health insurance policy § Suggested websites for information and quotes § www. sevencorners. com (commercial side) § www. insubuy. com § www. squaremouth. com

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES