Accident and Sickness Program for Exchange (ASPE) Health Benefits Plan

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES

ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGE (ASPE)

HEALTH BENEFITS PLAN

Academic Exchange Grantees in the United States


Health Benefit PlanASPE is not an insurance policy

Limited health benefits planSelf-funded through US Dept of State


Health Benefit PlanAdministered by Seven Corners, Inc.

Seven Corners administers the program based on ASPE’s policies and procedures in benefit guide


ASPE Guide

Version 1/2011


EligibilityDates 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.


ID Card

Exchange Grantee NameID number

01/01/2010 to 12/31/2010Citizen Country

Exchange Grantee NameUnique ID number



Back of ID Card

Exchange Grantee NameUnique ID number



Coverage $100,000.00 maximum per covered sickness

or per injuryMedevac Coverage Repatriation Coverage


Co-payASPE requires all exchange grantees to pay a

$15.00 co-pay. The co-pay is printed on the your ID card and will be due at the time-of-service for:

Office visits Emergency Rooms Urgent Care Hospitalizations

$15.00 co-pay for office visits*


Benefit LimitationsASPE has a lifetime pre-existing clause for

medical conditions Had its origins (condition) prior to your start date. Consulted a physician prior to start date. Treatment or medication received prior to

start date. Condition would have caused a “prudent” person

to seek treatment prior to start date.


Exceptions to Pre-exPregnancyPrescription Medications

Prescription medications are not subject to the pre-existing clause, only medical conditions. Diabetes would be pre-ex, the medication, i.e. insulin,

and syringes would be covered


Benefit LimitationsASPE 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*


ExceptionsDental 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.


ExceptionsVision exception (eyes)

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 $300.00.


ExceptionsImmunizations/vaccinations

Vaccinations that follow the guidelines set by the American College Health Association (ACHA) which include: 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 test (PPD) are also covered.


Seven CornersAdministers ASPE plan

Process claims Customer service Eligibility—enrollment Prescriptions www.usdos.sevencorners.com MyPlan (secure website)

http://www.usdos.sevencorners.com/


www.usdos.sevencorners.com


https://myplan.sevencorners.com


Customer ServiceStaffed 24/7

Call toll free 1-800-461-0430 E-mail: [email protected]

Find a doctor or hospital Questions about ASPE or medical bills Need forms For hospitalization/surgery For treatment of dental pain

mailto:[email protected]


Provider NetworksASPE uses a preferred provider network for

medical care ChoiceCare Network—www.choicecare.com

48 states excluding New Jersey and New York Beechstreet Network—www.beechstreet.com

Only in New Jersey and New York


www.choicecarenetwork.com

http://www.choicecarenetwork.com/


Provider Search


www.beechstreet.com

http://www.beechstreet.com/


Provider Search


Claim Form If you use a provider network—you do not

have to file a claim form, the provider will bill Seven Corners


Claim Form 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 in back of guide or online

www.usdos.sevencorners.com

http://www.usdos.sevencorners.com/


Primary or Secondary If ASPE is your only coverage—ASPE is primary If you are covered by a University Insurance Policy—

ASPE is secondary


Pharmacy NetworkBeneScript

http://bsi.lc.healthtrans.com Paid prescriptions—show your ID card with

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 Exclusions to the prescription program on page 19


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.

To Fill a Prescription


Reimbursement If you are not in the system you can pay for

your prescription out-of-pocket and get reimbursed

Use claim form in back of guide or download a copy from www.usdsos.sevencorners.com

BeneScript Prescription Reimbursement Form

http://www.usdsos.sevencorners.com/

http://usdos.sevencorners.com/docs/BeneScript_PrescriptionReimbursementClaimForm.pdf

http://usdos.sevencorners.com/docs/BeneScript_PrescriptionReimbursementClaimForm.pdf


Medical CarePrimary Care ProviderUrgent Care CenterEmergency Room


Medical Care Primary Care Provider

Unless you are experiencing a life-threatening emergency, primary care centers are the best places to start.

Primary care providers are physicians who deliver basic care for common illnesses. They are your first stop for most undiagnosed health concerns.

When to go You should visit a primary care center for illnesses such as

colds, flu, and sore throats; minor injuries, aches, and pains. You can schedule appointments with primary care

providers during the week.


Urgent Care 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 similar resources to primary care facilities, but they provide comprehensive quality care on a walk-in basis with extended hours.

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.


Hospital Emergency Rooms

Emergency Room Life-threatening emergencies and late-night trauma require an

immediate visit to the hospital. Emergency rooms offer inpatient care, emergency services,

trauma services, and more. Emergency clinicians are able to recognize, diagnose, and make recommendations for a wide array of medical issues.

When to go Call 911 or drive to the emergency department at your nearest

hospital whenever conditions cause severe symptoms and/or put your health at serious risk. Examples include heart attacks, poisoning, severe bleeding, and broken bones.


DependentsASPE 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

http://www.sevencorners.com/

http://www.insubuy.com/


QUESTIONS

Documents

Accident and Sickness Program for Exchange (ASPE) Health Benefits Plan