Health Insurance designed for the International Students of the THE TEXAS A&M UNIVERSITY SYSTEM 2011-2012 Underwritten By: Companion Life Insurance Company

Health Insurance Health Insurance designed for the International Students designed for the International Students

of theof theTHE TEXAS A&M UNIVERSITY SYSTEMTHE TEXAS A&M UNIVERSITY SYSTEM

2011-20122011-2012

Underwritten By: Companion Life Insurance Underwritten By: Companion Life Insurance Company (A+)Company (A+)

Administered by: Associated Insurance Plans Administered by: Associated Insurance Plans International, Inc. (AIP)International, Inc. (AIP)

Serviced By: Dunlap Financial Services, College Serviced By: Dunlap Financial Services, College StationStation

www.TAMUInsurance.com800-452-5772800-452-5772

http://www.tamuinsurance.com/

Student Health Student Health InsuranceInsurance

We’ve got you covered!We’ve got you covered!All International Students attending TAMU-All International Students attending TAMU-College Station will be insured under the A&M College Station will be insured under the A&M 200K International Student Insurance Plan.200K International Student Insurance Plan.

Fall Semester Coverage provided to midnight on Fall Semester Coverage provided to midnight on December 31, 2011.December 31, 2011.

Spring/Summer Semester Coverage provided to Spring/Summer Semester Coverage provided to midnight on August 16, 2012.midnight on August 16, 2012.

Benefits are provided 24 hours each day, anywhere in Benefits are provided 24 hours each day, anywhere in the world.the world.

www.TAMUInsurance.com

800-452-5772



Some “insurance terms” Some “insurance terms” you you

need to knowneed to know Preferred Provider – Preferred Provider – An organization where providers are under An organization where providers are under contract to an insurance company or health plan to provide care at contract to an insurance company or health plan to provide care at a discounted or negotiated rate.a discounted or negotiated rate.

Deductible – a specified amount the insured must pay before Deductible – a specified amount the insured must pay before the insurance company begins to make any payments to your the insurance company begins to make any payments to your providers for medical treatment. providers for medical treatment.

Co-Insurance – a specified percentage the insured is Co-Insurance – a specified percentage the insured is required to pay for all covered medical expenses remaining required to pay for all covered medical expenses remaining after the deductible has been met.after the deductible has been met.

Co-Pay – a specified amount the insured must pay towards Co-Pay – a specified amount the insured must pay towards medical treatment or prescriptions.medical treatment or prescriptions.

Pre-Existing Condition - A health insurance policy provision Pre-Existing Condition - A health insurance policy provision stating that benefits will not be paid for any illness and/or stating that benefits will not be paid for any illness and/or condition that existed prior to one becoming an insured condition that existed prior to one becoming an insured under the particular health plan in question, until the under the particular health plan in question, until the insured has been covered under the policy for a specified insured has been covered under the policy for a specified period.period.


800-452-5772



Preferred ProvidersPreferred Providers 1. A.P. Beutel Student Health Center - 100% 1. A.P. Beutel Student Health Center - 100%

reimbursement for covered medical expenses treated reimbursement for covered medical expenses treated at the Health Center.at the Health Center.

2. PHCS 2. PHCS National National Preferred Provider Network - 80% Preferred Provider Network - 80% reimbursement for Network treatment.reimbursement for Network treatment.

3. Beech Street 3. Beech Street National National Preferred Provider Network - Preferred Provider Network - 80% reimbursement for Network treatment.80% reimbursement for Network treatment.

60% reimbursement for out-of-Network treatment.60% reimbursement for out-of-Network treatment.

Outside the United States the Preferred Providers are Outside the United States the Preferred Providers are not available, but benefits will be reimbursed at 80%.not available, but benefits will be reimbursed at 80%.


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DeductibleDeductible $250 each plan year ($500 for family)$250 each plan year ($500 for family)

NOTE: NOTE: The deductible is always waivedThe deductible is always waived for medical for medical treatment received at A.P. Beutel Student Health treatment received at A.P. Beutel Student Health Center.Center.


800-452-572



Co-paysCo-pays Outpatient Physician visit Outpatient Physician visit

$25 plus 20%/40% of the remaining charges$25 plus 20%/40% of the remaining charges

Urgent Care Treatment Center: Urgent Care Treatment Center: $25 plus 20%/40% of the remaining charges$25 plus 20%/40% of the remaining charges

Emergency Room (ER) visit: Emergency Room (ER) visit: $250 $250 plus 20%/40% of the remaining plus 20%/40% of the remaining

charges charges


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Co-pays and PharmacyCo-pays and PharmacyAt the Student Health CenterAt the Student Health Center $15 co-pay per 30 day supply (paid at 100% to $15 co-pay per 30 day supply (paid at 100% to

$500 per policy year).$500 per policy year).

Prescription Drug CardPrescription Drug Card: cost of prescription : cost of prescription medication to $1,000 per policy year, subject to a medication to $1,000 per policy year, subject to a co-payment per 30 day supply. co-payment per 30 day supply.

Co-pays:Co-pays: $$15 co-pay for generic15 co-pay for generic $25 co-pay for brand$25 co-pay for brand $35 co-pay for single source$35 co-pay for single source(Contraceptives are included.)(Contraceptives are included.)


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Additional BenefitsAdditional Benefits Accidental Death & Dismemberment: Accidental Death & Dismemberment: $5,000$5,000 Repatriation of mortal remains: Repatriation of mortal remains:

$15,000 for International students$15,000 for International students Medical Evacuation: Medical Evacuation: up to $25,000 up to $25,000 (advance (advance

approval required)approval required) Travel Assistance: Travel Assistance: Referrals to the nearest Referrals to the nearest

most appropriate facilities and providers - with most appropriate facilities and providers - with guarantees of payment to providers, and guarantees of payment to providers, and assistance in coordinating insurance benefits.assistance in coordinating insurance benefits.

24 hour Nurse Advice Line24 hour Nurse Advice Line


800-452-5772

$200,000 per condition$200,000 per condition

Maximum BenefitMaximum Benefit


800-452-5772

Policy LimitationsPolicy Limitations


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Note: Note: This policy provides benefits for This policy provides benefits for accidents and sicknesses. Routine care for accidents and sicknesses. Routine care for “wellness” is not covered.“wellness” is not covered.

Pre-existing conditions:Pre-existing conditions: Pre-existing conditions are covered if (1) Pre-existing conditions are covered if (1) you are 12 you are 12

months treatment free from your pre-existimonths treatment free from your pre-existing condition; ng condition; or (2) you have been continuously insured through an or (2) you have been continuously insured through an insurance plan, or through your country or government insurance plan, or through your country or government for 18 consecutive months prior to enrolling in this for 18 consecutive months prior to enrolling in this TAMU insurance plan; or (3) TAMU insurance plan; or (3) you have been continuously you have been continuously insured for 12 months under any TAMU student plan.insured for 12 months under any TAMU student plan.

Exception to pre-existing condition limitationException to pre-existing condition limitation: : MaternityMaternity

Policy Exclusions: Read your brochure carefully.Policy Exclusions: Read your brochure carefully.

How do I file a claim?How do I file a claim? 1) Secure the necessary medical treatment.1) Secure the necessary medical treatment. 2) Obtain itemized bills from your doctor or 2) Obtain itemized bills from your doctor or

other provider.other provider. 3) Complete a claim form. Make sure you 3) Complete a claim form. Make sure you

answer all of the questions or your answer all of the questions or your reimbursement may be delayed.reimbursement may be delayed.

4) Mail your completed claim form and itemized 4) Mail your completed claim form and itemized bills to bills to Administrative Concepts, Inc. Administrative Concepts, Inc.

994 Old Eagle School Road, Suite 1005 994 Old Eagle School Road, Suite 1005

Wayne, PA 19087-1802Wayne, PA 19087-1802


800-452-5772

Options for Dental & Vision Options for Dental & Vision CoverageCoverage

Discount Card Option:Discount Card Option:

low annual premium for low annual premium for pharmacy, dental, and pharmacy, dental, and vision discountsvision discounts

Participating providers Participating providers include all major vision and include all major vision and pharmacy chainspharmacy chains

No claim forms to completeNo claim forms to complete Discount is immediate at the Discount is immediate at the

time of servicetime of service

Dental & Vision Insurance Dental & Vision Insurance Option:Option:

Choice of 3 plans with Choice of 3 plans with different different

co-insurance optionsco-insurance options Choice of $1,000, $1,500 or Choice of $1,000, $1,500 or

$2,000 annual maximum $2,000 annual maximum benefitbenefit

No waiting periodNo waiting period Optional Vision coverageOptional Vision coverage Premium as low as $20 per Premium as low as $20 per

month for annual coveragemonth for annual coverage


800-452-5772

Information Available Information Available At: At:

www.TAMUInsurance.cwww.TAMUInsurance.comom Description of CoverageDescription of Coverage

Dependent Enrollment LinksDependent Enrollment Links Print Identification Card Print Identification Card Preferred Provider Look-upPreferred Provider Look-up Claim FormsClaim Forms Online Claim Status InquiryOnline Claim Status Inquiry Claim ProceduresClaim Procedures Frequently Asked QuestionsFrequently Asked Questions Student Insurance SurveyStudent Insurance Survey Dental and Vision Coverage optionsDental and Vision Coverage options

800-452-5772

Questions and Questions and AssistanceAssistance

Contact AIP for personal attentionContact AIP for personal attentionMonday through Friday, Monday through Friday, 8:00 a.m. to 7:00 p.m.8:00 a.m. to 7:00 p.m.

(CST)(CST)

(800) 452-5772 (800) 452-5772 or email us throughor email us through

www.TAMUInsurance.comwww.TAMUInsurance.com

or contact our Representative in College Station or contact our Representative in College Station

(located in the Bank of America building):(located in the Bank of America building):Dunlap Financial ServicesDunlap Financial Services

(979) 260-9632(979) 260-9632

Documents

Health Insurance designed for the International Students of the THE TEXAS A&M UNIVERSITY SYSTEM 2011-2012 Underwritten By: Companion Life Insurance Company