accident and sickness program for exchange (aspe) health benefits plan
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Accident and Sickness Program for Exchange (ASPE) Health Benefits Plan. Academic Exchange Grantees in the United States. Health Benefit Plan. ASPE is not an insurance policy Limited health benefits plan Self-funded through US Dept of State. Health Benefit Plan. - PowerPoint PPT PresentationTRANSCRIPT
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGE (ASPE)
HEALTH BENEFITS PLAN
Academic Exchange Grantees in the United States
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Health Benefit PlanASPE is not an insurance policy
Limited health benefits planSelf-funded through US Dept of State
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Health Benefit PlanAdministered by Seven Corners, Inc.
Seven Corners administers the program based on ASPE’s policies and procedures in benefit guide
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
ASPE Guide
Version 1/2011
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
ID Card
Exchange Grantee NameID number
01/01/2010 to 12/31/2010Citizen Country
Exchange Grantee NameUnique ID number
06/01/2011 to 05/31/2012Citizen Country
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Back of ID Card
Exchange Grantee NameUnique ID number
06/01/2011 to 05/31/2012Citizen Country
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Coverage $100,000.00 maximum per covered sickness
or per injuryMedevac Coverage Repatriation Coverage
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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*
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
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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
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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*
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Seven CornersAdministers ASPE plan
Process claims Customer service Eligibility—enrollment Prescriptions www.usdos.sevencorners.com MyPlan (secure website)
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www.usdos.sevencorners.com
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https://myplan.sevencorners.com
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
www.choicecarenetwork.com
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Provider Search
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Provider Search
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Claim Form If you use a provider network—you do not
have to file a claim form, the provider will bill Seven Corners
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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
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Primary or Secondary If ASPE is your only coverage—ASPE is primary If you are covered by a University Insurance Policy—
ASPE is secondary
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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
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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
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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
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
Medical CarePrimary Care ProviderUrgent Care CenterEmergency Room
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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.
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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.
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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.
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
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
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ACCIDENT AND SICKNESS PROGRAM FOR EXCHANGES
QUESTIONS