2007-2008
Dear Students and Families,
Maintaining good health is important for the successful completion of your studies at Sussex County College. No one can avoid occasional Sickness or accidental injuries. Yet we can all prepare for the financial consequences of such occurrences and provide
for the required medical care.
As a service to you, the College has contracted to provide all full-time students with health and accident medical insurance. The cost of $47.50 per semester is included in your tuition billing and is to be paid along with your tuition. In fact, the State of New jersey requires that every full-time student have health and accident insurance. The College's plan may be waived only if you demonstrate that you presently have adequate coverage. A waiver form is available from the College Cashier, and must be returned by September 11, 2007.
Even if you do currently have coverage, you may wish to purchase the College plan. The college plan pays claims without regard to other coverage, and if your plan has deductible and co-insurance's, your "out of pocket" expenses would be reduced by the benefits available through the College Plan.
I am certain that you see the clear advantage and excellent benefits of this program. On the other hand, I hope that you will never have to utilize the benefits available under this program.
Best Wishes for a successful year!
Sincerely,
Mr. Harold Damato
Vice President of Student Services
Coverage is in effect 24 hours a day. For students
enrolled during the Fall Semester, coverage will be in effect from
either September 1, 2006 or the date of Premium Payment whichever is
later. until September 1, 2007. For students enrolled during the Spring
Semester, coverage will be in effect from either January 1, 2007, or the
date of Premium Payment, whichever is later, until September 1, 2007.
The plan covers injuries sustained and Sickness contracted and causing
loss commencing during the coverage period. The policy expires September
1, 2007. (Please note that the Policy cannot establish physician's fees,
and therefore cannot guarantee that payments made by the insurance
company will cover all physician and surgeon charges in full).
ACCIDENT MEDICAL EXPENSE BENEFITS
Benefits are provided up to $2,500 for accidental injuries for which medical treatment by a physician, surgeon, dentist, registered nurse, hospital services, ambulance services, or x-rays are rendered. The initial treatment must be rendered within 90 days of the accident and benefits are limited to treatment rendered within 52 weeks of the date of accident. Specific benefit levels are as shown below:
Hospital Room and Board: The expense actually incurred is allowed not to exceed the semi-private rate per day.
Hospital Inpatient Miscellaneous Expense: The expenses actually incurred are allowed not to exceed $500 as the result of any one Injury.
Surgical Expense: The expense actually incurred is allowed not to exceed $24 times the unit value of the 1974 California Relative Value Studies. or $2,500 in total for all surgical operation(s) performed for any one Injury.
Ambulance Expense: The expense actually incurred is allowed not to exceed the usual and customary charge for any one Injury.
Physician's Expense: The Usual and Customary Charge is allowed not to exceed $2,500 for any one Injury. Second surgical opinions will be covered up to the expense incurred subject to a maximum of the usual and customary expense.
Registered Graduate Nurse Expense: The expense actually incurred is allowed subject to a maximum benefit of the usual and customary charge per 24 hour period.
Outpatient Miscellaneous Expense: The expense actually incurred is allowed subject to a maximum $500 as the result of any one Injury.
Dental Expense: The Company will pay up to the usual and customary charge per tooth with a maximum of $500 per Injury for treatment to sound and natural teeth injured in a covered accident.
Physiotherapy Benefit: Up to the usual and customary charge per visit is allowed subject to a maximum of $2,500 for any one Injury.
Prescription Drug Expense: The expense actually incurred is allowed up to a maximum of $25 per covered Injury.
Anesthesia Expense: The expense actually incurred is allowed up to 30% of the surgeon's allowance under the policy subject to a maximum of $750 for any one Injury.
Consultant's Expense: The expense actually incurred is allowed up to the
usual and customary charge per covered Injury.
ACCIDENTAL DEATH
$1,000 payable when Injury results in the loss of life within 180 days
of the accident.
ACCIDENTAL DISMEMBERMENT
$1,000 payable per the schedule as shown in the Master Policy.
SICKNESS MEDICAL EXPENSE BENEFITS
Sickness benefits will be paid up to $2,500 for medical expenses
incurred within 52 weeks of the date of the first medical treatment
subject to the following:
Hospital Room and Board: The expense actually incurred is allowed not to
exceed $100 per day.
Hospital Inpatient Miscellaneous Expense: The expenses actually incurred are allowed not to exceed $500 as the result of any one Sickness.
Surgical Expense: The expense actually incurred is allowed not to exceed the Usual and Customary Charge, or $1,000 in total for all surgical operation(s) performed for any one Sickness
Ambulance Expense: The expense actually incurred is allowed not to exceed $100 for any one Sickness.
Physician's Expense: The expense actually incurred is allowed not to exceed $250 for any one Sickness. The allowance will be $25 for the first qualifying call and $25 for each subsequent call. Second surgical opinions will be covered up to the expense incurred subject to a maximum of $50.
Registered Graduate Nurse Expense: The expense actually incurred is allowed subject to a maximum benefit of $24 per 24-hour period or $100 as the result of any one Sickness.
Outpatient Miscellaneous Expense: The expense actually incurred is allowed subject to a maximum $50 as the result of any one Sickness.
Prescription Drug Expense: The expense actually incurred is allowed up to a maximum of $50 per covered Sickness.
Anesthesia Expense: The expense actually incurred is allowed up to 30% of the surgeon's allowance under the policy subject to a maximum of $180 for any one Sickness.
Consultant's Expense: The expense actually incurred is allowed up to the usual and customary charge per covered Sickness.
Wellness Health Examinations: Benefits will be provided on the same basis as benefits for any other Sickness. We will pay for: (1) all Insureds 20 years of age or older, annual tests to determine blood hemoglobin, blood pressure, blood glucose level and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high density lipoprotein (HDL) level and an annual consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being: (2) All insureds 35 years or older, a Glaucoma eye test every 5 years; (3) All Insureds 40 years of age or older, an annual stool examination for presence of blood; (4) all Insureds 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years (this examination is subject to a limit of $158.00). (5) all female Insureds 20 years of age or older, a pap smear every two years; (6) all female Insureds 40 years of age or older, an annual mammogram examination; and (7) all adult Insureds, recommended immunizations. Benefits payable under this section shall not exceed the following maximums for any one year: (1) $131.00 for Insureds between the ages of 20 and 39. (2) $152.00 for all male Insureds ages 40 and over: and (3) $248.00 for all female Insureds ages 40 and over. The cost of a left-sided colon examination is not included in these benefit limits.
MANDATED BENEFITS
The plan will pay for the following mandated benefits and any other
applicable mandate in accordance with New Jersey insurance laws:
Maternity, Mammography, Wellness Health Examinations, Mastectomy and
Reconstructive Breast Surgery, Diabetes Treatment, Childhood
Immunizations, Lead Poisoning Screening, Alcoholism Treatment, Home
Health Care, Wilm’s Tumor, Blood Products and Blood Infusion Equipment,
Dose-Intensive Chemotherapy, Prostate Cancer Screening, Therapeutic
Treatment of Inherited Metabolic Diseases, Pap Smear Coverage, Audiology
and Speech-Language Pathology, Certain Dental Services,
Biologically-Based Mental Illness, Infertility Benefits, Colorectal
Cancer Screening, Non-Standard Infant Formulas, Newborn Hearing Loss
Screening, and Off-Label Drugs.
MAJOR MEDICAL EXPENSES
For Both Accident and Sickness
After the Company pays $2,500 in basic benefits under either the
accident or Sickness provision of the policy for any one accident or
Sickness, the Policy will pay 80% of the expenses incurred in excess of
$2,500 up to but not exceeding $12,500 for physician's services,
hospital confinement, nursing services, X-Rays, operating room,
emergency room, anesthesia, laboratory service, dressings, prescription
medicines. casts, use of wheel chair, crutches, or ambulance for any one
covered accident or Sickness. Expenses must be incurred within two years
from the date of accident or Sickness.
EXCLUSIONS
This Policy does not cover:
Service or treatment rendered as part of the duties of a physician or any other person employed or retained by the Policyholder;
Health treatment or examinations where no Injury or Sickness is involved, except for treatment or examinations specifically covered under the Sickness Expense provision;
Injury or Sickness for which the Insured is entitled benefits under any Worker's Compensation Act or Law or similar legislation;
Elective abortions or any other voluntary termination of pregnancy;
Injuries resulting from air travel except as a fare-paying passenger on a scheduled airline;
Eyeglasses, eye examinations or fitting of glasses;
Dental treatment except for Injury to sound, natural teeth;
Elective surgery, treatment or preventative medicines except cosmetic surgery due to accident occurring while the Policy is in force;
Participation in tackle football in any form;
Injuries sustained as a result of practice or participating in intercollegiate sports in any form;
Intentional self-inflicted injuries, suicide, or attempt thereat whether sane or insane;
Loss sustained or contracted as a direct result of being intoxicated or under the influence of any narcotic, unless administered on the advice of a physician.
Commission of or attempt to commit a felony;
Injuries sustained as a result of snow skiing of any kind;
Any disease, Injury, or condition which had its cause, beginning, inception or symptoms, or for which there was consultation or treatment in any of the [6] consecutive calendar months prior to the effective date of coverage, except for individuals who have been insured under another group policy issued by this Company immediately preceding the individual's Effective Date under the Policy, and the Company paid benefits for the Pre-Existing Condition under the preceding group policy.
The following exclusions shall only apply to coverage under the MAJOR
MEDICAL EXPENSE BENEFITS.
Expense incurred as the result of mental disorders of any type;
Expenses incurred as the result of any Injury to teeth;
Injuries sustained as a result of operating, riding in or on, or
alighting from, a 2 or 3 wheel motor vehicle or snow mobile.
CLAIM PROCEDURES
In the event of a non-emergency Injury or illness, students should
contact the College Health Office at once to obtain a claim form. All
claim payments are made from the Short Hills office of Bollinger Inc.
Proofs of loss must be submitted within 90 days following the date of
accident or start of sickness.
THIS PLAN IS ADMINISTERED BY:
P.O. Box 727
Short Hills, NJ 07078-0727
866-267-0092 (Claims/Coverage)
800-526-1379 (Other Questions)
PREFERRED PROVIDER NETWORK PROVIDED BY:
THIS PLAN UNDERWRITTEN BY:
PEOPLES BENEFIT LIFE INSURANCE COMPANY
Cedar Rapids, Iowa
PLEASE PRINT OUT THIS BROCHURE AND KEEP IT AS A GENERAL SUMMARY OF THE INSURANCE BENEFITS. The Master Policy on file at the College contains all of the provisions, limitations, exclusions and qualifications of your insurance benefits, some of which may not be included on this brochure. If any discrepancy exists between the brochure and the Master Policy, the Master Policy will govern and control the payment of benefits.
Policy Form NHG-A&S-MP-693-NJ
1283686
