Student Health Advantage Insurance Forum

Dear Mam/Sir,
I would like to apply for the insurance with your company. I have come here in J1 visa and my spouse is with me on J2. The type of insurance that I am interested in is the Student Health Advantage (Standard) for me and my husband. I went through the brochure that was provided online, however, I need to understand some terms as they seem to be a bit complicated for me to understand. Here are the following points:

• Is the deductible amount that is mentioned is the amount that I will have to pay from my pocket whenever I visit a doctor ??? (Like here, they say 100 $ per illness or injury)
• What does co-insurance exactly mean???
  • What is Outside US and Canada-No coinsurance - Does it mean that I do not pay from my pocket or you will not pay for it??
  • In PPO network or student health center-No coinsurance - What is meant by PPO ??
  • Out of PPO network - 80% of eligible expenses up to 5000, then 100% thereafter means what??
• Can you also explain about the maternity points, they have mentioned PPO provider, what does it mean?? I am located in Athens and will I have that service here??
• In Pre-existing conditions, its written as after 12 months of continuous coverage, what does that mean?? Like now I would like to have it for 6 months, so will I not be eligible for this !!!
• What is AD and D ??

Please let me know these answers before I finalize this plan.
Thank you.
Regards,
Poonam

Dear Poonam,
Thank you for contacting us at American Visitor Insurance for your Students health insurance needs!
Following are the answers to your queries:

• Is the deductible amount that is mentioned is the amount that I will have to pay from my pocket whenever I visit a doctor ??? (Like here, they say 100 $ per illness or injury)
  Answer: The deductible of per illness or injury means that each time a new illness or new emergency arises, there is a $100 deductible that you will have to pay. Follow up visits will not be considered new, therefore, there will be no deductible involved. Usage of a Student Health Center is only $5 deductible.
• What does co-insurance exactly mean???
  Answer: Besides the deductible that you will have to pay, Co insurance is another out of pocket expense for you.
  • What is Outside US and Canada -No coinsurance - Does it mean that I do not pay from my pocket or you will not pay for it ??
    Answer: Yes, Co insurance does not apply outside the US or in Canada. Co insurance only applies in the US, so that company will pay all eligible expenses.
  • In PPO network or student health center-No coinsurance - What is meant by PPO ??
    Answer: For co-insurance purposes, Student Health Advantage operates with a PPO network. In order to avoid paying co insurance, you must see a provider within the PPO network. Using the link below, you will be able to search for providers that are in the network:
    US PPO
    Usage of Student Health Center does not involve paying a co-insurance.
  • Out of PPO network - 80% of eligible expenses up to $5,000, then 100% thereafter means what???
    Answer: If you decide to utilize providers outside the PPO network, then the co insurance will kick in. It means that the insurance plan will pay 80% for the first $5,000 medical expenses. Your part is the 20% of the first $5000. After this part is meet, the insurance will pay 100%.
• Can you also explain about the maternity points, they have mentioned PPO provider, what does it mean?? I am located in Athens and will I have that service here??
  Answer: First of all, if pregnancy occurs after the effective date, you need to get a pre certification.
  For maternity coverage, the plan will pay 80% eligible expenses to maximum limit within the PPO network in the US and in Canada.
  To search for Gynecologist in your area use the link provided above using your zip code and specific provider you are looking for.
• In Pre-existing conditions, it is written as after 12 months of continuous coverage, what does that mean?? Like now I would like to have it for 6 months, so will I not be eligible for this !!!
  Answer: Coverage for pre-existing coverage is only available after 12 months of continuous coverage. Less than a year of coverage will not have coverage for pre-existing condition.
• What is AD and D ??
  Answer: AD and D stands for Accidental Death and Dismemberment. It means that if the primary holder and in your case the J1 visa holder will die accidentally, the dependent spouse or whoever is listed on the application will receive $10,000 as a result from that death. And Dismemberment means that if the primary holder will loses both eyes, ears, arms and legs, then the spouse or whoever is listed on the application will receive $10,000.

Regards,
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