Coinsurance and Deductible - FAQs

1. Is co-pay and coinsurance counted as deductible?

No co insurance and deductible are different. There is a deductible which must be paid first, then there is coinsurance if outside the PPO network which is 20% of the first $5,000 only. These are per person.

2. What is the amount of co-pay per visit to a doctor?

There is no co-pay. All medical expenses are subject to deductible and coinsurance.

3. Is regular medical check-ups covered?

No. Wellness visits and immunizations are not covered.

4. Does the insurance cover sports such as bike riding, skiing, soccer, and basketball, etc?

The Atlas plan covers these as long as they are done for recreation and not part of professional or organized interscholastic sports.

5. What are the detailed dental coverage?

The coverage is for damage to a sound natural tooth in an accident or taking care of an acute dental pain (within 24 hours of pain).

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1. "Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider" - Does this mean that if the underwriter reviews and pays the provider, the claim will be paid 100% even for the first $5000? Or we pay the provider first, and submit a claim for which we will be reimbursed 100% by Atlas?

Not exactly. If you use their PPO network of hospitals/doctors, then you will only have to pay deductible (coinsurance is waived). However, it may be possible that you would initially pay up front and then get reimbursed from the company.

In the end, however, you would only pay the deductible. Typically, if you are in the PPO they will direct bill, but this is up to the provider and no one else.

If you are not in an emergency, you can always ask what they will do for you. Of course, we are here to help with the process should you need it.

2. What does a semi-private room mean?

It means a standard room that is shared (usually with one or two patients). Some hospitals charge extra for a private room and that additional charge would not be covered by the insurance.

3. Is the coverage amount per person or for both the travellers?

Each person has their own deductible and maximum amount.

4. Can the payment be made as monthly premium for the duration of the plan?

No. You purchase for the whole trip. However, with Atlas, you can purchase one month and then manually renew the plan for an additional $5 fee.

This can be helpful if the departure date is not set at the outset. However, you must remember to renew the policy or it will expire.

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1. 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)

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.

2. What does co-insurance exactly mean?

Besides the deductible that you will have to pay, Co insurance is another out of pocket expense for you.

a.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?

Yes, Co insurance does not apply outside the US or in Canada. Co-insurance only applies in the US.

b. In PPO network or student health center-No coinsurance - What is meant by PPO?

For co-insurance purposes, Student Health Advantage operates with a PPO network. In order to avoid paying co insurance, you must see a provider with in the PPO network.

Using the link below, you will be able to search for providers that are in the network: imgglobal ppo network

Usage of Student Health Center does not involve paying a co-insurance.

c. Out of PPO network - 80% of eligible expenses up to 5000, then 100% thereafter means what?

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 $5000 medical expenses.

Your part is the 20% of the first $5000. After this part is meet, the insurance will pay 100%.

3. 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?

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.

4. 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 !!!

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.

5. What is AD and D?

AD and D stands for Accidental Death and Dismemberment. It means that if the primary holder and in your case the J 1 visa holder will die accidentally, the dependent spouse will receive $10,000 as a result from that death.

Regards,
Customer care
www.americanvisitorinsurance.com
(877) 340 7910