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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.

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Accident and sickness program for exchange aspe health benefits plan

Accident and Sickness Program for Exchange (ASPE) Health Benefits Plan

Academic Exchange Grantees in the United States


Health benefit plan
Health Benefit Plan Benefits Plan

  • ASPE is not an insurance policy

    • Limited health benefits plan

  • Self-funded through US Dept of State


Health benefit plan1
Health Benefit Plan Benefits Plan

  • Administered by Seven Corners, Inc.

    • Seven Corners administers the program based on ASPE’s policies and procedures in benefit guide


Aspe guide
ASPE Guide Benefits Plan

Version 1/2011


Eligibility
Eligibility Benefits Plan

  • Dates 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.


Id card
ID Card Benefits Plan

Exchange Grantee Name

ID number

01/01/2010 to 12/31/2010

Citizen Country

Exchange Grantee Name

Unique ID number

06/01/2011 to 05/31/2012

Citizen Country


Back of id card
Back of ID Card Benefits Plan

Exchange Grantee Name

Unique ID number

06/01/2011 to 05/31/2012

Citizen Country


Coverage
Coverage Benefits Plan

  • $100,000.00 maximum per covered sickness or per injury

  • Medevac Coverage

  • Repatriation Coverage


Co pay
Co-pay Benefits Plan

  • ASPE 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*


Benefit limitations
Benefit Limitations Benefits Plan

  • ASPE 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.


Exceptions to pre ex
Exceptions to Pre-ex Benefits Plan

  • Pregnancy

  • Prescription 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


Benefit limitations1
Benefit Limitations Benefits Plan

  • ASPE 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*


Exceptions
Exceptions Benefits Plan

  • Dental 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.


Exceptions1
Exceptions Benefits Plan

  • Vision 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.


Exceptions2
Exceptions Benefits Plan

  • Immunizations/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.


Seven corners
Seven Corners Benefits Plan

  • Administers ASPE plan

    • Process claims

    • Customer service

    • Eligibility—enrollment

    • Prescriptions

    • www.usdos.sevencorners.com

    • MyPlan (secure website)




Customer service
Customer Service Benefits Plan

  • Staffed 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


Provider networks
Provider Networks Benefits Plan

  • ASPE 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



Provider search
Provider Search Benefits Plan


Www beechstreet com
www.beechstreet.com Benefits Plan


Provider search1
Provider Search Benefits Plan


Claim form
Claim Form Benefits Plan

  • If you use a provider network—you do not have to file a claim form, the provider will bill Seven Corners


Claim form1
Claim Form Benefits Plan

  • 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


Primary or secondary
Primary or Secondary Benefits Plan

  • If ASPE is your only coverage—ASPE is primary

  • If you are covered by a University Insurance Policy—ASPE is secondary


Pharmacy network
Pharmacy Network Benefits Plan

  • BeneScript

    • 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


To fill a prescription
To Fill a Prescription Benefits Plan

  • 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.


Reimbursement
Reimbursement Benefits Plan

  • 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


Medical care
Medical Care Benefits Plan

  • Primary Care Provider

  • Urgent Care Center

  • Emergency Room


Medical care1
Medical Care Benefits Plan

  • 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.


Urgent care
Urgent Care Benefits Plan

  • 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.


Hospital emergency rooms
Hospital Emergency Rooms Benefits Plan

  • 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.


Dependents
Dependents Benefits Plan

  • ASPE 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


Questions
QUESTIONS Benefits Plan


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