Medical Insurance 2012-2013
Student Health Center
The Covered Person must use the services of Student Health Services (the Health Services Center and Psychological Services) first where either treatment will be administered or referral issued. Eligible Expenses incurred for medical treatment rendered outside of the Health Services Center or Psychological Services for which no prior referral is obtained are excluded from coverage. A referral issued by the Health Services Center or Psychological Services must accompany the claim when submitted.
The referral requirement is waived under the following circumstances:
- Medical emergency. The Covered Person must return to Student Health Services for necessary follow up care;
- When Student Health Services is closed;
- When service is rendered at another facility during break or vacation periods;
- Medical care received when the Covered Person is more than 50 miles from campus.
The Covered Person must visit Student Health Services for outpatient care before incurring medical expenses off-campus. The Deductible will be waived if the Covered Person is referred to an outside provider by the approved Student Health Services. There is no Deductible for services rendered at the approved Student Health Services.
Right of Subrogation
The Company shall be fully and completely subrogated to your rights against parties who may be liable to provide indemnity or make contribution in respect of any matter which is the subject of a claim under this insurance.
You further agree to cooperate fully with us in seeking such indemnity or contribution including, where appropriate, insurers instituting proceedings at their own expense against such parties in your name.
Policy coverage, benefits and limitations are summarized in this description of the insurance policy. A policy detailing the benefits of the program is available on request at the International Education Center or the Health Center.
This insurance is subject to certain terms, conditions and exceptions. It is important that you read and understand the whole policy wording. Set out below are very important notices, conditions and exceptions.
In the event of Injury of Sickness:
1. After you
receive treatment, complete the insurance company claim form.
Claim forms are available from Personal Insurance Administrators,
Inc. or you may download a claim form from www.4studenthealth.com/smc.
Be sure to include your policy number (as shown on your ID card)
on the claim form.
Answer all the questions and be sure to sign the claim form before
2. If you
have any other expenses such as medicines, x-rays or laboratory charges, be sure
to attach these bills to the claim form.
claim forms and all other bills to Personal Insurance Administrators, Inc. at
the address below. Try to have all itemized bills attached to the same claim
Please do not send bills without completed claim form. Bills
cannot be considered unless all the information required on the claim form is
A properly completed claim form must be submitted for each Injury
forms and bills should be sent to:
Personal Insurance Administrators, Inc.
Agoura Hills, CA 91376-6040
Providers may submit claims electronically:
5. If you
have questions about the status of your claim after it has been submitted,
please call Personal Insurance Administrators, Inc. at 1-800-468-4343.
All Hospital and medical bills must be submitted for payment within 90 days after the first date of treatment. Failure to furnish this information within the 90-day period shall not invalidate nor reduce the Covered Person’s claim if it was not reasonably possible to file the claim within this time, provided that the claim is submitted as soon as is reasonably possible. In no event, except in the absence of legal capacity, will a claim be honored later than one (1) year from the date of last medical treatment.
Covered Persons have the right to file a written complaint and obtain an expedited review if health care services have been improperly denied, modified, or delayed.
Always keep a copy of all documents submitted for claims.
Health Care Links: