international student insurance

Posts Tagged ‘PPO’

Maternity Benefits and How They Can Affect You

Friday, December 5th, 2008

Insurance benefits and terms can be tricky to understand at first even to seasoned insurance buyers. However, it’s important to understand fully what your policy covers and doesn’t cover. If you don’t, you may be caught in a situation where your policy doesn’t cover it and you may have a high medical bill to pay all yourself.

Let’s take for example, maternity benefits. These benefits will vary in most insurance policies you look at. Some policies may cover it after a 12 month waiting period, some may cover it right away and others might not cover it at all. You also want to make sure how much it covers and what the actual limit it is covered up to. For instance, the Citizen Secure policy offers maternity benefits after 12 month of continuous coverage. Covered maternity benefits include pre-natal, delivery and post-natal care. The insurance company will pay 50% of the next $100,000 worth of eligible expenses after the deductible, then 100% to a lifetime maximum of $250,000. On this policy the deductible is per certificate period and you must meet it before the insurance company will pay towards your eligible expenses. You will also have coinsurance if you choose not to go within the PPO. If you choose to go within the PPO, then you would have 0% coinsurance.

Maternity benefits for the Student Secure policy are quite different. If you are not pregnant before the policy is effective, then you receive full maternity benefits from the first day your policy starts. Covered maternity benefits include but are not limited to pre-natal, delivery and post-natal care as well as expenses for miscarriage and complications of pregnancy. Like all benefits on this policy, maternity benefits are first subject to the deductible and coinsurance. The deductible for this policy is $100 per injury or illness. Coinsurance is dependent upon which level you purchase. On the budget level, the insurance company will pay 80% of the next $10,000 worth of eligible expenses (after the deductible), then 100% to the overall limit ($250,000). On the select level, the insurance company will pay 100% of eligible expenses (after the deductible) up to the overall limit ($300,000) if you go within the PPO or to the student health center.

Finally, the Atlas Travel series policy does not offer maternity benefits. However, if you are already pregnant then this may be the only option we offer. The Atlas series does offer coverage for complications of pregnancy up to the 26th week. This is defined as illnesses whose diagnoses are distinct from pregnancy, but are adversely affected by pregnancy or cause by pregnancy, and not associated with a normal pregnancy. Like the other two plans, benefits are subject to the deductible and coinsurance. With this policy, you have the freedom to choose your deductible (ranging from $0 up to $2,500) and your policy limit (from $50,000 up to $1,000,000). Coinsurance is 100% of eligible expenses while outside the U.S. and inside the U.S. (if you go within the PPO).

 

What is a PPO and why is it important to you?

Wednesday, October 17th, 2007

A PPO, also known as a Preferred Provider Organization, is defined as an organization of doctors, hospital and medical care facilities that have contracted with the insurance company to all provide services at a contracted rate. Usually the rate they receive is at a reduced rate. A PPO type arrangement can be beneficial for both the insurance company and the insured. The rates are usually significantly reduced so the insured does not have to pay as much out-of-pocket as they would if they went outside of the PPO. The insurance company also receives the lower rate so in effect they do not have to pay high claims amounts. This in turn, allows your renewal and premium rates to remain as low as possible.

With most of our plans, they do offer a PPO. However, you are not required to follow it. If you do choose to go within the network or PPO, then you will receive significant benefits. For example, the Student Secure plan, offers the coinsurance (coinsurance is the percentage that you would responsible to pay after the deductible) to be waived (select level only) if you go within the PPO or to the Student Health Center. The PPO for this plan is quite vast. To search the PPO go here: www.InternationalStudentInsurance.com/network. This can greatly reduce your out-of-pocket expenses. If you went to the emergency room let’s say for a broken arm and your total eligible expenses were $2,000 (the hospital you went to was in the PPO and all of your expenses were eligible expenses). The insurance company would pay 100% of your eligible expenses (select level only) after you paid the $100 deductible (the deductible is the amount that you are required to pay before the insurance company will pay towards your expenses).

Now let’s say for the same example you chose not to go to a hospital within the PPO. You would see much higher out-of-pocket expenses. Your deductible would remain the same however, the coinsurance would not be waived and you would be responsible for 20% of your eligible expenses (for this example it would cost approximately $500 total for you). On the select level of the Student Secure plan, the insurance company would pay 80% of your eligible expenses after the deductible up to $5,000 then they would pay 100% up to the overall policy maximum. So, as you can see, it’s much better for you to go within the PPO.

The Student Secure plan is available for full-time students studying outside of their home country. Outside of the U.S. there is not a PPO. You can go to any doctor or hospital and you will be provided 100% coverage for your eligible expenses after the deductible and up to the overall policy maximum (select level only). To find further information about all of our plans please visit our site: InternationalStudentInsurance.com