Office of Risk Management Christopher Johnson
NORTHWESTERN UNIVERSITY
Office of Risk Management Christopher Johnson
Director
May 5, 2003
To: Study Abroad Program Participants
Subject: Travel Abroad Health Insurance
The safety and well being of students participating in Northwestern University Study Abroad Programs is of paramount importance. To best meet the medical needs of Students traveling abroad Northwestern University has contracted with MEDEX/Hinchcliff International Group Services to provide Comprehensive Study Abroad Health Insurance effective. All students traveling abroad are required to participate in the MEDEX Plan or provide evidence of coverage in another medical plan that offers comparable benefits.
A summary of benefits provided by MEDEX for students participating in University-sponsored travel abroad programs is located at the end of this memorandum.
Enrollment Procedure
Students traveling abroad will receive an enrollment form from the University between two and three months prior to their departure. Forms are also available in Microsoft Word format or via fax and can be obtained by contacting the Office of Risk Management (847-491-8518 or ). Completed forms must be returned to the Study Abroad Office at least 30 days prior to the student’s departure. The Office of Risk Management will complete the enrollment process and will mail identification cards to Plan enrollees within one week of receipt of completed enrollment forms.
For the 2002 – 2003 academic year, the cost of the MEDEX plan is $6.00 per week (or partial week) for the student participant (coverage is also available for the participant’s spouse and family at additional charge). Charges for coverage will be made through Student Accounts. There is no charge for students who are enrolled in the University’s Student Hospitalization Plan. Please note that MEDEX coverage is not designed to substitute for the Student Hospitalization Plan or any other domestic health plan in which the student is enrolled. It is coverage that is supplemental to the Student Hospitalization Plan or domestic health plan that only provides coverage for a student when traveling outside the United States. Because MEDEX does not provide coverage for students who return to the United States is essential that another health plan which does provide such coverage in the U.S. remain in effect.
Those students wishing to provide proof of alternative coverage and waive the MEDEX Plan should note the following:
1. Most HMO’s and PPO’s do not provide coverage for medical evacuation. This can be very costly and is covered at 100% by the MEDEX Plan.
2. Most HMO’s and PPO’s do not have referral service outside their local domain. The MEDEX Plan does.
3. Most HMO’s and PPO’s do not have medical advisors overseas who will monitor the nature and quality of care provided. The MEDEX Plan does.
A summary page from the student’s alternative health insurance plan must accompany enrollment forms when a waiver of MEDEX coverage is desired.
The table below provides a comparison of several potential alternative plans that have been brought to the University’s attention. It is important to note that none of these alternative plans provide coverage at levels offered by MEDEX. You should also note that in some cases, the cost of medical insurance as indicated below is included in tuition charged by the program. The Study Abroad Office is in the process of determining whether the program’s insurance can be waived with a tuition reduction for those students who enroll in the MEDEX Plan through Northwestern University. Although it is not recommended, students traveling abroad may opt to waive the MEDEX Plan if they are enrolled in an alternative plan that carries a minimum medical benefit of $100,000.
Plan / Medical Benefit / Medical Evacuation Limit / Repatriation LimitMEDEX / $250,000 / Unlimited / Unlimited
COPA (Butler University) / $6,000 / $25,000 / $25,000
Beaver College / $100,000 / Not Stated / Not Stated
SIT / $100,000 / $50,000 / $7,500
DIS / $75,000 / $6,000 / Not Stated
IES / $100,000 / $50,000 / $50,000
Marymount College / $1,500 / Not Stated / Not Stated
Sweet Briar College / $50,000 / $50,000 / $50,000
Duke University / Not Stated / $25,000 / $10,000
Questions can be directed to Chris Johnson at (847) 491-8518 or via e-mail at .
Northwestern University
STUDY ABROAD PROGRAMS
Information on
HTH WORLDWIDE\MEDEX
International Assistance,
Emergency Evacuation and Repatriation
Accident and Sickness Insurance
MEDEX Group No. 545
Administered By:
HTH Worldwide Insurance Services, 12900 Federal Systems Park Drive, Suite 2A, Fairfax, VA 22033
Phone (703) 322-0048 FAX (703) 322-1636
In the event of an emergency, please consult your MEDEX Identification Card for the appropriate toll-free access number or call MEDEX collect at:
(410) 453-6330 – United States
44-1-273-223000 – United Kingdom
This is a brief summary of the features for insured participants. For complete details, please refer to the Certificate of Insurance
MEDICAL EXPENSE BENEFIT
If while insured a Covered Person incurs expenses due to an injury or sickness as defined in this policy, the company will pay the Reasonable Charges for the Covered Expenses listed below. All Covered Expenses incurred as a result of the same or related cause (including any complications) shall be considered as resulting from one Sickness or Injury. The amount payable for any one Sickness or Injury will not exceed a maximum benefit limit of $250,000 subject to the deductible amount and co-payment levels. The expenses must be incurred within 52 weeks of the date of Injury or commencement of Sickness, and the Covered person must remain continuously insured.
Deductible Amount. The deductible is the dollar amount of Covered Expenses that must be incurred as an out-of-pocket expense by each Covered Person on a per injury or sickness basis before certain benefits are payable under the policy. The Basic Medical deductible is $50 per Injury or Illness.
COVERED MEDICAL EXPENSES
1. Fees for diagnosis and treatment by a legally qualified physician, surgeon, registered nurse, professional anesthetist, or radiologist.
2. Infirmary and Hospital room and board charges which includes all general nursing charges. Payment will be limited to the Hospital’s normal charge for semi-private accommodation. Intensive Care Unit charges will be covered.
3. Laboratory, diagnostic and X-ray examinations.
4. Drugs and medicines which require a physician’s written prescription, and which can only be dispensed by a licensed pharmacist, are payable to 50% for outpatient treatment.
5. Expenses incurred for treatment of nervous or mental disorders. Benefits are payable a) up to $500 for outpatient treatment or b) up to $5,000 for an inpatient basis. The company shall not be liable for more than one such inpatient or outpatient occurrence with respect to any insured.
6. Rental charge for Durable Medical Equipment, or the purchase of this equipment, whichever is less.
7. Professional ambulance service to the nearest hospital up to $350.
8. Expenses incurred for treatment of specified therapies, including acupuncture and physiotherapy up to $2,500 on an in-patient basis. Physiotherapy means a physical or mechanical therapy, diathermy, ultrasonic, heat treatment in any form, manipulation or massage.
9. Expenses incurred for treatment of sports related accidents resulting from interscholastic, intercollegiate, intramural, club or professional sports are payable up to $5,000.
10. Covered medical expenses incurred for treatment of injuries sustained as the result of a covered motor vehicle accident.
REPATRIATION – UNLIMITED
If a covered person dies, the Company will pay the necessary expenses for repatriation of the Covered Person’s remains to the person’s home country or country of regular domicile. This benefit covers the legal minimum requirements for the transportation of the remains, but does not include the transportation of anyone accompanying the body or visitation or funeral expenses. Any expenses with respect to repatriation requires prior approval of the Company.
MEDICAL EVACUATION – UNLIMITED
If a Covered Person sustains an injury or suffers a sudden sickness, the Company will pay the necessary expenses for a medical evacuation to the nearest hospital, appropriate medical facility or back to the Covered Person’s home country or country of regular domicile. However, before the Company makes the payment, the Company will require written certification by the attending physician that the evacuation is medically necessary. Any expenses with respect to medical evacuation require the Company’s prior approval.
NOTICE OF CLAIM
Written notice of any event that may lead to a claim under the Policy must be given to the Company within 30 days after the even, or as soon thereafter as is reasonably possible.
GENERAL MEDICAL EXPENSE BENEFIT POLICY EXCLUSIONS
1. Treatment or services within the Covered Person’s home country.
2. Professional services rendered by a member of the covered Person’s immediate family, or anyone who lives with the Covered Person.
3. Routine physical examinations or health examinations including routine care of a newborn infant. Services and supplies not medically necessary for diagnosis or treatment.
4. Treatment to the teeth, gums, jaw or structures directly supporting the teeth, except the repair of injuries to sound natural teeth caused by a covered Injury, in which case dental treatment shall be limited to $250 per tooth per Injury.
5. Services in connection with eye examinations, eyeglasses or contact lenses, or hearing aids, except those incurred as a result of a covered Injury.
6. Treatment of weak, strained or flat feet, corns, calluses or toenails.
7. The diagnosis or treatment of congenital anomalies.
8. The diagnosis and treatment of acne.
9. Plastic or cosmetic surgery, unless resulting directly from a covered Injury which necessitated medical treatment within 24 hours of an accident.
10. Services related to the diagnosis or treatment of infertility.
11. Claim covered under any other valid and collectible insurance.
12. The excess of Reasonable charges.
13. Services and supplies that are experimental or investigative in nature.
14. Outpatient treatment for specified therapies including physiotherapy and acupuncture.
15. Deviated nasal septum, including submucous resection.
16. Claims arising from the use of alcohol or drugs except as prescribed by a licensed Physician.
17. Self-inflicted injury, suicide, or any attempt thereof.
18. Act of war, service in Armed Forces, riot, civil commotion, or acts of terrorism.
19. Flying except as a fare-paying passenger.
20. Birth Control, including surgical procedures and devices.
21. Organ Transplants
Study Abroad Health Insurance Enrollment/Waiver Form
Student Name: ______E-Mail Address: ______
Social Security Number: ______DOB: ______
Name of Study Abroad Program (i.e. NU, Butler University, etc):
______
Sponsoring University Department: Study Abroad Summer Session
Kellogg Medill
Other ______
Study Abroad Location (Destination): ______
Dates at Study Abroad Program Location: ______to ______
month/day/year month/day/year
As a participant in the Study Abroad Program, I acknowledge and accept the University’s policy that requires me to have adequate health insurance for the time that I am at the Study Abroad Program location. Therefore I elect one of the following options:
I choose to enroll in the MEDEX/Hinchcliff International Assistance Program. I authorize the University to bill me $6.00 for each week (or partial week) I am at the Study Abroad program location and to place such charges into to my account as administered by the Northwestern University Office of Student Accounts.
I am enrolled in the Northwestern University Student Hospitalization Plan (SHP) for the period of time that I will be Studying Abroad (note: proof of enrollment must be available when this form is submitted). I understand that I will receive MEDEX/Hinchcliff coverage at no cost for the above period during which I am abroad.
Attached hereto, I am submitting proof of health insurance coverage comparable to that provided by the MEDEX program ($250,000 medical benefits, unlimited medical evacuation and repatriation, and an international network of physicians and service providers). I release and discharge Northwestern University, its employees and agents from any obligations I may incur as a result of illness or injury while I am traveling.
I waive coverage in the MEDEX/Hinchcliff program because the Travel Abroad Program in which I am participating offers health insurance coverage. I understand that the insurance I will be using may have limits less than those offered through the MEDEX/Hinchcliff Plan. I release and discharge Northwestern University, its employees and agents from any obligations I may incur as a result of illness or injury while I am traveling abroad.
Signature: ______
Date: ______
Address to Where
ID Card Should be
Mailed: ______
______