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2011-1705-74 benefit summary flyer-v2_summary-temp-

Student Injury and Sickness
Insurance Plan for
Avila University
2011-2012

Avila University is pleased to offer an Injury and Sickness Insurance Plan underwritten by UnitedHealthcare Insurance Company. All registered students taking 6 or more credit hours per semester are eligible to enroll in the plan on a voluntary basis. Students who meet the eligibility requirements and have paid the required premium for Spring semester maycontinue coverage through the Summer semester by paying the required premium. The eligibility requirements need not be met again for the Summer period only.
Coverage to determinewhether this plan is right foryou before you enroll. The Highlights of the Coverage and Services
offered by UnitedHealthcare StudentResouces are:
the coverage including costs,benefits, exclusions, any Covered medical expenses are payable to a maximum benefit of $50,000 per each Injury Benefits are payable up to 80% of Usual and Customary Charges with a $50 deductible per each injury or sickness (all benefits are subject to satisfaction of the deductible, specific benefit limitations, maximums and copays as described in the policy).
Certificate are available fromthe University, or may be Prescription Drug Benefits are payable up to 50% of Usual and Customary Charges with Coverage available for eligible dependents.
Scholastic Emergency Services – Domestic Students are covered when 100 miles or more away from their campus or home address. International Students are covered worldwide except in their home country.
MyAccount, available through www.UHCSR.com, allows insured students to check their claim status, search for network providers, print ID cards, enter accident details and Included with every policy, the UnitedHealth Allies® discount program provides 5% to 50% savings on dental and vision services, fitness clothing and equipment, andtextbooks from McGraw-Hill Professional. The UnitedHealth Allies program is notinsurance and is offered by UnitedHealth Allies, a UnitedHealth Group company.
For online enrollment visit ourwebsite at www.UHCSR.com,click on “Find My School’sPlan” link and follow the onlineinstructions or call 800-767-0700 Each Child
UnitedHealthcare StudentResources
School Benefit Summary
2011-1705-74
PRE-EXISTING CONDITION means any condition which is diagnosed, 28. Outpatient Physiotherapy; except for a condition that required surgery treated or recommended for treatment within the 12 months or Hospital Confinement: 1) within the 30 days immediately preceding immediately prior to the Insured's Effective Date under the policy.
such Physiotherapy; or 2) within the 30 days immediately following theattending Physician's release for rehabilitation; Exclusions and Limitations
29. Participation in a riot or civil disorder; commission of or attempt to No benefits will be paid for: a) loss or expense caused by, contributed to, or resulting from; or b) treatment, services or supplies for, at, or 30. Pre-existing Conditions, except for individuals who have been continuously insured under the school's student insurance policy for at Acne; acupuncture; allergy, including allergy testing Addiction, such as: nicotine addiction and caffeine addiction; non- 31. Prescription Drugs, services or supplies as follows: chemical addiction, such as: gambling, sexual, spending, shopping, a) Therapeutic devices or appliances, including: hypodermic needles, syringes, support garments and other non-medical substances, Autistic disease of childhood, hyperkinetic syndromes, milieu therapy, b) Immunization agents, biological sera, blood or blood products learning disabilities, behavioral problems, parent-child problems, attention deficit disorder, conceptual handicap, developmental delay or c) Drugs labeled, “Caution - limited by federal law to investigational use” or experimental drugs, as specifically provided in Benefits for Chemotherapy; Radiation Therapy; Injections; e) Drugs used to treat or cure baldness; anabolic steroids used for Congenital conditions, except as specifically provided for Newborn or f) Anorectics - drugs used for the purpose of weight control; g) Fertility agents or sexual enhancement drugs, such as Parlodel, 10. Cosmetic procedures, except cosmetic surgery required to correct an Pergonal, Clomid, Profasi, Metrodin, Serophene, or Viagra; Injury for which benefits are otherwise payable under this policy or for newborn or adopted children; removal of warts, non-malignant moles i) Refills in excess of the number specified or dispensed after one (1) 11. Custodial care; care provided in: rest homes, health resorts, homes for 32. Reproductive/Infertility services including but not limited to: family the aged, halfway houses, college infirmaries or places mainly for planning; fertility tests; infertility (male or female), including any services domiciliary or custodial care; extended care in treatment or substance or supplies rendered for the purpose or with the intent of inducing abuse facilities for domiciliary or custodial care; conception; premarital examinations; impotence, organic or otherwise; 12. Dental treatment, except as specifically provided in Benefits for Dental tubal ligation; vasectomy; sexual reassignment surgery; reversal of General Anesthesia or except for accidental Injury to Sound, Natural 33. Research or examinations relating to research studies, or any treatment 13. Elective Surgery or Elective Treatment; for which the patient or the patient’s representative must sign an 14. Elective abortion, unless elected by the Policyholder and an additional informed consent document identifying the treatment in which the patient is to participate as a research study or clinical research study; 15. Eye examinations, eye refractions, eyeglasses, contact lenses, except as specifically provided in Benefits for Clinical Trial for Cancer prescriptions or fitting of eyeglasses or contact lenses, vision correction surgery, or other treatment for visual defects and problems; except 34. Routine Newborn Infant Care, well-baby nursery and related Physician charges in excess of 48 hours for vaginal delivery or 96 hours for 16. Foot care including: flat foot conditions, supportive devices for the foot, subluxations of the foot, care of corns, bunions (except capsular or bone 35. Routine physical examinations and routine testing; screening exams or surgery), calluses, toenails, fallen arches, weak feet, chronic foot strain, testing in the absence of Injury or Sickness; except as specifically 17. Health spa or similar facilities; strengthening programs; 36. Services provided normally without charge by the Health Service of the 18. Unless coverage is elected by the Policyholder, hearing examinations or Policyholder; or services covered or provided by the student health fee; hearing aids; or other treatment for hearing defects and problems, 37. Skeletal irregularities of one or both jaws, including orthognathia and except as specifically provided in the Benefits for Newborn Hearing mandibular retrognathia; temporomandibular joint dysfunction; deviated Screening. “Hearing defects” means any physical defect of the ear nasal septum, including submucous resection and/or other surgical which does or can impair normal hearing, apart from the disease correction thereof; nasal and sinus surgery; except for treatment of 38. Skydiving, parachuting, hang gliding, glider flying, parasailing, sail planing, bungee jumping, or flight in any kind of aircraft, except while 21. Immunizations, except as specifically provided in the policy; preventive riding as a passenger on a regularly scheduled flight of a commercial medicines or vaccines, except where required for treatment of a 22. Injury caused by, contributed to, or resulting from the use of alcohol, 40. Unless coverage is elected by the Policyholder, speech therapy; intoxicants, hallucinogenics, illegal drugs, or any drugs or medicines that are not taken in the recommended dosage or for the purpose 41. Supplies, except as specifically provided in the policy; prescribed by the Insured Person's Physician; 42. Surgical breast reduction, breast augmentation, breast implants or 23. Injury or Sickness for which benefits are paid or payable under any breast prosthetic devices, or gynecomastia; except as specifically Workers' Compensation or Occupational Disease Law or Act, or similar 43. Travel in or upon, sitting in or upon, alighting to or from, or working on or 24. Injury sustained while (a) participating in any interscholastic, club, around any motorcycle or recreational vehicle including but not limiting intercollegiate, or professional sport, contest or competition; (b) to: two- or three-wheeled motor vehicle; four-wheeled all terrain vehicle traveling to or from such sport, contest or competition as a participant; (ATV); jet ski; ski cycle; or snowmobile skiing scuba diving, surfing, roller or (c) while participating in any practice or conditioning program for 44. Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such treatment; 45. War or any act of war, declared or undeclared; or while in the armed 27. Organ transplants, including organ donation; forces of any country (a pro-rata premium will be refunded upon requestfor such period not covered); and 46. Weight management, weight reduction, nutrition programs, treatment for obesity, surgery for removal of excess skin or fat.

Source: http://www.avila.edu/wellness/documents/2011-1705-74BenefitSummaryFlyer-v2.pdf

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