SACM Students Guide-EN.pub - Saudi Arabian Cultural Mission

SACMStudent GuideAnswers to your questions about yourAetna InternationalplanMission Statement: Onsite SACM Team, Fairfax, VAAs an ambassador to health care in the U.S., Aetna International's Onsite Service and Support Team’s function is toserve as a SACM student health care "advocate". We promote an environment of friendship and stewardship as youadjust to your new environment in the U.S.In a spirit of true partnership and collaboration with SACM, Aetna network providers and U.S. learning institutions, weprovide access to health care while promoting health education for healthy living. This enhances the student scholarshipexperience in support of the SACM mission.()Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

The Aetna WayOur Core ValuesEmpowering people to live healthier livesthrough innovative global coverage, wellnessand care management solutions.s(2)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

We Focus on Your HealthYou Focus on Your StudyYour health and wellness play an important role inyour everyday life. We know how important it is toreceive quality and timely medical care, no matterwhen or where you need it.Table of ContentsHealth Insurance General Information 3Student Medical Plan Benefits 5Applying for your Health Insurance ID Card 8How to Find a Health Care Provider 23Why to Find a Primary Care Doctor 23How to Access Emergency & Urgent Care 24How to File a Claim 25Useful Questions & Answers 26How to Contact Us 29That’s where we come in.Aetna International is here to make sure you have accessto the care that you need in the event of a routineor emergency medical situation. Our service modelplaces you at the center of everything we do, ensuringthat you receive the care you need with ultimate convenience.With Aetna International as your health benefits provider,you can rest assured that you will have reliable servicesand world-class resources. For over 30 years, wehave been working to make it as easy as possible forour members to access quality health care, whereverthey go.Now, it’s time for you to experience the AetnaInternational difference.Within this guide, you will find valuable informationon the programs and services available to you as anAetna International member. We encourage you toread these materials to learn about your plan andhow to use your benefits.(3)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexWhy Health InsuranceBoth the private and public sectors provide very high quality medical carein the United States. However, it is important for visitors and students tothe United States to have health insurance to cover the costs of medicalcare. Costs for doctor and hospital care can be very high without insurance.Insurance policies differ in terms of the covered services, availabledoctors and hospitals, deductibles to meet, and copayments the patientmay have to make.Insured people should make every effort to understand the terms and conditionsof their insurance policy.Your Medical Coverage — PPO Plan:Aetna provides a generous health insurance benefits plan for SACM students inside and outside theU.S. SACM students are covered at 100% for medically necessary care and services. The Aetnanetwork is one of America’s largest health care networks, with over 1 million U.S. network providers.Your medical plan includes:– 100% coverage anywhere in the world ( Applies in Aetna network in US only)– Doctor office visits (primary care physicians and specialists)– Diagnostic lab and radiology tests– Vision care– Dental care, including orthodontia coverage for dependent children– Pharmacy coverage– Inpatient and outpatient care– Preventive care (routine physicals, immunizations, cancer screenings)– Inpatient and outpatient mental health services– Home health care– Maternity care– Spinal disorder treatment– Short-term rehabilitation (physical, occupational and speech therapy)– Emergency and urgent careFor the summary of your medical plan coverage, refer to the next pages or call theAetna Internaonal Member Service Center at 1‐866‐236‐1038.(4)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexEmployeeDependentGroup Insurance Plan of Benefits forSaudi Arabian Cultural Mission (Control #881633 / On Shore)insured by Aetna InternationalEffective Date: August 1, 2012Eligibility ProvisionRegular full-time employees of Cultural Mission of the Royal Embassy of Saudi Arabia participatingin this plan working a minimum of 25 hours per week.Wife or husband, same or opposite sex domestic partner; children to age 26 regardless of studentstatus.PPOPLAN FEATURES OUTSIDE THE U.S. Preferred Benefits(In-Network)In the U.S.Non-Preferred Benefits(Out-of-Network)Individual deductible $0 per calendar year $0 per calendar year $0 per calendar yearFamily deductible $0 per calendar year $0 per calendar year $0 per calendar yearPrior Plan CreditPrior plan credit accrued within the last calendar year from previous carrier applies to the currentyearIndividual Coinsurance Limit Unlimited per calendar year Unlimited per calendar year Unlimited per calendar yearFamily Coinsurance Limit Unlimited per calendar year Unlimited per calendar year Unlimited per calendar yearInpatient Per ConfinementdeductibleNone None None(Maximum of 3 per calendar year)Lifetime Year MaximumUnlimitedPlan Payment PercentagesHospital ServicesInpatient 100% 100% 100% of Reasonable &Customary (R&C)Outpatient 100% 100% 100% of Reasonable & CustomaPrivate Room LimitThe institution's semiprivate ratePre-certification Penalty No Penalty No Penalty $400To avoid penalties and/or benefit reductions for non-preferred benefits received in the U.S., contact the service center to determine if precertificationis needed for a procedure.Non-Emergency Use of theEmergency Room100% 100% after $50 co-pay 100% after $50 deductibleEmergency Room 100% 100% 100% of Reasonable &Customary (R&C)Non-Urgent Use of Urgent CareProvider100% 100% 100% of Reasonable &Customary (R&C)Urgent Care 100% 100% 100% of Reasonable &Customary (R&C)Physician ServicesPCP Office Visit 100% 100% 100% of Reasonable &Customary (R&C)Specialist Office Visit 100% 100% 100% of Reasonable &Customary (R&C)Mental Health ServicesMental Health InpatientCoverage(Unlimited days per calendar year)Mental Health OutpatientCoverage(Unlimited visits per calendar year)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)Note: This is not evidence of coverage. You must enroll and be accepted for coverage with the Coverage Administrator before these documents will beeffective. In the case of a discrepancy between the Plan Documents and this document, the Plan Documents will determine the Plan of Benefits. Asused herein, the term "Plan Documents" includes, but is not limited to, the Booklet, Schedule of Benefits and any Booklet Amendments/Riders includingany state-specific variations, as applicable. For further details, refer to your Plan Documents.08/06/2012(5)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexGroup Insurance Plan of Benefits forSaudi Arabian Cultural Mission (Control #881633 / On Shore)insured by Aetna InternationalEffective Date: August 1, 2012PLAN FEATURES OUTSIDE THE U.S. Preferred Benefits(In-Network)Plan Payment PercentagesAlcohol/Drug Abuse ServicesPPOIn the U.S.Non-Preferred Benefits(Out-of-Network)Substance Abuse InpatientCoverage(Unlimited days per calendar year)Substance Abuse OutpatientCoverage(Unlimited visits per calendar year)Other ServicesSkilled Nursing Facility(120 days per calendar year)Hospice Care Facility Inpatient(30 Days lifetime maximum)Hospice Care Facility Outpatient(Unlimited lifetime maximum)Home Health Care(120 visits per calendar year)Private Duty Nursing(70 shifts per calendar year)Spinal Disorder Treatment(Unlimited visits per calendar year)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of Reasonable &Customary (R&C)Short Term Rehabilitation 100% 100% 100% of R&C(Includes coverage for Occupational, Physical and Speech Therapies; 60 Visits combined maximum visits per calendar year)Diagnostic Outpatient X-ray 100% 100% 100% of Reasonable &Customary (R&C)Diagnostic Outpatient Lab 100% 100% 100% of Reasonable &Customary (R&C)Bariatric SurgeryUnlimited per lifetimeRoutine Hearing ExamIncludes one routine exam every24 months.100% 100% 100% of Reasonable &Customary (R&C)100% 100% 100% of R&CHearing Aids 100% 100% 100% of Reasonable &Customary (R&C)1 hearing aid per ear to $3,500 maximum per ear every 3 years for child to age 24Global Emergency AssistanceProgram100% 100% 100% of R&C($500,000 calendar yearmaximum)International EmployeeAssistance Program (IEAP)Included Included IncludedIncludes up to 5 counseling sessions per issue per year per enrolled member. Access benefits by calling the member service number on ID card:800-231-7729 or collect 813-775-0190. Services include: Cultural adjustment assistance, Marital/Family Stress, Child care and behavioral concerns,Social adaptation needs, Alcohol/Substance Abuse, Work/Life Balance and Depression.Note: This is not evidence of coverage. You must enroll and be accepted for coverage with the Coverage Administrator before these documents will beeffective. In the case of a discrepancy between the Plan Documents and this document, the Plan Documents will determine the Plan of Benefits. Asused herein, the term "Plan Documents" includes, but is not limited to, the Booklet, Schedule of Benefits and any Booklet Amendments/Riders includingany state-specific variations, as applicable. For further details, refer to your Plan Documents.08/06/2012(6)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexGroup Insurance Plan of Benefits forSaudi Arabian Cultural Mission (Control #881633 / On Shore)insured by Aetna InternationalEffective Date: August 1, 2012PLAN FEATURES OUTSIDE THE U.S. Preferred Benefits(In-Network)Plan Payment PercentagesWellness BenefitsRoutine Children PhysicalExamsPPOIn the U.S.Non-Preferred Benefits(Out-of-Network)100% 100% 100% of R&C7 exams in the first 12 months of life, 3 exams in the second 12 months of life, 3 exams in the third 12 months of life, 1 exam per 12 months thereafterto age 22 (includes immunizations)Routine Adult Physical Exams 100% 100% 100% of R&CAdults age 22+ & -65: 1 exam/12 months Adults age 65+: 1 exam/12 months (includes immunizations)Routine Gynecological Exams 100% 100% 100% of R&CIncludes 1 exam and pap smear per calendar yearMammograms(Unlimited visits per calendar year)100% 100% 100% of R&CProstate Specific Antigen (PSA) 100% 100% 100% of R&CIncludes 1 PSA per calendar year for males 40+Digital Rectal Exam (DRE) 100% 100% 100% of R&CIncludes 1 DRE per calendar year for males 40+Cancer Screening 100% 100% 100% of R&CIncludes 1 flex sigmoid and double barium contrast every 5 years; and at age 50+ 1 colonoscopy every 10 yearsPrescription Drug Coverage HereGeneric Drugs(365 day maximum supply)Includes contraceptivesFormulary Brand Name Drugs(365 day maximum supply) IncludescontraceptivesNon Formulary Brand NameDrugs(365 day maximum supply)Includes contraceptives100% 100% per month supply(includes Mail Order Drugs)100% 100% per month supply(includes Mail Order Drugs)100% 100% per month supply(includes Mail Order Drugs)100% of Reasonable &Customary (R&C)100% of Reasonable &Customary (R&C)100% of Reasonable &Customary (R&C)Vision ExpensesRoutine Eye Exam 100% 100% 100% of R&C(Covered under medical) Includes one routine exam every 12 months.Vision Care Supplies 100% up to $400 maximum 100% up to $400 maximum 100% up to $400 maximum(Schedule maximums apply every 12 months)Note: This is not evidence of coverage. You must enroll and be accepted for coverage with the Coverage Administrator before these documents will beeffective. In the case of a discrepancy between the Plan Documents and this document, the Plan Documents will determine the Plan of Benefits. Asused herein, the term "Plan Documents" includes, but is not limited to, the Booklet, Schedule of Benefits and any Booklet Amendments/Riders includingany state-specific variations, as applicable. For further details, refer to your Plan Documents.08/06/2012(7)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexGroup Insurance Plan of Benefits forSaudi Arabian Cultural Mission (Control #881633 / On Shore)insured by Aetna InternationalEffective Date: August 1, 2012PPO Dental HerePLAN FEATURES OUTSIDE THE U.S. Preferred Benefits(In-Network)In the U.S.Individual deductible None None NoneFamily deductible None None NoneType A Expense(Diagnostic & Preventative)100% 100% 100%Type B Expense100% 100% 100%(Basic Restorative)Type C Expense100% 100% 100%(Major Restorative)Calendar Year Maximum $5,000 $5,000 $5,000Orthodontic Treatment Coverage 100% 100% 100%For Dependents Only Coverage forchildren to age 20Orthodontic Lifetime Maximum $2,000 $2,000 $2,000Services and ProgramsInformed Health Line (24-hour nurse line) InternationalDisease Management International MaternityManagement Program Simple Steps To AHealthier Life®Wellness CheckpointWeight Watchers® ProgramOn-Line Global Health and Travel Information through HTH Worldwide (http//www.aetnainternational.com)Non-Preferred Benefits(Out-of-Network)Note: This is not evidence of coverage. You must enroll and be accepted for coverage with the Coverage Administrator before these documents will beeffective. In the case of a discrepancy between the Plan Documents and this document, the Plan Documents will determine the Plan of Benefits. Asused herein, the term "Plan Documents" includes, but is not limited to, the Booklet, Schedule of Benefits and any Booklet Amendments/Riders includingany state-specific variations, as applicable. For further details, refer to your Plan Documents.08/06/2012(8)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexAetna International website registration and photo upload stepsDownloading photos from a device to your computerAetna International website registrationRegister for www.aetnainternational.com (Aetna International’s secure member website)Photo upload through www.aetnainternational.comLog in to Aetna International's secure member websiteUpload and maintain a personal photoEdit or replace an existing personal photo or personal informationDownloading photos from a device to your computerThere are many different ways to get photos from one device (e.g., your camera) to another (e.g., your computer).This includes, but is not limited to, a USB cord, Bluetooth connection, memory card/drive or wirelessconnection.The best method to transfer the photo is unique to your device. Therefore, please visit the device manufacturer’swebsite for this information.Aetna International website registrationStep 1■ Type www.aetnainternational.com in the browser URL address line.■ Click Go (or Enter).(9)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexStep 2Click Login/Register under “Members on U.S. based plans, start here”.Step 3Click the Register for online access button.Note: Once you register, you can access the site by following Steps 1 and 2 and then entering your User name andPassword and selecting Log in under Member login.(10)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexStep 4Choose Aetna International Member from the Aetna International Registration drop-down box.Step 5Verify you are an active Aetna International member.If you have a plastic Aetna International member ID card with a member ID number on the front:■ Add the member ID number listed on the front of the card in the Member ID field (include the W).■ Add the following in the Temporary Password field: The first letter of your first name PLUS the first 10 letters of your last namePLUS your date of birth in MMDDYY formatExample: John Smith born on May 6, 1967 would enter: JSMITH050667.(Select the that appears next to the Temporary Password field heading to see these instructions while onscreen)Then select the Register button.(11)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexIf you do not have a plastic Aetna International member ID card with a member ID number on the front – please refer toyour Saudi National ID Number. This is a 10-digit number. The first digit (when reviewing from left to right) usuallystarts with the number “1”.Enter the following in the Member ID field :Drop the first digit from the Saudi National ID Number and enter the remaining 9-digits.Example: If your Saudi National ID Number is: 1234598765Drop the first digit: 1 andEnter the remaining 9-digits: 234598765 in the Member ID fieldNOTE: Use the same 9-digit number that you entered in the Member ID field if you call the Aetna International CustomerService Center and are asked to provide your Member ID.This ID should not include a W when entered. Add the following in the Temporary Password field:◦ The first letter of your first name◦ PLUS the first 10 letters of your last name◦ PLUS your date of birth in MMDDYY formatExample: John Smith born on May 6, 1967 would enter: JSMITH050667.(Select the that appears next to the Temporary Password field heading to see these instructions while onscreen)Then select the Register button.(12)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexStep 6Set up your account for future visits to the website.■ Choose and enter a unique user name. Your User name must:Be between six and 20 characters, andContain no spaces.■Choose and enter a unique password. Your Password must:Contain at least one letter and at least one number;Be between eight and 20 characters; and Be different from your user name.(Example: 2be1validpassword)■■Re-enter your password in the Confirm Password field.Select a Challenge Question from the drop-down box and enter the applicable Answer. We will use this informationin case you forget your password in the future.(13)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexStep 6 (Continued)■■■■■■■■■Enter a valid Email address. This is required to register for the Aetna International website.Re-enter the email address in the Confirm Email field.Select the Destination Country where you will reside while covered under this Plan.Select the Destination City where you will reside within the Destination Country while covered under this Plan.If your Destination Country is the UNITED STATES OF AMERICA, your Destination City will display OTHER.Enter the City and State in the If Other, please specify field (example: Atlanta, Georgia).Select your Language Preference from the available drop-down.Select the checkbox if you would like to Email Notifications about Aetna International products and services thatmay be available to you.Select Submit.Step 7View the congratulations confirmation page. This will list your User name and Password.Important note: Please record your User name and Password in a safe place. While the challenge question can be usedto assist with password recovery, User names cannot be recovered. If you forget your User name, contact the AetnaInternational Service Center (at the number on your member ID card) to reset your account.(14)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexLog in to Aetna International’s secure member websiteStep 1■ Type www.aetnainternational.com in the browser URL address line.■ Click Go (or Enter).■ Click Member under Secure login.Step 2Click Login/Register under “Members on U.S. based plans, start here”.(15)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexStep 3Click the Register for online access button (if you have not yet registered for the Secure Member site).Note: Once you register, you can access the site as follows:■ Follow Steps 1 and 2■ Enter your User name and Password and■ Select Log in under Member login.Upload and maintain a personal photoStep 1Click the UPLOAD AND MAINTAIN PHOTO FOR ID CARDS link.You will then see a page listing your name and any eligible family members enrolled and approved for coverage.(16)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexStep 2Click Upload Photo for you or an individual family member. You will need to repeat the following process for each individual.Note: Family members under five years of age will not have the option to upload a photo (as this requirement does notapply to them).Step 3Enter the following information on the ID Card Photo Maintenance page.■■■Name: This is the name that will appear on the member ID card. It cannot be changed. (Note: if the total number ofcharacters for the first and last name, with a space between the two, exceed 26 characters, the ID card will list themember’s first name initial and up to 24 characters of the member’s last name.)Telephone number: Enter a 10-digit telephone number and an extension, if it applies.E-mail address: Enter a valid e-mail address. This must include a “@” and a “.” in the address.(17)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to Index■ Mailing address: Add address line 1 (required). Add address line 2 (optional, use as needed). Add the 5-digit U.S. postal zip code number. This will pre-fill the city and state of your address.Confirm city and state (based on the zip code entry).Example:123 Main StreetApt# 14ACity, State, 55555 (zip code)Select the tip icon next to each entry field for help.Once these fields are completed:■ Click the Browse button.■ Locate and select the .jpg file to upload (for placement on the member ID card).Click the Open button, once the file name appears in the File Name field. (Or double-click on the file name when selectingthe file.)The path to the .jpg file will populate the area that precedes the Browse and Upload buttons.Click the Upload button.Step 4Adjust the uploaded photo to focus on the section that will appear on the member ID card. You can drag the smallsquares that border the grey frame to focus the border on your face.NOTE: the photos given to you as examples in these instructions are not the ideal photos that we require to be uploadedin the system. Our example images may appear dark and the faces do not look straight into the camera. They wereincluded to be able to provide an image to fill the available image space rather than to act as examples of quality.Please be aware of this when reviewing the photos in this document and when selecting your photo image to upload.(18)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexSelect Save Photo and Information; Create ID Card Preview. You will then receive a confirmation page.Step 5On this confirmation page, you can:■ Select the Review My Data and View Card Preview link to review your submitted information.■ Select the Print this Page link to keep a record of the successful upload.■ Select the Members list link to repeat this process for another covered family member (as needed).■ Select Welcome to return to the welcome page.(19)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexOn the Review My Data and View Card Preview link, you can:■ Review the image that appears on the member ID card for: clarity (a clear photo of your entire face);format (a close, centered photo of your entire face); andappropriateness (a single image of you; no other people in the photo).Review your phone number, e-mail and address information for accuracy. If you want to make changes to this information, select the Edit Information link to return to the ID Card PhotoMaintenance page.Select the Return to List of Members link if you are ok with the image and contact information, and wish to upload photosfor other family members.The Edit Information link will return you to the ID Card Photo Maintenance page where you can:■ Remove the pending image and upload a new image (or re-crop the prior photo image); and/or■ Edit your phone number, e-mail and address information.Once you make your changes, you can:■Click the Save Photo and Information; Create ID Card Preview link to apply any updates/changes. This will repeatthe prior process.■Click the Cancel button to cancel your updates/changes. This will prompt a “Are you sure you want to cancel and lose any changes made?” message. Click the Cancel button to return to the previous page.Click the OK button to cancel your updates/changes.(20)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to Index■The ID Card Photo Maintenance page displays the member’s personal information. You can change the telephonenumber, e-mail address and mailing address on this page.■Any uploaded photos, not already reviewed and approved for use on the member ID card, will display as a PendingImage. To replace the pending image: Click the Browse button.Locate and select the .jpg file to upload (for placement on the member ID card).Click the Open button, once the file name appears in the File Name field. (Or double-click on the file name whenselecting the file.)The path to the .jpg file will populate the area that precedes the Browse and Upload buttons.Select the Upload button.The new image will then replace the previous image.You may also click the Remove link under the image before following the above steps.Follow the remaining steps under the upload and maintain a personal photo section.Note: If any prior approved or rejected images exist, a historical images section will show at the bottom of the page.Placing the mouse over this section will provide details on the date/time/status of each image. The color of the border orimage background explains its status: grey (image pending approval or rejection), green (approved image/available foruse on ID card) or red (rejected image/not available for use on ID card).(22)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to Index(23)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexHow to Find a Health Care ProviderVisit our DocFind ® online directory at www.aetna.com/docfind1. Insert your Zip Code2. Insert the Distance; for example: 5 or 10 miles3. Choose the Provider Category you are looking for; for example:Medical Providers4. Choose the Provider Type; for example: Primary Care Physicians5- Under Plan, choose Open Choice PPOIf you are looking for DENTAL, your plan will be: PPO/PDN6. Select Start Search to get the names and addresses of thehealth providers.Primary Care Physician (PCP)Primary care doctorswill guide your wayVisiting a PCP (for example, internist, pediatricians, generalpractitioners) Your PCP is the doctor you go to first. He or she will help youlearn about your health and how to manage it. Go to your PCP for checkups, or whenever you are sick or hurt. Your PCP will help you decide if you need care from anotherdoctor.Appointments are typically required at doctor’s offices and maynot always be available on the same day you call.Choosing a PCP You can choose any PCP from Aetna’s network. Plus, it’s goodto know that anyone you choose meets our standards. Choosing a doctor is a personal decision – that’s why eachmember of your family can have his or her own PCP. You can change your PCP at anytime.A primary care physician(PCP) will get to know youand help you get the careyou need. We encourage youto visit a PCP, who can beyour main point of contactfor your health care needs.(24)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexEmergency and Urgent CareTips on Emergency Room UseMore convenient options to considerThe average Emergency Room (ER) visit tops three hours, while urgent care visits are generally anhour or less¹. To receive faster, more convenient treatment, you can visit an urgent care center orwalk-in clinic for non-life threatening medical issues. However, you should go straight to the nearestER when you experience a life-threatening problem, uncontrolled bleeding, heart attack, stroke orunconsciousness.If you do not have a life threatening condition, you can use one of the following options to receivehigh-quality care:■■■Walk-in clinicsUrgent care centersPhysician’s officesFrequently Asked QuestionsWhat is the Informed Health Line?It is a toll-free number accessible 24 hours a day, 7 days a week. You can speak with a registerednurse regarding your health-related questions. The helpful audio health library has hundreds of topicsin both English and Spanish.What is the number to the Informed Health Line?1-800-556-1555What is the difference between a walk-in clinic and urgent care center?A walk-in clinic is found in stores and pharmacies, and typically keep extended business hours.They offer convenient, low cost treatment for minor medical problems such as ear infections, colds,allergies, strep throat and bronchitis. An urgent care center provides care for more serious problemssuch as sprained ankles, fevers and minor cuts and burns.How do I locate a walk-in clinic or urgent care center?You can visit the DocFind® online provider directory at www.aetna.com/docfind.What is the most cost effective care option?The most cost effective option is typically a walk-in clinic, followed by urgent care centers. In case ofa medical emergency, you should proceed directly to the nearest medical location for immediatecare.How do I know if it is a true emergency?It is an emergency if you are experiencing a life-threatening medical condition.1 Information and Publications. Urgent Care Association of America. Accessed September 23, 2008 on www.ucaoa.org/urgentcare.html.(25)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexHow to File a Claim1. Complete the appropriate claim form, which can be found on your Aetna International secure member website atwww.AetnaInternational.com (Resources > Forms).2. Copy all receipts on a single piece of paper (or as many as necessary). Be certain that all receipts are legible. Receiptsmust be fully itemized bills and/or detailed receipts that include diagnosis (nature of illness) and the proceduresor services performed.3. Write your member identification number on each document submitted with your claim form (refer to your ID card).4. Be sure to indicate the name of the person who received care (either yourself or your dependent).5. Include contact information (phone or fax) where you can be reached in case we have any questions about yourclaim.Completing your claim formWhile it is important to fill out your claim form in its enrety, here are some fields in parcularto pay close aenon to:A. Paent’s Name — The person who received the care/service(s). Please indicate if it isyou or your eligible dependent that received the service(s).B. Dates of Service — The date(s) that you or your dependent received the service(s).Please list in the following format: MM/DD/YYYY.C. Descripon of Service — The service(s) that were received (e.g., office visit, X‐ray).D. Diagnosis (reason for visit) — The reason for obtaining the service(s) (e.g., well‐visitcheckup, broken wrist, influenza).E. Summary of Reimbursement — Select the appropriate checkbox to indicate yourpreferred method of reimbursement (e.g. electronic funds transfer, check or wire).To ensure mely claim reimbursement,please make sureto fill out the claim form completelyand sign it. Any missinginformaon may result ina delay in reimbursement.Then submit it to Aetna eitherbyfax: +1-813-775-0625orE-mail: gbservice@aetna.com(26)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexUseful Questions and AnswersGeneral InformationAm I covered for medical expenses anywhere in the world?Yes. Coverage is provided to enrolled students, attending school in the U.S., and their enrolled dependents.Does coverage terminate with Aetna International when I temporarily return to my home country for vacation?No. Coverage stays with you anywhere in the world.What type of customer assistance does Aetna International provide to members?Aetna International customer service professionals are multilingual representatives with the ability to converse, comprehendand translate virtually any language including Arabic. Our highly trained representatives are available 24 hoursa day, 7 days a week at 1-866-236-1038. In addition to personalized assistance, you have access to integrated, selfserviceWeb tools through our password-protected member website. A dedicated team of clinical case managers is alsoavailable to assist you with specialty care.Who should I tell about changes in family status?You should notify SACM within 30 days of any change to your family status. Changes in family status may include:marriage, divorce, or legal separation; birth or adoption; or death of a child or spouse.What is the name of my Aetna International insurance plan?You are enrolled in the Aetna Open Choice ® PPO plan. When looking for network providers, please search for providerslisted under this plan name.Insurance TerminologyWhat is a PPO?A PPO, or preferred provider organization, is a group of U.S.-based hospitals, doctors and other health care professionalswho have agreed to provide contracted health care services to Aetna Open Choice PPO plan participants. You arefree to receive services from any health care provider you wish, but we recommend you use an Aetna PPO providerto avoid any out-of-pocket costs.When you use health care professionals (hospitals, doctors, dentists, labs, pharmacies) who belong to the Aetna PPOnetwork, all of your medical claims will be paid at 100% with no additional costs to you.Whose responsibility is it to verify that a provider is in the PPO network?It is always the member’s responsibility to verify that a provider is participating in the PPO network. These providers areknown as “preferred providers.” You should verify this before each visit with a new provider by checking your memberwebsite or calling Aetna International Member Services. You may also do so by calling the provider’s office. This includesdoctors, hospitals, labs, pharmacies, etc.What are Reasonable and Customary Guidelines? What happens if my claim exceeds the Reasonable and CustomaryGuidelines?Reasonable and Customary (R&C) Guidelines are applied to claims incurred in the United States. They are geographically-determinedaverage claim costs for various types of medical services. The guidelines are used to determine if aprovider (doctor, hospital, etc.) is charging too much money for any given service — more than what is “reasonable andcustomary” — for a service within a defined geographic area.If your claim exceeds Reasonable and Customary Guidelines and you received care from a preferred provider, you willnot be responsible for any amount over what is reasonable and customary. However, if you received care from a nonpreferredprovider, you would be responsible for paying for the entire amount over what is determined to be reasonableand customary. Claims from providers outside the United States are not subject to Reasonable and Customary guidelines.Please see the example below:In-Network-Provider (Preferred) Out-of-Network Provider (Non-Preferred)Doctor Office Visit Doctor Files Claim Doctor Office Visit Student files claimCharge: $200 Charge: $200R&C Amount: $150 R&C Amount: $150Aetna Reimbursement: $150 Aetna Reimbursement: $150Student Owes: $ 0 Student Owes: $50(27)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexDoes this plan cover everything the doctor orders or recommends?No. This plan is very comprehensive and covers most services at 100%. However, the plan does not cover items thatare experimental. The plan also covers services based on medical necessity, and there are criteria that need to be metfor certain services. If you do not meet this criteria, the plan will not cover the service. Information on this criteria can befound at www.Aetna.com/cpb.Maternity CareHow is maternity care covered?As with all providers, it is your responsibility to verify if your provider is in the Aetna Open Choice PPO network. If yourdoctor is in the network, you are covered at 100% for all treatment related to your pregnancy.If you are required to go to a facility outside of your doctor’s office for related tests, the facility must be part of the PPOnetwork for your bill to be paid at 100%. It is your responsibility to confirm with your doctor or with the facility that it ispart of the Aetna PPO network.When you go to a preferred hospital to deliver your baby, the hospital and doctor charges will be covered at 100%.If your doctor is not in the PPO network, your out-of-pocket expenses may be significantly higher. If you see a doctoroutside of the PPO network, you will be required to pay any amounts over the Reasonable and Customary level. Thispolicy is applicable to every office visit. If you deliver your baby at a non-preferred hospital, you are responsible for payingany amounts over the Reasonable and Customary level.Regardless of network participation, personal items are not covered under this plan. This would include items such as,but not limited to, television, telephone or guest food trays.What type of doctor should I see if I am pregnant?There are several types of doctors who can treat you for your prenatal care, such as an obstetrician and/or gynecologist.Obstetricians and gynecologists are specifically trained in this field, and can deliver babies either vaginally or by cesareansection. However, it is up to you to select the type of doctor that is right for you.How do I enroll my newborn baby?Once the baby is born, we will pay the newborn claims for the first 30 days of the baby's life as part of the member’s orcovered dependent’s existing plan of benefits. Within the first 30 days of the baby’s birth, you must contact SACM toenroll the baby in your plan. If your baby is not enrolled within the first 30 days of birth, he/she will not be covered forhealth care expenses under your plan of benefits. To ensure that there is no delay of covered benefits for your child,please contact SACM within the first 30 days of your baby’s birth.Labs and X-raysHow does my plan cover lab and X-ray expenses?Lab and X-ray expenses are covered at 100% if services are rendered at a preferred hospital outpatient department,freestanding lab facility or doctor’s office. Blood work is covered whether it is for wellness or sickness. Aetna InternationalMember Service is available 24 hours a day, 7 days a week at 866-236-1038 to assist you with any lab or x-ray questions you may have.Dental CoverageDoes this plan cover all dental procedures?It is strongly advised that if you are having a major dental procedure done, you ask your dentist to submit a“Pre-Determination” before the service is performed. We will review what procedures will be performed and will adviseyou and your dentist how much of the procedure will be covered by the plan. Your dental plan covers medicallynecessary dental procedures at 100%, up to an annual maximum of $5,000. If you are charged more than $5,000 percalendar year, you will be responsible for any charges above $5,000.(28)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexVision Benefits and Discount ProgramWhat is the Aetna Vision Care® program, and how does it work?Aetna Vision Care® program is a discount program available to all members. Aetna Vision Care® providers will offeryou both lenses and frames at a discounted rate, provided you present your member ID card at the point of purchase.You will not need to submit a claim form to receive this discount. You can locate Aetna Vision Care® providers by visitingwww.aetna.com/docfind. Use the standard search function to find Aetna Vision Care® facilities near you.Is Lasik Surgery covered under the plan?No, the plan does not provide coverage for Lasik surgery. However, you are eligible for discounts through the AetnaVision Care® program.What if an Aetna Vision Care® program provider has an optometrist or ophthalmologist on site? May I accesscare from this doctor?A provider does not always guarantee participation of the resident (on site) optometrist or ophthalmologist in the AetnaPPO network. Routine eye exams are covered as part of your plan of benefits. As with all doctor visits, when youschedule your appointment for a routine eye exam, please be certain that the selected provider participates in the AetnaPPO network. If he/she is an Aetna PPO provider, your exam will be covered at 100%. If your provider is not an AetnaPPO provider, your exam will be covered at 100% of Reasonable and Customary Guidelines. You will be responsiblefor amounts over the Reasonable and Customary level.(29)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038

Go to IndexHow to reach Aetna InternationalService Center is open 24 hours a day/ 7 days a week(toll-free)1-866-236-1038 (Inside the USA)1-813-775-0190 (Outside the USA)Fax1-800-475-8751 (Inside the USA)1-813-775-0625 (Outside the USA)Mailing AddressEl Paso, Texas 79998-3836P.O. Box 981543USAUrgent MailAetna International4630 Woodland Corporation BLVDTampa, FL 33614USAWe can assist you with: Locating quality health carein the USA Answering questionsregarding claims, benefitlevels and coverageProcessing claims in virtuallyany language Coordinating reimbursementin over 180 currenciesand payments through electronicreimbursementdirectly to bank accountsWebsitewww.aetnaInternational.comGeneral QuestionsSACMmemberoutreach@sacm.orgFacebookhttp://www.facebook.com/SACMAetnaInternationalHealthPlanTDD1-800-628-3323Health insurance plans and programs are offered, underwritten or administered by Aetna Life &Casualty (Bermuda) Ltd. or Aetna Life Insurance Company (Aetna). Providers are independentcontractors and are not agents of Aetna. Provider participation may change without notice. Aetnadoes not provide care or guarantee access to health services. Not all health services are covered.See plan documents for a complete description of benefits, exclusions, limitations and conditionsof coverage. Plan features are subject to change. Information subject to change. For more informationabout Aetna International, refer to www.AetnaInternational.com.(30)Aetna International Member Services - Toll Free - 24 hours, 7 days a week: 1-866-236-1038