For Questions About Enrolling in the Student Health Plan:

How do I enroll?

Go to www.studenthealthplan.com and click on enroll now and fill out the required information.

Need help with enrolling?

Enrollment assistance is available toll free, Monday through Friday, from 7 a.m. to 9 p.m. Eastern Time at (877) 270-1159.

For Questions About Eligibility:

How Do I know if I am eligible for the Student Health Plan?

All domestic students taking a minimum of six credit hours or more, who are in good standing, are eligible to enroll in the College Parents of America Student Accident & Sickness Program. In order to be accepted, you must be actively enrolled in a college or university or your enrollment in the college or university must occur within 30 days of the effective date for the term applied. 

After I purchase, when does coverage become effective?

An eligible member’s coverage becomes effective on the date immediately following the date the member enrolls online provided the premium has been paid.

For Questions About Seeing a Physician:

Is pre-authorization or pre-certification required? 

The plan does not require pre-authorization or pre-certification. The determination of whether a medical expense is covered cannot be made until a claim is filed.

Does the plan provide coverage for preventive care?

If you choose the Premium Plan, preventive care is covered. Refer to the Schedule of Benefits for a description of how preventive services will be reimbursed.  If you have chosen the Basic Plan there are no benefits for preventive care.

For Questions About Preferred Providers:

Can I use any physician or hospital?

Yes, you may use any physician or hospital.  The plan includes a PPO network. If you use a doctor or hospital in the network the charge may be discounted which can reduce the patient’s out-of-pocket costs.

For a list of participating providers, please visit:

www.studenthealthplan.com/2011network or call (800) 226-5116

For Questions About Prescriptions:

Does the plan include a prescription drug card? 

No.  In order to receive reimbursement you must pay for your prescription at the pharmacy then mail a completed and signed claim form along with a detailed pharmacy receipt to Klais & Company, Inc.

For Questions About State Mandated Benefits:

Does this Plan Cover Benefits that are State Mandated?

The policy provides all required state mandated benefits. 

What Benefits are Mandated by my State?

Because these mandates are subject to change with out notice Student Health Plan recommends that you contact Klais & Company, Inc. (800.331.1096) to obtain a complete list of applicable state mandated benefits.

For Questions About Claims:

How Do I File a Claim?

Obtain a claim form online at: www.studenthealthplan.com/2011brochure. Submit the fully completed and signed claim form and itemized bills to the claims administrator. 

Klais & Company, Inc.

1867 West Market Street

Akron, OH 44313

Balance due bills are not acceptable because they do not show the date of service, procedure code and diagnosis.

How do I check the status of an existing claim?

After you have filed a claim, you may view the status of your claim online at: www.klais.com. Online claim status requires a group number.  The group numbers are: Premium Plan CP800B1/Basic Plan CP800C1. You may also call Student Health Plan at (877) 270-1159 and follow the prompts for claim questions.

What are some of the reasons Student Health Plan may not reimburse my medical provider for a claim I submitted?

Klais & Company, Inc. will send a letter when a claim is denied. The following are common reasons for denial:

∑ Other insurance may be responsible for paying the claim

∑ The services may not be covered according to the exclusions listed in your Student Accident and Sickness Insurance Program brochure

∑ The claim may not have occurred while you were covered.

∑ The charges may be over reasonable and customary (any questions about the Reasonable and Customary policy please contact SHP)

∑ Your Condition may be considered Pre-Existing

For general claims questions call: (877) 270-1159

For claim procedures and to download a claim form: Please visit: www.studenthealthplan.com/claimform  

For status on an existing claim: please call (877) 270-1159 or visit www.klais.com

For Questions About ID Cards:

When should I expect to receive my ID card?

Once you have purchased the coverage online, a card will be mailed to the address you provided at the time of purchase and should arrive within 7-10 business days.

Must I receive my ID card in order to see a physician?

This card is for identification only. It is not a guarantee of eligibility or benefits. If you need medical attention before your permanent ID card is received, benefits will be payable according to the policy. You do not need an ID card to be eligible to receive benefits.

How are dependents identified on the ID cards?

If a dependent was added to your policy, you will receive the same number of cards as dependents insured. However, the cards sent will all carry the name of the first insured or name on the policy.

What if I lost my ID card(s)?

For lost ID cards, call (877) 270-1159

Questions About Pre-Existing Conditions:

What is a "pre-existing condition"?

A pre-existing condition is any condition for which you have had symptoms or services provided before the effective date on the plan. Pre-existing condition means a condition that manifested itself during the six months immediately preceding the covered person’s effective date of coverage in such a manner as would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment was recommended or received.

Are Pre-existing Conditions Covered? 

Pre-existing conditions are not covered unless the patient can demonstrate proof of prior creditable coverage within 63 days of the plan effective date.  Each day of prior creditable coverage reduces the pre-existing coverage period (six months) by one day.  Please consult the Plan brochure for a complete description of the pre-existing Conditions Coverage limitation.

Link to the Plan Brochure

Questions about Emergency Medical Transportation Services:

What is Medical Transportation Services?

Some key services include: emergency evacuation, medically necessary repatriation, repatriation of remains, and family or friend transportation arrangements.

How do I contact them?

Worldwide medical, legal and travel services are available 24 hours a day, 365 days a year and may be contacted using the following numbers:

Toll Free: 1-866-509-7715 (within U.S.) or 1-603-328-1728 (World Wide)

General Question about the Following:

Insurance Benefits

Enrollment

Claims Processing

ID Cards

Inpatient Admission Pre-Certification

Excluded Drugs and Pre-Authorization

Updating your personal information such as mailing address, name, etc.

Please contact, Student Health Plan at (877) 270-1159

Other General Questions:

Who Underwrites this Plan?

This plan is underwritten by United States Fire Insurance Company, a Crum & Forster Company.  This company has an A.M. Besting Rating “A” (Excellent)

If I have questions about my policy benefits, who should I ask?

We recommend that you familiarize yourself with your covered benefits located in the Student Accident and Sickness Insurance Program brochure. Link to the Plan Brochure.  If you still need assistance, please email or call Student Health Plan and a claims administrator can help you with your benefit questions. You may contact SHP at info@studenthealthplans.com or (877) 270-1159.

Does this plan cover dental?

The only dental coverage that you will have is treatment for any injury to sound natural teeth.

Who is College Parents of America? Who is Klais & Company? What are their roles? How do I contact them?

College Parents of America (CPA) is the only national membership organization of future and current college parents.  The blanket student health insurance policy is issued to CPA by United States Fire Insurance Company.  For more information, please visit www.collegeparents.org or call (888) 761-6702.  Klais & Company is the claims administrator of the Student Health Plan responsible for all claims and any related issues pertaining to claims.  Klais processes all fulfillment documentation sent out once you have enrolled in the Student Health Plan.  For more information, please visit www.klais.com or call (877) 270-1159

What is my policy number?

Your policy number is UDL3376S / Form No.: CPA11.

As a parent or guardian, may I speak with the Customer Care Unit about the status of my son’s or daughter’s claim? 

Due to the HIPAA Privacy Laws enacted several years ago, to discuss a claim with the Customer Care Unit you must mail or fax a fully completed HIPAA Consent Form to Klais & Company.  Consent forms can be obtained by calling Student Health Plan at: (877) 270-1159.  Consent forms are also available online at www.klais.com.

What happens if I withdraw or graduate from school while I am enrolled in your insurance plan? Will you refund my money? If not, am I still covered?

You will not receive a refund. However, your plan will continue through the period for which you have paid.

What is a “Reasonable and Customary” charge and how does that charge affect me as a consumer?

Reasonable and Customary charges are guidelines developed by an independent source and used by insurance companies. These guidelines help to reinsure that the fees that providers are charging are reasonable for the service(s) provided in their geographic area.

What Is your refund policy?

Insured Students entering the Armed Forces of any country will not be covered under this Plan as of the date of such entry. Those students withdrawing from the school to enter military service will be entitled to a pro rata refund of premium. Requests should be made to the Program Manager by calling: (877) 270-1159. Premium received by the Company is fully earned upon receipt. No other requests for a refund of premium can be considered.

 

The Student Health Plan is underwritten by the United States Fire Insurance Company. Fairmont Specialty and Crum & Forster are registered trademarks of United State Fire Insurance Company.  The Crum & Forster group of companies is rated A (Excellent) by AM Best Company 2009