************************************************************** IFCSS Headquarters News Release No. 5088 Dec 16, 1993 ************************************************************** Independent Federation of Chinese Students and Scholars (IFCSS) 733 15th Street, N.W., Suite 440, Washington, D.C.20005 Tel. (202)347-0017 Fax: (202)347-0018 Email: ifcss@wam.umd.edu Updating IFCSS Medical Insurance Program ======================================== At this time of family, love and care, please accept our warmest holiday greetings to you and your family. We would like to take this opportunity to proudly recommend to you the renewed IFCSS Medical Insurance Program (1994), which is currently held by over 4,500 members in our community. The IFCSS Medical Insurance Program is the most affordable program with the kind of coverage designed to meet the special need of students and scholars from China, Taiwan and Hong Kong. Compared to the last year's version, the renewed program has NOT INCREASED its premium cost. Instead, several new benefits and broadened coverage are added to it. Now the new version will also cover medical cost incurred while you are in your home country (China, Taiwan or Hong Kong). 1-800 hotlines will be established to assist you in looking for doctors and for processing your claims. The program will also cover the cost for traditional Chinese medicines prescribed by registered Chinese medicine practitioners. By joining the IFCSS Medical Insurance Program, you are double insured. For you have an strong organization to assist you to settle disputes and to speed up your claim. Over the last four years, we have never allowed a single complaint to stand. Our record is 100% satisfaction over dispute settlement. By participating in the program, you will also help IFCSS with its financial future, and help your local CSS organization with needed activity funds. We need your support!! Attached is the entire brochure of the insurance program. After comparing both its cost and benefit features with other similar plans, you will see it is the best deal in the market. Please read the brochure carefully, and print out the Enrollment Form in it. To apply for the program, you need to fill out the Enrollment Form and send it (with check or credit card authorization) to: IGS, 10530 Rosehaven Street, Suite 350, Fairfax, VA 22030. If you need a brochure by mail, please call IGS at 1-800-394-2500 or IFCSS at (202)347-0017 or fax (202)347-0018. If you have questions regarding the policy, please call IGS at 1(800)394-2500. We also encourafe you to save this message for your own reference and for your friends or relatives who may not have access to it. Thank you very much. * * * * * * IFCSS Medical Insurance Program (1994) Underwritten by: PanAmerican Life People you can trust for life (Rated "A" by A. M. Best) Administered by: International Group Services 10530 Rosehaven Street, Suite 350 Fairfax, Virginia 22030 800-394-2500 The Policy Holder of the Plan is The Independent Federation of Chinese Students and Scholars 733 15th Street, N. W. Washington, D. C. 20005 This brochure is only a brief summary of the Insured Person's coverage provided by the Master Policy. A complete description will be contained in the Certificate of Insurance which will be provided to each Insured Person. Any discrepancies between this brief summary and the Master Policy will be governed by the Master Policy. This Master Policy is issued to International Federation of Chinese Students and Scholars. This policy is subject to filing approval with the District of Columbia Insurance Department and is subject to the laws of the District of Columbia and various states which assert extraterritorial jurisdiction. The insurance described herein is subject to change at the direction of any and all applicable State Insurance Departments. This coverage is Title IX compliant; i.e. it provides coverage for maternity as any other temporary disability when conception occurs within the Period of Insurance. Eligibility of Coverage All Chinese Students, Scholars and their accompanying eligible dependents from mainland China, Taiwan and Hong Kong; who are associated with IFCSS; who have valid F-1 or J-1 visa status or who have applied for or have been granted Permanent Residence Status; who are temporarily residing outside their Home Country; who are actively engaged in education or educational research activities in the United States. Actively engaged with respect to a student or scholar means a person who is enrolled and attending classes in a college, University or community college for six or more credit hours; this requirement applies to F-1, J-1, F-2, and J-2 visa status and Permanent Residents. Graduate students holding J-1 or F-1 visas or Permanent Residents may have 3 or more credit hours. Practical training students are eligible. Period of Insurance: A. Effective Date of Insurance. Provided the required premium is paid, your insurance will become effective on the later of: o the Policy Effective Date. o 12:01 a. m. Standard Time on the date you indicated on the Enrollment Form; or o 12:01 a. m. Standard Time on the date the Enrollment Form and premium are received by The Administrator. NOTE: In no event may a person be insured for a period of more than 12 months under The Plan. The Plan renews annually on the first of each year. B. Termination of Insurance. Your Insurance will terminate on the earliest of: o 12:01 a. m. Standard Time on the last day for which your premium has been paid, subject to the Grace Period; o 12:01 a. m. Standard Time on the date you cease to be eligible for this insurance; o 12:01 a. m. Standard Time on the date you depart the U. S. A. for your Home Country; o 12:01 a. m. Standard Time on the date The Plan is canceled. Medical Treatment Benefit This benefit will pay for the Medically Necessary Eligible Expenses incurred for the treatment of a Covered Injury or Covered Sickness which first occurs after you become insured. This benefit covers up to $200,000 of the Eligible Expenses incurred for each Covered Injury or Covered Sickness according to the table below. You must pay any deductible or amount not eligible for benefits under The Plan. Per Covered Injury or Covered Sickness, the following is the portion of the Eligible Expense incurred in excess of the deductible amount and the coinsurance percentage payable, subject to the Excess Coverage Provision: Eligible Expense This Benefit Pays Covered Person Incurred Pays ================================================================ The Deductible None All expenses Amount ($50.00) $50.01 but less than 100% of Eligible Any expense $5,000.00; then Expense Incurred not covered by The Plan $5,000.01 but less than 80% of Eligible 20%of Eligible $50,000; then Expense Incurred Expense Incurred and any expense not covered by The Plan $50,000.01 but less than 100% of Eligible Any expense not $200,000.00,then Expense Incurred covered by The Plan $200,000.00 or more None All expenses In addition, Eligible Expenses Incurred for a Covered Injury or Covered Sickness are subject to the following limits: Therapeutic Termination of Pregnancy $500.00 Maximum Benefit In Hospital Room and Board Prevailing Semi-Private Room Rate Newborn First 31 days/ $500.00 Maximum Routine Nursery Care Benefit Accidental Dental Expenses $1,000.00 Maximum Benefit (Covered Injury Only) Limited to $100.00 per tooth Emotional and Mental Disorders Inpatient Limit 50% of Eligible Expenses 30 day Maximum Benefit Outpatient Limit $500.00 Maximum Benefit per lifetime Outpatient Prescription Drugs 50% of Actual Charge Outpatient Back and Spine $1000.00 per Year Maximum Disorders (including modalities) $35.00 per visit (Maximum 3 visits per week) Home Country Benefit $1000 Maximum Benefit/30-Day Limit Medical Evacuation Benefit Maximum Benefit: $200.00 If you become unable to continue your academic program because of a Covered Injury or Covered Sickness, the insurance will pay the necessary expenses to the Maximum Benefit for your evacuation to your Home Country; or to a facility for the treatment of injured or ill persons in your Home Country; or to another medical facility in the U. S. A. A medical evacuation would be considered only if Medically Necessary and after being hospitalized for at least five consecutive days. Any expenses in respect of medical evacuation require prior approval of both the attending physician and The Administrator. Repatriation Benefit Maximum Benefit: $200,000 If you should die from a Covered Injury or Covered Sickness, the insurance will pay to the Maximum Benefit necessary expenses for the preparation and transportation of your body to your Home Country. All expenses must be approved by The Administrator before the body is prepared for transportation. All benefits afforded are payable up to the first to occur of: a.) the Maximum Benefit payable; b.) 52 weeks from the onset of or the date of Covered Injury or Covered Sickness; or c.) the date of Covered Person's Insurance termination. However, if he or she is Hospital Confined on such date, benefits are payable up to the first to occur: 1.) 26 weeks from the date of termination; or 2.) the date he or she is no longer Hospital Confined. Benefits will continued to be paid under any Subsequent Group Insurance Plan issued to The Independent Federation of Chinese Students and Scholars and administered by IGS for a Covered Injury or a Covered Sickness if all of the following conditions are met: a.) the Maximum Benefit payable* under The Plan has not been exhausted; b.) 52 weeks has elapsed from the onset of or the date of Covered Injury or Covered Sickness; c.) the Covered Person is Continuously Covered from The Plan to any Subsequent Group Insurance Plan issued to the Independent Federation of Chinese Students and Scholars and administered by IGS; or d.) the Covered Person's Insurance has not been terminated. *The Maximum Benefit payable for the Medical Treatment Benefit described above is $200,000, subject to the deductible and coinsurance amounts. DEFINITIONS (The following are some important definitions. Refer to the Certificate of Insurance and your Conditions of Insurance for a complete list of terms.) Covered Injury means bodily injury of a Covered Person which results directly and independently of all other causes from an accident which occurs while he or she is covered under The Plan. A Covered Person must begin receiving services, supplies or treatment within 72 hours from the time of the accident in order for it to be considered a Covered Injury. Covered Sickness means sickness or disease of Covered Person which first Manifests itself while he or she is covered under The Plan. Important Information Preferred Provider Organization (PPO) The Policy offers the use of a Preferred Provider Organization (PPO). PPO's are arrangements with hospitals, Physicians, and other providers to furnish You medical care at negotiated costs. Insured Persons will receive a toll-free telephone number to access the PPO Network for medical providers in their area. The PPO is staffed with Chinese speaking representatives. The availability of the PPO does not restrict the choice of Providers. Insured Persons may seek medical care from any hospital, Physician or other provider desired, however, you are urged to obtain care from Preferred Providers whenever possible as this will offset medical inflation and control premium increases. Right of Subrogation The Underwriters shall be fully and completely subrogated to your rights against parties who may be liable to provide indemnity or make a contribution in respect to any matter which is the subject of a claim under The Plan. EXCLUSIONS 1.) The Plan will not cover medical Expenses incurred unless for a Covered Sickness or a Covered Injury (see definitions). 2.) The Plan will not cover medical expenses resulting from a motor vehicle accident if the Covered Person is not properly licensed to operate the motor vehicle within the jurisdiction in which the accident takes place. 3.) The Plan will not cover: a.) Any claim arising from a routine physical or other examination where there is not objective indication or impairment of normal health; b.) Any claim for dental treatment except when as the direct result of a Covered Injury; c.) Any claim with respect to the treatment of Congenital Conditions or the costs of cosmetic surgery except when necessitated by a Covered Injury. Any claim with respect to the treatment of Deviated Nasal Septum including Submucous Resection and/or other surgical corrections unless caused by a covered accident; d.) Any claim arising from intentionally self-inflicted Covered Injury, suicide or attempted suicide, the influence of alcohol or intoxicants, or the use of drugs except as prescribed by a licensed Physician; e.) Any claim arising from war, declared or undeclared, or any act of war, or loss while in the military, naval or air service of any country or international authority; f.) Any claim arising from riding in any aircraft other than as a passenger in an aircraft licensed for the transportation of passengers; g.) Any claim with respect to examinations for, or prescriptions of eyeglasses or hearing aids except as a result of a Covered Injury; h.) Any claim arising from participation in club, interscholastic, intercollegiate or professional sports; i.) Expenses incurred as a diagnostic investigation or medical treatment in connection with infertility, fertility or birth control; j.) Any expense in excess of the prevailing semi-private room rate unless Medically Necessary; k.) Any claim for treatment, services, supplies or facilities in a Hospital owned or operated by a national government or any of its agencies. (This exclusion does not apply to treatment when a charge is made which the Covered Person is required by law to pay.) 4.) The Plan will not cover any medical treatment received in the Home Country of the Covered Person. 5.) The Plan will not pay any Expenses incurred for a Covered Injury or Covered Sickness covered under any occupational benefit plan, other insurance or public assistance program. Premium Rates These rates are valid for coverage which has an effective date on or after January 1, 1994 and until December 31, 1994. For rates effective after these dates, please call The Administrator. Premium must be paid either annually or semi-annually. Only if dependent Refund of Premium Premiums received by The Administrator will be considered fully earned and non-refundable. Refund of premium will be considered only if you cease to be eligible for the insurance on a pro rata basis. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ IFCSS MEDICAL INSURANCE ENROLLMENT FORM PLEASE PRINT - PLEASE ANSWER ALL QUESTIONS DATE OF BIRTH:________________________________ FAMILY NAME FIRST NAME (GIVEN NAME) USA STREET ADDRESS: ____________________________________________________________ HOME TELEPHONE NUMBER: _____________________________________ CITY:_______________________________________________________ STATE: _____________________ ZIP: __________________ NAME OF UNIVERSITY/SCHOOL: _________________________________ TYPE OF VISA HELD:__________ ____PR ____Male _____Female YOUR UNIVERSITY/SCHOOL ADVISOR: _________________________________________ ADVISOR PHONE #:____________________________ Have you ever had insurance by International Group Services, Inc. before? _____ No _______ Yes If Yes, Prior Identification #:___________________________________________ Prior Policy #:____________________________________ Home Country: __________________________________ I want my insurance to begin on: ______________/_____________, 1994. Month Day Circle applicable premium(s) and add for your total premium. NOTE: Premium must be paid annually or semi-annually. Only if dependents are covered may premium be paid annually, semi-annually,or quarterly. coverage is purchased may premium be paid annually, semi-annually or quarterly. Over Age 65 Annual Semi-Annual Quarterly (Annual Only) Student $ 396.00 $198.00 $ 99.00 $3,000.00 Student & Spouse $1,980.00 $990.00 $495.00 $8,400.00 One Child $ 480.00 $240.00 $120.00* N/A Two or More Children $ 960.00 $480.00 $240.00* N/A *(Available only if parent(s) also insured) NOTE: Dependents may only be enrolled on the date the member is enrolled or within 31 days of birth, or 90 days of marriage, or arrival in the U. S. A. authorize premium deductions from my bankcard. ______MasterCard _____Visa Number______________________________________ Expiration__________________________________ Student & Signature___________________________________ Do not elect this payment option if you reside in AL, NC, NY, TX or PA ____________________________________________ _ Student's Signature Two or More If you wish to pay by check or money order, make payable to International Group Services, Inc. and mail with enrollment form to: ADMINISTRATOR, International Group Services, Inc. 10530 Rosehaven Street, Suite 350, Fairfax, VA 22030 REMITTANCE ACCEPTED IN U. S. FUNDS ONLY. If you have any questions, please call the Administrator (toll-free) 800-394-2500. NOTE: Your spouse must be enrolled as a spouse unless also registered as a student or scholar, then separate applications are required. Dependents may only be enrolled on the date the student is enrolled or within 31 days of birth, or within 90 days of marriage or arrival in the U. S. A. Spouse and/or children may only be enrolled if student is enrolled. If you are insuring dependents: Names Date of Birth Spouse_________________________________________________ Child__________________________________________________ Child__________________________________________________ ********************************************************************* * IFCSS Headquarters Office * *-------------------------------------------------------------------* * President: Lin Changsheng Vice President: Shi Heping * * Exec. Director: Liu Xiaozhu Chief of Staff: Huang Songyun * *-------------------------------------------------------------------* * PBS-L is IFCSS's news distribution list for individuals. To sign * * on or off from IFCSS E-mail mailing list, please send email to : * * listserv@ifcss.org * * leave the subject line open and put in the mail body: * * (For signing on) sub PBS-L last_name first_name * * (For signing off) unsub PBS-L last_name first_name * * For more information about IFCSS, write to ifcss-info@ifcss.org * *********************************************************************