STUDENT INJURY AND SICKNESS INSURANCE PLAN
SOUTHERN UNIVERSITY AND A&M COLLEGE SYSTEM
BATON ROUGE, LOUISIANA
2005-2006 ACEDEMIC YEAR

All students officially enrolled within the Southern University and A & M College System have health insurance coverage in a Student Injury and Sickness Insurance Plan. This plan is underwritten by Monumental Life Insurance Company for the 2005-2006 school year. The insurance plan is mandatory for all enrolled students, and the premium is added to their tuition billing. The policy is designed for all enrolled students who attend the Fall and Spring semesters, to have continuous/year round coverage, and it covers the period August 13, 2005 through August 12, 2006. Eligible students who do enroll may also insure their Dependents. The plan is written under policy #CLA506B.

The Student Injury and Sickness Insurance Plan, which is a PRIMARY insurance policy for the student, is in force only when a student is officially enrolled. The plan provides coverage for students that participate in the intramural sports and cheerleader programs, but does not cover injury incurred by student athletes while participating in the practice or play of any National Collegiate Athletic Association (NCAA) sanctioned intercollegiate varsity sports.

The plan, which also includes life, accidental death, and dismemberment benefits, is a supplement to using the resources of the Student Health Center (SHC). Students must use the resources of the Student Health Center FIRST, where treatment will be administered or a referral issued. Exceptions to obtaining a referral from the SHC for outside care are outlined in the Student Injury and Sickness Insurance Plan Brochure. If a referral is issued, the student should present the referral, along with a validated University ID card and a current Health Insurance ID card (which is located in the Health Insurance Brochure), to the medical facility where treatment will be received. A copy of the referral received and the completed claim form should be mailed BY THE STUDENT directly to the insurance claims office. Expenses incurred for medical treatment rendered outside of the SHC for which no prior approval or referral is obtained are excluded from coverage.

CLAIM PROCEDURE

The Claims Administrator for this school year is Bollinger, Inc. In the event of Injury or Sickness, the student should:

 

1.	In a non-emergency situation, report at once to the Student Health Center for treatment or referral, or when not in school, to the nearest physician or hospital. In an emergency situation, upon discharge, report to the SHC for a claim form and/or referral if follow-up care is needed. Refer to DEFINITIONS in the insurance brochure for what is considered a MEDICAL EMERGENCY by the insurance company.
2.	Secure a claim form from the Student Health Center, from the plan website at www.BollingerInsurance.com/southern, or from the address below. Fill in the necessary information, attach all itemized bills, and mail to: Bollinger, Inc., P. O. Box 727, Short Hills, NJ 07078-0727. The claims office number is: 1-866-267-0092; select option (1) College Claims.
3.	File a claim within 30 days of the injury or first treatment for a sickness. Bills must be received by the claims office within 90 days of service to be considered for payment.
4.	Referrals must accompany the claim form when submitted. Claims without a referral, where required, WILL NOT be processed. These procedures must be followed for all medical treatment received from an outside facility and must be done by the student. Treatments not covered in the policy will not be paid and will be the responsibility of the student. Refer to the insurance brochure for covered and non-covered treatments.

Brochures will be available at the following locations on the campus: The Law Center-Baton Rouge, Office of Admissions; The Main Campus -Baton Rouge, Office of Admissions; Office of the Registrar; Office of Student Financial Aid; Office of Enrollment Management/University College; Residential Housing; Smith-Brown Memorial Union Lobby; Office of International Students; Office of Student Affairs; Office of Career Services; Office of Student Life; Office of Student Media; Athletics Department, Trainer's Office; Office of Graduate Studies; School of Nursing; the Counseling Center; and the Student Health Center, Lobby/Insurance Coordinator.

Students can also view and print brochures, claim forms, dependent enrollment forms, and check the status of claims on Bollinger's website at www.BollingerInsurance.com/southern. Bollinger, Inc. is affiliated with the CCN Preferred Provider Network. Providers on this network have agreed to accept the insurance and discount the charges. A directory of hospitals and specialty physicians throughout Louisiana and other states can be found on CCN's website at www.ccnusa.com. Students are encouraged to use the Provider Network when being referred for medical treatment at an outside facility.

Claim forms, Dependent Enrollment forms, and Insurance Brochures are also available in the SHC. Students who wish to enroll dependents must secure a Dependent Enrollment form from the Insurance Coordinator and submit premium, along with form, directly to the insurance company. Students, NOT THE UNIVERSITY, are responsible for paying the balance of medical bills that exceed the plan benefits, or charges for treatments not covered by the plan. Students MUST follow correct procedures for claims to be processed and paid. Students may contact the Insurance Coordinator for assistance in processing claims for medical bills or resolving problems with providers and the insurance claims office. DO NOT IGNORE MEDICAL BILLS. Direct any questions or concerns to the Student Health Insurance Coordinator at the SHC or call (225) 771-4770.
 

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