Summary of Benefits for CIEE Insurance Coverage
Provider Network
Aetna Preferred Provider Network with access to over 672,000 health care service providers nationwide www.ciee.org/in-the-usa/insurance
Claims Process
To file a claim: www.ciee.org/insurance for a claim form and instructions on how to submit a claim for reimbursement
Claims Filing Limit
90 days for Medical Claims/Reimbursements 15 days Non-Medical Claims 5 days from notification for Liability Claims
Maximum Coverage
Please refer to your Confirmation of Insurance
Notification Requirement
CIEE must be notified of all hospitalizations, testing, medical procedures, surgeries, or specialist visits within 48 hrs.
Pre-Certification
Participant or representative of participant, must contact CIEE if hospitalization is required. A 50% Reduction of Eligible Medical Expenses if Precertification requirements are not met
Non-urgent/Elective Outpatient Procedures or Surgeries
15,000 Maximum limit
Copays
Preferred or Non Preferred Care $20-Urgent Care Facility/visit $50-Doctor Office/Specialist/visit $100-ER and Inpatient/visit $20-Prescription
Coinsurance
In-Network (Aetna) – 100% of Negotiated Charge Out of Network (non-Aetna) – 80% of Reasonable Charge
Routine visits, Sports physicals, Immunizations or Exams
These visits are not covered on this plan, this includes eye visits and glasses
Treatment Period
90 days per Injury or Illness
Physical Therapy
$1,000 maximum and/or 90 days with a referral from a medical doctor
Chiropractic Therapy
$1,000 maximum and/or 90 days with a referral from a medical doctor
Hospital Room & Board
Up to the average semi-private room rate, including nursing service after $100 copay, must be precertified with in 48 hrs of admittance, call during business hours 1-888-268-6245
Inpatient Mental Health
Usual, Reasonable and Customary; inpatient benefits are limited to a maximum of 10 days per policy.
Outpatient Mental Health
Usual, Reasonable and Customary; outpatient benefits are limited to a maximum of 10 visits per policy.
Eligible Medical Expenses
Aetna Provider: 100% of Negotiated Charge Non Aetna Providers: 80% of Reasonable Charge; 100% of Negotiated Charge if Insured Person lives more than 50 miles from an Aetna Provider
Prescription Drugs
$20 copay per prescription per 30 day supply, participant must pay in full for the prescription and submits claim for reimbursement
Dental Treatment
Coverage Applies to Sound Natural Teeth Dental Injury: $1,000 maximum, including fracture of jaw Dental Illness: $500 maximum ***This policy does not cover cavities, fillings, crowns or bridges***
Urgent Travel Expense
Up to $2,000 for transportation to home country in the event of death of father, mother, brother, sister, or grandparent
Emergency Medical Evacuation Expenses
Up to $75,000 Maximum Limit
Emergency Reunion
Up to $15,000 Maximum Limit
Return of Mortal Remains
Up to $30,000 Maximum Limit
Accidental Death and Dismemberment
Accidental Death: $10,000 Dismemberment: Up to $85,000 Maximum Limit
Baggage
Loss or theft of Baggage
Loss or theft of Valuables
Loss or theft of Personal Papers
Up to $1,500 per Period of Insurance
Up to $350 per Period of Insurance
Up to $500 per Period of Insurance
*Any loss, theft or damage to mobile telephones or other personal handheld communication devices, MP3 players, IPods, IPads, portable DVD players, portable GPS or similar personal electronic devices are not covered on this policy*
Insurance Name: CIEE
Claims Administrator: Aetna Student Health
Network: Aetna
Group Number: CIEE-697401
Member ID: (located on insurance ID card)
Mail Medical Claims to:
Aetna Student Health
PO Box 981106
El Paso TX 79998
Mail Non-Medical Claims to:
CIEE: Insurance Dept.
600 Southborough Drive, Suite 104t
South Portland, Maine 04106
CIEE 24 Hour Emergency service line: 1-888-268-6245
For General Insurance Inquiries: email insurance@ciee.org, or call 1-888-268-6245