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At 4/30/07 02:22 AM, Luis wrote: Happy birthday Tom :)

yeah! happy birthday..... today's his birthday? well, anyway, congrats =D

At 5/4/07 09:34 PM, MrLino wrote:

At 4/30/07 02:22 AM, Luis wrote: Happy birthday Tom :)

yeah! happy birthday..... today's his birthday? well, anyway, congrats =D

A little late there bud. It was Monday.

At 5/5/07 01:07 AM, HooglyBoogly wrote:

At 5/4/07 09:34 PM, MrLino wrote:

At 4/30/07 02:22 AM, Luis wrote: Happy birthday Tom :)

yeah! happy birthday..... today's his birthday? well, anyway, congrats =D

A little late there bud. It was Monday.

fine... sorry bout that tom. LATE happy birthday =D

At 4/30/07 02:22 AM, Luis wrote: Happy birthday Tom :)

Have a spam-a-licous B-day.

oh....wait

Well that's just birth-tastic Tom!

Same lollipop =)

Its kinda spam, but u have right in Happy birtday and well i think ur soaming... or not... o well forget it!!!

Spam?!

­

▓

Fucking stop it.

­

­

saaaaaaaaaa

At 6/12/07 03:52 PM, Frattochino wrote: saaaaaaaaaa

aaaaaaaaaas

At 4/30/07 02:22 AM, Luis wrote: Happy birthday Tom :)

This is spam.

­

Happy b-day Tom.

2007 - 2008
Student Medical Insurance Plan
for Students and Dependents
August 23, 2007 - August 22, 2008
A referral is required from Student Health Services for full-time and three-quarter time
students who are insured under the Plan prior to receiving treatment outside Student
Health Services. Three-quarter time students who waive the Plan and all part-time
students and dependents are not eligible to use Student Health Services. School of
Public Health and Graduate Medical Science students have the option to obtain
treatment/referrals from Evans Medical Foundation or the Department of Family
Medicine at Boston Medical Center.
*Note: School of Public Health and Graduate Medical Science students will be
subject to a $25 Copay per visit at Evans Medical Foundation and the Department of
Family Medicine.
Offered by:
Chickering Benefit Planning Insurance Agency, Inc.
Administered by:
Chickering Claims Administrators, Inc.
Underwritten by:
Aetna Life Insurance Company
(ALIC)
Policy No. 711110
Table of Contents
Accidental Death and Dismemberment Benefit .............................................
.................................35
Additional Benefits.....................................
.............................................
........................................16
Claim Procedures...................................
.............................................
.............................................
34
Description of Benefits.....................................
.............................................
...................................13
Directory of Assistance...................................
.............................................
......................................4
Definitions .............................................
.............................................
.............................................
23
Exclusions...................................
.............................................
.............................................
...........28
Extension of Benefits .............................................
.............................................
.............................33
General Provisions...................................
.............................................
...........................................22
How to Appeal a Claim .............................................
.............................................
..........................34
Incapacitated Dependent Children .............................................
.............................................
.........33
Inpatient Admission Pre-Certification............................
.............................................
.....................12
Important Facts .............................................
.............................................
........................................5
Important Notes .............................................
.............................................
.....................................37
Insurance Enrollment Eligibility and Waiver Information .............................................
...................7
Insurance Enrollment for Dependents...................................
.............................................
................9
Insurance Enrollment for Part-Time Students.....................................
.............................................
..8
Insurance Enrollment for Students Graduating in January, 2008.........................................
.............9
Medical Evacuation and Return of Mortal Remains Services.....................................
....................36
Non-Duplication of Benefits .............................................
.............................................
..................23
Periods of Coverage.....................................
.............................................
.........................................3
Preferred Provider Network......................................
.............................................
...........................11
Premium Rates........................................
.............................................
.............................................
.3
Premium Refund Policy .............................................
.............................................
...........................6
Prescription Drug Claim Procedure .............................................
.............................................
.......34
Referral Requirements .............................................
.............................................
............................11
State Mandated Benefits.....................................
.............................................
.................................22
Student Health Services.....................................
.............................................
..................................10
Student Medical Insurance Plan.........................................
.............................................
.................10
Subrogation/Reimbursement Right of Recovery Provision....................................
.........................22
Summary of Benefits.....................................
.............................................
.....................................14
Termination of Insurance....................................
.............................................
.................................33
Waiver Deadlines....................................
.............................................
.............................................
.8
Where To Find Help .............................................
.............................................
.................................3
Worldwide Emergency Travel Assistance Services .............................................
............................35
THIS SUMMARY OF COVERAGE IS NOT MEDICARE SUPPLEMENT COVERAGE
If you are eligible for Medicare, review the Medicare Supplement Buyer’s Guide available from
Chickering Claims Administrators, Inc.
2
Boston University Student Medical Insurance Plan
Periods of Coverage
Coverage for insured students enrolled in the Annual Policy, before the deadline date, will be
effective on August 23, 2007, and will terminate on August 22, 2008. Spring Semester coverage
will be effective on January 7, 2008, and terminate on August 22, 2008.
Premium Rates
Prior to most types of treatment, a referral may be required from Student Health Services (School
of Public Health and Graduate Medical Science students have the option to obtain treatment/
referrals from Evans Medical Foundation or the Department of Family Medicine at Boston
Medical Center and will have the referral requirement waived for services rendered at Boston
Medical Center)* for full-time and three-quarter time students who are insured by the Plan.
*Note: School of Public Health and Graduate Medical Science students will be subject to a
$25 Copay per visit at Evans Medical Foundation and the Department of Family Medicine.
To enroll your eligible dependent(s), please complete the Enrollment Form located online.
Attention dependents and less than three-quarter time students: Because you are not eligible
to be seen at Student Health Services, you are not required to obtain a referral. A list of
Preferred Providers may be obtained by contacting Chickering Claims Administrators, Inc. at
(800) 966-7772 or you can use Aetna’s DocFind® Service: www.chickering.com.
Where To Find Help
Got Questions? Get Answers with Aetna NavigatorTM
As a Chickering Student Health Insurance Plan member, you have access to Aetna Navigator, your
secure member website, packed with personalized benefits and health information. You can take
full advantage of our interactive website to complete a variety of self-service transactions online.
3
Annual Policy Spring Semester
8/23/07 to 8/22/08 1/07/08 to 8/22/08
Student Rate $1,412 $974
Spouse Only $2,660 $1,661
Child(ren) Only $1,487 $929

By logging into Aetna Navigator, you can:
• Review who is covered under your plan
• Request member ID cards
• View Claim Explanation of Benefits (EOB) statements
• Estimate the cost of common health care services and procedures to better plan your expenses
• Research the price of a drug and learn if there are alternatives
• Find health care professionals and facilities that participate in your plan
• Send an e-mail to Chickering Customer Service at your convenience
• View the latest health information, news and more!
How do I register?
• Go to www.chickering.com
• Click on “Find Your School”
• Enter your school name and then click on “Search”
• Click on Aetna Navigator and then the “Access Navigator” link
• Follow the instructions for First Time User by clicking on the “Register Now” link.
Note: When prompted for member ID, if you don’t know your Aetna ID number, enter “33”
and the eight digit BU Student ID number (omit the “U”). Do not enter your SSN.
• Select a user name, password and security phrase
Your registration is now complete, and you can begin accessing your personalized information!
Need help with registering onto Aetna Navigator?
Registration assistance is available toll free, Monday through Friday, from 7 a.m. to 9 p.m.
Eastern Time at (800) 225-3375.
Directory of Assistance
1. Chickering Claims Administrators, Inc.
(800) 966-7772 or (617) 218-8400
• Pre-Certification
• Claims and Benefits Questions
• Supplemental Insurance Brochure
2. Aetna Pharmacy Management
Pharmacy Claims and Benefits Questions (800) 238-6279. Aetna Prescription Drug claim forms
are available at: Boston University Student Health Services, 881 West Commonwealth Avenue,
Boston, MA 02215 or at Chickering Claims Administrators, Inc. at (800) 966-7772.
Aetna Prescription Drug claim forms may also be downloaded from our website at
www.chickering.com. Click on the Help Center button on the school page.
3. Preferred Provider Network Listing (including Preferred Care Pharmacy listings)
For information call Chickering Claims Administrators, Inc. at (800) 966-7772 or (617) 218-8400
or you can use Aetna’s DocFind service: www.chickering.com.
4. Medical Insurance Enrollment/Waiver
• Boston University Student Link at www.bu.edu/studentlink
• Student Accounting Services website at www.bu.edu/comp/saweb
• Boston University Terrier Phone at (617) 353-6561
4
5. Medical Insurance ID Card
A permanent ID card will be issued as soon as possible. If you need medical attention before
the 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. Once you have received your ID card,
present it to the provider to facilitate prompt payment of your claims.
Note: Please be advised you will receive a unique Aetna member ID number on your
membership card.
For lost ID cards, contact:
Chickering Claims Administrators, Inc. at (800) 966-7772 or visit www.chickering.com,
click on “Find Your School” and enter 711110 as your Policy Number or search by school name.
6. Worldwide Emergency Travel Assistance Services
For questions about: Worldwide Emergency Travel Assistance Services – Please contact:
Assist America, Inc. at (800) 872-1414 (within U.S.). If outside the U.S., call collect by dialing
the U.S. access code plus (301) 656-4152.
E-mail address: medservices@assistamerica.com
Important Facts
1. Massachusetts law requires all full-time and three-quarter time students at institutions of higher
education in the state to have health insurance that meets state requirements. In addition, Boston
University policy requires that all international students (i.e., visa code F1, F2, J1, or J2) to
participate in a qualifying medical insurance plan. Please note that Embassy sponsored
non-U.S. based plans are no longer qualifying medical insurance plans.
2. All full-time and three-quarter time students insured under the Plan must seek treatment or
telephone advice from Student Health Services (School of Public Health and Graduate Medical
Science students have the option to obtain treatment/referrals from Evans Medical Foundation or
the Department of Family Medicine at Boston Medical Center) prior to obtaining any medical
treatment (except for emergencies and obstetrical/gynecological care) and must be seen at Student
Health Services for any follow-up care. If the provider at Student Health Services determines
outside treatment is necessary, a referral must be obtained from Student Health Services.
A referral is required each new academic year, and for each medical condition. Some examples
of when a referral is not required are:
• Emergencies (The referral requirement is also waived for any necessary follow up treatment
resulting from an emergency).
• Obstetrical and gynecological care.
• If outside the Greater Boston area.
• When Student Health Services is closed.
• Anyone not eligible to use the Student Health Services (all insured dependents and students who
are less than three-quarter time).
*Note: School of Public Health and Graduate Medical Science students will be subject to a $25
Copay per visit at Evans Medical Foundation and the Department of Family Medicine.
5
3. All inpatient Hospital admissions require Pre-Certification.
4. The Policy is an excess Policy. This insurance does not duplicate expenses paid or payable by
other insurance or service organizations.
5. Keep this Brochure as your record of insurance benefits. An Evidence of Coverage document
will be available at a later date at Student Health Services or on the internet by accessing
www.chickering.com. This Brochure is a general summary of the Master Policy, which is on
file at The Chickering Group.
6. You will be issued a permanent ID card as soon as possible. If the Covered Person must seek
medical attention before the ID card is received, benefits will be payable according to the
Policy. The Covered Person does not need an ID card to be eligible to receive benefits.
In the event of any questions, the provisions of the Master Policy will govern.
Premium Refund Policy
Except for a medical withdrawal due to a Covered Injury or Sickness, any student withdrawing
from school during the first 31 days of the period for which coverage is purchased shall not be
covered under the Policy, and a full refund of the premium will be made unless a claim has
been submitted.
Students and their dependents withdrawing after the first 31 days will remain covered under the
Policy for the full period for which premium has been paid and no refund will be available. This is
also true for students on leave for medical or academic reasons, and students electing to enroll in a
separate comparable or better plan during the Policy Year.
Students, or dependents of students, who enter into the armed forces of any country will be
issued a refund for the unearned pro-rata premium upon written request. Written request must be
submitted and received by Chickering Claims Administrators, Inc. within 90 days of withdrawal
from School.
6

Insurance Enrollment Eligibility and Waiver Information
Boston University requires that all full-time, three-quarter time, and international students
(i.e., visa code F1, F2, J1, or J2) participate in a qualifying health insurance plan.
Full-time students are those registered for at least 12 credits in a semester in the Fall and Spring
Semester for most schools within Boston University and graduate students registered below
12 credit-hours who have certified full-time status.
Three-quarter time students are those certified as part-time, but registered for 75 percent or more
of a full-time course load (nine or more credit hours for most schools within Boston University.)
All full-time, three quarter time, and international students are assessed the student medical
insurance charge at the time of registration. These students will automatically be enrolled in
the student Medical Insurance Plan if they do not waive this coverage by August 16, 2007.
The deadline for newly enrolled Spring Semester students is February 1, 2008.
Students who waive the coverage may later enroll up to September 23, 2007 (February 1, 2008
for newly enrolled Spring Semester students), however coverage will be effective on the day after
the date of enrollment.
If a student has an alternate health insurance plan with comparable coverage, the student may
request a waiver from participating in the Boston University Student Medical Insurance Plan for
the 2007/2008 policy year.
However, to be comparable, the plan must provide to the student reasonably comprehensive
coverage of health services, including preventive and primary care, emergency services,
hospitalization benefits, ambulatory patient services and mental health services throughout the
school year. Also, the services covered under the alternate health plan must be reasonably
accessible for all health services to student in the area where the student attends school.
The burden of proof that the alternate insurance is adequate falls on the student.
Many students have insurance coverage through their parents. However, a health plan through
a closed network of providers and accessible only for emergency services is not comparable
coverage. Students and parents should be aware of this very important fact.
Important Message to International Students Who Wish to Waive Student
Medical Insurance
In accordance with the Massachusetts Qualifying Student Health Insurance Plan (QSHIP) laws,
Boston University cannot accept medical insurance Waivers based on coverage issued by a foreign
insurance carrier, if the student is studying in the United States.
Insurance through a carrier outside the U.S. or from foreign National Health Service programs is
comparable only if the student is studying outside the United States and the foreign insurance plan
provides coverage in that non-U.S. location.
The text of the Massachusetts QSHIP law can be viewed at the Department of Health Care and
Finance Policy website, at www.state.ma.us/dhcfp under “Student Health Insurance.”
7
Waiver Deadlines
• August 16, 2007 for students who attend school during the Fall Semester 2007.
• February 1, 2008 for students who attend school beginning with the Spring Semester 2008.
For students who increase their part-time course load to 75 percent of the full course load
(nine or more credit-hours) or who change to full status effective Spring Semester 2008.
Options for Confirming Enrollment or Waiving Insurance
• Student link at www.bu.edu/studentlink. Starting at the main menu, select Money Matters,
then Medical Insurance. An Academic Computing System (ACS) account is required to access
the system. Students can confirm enrollment or electronically file a Waiver Form.
• Download Waiver Forms from the Student Accounting Services website at
www.bu.edu/comp/saweb under Medical Insurance.
• Terrier Phone at (617) 353-6561. Starting at the main menu, select Option 1 (Student Accounts
General Functions), then Option 5 (Medical Insurance). A six-digit Personal Identification
Number (PIN) is required to access the system. Students can confirm enrollment or request a
Waiver Form.
• Contact Student Accounting Services at 881 Commonwealth Avenue, Boston, MA 02215
(617) 353-2264 to confirm enrollment or request a Waiver Form.
Note: If the student is under the age of 18, the parent or guardian must cosign the Medical
Insurance Waiver. Students under age 18 should use the paper Medical Insurance Waiver form
which may downloaded from the Student Accounting Services website (www.bu.edu/comp/saweb),
rather than the Student Link.
Students who do not submit a Medical Insurance Waiver by the appropriate deadline are
automatically enrolled in the Plan and are responsible for the ensuing charge.
Insurance Enrollment for Part-Time Students
Some part-time students may have their student account automatically assessed for medical
insurance. If your student account was assessed for medical insurance, you will automatically be
enrolled in the student medical insurance plan unless you active actively decline (waive)
enrollment in the student medical insurance plan by the Medical Insurance Waiver deadline.
Those Part-time students whose student account is not automatically assessed for medical
insurance for the 2007/2008 policy year may enroll by contacting Student Accounting Services in
writing prior by September 23, 2007. The enrollment deadline for new students entering Boston
University in the Spring 2008 semester is February 1, 2008.
Requests for an application to add insurance and a Brochure describing the Plan benefits may also
be made via the Student Link or the Terrier Phone System.
Certified part-time students who enroll below the 75 percent of the full-time course load are not
eligible to utilize Student Health Services.
8

Insurance Enrollment for Dependents
Insured students may enroll their eligible dependents by completing the secure online enrollment
form prior to September 23, 2007, for the Annual Policy or February 1, 2008, for the Spring
Semester. Online Enrollment is accessible by our website at www.chickering.com. Eligible
dependents are the insured student¡¯s spouse and unmarried children under 19 years of age who
reside with, and are fully supported by, the covered student.
Newborn Infant Coverage: A child born to an insured student or spouse will be covered for
Injury, Sickness, and congenital defects for 31 days from the date of birth. Coverage will cease at
the end of 31 days. To extend the coverage for a newborn beyond the 31 days, the Covered Person
must: (1) enroll the child within the 31 days from the birth date and (2) pay the applicable
premium starting from the date of birth. Contact Chickering Claims Administrators, Inc. for
questions regarding separate premium rates and applications at (800) 966-7772.
Adopted Children Coverage: Coverage is provided for a child legally placed for adoption with
a Covered Person for 31 days from the moment of placement, provided the child lives in the
household of the Covered Person and is dependent upon the Covered Person for support. At the
end of this 31-day period, coverage will cease.
Dependents of International Students: The United States Federal Government requires all J-2
Visa dependents to have insurance coverage under an approved insurance plan. Also, all F-2 Visa
holders and other dependents are strongly recommended to have insurance coverage under an
approved plan. The Boston University Medical Insurance Plan described in this Brochure meets
the State and Federal requirements.
Dependent enrollment is now available online:
1. Visit www.chickering.com
2. Click on ¡°Find Your School¡±
3. Type in your School Policy Number, 711110, or search by school name
4. Once at your school web page, click on the Enroll Tab
5. Click on Online Enrollment for Dependents
6. Follow the prompts on the screen by providing all information requested
7. A confirmation e-mail is sent within minutes of enrollment completion
Insurance Enrollment for Students Graduating in January, 2008
Insured students who will be graduating in January, 2008 are eligible to request a pro-rated
portion of their student medical insurance premium for the Fall Semester only. Fall Semester
coverage will be effective from. August 23, 2007, and will terminate on January 6, 2008. Insured
students will be charged the annual premium rate of $1,412 until they have applied and have been
approved for the Fall Semester coverage option. The premium rate for Fall Semester coverage will
be $684. Students must request this adjustment to their student medical insurance premium prior
to January 7, 2008, in order to be eligible for this option. An adjustment of the student medical
insurance premium will not be approved if a claim has been submitted with a date of service after
January 6, 2008. Approved students who register for Spring 2008 or who do not graduate in
January, 2008, will have the premium adjustment reversed and will be responsible for the full
annual premium.
9
Please contact Student Accounting Services at (617) 353-2264 to request a Medical Insurance
Premium Adjustment Form for students graduating in January, 2008, or download this Form from
the Student Accounting Services website at www.bu.edu/comp/saweb.
Please note: Students who have been approved for the Fall Semester coverage and who also have
dependent coverage through Chickering Benefit Planning Insurance Agency, Inc., must be aware
that they may not continue dependent coverage and will be refunded a partial premium for their
dependents. Please contact The Chickering Group at (800) 966-7772 for further information.
Student Medical Insurance Plan
The following is an outline of the BOSTON UNIVERSITY STUDENT MEDICAL
INSURANCE PLAN. The Plan is administered by Chickering Claims Administrators, Inc.
Complete details of coverage are provided in the Master Policies issued to the University by Aetna
Life Insurance Company (Aetna) and by Unum Provident Life Insurance Company of America/
Assist America, Inc. The Master Policies may be inspected during normal business hours by
appointment at Boston University Student Health Services.
The Plan offered through the University and described on the following pages meets, and in most
cases exceeds, the minimum standards defined by the Commonwealth and is reasonably priced at
$1,412 annually.
You should note that this Student Medical Insurance Plan is separate from Student Health Services
and may not cover the total Hospital or other medical care bills due to Policy benefit limitations,
reductions, or exclusions. Unpaid medical charges are the Covered Person¡¯s responsibility.
Student Health Services
Boston University Student Health Services provides medical care at 881 Commonwealth Avenue
for all full-time students, regardless of their insurance choice, and for students who participate in at
least 75 percent of the full-time curriculum if they do not waive the insurance offered through the
University. Refer to page 7 for definitions of three-quarter time and full-time status.
Part-time students who are enrolled below 75 percent of the full-time curriculum are not eligible to
utilize Student Health Services. The office is open Monday through Thursday 8 a.m. to 8 p.m.,
Friday from 8 a.m. to 5 p.m. and Saturday from 9 a.m. to 5 p.m. We do not have on campus
overnight care, but students who require inpatient care will be referred to local hospitals.
Many health services are covered under the graduate health services fee or undergraduate student
fee, others are not. Students are financially responsible for any uncovered costs within the clinic
and all services incurred outside the clinic. If the provider at Student Health Services determines
outside treatment is necessary, the student must obtain a referral from Student Health
Services (School of Public Health and Graduate Medical Science students have the option to obtain
treatment/referrals from Evans Medical Foundation or the Department of Family Medicine at
Boston Medical Center and will have the referral requirement waived for services rendered at
Boston Medical Center).* Except for Emergency Medical Conditions (including any required
emergency room follow-up care) and for routine and emergency obstetrical (including maternity
care) and gynecological services, benefits are not payable for services rendered to a full-time or
three-quarter time student who has not received a referral from the Student Health Services.
*Note: School of Public Health and Graduate Medical Science students will be subject to a
$25 Copay per visit at Evans Medical Foundation and the Department of Family Medicine and
will have the referral requirement waived for services rendered at Boston Medical Center.
10
Preferred Provider Network
Chickering Benefit Planning Insurance Agency, Inc. has arranged for you to access a Preferred
Provider Network through Aetna, in your local community. Acute care facilities and mental health
networks are available nationally if you require hospitalization outside the immediate area of the
Boston University campus.
To maximize your savings and reduce your out-of-pocket expenses, select a Preferred Provider.
It is to your advantage to utilize a Preferred Provider because significant savings can be achieved
from the substantially lower rates these providers have agreed to accept as payment for their
services. Preferred Providers are independent contractors and are neither employees nor agents
of Boston University, Chickering Claims Administrators, Inc. or Aetna.
A complete listing of Preferred Providers is available to full-time, three-quarter time, and part-time

students as well as to dependents at Boston University Student Health Services. You may also
contact Chickering Claims Administrators, Inc. at (800) 966-7772. Additionally, you can obtain
information regarding Preferred Providers by using Aetna’s DocFind service: www.chickering.com.
Referral Requirements
The Plan provides benefits to help cover costs for care. Primarily it protects against costs in cases
of major Hospital emergency, anytime, anywhere in the world.
You should note that this insurance is separate from Student Health Services and may not cover
the entire Hospital or other medical care bills due to Policy benefit limitations, reductions,
or exclusions. Unpaid medical charges are the Covered Person’s responsibility.
When Student Health Services is available, all full-time and insured three-quarter time students
must first report to the Student Health Services for treatment (School of Public Health and
Graduate Medical Science students have the option to obtain treatment/referrals from Evans
Medical Foundation or the Department of Family Medicine at Boston Medical Center and will
have the referral requirement waived for services rendered at Boston Medical Center).* Refer to
page 7 for definitions of three-quarter time and full-time status. A referral is required from
Student Health Services prior to receiving treatment outside Student Health Services.
If students do not obtain the referral prior to treatment, benefits are not payable. A new referral is
required at the beginning of each Policy Year prior to obtaining treatment for ongoing conditions.
A referral is not required for the following services:
• Obstetrical and gynecological services including:
– Maternity care;
– Treatment for acute or emergency gynecological conditions;
– Obstetric or gynecological services;
– Treatment of an Emergency Medical Condition. (A Student Health Service referral is also not
required for follow-up treatment related to emergency care).
• – Dental treatment as a result of an Injury as defined in the Schedule of Benefits.
*Note: School of Public Health and Graduate Medical Science students will be subject to a $25
Copay per visit at Evans Medical Foundation and the Department of Family Medicine and will
have the referral requirement waived for services rendered at Boston Medical Center.
11
Inpatient Admission Pre-Certification
All inpatient stays must be certified by contacting Chickering Claims Administrators, Inc.,
at (800) 966-7772.
Chickering Claims Administrators, Inc. must be notified of all inpatient admissions as stipulated
below. You are responsible for advising your Physician of the pre-admission certification
requirement of the Plan.
Pre-Certification of Non-Emergency Inpatient Admissions: The patient, Physician, or Hospital
must telephone at least three business days prior to the planned admission. In the case of a
maternity claim, notification is required three days prior to planned delivery or within two business
days of a spontaneous delivery. Although Pre-Certification is not required for pre/post-natal care,
it is beneficial for the Covered Person to notify Chickering Claims Administrators, Inc. at the time
prenatal care begins.
Notification of Emergency Inpatient Admissions: The patient, patient’s representative, Physician,
or Hospital must telephone Chickering Claims Administrators, Inc. within two business days
following admission.
Certification of the admission is determined after receipt and review of the required administrative
and clinical information.
Certification will include the review of eligibility, adherence to notification guidelines, and benefit
coverage under the Student Medical Insurance Plan. Pre-Certification does not guarantee the
payment of benefits for your inpatient admission. Each claim is subject to medical and Policy
review in accordance with the exclusions and limitations contained in the Policy.
All certification and notification information and questions will be handled by contacting
Chickering Claims Administrators, Inc. Address all notices to:
Chickering Claims Administrators, Inc.
P.O. Box 15708
Boston, MA 02215-0014
(800) 966-7772
Hours: Monday - Friday 8:30 a.m. to 5:30 p.m. EST
If you do not secure Pre-Certification for non-emergency inpatient admissions or provide
notification for emergency inpatient admissions, your Covered Medical Expenses will be subject
to a $200 per admission Deductible.
12
Description of Benefits
Payment will be made as allocated herein, for Covered Medical Expenses incurred for an Injury
or Sickness while insured under the Policy, not to exceed the Aggregate Maximum benefit while
continuously insured of $250,000 per policy year.
In addition to the Plan’s Aggregate Maximum the Policy may contain benefit level
maximums. Please review the Summary of Benefits section of this brochure for any
additional benefit level maximums.
Maximize your Benefits … Utilize a Preferred Provider
This Plan always pays benefits in accordance with any applicable Commonwealth of
Massachusetts Insurance Law(s).
13
14
Go To Index
Aggregate Maximum $250,000 per Policy Year
Out-of-Pocket Preferred Care: $2,500
Maximum Non-Preferred Care: $2,500
(Copays, Deductibles NOTE: The preferred and non-preferred care out-of-pocket maximums
and non-covered are separate.
expenses do not apply
towards meeting the
out-of-pocket
maximum)
Annual Deductible $250 (applies to non-preferred care only)
Inpatient Hospitalization Benefits
Hospital Room and Covered Medical Expenses are payable as follows:
Board Expenses Preferred Care: 80% of the Negotiated Charge after a $100 copay
per admission.
Non-Preferred Care: 70% of the Reasonable Charge.
Miscellaneous Covered Medical Expenses are payable as follows:
Hospital Expenses Preferred Care: 80% of the Negotiated Charge.
(including X-rays, Non-Preferred Care: 70% of the Reasonable Charge.
labs, etc.)
Surgical Benefits (Inpatient and Outpatient)
Surgical Expenses Covered Medical Expenses for charges for surgical services performed
by a Physician are payable as follows:
Preferred Care: 80% of the Negotiated Charge after a $75 copay.
Non-Preferred Care: 70% of the Reasonable Charge.
Anesthetist and Covered Medical Expenses for the charges of an anesthetist and an
Assistant Surgeon assistant surgeon during a surgical procedure for surgical services
Expenses performed during a surgical operation are payable as follows:
Preferred Care: 80% of the Negotiated Charge up to a maximum of
30% of the payment made under the above Surgical Expense Benefit.
Non-Preferred Care: 70% of the Reasonable Charge up to a maximum
of 30% of the payment made under the above Surgical Expense Benefit.
Consultant Expenses When ordered by the attending physician for the purpose of confirming
or determining a diagnosis, Covered Medical Expenses for the charges of
a consultant or specialist are payable as follows:
Preferred Care: 80% of the Negotiated Charge.
Non-Preferred Care: 70% of the Reasonable Charge.

the name of this thread doesnt explain what the thread is about, Luis if you don't ban urself imma kill you O=)

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*stands up* OmFG what a- *pauses, sits down*...damn..

Ps- happy b-day tom

Now I know Tom's birthday, I might just post a 'happy birthday Tom' topic in the general forum next year just for the hell of it. Well, chart up another post for me, YAY!

This was not a spam post!

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At 7/11/07 01:16 PM, GuyWithoutAProfile wrote: ­

That was spam, I mean, 3 spaces?! Come on, I know you guys can do better than that. Geez, I know the minimum character limit is three chars, but how spammy and stupid can you get?

gotta test this somewhere, my mouse brought me here

Post count +1

Thats not spam anyway, probably cause it has something to do with Tom Fulp, the creator of newgrounds. so nope, its not spam.