Frequently Asked Questions About Insurance

Question: What does "in-network" or "out of network" mean?

Answer: In-network refers to the doctors, hospitals and other health care providers who have arranged to provide specific medical care to Insureds under this policy at negotiated rates. Out-of-network refers to providers who are not part of this contracted arrangement.

This insurance program allows you to receive care from any doctor or hospital. However, your deductible will be lower whenever you use in-network providers. You should choose in-network providers whenever possible, and go to out-of-network providers only when there is not a suitable in-network option in your area. When an out-of-network provider is used, the insurance company will not pay more than reasonable and customary charges for the geographic area, which may be less than the medical bill presented. You may be held responsible for the difference in cost.

for more information, visit the Insurance FAQ page.

Question: What do I do in case of an emergency?

Answer: For a life-threatening emergency you should go to the nearest emergency room or dial 911 for an ambulance.

Question: What if my injury is not life-threatening?

Answer: For less serious accidents or illnesses, you should go either to a minor emergency clinic or make an appointment with a doctor at his or her office. Hospital emergency rooms treat the most serious cases first. Because of this, people with minor emergencies sometimes experience long waits for attention. Hospital emergency rooms are also more expensive than other places to receive treatment. (please delete space between this question and answer)

Question: Does the insurance cover prescription drug charges?

Answer:The insurance covers prescriptions made by a medical professional in connection with a covered accident or illness. The policy does not pay for over-the-counter medications, vitamins, or prescription drugs not prescribed in response to an accident or illness, such as birth control pills, weight loss medication or stop-smoking aids. If you want to make a claim for reimbursement of prescription drug costs, download the claim form from www.wisefoundation.com. The insurance company requires the date, name of drug, person for whom prescribed, and the charge. This information is often attached to the bag by the pharmacist but may come in other forms. Make sure your pharmacy receipt includes all requested information. Cashier receipts are not accepted.

More Frequently Asked Questions about insurance are available here.

 


Medical Insurance

WISE® participants are covered by insurance during their program dates.

Your insurance card arrived along with your DS-2019 form. Please be sure to carry this card with you at all times, along with the insurance booklet that contains information about your policy and a copy of a claim form. If you do not have your card with you in the US, please contact WISE® immediately for a replacement.

If you need medical attention while on your program, this page provides you with helpful information to ensure you are reimbursed for any costs above and beyond your deductible. Please read all information carefully, and if you have any questions, do not hesitate to contact WISE® or your insurance provider (ACE or STARR.)


STARR Insurance 2010
Claims Administrator
To file a claim or
to confirm benefits or
for approval of surgery or hospitalization:

Health Special Risk (HSR)
Tel: 1-866-345-0959
Email: StarrClaims@hsri.com
Available Monday through Friday
7:00 AM – 7:00 PM Central Standard Time

Travel Assistance Provider
For 24-hour emergency medical assistance worldwide
Europ Assistance
Tel: 866-690-5111 inside the USA
Tel: 202-659-7776 collect outside the USA

Medical Network Provider
To find local in-network medical care
Beech Street
www.beechstreet.com


ACE Insurance 2009
Claims Administrator
To file a claim or
to confirm benefits or
for approval of surgery or hospitalization:

Health Special Risk (HSR)
Tel: 1-866-345-0959
Email: ACEclaims@hsri.com
Available Monday through Friday
7:00 AM – 7:00 PM Central Standard Time

Travel Assistance Provider
For 24-hour emergency medical assistance worldwide
Europ Assistance
Tel: 866-690-5111 inside the USA
Tel: 202-659-7776 collect outside the USA

Medical Network Provider
To find local in-network medical care
Beech Street
www.beechstreet.com

 

ACE Insurance 2006-2008
Claims Processing Center:

ACE American Insurance Company Accident and Health Claims
1 Beaver Valley Road
PO Box 15417
Wilmington, DE 19850

Emergency Phone Number: 1-800-243-6124

 

Information about your insurance coverage, benefits, and how to file a claim can be found in the Policy and Insurance Handbook provided to you with your DS-2019 form and insurance card. To view a copy of this handbook, please click below:

STARR Policy and Insurance Handbook 2010

ACE Policy and Insurance Handbook 2009

ACE Policy and Insurance Handbook 2006-2008


Claim Procedure
If you need medical attention, you will need to pay a $50-$75 deductible (depending on your policy) at the time you receive treatment. In some cases, you may be required to pay for services up front and then file a claim form in order to receive reimbursement. A copy of this claim form can be found in the packet sent to you along with your DS-2019 form and insurance card and handbook. Below is a link to a copy of the insurance claim forms.

STARR Insurance Claim Form 2010

ACE Insurance Claim Form 2009
ACE Insurance Claim Form 2006-2008


One claim form must be completed for each accident or illness. The claim form should then be filled out completely and returned to the address indicated on the form, along with an itemized bill that you received at the doctor’s office.Be sure to make a copy of your claim form and itemized bill for your personal records before you send it to the insurance company. All claims for should be filed as promptly as possible and returned no later than 90 days from the date of service.

If possible, a claim form should be brought along with you to all medical visits. The provider can then submit all bills and claim form together. A claim form should also be submitted with any prescription receipts or medical bills you are submitting. In this case, a doctor's signature is not necessary if the provider has already submitted a claim form. Indicate to whom the payment should be made. If you have paid the provider, then make sure you have noted this on the claim form. In this case, it will be your responsibility to send in the claim form and bills/receipts.

Helpful Hint: When you are at the doctor's office, request a super-bill or standard health insurance bill. When in the hospital, request a form UB-92 or its equivalent. For prescription drugs, the company requires the date, name of drug, person for whom prescribed, and the charge. This information is often attached to the bag by the pharmacist but may come in other forms. Make sure your pharmacy receipt includes all requested information. Cashier receipts are not accepted.

All bills must be original, no photocopies, with diagnosis, date of service, provider's name and amount. If you or someone else other than the provider submits the claim form, verify that all this information is on the bill before mailing it to the processing center. The claim will not be paid until bills with all required information are submitted.

KEEP A PHOTOCOPY FOR YOUR RECORDS OF THE INFORMATION YOU SEND TO PROCESS A CLAIM INCLUDING THE COMPLETED CLAIM FORM AND ALL RECEIPTS.

Home     |     About     |        Programs     |     Contact

WISE Foundation® © 2009