Medical Insurance

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

Starting in January 2017, your medical coverage has been updated. For current participants that have received their DS-2019 packages in 2016, we are currently in the process of sending out your replacement insurance card via e-mail and also sending an original to you by mail.
For participants receiving their DS-2019 packages in January 2017 or later, you will receive your insurance information 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 medical services. Please read all information carefully, and if you have any questions, do not hesitate to contact your insurance claims administrator,
CAMBRIDGE ADMINISTRATORS at telephone number: 1-855-868-7554 or WISE®.

2017 Policy – BERKLEY ACCIDENT AND HEALTH POLICY
Policy #BTA L10100237 001

Claims Administrator

To file a claim or to confirm benefits or for approval of surgery or hospitalization contact:
Cambridge Administrators
5832 South 142nd Street, Suite A
Omaha, Nebraska 68137

Available 24 hours / 7 days a week
Toll Free Telephone #:  1-855-868-7554        5 am – 7 pm CST  /   Monday – Friday
After office hours (nights and weekends): 1-800-344-2500

Email: Info@CambridgeAdministrators.com

How to find a Medical Provider

Persons insured under this plan may choose to be treated within or outside of the CAMBRIDGE ADMINISTRATORS NETWORK, however if you are treated out of network you may incur additional costs out of pocket. The CAMBRIDGE ADMINISTRATORS NETWORK consists of hospitals, doctors and other health care providers organized into a network for the purpose of delivering quality health care at affordable rates. In order to use the services of a Network Provider, you must present your identification card that was issued to you when your official documents were presented to you at the start of your program.

If you confer with CAMBRIDGE ADMINISTRATORS by telephone or email for help in finding a medical provider, you will pay the lowest deductible of $50. Don’t hesitate to call them at (toll-free) whether the medical concern is big or small.

You may also contact CAMBRIDGE ADMINISTRATORS on-line to find an in-network medical facility. When you use a medical facility on this list, you will pay the lowest deductible of $50 or $200 for a hospital. Cambridge Administrators provides details on your health insurance card about how to locate in-network doctors, hospitals, and medical facilities.

To find a medical provider online, please follow the below steps:
• Go to: www.MyFirstHealth.com
• When page loads, Enter the zip code or city of where you are living
• Enter the condition you are suffering from
• Click on “GO”
• Review and contact one of the in-network doctors from the directory provided to you

Call CAMBRIDGE ADMINISTRATORS at the beginning of your program to find an in-network general practice physician and to locate an in-network urgent-care facility in your city or zip code. Keep this information available in your wallet and on your smartphone should you need it later.

General Insurance Information

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:

Berkley Life & Health Insurance Company Booklet – 2017

 

Claim Procedure

If you need medical attention, you will need to pay a $50-$200 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:

Cambridge Administrators Claim Form – 2017

 

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. Claim processing delays can occur if the claim form is not fully completed, if you send in “balance due” statements instead of itemized bills, which detail all the charges incurred for your treatment(s). 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 form 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. A claim form should also be submitted with any prescription receipts or medical bills you are submitting. The provider can then submit all bills and claim forms together to the insurance company. 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: Please ask your provider to submit all medical bills. The bills must be itemized for service. A physician’s office should submit an invoice utilizing a CMS 1500. A hospital and/or emergency room should submit an invoice utilizing a UB04 (CMS 1500 and UB04 are universal billing forms supplied by the physician’s office and/or hospital). If the provider will not submit the bill(s) directly, please request these forms from the provider(s) and attach to the claim form for submission. A balance due or patient statement is not acceptable and will only delay processing.

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.