This document addresses frequently asked questions about the travel medical insurance program in which you are enrolled. It accompanies the Accident and Sickness Insurance Handbook that describes the travel insurance limits, conditions and terms. Please note that WISE is not the insurance company but buys an insurance policy to cover you in emergency medical situations.

This FAQ document addresses coverage issues in a broad way, and does not contain all of the policy details that govern the insurance. The insurance policy is available from WISE Foundation upon request. In the event of a coverage dispute or discrepancy, the wording of the policy on file will apply. Benefits are subject to change without notice.

The insurance company is BERKLEY LIFE AND HEALTH INSURANCE COMPANY. It contracts with CAMBRIDGE ADMINISTRATORS to administer the insurance claim procedure and assist you with managing the insurance.

Your regular contact should be with claims administrator, CAMBRIDGE ADMINISTRATORS. They are open Monday-Friday, 7am-5pm CST. You will need to talk to them during business hours for any emergency and non-emergency matters.

CAMBRIDGE ADMINISTRATORS can explain what is covered under the insurance, answer questions about the medical matter you are experiencing and help you find a doctor or medical facility. They can also evaluate plans for your surgery or hospitalization and handle your claims.

If you have an emergency AFTER HOURS, you should contact EUROP ASSTANCE at 1-800-344-2500 for assistance.

Any question can be addressed by CAMBRIDGE ADMINISTRATORS at 1-855-868-7554 (toll-free). Call them with non-urgent or emergency questions during business hours (Monday-Friday, 7am-5pm CST)

If you have an emergency AFTER HOURS, you should contact EUROP ASSTANCE at 1-800-344-2500 for assistance.
In addition, you can find this information in these FAQs:

The insurance covers travel medical risks, including Medical Expense and Emergency Medical Evacuation, that occur while you are on the WISE program inside the US. It does not provide any kind of liability insurance or baggage insurance.

The benefits and limits of the travel medical insurance program are:

See the insurance handbook for more detailed explanations of these benefits.

Travel medical risks are emergency health issues that happen while you are in the US. This insurance is meant to address unforeseen medical expenses that cannot wait until you return to your home country. The insurance policy has exclusions for medical conditions that can be expected, such as routine check-ups or treatment for pre-existing conditions. See FAQ question #41 for brief information about exclusions under the insurance policy.

You should read the insurance handbook for a full list of the risks that are not covered under this insurance. Coverage is available only to participants who are able to actively participate in the WISE program within the US.

The insurance also has some parts designed specifically for travelers. There is coverage for your family to join you if you are hospitalized in the U.S. (see FAQ #39) as well as travel assistance services not found in regular health insurance. Travel assistance is the part of coverage that helps with handling medical emergencies, such as medical evacuation or translation, while you are on the WISE program.

A medical emergency is a condition caused by an accident or an illness with symptoms that are severe enough that someone could reasonably expect serious jeopardy to health unless there is immediate medical attention.

Coverage is valid in the United States while you are a part of the WISE program. Coverage is no longer effective once the WISE program is over, or when you have ceased to be an active participant in the WISE program. Once you have departed the U.S. you will need to use another form of health insurance, even if you became ill or injured while you were in the U.S.

Your insurance coverage is not valid whenever you travel outside of the U.S. while participating in your program, including on vacations to nearby international destinations such as Canada, Mexico or Bahamas, or while traveling to your home country.

Coverage begins on the day indicated on your insurance card and stays in effect until the end date indicated on your card or when you cease to be a participant in the program. The insurance does not cover ordinary travel to and from the airport, or to and from the international disembarkation point. However, if you return from your program by Emergency Medical Evacuation, coverage applies for transportation directly to the designated medical facility or to your home. If you are unable or chose not to continue your program as a WISE participant, the insurance coverage will end prior to the end date of the card.

You may purchase additional coverage should you plan to arrive a few days before the beginning of your program or for the 30 day grace period available to you at the successful conclusion of your program.

Coverage ends when your WISE program is over, or the date indicated on your insurance card, whichever is earlier, even if you choose to remain in the US, stay at the program location, or do not return directly home.

A deductible is the part of the medical expense for which you are responsible when you first seek medical care for an accident or illness. The deductible is payable one time per accident or illness. Once you pay the deductible, the claims administrator will pay all eligible expenses for a covered accident or illness up to the policy limits.

If you use a medical facility, such as a doctor or hospital, that is “in-network”, the deductible is $50. The deductible is also $50 if you use a medical facility such as an urgent care center, or a walk-in clinic. Examples are those found in major stores and drugstores, like Walmart, Target, CVS or Walgreens.

If you use a medical facility that is not “in-network”, the deductible is $400. If you use an Emergency Room (ER) without first consulting with administrator CAMBRIDGE ADMINISTRATORS, the deductible is $400. In many cases when you need emergency care, you may be able to pay the lower deductible of $50 by using an in-network urgent care facility or doctor’s office instead of an Emergency Room for situations that are not life-threatening.

Note that whenever you call CAMBRIDGE ADMINISTRATORS before pursuing medical care and receive their advice on available medical facilities, the lower deductible of $50 will apply. This is the case even if CAMBRIDGE ADMINISTRATORS advises you to go to the Emergency Room.

No. A copayment is a percentage payable by the insured person on every claim. There are no co-payments on the WISE travel medical insurance program. Once the deductible has been paid and the insurance is in effect, you’re protected up to the policy limits for covered medical expenses arising from that illness or injury, except for any exclusions or limited provisions under the coverage. You will have no expenses beyond the deductible when you use a medical facility that is in-network.

After the deductible is paid one time for any illness or injury, no more deductibles are required for follow-up care for the same illness or injury. If you need medical care for a new illness or injury, another deductible would be payable for that.

Note that even though there is no co-payment, the cost of using out-of-network medical facilities are covered only to the medical industry’s “reasonable and customary” payment standards for your geographic area. This means that you can be billed for extra costs for using a medical facility that is not in-network.

In-network refers to the medical facilities, such as doctors, hospitals and other health care providers who have arranged with claims administrator CAMBRIDGE ADMINISTRATORS to provide specific medical care under this insurance policy at negotiated rates. Out-of-network refers to medical facilities that are not part of this contracted arrangement.

The WISE insurance program allows you to receive care from any doctor or hospital. However, your cost, such as your deductible, will be lower whenever you use an in-network medical facility. Claims administrator CAMBRIDGE ADMINISTRATORS can help you find in-network providers by telephone or over the web. 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.

Claims administrator CAMBRIDGE ADMINISTRATORS maintains a database of medical providers with whom they have network arrangements all around the United States. 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. CAMBRIDGE ADMINISTRATORS can speak with you about your medical condition and choices for medical care. Don’t hesitate to call them at 1-855-868-7554 (toll-free) during normal business hours, whether the medical concern is big or small.

You may also find an in-network medical provider on-line at www.myfirsthealth.com. Medical providers associated with the First Health Network can be searched within your zip code by provider type, specialty or medical condition. If you require assistance, need a broader range of in-network providers, or desire a referral, you can contact Cambridge Administrators toll-free at 855-868-7554, Monday-Friday from 7:00am to 5:00pm, Central Standard Time.

The travel assistance company, Europ Assistance, can be contacted after-hours for medical provider assistance toll-free at 1-800-344-2500. Your medical deductible will be lower when you utilize in-network doctors and hospitals.

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.

CAMBRIDGE ADMINISTRATORS is the claims administrator for BERKLEY LIFE AND HEALTH INSURANCE COMPANY under the WISE program. They determine if claims are covered and how to process them. Send completed claims forms to CAMBRIDGE ADMINISTRATORS using the contact information listed in question #15.

CAMBRIDGE ADMINISTRATORS is responsible for making claim reimbursements and payments, as well as helping you to find in-network medical facilities. CAMBRIDGE ADMINISTRATORS works for the insurance company but they are not the insurance company and they do not create the policy terms.

Doctors and hospitals can also call CAMBRIDGE ADMINISTRATORS to confirm the coverage you have available under the WISE insurance program.

When you need to undergo a medical procedure in a situation that is not life-threatening, CAMBRIDGE ADMINISTRATORS can first work on your case and coordinate your medical care. If your doctor says that you need to pursue further treatment, give them the contact information for CAMBRIDGE ADMINISTRATORS so that they can advise on how to proceed.

If you have already paid your medical bill, you will have 90 days to send a completed claim form and original (paid) medical bills to CAMBRIDGE ADMINISTRATORS, the claims administrator.

If you have not paid your medical bills, you will have 30 days to send a completed claim form and original (unpaid) medical bills to CAMBRIDGE ADMINISTRATORS.

Make sure that you send in itemized bills instead of “balance due” statements. You can get a claim form from CAMBRIDGE ADMINISTRATORS or from www.wisefoundation.com.

CAMBRIDGE ADMINISTRATORS works with your insurance company to process your claim. At your request, and of course subject to coverage, they will either compensate the medical provider directly, or reimburse you if you have already paid the bill.

You should keep copies of the claim documents sent to the insurance company until the claim has been settled.

Send claims to:

After you report a medical claim you might receive a request for additional information from CAMBRIDGE ADMINISTRATORS. They may need to know specific information about the accident or injury in more detail than can be included in the claim form. Please provide the information as fully and as quickly as you can and send it back to the claims administrator by return email. This information will help them to correctly process your claim.

If you have a true, life-threatening emergency, get to the nearest available form of appropriate medical care, which is generally the local Emergency Room. You can dial 911 to get an ambulance. Then contact both WISE and CAMBRIDGE ADMINISTRATORS as soon as possible.

If you have the option to make a phone call first, contact CAMBRIDGE ADMINISTRATORS at 1-855-868-7554 (toll-free) Monday-Friday, 7am-5pm CST. If it’s after normal business hours, please contact EUROP ASSISTANCE USA at 1-877-243-4134 (toll free).

CAMBRIDGE ADMINISTRATORS encourages you to call them with medical care questions, even in cases of minor emergency or medical concern.

Both are medical facilities that you can use under this insurance. Hospital emergency rooms are designed for serious, life-threatening cases and prioritize these cases for treatment. That is why there can be a long wait for care for less serious cases. Emergency Room treatment can also be very expensive. Use the emergency room if you feel that your medical condition is life-threatening.

Urgent care centers are medical facilities outside of hospitals. They are walk-in medical clinics that have the resources to treat most accidents or illnesses that require immediate attention but are not life-threatening. Care can be delivered quickly and effectively for many kinds of medical cases, and they can be a good alternative if you have no regular doctor.

If you use an Emergency Room without calling CAMBRIDGE ADMINISTRATORS first, your deductible will be $400, while the deductible for using an urgent care center is $50. CAMBRIDGE ADMINISTRATORS can advise you where to find an urgent care center or whether it is necessary to the go the emergency room. If you seek their advice before receiving medical care you will pay the lowest deductible of $50. This is true even if CAMBRIDGE ADMINISTRATORS advises you to go to the Emergency Room.

There is an exclusion in the coverage for medical expenses that arise from activities at your host site. This is because these expenses are meant to be paid by Workers’ Compensation, a kind of insurance that employers are required to maintain. If you are hurt at your host site, contact the claims administrator, CAMBRIDGE ADMINISTRATORS, immediately and let them know. They and your insurer can help to arrange coverage for you from your host site’s Workers’ Compensation insurance. You should also speak at once with your host site manager and contact WISE.

The WISE insurance program will cover you if you are in a car accident, but NOT if you are the driver. For an additional premium of $5 per month you can buy coverage that will pay for your medical expenses per the terms of the policy if you are injured while driving a passenger car as a legal driver. Contact WISE before you begin your program to arrange for the extra insurance. This additional coverage is not valid for Mopeds, Motorcycles, ATVs, etc. whether licensed for on road use or not.

The insurance program provided by WISE is mandatory for all participants, regardless of medical insurance you may have at home. Often insurance in your home country will not cover all expenses incurred outside your Home Country. In particular, many policies do not cover Emergency Medical Evacuation. WISE arranges for this insurance to make sure that you don’t encounter gaps in coverage that might impede your medical care while on the WISE program.

The medical expense limit is $200,000. “Medical expense” means the cost of covered reasonable and customary medical care received in the U.S., such as doctors’ visits or emergency surgery. Insured must contact CAMBRIDGE ADMINISTRATORS before proceeding with any non-emergency surgery or procedure. Medical Evacuation is a separate benefit. There are important exclusions to the medical expense benefit, such as: (See next question)

Pre-existing Conditions are excluded. These are the expenses arising from an Injury or Illness for which a person has incurred charges, received medical treatment, or taken prescribed drugs or medicine in the 2-year period immediately before the dates of travel.

The following items are not covered by the insurance policy:

• Routine physical examinations and vaccinations
• Routine eye examinations, eyeglasses and contact lenses
• Preventive medical Services and wellness benefits
• Maternity, pregnancy, abortion or childbirth
• Claims for sexually transmitted diseases
• Mental and nervous claims
• Self-inflicted injury and suicide or attempted suicide
• Medical claims arising from use of alcohol, drugs or criminal activity

There is also a summary of general policy exclusions in question #41. Look for the complete listing of exclusions in your coverage pamphlet.

When surgery appears to be of a non-emergency nature, you or your doctor must contact CAMBRIDGE ADMINISTRATORS to determine how to proceed.

There is no restriction on covered surgery that cannot wait until you return to your home country without jeopardizing your health. If you need non-emergency surgery you may need to end your program early and return to your home country to have surgery in your home country.

In cases of medical emergency, the medical provider should contact CAMBRIDGE ADMINISTRATORS, who can authorize direct payment for covered expenses. If no such arrangement is made, or if the visit does not appear to be covered by the insurance, you may be asked to pay the bill up front and make a claim for reimbursement from the claims administrator CAMBRIDGE ADMINISTRATORS.

You should be prepared to pay for non-emergency expenses and your deductible and submit a claim to the claims administrator later if necessary.

Before CAMBRIDGE ADMINISTRATORS can talk to any party other than you in the event of a medical emergency, they need to know that you give permission for them to discuss your medical case with your doctors, your insurance company, WISE and your family. You gave permission for this use of your medical information in your WISE application and the HIPAA consent form declares this permission to the other parties in a way that is compliant with the medical privacy law. This is why WISE asks you to complete this form in advance of any medical emergency.

The insurance is unlimited for covered emergency medical evacuations. When there is a need for an emergency medical evacuation, CAMBRIDGE ADMINISTRATORS and EUROP ASSISTANCE will be there to offer assistance.

Emergency Medical Evacuation is used when you become injured or ill and the Physician assisting you recommends that your condition requires an Emergency Medical Evacuation to the nearest medical facility where appropriate medical treatment can be obtained, or to your Home Country. It can include the costs of a nurse or physician to accompany you, either on a commercial airliner, on a special chartered plane, or other means of transportation.

It is important to note that Emergency Medical Evacuation is subject to the general terms and conditions of the policy, which means that coverage exclusions apply. You can find a summary of these in #41. If it is possible that you could be medically evacuated for a reason excluded under this policy, you should make special provisions for coverage.

Note that Emergency Medical Evacuation is done only in serious cases, where your life is threatened or where you face a risk of permanent disability. It is used when your health would be threatened by using regular forms of transport.

The decision to medically evacuate, and the determination of whether the evacuation is made to the home country or to a different medical facility, is made based on information from medical professionals working on the case. This information is managed by CAMBRIDGE ADMINISTRATORS and EUROP ASSISTANCE.

The process has to be coordinated by CAMBRIDGE ADMINISTRATORS and EUROP ASSISTANCE in order to be covered, including medical care, transportation arrangements and travel plans for you or for an immediate family member. Do not arrange a Medical Evacuation on your own, or make any arrangements for your family to visit you on your own. Make sure that both CAMBRIDGE ADMINISTRATORS and WISE are involved in helping with any medical evacuation plans.

CAMBRIDGE ADMINISTRATORS can authorize an emergency hospital admission deposit unless there is clear indication that the situation is not an emergency.
You should be prepared to pay for non-emergency expenses and submit a claim to the claims administrator later if necessary.

If you have a medical bill that was not authorized for direct payment by CAMBRIDGE ADMINISTRATORS to the medical facility, such as a medical bill for non-emergency treatment, you may need to pay the bill yourself and claim the expenses back from the insurance company. You can get a claim form from CAMBRIDGE ADMINISTRATORS or from www.wisefoundation.com.

Download the accident and illness claim form. Complete it and attach the original medical bills and back-up information requested. Make a copy for yourself and then send in the form as soon as possible, but no later than 90 days after you incur the expense. Send it to the claims administrator as specified in question #15. Shortly after you submit the claim, you may receive an email from the claims administrator asking for further details on the accident or illness. Answer the questions in that email and return it as quickly as possible so that your claim can be processed.

For more helpful information on how to complete and use a claim form successfully, see the section on Insurance at www.wisefoundation.com.

Carry your insurance card with you at all times or keep an image of it on your smartphone. Keep your insurance handbook and a copy of the claim form with you as well. You received your insurance card in the same packet with your DS-2019 form. Carry your personalized directory of local doctors or hospitals, which you can create by following the directions in question #19. When you are in the doctor’s office, request a super-bill or a standard health insurance bill. When in the hospital, request a form UB-92 or its equivalent. If the doctor suggests follow-up procedures or surgery that is not of an emergency nature, this should be arranged through CAMBRIDGE ADMINISTRATORS.

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 or prescription medications to treat pre-existing conditions. 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.

When you cannot obtain adequate care for a medical situation in your travel location, your physicians may recommend an emergency medical evacuation to a location where you can get adequate medical care. Medical evacuation occurs when insured need to go to another location to get adequate care for a medical emergency. The Medical Repatriation benefit applies when you must return to your home country because your injury, illness or follow-up care needs make you unable to properly continue with your WISE program, even if your medical situation is not an emergency. Medical repatriation can occur even when local medical care is adequate.

Repatriation can occur when a participant receives covered hospitalization or treatment, but is then unable to continue his or her active participation in a WISE program or requires continuing follow-up treatment. WISE, together with CAMBRIDGE ADMINISTRATORS and in conjunction with your doctors, can arrange for the repatriation to your country of residence or country of citizenship, when the gravity of the case requires. If medical professionals determine that you can travel safely, you must follow through with the repatriation. Otherwise you will be held responsible for medical costs incurred in the US as a result of opting not to be medically repatriated.

Return of Mortal Remains means the transport of bodily remains or ashes to your Home Country. The process has to be coordinated by CAMBRIDGE ADMINISTRATORS and EUROP ASSISTANCE in order to be covered.

This benefit of $10,000 is paid to a beneficiary if you die as the result of a covered injury that occurred while on your program. It is also payable in the event of quadriplegia. It does not apply to death resulting from illness. The dismemberment benefit is a percentage of that sum and applies to loss of a part of the body, including vision and hearing, from a covered accident but not from illness.

There is also a benefit of $2,500 payable for covered injuries that arise from a felonious assault against you, such as when an injury occurs as a result of a holdup or a robbery.

The limit of $500 covers injury to sound, natural teeth or for relief of pain. It does not cover fillings or routine dental exams.

A lump sum of $10,000 is payable if you are permanently and totally disabled because of a covered injury beyond any hope of improvement and will be prevented from engaging in any profession.

If you suffer a covered injury or sickness while in the US and must be confined to a hospital for at least seven days, the insurer will reimburse the expenses for a Family Member to visit you during your stay in the hospital. The benefit pays up to $1,000 per day for a maximum of ten days. The benefit includes transportation and lodging arrangements made in the most direct and economical way and not exceeding the usual level of charges for similar transportation or lodging locally. Benefits need to be approved in advance through CAMBRIDGE ADMINISTRATORS, and travel arrangements made by CAMBRIDGE ADMINISTRATORS.

The Emergency Reunion benefit can also be used by a family member who must travel overseas to assist with the return of mortal remains.

“Family Member” means your parent (including stepparent), parent-in-law, spouse, child (including legally adopted or stepchild), son- or daughter-in-law, sister, brother (including stepbrother or stepsister), brother- or sister-in-law.

The policy excludes claims arising from professional athletics, amateur or interscholastic athletics. If you join a club to play organized soccer with scheduled practice and meets against other teams, this type of activity is excluded. If you meet a group of friends to play soccer at the park, this is generally covered by your insurance.

Claims arising from the following sports are excluded: taking part in mountaineering where ropes or guides are normally used; hang gliding, parachuting, bungee jumping, racing by horse, motor vehicle, or motor cycle, snowmobiling, motor cycle/motor scooter riding, scuba diving involving underwater breathing apparatus (unless PADI or NAUI certified), spelunking (caving), or parasailing.

Exclusions are conditions under which the insurance company does not provide coverage.

Every benefit under this insurance is subject to the following exclusions:

These are not the only exclusions under the policy; a full list is found in the insurance policy. These FAQs provide only a brief description of the coverage, and in the event of a claim, the terms of the insurance policy will apply.