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Results from search: http://www.mrmib.ca.gov/MRMIB/MRMIP.html

MRMIP - TOC and Introduction Introduction Eligibility Applicants Who Know They Are Currently Not Eligible But Expect To Be in the Future Agents/Brokers, Employers and Applicants Medi-Cal Beneficiaries How the Program Works Choosing a Health Plan Benefits and Copayments Pre-Existing Condition Exclusion Period for Blue Cross and Blue Shield PPO Subscribers Post-Enrollment Waiting Period for Blue Shield HMO, Contra Costa Health Plan, Kaiser Permanente and Maxicare How You May Waive All or Part of the Exclusion/Waiting Period Dependent Coverage Information Waiting List Transfer of Enrollment Disenrollment Dispute Resolution/Appeals Binding Arbitration Coverage Brochures Coordination of Benefits Description of Plans and Benefit Highlights Blue Cross of California Blue Shield of California- Access + HMO Blue Shield of California- Preferred Plan Contra Costa Health Plan Kaiser Permanente Northern California Kaiser Permanente Southern California Subscriber Contribution by County Charts Area 1 Rates Area 2 Rates Area 3 Rates Area 4 Rates Area 5 Rates Area 6 Rates Application For more information call 1-800-289-6574 Introduction The California Major Risk Medical Insurance Program (MRMIP) is an innovative MRMIP developed to provide health insurance for Californians who are unable to obtain coverage on the open market. The MRMIP is administered by a five-member Board who has established a comprehensive benefit package. Services in the MRMIP will be delivered through contracts with health insurance providers. Californians qualifying for the MRMIP will participate in the payment for the cost of their coverage by paying premiums on their own behalf. The MRMIP will supplement those premiums to cover the cost of care. The MRMIP is funded by $40 million from tobacco tax funds. Eligibility Requirements In order to be eligible for the Major Risk Medical Insurance Program: You must be a resident of the state of California. A resident is a person who is present in California with intent to remain in California except when absent for transitory or temporary purposes. However, a person who is absent from the state for a period greater than 180 consecutive days shall not be considered a resident. You cannot be eligible for both Part A and Part B of Medicare, unless eligible solely because of end-stage renal disease. (Being eligible for one part or the other is acceptable.) You cannot be eligible to purchase any health insurance for continuation of benefits under COBRA or CalCOBRA. (COBRA and CalCOBRA refers to the federal law giving people under certain circumstances the right to continue coverage in an employee health plan for a limited time.) If you have COBRA or CalCOBRA you may apply for deferred enrollment. You must be unable to secure adequate coverage. This can be demonstrated in any of four ways: If you have been denied individual coverage within the previous 12 months. A letter/copy of letter from a health insurance carrier or health plan or health maintenance organization denying individual coverage within the last 12 months must be submitted with your completed application. If you have been involuntarily terminated for health insurance coverage within the previous 12 months for reasons other than nonpayment of premium or fraud. A letter/copy of letter indicating involuntary termination from a health insurance carrier or health plan or health maintenance organization or employer for reasons other than nonpayment of premium or fraud must be submitted with your completed application. If you have been offered, in the previous 12 months, an individual, not a group, health insurance premium in excess of the Major Risk Medical Insurance Program subscriber rate for your first-choice participating health plan. A letter/copy of letter must be submitted with the completed application indicating that, within the last 12 months, you have been offered by a health insurance carrier or health plan or health maintenance organization, a premium for the subscriber and/or their dependents (when applicable) in excess of the MRMIP rate for the subscriber and/or their dependents. If you are a member of a group of two or fewer (not including dependents) who has been denied health insurance coverage in the previous 12 months. A letter/copy of letter indicating that a member of a group of two or less has been denied by a health insurance carrier or health plan or health maintenance organization for health insurance coverage within the last 12 months must be submitted with your completed application. Note: Letters from agents/brokers indicating that an individual is unable to secure adequate private coverage will not be accepted as documentation for eligibility. Applicants Who Know They Are Currently Not Eligible But Expect To Be in the Future If you are not currently eligible for the MRMIP, but anticipate becoming eligible, you may also apply for this MRMIP. Examples of this are: if you are currently enrolled in COBRA or CalCOBRA coverage or if your employer has informed you that you will be involuntarily terminated from insurance coverage sometime in the future. To apply for a deferred enrollment, indicate when you will become eligible and include acceptable documentation. Acceptable documentation is a letter from a health insurance carrier or employer indicating when your coverage will end. The documentation must specify the exact date of termination of current coverage. Enrollment in temporary policies does not qualify for deferred status. If the MRMIP is not at maximum enrollment and all other eligibility criteria are met, you will be enrolled in the MRMIP on the date that eligibility will occur. If the MRMIP is at maximum enrollment at the time you become eligible, your place on any waiting list is determined by the date on which you originally applied, not the date that you became eligible for the MRMIP. Applicants for deferred enrollment must submit their initial subscription contribution with their application. Payment will be refunded to you immediately if your deferred effective date is more than sixty (60) days from the date we receive your application. Agents/Brokers, Employers and Applicants Insurance Code Section 12725.5 states that it shall constitute unfair competition for an insurer, an insurance agent or broker, or administrator to refer an individual employee, or their dependent(s) to apply to this MRMIP, for the purpose of separating that employee, or their dependent(s) from group health coverage provided in connection with the employee's employment. Insurance Code Section 12725.5 further states that it shall constitute an unfair labor practice contrary to public policy for any employer to refer an individual employee, or their dependent(s) to this MRMIP, or to arrange for an individual employee, or their dependent(s) to apply to the MRMIP, for the purpose of separating that employee, or their dependent(s) from group health coverage provided in connection with the employee's employment. Medi-Cal Beneficiaries While Medi-Cal beneficiaries are not prohibited from enrolling in the Major Risk Medical Insurance Program, a Medi-Cal beneficiary should carefully consider the cost before signing up for our additional coverage. MRMIP subscribers are responsible for their monthly subscriber contributions, a deductible and/or a copayment for services which could be up to $4,000 per year. Medi- labels cannot be used for MRMIP copayments. How the Program Works Benefits and Copayments Subscriber may choose from any plan available to them as listed in the enclosed subscriber contribution by county charts. Description of Plans and Benefit Highlights and are also available by calling any MRMIP health plan at their toll-free number and asking for an Evidence of Coverage or Certificate of Insurance. Subscribers will be responsible for their monthly subscriber contribution whether or not they receive a bill in that month. Subscribers may choose from any plan available to them as listed in the Subscriber Contribution by County Charts . Health Maintenance Organizations (HMOs) in the MRMIP require a fixed dollar co-payment for some services and up to a 20% co-payment for other services. The Preferred Provider Organizations (PPOs) in the MRMIP may also require a fixed dollar co-payment for certain services and up to a 25% co- payment for other services. The out-of-pocket maximum per calendar year for all MRMIP plans is $2,500 for individuals and $4,000 for an entire household covered by the MRMIP. This maximum does not apply to services recieved by providers that do not participate in the subscriber's chosen health plan's provider network, or to services not covered by MRMIP. There are MRMIP benefit limits of $75,000 per calendar year and $750,000 in a lifetime. Subscriber contribution amounts are updated on January first of each year. In addition, your subscriber contribution may change during the year if your birthday moves you into a new age category. For married subscribers enrolled under two-party or family coverage, the age rating category will be based on the age of the subscriber. Adjustments to subscriber contributions due to age changes will occur on the first of the month following the birthdate. Subscriber contributions may also change when a member moves from one area of the state to another. Adjustments to subscriber contributions will occur on the first of the month following notification of the move. Each month you will receive a subscriber contribution notice from MRMIP. Subscriber contributions are payable in advance and are due the first day of every month. A subscriber contribution notice will be generated monthly, and will be sent out 30 days prior to the due date. A delinquency billing or final notice will be sent out on the 15th day following the paid to date. There is a grace period of 31 days from the paid to date, and the member's coverage will remain in effect during this time. Cancellation for nonpayment of subscriber contribution will take place on the 32nd day following the paid to date. The cancellation will be retroactive to the paid to date, and a cancellation letter will be generated to the subscriber. A subscriber may pay either by check or money order. In addition, a subscriber may elect to have their monthly subscriber contribution automatically deducted from their checking account when accepted into the MRMIP. Subscriber contribution checks that are returned to the subscriber's bank will result in disenrollment back to the last month(s) paid. The subscriber may be reinstated upon request only if membership history indicates that cancellations of the same subscriber have not exceeded two instances in a rolling 12 month period. The replacement check must include subscriber contributions to bring the account to current status with an additional $25.00 NSF processing fee and must be received within the 31 day grace period. There is no application fee for applying to this MRMIP. You are required to submit your first month's subscriber contribution for MRMIP health care coverage, which is completely applied toward your first month of coverage if you are enrolled. Qualified insurance agents and brokers may be paid a $50 fee by the state for explaining the MRMIP and assisting you in completing the application. The state does not require an individual applying to this MRMIP to pay any fee, charge or commission to a broker or agent. Pre- Existing Condition Exclusion Period for Blue Cross and Blue Shield PPO Subscribers For individuals who are enrolled in a participating health plan offering a Preferred Provider Organization (PPO), there is a pre-existing condition exclusion period of 90 days. During this period, no benefits or services related to a pre-existing condition shall be covered. Subscribers shall be required to pay subscriber contributions during this period. ‹Pre-existing conditionþ means any condition which during the six months immediately preceding enrollment in the Program for which medical advice, diagnosis, care, or treatment, including use of prescription drugs, was recommended or received from a licensed health practitioner during that period. Post- Enrollment Waiting Period for Blue Shield HMO, Contra Costa Health Plan and Kaiser Permanente For individuals who are enrolled in a Health Maintenance Organization (HMO) participating health plan, there is a post-enrollment waiting period of 90 days. Subscribers will not be eligible for health care services during this period. Subscribers will be notified when this period begins and ends. The initial one-month subscriber contribution that is submitted with the application will be applied to the first month of service eligibility. Subscribers shall not be required to pay any other amount during this waiting period. How You May Waive All or Part of the Exclusion/Waiting Period The exclusion/waiting period requirement may be waived in part or all if: The subscriber has been on the MRMIP waiting list for six months or longer. In this circumstance the exclusion/waiting period will be completely waived. The subscriber has been insured by another health insurance policy (including any MRMIP-related temporary or interim insurance policy and Medi-Cal) for at least 90 days at the time you apply to the MRMIP or were covered by another health insurance policy for at least 90 days and application for eligibility in this MRMIP was made within 31 days following the termination of that coverage. In these circumstances you may completely waive the 90 day period. If the coverage was less than 90 days but was at least 30 days, the subscriber will be given credit for either 30 or 60 days toward their MRMIP exclusion/waiting period. The subscriber was previously receiving coverage under a similar program in another state within the last year. In this circumstance the exclusion/waiting period will be completely waived. Please submit appropriate documentation and/or check the appropriate boxes on the application (Questions 6 and/or 7 in the Program Eligibility Section) if you have met the criteria in #2 or #3 to waive this exclusion/waiting period. All documentation must be received prior to or with your first month's subscriber contribution. Dependent Coverage Information Dependents may be covered under this MRMIP and are defined as a subscriber's spouse and any unmarried child who is an adopted child, a stepchild or a recognized natural child. A dependent ceases to be a dependent upon marriage, or age 23, whichever comes first. A dependent also includes any unmarried child who is economically dependent upon the applicant. An unmarried child over 23 years old may be covered, if that unmarried child is incapable of self-support because of physical or mental disability which occurred before the age of 23. An applicant must provide documentation in the form of doctors' records which show that the dependent child cannot work for a living because of a physical or mental disability which existed before the child became 23. A dependent of a subscriber can seek independent enrollment in the MRMIP if their separate MRMIP eligibility can be documented. It is the responsibility of subscribers to notify the MRMIP of changes in the number of dependents. Coverage for newborn or adopted children shall begin upon birth or adoption of the child. Coverage for stepchildren shall begin upon marriage by a subscriber to the stepchild's parent. In all cases, the Program must be notified within 30 days. All other dependents are covered within 90 days of Program notification. To add a dependent to your policy, you may request an –Add Dependent” application by calling (800) 289-6574 and talking to a representative in the MRMIP Unit at Blue Cross, the enrollment contractor for MRMIP. Enrolled dependents of a deceased subscriber or dependents of a subscriber who become eligible for Medicare (Parts A and B) are eligible to continue coverage in the Program for as long as the enrolled dependent continues to pay subscriber contributions and meet the definition of dependent as explained in #1 above. Waiting List If the MRMIP reaches maximum enrollment, applicants and dependents will be placed on a waiting list. Applicants and dependents will be enrolled when spaces become available in order of the date of receipt of a complete application. Any time spent solely on the waiting list does not count toward your ninety (90) day pre-existing condition exclusion period, or post-enrollment waiting period (once enrolled) unless you have been on the waiting list for at least six (6) months. If you have been on the waiting list 6 months or longer, your 90-day exclusion period will be waived. Transfer of Enrollment Subscribers and enrolled dependents may transfer from one participating health plan to another if either of the following occurs: The subscriber requests a transfer because the subscriber has moved and no longer resides in an area served by the health plan in which they are enrolled and there is at least one participating health plan serving the subscriber's new area. The subscriber or participating health plan requests a transfer in writing because of the failure to establish a satisfactory subscriber-plan relationship and the executive director determines that the transfer is in the best interests of the MRMIP. Any transfer request must be in writing to the Major Risk Medical Insurance Program at P.O. Box 2769, Sacramento, CA 95812-2769. Subscribers who transfer enrollment are not subject to pre-existing condition/waiting period exclusions. Disenrollment A subscriber and enrolled dependents will be disenrolled from the MRMIP when any of the following occur: The subscriber so requests. The subscriber fails to make subscriber contributions in accordance with the Program's existing subscriber contribution payment and grace period practices. The effective date of disenrollment for nonpayment of subscriber contribution will be retroactive to the last day for which subscriber contribution was paid. The subscriber fails to meet the residency requirement or becomes eligible for Part A and Part B of Medicare unless eligible solely because of end- stage renal disease or the subscriber or enrolled dependent has committed an act of fraud to circumvent the statutes or regulations of the MRMIP. Subscribers who have been disenrolled may not re-enroll in the MRMIP for a period of one year. Dispute Resolution/Appeals If a subscriber is dissatified with any action, or inaction, of the plan/ provider organization in which they are enrolled, the subscriber should first attempt to resolve the dispute with the participating plan/organization according to its established policies and procedures. This is a state program and the subscriber's rights and obligations will be determined under Part 6.5 Division 2 of the California Insurance Code and the regulation of Title 10, Chapter 5.5. Subscribers may file an appeal with the Board over (1) any actions or failure to act which has occurred in connection with participating health plan/organization coverage, (2) determination of an applicant's or dependent's eligibility, (3) a Program determination to disenroll a subscriber or dependent, and (4) a Program determination to deny a subscriber request or to grant a participating health plan request to transfer the subscriber to a different participating health plan. More information on the appeals process may be obtained by writing the Major Risk Medical Insurance Program at P.O. Box 2769, Sacramento, CA 95812-2769. Binding Arbitration Binding arbitration is an agreement between some insurance plans and subscribers to have health care disputes reviewed by a neutral person. Does the plan require its members to use Binding Arbitration to resolve disputes? Blue Cross:    No Blue Shield:    No Contra Costa Health Plan:    No Kaiser Permanente:    Yes (includes medical and hospital malpractice) Coverage Brochures Health coverage brochures are available from each health plan upon request. Please see each health plan description for a phone number to call to request one. Coordination of Benefits The MRMIP will coordinate its coverage of benefits with any other health insurance you may have and by state law will only pay after your other insurance has paid (not including Medicare, Medi-Cal and other state programs). For more information call 1-800-289-6574 You may contact the MRMIB at: MRMIB P.O. Box 2769 Sacramento, CA 95812-2769 Tel: (916) 324- 4695 Fax: (916) 324- 4878 Top of AIM HFP Site Top of MRMIP Home

Results from search: http://www.specialtyrisk.com/travel_medical.htm

Travel Medical Insurance Since 1993, international travelers throughout the world have relied on SRI's travel medical programs to provide medical protection and assistance services when spending time outside of their home country. Liaison International, with up to $1,000,000 in medical benefits, provides protection to citizens of any nation when traveling away from home. View and Print the Liaison International Brochure... In HTML In Microsoft Word In Adobe Acrobat pdf   New for 2002 This year brings exciting improvements to the Liaison International program. Effective January 1st, 2002, the program is underwritten by Virginia Surety Company, Inc., a US insurance carrier with an A+ "Superior" rating by A.M. Best. Outstanding Features Hospital Indemnity benefit of $100 per night for those traveling outside the US and Canada. $1000 coverage for an unexpectant recurrence of a pre-existing conditional when traveling outside the US and Canada. Automatic Home Country Coverage. Online Quote and Purchase System, you no long have to wait for the mail to obtain an ID Card. Click on the link below.   What Liaison International Provides... Even if you have comprehensive medical insurance at home, such coverage may either be of no use to you or invalid while abroad. Liaison International not only provides medical coverage for conditions that develop or accidents that occur while abroad, but other valuable benefits such as emergency evacuation and assistance services as well. Your home country insurance company rarely offers these features.     Travel Medical Insurance - Immigrant Medical Insurance - Worldwide Health Insurance - Trip Benefits - Other Products - Travel Advisor - Help Desk - Product Forms & Brochures - Agents & Brokers - Groups & Corporations - Information & History - Our Record of Service - Financial Security - Guarantee Liaison® is a registered trademark of Specialty Risk International, Inc. Copyright 1999 - 2002, Specialty Risk International, Inc.

Results from search: http://www.appealsolutions.com/tal/denied-claims-requires-attitude.htm

Medical Insurance Claims Recovery Requires Attitude Table of Contents Home page of The Appeal Letter e-zine. Case Studies Case studies providing insight in overturning insurance denials. Articles News articles devoted to increasing insurance reimbursement. Sample Letters Download sample appeal letters relevant to various denial reasons. Resources Resources to assist you increase your insurance reimbursement. Appeal Solutions Visit Appeal Solutions, an industry leader in insurance recovery products and services. Your E-mail Keep abreast of reimbursement issues by signing up for the free e-mail edition of The Appeal Letter. You are Here: Table of Contents : Insurance Recovery Requires Attitude Insurance Recovery Requires Attitude Perseverance Key to High Rate of Overturned Denials "Attitude is more important than facts." This quote is from noted psychiatrist Karl Menninger who understood the vast importance about attacking a difficult situation with a strong mindset. In appealing denied insurance claims, you need to have the mindset that it is the insurance carrier's burden to prove that the claim has been processed correctly and that any ambiguities in the coverage terms were construed in the insured's favor. A strong mindset will also give you the perseverance necessary to continuing to appeal a claim the insurer strongly defends. Attitude is more important that facts, because the right attitude will help you persuade the insurance carrier to look at the facts differently. Many claims are overturned after a single appeal letter. However, you want to persist with filing appeals until you get a satisfactory answer. When you do not receive an adequate response to your appeal from the appeals committee, it is imperative that you continue to appeal.  Persistence is often the key to overturning a denied claim. Many carriers overturn as many appeals during the second and third appeals as on the first appeal. It is crucial to keep the appeal active, even after the initial denial. In fact, statistics released from major insurance carriers indicate that about 25 percent of appeals are overturned on the first appeal and another 25 percent are overturned on the second appeal. If you believe payment is indicated by the policy terms, continue to appeal the claim. See below for information on keeping your appeal alive. Don't Settle For "Denial Upheld" Appealing denied insurance claims requires perseverance. You may find that your carefully researched and strongly worded appeal is not being reviewed adequately by the claims department. In such instances, you can redirect your appeal to someone in a better position to review and respond to the information you have cited. Consider sending your appeal to one of the following: Carrier Legal Counsel - If you have cited regulatory information, you can request a review and written response from the legal department. Carrier President - If your appeal involves a possible breach of claim processing procedures, ask the President or other senior management official to respond.  Department of Labor - If the insurance is self-funded, file a complaint with the Department of Labor. Send a copy of the complaint to the insurer. Employer - The employer will have an appeals committee if the group is self-insured. Department of Insurance - File a formal complaint with your state's Department of Insurance if you are unable to get a satisfactory response. Send a copy of the complaint to the insurer. State Medical Association - Many medical associations now have a complaint review process and will assist you with resolving denied insurance claims. Download Free Sample Appeal Letters for responding to insurance claim denials. Need help in appealing your denied insurance claims?  Appeal Solutions specializes in insurance claims recovery and can assist you with your denials...  

Results from search: http://www.chabot.cc.ca.us/int/med.html

Chabot College: Information for International Students MENU   PAGES IN INTERNATIONAL STUDENTS AREA International Students Home Page International Student Supplemental Application Statement of Sponsor Support Medical Insurance Statement Doctor's Health Statement   Student's Medical History   Affidavit of Financial Responsibility Checklist of Required Application Materials   (NOTE: This form must be printed out, filled out entirely, and mailed to: International Students Office Chabot College 25555 Hesperian Blvd. Hayward, CA 94545 U.S.A. Medical Insurance Affidavit   I hereby submit the attached evidence of health and medical insurance which I have purchased.  This insurance will cover the usual and normal costs which I might incur due to accident and/or illness while in attendance at Chabot College.  Name of insurance carrier:__________________________________  Policy number or identification:___________________________  Policy expiration date:____________________________________  Address of insurance carrier:______________________________ OR I hereby agree to purchase prior to my initial registration, the health and medical insurance policy recommended by Chabot College. I will present evidence of compliance to the Registrar before the end of the second week of classes.  FAILURE TO DO SO MAY RESULT IN MY DISMISSAL FROM THE COLLEGE.                     ________________________________________                        Student's Name - - Please Print                      _______________________________________                        Student's Signature   Back to International Students Page Chabot Home Page | Admission | Courses/Majors | Services / Info | Library&Catalog | International Students | Employment | Counseling | Bookstore | LPC Statement of Non-Discrimination Comments and questions are welcome. webmaster © 1998, Chabot College. 25555 Hesperian Blvd. Hayward. CA 94545 (510) 723-6600 Last Update: March 27, 2000

Results from search: http://courses.mbl.edu/ISO/Insurance%20Compliance%20Form.pdf

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