To view the most current version of the Plan Document and Summary Plan Description for your Health Insurance, please login at PhysiciansCare (ASR Corporation).

• Andrews University is a self-insured employer and PhysiciansCare (ASR Corporation) is a third party administrator, which means that ASR pays your medical, prescription Drug, and vision claims from a bank account that is fully funded by Andrews University.

• Payment will be made directly to your doctor or other provider under the terms of your health plan. If you have paid the bill and should be reimbursed under the terms of your medical plan, payment will be sent to you if you complete the appropriate reimbursement form and submit a paid receipt to PhysiciansCare (ASR Corporation).

  • Login at PhysiciansCare homepage (www.physicianscare.com) to

    • view your health plan benefits, claim status, and plan document,
    • search for a medical provider

The difference between in-network and out-of-network providers:

The medical benefits of the Plan may be obtained from a provider participating in the PhysiciansCare (ASR) Network, Community Health Alliance Network (CHA), Lakeland Care, Inc. Network, Multi-Plan PPO Network, or an out-of-network provider.

This Plan has elected to work with the network listed above, called preferred (or in-network) provider organizations. Because these preferred providers have agreed to charge reduced fees to persons covered under the Plan (called the fee schedule), the Plan can afford to offer a lower co-payment or coninsurance for the benefit.

Therefore, when a covered person uses a preferred provider, they will incur fewer fees that would a covered person who chooses to use a non-preferred provider. It is the covered person's choice as to which provider to use.

Covered persons are responsible for charges over the fee schedule amount when a non-preferred (out-of-network) provider is used.

Important Note:
A listing of the preferred providers can be found at:
• Physicians Care Network (www.physicianscare.com),
• Lakeland Care (www.lakelandcare.com),
• Community Health Alliance (www.chanetwork.com), and
• Multiplan Network (www.multiplan.com)



If you have questions about your claim:

You can call PhysiciansCare (ASR). A specially trained phone representative will be able to answer questions regarding your claim and benefit plan. It is important to have your social security number ready when you call.

To reach a claims analyst call: 800.968.3033
If your last name begins with the letter A-L, please use extension 3127.
If your last name begins with the letter M-Z, please use extension 3048.
Otherwise please use extension 0 and ask to speak with a claims analyst on Team A.

Open Enrollment:

Employees can make any new additions or changes to the health plan during the "Open Enrollment Period." Open enrollment is once a year and changes are effective on July 1^st of the same calendar year. Changes submitted after the open enrollment deadline will be applied in the plan year after the next with all conditions remaining the same. For example, if the deadline is May 15, 2009 and your changes were submitted on May 16, 2009, your changes would not be reflected on July 1, 2009 (for fiscal year). Rather, they would be reflected on July 1, 2009 (for the fiscal year), assuming that there are no changes in all conditions.

Extended Coverage Option:

The University allows employees who are terminating employment to continue with their health insurance under their own expense for up to twelve (12) months after termination. For more information on this issue, please contact Benefits.

Prescription Drug Benefits:

This benefit is included with the University health insurance. When the covered person's health insurance card is presented to a participating pharmacy, the covered person will be responsible for the copayment or with the high deductible health plan, the co-insurance amount (the full amount if the Benefit Period deductible has not been reached). The pharmacist will submit the remaining cost to Navitus for payment.

Generic versus Brand Name Drugs

The law permits that a prescription written for a brand name drug be filled with the generic equivalent, if available. When you purchase a brand name drug and a generic version is available, and the Physician has not written DAW (dispense as written), you pay the brand name copayment plus the difference in cost between the brand name and the generic product.

Navitus FAQ
Welldyne FAQ

Vision Care Benefits:

Coverage includes one (1) routine exam per Benefit Period. The co-pay for an eye examination is $15.00 after which insurance coverage is at 100% of reasonable and customary charges.

The plan will pay up to $250.00 per Benefit Period for eyeglass frames and eyeglass/contact lenses. Any amount over $250 is the covered person's responsibility.

Dental Insurance

Description:
The Health Insurance Plan also provides eligible Andrews University faculty and staff with dental coverage. The plan covers services such as bridgework, cleaning, crowns, dentures, emergency treatment, fillings, oral exams, orthodontics, root canals, treatment of gum disease, and x-rays.

Summary of Dental Plan Benefits

Please submit your receipts and reimbursement form to PhysiciansCare/ASR Corp.

Control Plan - PhysiciansCare (ASR Corporation)

Benefit Year - July 1 through June 30

Covered Services

	Plan Pays	You Pay
Class I Benefits
Diagnostic and Preventitive Services - Used to diagnose and/or prevent dental abnormalties or disease (includes exams, cleanings and fluoride treatments)	100%	0%
Emergency Palliative Treatment - Used to temporarily relieve pain	100%	0%
Radiographs - X-rays	100%	0%
Sealants - Used to prevent decay of pits and fissures of permanent back teeth	100%	0%
Class II Benefits
Oral Surgery Services - Extractions and dental surgery, including preoperative and postoperative care	75%	25%
Endodontic Services - Used to treat teeth with diseased or damaged nerves (for example, root canals)	75%	25%
Periodontic Services - Use to treat diseases of the gums and supporting structures of the teeth	75%	25%
Relines and Repairs - Relines and repairs to bridges and dentures	75%	25%
Minor Restorative Services - Used to repair teeth damaged by disease or injury (for example, fillings)	75%	25%
Major Restorative Services - Used when teeth can't be restored with another filling material (for example, crowns)	75%	25%
Class III Benefits
Prosthodontic Services - Used to replace missing natural teeth (for example, bridges and dentures)	75%	25%
Class IV Benefits
Orthodontic Services (to age 24) - Used to correct malposed teeth and/or facial bones (for example, braces)	50%	50%

Sealants are only payable for the occlusal surface of first permanent molars to age nine and second permanent molars to age 14. The surface must be free from decay and restorations. Sealants are payable once per tooth per lifetime.

Maximum Payment - $1,000 per person total per benefit year on Class I, Class II, and Class III Benefits. PhysiciansCare's payment for Class IV Benefits will not exceed a lifetime maximum of $1,760 per eligible person.

A Fast and Easy Way to Check Your Dental Benefits and Claim Status

Log on the website at www.physicianscare.com. Then, follow the directions on the screen.

Health Savings Account (HSA):

• HSA Diagram
• HSA and High Deductible Plans (HDHP)
• HSA Frequently Asked Questions
• IRS Publication 502 for 2009

Forms

Forms are available when you log in at www.andrews.edu/go/mybenefits/. If you have any questions, please call Corporate Benefit Strategies (CBS) at 1.866.365.2413 ext. 108.

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