Dear Student:
Ave Maria University is offering a student injury and sickness insurance program on a blanket basis. The University has selected a plan that will provide this coverage automatically for all full-time students enrolled in twelve or more credit ours per semester. The Coverage is underwritten by Monumental Life Insurance, Cedar Rapids, Iowa.

We are hopeful every student will take advantage of the program. Your participation will help relieve some of the financial burden resulting from unexpected medical expenses in the event of Injury or Sickness.
Note: Your current insurance plan may not include providers in Collier County, Florida. Please check with your insurance company regarding medical providers and coverage in Collier County. You may incur out-of-pocket expenses if your current plan is not accepted by area physicians. Because of the very low cost of this plan you may wish to carry it in addition to any coverage you may now have.
The brochure outlines the scope of coverage and benefits and should be retained for future reference. If you have any questions about the actual policy details, please contact the Student Life Office or visit the plan website which is www.BollingerInsurance/AveMaria.

ELIGIBILITY
All registered full-time students at Ave Maria University will automatically be included in this program. The $1,010 annual premium is added to your student bill. UNLESS THE PARENT, GUARDIAN OR STUDENTS SPECIFICALLY REQUESTS EXCLUSION BY RETURN-ING THE WAIVER STATEMENT ALONG WITH A COPY OF THEIR INSURANCE CARD TO AVE MARIA UNIVERSITY’S STUDENT LIFE OFFICE BEFORE SEPTEMBER 7th, 2007 (or January 18th, 2008 for Spring Term enrollees). The spring premium is $675.

Students who enroll in the plan may secure family coverage for dependents. An eligible dependent is the Insured’s legally married spouse who is residing with the Insured; child who is dependent upon the Insured for support, is living in the Insured’s household, or is a full-time or part-time student, and is under the age of 25 (the child will be insured until the end of the calendar year in which the child reaches the age of 25); or child who is dependent upon the Insured for support and is incapable of self-sustaining employment by reason of mental pr physical handicap, and is age 25 and over.

Dependent enrollment is only allowed during the open period which is 8/15/07 to 9/16/08 (1/10/08 to 2/10/08 for second semester enrollees). Exceptions will be made for the following;

1. Adding a new spouse or dependent child within 31 days of marriage, birth or adoption.
2. Enrolling as a new or transfer student within 31 days of enrollment at he school.
3. Ineligibility under another plan of creditable coverage and accepted and exhausted COBRA continuation of coverage if offered.

Newborn children are covered for Injury or Sickness from birth until 31 days old. Coverage may be continued for that child when we are notified within 31 days form the date of birth and required premium is paid.

The Company maintains the right to investigate student status and attendance records to verify that policy eligibility requirements have been met. If the Company discovers that the policy eligibility requirements have not been met, the Company’s only obligation is return of premium. Eligibility requirements must be met each time a premium is paid to continue coverage.

EFFECTIVE AND TERMINATION DATES
The Master Policy on file at the school becomes effective at 12:01 A.M. August 15 , 2007. Coverage becomes effective on that date or the date the enrollment form and full premium are received by the Company or its authorized representative, whichever is later. The Master Policy terminates at 12:01 A.M. August 15, 2008. Insurance for the covered person and dependents will end on the earliest of the date that: you are no longer in an eligible class; you become an active, full-time member of any armed forces; you reach the end of the period for which premium was paid; the Policy is terminated; or the date the subscriber ceases to be a participant under the Policy. Dependent coverage will not be effective prior to that of the covered person or extend beyond that of the covered person.

Coverage is effective the first day of the term of coverage for enrolled full-time students whose premium is added to the registration fees. For Dependents, coverage is effective the date premium and enrollment are received by us prior to the enrollment deadline.

EXTENSION OF BENEFITS AFTER TERMINATION
The coverage provided under the Policy ceases on the termination date. However, if the Insured person is Totally Disabled on the termination date from a covered Injury or Sickness, Covered Medical Expenses for such Injury or Sickness will be paid until the Injured person is no longer Totally Disabled, but not to exceed 90 days from the expiration date of coverage, or the maximum policy benefit, whichever occurs first. Covered Medical Expenses for maternity care for a pregnancy, which commenced while the Policy was in effect shall be continued for the period of that pregnancy and will not be based upon total disability. The total payments made in respect of the Insured person for each condition both before and after the termination date will never exceed the maximum benefit.

RATES

NON-DUPLICATION OF BENEFITS
The Policy provides benefits in accordance with all of its provisions only to the extent that benefits are not provided by any other valid and collectible insurance. If the Insured person is covered by other valid and collectible insurance, all benefits payable by such insurance in excess of $100 will be determined having primary status or no coordination or non-duplication of benefits pro-vision. If the Insured person is insured under group or blanket insurance which is also excess to other coverage, the Policy pays a maximum of 50% of the benefits otherwise payable.

PRE-EXISTING CONDITION LIMITATION
No benefits will be payable for the Covered Person’s Pre-existing Conditions. They are defined as an Injury sustained or a Sickness for which the Covered Person was medically treated or advised by a Physician within the twelve months immediately prior to his Effective Date of Coverage under this Policy.

This Pre-Existing Conditions Limitation provision does not apply to:
(1) Genetic information in the absence of a diagnosis of the condition related to such information;
(2) a Covered Person who, as of the last day of the 30-day period beginning with the date of birth, was covered under prior creditable coverage;
(3) a Covered Person who has prior coverage without a lapse of 62 days or more;
(4) a child who is adopted or placed for adoption before attaining 18 years of age: and as of the last day of the 30day period beginning on the date of adoption or placement for adoption, is covered under creditable coverage;
(5) pregnancy.

Click here to view the schedule of benefits

Covered Medical Expenses resulting from a Pre-existing Condition will not be covered unless: (1) twelve consecutive months have elapsed during which no medical treatment or advice is given by a physician for such condition; or (2) the covered person has been insured under the Policy or the University’s prior policies for the immediately prior year; or (3) the covered person has been receiving benefits under the University’s prior policies and has been continuously insured since the date of accident, Injury, or Sickness, whichever occurs first.

Routine follow-up care to determine whether a breast cancer has recurred in a person who has been previously determined to be free of breast cancer does not constitute medical advice, diagnosis, care or treatment for purposes of determining pre-existing conditions unless evidence of breast cancer is found during or as a result of the follow-up care.

MANDATED BENEFITS
The Plan will pay benefits for the following Mandated Benefits and any other mandate in accordance with Florida insurance laws. A detail of Benefits for Mammography Benefit; Prosthetic Devices and Breast Reconstructive Surgery Benefit; Post Surgical Mastectomy Care Benefit; Child Health Supervision Services Osteoporosis Benefit; Maternity; Mid-Wife Care Benefit; Post Delivery Care Benefit; Cleft Lip and Cleft Palate of Children benefit; Diabetes Supplies, Equipment and Self-Management training Benefit; Dental General Anesthesia and Hospital Dental Procedure Benefit; and Bone Marrow transplant Benefit may be found in the Master Policy on file at the University.

DEFINITIONS
COINSURANCE means the out-of-pocket expenses to be paid by the Insured as a percentage of the Covered Medical Expenses.

INJURY means bodily injury caused by an accident. The accident must occur while the Covered Person's insurance is in effect under this Policy. A Covered Person must begin receiving services, supplies or treatment within 30 days from the time of accident in order for it to be considered a covered Injury. All injuries sustained by one person in any one accident, including all related conditions and recurrent symptoms of these Injuries, are considered a single covered Injury. The Injury must be the direct cause of loss and must be independent of all other causes. The Injury must not be caused by or contributed to by Sickness.

SICKNESS means an illness, or disease which first manifests while this Policy is in effect which results in Covered Medical Expenses. All related conditions and recurrent symptoms of the same or a similar condition will be considered the same Sickness. It also includes complications of Pregnancy.

TOTALLY DISABLED means as the result of an Injury or Sickness, the Covered Person’s the inability to perform the material and substantial duties of any occupation for which he is reasonably fitted by education, training, or experience.

USUAL AND CUSTOMARY CHARGE means those charges for necessary treatment and services that are reasonable for the treatment of cases of comparable severity and nature. This will be derived from the mean charge based on the experience in a related area of the service delivered and the MDR (Medical Data Research) schedule of fees provided by Ingenix.

EXCLUSIONS AND LIMITATIONS
Benefits will not be paid under this Policy for any expenses which
result from: 1) Routine physical examinations, preventive testing or treatment, screening exams or testing in the absence of Sickness or Injury, pre-marital examinations, pre-employment examinations, health examinations or pre-school physical examinations including routine care of a newborn infant, well baby nursery and related Physician charges, other than Hospital nursery expense of a newborn baby, and any associated laboratory work, not including mammograms and routine Papanicolaou cytology test;
2) Elective Surgery or Elective Treatment;
3) Committing or attempting to commit an assault or felony; or fighting, except in self-defense;
4) Treatments, procedures, facilities, equipment, drugs, devices, supplies or services that are experimental or investigative;
5) Riding as a passenger or otherwise in any vehicle or device for aerial navigation, except as fare-paying passenger in an aircraft operated by a commercial scheduled airline. This exclusion does not apply to insured students while taking flight instructions for University credit;
6) Injury or Sickness for which benefits are paid under any Worker's Compensation or Occupational Disease Law;
7) Injury sustained or Sickness contracted while in the service of the armed forces of any country. When an Insured enters the armed forces, we will refund any unearned pro-rate premium with respect to such person;
8) Treatment provided in a government hospital unless there is a legal obligation to pay such charges in the absence of other insurance;
9) Cosmetic surgery, except for the correction of birth defects, correction of deformities resulting from cancer surgery, or surgery that is required as a result of an Injury which necessitates medical treatment within 24 hours of the accident. Correction of deviated nasal septum shall be considered as Cosmetic surgery for the purpose of this Policy;
10) Accident sustained or Sickness contracted as a result of the use of alcohol or the misuse of drugs, medicines, or narcotics, unless taken in the dosage and or the purpose prescribed by the Covered Person's Physician;
11) Treatment for mental or emotional disorders;
12) Eyeglasses, radial keratotomy, contact lenses, hearing aids or prescriptions or examinations except as required for repair caused by a covered Injury;
13) Organ transplants;
14) Elective abortion;
15) Injury resulting from the playing, practice, participating, or conditioning in any intercollegiate, interscholastic sport, contest or competition sponsored by the University, any professional or semi-professional sport, or Injury sustained while traveling to or from such sport, contest or competition as a participant;
16) Services that are provided normally without charge by the University's health center, infirmary or Hospital; or by any person employed by the University;
17) Suicide or attempted suicide while sane or insane, including drug overdose; or intentional self-inflicted Injury (except in Colorado and Missouri, while sane);
18) Expenses resulting from a motor vehicle accident for which benefits are payable from other valid insurance.
In the event of a non-emergency Injury or Sickness, students should report to Student Health Services for treatment or referral, or when not in school, to their Physician or Hospital.
CLAIM PROCEDURE:


1. Secure a Claim Form from the Plan Administrator or from Student Health Services. No claim will be processed without a completed claim form. Claim forms can also be obtained online at: www.BollingerInsurance.com/AveMaria.
The claim form must be completed on both sides, including the “Statement of Other Insurance”.
3. File claim within 30 days of Injury or first treatment for a sickness. Bills must be received by the Plan Administrator within 90 days of service or as soon as reasonably possible to be considered for payment.
4. Upon receipt of properly documented Claim Forms, the Plan Administrator will determine the amount of any benefits payable or will notify you of any additional information needed. Benefit payments will be sent directly to your health care provider(s) unless you have specified otherwise in writing.
5. You will be sent an Explanation of Benefits (EOB).


For claim inquiries, please contact the plan administrator at: 1-866-267-0092. Customer Service Representatives are available 8:00 am to 5:00 pm (EST) Monday through Friday.

This Plan Administered By:



101 JFK Parkway
Short Hills, NJ 07078
(866) 267-0092 (Claims/Coverage)
(800) 526-1379 (Other Questions)


PREFERRED PROVIDER NETWORK

www.firsthealth.com/ccnUsa/ed/index.html
1-800-226-5116


PLEASE KEEP THIS AS A GENERAL SUMMARY OF THE INSURANCE BENEFITS. The Master Policy on file at the University contains all of the provisions, limitations, exclusions and qualifications of your insurance benefits, some of which may not be included in this Brochure. If any discrepancy exists between the Brochure and Master Policy, the Master Policy will govern and control the payment of benefits.

Policy: CFL-211D
Policy Form: SH1000GPM.FL (Ave Maria 07-08)
Form: MLICBROCHURE.FL (Ave Maria 07-08)