Coverage

HOW MUCH DOES THE STUDENT MEDICAL PLAN COST?

The fee for the 2007-2008 OCPM Student Medical Plan is $433 per semester. The fee for the Student Medical Plan is automatically billed each Fall and Spring semester to all students. The fee will appear on the student's tuition bill each semester. Payment is due in accordance with OCPM's tuition schedule.

Students who waive the Plan will receive a credit of $433 on their account.

WHO IS ELIGIBLE TO OBTAIN THIS COVERAGE?

Students attending the Ohio College of Podiatric Medicine; and Spouses, domestic partners, and dependent children of OCPM students who are enrolled in the plan.

All students who:

1. are enrolled during the Fall and/or Spring and/or Summer Semester at OCPM; and

2. who carry 1 or more credit hours and have paid all registration and tuition fees become Insureds unless coverage is waived as specified.

Students must actively attend classes for at least the first 31 days after the date for which coverage is purchased. Home study, correspondence, and television (TV) courses do not fulfill the Eligibility requirements that the student actively attend classes. We maintain the right to investigate student status and attendance records to verify that the policy eligibility requirements have been met. If and whenever we discover that the policy eligibility requirements have not been met, our only obligation is refund of premium.

Eligible students who do enroll may also enroll their dependents. Eligible dependents are the spouse (or domestic partner) and unmarried children under 19 years of age who are not self-supporting. Dependent eligibility expires concurrently with that of the Insured student. Coverage will coincide with the period for which the Insured student is covered or the date the premium and application are received by the Plan Administrator, which ever is later.

WHAT IS THE PERIOD OF COVERAGE?

Fall Semester: . . . . . . . .August 1, 2007 (12:01 a.m.) to January 2, 2008 (12:01 a.m.) Spring Semester: . . . . .January 2, 2008 (12:01 a.m.) to August 1, 2008 (12:01 a.m.)

WHAT BASIC MEDICAL COVERAGES ARE PROVIDED?

Outpatient Services:
When referred by the Case Western Reserve University Health Service, the Plan pays up to $250 per Plan Year for the following types of services:

1. Diagnostic x-rays and lab tests; and

2. Physical therapy.

Inpatient Hospital:

1. Hospital Room and Board: The Plan pays the full semi-private room rate for the first five days per Plan Year, plus up to $1,000 per day for the first two days of I.C.U. per Plan Year.

2. Hospital Miscellaneous: While confined in a hospital, services such as operating room, anesthetics, drugs, medicines, tests, x-rays, etc., are payable up to a maximum benefit of $600 per Plan Year. (Includes hospital charge for same day surgery.)

When the limits of the Basic Medical Coverage have been met, additional charges may be payable under the Major Medical/Extended Major Medical Coverages.

MAJOR MEDICAL COVERAGE (Maximum Benefit $50,000 - Basic and Major Medical Coverages Combined)

After benefits payable under Basic Medical Coverage have been exhausted:

1. the student is responsible for paying* 20% of the excess of eligible expenses incurred, up to a maximum copayment amount of $3,000, and

2. the Plan will pay 80% of the excess of eligible expenses incurred, up to a maximum copayment amount of $12,000.

* The participant is responsible for paying 30% if non-network provider.

Eligible expenses which exceed $15,000 will be paid at 100% by the Plan, up to a maximum total benefit under both the Basic and Major Medical Coverages combined of $50,000.

Exceptions:

• Inpatient mental/nervous and alcohol/substance abuse expenses are limited to a maximum benefit of $20,000 per Plan Year.

• Dental benefits are limited to the services specifically outlined under the Dental Coverage section.

EXTENDED MAJOR MEDICAL COVERAGE (Maximum Benefit of $200,000)

After benefits payable under Major Medical Coverage have been exhausted, the Plan will pay 100% of the excess of eligible expenses incurred, up to a maximum benefit of $200,000 per Plan Year.

NOTE: No benefits are payable under Extended Major Medical Coverage for inpatient or outpatient mental/nervous or alcohol/substance abuse expenses.

IMPORTANT DEFINITIONS

INJURY means bodily injury caused by an accident. 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, or trauma related disorder due to Injury which causes a loss while this Policy is in force and 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 Pregnancy and Complications of Pregnancy.

POLICY YEAR means the period of time starting with the Effective Date of this Policy through the Termination Date of this Policy as shown on the Schedule of Benefits. The Policy Year is agreed to by the Policyholder and the Company.

SICKNESS means an illness, or disease, or trauma related disorder due to Injury which causes a loss while this Policy is in force and 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 Pregnancy and Complications of Pregnancy.

POLICY YEAR means the period of time starting with the Effective Date of this Policy through the Termination Date of this Policy as shown on the Schedule of Benefits. The Policy Year is agreed to by the Policyholder and the Company.

WHAT DOES THE OCPM STUDENT MEDICAL PLAN OFFER?

The OCPM Student Medical Plan, subject to the outlined benefits, limits and exclusions, protects the student during the term for which the fee has been paid. The Company reserves the right to coordinate benefits with any other medical coverage.

Participants of the OCPM Student Medical Plan are encouraged to access providers in the First Health Network for services received both in Ohio and out-of-state. The First Health PPO Network is comprised of hospitals, physicians and ancillary providers. Participants may realize substantial savings based on the negotiated discount agreement with First Health Network. You can obtain a list of PPO providers or other information at www.firsthealth.com/ccnUsa/ed/index.html or by calling First Health Network at (630) 737-7900.

Failure to utilize a First Health network provider will result in a benefit reduction to 70% of covered charges.

In the case of a medical emergency, as determined by the plan administrator, a participant who obtains health care from an out-of-network provider will be subject to the in-network limits and restrictions to such care.

When hospital or medical care is required because of a Sickness or Injury eligible for benefits under this Plan, the Reasonable and Customary expense actually incurred will be paid, up to the specified limits for each Sickness or Injury.

ARE ANY BENEFITS AVAILABLE FOR ROUTINE PREVENTIVE CARE?

The Plan will pay the cost, up to $85 per exam, for routine mammograms as follows:

WHAT BENEFITS ARE PAYABLE FOR OUTPATIENT MENTAL/NERVOUS OR ALCOHOL/SUBSTANCE ABUSE TREATMENT?

The Plan pays 80% of eligible expenses incurred, up to a maximum benefit of 26 visits per Plan Year for: diagnosis, treatment, couples counseling, services and supplies, legally rendered by a licensed psychiatrist, psychologist or social worker. Such outpatient service may be provided in a physician’s office, hospital outpatient department, community mental health facility or an alcoholism or drug abuse treatment facility.

Biofeedback is covered only when referred by the Case Western Reserve University Counseling Services.

HOW ARE PRESCRIPTIONS COVERED?

Prescription drug expenses are covered under the medical plan the same as other expenses related to a covered sickness or injury. Students enrolled in the Student Medical Plan are automatically enrolled in the drug plan, administered through Caremark.

The plan includes a co-payment that is required to be paid when a prescription is purchased. You will pay your predetermined co-payment and the plan will pay the remainder of the cost. The Plan allows up to $5,000 per Plan Year for prescription reimbursement.

In some cases, it may be necessary to pay the entire cost of the prescription and submit a claim form along with a pharmacy receipt to Caremark when a network pharmacy is used.

Most Pharmacies in the U.S.A. participate in the Caremark Program. To locate a network pharmacy please visit www.BollingerDrugCard.com. Please note that no prescriptions will be paid for at non-network pharmacies. You should show your Caremark Rx ID card at the point of purchase.

Your pharmacist will be able to determine which category your prescription applies to in order to collect the correct co-payment at the time of purchase. Caremark customer service representatives are available to help in this determination as well.

The mail order facility for this plan is through Caremark. You may receive up to a 90 day supply by mail with a properly written prescription from your physician.

MAIL ORDER

For long-term medications you need right away, ask your doctor for two prescriptions – one for a small supply to fill at a participating retail pharmacy and one for a long term supply to fill through the mail.

Most orders are shipped by the U.S. Postal Service. Controlled substances may require a signature upon receipt. Packaging does not show any indication that medications are enclosed.

Include payment if applicable to avoid any delays. Do not send cash. Make check payable to Caremark. Credit cards are accepted. Allow 2 weeks for delivery.

Mail Pharmacy Customer Service:
(800)391-6443 (Refills, Mail Pharmacy and Customer Service) www.bollingerdrugcard.com This is a 24 Hour Service.

DENTAL COVERAGE

Coverage is provided per the benefits outlined in the Plan for Injury to sound, natural teeth.

Participants are eligible for the following services only when obtained from the Case Western Reserve University School of Dental Medicine.

Two oral exams and evaluations, including one dental and medical history per Plan Year at 100% coverage.

Two oral cleanings per Plan Year at 100% coverage. Periodic x-rays per Plan Year at 100% coverage. Emergency dental care for the relief of pain at 100% coverage.

20% discount on all other dental services offered at the Case Western Reserve University School of Dental Medicine.

Services are provided at the Case Western Reserve University School of Dental Medicine by both Pre- Doctoral and Doctoral Students.

Appointments are necessary and may be made by calling the Case Western Reserve University Dental Clinics at (216)368-3200.

Please Note: The Case Western Reserve University School of Dental Medicine closes periodically throughout the year. Oral cleanings are not provided when the clinic is closed. Emergency care is limited at this time and is accessed by calling (216)368-3200.

ARE ANY OTHER COVERAGES AVAILABLE?

In addition to the Basic Medical, Major Medical and Extended Major Medical Coverages already described, the Plan will also pay Repatriation and Medical Evacuation expenses, subject to the exclusions and limitations of the Plan.

REPATRIATION

In the event of the death of a covered student while outside his/her home country, the Plan will pay expenses incurred in connection with the preparation and transportation of the body to the student’s place of residence in his home country, up to a maximum amount of $7,500. This coverage does not include transportation expenses of any person accompanying the body, or visitation, memorial or funeral expenses. Repatriation benefits must be pre-approved by the Plan Administrator.

MEDICAL EVACUATION

The Plan will pay expenses incurred for air evacuation of a covered student to his/her home country or to a hospital operated pursuant to applicable law, where required special treatment can be rendered, if the attending Physician certifies that:

1) adequate treatment is not available locally, and;
2) the special treatment is medically necessary for the proper care of the student’s covered Sickness or Injury.

Covered expenses include those incurred for an accompanying physician or nurse, if medically necessary. Coverage is limited to a maximum of $10,000 per Plan Year. Medical evacuation benefits must be pre-approved by the Plan Administrator.

MANDATED BENEFITS

The plan will pay for the following mandated benefits and any other applicable mandate in accordance with Ohio insurance laws: Mammography and Cytological Screening; Maternity Length of Stay; Off Label Prescriptions; Alcoholism; Emergency Services; Child Health Services; Mental and Emotional Disorders; and Nurse Midwife.

WHEN DOES COVERAGE TERMINATE?

Coverage terminates at 12:01 a.m. local time at the address of the Ohio College of Podiatric Medicine on the earliest of the dates indicated below:

• The termination of the policy August 1, 2008;

• The date a student withdraws from school to enter military service; in this case a prorated refund will be available upon request;

• The first day of any term for which a student waives coverage;

• The end of the period for which the required payments have been received, if future payments cease.

For Fall Coverage Only: If a student terminates this Medical Plan and if, at the time of termination, the student is receiving or is entitled to receive benefits for a covered Sickness or Injury, the student’s coverage under this Plan will continue for that Sickness or Injury only, for up to 90 days following the date the student’s coverage terminated or in accordance with the time period stated under Extended Major Medical Coverage. The 90 day extension does not include prescription coverage for retail purchases and or mail order.

If OCPM terminates and does not replace this Medical Plan, students then receiving or entitled to receive benefits for a covered Sickness or Injury will continue to be covered for that Sickness or Injury for up to 52 weeks following the date of termination or in accordance with the time period stated under Extended Major Medical Coverage, whichever is less.

Benefits payable during this period will not be more than the amounts provided under the Plan at the time the Sickness or Injury began.

PLEASE NOTE: Any subsequent increase in the benefits provided under this Plan will not affect the benefits payable for a Sickness or Injury for which benefits have been extended under this provision.

CAN COVERAGE BE EXTENDED FOR A PERSONAL MEDICAL LEAVE?

Coverage may be continued without interruption for one additional semester for a student who leaves OCPM due to a personal medical condition provided the student was registered and enrolled in the Medical Plan during the semester in which the student left.

In order to continue medical coverage under the OCPM Student Medical Plan, the Office of Student Affairs must be notified of the leave prior to the semester in which the leave is to take effect.

Students must provide the following to the Office of Student Affairs:

1. A letter from a Dean or Advisor approving the requested medical leave;

2. A letter from the student’s medical provider or counselor/therapist confirming the medical necessity for the requested medical leave; and

3. Payment (in cash or check) of the Medical Plan fee prior to the beginning of the semester in which the leave is to take effect.

This extension does not apply to students who are leaving OCPM for reasons other than a personal medical condition.

PLEASE NOTE: When a student is on a leave of absence, the student is not eligible to use the services offered by the Case Western Reserve University Health Service or the Case Western Reserve University Counseling Services. When a student is on a personal medical leave of absence, payment of the Medical Plan fee allows coverage under the OCPM Medical Plan only, subject to the exclusions and limitations of the Plan, as outlined in this brochure.

IS AN IDENTIFICATION CARD PROVIDED?

Collegiate Risk Management will provide you with an I.D. card. It is necessary for each student participating in the Student Medical Plan to have an I.D. card. If you have not received one, or you need a replacement, please contact Collegiate Risk Management at (800)922-3420.

HOW ARE MEDICAL EXPENSES PAID?

COVERED STUDENTS ARE RESPONSIBLE FOR INITIATING ALL MEDICAL PLAN CLAIM FORMS FOR THE PAYMENT OF MEDICAL BILLS. These forms are available at OCPM in the Office of Student Affairs, at the Case Western Reserve University Health Service, and from Bollinger, Inc., P.O. Box 727, Short Hills, NJ, 07078-0727, (800)526-1379, or online. When at home or traveling away from Cleveland, claims must be filed within 90 days of the date of treatment. In all cases, expenses must be filed within 15 months of treatment to be considered for payment under this Plan. In general, the Medical Plan will reimburse the covered student for all receipted bills and will pay other bills directly to the provider. Any covered student is encouraged to contact Bollinger, Inc. (800-526-1379) directly whenever additional assistance or information would be helpful.

CAN THE MEDICAL PLAN BE WAIVED?

Under certain conditions, the $433.00 per semester Medical Plan fee may be waived.

1. Students who have insurance comparable to the Medical Plan may waive the coverage described in this brochure. HOWEVER, IT IS EACH STUDENT’S RESPONSIBILITY TO ENSURE THAT THE ALTERNATE COVERAGE IS ADEQUATE. Before submitting a waiver, please note that many commercial insurance plans do not cover a student after a certain age.

2. A WAIVER REQUEST IS VALID FOR ONE SEMESTER ONLY. Students who elect to waive the Medical Plan must submit a waiver EACH SEMESTER in support of their request. The waiver must be received NO LATER THAN September 5, 2007 for the Fall Semester and no later than January 11, 2008 for the Spring Semester.

3. Students can waive the Medical Plan by submitting a waiver form to the Office of Student Affairs.

Students who waive the Plan for a given semester are eligible to apply for coverage during that semester if they experience a termination of their current medical coverage that is beyond their control. Contact OCPM’s Office of Student Affairs at (216)231-3300, ext. 7325, or Collegiate Risk Management at (800)922-3420, for further details.

IS THE FEE FOR THE MEDICAL PLAN REFUNDABLE?

After the deadline for submitting a waiver request (see the preceding section), no portion of the fee is refundable, with one limited exception. If a student withdraws from school to enter military service, a prorated refund will be available upon request.

HOW TO APPEAL A DENIAL OF BENEFITS

If you believe a claim was improperly settled, please complete the following process:

1. Within 60 days of receipt of the claim, you may request, in writing, that Bollinger Inc., the plan administrator, conduct a review of the processed claim. The plan administrator will review the processed claim and inform you whether or not an error was made.

2. If you are not satisfied with the above review, a written request for a second review may be submitted to Bollinger Inc., the plan administrator, within 60 days of the first review. The request should state, in clear and concise terms, the reason for disagreement with the way the claim was processed. When the written request is received, the claim will be reviewed again and the results of this review furnished in writing to you within 60 days in most cases, but no longer than 120 days.

All requests for review of denied benefits should include a copy of the initial denial letter and any other pertinent information. Send all information to:

Bollinger, Inc.
Att: Don Jenkins, Sr. VP of Claims
P.O. Box 727
Short Hills, NJ 07078-0727

WHAT IS EXCLUDED UNDER THIS PLAN?

1. Routine physical examinations, preventive testing or treatment, screening exams or testing in the absence of Sickness or Injury, pre-marital examinations, preemployment examinations, health examinations or pre-school physical examinations and any associated laboratory work, not including mammograms and routine Papanicolaou Cytology Test;

2. Treatment for mental or emotional disorder or alcohol or substance abuse except as specifically provided;

3. 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;

4. Expenses resulting from a motor vehicle accident for which benefits are payable from other valid insurance;

5.  Expenses incurred as the result of dental treatment, except as specifically included and when needed for treatment resulting from Injury to natural teeth;

6. Eyeglasses, radial keratotomy, contact lenses, hearing aids or prescriptions or examinations except as required for repair caused by a covered Injury;

7. Injury or Sickness for which benefits are payable under any Worker's Compensation or Occupational Disease Law;

8. Expenses or supplies related to sex changes, sexual dysfunctions or inadequacies with the exception of penile prosthesis required for physiological impotence;

9. Injury resulting from the playing, practice, participating, or conditioning in any intercollegiate sport, contest or competition sponsored by the college or Injury sustained while traveling to or from such sport, contest or competition as a participant;

10. Declared or undeclared war, riot, civil disorder, civil commotion or acts of terrorism;

11. 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-rata premium with respect to such person;

12. Treatment provided in a government hospital unless there is a legal obligation to pay such charges in the absence of other insurance;

13. Committing or attempting to commit an assault or felony; or fighting, except in self defense;

14. Services or supplies which are experimental or investigative in nature: including the treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice and any such items requiring federal or other governmental agency approval not received at the time services were rendered;

15. 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 college credit;

16. Services and supplies not Medically Necessary for the diagnosis recommended by the attending physician;

17. Treatment of obesity and any condition resulting therefrom (including hernia of any kind);

18. Transportation services except as specified;

19. Homemaking, companion or chronic (custodial) care services. Charges of a home health aide who is a member of your household. Charges of any care provided by relatives (by blood, marriage or adoption);

20. Organ transplants.

BENEFIT PROVISIONS

This Policy and any riders attached provide benefits for Covered Medical Expenses incurred by a Covered Person that are:

1. Usual, customary, and Medically Necessary;

2. incurred after the Covered Person's effective date of coverage;

3. incurred while this Policy is in force;

4. due to a covered Injury or Sickness;

5. in excess of the appropriate Deductible or copayment amount;

After the appropriate deductible or copayment amount has been met, Covered Medical Expenses will be payable according to benefit limits specified on the Schedule of Benefits, including any Coinsurance requirements.

Covered Persons will be covered at home, at school and while traveling, 24 hours a day during each semester for which a premium has been paid.

Preferred Provider Network:

PLEASE KEEP THIS BROCHURE AS A GENERAL SUMMARY OF THE INSURANCE. The Master Policy on file at the College 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 the Policy, the Master Policy will govern and control the payment of benefits.

This web site is based on Policy COH322D Policy Form: SH5000GPM-OH 597676