Frequently Asked Questions

What do I do if I have an accident or become sick while insured under your plan?
When you are in need of medical attention, the very first place you should go is to your college/university Student Health Center, if there is one. In most instances, the treatment you receive there is free or very low cost, does not require filing a claim, and will take care of your problem. The Student Health Center should always be your first stop. In many plans, any off-campus treatment must first be referred by the Student Health Center to be covered, so go there first. If the Student Health Center is closed or otherwise unavailable or if your university does not have a Health Center, you will want to look to see if your plan requires use of a PPO (look in your Student Health Insurance Brochure, available at the Student Health Center or in the International Office). If your school has no PPO plan, you may use any licensed provider. If your plan DOES require the use of a PPO provider, go to a Provider that is on the PPO plan of your school (see reference to PPO plans that follows) If you receive medical treatment off-campus, refer to the following information on the claim filing process.
How do I file a claim?
When you have incurred covered medical expenses, download the correct claim form for your school from this Website, print it, complete and sign it, and mail it to the address at the top of the claim form along with ITEMIZED billings for your medical treatment. You may also e-mail this information to customerservice@amaofsa.com.
What is an ITEMIZED bill?
This is a billing given to you by the medical provider that “itemizes” each service for which you are billed. (The Physician’s itemized bill is called a “CMS 1500”; the Hospital’s itemized bill is called a “UB-04 CMS-1450”) We can only process your claim with the ITEMIZED bill. The medical provider will at times send you a STATEMENT after you have been treated which shows how much in total you still owe. WE CANNOT process your claim if you send us this statement. We must have an itemized billing. The ITEMIZED billing shows every detail of the service you received, the STATEMENT only shows the amount due.
How soon should I file my claim after my medical treatment?
You should obtain a claim form and submit it within 90 days after the date of accident or onset of illness.
Do you pay the Provider or me?
If your benefits were assigned to the provider at the time of treatment, which is the usual case, we will pay the provider. If you paid the provider at time of treatment, indicate that on the claim form. We will then send the payment directly to you.
Will you need information from me in addition to what I put on the claim form?
In some situations, we may have to write you and request additional information. Please respond as soon as you receive a letter from us. Failure to respond to one of our letters results in the claim being suspended.
What other information would you need?
Sometimes we may need additional clarification on how an incident occurred or we may have to order a copy of your medical records from your Provider. This may take several weeks.
What if I have Insurance with another Company in addition to yours?
If your policy requires that we are secondary coverage to your other existing Insurance, we will consider payment of the expenses that your other insurance does not pay. You will need to send in your claim form with the Explanation Of Benefits (EOB) the other company sends you which will show what they have not covered, along with a copy of the ITEMIZED billings.
What is a “Deductible?”
On some plans you may have a deductible, which is the amount the Company subtracts from the eligible payment. This is what you pay directly to the medical provider.
What is “Co-Insurance”?
This is the percentage of covered expenses the Policy pays, after the deductible is satisfied. Usually it is a set percentage, often 80%, which means the Company pays 80% and you are responsible for 20%. Your co-insurance amount is designated on your Explanation of Benefits (EOB) as what you pay directly to your medical provider.
What is a “Co-Pay”?
Some plans have, in addition to a Deductible, a co-pay which is the amount the insured must pay to the physician or hospital for each procedure, office visit, or confinement each time the insured receives a covered service.
What is “Usual & Reasonable”?
Usual & Reasonable is how the Company determines if a charge by a Provider is the “usual” charge for your area. We access the Medical Data Research Table provided by Fair Health, Inc, to determine the normal fees and prices generally charged in the locality where the service is performed. The Policy will not cover the charge in excess of Usual & Reasonable.
My Plan has a PPO associated with it. What does that mean and how does the PPO discount work?
We contract with groups of medical providers who agree to charge the student a discounted fee if the student uses their services. They are called Preferred Provider Organizations (PPO) because they are first determined to be physicians or hospitals of excellent reputation and distinction, and second because they will treat you for a discounted fee. AMA & Associates, in return, agrees to pay the discounted fee of the PPO provider. This is very important, in that it means that if you go to a PPO provider, your benefits are greater than if you should go to a Non-PPO provider. If you do go to a Non-PPO provider, however, there are usually penalties in the plan, which may be either increased deductibles, decreased benefits, or both. Read your brochure carefully to find if your plan has a PPO plan and who the PPO is. PPO providers located near you can be looked up online (see the following question for web addresses). Make sure the provider is still a member of the PPO at the time of treatment as they may change their PPO contracts at times. AMA & Associates cannot be responsible for or accept liability for charges by a doctor who terminates his contract with a PPO.
Where do I find a list of medical Providers in my PPO?
If your plan requires you to be treated by a Preferred Provider Organization (PPO) to receive full benefits, the list of providers is now accessible on the Internet. Simply access the PPO service listed below which is used by your plan. The Student Health Insurance Brochure for your school will indicate which PPO to use. You may also call your Student Health Center, or you may call AMA & Associates for the name of your PPO. If your Brochure does not indicate a PPO plan for your school, you may use any licensed provider of your choice.
PPO Websites
• HealthEos (if you attend a school in Wisconsin)
• MultiPlan, then select PHCS (for students who attend a school in Wisconsin, but are in another state when treatment is needed, as well as students attending Maharishi University, but are in a state other than Iowa when treatment is needed)
• HealthEOS (Maharishi University, INSIDE IOWA)
• All schools not listed above will us MultiPlan, and select PHCS
Is a Pre-Certification required before I get treatment?
Your plan does not require pre-certification for treatment or hospital admission. You should, however, always consult your student health service to be sure the level of care you are receiving is appropriate.
What address do I mail my bills and /or claim forms to?
Mail your bills and claim forms to the address at the top of the claim form. To be certain you have the right claim form and the correct address, be sure to download the correct form for your school on this website. You may also e-mail your completed claim form and bills to customerservice@amaofsa.com.
Does my plan cover routine exams, vision exams, or dental treatment?
Unless specifically included as a benefit of your particular plan (see your Student Health Center), there is generally no coverage for routine health exams, vision exams or preventive medical treatment.
Does my plan cover immunizations?
Unless specifically included as a benefit of your particular plan (see your Student Health Center), there is generally no coverage for immunizations of any type.
I am travelling out of the country and will need travel immunizations, are they covered?
Unless specifically included as a benefit of your particular plan (see your Student Health Center), there is generally no coverage for immunizations of any type.
How do I file a claim for Prescription drug reimbursement?
If your plan includes the Catamaran RX Pharmacy Network, you need only to pay the correct co-pay for your drug at the time you fill your prescription at a participating Pharmacy. Please show your your identification care to receive benefits at a participating pharmacy. The pharmacy will inform you the amount of your co-pay for your specific drug. To locate a participating pharmacy, please call Catamaran RX Member Services at 800-207-2568, or access their website at www.mycatamaranrx.com.
AMA & Associates does not pay the Pharmacy or drug store directly for prescription drug expenses. If your plan does not utilize the Catamaran RX Pharmacy Network but does provide prescription drug benefits, you must first purchase the drugs, then file for reimbursement. When you have incurred covered prescription drug expenses, download the correct claim form for your school from this Website, print it, complete and sign it, and mail it to the address at the top of the claim form along with a copy of the receipt for your prescription drug purchase.

MOST COMMON FAQ’s

The following questions are common inquiries that we will need to respond to you with specific information from our claim files. Since our phone lines can often be busy during peak hours, feel free to send an email to us detailing your question exactly, and we will attempt to reply very shortly. For all written claim inquiries, always provide us with your name, school attending, return email address, and a complete detailed question. Our email address for all claim questions is customerservice@amaofsa.com.

Is my particular injury/illness covered?

Give complete details of the injury or illness including when the accident happened or when you first noticed the symptoms of the illness

What has been paid on my claim?

Have you received bills from my Provider?

What are the benefits/details of my plan? (provide us the school you attend, policy # from the brochure, your ID#)

Why did you not pay all of my claim? (list the Providers not paid in full)

Have you received my claim form?

How do I appeal a denied claim?

I do not understand your correspondence, please explain (Provide date of correspondence)

I do not understand your Explanation of Benefits.

Have you received my premium payment?

When does my coverage start/end?

OTHER COMMON FAQ’s

My ID Card has the wrong address, how do I get a replacement?

The address on the ID Card is used mainly so the Post Office can deliver it to you. It is not necessary for your Card to have your current address to get medical attention, therefore we do not replace ID Cards for an address change. However, if our office errors in the spelling of your address, a replacement card will be issued.

My name/address has changed.

Drop us an email at customerservice@amaofsa.com with your corrected name or address.

How do I add my newborn child to my policy?

A newborn child needs to be added to the coverage within 30 days of his/her birth. Send us an email with the newborn’s name, date of birth, address and the primary insured’s name.

What doctors and Hospitals can I use?

Unless your plan requires you to use a PPO provider, you can use any licensed physician or hospital. (See reference to PPO plans above)

Do you have a copy of my brochure/policy online or on the Website?

Yes, we do have the brochures for our plans available on this Website. Click on the claims tab, Download Forms, find your school, select a policy year, and download your brochure.

Can I enroll in my insurance plan online at your website?

Not currently.

Can my wife/parents/friends/roommate/relative call you and get information on my claim?

Because of Federal Privacy laws, we are not allowed to give private medical information to anyone other than the insured student. To be in compliance with this law, we will need the insured student to give us prior written and signed authorization specifically stating who we may provide medical information to other than himself. The form, Authorization for Disclosure of Protected Health Information, is on this website and may be e-mailed to customerservice@amaofsa.com or faxed to 210-822-4113.

Will I get a refund or reimbursement when I cancel my coverage?

A pro-rated premium refund will be made for the following situations only: if the Plan Administrator receives a written notice, including the date of occurrence that the insured student has entered into full-time active duty military service; or if the insured student withdraws from his/her academic activities at the school and returns permanently to his/her home country. A refund will not be issued if any claims have been filed. Otherwise, the coverage you purchase stays in force for the full time period chosen, no refunds.

When will I receive my ID Card?

During fall and spring enrollment periods we have hundreds of colleges enrolling, and data input may take a little longer than usual. You should receive a card in about two weeks. However, should you need medical attention before then, simply present your Student Insurance brochure to the Provider, who may call us for coverage verification.

When does my coverage go into effect?

If you mail or fax your application to us, your coverage will be effective on the day after postmark if mailed, or the day after you fax it to us.