Changes for CSULB International Student Health Insurance fees for - DOC by ColeBer

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									      Example of How the CSU International Student Health Insurance Plan Works
To illustrate how the insurance works for a CSULB student who falls ill, we can look at the following example. Carlos
is a 25-year-old student from Colombia who purchases the approved CSU International Student Health Insurance plan
for the full academic year ($759). He wakes up one Saturday morning in September and feels very ill. He goes to an
in-network doctor who refers him to a medical lab for some blood tests and chest x-rays. After getting the tests, he
returns to the doctor who determines that Carlos has a serious lung infection, prescribes medication and tells Carlos to
return in 2 weeks. Carlos goes to Student Health Services on campus to fill the prescription (because he knows that the
insurance covers the cost of drugs from SHS at a higher rate than at the local RiteAid). The total charge for all
doctor’s office visits, blood tests, x-rays and prescription drugs is $2,500. The doctor’s office and lab will each send a
bill to the insurance company (Carlos will need to pay SHS for his prescription and send the bill to the insurance
company for reimbursement). The insurance company processes the claims and pays the doctor, the lab and
reimburses Carlos. The breakdown of payment responsibility is as follows:

Total Charge for 3 Doctor Visits                                                  $300
Total Charge for Lab Tests                                                      $2,000
Total Charge for Prescription Drugs                                               $200
Carlos Pays                                    $10 copay for each
                                               doctor visit                  $30
                                               $100 deductible              $100
                                               10% of tests                 $200
                                               10% of prescription
                                               drugs                         $20
        Total that Carlos Pays Doctor as a
        result of lung infection                                            $350
Total that Insurance Pays                                                      $2,150

Because Carlos has paid the $10 copay at each doctor’s office visit, he will not receive any additional bill from the
doctor. Carlos will receive a bill from the Lab for $300 ($100 deductible + 10% of $2000).

In March, Carlos gets a bad sore throat and an ear infection and goes back to the same doctor twice, who again refers
him to the lab for blood tests, and then prescribes medication (which Carlos buys from SHS). The breakdown of
payment responsibility is as follows:

Total Charge for both Doctor Visits                                                $200
Total Charge for Lab Tests                                                         $320
Total Charge for Prescription Drugs                                                $100
Carlos Pays                                    $10 copay for each
                                               doctor visit                  $20

                                               10% of tests                  $32
                                               10% of prescription
                                               drugs                         $10
        Total that Carlos Pays Doctor as a
        result of the sore throat/ear
        infection                                                            $62
Insurance Pays Doctor                                                              $558

Again, the doctor’s office does not send Carlos an additional bill because he paid the $10 copay at each visit.
Carlos already paid the $100 deductible for the year as a result of the lung infection, so the only additional
amounts he will pay will be the $32 to the lab and he will be reimbursed for all but $10 for his prescription
drugs.


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                                                                                                                        April 2005

								
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