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1- Aetna coverage guidelines: When you have a confirmed scholarship through SACM, you have insurance coverage by Aetna International anywhere in the world.
If your scholarship is postponed your health care coverage will be terminated. Your health care coverage will be terminated a month after your scholarship end date.
2- University Waiver form-Mandatory completion required: Once you arrive at your college or university, proceed to the International Admission Office and obtain an Insurance Waiver Form. If you don’t, the university will require you to purchase insurance coverage through the university and you will be responsible for the costs. Neither SACM nor Aetna will reimburse you. 3- Welcome Email from Aetna-New Students: After SACM sends your information to Aetna, you will receive a welcome e-mail from Aetna. You must register and upload your photo online through the link provided for yourself and your dependents older than 5 years old at www.aetnainternational.com. You must complete this step in order to receive your insurance card(s). You and your eligible dependents will have the same Aetna ID number. 4- Mandatory changes to name and date of birth: You must update (In Arabic and English) any change in the spelling of your name, your date of birth in the SACM Database, and inform the SACM Medical Department by e-mail to firstname.lastname@example.org. SACM instructed Aetna to forward all address and name changes requests to them directly. Change of address: First, you must contact customer service 1-866-236-1038 and Second, you need to make the change at Mohe Student portal. 5- Contacting Aetna member services: When calling Aetna Member Services you will need to provide them your last name and first name if you don’t have your Aetna ID card with an ID number. Use the exact spelling of your name and your Date of Birth (mm/dd/yy) as shown on your passport. 6- SACM enrollment process: If your right information is not in the Aetna system, you must inform the SACM medical Department at email@example.com . Your enrollment information needs to be sent to Aetna. Aetna must receive a request from SACM to enroll you and your dependents before you will receive an Aetna ID card.
Enrolment of newborns and dependents: Newborns are under health insurance coverage of the mother for the first 31days,during which an email is sent to SACM medical Department at firstname.lastname@example.org , requesting enrolment of the newborn. Same procedure is followed when adding dependents, SACM medical Department needs to be informed.
7- Aetna network providers: You are responsible to ensure the provider you use is in the Aetna PPO network. You can find a provider or facilities by logging on to DocFind on the Aetna website. You can also review all your claims processed at Aetna Navigator at www.aetna.com.
When you contact the providers, you must ask them if they are in the Aetna PPO network. Using a provider not in the Aetna PPO network will cost you more money out of your pocket. Many providers will accept Aetna insurance; however, this does not guarantee that they are in the Aetna network.
8- Pre Determination of care: To be certain all services you are seeking are covered, it is advised that you or your provider contact Aetna Member Services to obtain pre-authorization (determination) prior to the treatment. Meeting medical necessity is required for all services and procedures and standard Aetna guidelines apply. 9- Care outside the US: If you leave the U.S. you are covered by Aetna insurance, however, you must pay for all treatment out of pocket unless you set up a direct pay reimbursement in advance with the facility. Upon returning from vacation you must submit a claim form, receipts, and detailed reports from the doctor to Aetna for reimbursement. Check your claim status by calling Aetna Member Service or logging onto Aetna Navigator through the Aetna website. Claim denials: If your claim is denied by Aetna and you do not agree with Aetna decision, you have the right to appeal in writing within 180
calendar days from the date of denial. Claim appeals should be sent to: Aetna International /Attention: Appeals/P.O. Box 981543, El Paso, TX 79998-3836, Fax: (800) 475-8751 (inside the US),(813) 775-0625 (outside the US).
10- You have the ability to call and speak with one of our Informed Health Line nurses at any time by dialing 1-800-556-1555. The nurses can: Answer your questions about all health concerns. Provide current educational information regarding a wide-range of health issues. Discuss options for seeking medical attention.
Stay connected to SACM Aetna International Health Plan, http://www.facebook.com/SACMAetnaInternationalHealthPlan