2021-2022 PLAN SUMMARY - 4STUDENTHEALTH.COM

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2021-2022 PLAN SUMMARY - 4STUDENTHEALTH.COM
2021–2022 Plan Summary

UNIVERSITY OF REDLANDS
STUDENT HEALTH INSURANCE PLAN SHIP

                                                                Underwritten by:
                                                   Wellfleet Insurance Company

                                                               Administered by:
                                                            Wellfleet Group, LLC
                                                dba Wellfleet Administrators, LLC

                                                                Policy Number:
                                                               WI2122CASHIP98

                                                                 Group Number:
                                                                     ST1383SH

                                                               Revised 09/03/2021 8:14 AM
2021-2022 PLAN SUMMARY - 4STUDENTHEALTH.COM
Important Contact Information & Resources
        Plan Administration                                         PPO Network
                                                                    Cigna OAP
        Enrollment, Eligibility & Waivers                           www.mycigna.com
        Relation Insurance Services
        PO Box 240042
        Los Angeles, California 90024                               Pharmacy Benefits Manager
        (800) 537-1777                                              For information about the Wellfleet Rx/ESI
        clientservices@relationinsurance.com                        Prescription Drug Program, please
        Monday–Friday, 8:00 a.m. to 5:00 p.m.                       visit www.wellfleetstudent.com.
        Pacific Time
                                                                    Member Pharmacy Help
        Benefits, Claim Status, & ID Cards                          (877) 640-7940
        Wellfleet Group, LLC
        dba Wellfleet Administrators, LLC
        PO Box 15369                                                Travel Guard
        Springfield, Massachusetts 01115-5369                       Contact Travel Guard when you are traveling
        (877) 657-5030, TTY 711                                     away from home and you need assistance with
        www.wellfleetstudent.com                                    things such as transfer of medical records, legal
        Monday–Thursday, 8:30 a.m. to 7:00 p.m.                     referrals, transfer of funds, and information on
        Eastern Time                                                travel conditions.
        Friday, 8:30 a.m. to 5:00 p.m.                              Travel Guard
        Eastern Time                                                www.travelguard.com
                                                                    (877) 305-1966 (in the U.S. & Canada)
        Claims                                                      Call collect +1 (715) 295-9311 (outside U.S. &
                                                                    Canada)
        Cigna
                                                                    Available 24/7/365
        PO Box 188061
        Chattanooga, Tennessee 37422-8061
        Electronic Payor ID: 62308                                  CareConnect
                                                                    Behavioral Health and Nurseline access
                                                                    offering student members easy access
                                                                    to licensed behavioral health clinicians
                                                                    24/7/365 via telephone.
                                                                    CareConnect
                                                                    (888) 857-5462

 Notice
 This is only a brief description of the coverage(s) available under Certificate form CA SHIP Cert (2019). The
 Certificate will contain reductions, limitations, exclusions, and termination provisions. Full details of coverage
 are contained in the Certificate. If there are any conflicts between this document and the Certificate, the
 Certificate shall govern in all cases.
 Any provisions of the Policy, as described in this Summary, that may be in conflict with the laws of the state
 where the school is located will be administered to conform with the requirements of that state’s laws,
 including those relating to mandated benefits.
 The information contained in this Summary is accurate at the time of publication, but may change in
 accordance with state and federal insurance regulations during the course of the Policy year. The most
 current version of this document will be posted online at the website listed on the cover. In the case of a
 discrepancy between two versions of the Summary, the most recent will apply.
2021-2022 PLAN SUMMARY - 4STUDENTHEALTH.COM
What’s Inside
General Information
   Eligibility & Enrollment ....................................................5
   Effective Dates & Plan Costs .........................................5
   ID Card ................................................................................5

Seeking Medical Care
   Prescriptions / Medications ...........................................6
   Preferred Provider Organization ..................................6

Filing a Claim ........................................................................ 7

Plan Benefits
   Benefit Highlights .............................................................8
   AD&D Benefit .................................................................. 10

Exclusions & Limitations .................................................. 11

Travel Guard ....................................................................... 14

CareConnect....................................................................... 15
2021-2022 PLAN SUMMARY - 4STUDENTHEALTH.COM
/ 4 /   2021–2022 Plan Summary / University of Redlands
2021-2022 PLAN SUMMARY - 4STUDENTHEALTH.COM
General Information
Eligibility & Enrollment                                       Effective Dates & Plan Costs
Any full-time student (9 credit hours or more) who is          The plan costs and coverage terms are listed below.
registered and attending classes at the University of          Coverage terms are effective at 12:00 a.m. and terminate
Redlands is required to have adequate health insurance         at 11:59 p.m. Plan Costs include the medical insurance
coverage. You will be automatically enrolled in SHIP,          premium and administrative fees.
unless you provide comparable coverage and submit a
waiver by the Waiver Deadline Date (see Waiver FAQ,                                     WAIVER
located at www.4studenthealth.com/redlands for more                                    DEADLINE          STUDENT
information). If you have other health insurance, such as                                DATE
coverage under your parent’s or employer’s insurance           Annual
plan, and you do not wish to enroll in SHIP, you may           08/10/2021 to           09/20/2021       $ 1,713.00
submit a waiver application.                                   08/09/2022
Students must actively attend classes for at least the first   Fall
31 days after the date for which coverage is purchased.        08/10/2021 to           09/20/2021           N/A
Home study, correspondence, and television (TV)                12/31/2021
courses do not fulfill the Eligibility requirements that the   Spring / Summer
student actively attend classes. The Company maintains         01/01/2022 to           01/17/2022           N/A
its right to investigate student status and attendance         08/09/2022
records to verify that the Policy Eligibility requirements
have been met. If and whenever the Company discovers
that the Policy Eligibility requirements have not been
met, its only obligation is refund of premium.                 ID Card
Coverage for dependents is not available under this plan.      You will receive an email when your insurance
                                                               ID card is available. To access your ID Card, visit
For questions about enrollment, contact Relation
                                                               www.wellfleetstudent.com.
Insurance Services at (800) 537-1777 (Monday–Friday,
8:00 a.m. to 5:00 p.m. Pacific Time).                          Carry your ID card with you at all times! You will need
                                                               your card when you visit the physician’s office, urgent
                                                               care centers, or hospital.

2021–2022 Plan Summary / University of Redlands                                                                      / 5 /
2021-2022 PLAN SUMMARY - 4STUDENTHEALTH.COM
Seeking Medical Care
If you experience an Injury or Sickness:                    Preferred Provider Organization
1. If you need to seek medical treatment, using PPO
                                                            This plan includes a network of medical professionals,
   providers that are part of the Cigna OAP Network
                                                            including doctors and hospitals, known as the Preferred
   could decrease your costs. For a complete listing of
                                                            Provider Organization (PPO). This PPO is available
   PPO physicians, hospitals, and other facilities, visit
                                                            through Cigna OAP Network. If you need to see a
   www.mycigna.com.
                                                            provider, you should utilize a PPO provider. While you
2. In case of an Emergency, go to the nearest hospital      are allowed to visit any provider of your choosing, if you
   or call 911.                                             use a PPO doctor or facility, you will pay less money
3. If it is not an Emergency but you need to seek medical   out-of-pocket.
   treatment right away, using an Urgent Care Center        Network access provides benefits nationwide for
   instead of a Hospital ER may decrease your out-          Eligible Expenses incurred at 80% of the Negotiated
   of-pocket expenses. To locate a local Urgent Care        Charge (NC) when treated by network providers
   Center, visit www.mycigna.com.                           (PPO). Benefits are provided worldwide for Eligible
4. After you receive treatment at a PPO provider,           Expenses incurred at 60% of Usual & Customary
   you will receive an Explanation of Benefits from         Charge (U&C) when treated by non-network providers
   Welfleet Group, LLC detailing what the insurance         (non-PPO). Note: Charges in excess of U&C are still
   paid and what is your responsibility to pay. If you      the responsibility of the Plan Participant.
   have questions about your Explanation of Benefits        Preferred Providers have contracted to provide specific
   or what is your responsibility to pay, please call       medical care at negotiated prices. The availability of
   (877) 657-5030, TTY 711. Do not ignore any medical       specific providers is subject to change without notice.
   bills you receive.                                       The Plan Participant should always confirm that a
5. If your provider bills you directly or asks you to pay   Preferred Provider is participating at the time services
   up front, you will need to submit a claim. Please See    are required by checking the Preferred Provider Network
   Filing a Claim on the next page.                         website or calling the Preferred Provider Network
                                                            and by asking the provider when he or she makes an
                                                            appointment for services. Out-of-network providers
Prescriptions / Medications                                 have not agreed to any prearranged fee schedules.
                                                            You may incur significant out-of-pocket expenses with
The Pharmacy Benefits Manager (PBM) is Wellfleet            these providers. Charges in excess of the insurance
Rx / ESI. See the Schedule of Benefits for the copays       payment are your responsibility.
you will be responsible for at an IN-NETWORK pharmacy.
If you visit an OUT-OF-NETWORK pharmacy, you must           Please be aware that if you are treated at a PPO
pay for the prescription in full and then submit a claim    Hospital, it does not mean that all providers at that
for reimbursement.                                          Hospital are PPO providers. If you are referred by a
                                                            PPO provider to another provider or facility, it does
Please visit www.wellfleetstudent.com.                      not necessarily mean that the provider or facility to
                                                            which you are referred is also a PPO provider. For
Member Pharmacy Help
                                                            example, when a network provider refers you to a lab
(877) 640-7940                                              for tests, be sure it is a network lab. This information
                                                            can be found on the network website.

/ 6 /                                                                          2021–2022 Plan Summary / University of Redlands
Filing a Claim
In the event of either an Injury or a Sickness:
1. Report to a Physician, Hospital or the School’s Student Health Services.
2. Written notice of a claim must be submitted to the address below within ninety (90) days after the date of Injury or
   commencement of Sickness covered by the Policy, or as soon thereafter as is reasonably possible.
3. Send all medical and hospital bills, along with the patient’s name and insured student’s name, address, Social
   Security number or student ID number and name of the University under which the student is insured, to the address
   below. A Company claim form is not required for filing a claim.

                        Cigna                                              For Non-Cigna PPO Providers:
                   PO Box 188061                                                Wellfleet Group, LLC
        Chattanooga, Tennessee 37422-8061                                dba Wellfleet Administrators, LLC
             Electronic Payor ID: 62308                                             PO Box 15369
                                                                       Springfield, Massachusetts 01115-5369
                                                                             (877) 657-5030, TTY 711
                                                                            www.wellfleetstudent.com

Bills should be received by the Company within ninety (90) days of service. Keep copies of all the documents you
submit. To check the status of a claim you submitted, call (877) 657-5030, TTY 711 or visit www.wellfleetstudent.com.
Plan Benefits
Benefit Highlights
Actuarial Value: 85.31%
Metal Tier: Gold

Coinsurance is the cost sharing between what the insurance pays and what you pay. This insurance plan pays 80%
of the Negotiated Charge (NC) when using Cigna PPO providers and 60% of Usual & Customary (U&C) Charge when
using out-of-network providers. Unless otherwise specified below the Medical Deductible will always apply.

                                                      INNETWORK                       OUT-OF-NETWORK
                                                        PROVIDER                          PROVIDER
 Preventive Services
 In-Network Provider: The Deductible,
 Coinsurance, and any Copay are not
 applicable to Preventive Services.
                                                       100% of NC                           60% of U&C
 Out-of-Network Provider: The Deductible,
 Coinsurance, and any Copay are applicable
 to Preventive Services provided through a
 Non-Network Provider.
 Medical Deductible
 The Covered Person is responsible for paying
 the deductible amount listed before the                            $250 per Policy Year
 company will begin paying benefits, except
 as indicated below.
 Out-of-Pocket Maximum                            $6,350 per Policy Year                   No maximum
                                                       80% of the                  60% of Usual & Customary
 Coinsurance Amounts
                                                 Negotiated Charge (NC)                 (U&C) Charge

                                                      INNETWORK                       OUT-OF-NETWORK
 INPATIENT BENEFITS
                                                        PROVIDER                          PROVIDER
 Hospital Care
 Includes hospital room & board expenses
 and miscellaneous services and supplies.
 Subject to Semi-Private room rate unless               80% of NC                           60% of U&C
 intensive care unit is required. Room
 and Board includes intensive care. Pre-
 Certification Required.
 Physician Visits while Confined                        80% of NC                           60% of U&C
 Inpatient Surgery
 Surgeon Services, Anesthetist, and Assistant           80% of NC                           60% of U&C
 Surgeon. Pre-Certification required.

                                                                                                           CONTINUED

/ 8 /                                                                       2021–2022 Plan Summary / University of Redlands
Plan Benefits (continued)

                                                             INNETWORK                     OUT-OF-NETWORK
 OUTPATIENT BENEFITS
                                                               PROVIDER                        PROVIDER
 Outpatient Surgery
 Surgeon Services, Anesthetist, and Assistant
 Surgeon. Facility and Miscellaneous
 expenses for services & supplies, such as                     80% of NC                        60% of U&C
 cost of operating room, therapeutic services,
 oxygen, oxygen tent, and blood & plasma.
 Pre-Certification required.
                                                           $20 copay per visit
 Physician Office Visits                                                                          60% of U&C
                                                     then the plan pays 100% of NC
                                                           $20 copay per visit
 Specialist / Consultant Physician Services                                                     60% of U&C
                                                     then the plan pays 100% of NC
 Rehabilitative Therapy                                         80% of NC
 Including, Physical Therapy, and                    Pre-Certification Required after
                                                                                                60% of U&C
 Occupational Therapy, and Speech Therapy.           the 5th visit for Physical and/or
 Pre-Certification Required.                             Occupational Therapy
Emergency Services in an Emergency                         $50 copay per visit
                                                                                         Paid the same as In-Network
Department (includes Urgent Care for                   (copay waived if admitted)
                                                                                           Provider; subject to U&C
Emergency Medical Conditions)                        then the plan pays 100% of NC
Urgent Care Centers for
                                                               80% of NC                        60% of U&C
Non-Life-Threatening Conditions
 Diagnostic Imaging Services
                                                               80% of NC                        60% of U&C
 Pre-Certification required.
 Mental Health Disorder &
 Substance Use Disorder
 For the Treatment of Mental Health Disorders,
 including Gender Dysphoria and Behavioral
 Health Treatment for Pervasive Developmental
 Disorder or Autism and Substance Use
 Disorders.
 Outpatient Services other than Office Visits
 Outpatient services includes, but not limited
 to, Intensive Outpatient Programs; Partial
 Hospitalization, Electronic Convulsive Therapy,
 Repetitive Transcranial Magnetic Stimulation                  80% of NC                        60% of U&C
 (rTMS); Psychiatric and Neuro Psychiatric
 testing; and *Gender Dysphoria surgery.
 * Pre-Certification Required.
 In accordance with the federal Mental Health
 Parity and Addiction Equity Act of 2008
 (MHPAEA), the cost sharing requirements, day or
 visit limits, and any Pre-Certification
 requirements that apply to a Mental Health
 Disorder and Substance Use Disorder will be no
 more restrictive than those that apply to medical
 and surgical benefits for any other Covered
 Sickness.
 Outpatient Office Visits
 Including but not limited to physician visits,
                                                               80% of NC                        60% of U&C
 individual and group therapy, hormone
 therapy, medication management.

                                                                                                           CONTINUED

2021–2022 Plan Summary / University of Redlands                                                                        / 9 /
Plan Benefits (continued)

                                                                                                 INNETWORK                                           OUT-OF-NETWORK
 OTHER BENEFITS
                                                                                                   PROVIDER                                              PROVIDER
 Emergency Ambulance Service Ground                                                                                                            Paid the same as In-Network
                                                                                                    80% of NC
 and / or Air, Water Transportation                                                                                                              Provider; subject to U&C
 Non-Emergency Ambulance Service Ground
                                                                                                    80% of NC                                                60% of U&C
 and / or Air, Water Transportation
 Maternity Benefit                                                                                         Same as any other Covered Sickness
 Pediatric Dental Care Benefit
 To the end of the month in which the Insured
                                                                                                         100% of U&C for Preventive Services
 Person turns age 19. Refer to the Certificate for
                                                                                                        50% of U&C for non-Preventive Services
 a complete list of covered services, including
 applicable exclusions and limitations.
 Pediatric Vision Care Benefit
 To the end of the month in which the Insured
 Person turns age 19. Refer to the Certificate                                                                100% of U&C (deductible waived)
 for a complete list of covered services, includ-
 ing applicable exclusions and limitations.
 Accidental Injury Dental Treatment
                                                                                                    80% of NC                                                80% of U&C
 For Insured Persons over the Age of 18.
 Medical Evacuation Expense                                                                           100% of Actual Charge (deductible waived)

 Repatriation Expense                                                                                 100% of Actual Charge (deductible waived)

                                                                                                 INNETWORK                                           OUTOFNETWORK
 PRESCRIPTION DRUGS
                                                                                                   PROVIDER                                              PROVIDER
                                                                                                                      $20 copay Generic
 Prescription Drugs Retail Pharmacy                                                     $20 copay Generic         $50 copay Preferred Brand
 For each fill up to a 30-day supply filled at a                                    $50 copay Preferred Brand   $75 copay Non-Preferred Brand
 Retail pharmacy. Deductible waived. Copay                                        $75 copay Non-Preferred Brand      $75 copay Specialty
 will be incrementally increased for each                                              $75 copay Specialty             then the plan pays
 additional 30-day supply.                                                              (deductible waived)         60% of Actual Charges*
                                                                                                                      (deductible waived)

Pre-Certification required for Inpatient Services Care, selected Outpatient Services, and Outpatient Surgery. For a
complete list of these services, see the Plan Certificate.
* You must pay for prescriptions in full, then submit a claim for reimbursement.

Accidental Death and Dismemberment (AD&D) Benefit
Principal Sum ............................................................................................................................................................................... $10,000

Loss must occur with 365 days of the date of a covered Accident.
Only one benefit will be payable under this provision, that providing the largest benefit, when more than one loss
occurs as the result of any one (1) Accident. This benefit is payable in addition to any other benefits payable under
the Certificate.

/ 10 /                                                                                                                                 2021–2022 Plan Summary / University of Redlands
Exclusions & Limitations
Exclusion Disclaimer: Any exclusion in conflict with the Patient Protection and Affordable Care Act or any state imposed
requirements will be administered to comply with the requirements of the federal or state guideline, whichever is more
favorable to You. The Certificate does not cover loss nor provide benefits for any of the following, except as otherwise
provided by the benefits of the Certificate and as shown in the Schedule of Benefits.

1.   International Students Only. Eligible expenses                  •   Ovulation predictor kits;
     within Your Home Country or country of origin                   •   Reversal of tubal ligations;
     that would be payable or medical Treatment that
     is available under any governmental or national                 •   Reversal of vasectomies;
     health plan for which You could be eligible.                    •   Costs for and relating to surrogate
2. Treatment, service or supply which is not                             motherhood (maternity services are Covered
   Medically Necessary for the diagnosis, care or                        for Members acting as surrogate mothers);
   treatment of the Sickness or Injury involved.                     •   Cloning; or
   This applies even if they are prescribed,
                                                                     •   Medical and surgical procedures that are
   recommended by Your attending Physician or
                                                                         experimental or investigational, unless Our
   dentist.
                                                                         denial is overturned by an External Appeal
3.   Medical services rendered by a provider                             Agent.
     employed for or contracted with the Policyholder,
                                                                7.   Expenses paid by Workers’ Compensation,
     including team physicians or trainers, except as
                                                                     occupational benefits plan, mandatory
     specifically provided in the Schedule of Benefits.
                                                                     automobile no-fault plan, public assistance
4.   Professional services rendered by an Immediate                  program or government plan, except Medi-Cal.
     Family Member or anyone who lives with You.
                                                                8. Charges of an institution, health service or
5. Routine foot care, including the paring or                      infirmary for whose services payment is not
   removing of corns and calluses, or trimming of                  required in the absence of insurance or services
   nails, unless these services are determined to be               covered by Student Health Fees.
   Medically Necessary because of Injury, infection
                                                                9.   Any expenses in excess of Usual and Customary
   or disease.
                                                                     Charges except as provided in the Certificate.
6. Infertility treatment (male or female)-this includes
                                                                10. Treatment, services, supplies or facilities in a
   but is not limited to:
                                                                    Hospital owned or operated by the Veterans
     •    Procreative counseling;                                   Administration or a national government or any
     •    Premarital examinations;                                  of its agencies, except when a charge is made
                                                                    which You are required to pay.
     •    Genetic counseling and genetic testing;
                                                                11. Services that are duplicated when provided by
     •    Impotence, organic or otherwise;                          both a certified Nurse-midwife and a Physician.
     •    Injectable infertility medication, including but      12. Expenses payable under any prior policy which
          not limited to menotropins, hCG and GnRH                  was in force for the person making the claim.
          agonists;
                                                                13. Expenses incurred after:
     •    In vitro fertilization, gamete intrafallopian
          tube transfers or zygote intrafallopian tube               •   The date insurance terminates as to an
          transfers;                                                     Insured Person, except as specified in the
                                                                         extension of benefits provision; and
     •    Costs for an ovum donor or donor sperm;
                                                                     •   The end of the Policy Year specified in the
     •    Sperm storage costs;                                           Policy.
     •    Cryopreservation and storage of embryos;              14. Elective Surgery or Elective Treatment unless
     •    Ovulation induction and monitoring;                       such coverage is otherwise specifically covered
     •    Artificial insemination;                                  under the Certificate.

     •    Hysteroscopy;
     •    Laparoscopy;
     •    Laparotomy;
                                                                                                           CONTINUED

2021–2022 Plan Summary / University of Redlands                                                                       / 11 /
Exclusions & Limitations (continued)
15. Weight management. Weight reduction. Nutrition          31. Routine harvesting and storage of stem cells
    programs. This does not apply to nutritional                from newborn cord blood, the purchase price
    counseling or any screening or assessment                   of any organ or tissue, donor services if the
    specifically provided under the Preventive                  recipient is not an Insured Person under this plan.
    Services benefit, or otherwise specifically             32. Sleep Disorders, unless medically necessary,
    covered under the Certificate.                              except for the diagnosis and treatment of
16. Treatment for obesity except surgery for morbid             obstructive sleep apnea..
    obesity (bariatric surgery). Surgery for removal of     33. Treatment of Acne unless Medically Necessary.
    excess skin or fat.
                                                            34. Experimental or Investigational drugs, devices,
17. Charges for hair growth or removal unless                   treatments or procedures unless otherwise
    otherwise specifically covered under the                    covered under Covered Clinical Trials or covered
    Certificate.                                                under clinical trials (routine patient costs). See
18. Expenses for radial keratotomy.                             the Other Benefits section for more information.
19. Adult Vision unless specifically provided in the        35. Under the Prescription Drug Benefit shown in the
    Certificate.                                                Schedule of Benefits:
20. Charges for office visit exam for the fitting of              •   any drug or medicine which does not, by
    prescription contact lenses, duplicate spare                    federal or state law, require a prescription
    eyeglasses, lenses or frames, non-prescription                  order, i.e. over-the- counter drugs, even if a
    lenses or contact lenses that are for cosmetic                  prescription is written, except as specifically
    purposes.                                                       provided under Preventive Services or in
21. Charges for hearing screening, hearing aids and                 the Prescription Drug Benefit section of
    the fitting or repair or replacement of hearing                 the Certificate. Insulin and OTC preventive
    aids or cochlear implants except as specifically                medications required under ACA are exempt
    provided in the Certificate.                                    from this exclusion;

22. Surgery or related services for cosmetic                    •   drugs with over-the-counter equivalents
    purposes to improve appearance, except to                       except as specifically provided under
    restore bodily function or correct deformity                    Preventive Services;
    resulting from disease, or trauma, or for gender            •   allergy sera and extracts administered via
    dysphoria.                                                      injection;
23. Treatment to the teeth, including orthodontic               •   any drug or medicine for the purpose of
    braces and orthodontic appliances, unless                       weight control;
    otherwise covered under the Pediatric Dental                •   sexual enhancements drugs;
    Care Benefit.
                                                                •   vitamins, and minerals, except as specifically
24. Extraction of impacted wisdom teeth or dental                   provided under Preventive Services;
    abscesses.
                                                                •   food supplements, dietary supplements;
25. You are:                                                        except as specifically provided in the
         •   committing or attempting to commit a felony,           Certificate;
         •   engaged in an illegal occupation, or               •   cosmetic drugs or medicines, including
         •   participating in a riot.                               but not limited to, products that improve
26. Custodial Care service and supplies.                            the appearance of wrinkles or other skin
27. Charges for hot or cold packs for personal use.                 blemishes;

28. Braces and appliances used as protective                    •   refills in excess of the number specified
    devices during a student’s participation in sports.             or dispensed after 1 year of date of the
    Replacement braces and appliances are not                       prescription;
    covered.                                                    •   drugs labeled, “Caution – limited by federal
29. Services of private duty Nurse except as                        law to Investigational use” or Experimental
    provided in the Certificate.                                    Drugs;

30. Expenses that are not recommended and                       •   any drug or medicine purchased after
    approved by a Physician.                                        coverage under the Certificate terminates;
                                                                                                             CONTINUED

/ 12 /                                                                        2021–2022 Plan Summary / University of Redlands
Exclusions & Limitations (continued)
     •    any drug or medicine consumed or               38. Modifications made to dwellings.
          administered at the place where it is          39. General fitness, exercise programs.
          dispensed;
                                                         40. Hypnosis.
     •    if the FDA determines that the drug is:
          contraindicated for the Treatment of the       41. Rolfing.
          condition for which the drug was prescribed;   42. Biofeedback.
          or Experimental for any reason;
36. Non-chemical addictions.
37. Non-physical, occupational, speech therapies
    (art, dance, etc.).

                                                                                                   CONTINUED

2021–2022 Plan Summary / University of Redlands                                                           / 13 /
The following are not affiliated with Wellfleet Insurance Company and the services are not part of the Plan Underwritten
by Wellfleet Insurance Company. These value added options are offered by Relation Insurance Services.

Travel Guard
Travel Guard is travel insurance solutions and travel-related services, including assistance and security services.
Services are provided through a network of wholly owned service centers located in Asia, Europe and the Americas.
For additional information, please visit www.travelguard.com.
Wherever your travels may take you, in the event of a medical emergency or unexpected travel problem, Travel Guard
is never more than a phone call away. Our state-of-the-art service centers deliver global service 24 hours a day, 7
days a week, 365 days a year.

General Assistance                                              Medical Assistance
Flight delays, inclement weather, lost or stolen luggage        From Doctor referrals to coordinating medical
and other travel hassles are an unfortunate reality of          evacuations, we help traveling students address their
travel today. We keep traveling students on the move            medical needs with expediency and expert care:
with a variety of travel assistance services:                       •   Coordinate medical evacuation arrangements
     •   Lost or stolen documents assistance                        •   Physician/hospital/dental/vision care referral
     •   Embassy and consulate information and referrals                details, when medical attention is required
     •   Lost baggage search and luggage replacement                    including assistance with appointments
         assistance                                                 •   Coordination of repatriation arrangements for
     •   Emergency language interpretation and                          the return of mortal remains in accordance with
         translation services                                           local governmental procedures
     •   Emergency return travel arrangements                       •   Assistance with emergency prescription
                                                                        replacement while abroad
     •   Flight and hotel re-bookings
                                                                    •   Dispatch of doctor or specialist
     •   Immunization, visa and passport information
                                                                    •   In-patient and out-patient medical case
     •   Guaranteed hotel check-in                                      management
     •   Travel delay reports                                       •   Arrangements of visitor to bedside of hospitalized
     •   Emergency cash transfer assistance                             insured
     •   Legal referrals/bail bond assistance                       •   Eyeglasses and corrective lens replacement
     •   Foreign exchange, ATM and weather information                  assistance
     •   Worldwide public holiday information
     •   Urgent message relay to family, friends or
         university associates

Concierge Services
Whether it is finding local restaurants or concert tickets, our Concierge Desk is a direct line to a team of professional
and personal assistants available to help your travels be more effective:

     •   Referrals for counselling services                         •   Concert and event ticketing
     •   Restaurant or local activity assistance                    •   Electronic and wireless device assistance
     •   Recommendations for spring break                           •   Movie and theatre information and ticketing
     •   Moving coordination assistance                             •   Assistance with locating low fuel prices
     •   Locate laundry facilities, post offices or bus             •   Assistance with finding places to purchase room
         schedules                                                      supplies
     •   Recommend local car maintenance assistance                 •   Locating retail stores (including shopping, coffee
                                                                        shops with free wireless internet access)

                                                                                                                  CONTINUED

/ 14 /                                                                             2021–2022 Plan Summary / University of Redlands
Travel Guard (continued)

Website & Mobile App                                              How to Access Services
You can access our secure website, an online resource             If you require medical assistance or you need assistance
to stay a step ahead with the latest travel, security and         with a non-medical situation, such as lost luggage, lost
health information. Whether it’s prior to travel, during          documents or other travel issues, follow these steps:
the trip, or after the return home, our members-only                 •   Inside the U.S. and Canada:
assistance website provides student travelers access                     Dial toll-free (877) 305-1966
to in-depth travel, health and security information. You
can connect to the Travel Guard’s website from your                  •   Outside the U.S. and Canada:
computer, smartphone or tablet 24/7/365. Please visit                a) Request an international operator.
www.travelguard.com for more information about the
                                                                     b) Request the operator to place a collect call to
website and mobile app.
                                                                        the U.S. at +1 (715) 295-9311.
    •   Email alerts contain security developments,
        such as terror attacks, major strikes, disasters          Please provide the following information when you call:
        or disruptions and government warnings that                  •   Policy number or school name
        may affect your travel destination(s) and specific
        travel dates.                                                •   Nature of your call and/or emergency

    •   Country reports provide key information on                   •   Current location
        political conditions, security issues, travel logistics      •   Contact phone number and email address
        and cultural considerations.                                 •   Secondary point of contact
    •   The Travel Health section educates travelers                 •   Date of birth
        on health-related concerns, precautions and
        requirements for destinations and ability to create
        personal travel health profiles.
    •   The Medical Translations tool translates medical
        terms and phrases into multiple languages.
    •   The Drug Brand Equivalency tool generates
        drug brand names and their equivalent names
        in multiple countries.
    •   Security Awareness Training provides online
        travel safety videos and knowledge tests provide
        basic tools and information to be an aware,
        organized and prepared traveler.

CareConnect
24/7 Behavioral Telehealth and Nurseline Access
CareConnect is an integrated behavioral health program offering students easy access to licensed behavioral health
clinicians 24/7/365 via telephone.
Connect to a registered nurse within seconds, helping students manage their health on their terms through easy access.

Behavioral Health Care
Claims are handled as an in-network visit to ensure students face no disruption with their mental health and substance
abuse care using a wide-open Mental Health network.

$0 Prenatal Vitamin Program
Student members have access to select prenatal vitamins at no cost during pregnancy. Call (888) 857-5462 for
additional information.

2021–2022 Plan Summary / University of Redlands                                                                       / 15 /
Servicing Agent:
Relation Insurance Services
CA License No. 0G55426

Plan Administered by:
Wellfleet Group, LLC
dba Wellfleet Administrators, LLC
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