Health Care Coverage for International Students
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Health Care
Coverage for
International
Students
prepare
protect
April 2013
Medical Benefits Option 1A Option 2A Option 3
Period of Coverage Maximum
$50,000 $1,000,000 $1,000,000
Benefits
Maximum Benefit per Injury or
$50,000 $150,000 $100,000
Sicknesses
$5,000 $2,500 $2,500
Period of Coverage Out-of-Pocket Copayments and amounts above Copayments and amounts above Copayments and amounts above
Limit the maximums do not apply toward the maximums do not apply toward the maximums do not apply toward
the Out-of-Pocket Limit. the Out-of-Pocket Limit. the Out-of-Pocket Limit.
In PPO Outside PPO Limits
Physician Office Visits
OPTION 1A 80% after $100 Copayment
OPTION 2A 100% after $20 Copayment
OPTION 3 100% after $20 Copayment
60% 75%, 75%
Inpatient Hospital Services
OPTION 1A 80% after $250 Copayment
OPTION 2A 100% after $50 Copayment
OPTION 3 100% after $50 Copayment
2
Medical Benefits Limitations Option 1A Option 2A Option 3
Inpatient treatment of mental and $10,000 $10,000
$5,000 Maximum
nervous disorders including drug or Maximum for up Maximum for up
for up to 30 days
alcohol abuse to 30 days to 30 days
Outpatient treatment of mental and
nervous disorders including drug or $500 Maximum $1,000 Maximum $1,000 Maximum
alcohol abuse
Treatment of Specified therapies, $2,500 Maximum $1,000 Maximum $1,000 Maximum
including acupuncture and on an Inpatient on an Outpatient on an Outpatient
Physiotherapy basis. basis basis
Medical treatment of Injuries sustained
as a $10,000 $150,000 $100,000
Maximum Maximum Maximum
result of a motor vehicle accident
100% up to $500
Repairs to sound, natural teeth required 100% up to $500 100% up to $500 per Period of
due to per Period of per Period of Coverage
Coverage Coverage maximum
an Injury maximum maximum
No benefits for loss
No benefits for loss No benefits for loss due to a Preexisting
Pre-existing Condition Limitation due to a Preexisting due to a Preexisting Condition during
Condition during Condition during the first 6 months
the first 12 months the first 6 months of coverage
of coverage of coverage
Discount Card Only
50% of actual
Prescription Drugs – Not covered by *Universal RX
charges
insurance
3
OTHER COVERAGES OPTION 1A OPTION 2A + 3
Maximum Benefit up to Maximum Benefit up to
Repatriation of Remains $7,500 $15,000
Maximum Lifetime Maximum Lifetime
Benefit for all Benefit for all
Medical Evacuation Evacuations up to Evacuations up to
$10,000 $50,000
Maximum Benefit up to
Bedside Visit --
$1,000 for 1 person
Maximum Benefit:
Accidental Death & Dismemberment -- Principal Sum up to
$10,000
THIS IS A BRIEF SUMMARY OF THE FEATURES AND BENEFITS FOR INSURED PARTICIPANTS. FOR COMPLETE PLAN DETAILS, PLEASE
REFER TO THE CERTIFICATE OF INSURANCE.
IF THERE IS A DIFFERENCE BETWEEN THIS PROGRAM DESCRIPTION AND THE CERTIFICATE WORDING, THE CERTIFICATE CONTROLS
4
Go to
www.HTHStudents.com/Disney
and click on “Enroll Now” for the
Plan Choice the student wants to
select for his/her coverage option.
Click on “I Agree” after reading the
terms of enrollment
Disney International Student Health Plan
This plan is designed for and open to international students employed by The Walt Disney Company only.
I hereby certify that as the proposed participant, I will be employed by The Walt Disney Company and eligible for the
Disney International Student Health Plan. I further certify that I am a non-resident alien and not a resident of the United
States of America and that I am actively engaged in international education activities in the current or immediate
upcoming academic term. Further, I understand that a participant whose coverage under this policy lapses shall be
subject to all policy exclusions as of any subsequent effective date. I understand that the Company will not pay
benefits for one year for Pre-Existing Conditions.
5
Indicate that this is a New enrollment then click on Next>>
Complete all the fields then click on Next>>
6
Review the “Coverage from” dates, if correct,
then Click Next>>. [If incorrect, Click on “Update
Participant” and correct the information.]
Complete ALL the credit card information then
Click on Purchase Plan.
7
An enrollment
confirmation will be
displayed if all required
information is provided.
A letter with your
Certificate Number and
ID Card will be mailed to
you at the address you
provided.
After you receive the
letter, use the
information to register
online at
www.hthstudents.com./
disney
8
The ID Card has all the information
providers need to identify you as
an HTH Health Plan member. It
contains the addresses and phone
numbers that can be used for filing
claims and confirming your
eligibility.
The Certificate Number is used to
identify your eligibility and what
plan of benefits you are covered
under. Be sure to keep this with
you at all times!
9
1. Go to www.hthstudents.com/disney
1 and click on the Login/Register link in the upper
right-hand corner
2. Enter your e-mail address, choose ‘No, I’m
signing up for the first time’ and click on Sign In
3. Under Plan Members, enter your Certificate
Number and Name as they appear on your ID card,
reconfirm your e-mail address and submit
4. Review and accept the brief Site Use Agreement
10Enter your first and last name, create a password
(must contain letters and at least 1 number),
confirm password and submit.
If you have questions or need assistance please call
customer service at 1.888.350.2002.
The registration confirmation contains links
to tools and information essential to your
health and well being. It also contains a
link to your insurance benefits
11To find a doctor when you are traveling in the
U.S., go to the HTH website at
www.hthstudents.com/disney
and click on Doctors and Hospitals, then
select United States Destinations and select
Search for Practitioner
HTH Worldwide’s Provider Search Tool will then be displayed.
Step 1: Provide an address that can be used to find the doctor
nearest to you.
Step 2: Select a Practitioner Specialty to limit your search, if desired.
Step 3: Select Gender, Languages spoken and availability, if desired.
Step 4: Select Search
12The providers who fit
your criteria can be
printed.
Also, there is a link to
map he provider
address.
You can refine your
search to include such
preferences as the
provider’s gender and
languages spoken.
1314
For general assistance or questions about your
benefits or claims:
Email: customerservice@hthworldwide.com
Telephone:
Toll-free inside the U.S. 888.350.2002;
Collect outside the U.S. +1.215.793.6925
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