Helen Cook

AU PAIR INSURANCE INFORMATION  (ERIKA)

[Please note that this information is as up-to-date as possible.  However, as in any Insurance Program, changes are made and the information provided below is subject to change without my being notified of such changes.

Find A Doctor:  Please see No. 1 Below

Dentist:  See Information Below

Find Detailed Information Re Health Insurance Below Tips For Using Erika (Aetna) Insurance. - But Here Are “11 Tips For Using Erika (Aetna) Insurance”):

TIPS FOR USING ERIKA (AETNA) INSURANCE:

Using the Erika Insurance

Eleven Tips for Cultural Care Au Pairs

 Hopefully, you will never need to use your insurance!   But if you do, here are some helpful tips.   (Always check the more detailed Post on “Insurance” for advanced questions re insurance.)

1.  Find a Doctor.    Look up an Aetna provider on

                     http://www.aetna.com/docfind/erika.

 It will save you money to use a participating provider.  

The plan for our insurance is an Open Choice PPO Plan.

2.  Aetna vs. Erika Insurance.   Call the doctor’s office and say you have “Aetna”- not “Erika” - insurance.   They will not recognize the Erika name.

3.  Insurance Card.   Bring your Insurance Certificate Card with you to the doctor’s office.

• ID Number. Give the doctor’s office your CCAP booking number - this is your insurance ID number (do not give them the policy number 10462 or 11190 as your id number because all au pairs have the same policy number).
• Your Name. Provide the doctor’s office with your FULL name (as it appears in your passport or visa) - Including all of your family names.
• Billing Address. If the doctor does not send Aetna the bill, they will bill YOU instead. Tell your doctor to send bills to:

                    Aetna Student Health, P.O. Box 15719, Boston, MA   02215

• Deductibles. Do not pay the Aetna provider’s office for the visit except for your deductible: $65 for Basic and $35 for Extended.

 4.  Call Aetna If The Doctor’s Office Cannot Find Your Name.   Be sure to have the doctor’s office call Aetna at 800-783-7447 to confirm your insurance benefits and coverage dates.  Have them call while you are there in the office so you can have the insurance pay for the visit.  If they cannot reach someone or give you difficulties, be sure to take down the name of the person in the doctor’s office and we can contact them during the next business day. Call Aetna yourself and ask them to contact the doctor’s office on your behalf.

5.  If Aetna Does Not Have Your Name.  Call Cultural Care at 800-448-5753 and they will confirm your eligibility with Aetna. All au pairs have insurance coverage while participating on the program, so do not panic! It is usually just a clerical mistake that can be easily fixed.

6.  Emergency Room.   Remember that you have an extra Emergency Room deductible if you go to the Emergency Room:   $150 for Basic and $50 for Extended, plus your normal deductible of $65 or $35.

7.  Routine Care.  Remember that routine care is NOT covered - if you go for a doctor’s visit because you do not feel well, or something is wrong, remind the doctor’s office that routine visits are not covered and they must send Aetna a bill explaining why you needed treatment.

8.  Hospitalizations or Accidents While Driving:  Be sure to contact the Assistance Company in the event that you have to go to the hospital or are in an accident with your car.  The Assistance Companies are open 24/7 and the phone numbers are on your insurance certificate and in the policy booklet.

9.  If You Get A Bill At Home.   if you receive a doctor’s bill at home, please contact the insurance at 800-783-7447 to be sure the insurance has also received the bill to pay it.  Otherwise, the doctor will expect payment from you and you may begin to receive Collection Notices.  To prevent this from happening, contact Aetna immediately after you get a bill.

10.  Prescriptions.  If you have a prescription, you must first pay for it and then send in a claim form with the receipt from the pharmacy (both the cash register receipt and the medication information label attached to the prescription.)  You will be reimbursed for all medications except for acne, birth control or medication that you take for a pre-existing condition.

11.  Claim Forms.  Go to www.erikainsurance.com and you can download claim forms.

———————————————————-

DETAILED INSURANCE INFORMATION

Medical Insurance For Au Pairs:

Deductible payment

Au Pairs have a choice of having “Basic” Medical Insurance or “Extended” Medical Insurance.   The Deductible Rates are different depending on the type of Medical Insurance an Au Pair chooses.  The Deductible Rates are as follows (please remember that they are subject to change):

Basic Policy:  $95 for non-Aetna providers and $65 for Aetna providers

Extended Policy:  $65 for non-Aetna providers and $35 for Aetna providers

PRIMARY FEATURES OF “BASIC” MEDICAL INSURANCE COVERAGE:

• Maximum coverage for Medical Expenses due to an accident is $50,000
• No coverage for baggage or property loss
• No benefits for delays and program interruption
• No legal or liability coverage

EXTENDED INSURANCE:

 Extended Insurance is an optional insurance plan offered through Cultural Care Au Pair for all au pair participants.   We strongly recommend it!!!  Each au pair who purchases this plan is given 12 months of comprehensive coverage, from the date s/he arrives to the U.S. until her/his last legal date of work.  Au pairs are also able to purchase this insurance plan up to one month after their arrival to the U.S.

The extended insurance is 425 USD (2006) and you must sign up for it within 30 days of the start of his program.  You can contact the Boston Office at 1-800-333-6056 Press 3  to purchase this.

PRIMARY FEATURES OF “EXTENDED INSURANCE”

• Dental Insurance - $200 maximum (Basic Insurance has NO dental coverage!!)
• Unlimited reimbursement for Medical Expenses due to an accident
• Coverage for baggage or property loss
• Coverage for delays and program interruption
• Coverage for legal costs
• Flight reimbursement for the death/fatal illness of an immediate family member (does not apply to grandparents)

If you have purchased the Extended Insurance and if you have an accident or get sick, you will have unlimited coverage for all necessary and reasonable costs, including medicine and prescriptions.  Transportation to your home country, in an emergency, is also included.  Dental coverage for all accidents is unlimited, unless the accident is due to biting or chewing.  There is a limit of $200 maximum coverage per policy year for any acute and necessary dental treatment. Should you need to return home due to a serious illness or accident, or if a parent or sibling becomes seriously ill, your flight ticket home will be covered.

If you choose to return to the USA to complete your year, the return ticket will be covered as well. The extended insurance also covers stolen property up to $5000, and in case your baggage is delayed from your home country, you may be reimbursed up to $200.

13th MONTH INSURANCE 

We highly recommend to all Au Pairs remaining in the U.S. during their 13th month that they purchase the 13th month insurance.  With this insurance, Au Pairs are also covered for risky sports on Trek America trips.  Remember that if you do not buy this 13th Month Insurance, you will not be insured during this time!  Purchase in US through the Boston Office  (1-800-333-6056 Press 3) up until legal departure day.

 QUESTIONS AND PROCEDURES FOR EMERGENCIES:

 What Do I Do In An Emergency?

 ALWAYS have your insurance card on you, make sure to make a copy and leave that to your Host Family.   I do not have that information in my files, so I cannot help you with this. 

Every Cultural Care Au Pair arrives to the U.S. with Basic Insurance coverage.   The fee for the Basic Insurance is included in the host family’s program fee.   For an additional cost, Au Pairs can purchase optional extended coverage.   All Au pairs are covered under ERIKA Travel Insurance.

Procedure In An Emergency?

As soon as an Au Pair has any type of condition that requires hospitalization, Europ Assistance (800-871-9211) needs to be notified.  They can then give you information quickly  about exactly what is covered/not covered, which plan the Au Pair has, and what to do next.  They are a 24/7 phone line, and you should be able to get everything you need from them.

German and Austrian Au Pairs will have a new Assistance Team to contact in case of emergency or for evening and weekend assistance. “Inter Partner Assistance”, based in Munich, will handle all emergency cases for German and Austrian au pairs. Like Europ Assistance, they are open 24 hours, and their toll free number is (800) 847-3948.

Contact me (your LCC) by phone or email, so I know what’s happening.

Someone (the Au Pair, the Host Family, or your LCC (that’s me!)  needs to contact the Boston office, 1-800-333-6056.  When calling Cultural Care regarding an emergency, please have the following information available:

• The Au Pair’s first and last name
• The Au Pair’s reference number
• Name and Phone Number of the Host Family
• Name and Phone Number to the hospital/doctor
• Natural Family Phone Number

          and

• A brief description of diagnosis or medical situation

What number should I call in case of emergency?

Both the Basic and Extended policy include access to 24 hour emergency assistance in case of an emergency/hospitalization.  Below are the contact numbers for Au Pairs to call in the event of an emergency.

Inter-Partner Assistance

• German and Austrian Au Pairs: 800-847-3948 (Based In Munich)

Europ Assistance

• For All Other Nationalities: 800-871-9211 (Based in Stockholm)

Chickering Claims Administrators

• These Administrators should be contacted for any Claims and/or Billingquestions at: 800-783-7447

 Claims and Questions

• Your Au Pair will receive claim forms for use during the year.
• You can also download a claim form at: www.erikainsurance.com.

In addition to the claim form, you must send all receipts, itemized bills, police report and any other information related to the claim, as well as a copy of the insurance card. Claims will not be processed without the above documents.

When you visit a doctor, bring an insurance claim form with you (you can download a claim form at www.erikainsurance.com) and ask if the doctor can submit the claim directly to the insurance company.   In most cases, however, you will have to pay first, then complete the claim form and send it to the insurance company.   In turn, they will reimburse you with a check.  Remember to save all receipts.

Please note there is a pre-notification requirement for overnight hospitalizations. The Chickering Group must be contacted five days beforehand, or, in the case of an emergency, within two days after the hospitalization.  Many Au Pairs have never filed a medical claim before, particularly if they come from a country where medical treatment is free.  Therefore, we hope you will help explain to your Au Pair how the U.S. health system works.  All claims should be submitted directly to the insurance company (not Cultural Care Au Pair) at the following address:

          Chickering Claims Administrators, Inc.

          P.O. Box 15719

          Boston, MA 02215 

If you have a question about a claim, or for specific and detailed information about the insurance policy, please refer to the au pair’s travel insurance pamphlet or call The Chickering Group at (800) 783-7447 (during business hours EST) or (617) 582-5000.  Cultural Care Au Pair does not have access to the status of claims.

Do you have questions regarding medical bills, reimbursement for claims, policy questions or questions about non-emergency illnesses and doctor’s visits, please contact our claims agents at The Chickering Group directly as Cultural Care staff are not trained to answer these questions and cannot guarantee coverage. The phone number is 1-800-783-7447.

Chickering Claims

Chickering Claims, based in Boston, is still the U.S. claims agent, and au pairs can contact them for any issues regarding medical bills, reimbursement for claims, policy questions or questions about non-emergency illnesses and doctor’s visits. Chickering’s toll free number is (800) 783-7447 and their office hours are 9 am-5 pm EST.

Questions and Answers

   AU PAIR INSURANCE - FREQUENTLY ASKED QUESTIONS:

What number should I call in case of emergency? 

Both the basic and extended policy include access to 24 hour emergency assistance in case of an emergency/hospitalization. Below are the contact numbers for Au Pairs to call in the event of an emergency

Inter-Partner Assistance

• German and Austrian Au Pairs 800-847-3948 (Based in Munich)

Europ Assistance

• For All Other Nationalities: 800-871-9211(Based in Stockholm)

Chickering Claims Administrators

• These Administratorsshould be contacted for any claims/billing questions 800-783-7447

Insurance Card

ALWAYS have your insurance card on you, make sure to make a copy and leave that to your Host Ffamily.   I do npt have that information in my files, so I cannot help you.

Is Worker’s Compensation Insurance Included in the Au Pair’s Insurance Coverage?

No, it is not included in the program fee.   Host Families are to be referred to their tax and legal advisor for further information.

What Kind of Plan Does the Insurance Have? 

• The plan for our insurance is an Open Choice PPO Plan.

Who should I contact if I have question about regarding medical bills, reimbursement etc?

Chickering Claims, based in Boston, is still the U.S. claims agent, and Au Pairs can contact them for any issues regarding medical bills, reimbursement for claims, policy questions or questions about non-emergency illnesses and doctor’s visits. Chickering’s toll free number is (800) 783-7447 and their office hours are 9am-5pm EST.

An Au Pair is admitted the hospital. What do I do?

ALWAYS have your insurance card on you, make sure to make a copy and leave that to your Host Family.   I do not have that information in my files, so I cannot help you!

All Nationalities (except German or Austrian).  As soon as an Au Pair has any type of condition that requires hospitalization, Europ Assistance (800-871-9211) needs to be notified.  They can then give you immediately  about exactly what is covered/not covered, which plan the AP has and what to do next.   They are a 24/7 phone line, and you should be able to get everything you need from them.

German and Austrian Au Pairs will have a new Assistance Team to contact in case of emergency or for evening and weekend assistance. “Inter Partner Assistance”, based in Munich, will handle all emergency cases for German and Austrian au pairs. Like Europ Assistance, they are open 24 hours, and their toll free number is (800) 847-3948.

Contact me (your LCC) by phone or email, so I know what is happening.

Someone (the Au Pair, the Host Family, or your LCC) needs to contact the Boston office, 1-800-333-6056.   When calling Cultural Care regarding an emergency, please have the following information available:

• the Au Pair’s first and last name
• the Au Pair’s reference number
• Name and Phone Number of the Host Family
• Name and Phone Number of the Hospital and/or Doctor
• Natural Family Phone Number

             and

• A brief description of diagnosis or medical situation

An au pair has strep throat and needs to see a doctor. What should she/he do?

• The Au Pair finds an Aetna provider using the search on the Aetna website

At the doctor’s office, the Au Pair provides her insurance card at reception.  The Au {air should ask the office whether they will bill the insurance directly or whether they require payment from the Au Pair up front.

if the Au Pair is given a prescription, she will have to pay up front at the pharmacy.

The Au Pair should save the receipt AND the medication label from the prescription. This must be submitted along with a claim form and a copy of her insurance card to Chickering Claims (address is on the claim form.)

If the Au Pair receives any outstanding bills after the doctor’s visit, she should submit these bills along with a completed claim form to Chickering Claims.  It is not uncommon for the doctor’s office to try and bill the insurance company and then come back to the Au Pair claiming that the insurance company is not paying. Often they have billed the wrong place, spelled the Au Pair’s name incorrectly, etc.

Chickering will notify the Au Pair if there is any part of the bill that is not covered under the insurance policy.

An an pair keeps getting bills from a doctor’s office. What should she/he do?

If the Au Pair has not yet submitted the bills and a claim form to Chickering, she should do that immediately!

If the Au Pair has already submitted the bills and a claim form to Chickering, she/he should call them to confirm that they have received everything they need to process the claim.

 How Do I find a Doctor - Step-By-Step Instructions (See Suggested Doctors In The Area On Separate Page)

Cultural Care Au Pair Erika Travel Insurance

How to Find a Doctor in the Aetna Network

Go to www.aetna.com/docfind and follow the directions for “not yet enrolled in an Aetna plan” 

Click onto “Go to DocFind>>” You will now be on the Aetna Provider Directory Page and you may look up a doctor in several different ways. 

Go to “Standard Search” and the drop down menu will allow you to search by: zip code, city, county. The second drop down menu allows you to pick a state. 

Then click the “Search” button and you will be on the Search page.

 ”Step 1″ allows you to enter your ZIP Code and the number of miles the Au Pair wants to travel to get to your doctor

 ”Step 2″ allows you to choose the type of provider the Au Pair wants. It is easiest to go under “People” and choose “Primary Care Physician”, then click on “Continue”. Please Note: If the Au Pair needs a Behavioral Health Specialist, you or the Au Pair must contact your appropriate Assistance Company, after the first appointment for approval to continue services thereafter.

 ”Step 3″ is to “Select a Plan” You must select “Aetna Standard Plans” and then you will be given the choice of several to options. You must choose : “Aetna Open Choice PPO”

 At this point, if you choose “View search results now for all providers in your selected geographic area” your search will be completed and you can scroll down the names of the providers listed. Or, you may prefer to narrow the search further by using the drop down menu and then continue the search.

 Once you have your list of Aetna providers, please call for an appointment and please make sure they are accepting new patients and confirm that they are still contracted with the Aetna Provider Network.

Important Notes:

1. Please remember Au Pair’s have the Erika Travel Insurance which utilizes the Aetna Provider Network. Au Pair’s DO NOT have an Aetna Insurance Plan.

2. If the doctor’s office has a question about eligibility, you or the Au Pair may provide them with the Chickering Claims Administrators toll free number (800) 783-7447 to confirm eligibility.

3. The Au Pair should not have to pay the whole amount of the visit when they show thier Erika Travel Certificate with the Aetna logo on it.   Please suggest that the doctor’s office call Chickering if they insist on payment up front.

4. When an Au Pair uses an Aetna provider the deductible amount is reduced, the Au Pair benefits from the discounted rate for services and, insurance prices are kept lower over the long run.

 Erika Travel Insurance Schedule of Benefits

BASIC INSURANCE

 Deductibles (per Condition)

Basic

Aetna Provider: $65

Non-Aetna Provider: $95

Extended

Aetna Provider: $35

Non-Aetna Provider: $65

 Medical & Accident Insurance

A. Medical Expenses $50,000*

B. Emergency Home Evacuation $10,000

C. Home Repatriation $ 7,000

Liability Insurance

N. Third Party Liability $500,000

Handy Phone Numbers

Chickering Claims Administrators (for Claims while in the USA)

800-783-7447

Assistance Companies:

IPA Germany (Germany and Austria only)

800-847-3948

Europ Assistance (All other countries)

800-871-9211

Medical & Accident Insurance

A. Medical Expenses Unlimited*

B. Emergency Home Evacuation Unlimited

C. Home Repatriation Unlimited

D. Family Member Reimbursement Unlimited

E. Accidental Death $10,000

F. Accidental Disability $50,000

Baggage & Property Insurance

G. Baggage and Property $5,000

Sub limit for defined val. Property $2,000

H. Cash $ 500

I. Valuable Documents $2,000

Delay Insurance Important Information

-Exclusions and limitations apply to the policy - please see policy for details

-Familiarize yourself with the terms and definitions in the policy

-Note that the policy is secondary for Automobile accidents, Baggage & Property claims

-Proper documentation is required in order to process claims

-Mental Health Benefits are limited to $1,000

-Dental benefits are unlimited for accidents only. The Extended Plan only covers $200 for dental coverage

J. Baggage Delay $ 200

K. Personal Delay $ 900

Flight extra cost $ 500

 Program Interruption

M. Program interruption Paid training deposit**

Flight extra cost Unlimited

Return to program $2,000**

Liability & Legal Insurance

N. Third Party Liability $500,000

O. Legal Expenses $ 15,000

 *Note: There is a sub limit of $7,000 Out Patient Maximum Benefit

**not applicable to Additional Month Insurance

DENTISTS (Not a referral and these dentists do NOT accept Erika (Aetna) insurance but do provide lower cost dental services.)

Dentist:  A “clinic” for routine care follows - it is for “low income” and most Au Pair Insurance does not cover basic cleanings, etc.  THIS CLINIC DOES NOT ACCEPT Erika (Aetna) Insurance and the Au Pair would be responsible for all costs - costs are about 20% less than a “regular” dentist.

1.  Charles Chrin Dental Center, 100 North Third Street, Easton, Pa  — Hours:  8:00 a.m. to 5:00 p.m.   Monday thru Thursday   Phone:  610-419-7330