by Andrea Gardner
Arts & Entertainment Editor
Full-time traditional undergraduate students guaranteed coverage under the University of La Verne’s insurance by Guarantee Trust Life Insurance Company may face a deductible and a percentage of medical fees if ailments extend beyond coverage limits or are exceptions to insurance coverage.
According to George Tadros, Personal Insurance Administrator (PIA) customer assistance representative, the insurance does not cover “anything routine or preventative” except for once a year pap smears for females. Workers’ compensation, cosmetic surgery and dental and optical treatment, except in the case of injury are also not included in the coverage. Ailments from car accidents are covered up to $1,500.
According to Maureen Pray, the Health Center’s licensed vocational nurse, treatment done at the University of La Verne Health Center is covered free of charge. However, when a student’s illness is serious enough to be treated at a hospital or urgent care center, it then goes through a series of conduits, then determine fees, if any, a student must pay.
Coverage is divided into basic and major medical coverage. When covering illnesses, coverage first applies to the basic limits which are documented in the Student Accident and Sickness Insurance brochure. There, fees for treatments such as ambulance service, surgical operations and anesthesia and others are documented along with the amount to which the insurance covers.
After basic coverage has been exhausted, major medical insurance is put into effect and a $100 deductible is automatically charged to students along with the remaining 20 percent that is not covered, if students had no other forms of insurance to cover treatment.
According to Maureen Pray, Health Center nurse, students have become disappointed with the school’s insurance when they have had to pay the deductible and the 20 percent that the University insurance may not cover.
University insurance works as a secondary insurance for students covered first by another form of insurance, or as the primary insurance for students with no other insurance.
According to Deborah Williams, PIA supervisor of customer service, students must use the Health Center first, unless the ailment is an emergency. If the Health Center is unable to treat the student for a non-emergency at that time, they can receive a referral from the Health Center to go to an urgent care center or hospital where they will be covered by the university insurance up to the coverage limits. However, Pray said that they try to squeeze in as many students as possible.
“With this insurance they must use the Health Center when it is open,” said Tadros.
Williams says the referral requirement is waived when the Health Center is closed, as the ailments of students are subject to review for seriousness at urgent care centers. When the Health Center is closed during the holidays the referral is waived, coverage begins after the third day of treatment.
Williams said some students try to abuse the system, not wanting to be treated at a university health center. She said some try to schedule doctor’s appointments purposely outside of the Health Center’s normal business hours, expecting to be covered under the insurance. Because doctors request medical records for review in non-emergency situations that occur outside of Health Center hours, this tactic will not work for those who try to dodge going to the Health Center first.
On average, Pray says the Health Center sees at least 12 people daily and do the best they can to offer the free medical services to students in the Health Center before they get overbooked and have to refer students to urgent care.
“We hope that students will come to us when they are feeling the first signs of illness, so it doesn’t turn into an emergency later, when the Health Center might be too busy to handle it,” said Pray.
For more information about insurance policies, contact PIA at (800) 468-4343. For Health Center information, call ext. 4254.
