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FAQs

For your convenience we have compiled a summary of the most frequently asked questions (FAQ) regarding the Scholars Health Program. We hope you find this information useful. If there are any questions you would like to ask not illustrated below, please contact us.

GENERAL

HTH Worldwide

HTH is the claims administrator on behalf of the Clements Worldwide for the Scholars Health Program. HTH is responsible for processing overseas claims, specific medical condition inquiries, pre-certification for medical treatment and the coordination of emergency medical evacuation and repatriation. Please refer to your plan of benefits.

AmeriHealth

AmeriHealth works closely with HTH Worldwide to process claims, answer specific medical condition inquiries, and provides pre-certification for medical treatment within the United States.

Aetna AGB/PPO

This group provides the Preferred Provider Network in the U.S. This is a list of doctors and hospitals who participate in the Scholars Health plan.

Drug Source

Drug Source provides direct mail order prescription and retail services to Scholars in the U.S.
For more information on this program, please click here.

Universal Rx

Universal Rx provides direct mail order prescription services for overseas members.
For more information on this program, please click here.

The certificate of creditable coverage is a letter from your previous medical carrier confirming at least 12 months of consecutive medical coverage prior to enrolling into the Scholars program. Submitting a copy of the identification card from the previous medical provider is valid only if the card lists both the effective and expiration dates of coverage.

What is pre-certification?

Pre- Certification is when the covered person or someone on his or her behalf notifies the medical coordinator at HTH Worldwide (overseas cases) or AmeriHealth (U.S. cases) about a major medical emergency, major illness or upcoming medical procedure. The covered person is responsible for pre-certification. For cases inside the U.S. Pre-Certification determines the medical necessity of care and is not a guarantee of benefits. For cases inside the U.S., please also consult Customer Service after pre-certifying your care to discuss coverage for your treatment plan.

What medical treatments do I need to pre-certify?

Pre- Certification is required if the medical treatment is to take place. Please refer to your book of benefits for medical treatments requiring pre-certification.

How do I pre-certify?

We offer 24/7 customer service for verification of benefits and pre-certification. Please call HTH Worldwide at 1. 610.254.8767 (collect calls accepted) in the U.S. at 1.215.706.6191 or toll free 1.866.266.7506 additionally, you can pre-certify online at: www.scholarshealthprogram.com

For more information on Pre-Certification Click Here

What will happen if I do not pre-certify?

Eligible medical expenses will be reduced to 60% of the first $100,000.00. If any additional expense is incurred above the initial $100,000.00 the remaining portion of the balance will be paid at 40%.

What if I am admitted to the Hospital as an Emergency, and am unable to Pre-certify?

In the event of an Emergency Hospital admission, pre-certification must

be made within 48 hours after the admission. Persons who can assist you in pre-certifying if you are unable include the medical provider, a hospital representative, friend and/or a relative.

Once I complete the pre-certification requirement, is this a guarantee of coverage for that treatment?

No. Although you've completed the Pre-certification Requirement, all policy provisions and conditions must be met at the time of treatment. We cannot authorize or guarantee any benefit prior to the service. Pre-certification is not a guarantee of benefits. Please verify with HTH for your coverage benefit.

How do I enroll?

To enroll in the Scholars program you will need to speak with the Human Resources or Business Manager at your respective school and complete an enrollment form.

Can I add my spouse and dependents?

Yes, to add your spouse to the Scholars program, you will need to speak with the Human Resources or Business Manager at your respective school and complete an enrollment form within 31 days of the date he or she is first eligible for coverage.

Do I have a Prescription Benefits?

Yes, prescription benefits under your Scholars benefits are available from retail pharmacies or by mail order. Please refer to your table of benefits.

Can I use a mail order prescription drug service?

Yes, a Mail Order Prescription Drug Service benefit is available to all Scholars Health Program members. Please refer to your table of benefits.

How do I get prescriptions filled through a mail order pharmacy?

To get prescriptions filled via the mail, complete the RX mail order form and fax or mail to: Universal RX. For us mail and overseas mail procedures, please click here

How can I obtain a Claim form?

How do I file a claim?

Please submit a completed Claim form to HTH Worldwide with original invoices. If you have paid for the Medical Expense and are seeking reimbursement, please attach the original itemized bills. Claim forms and original invoices for reimbursement should be mailed directly to: HTH Worldwide Attn: Claims Department P.O. Box 1748 Southeastern, PA 19399-1748, USA

Please keep a copy for your personal files and send the originals to HTH Worldwide.

How long do I have to file a claim?

Generally, all claims must be filed within 180 days from the date of service. Be sure to attach a complete itemized bill prepared by the provider of service that includes the charges for each service along with the medical condition for which the treatment was performed.

How can I check the status of my claim?

You are able to view the status of your claim online by clicking on the Benefit & Claims link or by calling 1.866.750.6125 U.S. toll free or 1.610.254.8765 collect or email scholars@hthworldwide.com

Can I go to a non-network provider?

Yes, you are able to visit out of network provide but you will be subject to a higher co-payment and deductible.


Category: Insurance Reviews

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