Summary for OEA's Central Plan

Insurance Period: September 1, 2005 - August 31, 2006

Premium rate is $113.00 per month (pay every 6 months)

Policy Number 890432
Plan Name: Open Choice PPO

Maximum Benefits up to $500,000 for accident and sickness, unlimited amount for medical evacuation and repatriation of remains, all of which meet or exceed current insurance requirements for J-1 visa holders.

Covered Medical Expenses at 100% in-network (including Student Health Center) and 70% out-of-network.

Outpatient Prescription Medications, with a copay of $10 for generic drugs and $20 for brand name drugs.

For complete information, please visit Student Health Insurance Brochure.

For those of you who need to visit a doctor or hospital but have not received ID Card, 
please contact Julie or Jessica at (617)218-8434 and (617)218-8572, respectively.

Important Contacts

Policy arranged by:
The Harbour Group, LLC
25 East Central Avenue, Suite 4
P.O. Box 998
Springboro, Ohio 45066
Tel: 1-800-252-8160
www.hginsurance.com

Claim Processor:
The Chickering Group
P.O. Box 15708
Boston, MA 02215-0014
Tel: 1-877-375-7910
www.chickering.com

Underwritten by:
Aetna Life Insurance Company (ALIC)
For complete information, please visit Student Health Insurance Brochure.

Emergency Travel Assistance Provider:
Assist America
Tel. (800)872-1414 Call within the USA
Tel. (301)656-4152 Outside the USA
www.assistamerica.com

Policy Holder:
Office of Educational Affairs
Royal Thai Embassy
1906 23rd St, N.W.
Washington, DC 20008
Tel: 1-202-667-9112
www.oeadc.org

Download

• Student Health Insurance Brochure
• Health Insurance Enrollment Form for Scholars
• Health Insurance Enrollment Form for Dependent
• Claim Form