Layout
The United States Department of State (USDoS) is
pleased to welcome you to the Accident and Sickness
Program for Exchanges (ASPE) Health Benefit Plan. As an
Exchange Participant, you receive a limited health care
benefit plan designed by USDoS and administered by
Seven Corners, Inc. This plan IS NOT an insurance policy.
The ASPE is a self-funded, limited, health care benefit
plan designed to pay covered medical expenses for eligible
Exchange Participants. Covered medical expenses are subject
to limitations, and pre-existing conditions are not covered.
This guide is an overview of the health care benefits you
are provided while serving on your USDoS funded program.
It also explains how payments are made for your covered
medical expenses. It is your responsibility to read and under-
stand what medical expenses are covered and not covered
by the ASPE health care benefit plan.
Life-threatening medical emergency
Dial 911 from any telephone.
Find a doctor or hospital
Log on to www.usdos.sevencorners.com or call
Customer Service toll free at 1 .800.461 .0430
Show Your ID Card to the provider
This lets them know where to send your medical bills.
Questions about ASPE or medical bills
Call Customer Service toll free at 1 .800.461 .0430,
or send an email to Customer Service at
[email protected] or go to
Need a medical or prescription claim form
Call Customer Service toll free at 1 .800.461 .0430
or download forms at www.usdos.sevencorners.com
(
One form is provided in the back of this guide)
Contact Seven Corners toll free at 1 .800.461 .0430
ASPE requires all of its members (exchange participants)
to pay a $15.00 co-pay for all office visits, ER, urgent
care and hospitalizations. The provider will require the
co-pay at the time of visit. As a reminder the co-pay
amount will be pre-printed on your ASPE ID card.
Seven Corners must be contacted at 1 .800.461 .0430
to confirm coverage and benefits
as soon as non-emergency hospitalization is
within 48 hours of the first working day following
an emergency admission
when your physician recommends any surgery
including outpatient
prior to any treatment for dental pain
Life-threatening medical emergency
Contact your local emergency service or go to the
nearest hospital.
This lets them know where to send your medical bills.
Find a doctor or hospital
Getting reimbursed for medical care
Need a medical or prescription claim form
Questions about ASPE or medical bills
Easy way to contact Customer Service from outside the
US 24/7/365 is by calling collect at +01 .317.818.2867,
you will need assistance from the local operator to make
this free call. You can also visit AT&T direct at
to determine the AT&T toll free access code for your specific
country. This code should be dialed followed by our toll free
number 1 .800.461 .0430.
Contact Seven Corners collect at +01 .317.818.2867
C o - P a y
ASPE requires all of its members (exchange participants)
to pay a $15.00 co-pay for all office visits, ER, urgent
care and hospitalizations. The provider will require the
co-pay at the time of visit. As a reminder the co-pay
amount will be pre-printed on your ASPE ID card.
Seven Corners must be contacted:
to confirm coverage and benefits
as soon as non-emergency hospitalization
within 48 hours of the first working day
following an emergency admission
when your physician recommends any
surgery including outpatient
prior to any treatment for dental pain
The USDoS health benefit program is administered
by Seven Corners, Inc. As a specialist in claims and billing
administration, you can be assured of quick and personalized
service. Customer Service representatives are available to
answer any questions you may have regarding the medical
provider network, pharmacy program, medical bill payments
or covered benefits.
Business Hours: 8:00 am to 6:00 pm
Monday–Friday (Eastern Standard Time)
(Only emergency phone calls will be answered
after business hours)
Call toll free: 1 .800.461 .0430
Seven Corners utilizes AT&T Direct for its toll-free 800
numbers. Virtually anywhere in the world you can dial
an access code, and then dial 1 .800.461 .0430 and
be connected to Seven Corners. For a complete listing
of access codes please visit:
Call collect: +01 .317.818.2867 outside the US
Seven Corners can also be reached by contacting
your local operator and placing an international collect
call. Advise the operator you are calling collect to
+01 .317.818.2867. All collect calls are accepted
by Seven Corners.
Attn: Customer Service
Carmel, IN 46082-3724
It's easy to access information about your health plan
Once you log into www.usdos.sevencorners.com,
through the Seven Corners' customized website designed
you can select a special service called MyPlan, which
especially for USDoS members. You can have instant access
is an area where you can access secure information for
to ASPE health care plan information anytime day or night.
you specifically.
While this guide was meant to provide you with comprehen-
1. Claim Information—If you have a question about
sive information about your benefit plan, you should always
whether a claim has been paid to a provider or
refer to the website for the most up to date information
if Seven Corners has received your claim for reim-
bursement to you, you can log in and find all of
the medical service bills received by Seven Corners
The USDoS customized website is located at:
and the status of payment of those bills.
2. Eligibility Information—If you are interested to see
when you might have had breaks in coverage or
Access a list of all doctors and hospitals in
the dates you are eligible for coverage.
the Medical Provider Network
3. Printable ID cards—If you misplace the ID card
Access a list of pharmacies in the Pharmacy Network
provided to you, you can download a temporary
Download necessary forms for pharmacy and
ID card that has your personal information on it.
medical claim reimbursement
4. Secure Customer Service email—you can send an
View a list of frequently asked questions regarding
email and attach any information you have questions
on that you received or viewed on MyPlan. This is
Access this benefit guide electronically
a secure and encrypted email connection.
Review a glossary of medical terms
Because you are viewing personal health information
Access MyPlan. A password secure area where you
through MyPlan, a username and password are required.
can get personal and private health care information
It is easy to activate a MyPlan account, simply follow the
specifically for you.
steps on the website.
Click on the "Setup New Account" link
Enter your MyPlan ID
(ID card number) and PIN
Number
(first time login—use your date of birth)
Once your MyPlan ID and PIN Number have been
confirmed, you will be instructed to pick a username and
password that you will enter every time you want to login
to MyPlan
(see general login screen). The username and
password will now be your key to enter the MyPlan site.
Remember to bookmark the MyPlan login page
for future ease of use.
On the effective date of the grant as printed on
If your medical condition requires you to return to your
your ID card.
home country, your ASPE health benefits will terminate upon
arrival. If the grant is reinstated because your health permits
the return to the host country, then ASPE health benefits will
On the last date of your grant as printed on your ID card.
also be reinstated upon departure from your home for the
country of assignment.
Only you (the grantee) are covered under the ASPE
health care benefit plan. ASPE does not cover dependents
Example: If you are a US citizen and your host country is
(spouses or children).
France you are covered by ASPE for the dates on your ID card
(the dates of your grant). If you decide to go on personal leave
from your host country (France) and go to Egypt for a vacation
you are in your home country or country of
you are not covered by ASPE. In addition if you become ill or
regular domicile;
have an accident while on personal leave, and then return to
you are on personal leave;
your host country, your accident or illness will be considered
you travel outside the country of assignment
a pre-existing condition and will not be covered by ASPE.
without pre-approval from USDoS;
During extended stopovers en route to or from
Example: If you are on a grant in the United States and
your country of assignment; or
decide to vacation or holiday in Canada or Mexico, or any
During orientations in your home country.
other country outside the United States you are not covered
by ASPE. If you become ill or have an accident while outside
the United States and then return to finish your grant, your
accident or illness will be considered a pre-existing condition
and will not be covered by ASPE.
If you are not located in the system at Seven Corners,
contact your Program Agency.
As an Exchange Participant enrolled in the ASPE health
Accident and Sickness Program for Exchanges
benefit plan, you will receive an identification card to be used
$15.00 co-pay for office visits*
as proof of health care benefits when you need services.
Simply show your identification card to the hospital or doctor
at the time of service.
You should carry your ASPE identification card with
you at all times while you on your grant. Whether you are
inside or outside the United States the ASPE ID card provides
important information in case you need emergency treatment.
In addition, the ASPE ID card includes the address providers
need to file medical bills for payment.
If you have not received an ID card please contact your
program agency before contacting Seven Corners.
In the US the identification card is also your prescription
drug card for use when filling prescriptions. You will need to
show this card at the pharmacy, so carry it with you at all
If your ID card is lost or misplaced, you can obtain a
temporary ID card immediately to ensure no disruption
in service.
Call toll free: 1.800.461 .0430
Call collect: +01.317.818.2867 outside the US
Go online at www.usdos.sevencorners.com and
Or write to:
ASPE Health Benefits
Attn: Customer Service
Carmel, IN 46082-3724
You are responsible for a $15.00 co-pay for all office
All covered expenses incurred as a result of the same or
visits, ER, urgent care, and hospitalizations. The provider
related cause (including complications) shall be considered
will require the co-pay at the time of visit. As a reminder the
as resulting from one Injury or Sickness. To be sure medical
co-pay amount will be pre-printed on your ASPE ID card.
services are covered, Seven Corners must be contacted:
The maximum amount you will pay in co-pays is $500.00
to confirm coverage and benefits;
per benefit year. If during your grant period you reach that
as soon as non-emergency hospitalization
amount, you will be refunded any co-pays in excess of
$500.00 once you submit your receipts as proof of payment.
within 48 hours of the first working day following
ASPE will cover the remaining expenses at 100% up
an emergency admission;
to your Policy Maximum if the medical condition is not
when your physician recommends any surgery
including outpatient;
If you use a provider outside the Medical Network,
prior to any emergency treatment for dental pain, or;
you may have to pay additional charges if the Provider bills
for emergency evacuation, repatriation and
more than the Usual, Customary, and Reasonable Rate.
(See glossary for further explanation)
In the U.S. call: 1 .800.461 .0430
Outside the U.S. call collect: +01 .317.818.2867
$50,000 or $100,000 depending on your exchange
The ASPE health benefit plan will pay 100% of all Covered
Expenses listed below in the Schedule of Benefits. Payment
will not exceed the Maximum Benefit limit shown on the
Paid by USDoS at 100%, up to $10,000
Schedule of Benefits.
Paid by USDoS at 100%, up to the amount approved by
1. it does not exceed your program's Maximum Benefit;
USDoS after medical review.
2. you have been continuously covered under the
ASPE benefit plan;
3. the sickness or injury occurred in your assigned
You are responsible for a $15.00 co-pay per office
host country, or;
visit, ER, urgent care and hospitalization.
4. it is a covered service.
When an Exchange Participant ends their program, treat-
Hospital Room and Board Charges—Payment will be lim-
ment for a covered Injury or Sickness is covered up to one
ited to the hospital's normal charge for semi-private
calendar year from the date of onset. This coverage does not
apply to Acupuncture, Chiropractic, Massage Therapy or
Maternity care—-those benefits terminate at the end of the
Home Health and Skilled Nursing Services—Covered if
enrollment period regardless of other conditions of this
the medical condition is not pre-existing and the cost of the
policy. Covered Expenses are subject to the pre-existing
service is less than an inpatient stay.
Laboratory Tests and X-rays—Covered if recommended
Accident or Injuries—Including to mouth and teeth are
and performed by a licensed provider for diagnostic purposes
covered under medical benefits.
due to symptoms, illness or injury.
Acupuncture—When prescribed and performed by a
Massage Therapy—when prescribed by a licensed
physician or physical therapist to treat a covered injury or
physician or chiropractor and performed by a state licensed
sickness. Limited to 25 visits per benefit year. Acupuncture
massage therapist. Limited to 6 visits per benefit year,
benefits terminate at the end of the enrollment period
massage therapy benefits terminate at the end of enrollment
regardless of other conditions of this policy.
period regardless of other conditions of this policy.
Ambulance—Professional ambulance service.
Maternity—Medical expenses for maternity care, includ-
ing childbirth. Maternity benefits terminate at the end of the
Chemotherapy and Radiation Therapy—Services for
enrollment period regardless of other conditions of this policy.
medical conditions.
In addition to the medical expenses for maternity care for
the Exchange Participant, the medical expenses of the child
Chiropractic—Care is limited to 25 visits per benefit year.
newly born during the grant period are covered for the first
Chiropractic benefits terminate at the end of the enrollment
31 days up to the assigned maximum benefit. For coverage
period regardless of other conditions of this policy.
beyond the 31-day period, an Exchange Participant must
obtain commercial health insurance coverage for the new-
Diagnostic Care—Fees for diagnosis and treatment by
born dependent at personal expense. The ASPE health
a physician, surgeon, registered nurse, professional anes-
benefit plan does not pay the expenses of a newborn to a
thetist, including physical therapy related to a covered Injury
dependent of an Exchange Participant. The Exchange Partici-
pant is advised to obtain commercial insurance to cover ma-
ternity care of the dependent and dependent's newborn.
Durable Medical Equipment (DME)—Rental charge for
Durable Medical Equipment, or the purchase of this equipment,
Medevacs Outside of the US—Contact Customer Service
whichever is less. Prostheses and Orthopedic Appliances are
collect at +01 .317.818.2867 to arrange transportation and
covered only if required as the result of an accident. If pros-
medical care as well as pre-approval.
If pre-approval is not
thesis or an orthopedic appliance is required for a condition
obtained through Customer Service and transportation and
that is not pre-existing, coverage determination will be made
coordination of care is not provided through Seven Corners,
by USDoS on a case-by-case basis. Supporting documentation
travel services will not be covered.
must be forwarded to Seven Corners for review.
The ASPE program will pay the actual expense incurred as
Prescription Drugs—When prescribed by a licensed
a result of a covered Injury or Sickness for medical evacuation
physician. Refer to Prescription Drug Program section of
of Covered Person, including physician or nurse accompaniment
this guide and/or the website for more information.
to the nearest suitable medical facility. This evacuation will be
paid only upon USDoS/Seven Corners approval.
Repatriation of Mortal Remains—In the event of a cov-
ered Exchange Participant's death, the ASPE health benefit
Men's Health Benefits—Are covered after completing
plan will pay for actual charges incurred up to the Maximum
six months of eligibility, for men 50 and older one (1) annual
limit of $10,000.00 for services related to the preparation
prostate exam including a PSA.
and transportation of the body. This benefit does not include
the transportation expenses of anyone accompanying the
Mental or Nervous Disorders—Treatment of Mental and
body or any personal effects. Seven Corners should be
Nervous conditions are payable subject to the following
contacted in the event of a grantee's death.
Inpatient Care: Lifetime maximum benefit is thirty (30)
Utilization Management Program—The health benefit
days of hospital confinement;
plan includes a utilization management program to review
Outpatient Care: Lifetime Maximum benefit is thirty
the Exchange Participant's medical care to identify conditions
(30) visits. Outpatient Mental or Nervous benefits
that may adversely affect their completion of an exchange
terminate at the end of the enrollment period
program. The ASPE utilization management program is
regardless of other conditions of this policy.
administered by Registered Nurses and Board Certified
Authorized providers of care: A licensed physician,
Physicians and is focused on Individual case management
licensed clinical psychologist or a master of social
of potentially catastrophic cases.
work (MSW) may provide services that are medically
necessary for mental and nervous disorders.
Women's Health Benefits—Covered after completing six
months of eligibility for women 18 and older one (1) annual
Physical Therapy—Services provided by a licensed
GYN health exam per benefit year that includes one (1) pelvic
physician or a licensed physical therapist when prescribed
examination, Pap smear, breast examination and lab work
by a physician or chiropractor and directly related to the
related to ONLY GYN health when performed at the time of
complications associated with a covered Injury or Sickness
annual GYN exam. If follow-up diagnostic Pap smears are
incurred during the period of coverage.
medically necessary, they will be covered.
Contraceptive
management and HPV vaccinations are covered only when
Physiotherapy—A physical or mechanical therapy,
performed at the annual GYN health visit. In addition one (1)
diathermy, ultrasonic, a heat treatment in any form,
baseline mammogram for women 35 and older and one (1)
manipulation or massage, when ordered by a licensed
annual mammogram for women 40 and over; one (1) Bone
physician or chiropractor. (
See massage therapy benefit
Mineral Density (BMD) screening test for all women over age
on page 10).
65, estrogen deficient women and women at clinical risk for
osteoporosis when performed as part of the annual GYN
exam. A repeat BMD test is covered every two years.
Pre-existing Conditions are not covered. You are urged
Chiropractic—This program does not cover chiropractic
to retain or obtain your own health insurance to cover
services before or after the enrollment period.
ongoing or potential medical requirements relating to
Claim Submission—After 1 year from date of service.
Congenital Anomalies—Treatment of congenital
anomalies, and the conditions arising or resulting directly
As stated throughout the guide, the ASPE Benefit
Plan does not cover pre-existing conditions. A pre-existing
condition is any condition which:
Contraceptive Injections
a. originated prior to your effective date of coverage;
b. you received consultation from a physician about—
Cosmetic Surgery—Expenses incurred for elective plastic
prior to your effective date of coverage;
or cosmetic surgery. Plastic surgery is only covered if service
c. you received treatment or medication for—prior to
is a direct result of a covered Injury that necessitated medical
your effective date of coverage; or
treatment within 24 hours of the accident.
d. would have caused any prudent person to seek
medical advice or treatment, prior to your effective
Dental—No dental services are covered. Only treatment for
date of coverage.
emergency alleviation of pain will be paid, in which case dental
treatment shall be limited to $1,000 per benefit year.
Note: ASPE does not define pregnancy as a pre-
existing condition.
Dependents—Coverage for accompanying spouses and
dependent children must be purchased separately.
Other Services/Expenses in addition to pre-existing
conditions that are not covered include the following:
Expenses incurred for the treatment of an Injury or
Sickness more than one calendar year after the time of
Abortion—A surgical procedure used for the purpose
the Injury or onset of the Sickness.
of birth control and/or an elective termination of pregnancy.
Expenses incurred within your home country or country
Acupuncture—This program does not cover acupuncture
of regular domicile, unless:
before or after the enrollment period.
it is necessary and authorized treatment received after
the individual has proven Sickness or Injury in the country
Alcohol, Drug Abuse or Detoxification Treatment—
of assignment; or is related to a pre-approved medevac,
Expenses incurred resulting from the use of alcohol or
and which would have otherwise been covered had the
intoxicants, or any illicit drugs or abused drugs by the
expenses occurred in the country of assignment.
Exchange Participant, (abused drugs include prescription
drugs that may be used illicitly); expenses incurred due
Expenses in excess of Usual, Customary and Reason-
to substance abuse treatment.
able Charges (UCR).
Experimental Procedures—Services or supplies which
Maternity—This program does not cover maternity
are experimental or investigative in nature; including any
before or after the eligibility period.
treatment, procedure, facility, equipment, drugs, drug use,
devices, or supplies that are not recognized as accepted
Newborn Expenses for coverage beyond the 31-day
medical practice; and any such items that require federal
period—For coverage beyond the 31-day period an Exchange
or other governmental agency approval not received at the
Participant must obtain commercial health insurance cover-
time services were rendered.
age for the newborn dependent at their personal expense.
The ASPE Health Benefit Plan does not pay the expenses
Eyes—Services in connection with eye examination,
of a child newly born to a dependent of an Exchange
eyeglasses or contact lenses except as required for repair
Participant. The Exchange Participant is advised to obtain
caused by a covered Injury limited to $300 maximum.
commercial insurance to cover maternity care of the
dependent and dependent's newborn.
Feet—Expenses incurred in connection with weak,
strained or flat feet, corns, calluses or toenails, shoes and
Non-Medically Necessary Services and Supplies—
other supportive devices for the feet. This does not apply
The diagnosis or treatment of a covered Sickness or Injury,
to infections of the toenails or feet and does not apply to
of which are not recommended by an attending physician.
casts, splints or braces for treatment of injuries.
Nasal—Surgical correction of deviated nasal septum,
Hearing—Services in connection with hearing aids,
including submucosal resection.
except as required for repair or equivalent replacement
when caused by a covered injury.
Perilous Activity—
1. Flying, except:
a. as a passenger on a regularly scheduled airline;
b. as a passenger on a chartered carrier for pur-
poses of an approved grant program activity;
c. as a passenger in the Military Airlift Command
Infertility—Expenses incurred for services related to the
of the US or similar air transport services of
diagnostic treatment of infertility or other problems related
other countries.
to the inability to conceive a child, unless such infertility is a
2. Playing, practicing, or participating in intercollegiate,
result of a covered Injury or Sickness.
club (professionally organized) or professional sports,
or during travel for such purposes, e.g. skateboarding,
Injury or Sickness sustained or contracted during any
snowboarding, BMX racing, X-games (extreme sports).
period of unofficial travel outside the country of assignment.
If your participation in a professional sports event
is part of your grant the perilous activity clause does
3. Operation of a vehicle while not properly licensed to
Sexual Transformations, Sexual Impairment or
do so or riding in a noncommercial vehicle operated
Sexual Inadequacy Treatment
by a person not licensed to do so in the jurisdiction
in which the accident takes place.
Transportation—Expenses incurred for taxicabs or other
4. Operation of a vehicle while under the influence of
transportation to and from the doctor's office or other place
drugs or alcohol.
of treatment, except if an approved medical evacuation
5. Dangerous activity not directly related to the fulfill-
ment of grant objectives, e.g. bungee jumping,
scuba diving, skydiving, rock climbing (indoor/
Temporomandibularjoint Disease (TMJ)—Medical or
outdoor), hang gliding, operation of an all terrain
dental services or supplies for the treatment of TMJ.
vehicle (ATV) or motocross bike.
If your grant requires that you travel to areas
Vaccinations except those pre-approved. Contact Seven
requiring an ATV or snowmobile then item 5
Corners for information.
does not apply.
War—Loss due to war, declared or undeclared, while in
Personal Comfort Items—Any personal comfort item
the service in the Armed Forces of any country.
(purchased or rented) such as a dehumidifier, humidifier,
air cleaner.
Weight Loss Programs including Gastric Bypass and/or
Political Demonstration—Injuries due to participating
in any demonstrations against the government of your host
Workers Compensation—Expenses covered under any
country while you are on an ECA grant in your host country.
occupational benefit plan, Workers Compensation Act or
similar law, automobile medical payment or no-fault plans,
Professional Medical Services—Rendered by a member
public assistance programs, government plan, any other
of the Exchange Participant's immediate family or anyone
valid/collectible group insurance, or any primary insurance.
who lives with the Exchange Participant.
ASPE will pay medical expenses not paid by such primary
insurance due to application of deductibles or limitations
Routine Physical or Health Examinations—"Routine
on benefits, provided that such expenses would otherwise
exams" include but are not limited to health exams for
be covered by the provisions of this Program.
school, immunizations, vaccinations, etc.
Services or Supplies—For any Injury or Sickness received
prior to the Exchange Participant's effective date under the
ASPE health benefit plan, or which are not actually incurred
while this Program is in force.
ASPE health care benefit plan contains a Medical Provider
To locate a provider or hospital in the USDoS Medical
Network inside the US. A Medical Provider Network is a net-
Provider Network:
work, or group, of doctors and hospitals that have entered
Go to www.usdos.sevencorners.com and select the
into an agreement with Seven Corners to accept discounted
tab marked medical provider.
fees for medical services. The Medical Provider Network is
a Perferred Provider Network (PPO). Claims for services
The website will provide you with the most up to date
provided by a Preferred Provider are mailed directly to Seven
information about Medical Network Providers in your area.
Corners at the address on the back of your identification card.
If you do not have access to the Internet or want to discuss
If you receive your medical services from one of the
your provider choice with Customer Services, you can call
doctors and hospitals in the Medical Provider Network your
customer service toll free in the US at 1.800.461 .0430.
benefits will be paid at the negotiated provider contracted
Do not wait to find a provider for Emergency Care.
rate if they are a covered benefit. Also, if you use a provider
Go straight to the nearest ER. Emergency care is defined
in the Medical Provider Network the provider can not bill you
by Seven Corners as a need for hospitalization, trauma
for any covered benefits except the $15.00 co-pay for office
(i.e., broken bones, accidents), acute and spontaneous
visits, ER, urgent care or hospitalizations.
non-controllable pain, blurry vision, intense headache,
chest pain, shortness of breath, unmanageable high
fever, open wounds, or any life-threatening situation.
If you do not receive care from a provider in the Medical
If you have a life-threatening emergency, please call
Provider Network, benefits will be paid at standard Usual,
your local emergency service or go to the nearest hospital.
Customary and Reasonable Charges (UCR) for the area in which
If you are unsure where the nearest hospital is located,
care was delivered if they are a covered benefit. If the provider
Seven Corners staff can assist.
bills more than UCR, you will be responsible for any charges
over and above the UCR, as non-preferred providers are not
under negotiated contracted rates.
If you pay for your medical services out-of-pocket or are
billed at the time of service you will need to submit a claim for
payment or reimbursement.
(See page 30, Payment of Medical
If your home address is over 35 miles from the nearest
Claims) for more information.
medical network provider, you are exempt from the provider
network guideline. You are free to see any provider of your
choice. You will need to call Seven Corners Customer Service
to coordinate this exemption.
Using a Medical Provider Network means lower
out-of-pocket expense for you.
In the US, for all States except
New York and
New Jersey
In
New York and
New Jersey when you call a doctor's
and
Utah when you call a doctor's office for an appointment
office for an appointment or present your ID card to a
or present your ID card to a provider, it is important for you
provider, it is important for you to say:
"My healthcare coverage utilizes the Beechstreet
"My healthcare coverage utilizes the ChoiceCare PPO
PPO Network. Are you a Beechstreet Provider?"
Network. Are you a ChoiceCare Provider?"
Exchange participants on grants outside the US may
If a provider has not agreed to participate in the Seven
go to any provider they want. Seven Corners offers a Medical
Corners network, Seven Corners will still attempt to negotiate
Network outside of the US but the non-US Medical Network
a direct pay or guarantee of payment agreement with the
work slightly different than the US Medical Networks.
provider so you will not have to incur all of the out-of-pocket
Non US doctors and hospitals are contracted to provide
expenses at the time care is received.
access to USDoS participants based on payment of Usual
and Customary Rates for Local Nationals. Seven Corners has
To locate a provider or hospital in the USDoS Non-US
built Usual and Customary Rate tables for specific regions
Medical Network:
outside of the United States. There are two types of Non US
Call toll free: 1.800.461 .0430
(see page 4)
Medical Network Providers which are defined below:
Call collect: +01.317.818.2867 outside the US
Direct Pay Providers—Direct Pay Contracted Providers
Emergency—In the case of an emergency during which
are defined as providers that Seven Corners has reviewed
the member is outside the United States our Assistance
and determined that the provider meets all the necessary
Department should be contacted immediately. We ask that
requirements for quality care based on their country licens-
you gather as many details as possible for our Assistance
ing authority. Additionally, these providers have agreed to
staff during this call. Our office can be reached 24/7/365
a payment fee schedule which is not more than the rates
days a year by calling 1.800.461 .0430 or collect
local nationals pay and they have agreed to accept payment
+01.317.818.2867. You may dial this number direct
directly from Seven Corners without billing the participant
or you may contact your local operator and request to
first. Participants may not be required to pay out of pocket
make a collect call to this line. The caller may also visit:
when accessing these providers for covered services.
Seven Corners wire transfers payment to provider's bank
to determine the AT&T toll-free access code for your specific
account in the currency of the providers' choice or can mail
country. This code should be dialed followed by our toll-free
the provider a check.
number, 1.800.461 .0430.
Emergency care overseas is defined by Seven Corners
Referral Provider—Referral Providers are defined as
as a need for hospitalization, trauma (i.e., broken bones,
providers that Seven Corners has reviewed and has deter-
accidents), acute and spontaneous non-controllable pain,
mined the provider meets all the necessary requirements
blurry vision, intense headache, chest pain, shortness of
for quality care based on their country licensing authority.
breath, unmanageable high fever, open wounds, or any
Seven Corners has loaded these providers in a database,
life-threatening situation.
and has sent them information on joining the Seven Corners
Seven Corners is available to support you with an emer-
Direct Pay Network, but they have not yet agreed to join the
gency number and guide you to a Direct Pay or Referral Provider,
Direct Pay usually due to lack of large numbers of participants
but clearly we want you to seek immediate care at the nearest
in their area. As participant numbers in the area grow or
facility. In emergency situations where care is needed imme-
providers are accessed, Seven Corners continues negotia-
diately, you are not required to call Seven Corners.
tions with those providers in an attempt to move them into
If you have a life-threatening emergency, please call
our Direct Pay Contracted Provider list.
your local emergency service or go to the nearest hospital.
If you pay for prescription drugs out of your pocket,
you can complete the Prescription Reimbursement Standard
A copy of this form is provided in the back of this
guide, and additional forms are available through one of
the following ways:
The integration of CVS/Pharmacare and Caremark combines
Go to www.usdos.sevencorners.com and download
our services into one organization, CVS Caremark. Although
the
Prescription Reimbursement Standard Claim Form
the name has changed, you still have access to all prior
Call Customer Service: 1 .800.461 .0430
features utilized.
Present your ID card to have your prescriptions filled.
The ASPE benefit plan provides a US paid prescription
drug program with a Pharmacy Network to be used in combi-
Your health care plan requires that all maintenance
nation with your health benefits. Through the nationwide
medications or medications taken on an ongoing basis must
Pharmacy Network community and chain pharmacies, and the
be purchased though the Direct Mail Service.
mail service pharmacy option, you have the broadest choice of
Direct Mail Service provides a convenient way for you to
pharmacies to choose from to satisfy your prescription drug
have your medication delivered right to your home or office.
Mail Service should be the first choice for people using main-
Your identification card contains all the information that
tenance medications. These are medications taken on an
your pharmacist needs. Simply present your ID card to have
ongoing basis such as asthma, heart and cardiovascular
your prescriptions filled at any one of the Pharmacy Network
conditions, diabetes, and oral contraceptive medications.
providers in your area. The pharmacy will then electronically
With the Mail Service Pharmacy, you are authorized a 90-day
transmit a claim for that medication and within minutes have
supply of your medications each time it is refilled.
approval for filling the prescription.
To start using Direct Mail Service you'll need a prescrip-
The Pharmacy Network includes over 60,000 pharmacy
tion from your doctor for the medication. Ask your doctor to
locations nationwide.
authorize a 90-day supply and four refills. Be sure to also
obtain a prescription for an initial fill at your local pharmacy
if you need to use the medication right away or don't have
Go to www.usdos.sevencorners.com or go directly
existing supplies of your medications.
to www.pharmacare.com
Call Pharmacy Member Services at 1.800.777.1023.
Confidential Mail Service Enrollment Form is provided
In the unlikely event that a pharmacy in your area is
in the back of this guide, and additional forms are available
not part of our Pharmacy Network then please ask your
through one of the following ways:
pharmacist to request a participation agreement by calling
Go to www.usdos.sevencorners.com to download
PharmaCare's Network Service Department at
the
Confidential Mail Service Enrollment Form
1.800.237.6184 ext. 7555.
Go to www.pharmacare.com, select direct mail
service and enroll online
Call Customer Service: 1.800.461 .0430
Carrs Quality Centers
Costco Pharmacies
Leader Drug Stores
Costco Pharmacies
CuraScript Pharmacy
Costco Pharmacies
Gemmel Pharmacy Group
Leader Drug Stores
Hi-School Pharmacy
Fry's Food & Drug
Horton & Converse
Leader Drug Stores
Leader Drug Stores
Medicap Pharmacies
Medicap Pharmacies
Publix Super Markets
Payless Drug Stores
NeighborCare Pharmacies
PharmaCare Specialty Pharmacy
Payless Drug Stores
PharmaCare Specialty Pharmacy
Smith's Food & Drug
Raleys Drug Center
Ralph's Pharmacies
TrueCare Pharmacy
Save Mart Supermarkets
Brookshire Grocery Co.
Scolari's Food & Drug Co.
Harp's Food Stores
Leader Drug Stores
Medicap Pharmacies
Costco Pharmacies
Columbus Health Services
Pharmacy Providers
Costco Pharmacies
Leader Drug Stores
NeighborCare Pharmacies
TrueCare Pharmacy
Payless Drug Stores
Leader Drug Stores
PharmaCare Specialty Pharmacy
Medicap Pharmacies
Valu Merchandisers/
PharmaCare Specialty Pharmacy
SafeScript Pharmacy
SUPERVALU Pharmacies
The Pay-Less Pharmacy Group
Winn Dixie Stores
Medicap Pharmacies
Payless Drug Stores
Costco Pharmacies
Food Lion Pharmacy
Harris Teeter Pharmacy
Kash N Karry Food Stores
Leader Drug Stores
Leader Drug Stores
Smith's Food & Drug
Medicap Pharmacies
Yoke's Washington Foods
Navarro Discount Pharmacies
NeighborCare Pharmacies
NeighborCare Pharmacies
Pavilion Plaza Pharmacies
PharmaCare Specialty Pharmacy
Carle Rx Express Pharmacy
ShopRite Pharmacy
Sedano's Pharmacies
Costco Pharmacies
TrueCare Pharmacy
Winn Dixie Stores
Dierberg Family Markets
Dominick's Finer Foods
BJ's Wholesale Club
BJ's Wholesale Club
Columbus Health Services
Costco Pharmacies
Costco Pharmacies
Giant of Maryland
Leader Drug Stores
Food Lion Pharmacy
Leader Drug Stores
Medicap Pharmacies
ShopRite Pharmacy
J.H. Harvey Co.
Leader Drug Stores
Mercy Health System
Medicap Pharmacies
Nash Finch Company
PharmaCare Specialty Pharmacy
NeighborCare Pharmacies
Leader Drug Stores
Winn Dixie Stores
PharmaCare Specialty Pharmacy
PharmaCare Specialty Pharmacy
Rinderer's Drug Stores
Costco Pharmacies
Schnucks Pharmacy
BJ's Wholesale Club
PharmaCare Specialty Pharmacy
SUPERVALU Pharmacies
Costco Pharmacies
TrueCare Pharmacy
CuraScript Pharmacy
Valu Merchandisers/
Costco Pharmacies
Leader Drug Stores
Costco Pharmacies
Leader Drug Stores
Dillon's Pharmacy
Medicap Pharmacies
Costco Pharmacies
SafeScript Pharmacy
Leader Drug Stores
Thrifty Drug Stores
Medicap Pharmacies
TrueCare Pharmacy
Winn Dixie Stores
Leader Drug Stores
NeighborCare Pharmacies
Martin's Super Markets
PharmaCare Specialty Pharmacy
Medicap Pharmacies
Pharmacy Providers of Oklahoma
Community Pharmacies
Hannaford Brothers
NeighborCare Pharmacies
Price Chopper/Hen House
Leader Drug Stores
TrueCare Pharmacy
Pharma-Card Mgmt. Services
Valu Merchandisers/
Schnucks Pharmacy
SUPERVALU Pharmacies
TrueCare Pharmacy
BJ's Wholesale Club
Costco Pharmacies
Food City Pharmacies
Costco Pharmacies
Leader Drug Stores
Food Lion Pharmacy
NeighborCare Pharmacies
Giant Food Stores
Keystone Med-Chest
Payless Drug Stores
Leader Drug Stores
Leader Drug Stores
Medicap Pharmacies
SUPERVALU Pharmacies
Medicap Pharmacies
Nash Finch Company
TrueCare Pharmacy
NeighborCare Pharmacies
NeighborCare Pharmacies
PharmaCare Specialty Pharmacy
Pharmacy Express Services
Schnucks Pharmacy
Brookshire Brothers Pharmacy
Shoppers Pharmacy
Brookshire Grocery Co.
Twin Knolls Pharmacy
Stewart Memorial
Wegmans Food Markets
Community Hospital
Thrifty Drug Stores
TrueCare Pharmacy
Baystate Pharmacy
Pharmacy Providers
BJ's Wholesale Club
Wayne-Oakland Pharmacy Management
Costco Pharmacies
Price Chopper/Hen House
Allina Community Pharmacies
Rinderer's Drug Stores
Schnucks Pharmacy
SunScript Pharmacy
Hannaford Brothers
Costco Pharmacies
Leader Drug Stores
SUPERVALU Pharmacies
Louis & Clark Drug
Fairview Pharmacy Services
TrueCare Pharmacy
NeighborCare Pharmacies
Unity Retail Pharmacies
PharmaCare Specialty Pharmacy
Healtheast Pharmacies
Univeristy Health System Pharmacies
Leader Drug Stores
Valu Merchandisers/
Sedell's Pharmacy
Medicap Pharmacies
Nash Finch Company
Park Nicolett Pharmacies
Brookshire Grocery Co.
PharmaCare Specialty Pharmacy
Costco Pharmacies
D & W Food Centers
Snyder's Drug Stores
SUPERVALU Pharmacies
Leader Drug Stores
Thrifty Drug Stores
Medicap Pharmacies
Felpausch Pharmacy
Weber & Judd Kahler
Henry Ford Health System Pharmacies
SafeScript Pharmacy
Schnucks Pharmacy
Leader Drug Stores
Costco Pharmacies
TrueCare Pharmacy
Martin's Super Markets
Dierberg Family Markets
Medicap Pharmacies
Dillon's Pharmacy
Winn Dixie Stores
NeighborCare Pharmacies
Leader Drug Stores
May's Drug Stores
Costco Pharmacies
Medicap Pharmacies
Leader Drug Stores
Nash Finch Company
Professional Village Pharmacy
Sav-Mor Drug Stores
NeighborCare Pharmacies
BJ's Wholesale Club
Raleys Drug Center
Costco Pharmacies
Smith's Food & Drug
Smith's Food & Drug
SunScript Pharmacy
Snyder's Drug Stores
TrueCare Pharmacy
Thrifty Drug Stores
Hannaford Brothers
Leader Drug Stores
P & C Food Market
Buffalo Pharmacies
CuraScript Pharmacy
Costco Pharmacies
Dillon's Pharmacy
CuraScript Pharmacy
Drug World Pharmacies
Keystone Med-Chest
Kohll's Pharmacy & Homecare
BJ's Wholesale Club
Leader Drug Stores
Costco Pharmacies
Gristedes Pharmacy
Medicap Pharmacies
Nash Finch Company
Hannaford Brothers
NeighborCare Pharmacies
King Kullen Pharmacies Corp.
Pharmacy Express Services
Leader Drug Stores
Giant Food Stores
Maxor National Pharmacy
Medicap Pharmacies
TrueCare Pharmacy
Leader Drug Stores
Memorial Sloan Kettering
Medicap Pharmacies
Valu Merchandisers/
NeighborCare Pharmacies
NeighborCare Pharmacies
P & C Food Market
Quick Chek Food Stores
PharmaCare Specialty Pharmacy
Costco Pharmacies
ShopRite Pharmacy
Leader Drug Stores
Wegmans Food Markets
Payless Drug Stores
ShopRite Pharmacy
Raleys Drug Center
Ralph's Pharmacies
Wayne Drug Co.
Scolari's Food & Drug Co.
Costco Pharmacies
Wegmans Food Markets
Leader Drug Stores
Smith's Food & Drug
Medicap Pharmacies
NeighborCare Pharmacies
Costco Pharmacies
BJ's Wholesale Club
Risch Drug Stores
Costco Pharmacies
Farm Fresh Pharmacy
Ritzman Pharmacies
CuraScript Pharmacy
Food Lion Pharmacy
Riverside - Div of Penn Traffic
Harris Teeter Pharmacy
Sav-Mor Drug Stores
SUPERVALU Pharmacies
Leader Drug Stores
Giant Food Stores
Medicap Pharmacies
Greco Enterprises
NeighborCare Pharmacies
PharmaCare Specialty Pharmacy
Klingensmith's Drug Stores
Harp's Food Stores
Leader Drug Stores
Med-Fast Pharmacy
Leader Drug Stores
Medicap Pharmacies
Harris Teeter Pharmacy
May's Drug Stores
Leader Drug Stores
Medicap Pharmacies
NeighborCare Pharmacies
Medicap Pharmacies
Med-X Corporation/Drug Mart
Thrifty Drug Stores
PharmaCare Specialty Pharmacy
NeighborCare Pharmacies
Pharmacy Providers
TrueCare Pharmacy
Riverside - Div of Penn Traffic
Valu Merchandisers/
Anchor Pharmacies
ShopRite Pharmacy
Buehler Pharmacies
SUPERVALU Pharmacies
Costco Pharmacies
Discount Drug Mart
Bi-Mart Corporation
Wegmans Food Markets
Costco Pharmacies
Fitzgerald's Pharmacy
(F & F Pharmacies)
Costco Pharmacies
Hi-School Pharmacy
Leader Drug Stores
Leader Drug Stores
Medicap Pharmacies
Medicap Pharmacies
NeighborCare Pharmacies
NeighborCare Pharmacies
Payless Drug Stores
PharmaCare Specialty Pharmacy
PharmaCare Specialty Pharmacy
Quality Food Centers
PharmaCare Specialty Pharmacy
Costco Pharmacies
Costco Pharmacies
Schnucks Pharmacy
Food Lion Pharmacy
The Pay-Less Pharmacy Group
Intermountain Health Care
TrueCare Pharmacy
Leader Drug Stores
Harris Teeter Pharmacy
Payless Drug Stores
Smith's Food & Drug
Leader Drug Stores
Brookshire Brothers Pharmacy
Medicap Pharmacies
Brookshire Grocery Co.
Costco Pharmacies
NeighborCare Pharmacies
CuraScript Pharmacy
Costco Pharmacies
PharmaCare Specialty Pharmacy
Piggly Wiggly/Price Wise
Kelsey-Seybold Pharmacy
Hannaford Brothers
Leader Drug Stores
Leader Drug Stores
Market Basket Pharmacies
Maxor National Pharmacy
Leader Drug Stores
Medicap Pharmacies
Medicap Pharmacies
Minyard & Sack ‘N Save Pharmacies
Nash Finch Company
NeighborCare Pharmacies
Oncology Pharmacy Services
Peoples Rx Pharmacy
PharmaCare Specialty Pharmacy
Anchor Pharmacies
BJ's Wholesale Club
Pharmacy Providers
Costco Pharmacies
Costco Pharmacies
Randall's Food & Drugs
Farm Fresh Pharmacy
Rogers Pharmacies
Food City Pharmacies
Food City Pharmacies
SafeScript Pharmacy
Food Lion Pharmacy
SunScript Pharmacy
Giant Food Stores
Harris Teeter Pharmacy
Tom Thumb Food & Pharmacy
Harris Teeter Pharmacy
TrueCare Pharmacy
Leader Drug Stores
Leader Drug Stores
United Supermarkets
Medicap Pharmacies
Medicap Pharmacies
Moore & King Pharmacy
NeighborCare Pharmacies
Shoppers Pharmacy
Ukrop's Supermarkets
Wegmans Food Markets
Mercy Health System
Bartell Drug Company
Morton Drug Company
Bi-Mart Corporation
Nash Finch Company
Costco Pharmacies
NeighborCare Pharmacies
Northwest Health Ventures/Lehman
Hi-School Pharmacy
Leader Drug Stores
Schnucks Pharmacy
Medicap Pharmacies
Snyder's Drug Stores
NeighborCare Pharmacies
SUPERVALU Pharmacies
Pacmed Clinic Pharmacies
Thrifty Drug Stores
Payless Drug Stores
PharmaCare Specialty Pharmacy
Quality Food Centers
Yoke's Washington Foods
Leader Drug Stores
Medicap Pharmacies
Smith's Food & Drug
Giant Food Stores
Leader Drug Stores
For the most current list of pharmacies in the Pharmacy
Medicap Pharmacies
Network, go to www.usdos.sevencorners.com and click on
NeighborCare Pharmacies
the tab pharmacy network
You may obtain up to a one-month supply (30 days) of
your prescription medication from a Pharmacy Network
provider and up to a three-month supply (90 days) through
the Direct Mail Service.
Leader Drug Stores
Marshfield Clinic Pharmacy
Medicap Pharmacies
If you are planning to leave the US, and you know you
3. Even if the medication is a covered prescription under
will need a prescription drug refill of any kind while you are
ASPE, it may not be allowed into the country you are
overseas, you should follow these steps:
traveling. Don't assume that you can get a prescription
just because ASPE would pay for the medication.
1. Gather information about the availability of the
medication in the host country to which you are travel-
4. The following countries will not accept prescriptions
ing. Due to regulations regarding controlled sub-
shipped from the US.
stances and/or prescription medications, drugs
available in the US are not necessarily available over-
seas and vice versa. If the medication you are taking
is not available in your host country, there are many
restrictions on shipping prescription medication
that can affect your ability to get your medication. In
addition, if the medication you take is available in your
5. Take all of your findings into consideration relating to
host country, the Ministry of Health or customs may
your health before you make your travel arrange-
not allow your medication to be shipped from the US.
ments. Important medications may not be available,
(i.e. Birth control medication including the Nuvaring).
and you need to make every personal effort to deter-
Whether or not a medication can be sent to you
mine what your options are if you cannot obtain a drug
outside the US can vary by types of medication
your doctor has prescribed for you that you need to
(i.e., special packaging), by mail carrier type, and
continue to take while out of the US.
sometimes it is just simply not allowed.
If you find out your prescription is allowed and you
2. Call your doctor and see how much of a day
work everything out with your provider, the following process
supply of your medication he/she can prescribe you
describes the method of obtaining the prescription through
so you can have it filled before you leave, and discuss
with him/her the information you found out about your
specific prescription and its dispensing regulations in
1. Please review the list of medication excluded from the
the country you are going. Find out what s/he suggests
ASPE pharmacy benefits. If the drug you are taking is
and if there are any alternatives if you are NOT able to
not a covered ASPE approved medication, the pay-
get the drug you are currently being prescribed once
ment will be YOUR responsibility.
you leave the US.
2. If it is a covered ASPE medication and it is a mainte-
nance medication that is allowed to be shipped to your
It is your responsibility to determine and insure that
host country, the minimum for ordering through mail
you will be able to purchase maintenance medication
service is a 90-day supply. It is your responsibility to
in your host country. To ensure you do not encounter
purchase at least a 60-day supply of required medica-
issues, get all the facts!
tion to take with you to your host county—this is not
reimbursable by ASPE.
Prescriptions must be written by a licensed
US physician.
Prescriptions ordered through the mail order
When you pay for prescription drugs out of pocket and
pharmacy will be filled using generics unless
it is a covered ASPE medication you can complete a
Outside
specified by your Doctor.
the US–Reimbursement Form for Prescription Drugs. The
Mail order prescriptions cannot be filled until you
form is provided in the back of this guide and additional
are active on your grant—the start date on your
forms are available through one of the following ways:
ASPE ID card. ASPE does not pay for prescription
Go to www.usdos.sevencorners.com, select forms,
medications before or after your grant. (see dates
and download the
Outside the US–Reimbursement
on your ASPE ID card)
Form for Prescription Drugs
Please use the
Outside the US–Mail Order
Call Customer Service 1.800.461 .0430 or collect
Presription Form to order your prescriptions. The
at +01.317.818.2867
form must be completely filled out and include a
street mailing address plus phone number for a
To obtain reimbursement, the form must be submitted
FedEx or DHL shipment. A copy is provided in the
with the medication receipt which must include:
back of the guide and additional copies can be
the name and address of the pharmacy or hospital
obtained in one of the following ways:
where the medication was purchased,
the physician's name,
the date of service,
Go to www.usdos.sevencorners.com to download
a description of the prescription drug, and the charge
a
Outside the US–Mail Order Prescription Form.
Call customer service at 1 .800.461 .0430 or collect
at +01.317.818.2867
Carmel, IN 46082-3724
Remember that if you have less than 90 days left on
your grant, your refill will not be a full 90 day refill.
It will be filled with an amount necessary to cover
you during your eligibility period.
Any over-the-counter drug or medical supplies that
Drugs not approved by the FDA
can be bought without a prescription
Drugs labeled "Caution-Limited by Federal Law to
Any quantity of drugs dispensed which exceeds the
Investigational Use," drugs which are in connection
supply and refill limits
with experimental or investigative services or supplies,
Any prescription or refill dispensed more than one
including drugs requiring federal or other governmental
year after the original prescription
agency approval or granted at the time they are prescribed.
Prescriptions filled prior to the effective date or
Multiple Sclerosis agents such as Betaseron, Avonex,
after the termination date of the Exchange
Copaxone, Tysabri
Participant's coverage
AIDS related drugs (HIV)
Nutritional Supplements
Anorexiants, anti-obesity drugs
Drugs used to deter smoking
Therapeutic devices or appliances or other non-
Anti-narcolepsy drugs
medical substances, regardless of their intended use
Related services or supplies including, but not
Nonprescription contraceptives and supplies related to
limited to, administration of high dose chemotherapy,
birth control, injectable and implantable contraception,
radiation therapy, or any other form of therapy, or
with the exception of birth control pills, diaphragms,
Immunosuppressive drugs are not covered when
patch and ring which are covered
associated with any tissue or solid organ transplant
Unreceipted blood, blood plasma or blood expanders
Any drug for cosmetic purposes, including, but not
Vitamins, or vitamin derivatives
limited to, Rogaine
All drugs related to Erectile Dysfunction (ED)
Fluoride preparations
Human growth hormones
Immunization agents
If you receive covered medical services from a medical
Claims are automatically submitted to Seven Corners by
provider that is not in the Medical Provider Network and you
the provider or hospital when you use a medical provider that
paid for medical bills out of your pocket, you must complete
is in the Medical Provider Network. You are responsible for
an Accident/Illness Medical Claim Form and submit it along
paying your co-pay at the time of service. Payment for services,
with your itemized medical bills to receive reimbursement for
other than the co-pay, will not be expected in advance. Addi-
your payment.
tionally, when you use the Medical Provider Network, you will
not be responsible for charges over the usual, customary and
An Accident/Illness Medical Claim is provided in the
reasonable charges. All covered services are paid according
back of this guide, and additional forms are available through
to the negotiated fee schedule.
one of the following ways:
Go to www.usdos.sevencorners.com, to download
the Accident/Illness Medical Claim
ASPE requires all of its members (exchange participants)
Call Customer Service 1.800.461 .0430 or collect
to pay a $15.00 co-pay for all office visits, ER, urgent care and
at +01.317.818.2867 outside the US and one will be
hospitalizations. The provider will require the co-pay at the time
of visit. As a reminder the co-pay amount will be pre-printed
on your ASPE ID card.
You must submit information NO LATER than one year
from the date of the medical service to receive reimburse-
ment. Original bills will not be returned. Keep a photocopy of
If your claim is denied for payment, you may appeal the
all bills and receipts for your personal records. The bills you
denial decision by submitting an appeal in writing to:
submit MUST INCLUDE the following information:
Name, address and professional status of the
person or organization providing the service
Provider Tax ID number (for providers in the US)
ASPE Health Benefits
Name of patient receiving service
Description of each service
Carmel, IN 46082-3724
Charge for each service
For eligible psychotherapy expenses,
Payment of medical benefits is subject to the availability
include the length of each session and session
of appropriated funds at the time the claim is filed.
type (ex. group or individual)
Sign the completed claim form and mail it to the address
No legal action may be brought against the ASPE prior to
on the back of your identification card.
the expiration of 120–days after written claim form and other
proof of loss have been submitted. Additionally, no legal action
may be brought against the ASPE after the expiration of three
years from the time of submission of written claim form and
required proof of loss.
The ASPE program contains a Coordination of Benefits
If you receive an injury due to the actions of another
provision. This provision is used when you are eligible for pay-
person, and benefits are paid under your ASPE plan due
ment of claims under more than one health care benefit plan.
to that injury, USDoS will be entitled to a refund from such
When you have health care coverage other than ASPE
recovery of all benefits paid if money is recovered from the
(except Medicare or Medicaid), your other coverage is the
third party, its insurer, or uninsured motorist insurance.
primary payer and must pay claims first up to the limit of its
Upon request, you must complete the required Accident
policy. ASPE is then designated as the secondary payer and
forms and return them to USDoS and cooperate fully with
must pay any remaining amount covered by your ASPE plan.
USDoS asserting its right to recover.
The ASPE is secondary to all other insurance polices,
When payments for a given medical treatment have
except Medicare/Medicaid
been made in excess of the amount necessary, USDoS has
the right to recover such overpayments. The USDoS will
notify you of the overpayment and request reimbursement
If you have health care coverage other than this USDoS
from the health care provider
plan, use the following guidelines to determine when claims
should be submitted to USDoS as the primary payer:
1st: Submit claims to private insurance carrier and
obtain payment and EOBs
2nd: Submit your original medical bills and EOBs
from your primary carrier, and ASPE will pay
your remaining charges covered under your
ASPE benefit plan.
If you become disabled prior to age 65 or are otherwise
entitled to Medicare benefits (i.e. for renal dialysis), the bene-
fits you are entitled to receive from Medicare will be reduced
by the amount the ASPE health benefit plan would pay. You
must first use ASPE health plan benefits to which you are
entitled before submitting charges to Medicare or Medicaid
for reimbursement.
Administrator—A private company contracted by the USDoS to
Covered Services—Medical services or supplies covered by the ASPE
administer the ASPE health benefit plan. The current ASPE
health benefit plan are those related to medical conditions which are
administrator is
Seven Corners, Inc.
not pre-existing, and provided by a provider acting within the scope
of their license. In order to be considered a covered service, charges
Ambulatory Surgical Facility—An establishment which may or may
must be incurred while your coverage is in force.
not be part of a Hospital and which meets the following requirements:
1. is in compliance with the license or other legal requirements
Covered Expense—Expenses for medical services or supplies that are:
in the jurisdiction where it is located;
1. allowable by the ASPE health benefit plan,
2. is primarily engaged in performing surgery on its premises;
2. administered or ordered by a Physician,
3. has a licensed medical staff, including Physicians and
3. medically necessary to the diagnosis and treatment of an
Registered Nurses;
Injury or Sickness,
4. has permanent operating room(s), recovery room(s) and
4. related to medical conditions that are not pre-existing per
equipment for emergency care, and
the ASPE health benefit plan definition, and
5. has an agreement with a Hospital for immediate acceptance
5. not in excess of the negotiated rate based on services provided
of patients who require Hospital care following treatment in
or the usual, customary and reasonable fee schedule.
the ambulatory surgical facility.
Covered Person—Exchange Participants in an eligible ECA/USDoS
Benefit Year—The one-year period that begins on your start date in
sponsored exchange program enrolled in the ASPE benefit plan.
the ASPE program.
"Eligible Program" does not include those for which USDoS support
is primarily for administrative or facilitative support rather than direct
Certificate of Coverage—Is a "Proof of Coverage" letter providing
Participant costs. "Participants" does not include escorts, escort/
evidence of your prior health coverage. Upon request this document
interpreters, staff of organizations receiving grant support directly or
is provided by Seven Corners.
indirectly from USDoS, independent consultants associated with
these organizations, or dependents of program participants.
Co-Pay—Co-pay is the specified dollar amount that a patient is
expected to pay directly to the provider at the time of service.
Durable Medical Equipment (DME)—DME means medical
Covered Charges—Charges for medical services or supplies that are:
1. is prescribed by the Physician who documents the
1. allowable by the ASPE health benefit plan;
necessity for the item, including the expected duration
2. administered or ordered by an eligible health care provider;
3. medically necessary to the diagnosis and treatment of an
2. can withstand long term repeated use without replacement;
Injury or Sickness;
3. is not useful in the absence of Injury or Sickness; and
4. related to medical conditions that are not pre-existing per the
4. can be used in the home without medical supervision.
ASPE health benefit plan definition, and
5. not in excess of the negotiated rate based on services pro-
Emergency—A sudden, unexpected onset of a medical condition
vided or the usual, customary and reasonable fee schedule.
that is of such a nature that failure to render immediate care by a
licensed medical provider would place the Exchange Participant's
life in danger, resulting in the loss of life or limb, or would cause
serious impairment to the Exchange Participant's health.
Enrollment—Exchange Participants are eligible to participate in
Injury—An accidental bodily injury sustained by an Exchange
the ASPE Health Benefit Plan when they are enrolled in the program
Participant while covered under the ASPE health benefit plan and
by their program agency, commission or cooperating agency. The
which occurs independent of all other causes.
program agency, commission or cooperating agency issues each
Exchange Participant an ASPE identification card.
Inpatient—A person who is a resident patient, using and paying for
the room and board facilities of a Hospital.
Exclusions—Any services or supplies related to pre-existing conditions
or any other non-covered plan benefits.
Intensive Care Facility—An intensive care unit, cardiac care unit, or
other unit or area of a Hospital:
EOB—Is an acronym for Explanation of Benefits. Although EOBs often
1. reserved for the critically ill requiring close observation; and
look like a medical bill, the EBO tells you what portion of a claim was
2. equipped to provide specialized care by trained and qualified
paid to the health care provider and what portion of the payment, if
personnel and special equipment and supplies on a
any, you are responsible for.
standby basis.
Experimental—Any treatment, procedure, facility, equipment, drug,
Loss—The financial loss associated with an accident or illness for a
device or supply which:
claim submitted to the Administrator.
1. is not accepted as standard medical treatment for
the condition being treated; or
Medical Network Provider—Providers of service who have been
2. requires but has not received federal or other governmental
selected or have decided to become part of a preferred network to
agency approval at the time of service.
work with an insurer to help control costs to patients.
Health Care Provider—A licensed physician, hospital or clinic that
Medicare—The program of health care for the aged and disabled
provides medical services.
established by Title XVIII of the Social Security Act of 1965, as amended.
Hospital—An institution which:
Mental Health Care Provider—A licensed physician, licensed clinical
1. operates as a Hospital pursuant to law for the care and
psychologist, licensed clinical social worker or a master of social
treatment of sick or injured persons as inpatients;
work (MSW), acting within the scope of your license who is not the
2. provides 24-hour nursing service by registered nurses on duty
Exchange Participant or a member of the Exchange Participant's
immediate family, who may provide services that are medically
3. has a staff of one or more Physicians available at all times;
necessary for mental and nervous disorders only.
4. provides organized facilities for diagnosis, treatment and
surgery either on its premises, or in facilities available to it
Outpatient—A person who receives medical services and treatment
on a pre-arranged basis, and
on an Outpatient basis in a Hospital, Physician's office, Ambulatory
5. is not primarily a nursing, rest, convalescent home or similar
Surgical Center, or similar centers, and who is not charged room and
establishment, or any separate ward, wing or section of a
board for such services.
Hospital used as such.
Pharmacy Network—The retail and mail service pharmacy network.
Identification Card—A card issued by the ASPE health benefit plan
that bears the member's name, identifies the membership by
Physician—A qualified, licensed health care practitioner, acting
number and may contain information about your coverage.
pursuant to a license, who is not the Exchange Participant or a
member of the Exchange Participant's immediate family.
Pre-Existing Condition—Any condition which:
Other Providers—Nurse anesthetist, nurse practitioner,
a. had its origins prior to the Exchange Participant's effective
psychiatric social worker, respiratory therapist, speech
date of coverage;
therapist, occupational therapist, optician, optometrist,
b. a Physician was consulted prior to the Exchange Participant‘s
physicians'assistant, private duty nurse, technical surgical
effective date of coverage;
assistant, registered physical therapist or physiotherapist.
c. treatment or medication was received prior to the Exchange
All of the above mentioned providers must be licensed or
Participant's effective date of coverage, or
certified in the jurisdiction where the services were provided.
d. would have caused any prudent person to seek medical
Registered Nurse—A graduate nurse who has been registered
advice or treatment, prior to the Exchange Participant's
or licensed to practice by a State Board of Nurse Examiners or
effective date of coverage.
other state authority, and who is legally entitled to place the
Note: For purposes of the ASPE, pregnancy is not defined as a
letters RN after your name.
Right of Recovery—When payments for a given medical treatment
Pre-Notification—Seven Corners must be contacted:
have been made in excess of the amount necessary, the USDoS
to confirm coverage and benefits;
has the right to recover such overpayments. The USDoS will notify
as soon as non-emergency hospitalization
the Exchange Participant of overpayment and request reimburse-
ment from the health care provider.
within 48 hours of the first working day following
an emergency admission;
Sickness—An illness, disease, or physical condition of an Exchange
when your physician recommends any surgery
Participant commencing while coverage is in force.
including outpatient;
for emergency evacuation, repatriation and
Usual, Customary and Reasonable (UCR)—The payment amount
as determined by a nationally recognized MDR fee schedule based
upon geographic location. The Administrator purchases the MDR fee
Providers of Service—When you are ill or injured, your coverage helps
schedule from
Ingenix, and the Administrator reserves the right of
pay the hospital and your physician as well as appropriate charges for
final determination of the amount payable for any service or supply.
other approved health care professionals. These providers include
but are not limited to:
The following is the basis for determination of UCR:
Hospital—Any hospital accredited by the Joint Commission
Usual—an amount a professional provider routinely
on the Accreditation for Health Organizations, including
charges for a given service.
Veterans Administration Hospitals and Department of
Customary—an amount which falls within the range of
Defense Hospitals.
charges for a given service billed by most professional
Physicians—Any provider licensed in the state or country where
providers in the same locality who have similar training
the services were provided. These include: Doctor of Medicine
(MD), Doctor of Osteopathy (DO), Doctor of Dental Surgeries
Reasonable—an amount that is Usual and Customary or
(DDS or DMD), Podiatrist (POD) and Psychologist (Ph.D.).
an amount not considered excessive in a particular case
Certified Nurse Midwife—Must be a licensed registered nurse
because of unusual circumstances.
and certified as a nurse midwife by the American College of
If the charge is in excess of the UCR, no payment with
respect to the excess is made, and the excess will not
qualify as a Covered Expense under the ASPE health
benefit plan.
The Accident and Sickness Program for Exchanges (ASPE) complies
with the J-1 Visa regulations which govern incoming Exchange Par ticipants.
The ASPE Health Benefit Guide, when shown with a valid Identification Card
is evidence of health benefit coverage under the ASPE and of the associated
benefits and limitations.
No changes to the ASPE Health Benefit Plan shall be made, except by the
Executive Director, Bureau of Educational and Cultural Af fairs (ECA), United
States Depar tment of State (USDoS) who will make such changes that might
be required to address budget, policy, regulator y, or legislative mandates.
This ASPE Health Benefit Guide replaces all Cer tificates, if any, previously
issued to Eligible Par ticipants and Covered Persons ef fective 1 June 2009.
The ASPE Health Benefit Plan is funded by the USDoS through the Fulbright-
Hays authorizing legislation. The payment of medical benefits is subject to the
availability of appropriated funds at the time when the claim is filed.
ASPE Health Benefit Plan
Carmel, IN 46082-3724
Source: http://www.fulbright.sk/data/ASPE_Insurance.pdf
Formale Betrachtung von Anfragen auf RDF Datenbanken im Fachbereich Biologie und Informatik an der Johann Wolfgang Goethe Universität Frankfurt am Main bei Herrn Prof. Dott. Ing. Zicari betreut von Dipl. Math. Karsten Tolle Bartholomäus Ende Inhaltsverzeichnis Bartholomäus Ende Matr.-Nr. 2063702 1. Kurzfassung Dieses Dokument befasst sich mit der formalen Analyse von Anfragen auf RDF-Datenbanken. Zu diesem Zweck wird zunächst eine kurze Einführung in das Resource Description Framework (RDF) gegeben.
IN THE NAME OF THE QUEEN DISTRICT COURT THE HAGUE Civil law section Judgment of July 2, 2008 in the case having case number / cause-list number 293668/ HA ZA 07-2628 of NOVARTIS AG, a legal entity under foreign law, having its registered seat and principal place of business at Basel, Switzerland, plaintiff in the main action, defendant in (partly conditional) counterclaim proceedings, procurator litis: previously mr W. Heemskerk, presently mr P.J.M. von Schmidt