In the event of injury/accident or illness, the student should

• Consult a physician if necessary.
• Follow the physician's instructions.
• Show the medical provider your Cedarville University Student Health Insurance Plan Card.
• Claim Student Health Insurance Plan as primary insurance unless your private insurance is primary.

When using the student health insurance, ask medical provider to mail all claims/bills to:

Student Health Insurance Plan
Cedarville University Medical Services
251 North Main Street
Cedarville, OH 45314

or

Special Risk Claims
Commercial Travelers Mutual Insurance Company
70 Genesee St.
Utica, NY 13502

Notify Cedarville University Medical Services as soon as possible. Fill out the claim form as soon as possible. CLAIM FORMS MAY BE FILLED OUT AT CEDARVILLE UNIVERSITY MEDICAL SERVICES.

If you have any questions, call 937-766-7864 or write to the above address.

To view the status of your claim online go to: www.studentplanscenter.com

The Plan has been described in a general manner on this web site. The Master Policy 2009B1A08 describing the provisions of this Student Health Insurance Plan is on file at the Student Life Office. No individual certificates will be issued to participants.

How to File an Appeal

Once a claim is processed and upon receipt of an Explanation of Benefits (EOB), an insured student who disagrees with how a claim was processed may appeal that decision. The student must request an appeal in writing within 60 days of the date appearing on the EOB. The appeal request must include why they disagree with the way the claim was processed. The request must include any additional information they feel supports their request for appeal, e.g. medical records, physician records, etc. Please submit all appeal requests to the Claims Administrator listed below.

Note: The time you were covered under this Plan may count as creditable coverage under State and Federal Law; if you leave this Plan and go to an employers' plan within 63 days thereafter, you are eligible to receive a certification from the Company regarding the periods you were covered. Please contact Acordia at 1-800-228-6768 when you need such verification.

Underwritten and Claims Administered by:

Commercial Travelers Mutual Insurance Company
70 Genesee St.
Utica, NY 13502
1-800-756-3702
www.studentplanscenter.com

as Policy Form # CTBH-280 (Rev. 04) (OH)

For a copy of the Company's Privacy Notice

Go to www.commercialtravelers.com/privacy.html.

or

Request one from the Health office at your school

or

Request one from:
Commercial Travelers Mutual Insurance Company
c/o Privacy Officer
70 Genesee Street
Utica, NY 13502
(Please indicate the school you attend with your written request.)

Local Representative

Wells Fargo Insurance Services
P.O. Box 276
Columbus, OH 43216-0276
1-800-228-6768
wfis.wellsfargo.com/colleges

Representations of this plan must be approved by the Company.

This is not the Policy. Rather it is a brief description of the benefits and other provisions of the Policy. The Policy is governed by the laws and regulations of the state in which it is issued. Any provisions of the Policy, as described in this brochure, that may be in conflict with the laws of the state where the school is located will be administered to conform with the requirements of that state's laws, including those relating to mandated benefits.

Return to benefits page