Health Insurance

Using Your Insurance 

Medical visits and emergencies can be very costly in the U.S. San Jose City College requires all international students to purchase and subscribe to the health insurance plan selected by the San Jose/Evergreen Community College District. SJCC does not accept any other U.S. or foreign-based insurance plans. Only students who meet certain eligibility criteria may request a waiver by completing a health insurance waiver form and providing the required proof by the first day of classes of each semester. 

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Your Insurance ID Card 

Once you are enrolled in the plan, you will receive an e-mail notifying you of your Member ID Number. Use this number to download your insurance ID card from http://4studenthealth.com/sjcc. If you need medical treatment before you receive notice that your ID card is active, please contact Relation at (800) 537-1777

Carry your ID card with you at all times! You will need your card when you visit the campus health center, physician’s office, urgent care, or hospital.

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What You Will Pay 

• The cost of the insurance charge 

• A $20 copay when you go to an in-network doctor’s office, or $35 deductible at an out-of-network doctor’s office 

• A $20 copay when you go to an in-network urgent care center or a $35 deductible at an out-of-network urgent care center when the campus health center or doctor’s office is closed 

• A $50 copay when you visit an in-network hospital, or a $70 deductible when you visit an out-of-network hospital 

• A $100 copay if you go to an in-network emergency room, or a $200 deductible at an out-of-network emergency room 

• 50% of the cost of prescription medication and non-oral contraceptives up to a maximum benefit of $2,500 

• Expenses in excess of usual and customary charges if you do not use an in-network provider 

• Full amount for any services not covered by insurance (see exclusions and limitations in the Plan Summary)

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What Does “In-Network” Mean and Why Does It Matter?

In-network means providers such as doctors, specialists, and hospitals that accept this insurance plan. Note: Sometimes it is also called “PPO” or “Preferred” network. The network for this plan is Aetna Passport to Healthcare® Primary PPO

If you use an in-network provider, covered medical services are paid by the insurance company at 100% of the Preferred Allowance. If you use an out-of-network provider, meaning a provider who is not in-network, covered medical expenses are paid at 80% of Usual, Reasonable, and Customary Charges.

To find an in-network provider: 

1. Visit www.aetna.com/docfind/custom/passport

2. Enter your location and range, then click “Search”. 

3. Select the Passport to Healthcare® Primary PPO, then click “Continue”. 

4. Type the name, specialty, or type of provider you’re looking for into the search bar, or click the corresponding category. 

5. Select a provider from the list, and call to make an appointment. 

Always check with the doctor or medical facility directly to confirm that they accept Aetna Passport to Healthcare® Primary PPO Network before you receive treatment. 

It is best to locate an in-network physician, urgent care center, and emergency room near you before you get sick.

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What Is Covered? 

• $250,000 maximum benefit per injury or sickness 

• Most physician visits and hospital charges, paid at 100% (after copay) of Preferred Allowance when you use an in-network provider; or 80% (after deductible) of Usual, Reasonable, and Customary Charges when you use an out-of-network provider 

• Specific emergency benefit expenses 

• Surgery, in- and out-patient 

• Tests, procedures, and laboratory services, such as X-rays 

• Physical therapy, chiropractic care, acupuncture 

• Maternity and prenatal care 

• Prescription drugs Limitations and exclusions may apply. There is a six (6) month preexisting condition limitation of $5,000. Please see the Plan Summary at http://4studenthealth.com/sjcc for more details regarding benefits, terms, conditions, and exclusions of the insurance plan as underwritten by Allied World Assurance Company, Ltd. If there are any discrepancies between this document and the Policy, the Policy will govern.

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Urgent Care 

Do not go to the hospital for minor illnesses or injuries! If you need to see a doctor immediately and cannot wait for a scheduled appointment, please go to an urgent care center. Hospital emergency rooms typically charge 2-3 times more than a doctor’s office or urgent care center. Use an urgent care center instead of an emergency room to save time and money.

Here are some in-network urgent care centers close to campus: 

Valley Health Center – Moorpark
2400 Moorpark AVenue
San Jose, CA 95128
(888) 334-1000

SCVMC Outpatient Department
751 South Bascom Avenue
San Jose, CA 95128
(408) 885-5000

Action Urgent Care
1432 W San Carlos Street, Suite 10
San Jose, CA 95126
(408) 913-1163

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Claims 

After your visit, an in-network physician or provider will send a bill to the claims administrator, Relation Insurance Services. If the medical provider does not file a claim on your behalf, you will need to submit a claim for reimbursement. Follow these steps: 

• Download a claim form and fill it out completely. 

• Claim forms are available at www.4studenthealth.com/sjcc under Claims in the USE YOUR INSURANCE section. 

• Include your member number (as shown on your ID card) on the claim form. 

• Attach itemized bills for X-rays, laboratory charges, etc. 

• Send your claim form and all bills pertaining to this claim to Relation at the address below. Try to have all itemized bills attached to the same claim form. 

The address and fax number to submit claims information are as follows: 
Relation Insurance Services 
P.O. Box 6040 
Agoura Hills, CA 91376-6040 
Fax: (818) 735-3567 

Fill out the form completely so your claim will be processed promptly. Keep copies of all the documents you submit for claims. To check the status of a claim you submitted, call Relation at (800) 468-4343.


For more information you please visit the official website http://4studenthealth.com/sjcc.

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