International Student Medical Insurance Claim Submission 8/1/2013 – 7/31/2014 Creating an Account You will receive a medical insurance card. It is always advisable to have your medical insurance card whenever you seek medical treatment and when you purchase prescription drugs at a pharmacy. However, if you don't have your health insurance card with you, please ask your service provider to contact the Witherington Insurance Group by phone at 334-566-1477, fax at 334-566-7986, or email at firstname.lastname@example.org In order for you to have your medical insurance bills paid, you must first set up an online student account. Then, each time you return from a doctor’s or hospital visit, you must complete an online claim form. Follow the steps below. First, you must go online and setup an online student account. To establish a student account, go to www.visit-aci.com You will need your Member ID: UWAL000xxxxxx. (It is under your name on your health insurance card.) The Policy/Cert Number is: CLSP0032-xx (It is under the membership ID number on your health insurance card.) Click on Claim Status Click on Insured Then complete the required information to establish your account. Click Register. Submitting Claim Forms So Your Medical Bills Will Be Paid By The Insurance Company Then, once the account is setup, you must forward claim forms electronically to the insurance company in order to have your bills paid by them. Your medical bills will not be considered for payment if you do not submit a claim form. Each time you return from a doctor’s or hospital visit, you must sign in on your medical account online and complete the claim form within 90 days of the medical treatment. If the claim form is not completed and forwarded to the insurance company within that period of time and you have no reasonable explanation for the delay in filing, the doctor’s or hospital bill will not be paid and you will very likely be responsible for payment of the entire bill. How to complete an online claim form? Access the following webpage: https://secure.visit-aci.com/insuredlogin.asp Under Return Visitor complete the login information and click log in. Next click on I Agree and then Continue Click on Claim Form Click on New Form, then Sickness or Accident, then continue and complete the required information about your claim. There are three pages to the claim form, click Continue, you must click “agree” on the third page and then click submit. If you have any questions, please contact Perry Green @334 566-1477 or via email email@example.com or email, Mary Pagliero, International Programs Coordinator, at firstname.lastname@example.org. .