Welcome to GeoBlue
®
Simplifying the international healthcare experience to
keep you safe and healthy throughout your journey
Chapel Hill - UNC
2024-2025
WELCOME
Embarking on a study abroad program is an exciting
venture that gives students, faculty and staff a broader,
more global view of the world. Your GeoBlue health
insurance plan provides you access to global medical expertise
with responsive, multi-channel service. Register on the GeoBlue
mobile app or online through the Member Hub to learn
about the extra care you receive when you travel with GeoBlue.
INTRODUCTION TO
YOUR HEALTH PLAN
Important plan information and
health tools
ACCESSING CARE
How to receive care throughout
your journey
SELF-SERVICE TOOLS
Convenient tools available on the
GeoBlue mobile app and Member Hub
SUBMITTING A CLAIM
File a claim for reimbursement
REVIEWING PLAN BENEFITS
What is covered by your plan?
This pamphlet contains a brief summary of the features and benets for insured participants
covered under your school health insurance. This is not a contract of insurance. Coverage is
provided under an insurance policy under which your school is a participating school.
Coverage is provided under insurance policies issued by 4 Ever Life International Limited,
Bermuda. Complete information on the insurance is contained in the Certicate of Insurance
which is on le with the school and is made available to all insured participants. If there is a
difference between this program description and the certicate wording, the certicate controls.
TO YOUR INSTITUTION’S
HEALTH PLAN
Balance Billing: When a provider bills you for the difference between the provider’s charge and the amount your health
insurance plan pays. Your normal deductible and coinsurance are not counted as balance billing.
Coinsurance: The percentage of your healthcare costs that is not paid by the health insurance plan. Therefore, it’s the
percentage of the cost you are responsible for.
Coinsurance Maximum: The maximum amount of coinsurance a member pays during the policy year for covered
expenses. Limitations may apply.
Copay or Copayment: The specific dollar amount you will pay at the time of service.
Claim: Documentation submitted for payment from a provider or you for medical services rendered.
Certificate of Coverage: It describes the benefit plan with specific conditions in which you and all eligible dependents
have been enrolled (explains medical, dental, and vision coverage).
Coverage Period: The length of time that you are covered under a specific policy.
Deductible: An amount you are responsible to pay for eligible expenses before the health insurance plan begins to pay.
Explanation of Benefits (EOB): An EOB is not a bill, but a summary of how your claims were processed and what you
may owe. Your healthcare professional may bill you directly for the remainder of what you owe.
Prescription (RX): An instruction written by a medical practitioner that authorizes you to be provided a medicine or treatment.
Performing Provider: The individual or group licensed to perform medical care that provided medical services to you.
Primary Care Physician (PCP): A physician who provides both the first contact for you with an undiagnosed health
concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis.
Premium: The specific amount of money you have to pay to the health insurance company each month in exchange
for the health insurance company paying a portion of your healthcare costs.
Outpatient: When you receive care at a medical facility but are not admitted to the facility overnight or are at the facility
for 24 hours or less.
Out-of-Network Provider: A medical provider who is not contracted with Blue Cross Blue Shield companies. This typically
results in a higher coinsurance and may result in additional costs to you.
Out-of-Pocket Maximum: The most you pay during a policy period (usually a year) before your health insurance or plan
begins to pay 100% of the allowed amount.
Network: The facilities, providers, and suppliers your health insurance company contracts with to provide services at
discounted rates. The network you would utilize is Blue Cross Blue Shield companies.
Medical Evacuation: The insurer will pay the medically necessary expenses incurred for you if you become ill or injured
while traveling outside your home country for transportation to the closest location of adequate care. May also be referred
to as “Medical Repatriation.”
Inpatient: When you receive care at a medical facility and are admitted overnight, or are at the facility for more than 24 hours.
GLOSSARY
of Important Terms and Phrases
Apple and iTunes are trademarks of Apple, Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google. Inc.
This pamphlet contains a brief summary of the features and benefits for insured participants covered under your school health insurance. This is not a contract of
insurance. Coverage is provided under an insurance policy under which your school is a participating school. The policy is underwritten by 4 Ever Life International.
Complete information on the insurance is contained in the Certificate of Insurance which is on file with the school and is made available to all insured participants. If
there is a difference between this program description and the certificate wording, the certificate controls.
geobluestudents.com
Get your GeoBlue ID card
It is important to have your GeoBlue ID card to access healthcare
services; you will need to present your ID card whenever you
receive medical care. This card can be accessed from multiple
sources:
• Your ID card(s) will be mailed to you
• You can show, fax or email your ID card through the app
• Your ID card is available in the Member Hub on
www.geobluestudents.com
• Customer Service can provide replacement ID cards
When you receive your ID card, please check the information for
accuracy. Call Customer Service if you find an error.
Download the GeoBlue app to register
Download our app from the Apple or Google Play app stores to
put your plan in the palm of your hand:
• Display an electronic ID card
• Locate Blue Cross and Blue Shield providers and hospitals
within the U.S.
• Locate carefully selected, trusted providers and hospitals
outside of the U.S.
• Arrange direct payment to your provider
• Access global health and safety tools including translations,
drug equivalents, news and safety information
• Submit and track claims
You can also register online at www.geobluestudents.com.
Visit the GeoBlue Member Hub
Visit the Member Hub on www.geobluestudents.com to
view important plan information and to access convenient
self-service tools. Login with the username and password you
created when you registered through the app. If you have not
previously registered through the app, you can register directly
online.
Your institution provides you access to GeoBlue’s international health insurance plan. You can enroll online using a credit card.
Visit the Resource Center on www.geobluestudents.com and enter your self-enrollment code listed below to review plan details and pricing.
The rates listed below are valid from August 1, 2024 - July 31, 2025.
Program Name: UNC International Inbound Scholars-Chapel Hill
Self-Enrollment Code: SKN-627
Weekly rates for coverage are:
Participant P/Spouse P/Family P/Child(ren)
For Participants up to age 64
$35.96 $156.77
$92.61
$213.93
Getting Started
Important plan information and health tools
Need help with registration?
Contact us for assistance:
Inside the U.S. call 1.844.268.2686
Outside the U.S. call +1.610.263.2847
customerser[email protected]
Student Health Centers
Many schools have student health centers on
campus that can conveniently provide everyday
health services. Consult your school’s resources
for more specific information about facilities, the care
available and the coverage accepted.
Find a Provider
You have access to the leading Blue Cross Blue
Shield network within the U.S., Puerto Rico and
U.S. Virgin Islands. To find a doctor or facility, select
“Provider Finder” in the GeoBlue mobile app or
visit the “Doctor and Facilities Finder” section
then select “U.S. Provider Finder” in the
Member Hub on www.geobluestudents.com
Scheduling an Appointment with a
Blue Cross Blue Shield Provider
Once you select a provider, call to confirm they
are in network and schedule your appointment.
You will need to keep your GeoBlue ID card
handy when scheduling. If you need assistance with
scheduling an appointment, submit a “Service
Request” from the Tools & Services section on the
Member Hub on www.geobluestudents.com.
At the time of service, you will need to show the
provider your ID card to confirm you are covered
by Blue Cross Blue Shield. Depending on your
coverage, you may be responsible for a copayment,
coinsurance and/or deductible before a service
is completed.
Global TeleMD
™
We know it’s important to get the healthcare
you need, when you need it. We’ve teamed up
with Teladoc Health to bring you Global TeleMD,
a telemedicine service that provides unlimited,
24/7/365 access to free doctor consultations by
telephone or video. Doctors are available worldwide.
Prescriptions may also be provided, as appropriate
(subject to local regulations). To access Global
TeleMD, download the Global TeleMD app or select
“Telehealth” then “Talk to a Doctor” in the
GeoBlue mobile app.
Out-of-Network Providers
If you receive care from an out-of-network
provider, you may need to pay out of pocket
and submit a claim for reimbursement. Click
“How to File a Claim” in the Member Hub on
www.geobluestudents.com to download
the appropriate claim form. You can submit
claims electronically using the GeoBlue mobile
app or the Member Hub.
Prescription Benefits
Present your ID card at any participating pharmacy,
and you will be charged in accordance with your
plan benefits.*
* Certain limitations and exclusions apply to your coverage under
this plan and may affect your coverage. Your Certicate of
Coverage is on le with your institution and in the Member
Hub on www.geobluestudents.com.
ACCESSING CARE
FIND HEALTHCARE WITHIN THE U.S.
We offer a variety of emotional, practical and physical support services for you helping to make transitions more comfortable
and assignments more successful.
DEDICATED WELLNESS SUPPORT
GLOBAL WELLNESS ASSIST AVAILABLE 24/7/365
Emotional Support
✓ 24/7/365 clinical intake, message and
referral service
✓ Harmony between academic and
personal life
✓ Managing anxiety, depression, stress and
overall life changes
✓ Surviving the loss of a loved one
Practical Support
✓ Unlimited telephonic financial assistance
from financial professionals
✓ Telephonic or in-person legal assistance and
consultation with attorneys
✓ Managing academic or workplace pressure
Physical Support
✓ Wellness coaching and support for wellness
initiatives, including weight loss, fitness,
nutrition, stress management and overall
lifestyle improvement
✓ Health risk assessment to obtain and assess
individual and aggregate health data
✓ Support in finding assistance with
substance use
Global Wellness Assist
Global Wellness Assist is an international employee
assistance program (EAP) for students, faculty and
staff traveling globally on behalf of an institution,
providing access to six free confidential solution-
focused counseling sessions. Professionals are ready
to assist with any issue, anytime, any day.
To access Global Wellness Assist's services, download the GeoBlue mobile app or
visit the "Wellness" section in the Member Hub on www.geobluestudents.com.
SELF-SERVICE
TOOLS
Download the app today!
Register on the GeoBlue mobile app or online
through the Member Hub. Once registered the
login information will be the same whether
using the app or online.
Our digital tools put access to global healthcare right in your
hands! There is a wide range of information available to you
on the GeoBlue mobile app or Member Hub, including:
Provider Directory
Review profiles of preferred doctors and hospitals
to find the best match, view their contact details
and locate the office.
ID Card
Obtain an electronic copy of your ID card and
request replacements.
Telehealth
Talk to a doctor through Global TeleMD and/or talk
to a counselor through Global Wellness Assist—both
services are free, and you do not need to leave
your home.
Medicine Equivalent Tool
Find country-specific equivalents for prescription
and over-the-counter medications.
Medical Term Translations
USe the translation tool for common healthcare terms
and phrases.
Claim Submission and Status
Submit and track the status of your claims.
News and Safety Information
Receive push notifications and alerts detailing the
latest security and health issues based on your
location. You can also view country or city profiles
on crime, terrorism and natural disasters.
CLAIM
SUBMISSION
IF YOU NEED TO SUBMIT A CLAIM
FOR REIMBURSEMENT, YOU HAVE
THE FOLLOWING OPTIONS:
eClaims
The quickest most convenient way to submit your claims is
through the GeoBlue mobile app or Member Hub. Under
“Claims” you can chose to submit a claim through “File an
eClaim” or “View My Claims” to see saved claims.
Email and Fax
If you prefer to submit a claim via email or fax, a printable
claim form and detailed instructions are available in the
Member Hub on www.geobluestudents.com.
Visit the “How to File a Claim” section of the Member
Hub and click “How do you file a claim with GeoBlue?”
to download the appropriate claim form.
Email: claims@geo-blue.com
Fax: 1-610-482-9623
Postal Mail
If you prefer to submit a claim via postal mail, a printable claim
form and detailed instructions are available in the Member
Hub on www.geobluestudents.com.
Visit the “How to File a Claim” section of the Member
Hub and click “How do you file a claim with GeoBlue?”
to download the appropriate claim form.
Mail to: GeoBlue, P.O. Box 21974
Eagan, MN 55121
Missing information on the claim form
or supporting documentation may delay
your claim reimbursement.
Follow these tips to speed up the
claims reimbursement process:
✓ If you mail or fax your claim(s) make sure your
claim form is filled out completely, and don’t
forget to sign it.
✓ Fill out a separate form for each doctor or
office visit.
✓ Be sure to add a diagnosis or reason for
treatment.
✓ Provide a detailed description and amount
charged for each service.
✓ Clearly state how you’d like to be reimbursed.
✓ Make and keep handy copies of your bills,
receipts and claim forms.
Need to check the status of your claim?
No problem! Simply choose “Claims” in the GeoBlue app or visit the “Claims” section of the Member Hub.
If you are using the mobile app, you can elect to receive a push notification when your claim is processed.
For more help, visit the “Claims” section of the Member Hub.
SCHEDULE OF BENEFITS
ELIGIBLE CLASSES
The Classes eligible for coverage available under this Certificate are shown below. The coverages applicable to a Member’s Participants are as shown
in the Schedule of Benefits in the copy of the sample Individual Certificate attached to the Member’s Group Certificate.
X Class I: An international student, scholar, visiting faculty or other person with a current passport or non-immigrant visa, temporarily located
outside his or her Home Country as a non-resident alien and:
a. Is engaged in educational activities of the Member; and
b. Has not obtained permanent residency status in the United States; and
c. Is not a U.S. Citizen.
X Class II. Participants engaged in a sponsored English Language Program or similar program of the Member and maintains a valid F, J or
M visa status, and:
a. The Participant has not obtained permanent residency status in the United States; and
b. The Subscriber is not a U.S. Citizen.
X Class III. Eligible Dependents of any of the above classes
The Insurer maintains its right to investigate eligibility or student status and attendance records to verify that the eligibility requirements have been met.
If the Insurer discovers that the eligibility requirements have not been met, its only obligation is to refund premium.
Persons for whom coverage is prohibited under applicable law will not be considered eligible under this plan.
Enrollment cannot exceed 12 months.
All benefits and limits are stated per Individual Insured or Eligible Dependent (Covered Person).
SCHEDULE OF BENEFITS
TABLE 1
Limits
Individual Insured
Limits
Spouse
Limits
Dependent Child(ren)
MEDICAL EXPENSES
Coverage Year Limit
$250,000
$250,000
$250,000
Coverage Deductible
$500 per Coverage Year
$500 per Coverage Year
$500 per Coverage Year
Coverage Year Out-of-Pocket
Limit
Out-of-pocket Limit means the
amount of Reasonable Expenses
for which the Covered Person is
responsible after which the
Insurer pays 100% of the
Reasonable Expenses, subject
to the limits and provisions of this
Certificate
After the Covered Person reaches
a $3,500 Out-of-pocket Limit per
Coverage Year, the Insurer pays
the Reasonable Expenses at
100% and up to the applicable
maximums in the Tables 2 and 3.
Deductibles, Copayments, and
amounts above the maximums do
not apply toward the Out-of-
pocket Limit.
After the Covered Person reaches
a $3,500 Out-of-pocket Limit per
Coverage Year, the Insurer pays
the Reasonable Expenses at
100% and up to the applicable
maximums in the Tables 2 and 3.
Deductibles, Copayments, and
amounts above the maximums do
not apply toward the Out-of-
pocket Limit.
After the Covered Person reaches
a $3,500 Out-of-pocket Limit per
Coverage Year, the Insurer pays
the Reasonable Expenses at
100% and up to the applicable
maximums in the Tables 2 and 3.
Deductibles, Copayments, and
amounts above the maximums do
not apply toward the Out-of-
pocket Limit.
EMERGENCY MEDICAL
EVACUATION
Maximum Benefit up to $250,000
per Coverage Year
Maximum Benefit up to $250,000
per Coverage Year
Maximum Benefit up to $250,000
per Coverage Year
EMERGENCY FAMILY TRAVEL
ARRANGEMENTS
Maximum Benefit up to $1,500
per Coverage Year
Maximum Benefit up to $1,500
per Coverage Year
Maximum Benefit up to $1,500
per Coverage Year
REPATRIATION OF MORTAL
REMAINS
Maximum Benefit up to $100,000
per Coverage Year
Maximum Benefit up to $100,000
per Coverage Year
Maximum Benefit up to $100,000
per Coverage Year
ACCIDENTAL DEATH &
DISMEMBERMENT
Maximum Benefit:
Principal Sum up to $10,000
Maximum Benefit:
Principal Sum up to $5,000
Maximum Benefit:
Principal Sum up to $1,000
SCHEDULE OF BENEFITS
TABLE 2
MEDICAL EXPENSE BENEFITS
MEDICAL EXPENSES
PPO Plan
In PPO Limits+
PPO Plan
Outside PPO Limits
Physician Office Visits*
After the Deductible is satisfied, 90% of the
Negotiated Rate after a $20 Copayment per visit.
After the Deductible is satisfied, 70% of
Reasonable Expenses
Treatment at an Urgent Care Facility
After the Deductible is satisfied, 90% of the
Negotiated Rate after a $35 Copayment per visit.
After the Deductible is satisfied, 70% of
Reasonable Expenses
Hospital and Physician Outpatient
Services
After the Deductible is satisfied, 90% of the
Negotiated Rate after a $100 Copayment per visit.
After the Deductible is satisfied, 70% of
Reasonable Expenses
Inpatient Hospital Services
After the Deductible is satisfied, 90% of the
Negotiated Rate after a $100 Copayment per visit.
After the Deductible is satisfied, 70% of
Reasonable Expenses
Emergency Hospital Services
After the Deductible is satisfied, 90% of the
Negotiated Rate after a $250 Copayment per visit.
If admitted to Hospital, then 100% of Copayment
Waived.
After the Deductible is satisfied, 70% of
Reasonable Expenses
+Payment of Covered Medical Expenses for Preferred Providers is based on the Insurer’s Negotiated Rate. Preferred Providers have agreed to accept the
Negotiated Rate as payment in full.
*All Physician Visit Copayments for an Injury or Sickness are waived if treatment is received at Recognized Student Health Center.
If a Covered Person requires emergency treatment of an Injury or Sickness and incurs covered expenses at a non-Preferred Provider, Covered Medical
Expenses for the Emergency Medical Care rendered during the course of the emergency will be treated as if they had been incurred at a Preferred
Provider.
If a Covered Person incurs Covered Medical Expenses for services or supplies that are not of the type provided by any Preferred Provider, these
Covered Medical Expenses will be treated as if they had been incurred at a Preferred Provider.
SCHEDULE OF BENEFITS
TABLE 3
MEDICAL EXPENSE BENEFITS
The benefits listed below are subject to coverage maximums, Deductible, Coinsurance, and Copayments listed in Tables 1 & 2 above.
MEDICAL EXPENSES
Covered Person
Maternity Care for a Covered Pregnancy
Reasonable Expenses
Complications of Pregnancy
Reasonable Expenses
Inpatient treatment of mental and nervous disorders including
substance abuse
Reasonable Expenses up to $10,000 Maximum per Coverage Year for
a maximum period of 30 days per Coverage Year
Outpatient treatment of mental and nervous disorders including
substance abuse
Reasonable Expenses up to $1,000 Maximum per Coverage Year for
a maximum period of 30 visits per Coverage Year
Treatment of specified therapies, including acupuncture and
Physiotherapy
Reasonable Expenses up to 20 visits per Coverage Year on an
Outpatient basis
Annual cervical cytology screening for women 18 and older
Reasonable Expenses
Low dose mammography screening, one baseline mammogram
and one mammogram per year
Reasonable Expenses
Colorectal cancer screenings
Reasonable Expenses
Diabetic Supplies/Education
Reasonable Expenses
Prostate screening tests
Reasonable Expenses
Child Preventive and Primary Care Services
Reasonable Expenses
Breast Reconstruction due to Mastectomy
Reasonable Expenses
Medical treatment arising from participation in intercollegiate,
interscholastic, or club sports
Reasonable Expenses up to $5,000 Maximum per Coverage Year.
Injuries from participation in intramural sports are covered the same as
any other injury.
Repairs to sound, natural teeth required due to an Injury
Reasonable Expenses up to $500 per Coverage Year maximum
Dental Treatment (including extractions) to alleviate pain
Reasonable Expenses up to $500 per Coverage Year maximum
Outpatient prescription drugs including oral contraceptives and
devices
Prescription Drug Program with the Copayment stated below. Limited
to a 31 day supply for initial fill or refill.
1. Generic Drugs
All except a $25 Copayment per prescription
2. Brand Name Drugs
All except a $50 Copayment per prescription
GENERAL CERTIFICATE EXCLUSIONS
Unless specifically provided for elsewhere under the Certificate, the Certificate does not cover loss caused by or resulting from, nor is any premium
charged for, any of the following:
1. Expenses incurred in excess of Reasonable Expenses.
2. Services or supplies that the Insurer considers to be Experimental or Investigative.
3. Expenses incurred prior to the beginning of the current Period of Coverage or after the end of the current Period of Coverage except as described
in Covered General Medical Expenses and Limitations and Extension of Benefits.
4. Preventative medicines, routine physical examinations, or any other examination where there are no objective indications of impairment in normal
health, unless otherwise noted.
5. Services and supplies not Medically Necessary for the diagnosis or treatment of a Sickness or Injury, unless otherwise noted.
6. Surgery for the correction of refractive error and services and prescriptions for eye examinations, eye glasses or contact lenses or hearing aids,
except when Medically Necessary for the Treatment of an Injury.
7. Cosmetic surgery and therapies. Cosmetic surgery or therapy is defined as surgery or therapy performed to improve or alter appearance or self-
esteem or to treat psychological symptomatology or psychosocial complaints related to one’s appearance.
8. Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, except as specifically provided for in the Certificate.
9. Expenses incurred for elective treatment or elective surgery except as specifically provided elsewhere in the Certificate and performed while the
Certificate is in effect.
10. For diagnostic investigation or medical treatment for reproductive services, infertility, fertility, or for male or female voluntary sterilization
procedures, or the reversal male or female voluntary sterilization procedures.
11. Expenses incurred for, or related to sex change surgery.
12. Organ or tissue transplant.
13. Participating in an illegal occupation or committing or attempting to commit a felony.
14. While traveling against the advice of a Physician, while on a waiting list for a specific treatment, or when traveling for the purpose of obtaining
medical treatment.
15. The diagnosis or treatment of Congenital Conditions, except for a newborn child insured under the Certificate.
16. Expenses incurred within the Covered Person’s Home Country.
17. Treatment to the teeth, gums, jaw or structures directly supporting the teeth, including surgical extraction’s of teeth, TMJ dysfunction or skeletal
irregularities of one or both jaws including orthognathia and mandibular retrognathia, unless otherwise noted.
18. Expenses incurred in connection with weak, strained or flat feet, corns or calluses.
19. Diagnosis and treatment of acne.
20. Diagnosis and treatment of sleep disorders.
21. Expenses incurred for, or related to, services, treatment, education testing, or training related to learning disabilities or developmental delays.
22. Expenses incurred for the repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices.
23. Deviated nasal septum, including submucous resection and/or surgical correction, unless treatment is due to or arises from an Injury.
24. Expenses incurred for any services rendered by a family member or a Covered Person’s immediate family or a person who lives in the Covered
Person’s home.
25. Unless specifically provided for elsewhere under the Certificate, the cost of treatment or services that are provided normally without charge by
the Member’s Student Health Center, covered or provided by the student health fee, rendered by a person employed by the Member, including
team Doctor and trainers or any other service performed at no cost.
26. Loss due to an act of war; service in the armed forces of any country or international authority and Participation in a Riot or Civil Commotion.
27. Riding in any aircraft, except as a passenger on a regularly scheduled airline or charter flight.
28. Loss arising from
a. participating in any professional sport, contest or competition;
b. Racing or speed contests;
c. SCUBA diving, sky diving, mountaineering (where ropes or other climbing gear is customarily used), ultra-light aircraft, parasailing,
sailplaning/gliders, hang gliding, parachuting, or bungee jumping.
29. Medical Treatment Benefits provision for loss due to or arising from a motor vehicle Accident if the Covered Person operated the vehicle without
a proper license in the jurisdiction where the Accident occurred.
30. Under the Accidental Death and Dismemberment provision, for loss of life or dismemberment for or arising from an Accident in the Covered
Person’s Home Country.
31. Inpatient room and board charges in connection with a Hospital stay primarily for diagnostic tests which could have been performed safely on an
outpatient basis.
32. Orthopedic shoes (except when joined to braces) or shoe inserts, including orthotics.
33. Routine hearing tests except as provided under Preventive and Primary Care.
34. Expense covered under any Other Plan.
35. To the extent that such payments would be prohibited by law.
IMPORTANT CONTACT
INFORMATION
Contact us anytime, anywhere!
REACH US WORLDWIDE 24/7/365:
Toll-free within the U.S.
1-844-268-2686
Contact us through the GeoBlue mobile app
or Member Hub
Telemedicine services are provided by Teladoc Health, directly to members. GeoBlue assumes no liability
and accepts no responsibility for information provided by Teladoc Health and the performance of the services
by Teladoc Health. Support and information provided through this service does not conrm that any related
treatment or additional support is covered under a member’s health plan. This service is not intended to be
used for emergency or urgent treatment medical questions.
SCHL2406-MEM-11/22
This pamphlet contains a brief summary of the features and benets for insured participants covered under your school health insurance. This is not a contract of
insurance. Coverage is provided under an insurance policy under which your school is a participating school. Coverage is provided under insurance policies issued by 4
Ever Life International Limited, Bermuda. Complete information on the insurance is contained in the Certicate of Insurance which is on le with the school and is made
available to all insured participants. If there is a difference between this program description and the certicate wording, the certicate controls.
GeoBlue is the trade name of Worldwide Insurance Services, LLC (Worldwide Services Insurance Agency, LLC in California and New York), an independent licensee
of the Blue Cross and Blue Shield Association. GeoBlue is the administrator of coverage provided under insurance policies issued in the District of Columbia by 4 Ever
Life International Limited, Bermuda, an independent licensee of the Blue Cross Blue Shield Association. This coverage is offered to the members of the Global Citizens
Association, Washington, D.C.
Apple and iTunes are trademarks of Apple Inc., registered in the U.S. and other countries. Google Play and the Google Play logo are trademarks of Google Inc. All other
trademarks are property of their respective owners
Services are provided by WorkPlace Options, an independent company that is not afliated with GeoBlue and does not provide Blue Cross or Blue Shield products or
services. WorkPlace Options is solely responsible for referring participants for counseling, coaching and work-life services and health assessments by providers who
are appropriately licensed by local authorities. The evaluation and efcacy of any service delivered by a provider lies solely with the employee, spouse, dependent or
other authorized party who inquires on behalf of those or other participants. GeoBlue shall have no responsibility or liability whatsoever for any aspect of the provider
counseling, coaching, work-life services and health assessments or other similar services, or the counselor/participant relationship.
