If you would like to submit a paper claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of the Generic Reimbursement Claim Form located below.
After filling out the necessary information, please read the acknowledgement carefully (located at the bottom of page) and sign and date in the space provided.
To submit a Generic Reimbursement Claim Form, please be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed below:
Date prescription filled
Name and address of pharmacy
Doctor name or ID number
NDC number (drug number)
Name of drug and strength
Quantity and days’ supply
Prescription number (Rx number)
DAW (Dispense As Written)
Amount paid
This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. Your pharmacist can provide the necessary information as well.
Welcome to the Find a Doctor, Hospital, or Lab Center! Whether you’re looking for a doctor, hospital, laboratory, or even medical equipment and supplies, we have the information you need, all located right here.
Preferred Providers are the physicians, hospitals, and other health care providers who have contracted to provide specific medical care at negotiated prices. You should always confirm the Preferred Provider is part of the network, as this can change without notice by calling the Company at 800-505-4160 and/or by asking the provider.
The Preferred Provider for your plan is UnitedHealthcare Choice Plus PPO. If care is received from a Preferred Provider, any Covered Medical Expenses will be paid at the Preferred Provider level of benefits. Reduced or lower benefits will be provided when an Out-of-Network provider is used. By using a Preferred Provider you can also save yourself some out of pocket expenses. Use this link to search for participating physicians, hospitals, facilities, medical equipment, or supplies in your local area.
We recognize the increased need for appropriate mental health treatment for college students. We’ve partnered with United Behavioral Health (UBH) to ensure that you have access to UBH’s network of mental health care providers and facilities. UBH partners with more than 80,000 clinicians and more than 3,500 care facilities nationwide. Clinical excellence, innovation, and a relentless commitment to the most scientifically advanced health care solutions distinguish UBH as the national leader in behavioral health. To find a local Behavioral Health provider in your area, please click the link below:
To file an appeal, please include the following information:
 A letter requesting an appeal to your claim(s), including your:
Name,
Address,
Phone number,
UnitedHealthcare Student ID number,
Date of service for your injury/sickness,
Claim number(s) (located on the top of your Explanation of Benefits), and
Email address.
A copy of your Explanation of Benefits for the claim(s) in question.
Medical Records including all test results from all providers visited for the specific injury/sickness that you are appealing.
Once we receive the documentation, your appeal will be reviewed and a written response will be mailed to you. The response will include what the findings were, if the appeal was approved or denied, and the reason for the final decision.
If you have a question about your claim denial, you may call our Customer Service Department at telephone number 1-800-505-4160 for further explanation to informally resolve your appeal. If you are not satisfied with our explanation of why the claim was denied, you or your authorized representative may request an internal review of the claim denial. (For more information about an authorized representative, please click on “forms†on the left.)
Access your ID now by visiting My Account. From your My Account, you can print and download your ID card.
Permanent ID Card
In keeping with our Go Green initiative, permanent ID cards will be available by request only. Should you wish to obtain a permanent ID card, you can request one to be shipped to you by accessing your My Account. Permanent ID cards will be shipped 24 – 48 hours of your request.
Access Your ID card on your Mobile device
Use My Account Mobile to access your ID card from your mobile device. Students must have a set up my account to be able to access mobile site.
It would be our pleasure to assist you with any ID Card need you may have. Please feel free to visit our Customer Service center with any other questions regarding your ID card.
Create your My Account: You will be able to create your My Account 24-48 hours after your initial purchase of coverage.Be sure to use the email address you used to purchase coverage.
Forgot Username/Password:If you have forgotten your username or password, we’re happy to remind you. Follow the link and enter the information requested. If a match is found, you will be emailed the information to the email address you provided when setting up your account.
My Account Mobile: UnitedHealthcare Student Resources and First Student are proud to announce you can now launch our My Account site from our mobile version! The new site puts students’ critical student insurance coverage information in the palm of their hands. On the run, no problem. You can now check the status of a claim, locate a provider or pharmacy nearby and even access your I.D. card at your convenience.The mobile site can be accessed on the iPhone 3 and 4, HTC, Samsung and Motorola Droid phones and the Blackberry v6.0. Supported browsers are Firefox, Chrome and Opera Mini. Of course, users of non-supported mobile devices and browsers can access the full My Account site at www.firststudent.com.
As a UnitedHealthcare member, you have access to a comprehensive and quality pharmacy benefit provided through the UnitedHealthcare Pharmacy Benefit Program. UnitedHealthcare uses OptumRx. (www.optumrx.com) for certain pharmacy benefit services including your mail order benefit.
Make Informed Decisions
When selecting a medication, you and your doctor should consult the UnitedHealthcare Prescription Drug List (PDL). The PDL includes most brand and generic medications approved by the FDA. Medications may be placed on different “tiers” based on their overall value, with Tier 1 being the most affordable tier option. Click below to download and review the current Prescription Drug List:
Payment, pricing, and coverage information about most prescription medications
Information about lower cost medication alternatives,
A list of participating retail pharmacies by ZIP code, and
Your prescription history
Choose a pharmacy that’s in the network
To get the most from your pharmacy benefit, you should use a participating retail pharmacy. There are over 60,000 retail pharmacies in our network, including both chain and independent stores located across the United States.
Use the Pharmacy Locator to find a participating retail pharmacy.
Welcome to the Waive Your School’s Insurance Center!
This page is for those students who wish to opt-out (waive) out of the coverage under their school’s student insurance plan. The school’s student insurance plan can only be waived if the student has coverage under another acceptable insurance plan.
The first step to waive out of your school’s student insurance coverage is to verify that you are an eligible student.
All full-time students are automatically enrolled in this insurance Plan at registration unless proof of comparable coverage is furnished.
For those students who do not submit an approved waiver form before the deadline, you will be automatically charged and officially enrolled in the Student Health Insurance Plan. Once enrolled there are no refunds or cancellations. (Please note, automatic enrollment will occur AFTER the waiver deadline.)
Please Note:Â If you waive the insurance you will not be eligible to enroll until the following school year unless you experience a Qualifying Life Event.
Hard Waiver Student Waiver Instructions
Waiver Deadlines:
Annual Waiver Deadline:Â 9/15/16
Spring/Summer Waiver Deadline: 2/23/17Â (New Incoming Students Only)
For those students who do not submit an approved waiver form before the deadline, you will be automatically charged and officially enrolled in the Student Injury and Sickness Insurance Plan. Once enrolled there are no refunds or cancellations. (Please note, automatic enrollment will occur AFTER the waiver deadline.)
Open Enrollment Periods
If you are a student in the Fall semester and eligible to purchase coverage and you choose not to enroll for coverage before the Annual Enrollment Deadline of *September 15, 2016, you will not be eligible to enroll again until the start of the next Fall Semester unless you experience a “Qualifying Life Event†during the year.
*For new students in the Spring semester, your open enrollment deadline is February 23, 2017.
Qualifying Life Event
If you did not enroll during your open enrollment period and have since lost coverage under your original plan, you may qualify for a Qualifying Life Event upon providing proof of involuntary loss of coverage and payment within 30 days of losing coverage. (example: marriage, divorce, loss of job, etc) The enrollment form, check or money order, and the letter of creditable coverage must be received within 30 days of losing coverage. After 30 days the student will no longer be eligible to enroll in the plan until Fall of the following school year.
Please CONTACT US for cost and enrollment information as a Qualifying Life Event.
If you have any questions about the waiver process, please call 800-505-4160 or CONTACT US
It’s easy! Just download the claim form below. Fill out the first page with your personal information, dates of injury or sickness, the cause of the injury or date of first symptoms for a sickness, sign your name with today’s date, and attach all receipts. Please fill out the entire first page and be sure not to leave anything blank.
Your doctor will need to fill out the second page of the form.
Mail Claim Forms to:
FIRSTSTUDENT
P.O. Box 809025
Dallas, TX 75380-9025
Your Doctor can also submit a claim electronically using Emedeon (formerly WebMD). This gives a faster turn-around time than submitting a claim by mail. Check with your doctor to see if they are a participant. If they are, show them your ID Card. The Emedeon information is printed on the back of every ID Card.
If you have any problems filling-out these forms or would like to talk to a customer service representative, you can call us toll free at: 1-800-505-4160 or
Welcome to the Student Assistance Center! Your comprehensive Student Assistance benefit supports you and your eligible dependents with a wide range of issues—all at no cost to you. Our experts can offer trusted advice 24/7 and assist with balancing school and personal responsibilities. We look forward to serving you!
College life is exciting but it can also be stressful if you are balancing class with personal responsibilities. In addition, you may be facing more serious issues like family matters, depression, or substance abuse that you can’t handle by yourself. Don’t let problems keep you from enjoying college and preparing for the future. Get the help you need today!
Health Advocate will provide you with the right tools to help you through some of life’s toughest challenges. Students can call Health Advocate’s toll-free number for confidential, short-term professional assistance, focusing on coping skills for a full range of emotional, family, and other personal issues.
Welcome to the Customer Service Center! We are excited to assist you with any and all questions you may have regarding your policy.
On the left hand side we have provided you with a number of links and downloads for immediate access to any questions you may have regarding your school’s student insurance plan.
If you don’t see what you are looking for, or would like to speak to a live representative, it will be our pleasure to assist you.Â
Call Us
For questions regarding:
Benefits
Claims
Change of address
Requesting a new ID card
My Account assistance
General Policy Information
Please call 1-800-505-4160 to speak to a live customer service representative, toll free, 7 am – 7 pm CST.
