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File a Medical Claim – Saint Joseph’s University

Submit a Claim by Mail

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

Medical Claim Form


 

Submit a Claim Electronically

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 CONTACT US


 

Call A Nurse – Saint Joseph’s University

Welcome to the NurseLine / Student Assistance Center! Your comprehensive NurseLine / 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!

NurseLine   |   Student Assistance Program


 

NurseLine

Health questions and issues can come up anytime. With NurseLine you and your family have unlimited access to a Registered Nurse day or night. You can rest easy knowing there’s somewhere to turn for trusted advice when you need it most.

A Registered Nurse can help guide you to the right care at the right time, self-care measures to ease symptoms and treat non-urgent conditions, and dependable information about diseases and medications. NurseLine can help you take charge of your health.

Saint Joseph’s University Nurseline/Student Assistance Flyer

Our experienced nurses are available 24/7 to:

  • Offer self-care information for non-urgent health issues.
  • Direct you to the appropriate care for immediate attention.
  • Explain health conditions and treatments.
  • Answer questions about symptoms or medications.
  • Recommend how to treat a fever in the middle of the night.
  • Tell you if your symptoms mean you have the flu.
  • Advise how to ease common problems like a sore shoulder.
  • Inform you of side effects of your medications.

NurseLine is the perfect resource for when you can’t reach your doctor and need immediate answers to your health questions.

Call anytime 24/7 1-866-799-2670.

Student Assistance Program

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.

A Licensed Professional Counselor will…Â

  • Provide confidential, short-term, telephonic counseling.
  • Offer referrals for long-term counseling or specialized care, as needed.
  • Address stress, depression, family issues, substance abuse and more.
  • Provide assistance with budgeting and other financial concerns.
  • Research child care and eldercare resources.
  • Be available via telephone 24/7 in a crisis.

Call anytime 24/7 1-866-799-2670.

REMEMBER: Call 911 or go to the ER in an emergency.

Customer Services – Saint Joseph’s University

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.


Email Us

For questions and issues about the following:

  • Waiver questions
  • Enrollment questions
  • Life Status Changes

Please Contact Us


To send a written correspondence

Please send written correspondence to:
FIRSTSTUDENT
PO Box 809067
Dallas, TX 75380-9067

 

 

 

Waive Your Schools Insurance – Elizabethtown College

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.


2016-2017 Waiver Information



Hard Waiver Student Eligibility

  • Full-time Domestic Undergraduate students taking 12 or more credit hours
  • International students including those International students enrolled in the Japanese Summer English Language Program

Are automatically enrolled in this insurance Plan at registration, unless proof of comparable coverage is furnished. Hard waiver students are required to have health insurance to attend Elizabethtown College.

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.)


Hard Waiver Student Waiver Instructions

Waiver Deadlines:

  • Annual Waiver Deadline: 8/25/16
  • Spring/Summer Waiver Deadline: 1/13/17


After you verify that you are a hard waiver student and have other insurance you will need:

  • Your current health insurance plan ID card,
  • Your health insurance brochure or plan description (or you might want mom & dad’s phone number handy to help answer some of the waiver questions). There might be a few questions about your current plan.

Once you have completed the waiver form, an email will automatically be sent to the email address you provided notifying you of the waiver request decision. If you receive a:

  • Approval e-mail – Your waiver was approved. You should print this e-mail and save it with your records.
  • Denial e-mail – Your waiver was denied. If you would like us to look this over or if you answered a question incorrectly, please please contact us.
  • Pending e-mail– Your insurance information is being verified and you should receive a second e-mail within a few days.

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.


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

We are always happy to help in any way.

 

Privacy Policy

 

Health Advocate – Elizabethtown College

Health Advocate is an added bonus when you enroll in a UnitedHealthcare student medical plan. Your Health Advocate benefit, provided by Elizabethtown College, includes three important features: Healthcare Help, MedChoice Support, and Medical Bill Saver. This all-in-1 benefit is designed to help you and your enrolled dependents personally navigate the healthcare maze, make better decisions about your medical care, and lower your medical bills.

Health Advocate Flyer


 

Healthcare Help   |   MedChoice Support   |   Medical Bill Saver   |   Contact Health Advocate


Healthcare Help

What is Health Care Help?
You have unlimited access to a Personal Health Advocate (PHA), typically a registered nurse, supported by medical directors and billing and claims specialists. The PHA can help you resolve a full range of clinical and insurance-related issues quickly and dependably, saving you time, money, and worry.

How Does it Work?
If you have a healthcare or insurance-related issue, call our toll-free number. You’ll be assigned a PHA who can help you with issues from finding qualified providers and services, to clarifying health coverage, addressing claims and billing concerns, to offering cost estimates for common medical procedures.

Reasons to Call

  • Find the right doctors, hospitals,
  • Schedule tests, appointments,
  • Secure second opinions,
  • Untangle Claims, billing errors,
  • Navigate your insurance plan,
  • Explain conditions, treatments, and
  • Help you make informed decisions.

 

MedChoice Support

What is MedChoice Support?
MedChoice Support is an interactive online tool that helps you weigh the pros and cons of procedures, treatments, and medications, including the risks and potential outcomes to help you make the right decisions about your care.

How can it Help?

  • Step-by-step guidance for healthcare decisions, using evidence-based information, on topics from surgery to alternative treatments,
  • Personal assessments gauge feelings and decisions, and
  • Downloadable summary to share with your healthcare team.

To access MedChoice Support, please CLICK HERE.

 

Medical Bill Saver

What is Medical Bill Saver?
The Medical Bill Saver feature provides skilled negotiators who will work with your providers to lower your out-of-pocket costs on your medical or dental bills over $400 not covered by your insurance. We can attempt to negotiate bills to help reduce the balances that apply to deductibles and coinsurance.

How can it Help?

  • Negotiation can result in 25-50% savings.
  • Easy-to-read personal Saving Result Statement, summarizing outcome and payment terms.
  • Provider sign-off on payment terms and conditions.

All three features are available to students and their dependents who are enrolled in the UnitedHealthcare student medical plan. If you have a question about who is covered for service, simply call us.

 

Contact Health Advocate

Help is Only a Phone Call Away!

Phone Number:
 1-866-799-2670
Email:Â ANSWERS@HEALTHADVOCATE.COM
Web:Â HEALTHADVOCATE.COM/MEMBERS

                                                   Health Advocate can be accessed 24/7.

 

Forms – Elizabethtown College

To view or print the PDF files, you’ll need a free utility called Adobe Reader. If you already have Adobe Reader and still have trouble opening these forms you might need to download the most recent version of Adobe Reader.



Personal Representative Appointment Form (PRA)/Yearly Authorization Form

If you would like a parent or another specific person to assist you with filing your claim(s) and to be able to discuss details of your claim(s) with our claim department, you will need to complete and sign this form. The Yearly Authorization Form gives us permission to discuss any and all medical conditions with your Personal Representative throughout the school year. This form is filled out once and is good for every injury/sickness for the entire school year.

 

Specific Case Authorization Form

If you would like a parent or another specific person to assist you with filing your claim and to be able to discuss details of your claim with our claim department, you will need to complete and sign this form. The Specific Case Authorization Form gives us permission to discuss only one specific medical condition with your Personal Representative, as you would specify on the form.

 

Enrollment Form

Dependent Enrollment Form Coming Soon

This is the form that you will use to sign up for the School Injury and Sickness plan. It will show you the rates, coverage periods, and any optional coverages available to you.

 

Medical Claim Form

This form can help you get reimbursed for all covered medical benefits which you have already paid out of pocket. Please keep in mind when you are requesting reimbursement:

  • Clip, do not staple, all bills to the completed form.
  • Make sure all bills or itemized receipts indicate a diagnosis code, procedure code, date of service, cost, and the provider’s tax ID number.
  • Mail claim to: UnitedHealthcare StudentResources P. O. Box 809025 Dallas, TX 75380
  • OR Fax claim to: 469-229-5625

 

Claim Information Form

Please download this form if you’ve received a request from us for more information regarding a claim submitted by your doctor or if you would like to speed up the claim process. By providing the injury/sickness information we are able to process your claim accurately and efficiently.

Mail to:

UnitedHealthcare StudentResources
PO Box 809025
Dallas, TX 75380-9025

Or fax to:Â
469-229-5625

 

Pharmacy Claim Form

This form is used for reimbursement of prescription drugs. If you did not present your ID card when you purchased your prescription out of pocket, you will need to submit this form for a refund. Along with this form for prescriptions filled at a network pharmacy, please attach the paid prescription receipt and the paid cash receipt to:

OptumRx Claims Department

P.O. Box 29044

Hot Springs, AR 71903

 

Privacy Notice

This form describes how we will obtain your written authorization prior to use or disclosure of your health information. We are required by law and committed to protecting the privacy of your health information. This form explains how we may use information about you and when we can disclose that information to others. You also have rights regarding your health information that are described in this notice.

 

Travel Assistance – UHCG Program Guide

Anytime you travel more than 100 miles from your home or to another country and experience a medical emergency, you can make a single phone call to the Operations Center for help! You call will be answered by a medically-certified crisis managers who can put in motion a vast number of emergency resources to solve any problem, 24/7.

 

UnitedHealth Allies Discount Services

This program provides discounts on a wide variety of health care services from a nationwide network of health care professionals and facilities. This booklet describes the products and services available to you at discounted rates. There is no additional charge to you for the discount program.

Travel Assistance, Evacuation & Repatriation – Salus University

Global Emergency Services are included in your Student Accident and Sickness Insurance Plan.

Enrollment in a UnitedHealthcare StudentResources health insurance policy may include access to global emergency services. This program provides immediate access to doctors, hospitals, pharmacies, and certain other services when faced with a travel or medical emergency while traveling. Services are available when traveling 100 miles or more from your permanent residence of abroad.

Note on Frontier MedEx name change to UnitedHealthcare Global

2016-2017 School Year


2016 – 2017 School Year

Travel Assistance, Evacuation & Repatriation

Welcome to the Travel Assistance Center! As a UnitedHealthcare member you are eligible for global emergency and medical assistance services provided by UnitedHealthcare Global. These benefits are available if you are traveling 100 miles or more from your permanent home, campus address, or while you are abroad. These services are accessible 24 hours a day, 365 days a year!

Sometimes while traveling you may feel “if it can go wrong, it will go wrong with me”. With this service, you have a caring partner to provide peace of mind for all issues that may occur while traveling.  UnitedHealthcare Global is committed to resolve emergencies by doing whatever it takes…their goal is to save lives and solve problems!

One phone call to UnitedHealthcare Global connects you to:

  • A state-of-the-art Emergency Response Center with worldwide response capabilities,
  • Experienced crisis management professionals,
  • A global network of over 41,000 pre-qualified medical providers, and
  • Air and ground ambulance service providers.

To learn more about this valuable benefit, review the UHCG PROGRAM GUIDE.

There are many services provided by this program, below is just a sample of what is offered:

Worldwide Medical and Dental Referrals

We will provide referrals to help you locate appropriate treatment and quality care.

Facilitation of Hospital Admittance Payments

We will issue a prompt financial guarantee (or wire funds) up to five thousand dollars ($5,000) to facilitate admittance to a foreign (non-US) medical facility. To the extent additional funds are required; we will issue a prompt financial guarantee (or wire funds) to facilitate admittance upon securing such funds from you, your family, or your friends via wire transfer or credit card(s). You are ultimately responsible for the payment of the cost of medical care and treatment, including hospital expenses.

Dispatch of Doctors/Specialists

In an emergency where we determine that you cannot adequately be assessed by telephone for possible evacuation from your initial medical facility, or you cannot be moved and local treatment is unavailable, we will endeavor to send an appropriate medical practitioner to you when we deem it appropriate for medical management of a case. We will pay for the transportation and related expenses of the medical practitioner. You are responsible for the payment of the cost of medical care and treatment.

Transfer of Medical Records

Upon your consent, we will assist with the transfer of medical information and records to you or the treating physician.

Updates to Family, Employer, and Home Physician

With your approval, we will provide periodic case updates to appropriate individuals you designate in order to keep them informed.

Hotel Arrangements for Convalescence

We will assist you with the arrangement of hotel stays and room requirements before or after hospitalization for ongoing care. You are responsible for costs of lodging and incidental expenses.

Emergency Medical Evacuation

If you sustain an injury or illness, that in the opinion of UnitedHealthcare Global and the treating healthcare provider, requires urgent medical attention and adequate medical treatment is not available at your initial medical facility, we will arrange and pay for a medically supervised evacuation to the nearest medical facility we determine to be capable of providing appropriate medical treatment. Your medical condition and situation must be such that, in the professional opinion of the health care provider and UnitedHealthcare Global, you require immediate emergency medical treatment, without which there would be a significant risk of death or serious impairment. All such arrangements must be coordinated and approved in advance by us.

Transportation to Join a Hospitalized Participant

If you are traveling alone and are or will be hospitalized for more than three (3) days due to an illness or injury, we will coordinate and pay for economy round-trip airfare for a person of your choice to join you. We will also assist with the arrangement of their hotel stay during your hospitalization. Costs of lodging, meals, and incidental expenses are the responsibility of the traveler.

Return of Minor Children

If your minor child(ren) age 18 or under are present but left unattended as a result of your injury or illness, we will coordinate and pay for one-way economy airfare (or upgraded transportation to match your originally booked travel) to send them back to your home country. We will also arrange and pay for the services, transportation expenses, and required accommodations of a non-medical escort, if required and as determined by UnitedHealthcare Global.

Repatriation of Mortal Remains

In the event of your death, we will assist in obtaining the necessary clearances for your cremation or the return of your mortal remains. We will coordinate and pay for commercially reasonable efforts for the expenses of the preparation and transportation of your mortal remains to your home country or place of primary residence, as well as obtain and pay for the number of certified death certificates required by the Host Country and home country to release and receive the remains.

Replacement of Lost or Stolen Travel Documents

We will assist you in taking the necessary steps to replace passports, tickets, and other important travel documents.

Transfer of Funds

We will provide you with an emergency cash advance subject to us first securing funds from you or your family. You are responsible for any fees for the wiring of these funds.

Legal Referrals

Should you require legal assistance, we will direct you to an attorney.

Message Transmittals

You may send and receive emergency messages toll-free, 24-hours a day, through our Emergency Response Center.

IMPORTANT: Insureds must call UnitedHealthcare Global first in order to activate this benefit. UnitedHealthcare Global does not reimburse monies spent for services not dispatched and rendered by UnitedHealthcare Global.

To access services please call:

(800) 527-0218Â Toll-free within the United States

(410) 453-6330Â Collect outside the United States

Services are also accessible via e-mail at operations@unitedhealthcareglobal.com.

When calling the UnitedHealthcare Global Operations Center, please be prepared to provide:

  1. Caller’s name, telephone and (if possible) fax number, and relationship to the patient;
  2. Patient’s name, age, sex, and UnitedHealthcare Global ID Number as listed on your Medical ID Card;
  3. Description of the patient’s condition;
  4. Name, location, and telephone number of hospital, if applicable;
  5. Name and telephone number of the attending physician; and
  6. Information of where the physician can be immediately reached

UnitedHealthcare Global is not travel or medical insurance but a service provider for emergency medical assistance services. All medical costs incurred should be submitted to your health plan and are subject to the policy limits of your health coverage. All assistance services must be arranged and provided byUnitedHealthcare Global. Claims for reimbursement of services not provided by UnitedHealthcare Global will not be accepted.

Pack us in your suitcase and leave the worries to us!

Waive Your Schools Insurance – Eastern University

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.


2015-2016 Waiver Information



Hard Waiver Student Eligibility

  • Full-time Undergraduate Students
  • International Students including ELP (English as a Second Language Institute – ESLI)
  • Exchange Students regardless of course load

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

Hard Waiver students are required to have health insurance to attend Eastern University. You must complete an on-line waiver or enroll in the University’s policy.

Waiver Deadlines:

  • Fall Waiver Deadline:Â 9/8/15
  • Spring Waiver Deadline: Â 1/25/16

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 cancelations except for in-eligibility or entry into the armed forces.

 

After you verify that you are a hard waiver student and have other insurance you will need the following to waive out:

  • Your current health insurance plan ID card,
  • Your health insurance brochure or plan description (or you might want mom & dad’s phone number handy to help answer some of the waiver questions). There might be a few questions about your current plan.

Once you have completed the waiver form, an email will automatically be sent to the email address you provided notifying you of the waiver request decision. If you receive a:

  • Approval e-mail – Your waiver was approved. You should print this e-mail and save it with your records.
  • Denial e-mail – Your waiver was denied. If you would like us to look this over or if you answered a question incorrectly, please contact us.

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.


Open Enrollment Periods

Open Enrollment Periods for all Dependents and Students: If you have eligible dependents in the Fall or are a student in the Fall semester and eligible to purchase coverage and you choose not to enroll for coverage before the Fall Enrollment Deadline of *September 8, 2015, you or your dependents will not be eligible to enroll again until the start of the next Fall unless you experience a “Qualifying Life Event” during the year.

*For new dependents or new students in the Spring semester, your open enrollment deadline is January 25, 2016.


Qualifying Life Event

If you did not enroll or did not enroll your dependents (dependents of hard waiver or voluntary students) during your open enrollment period and have since lost coverage under your original plan, you or the dependents may qualify for a Qualifying Life Event upon providing proof of involuntary loss of coverage and paymentwithin 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 or dependents will no longer be eligible to enroll in the plan until Fall of the following school year.

Please CONTACT USÂ 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

We are always happy to help in any way.

 

Privacy Policy

Prescription Drug Information – Salus University

OptumRx

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:

2016 Calendar Year Prescription Drug List

2015 Calendar year prescription Drug List

To determine if a medication is covered by your pharmacy benefit, its tier level, and available lower cost alternatives log in to My Account.

After you log into My Account, you can access:

  • 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.

Participating Pharmacy Chains

If you had to pay out of pocket for a prescription and need to receive a reimbursement please download the prescription claim form:

Filling prescriptions at pharmacies outside our network will increase your cost.

To get prescription drug information please call 1-855-828-7716.

Access the OptumRx Member FAQÂ for more information. Mail order benefits included only when applicable in your policy brochure.