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Waive Your Schools Insurance – Dickinson 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
Must enroll or waive the school-sponsored insurance plan each academic year.
It is important for you to make an informed health assessment each year. Make sure you are not left without appropriate health coverage – it could hinder your academic progress.

PLEASE NOTE: If you are an International Student or Visiting Scholar, you are automatically enrolled in this insurance plan at registration.


International Students

  • International Students
  • Visiting Scholars
Are automatically enrolled in the insurance plan at registration.

Hard Waiver Student Waiver Instructions

You may waive coverage under this plan if:

  • You have health insurance that meets all of the College plan requirements
  • It is approved by the College
  • You are a U.S. Citizen

You will need to provide information about your coverage in the waiver section.

Waiver Deadlines:

  • Annual Waiver Deadline: 9/1/16
  • Spring/Summer Waiver Deadline: 1/31/17
Important: If you do not enroll for or waive coverage by the designated deadline you will be automatically enrolled in the school-sponsored plan and charged the applicable premium. Once you are enrolled the coverage cannot be cancelled except for certain life changing events and only if the policy has not been utilized.

  • If you do not enroll in or waive the student health insurance by 8/15/16 you may have a hold placed on your account.
  • Students who do not respond by 9/1/16 will be automatically charged for the student health plan.
  • The College reserves the right to audit all waivers in order to ensure compliance with the College insurance requirements. Please be sure to have a copy of your insurance policy as you may be asked to provide this documentation.
  • Waiver of the College’s sponsored plan does not impact your ability to utilize the services of the Dickinson College Student Health Center.

In Order to Complete the Waiver Card Below, You Will Need the Following:
  • Your current health insurance plan ID card.
  • Your health insurance brochure or plan description.
  • Please refer to the Dickinson College Policy Brochure to help you complete your assessment.

View BROCHURE

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

IMPORTANT INFORMATION FOR ALL STUDENTS: 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 1, 2016, you or your dependents will not be eligible to enroll again until the start of next Fall unless you experience a “Qualifying Life Event” during the year. Â

*For new dependents or new students in the Spring semester, your open enrollment deadline is January 31, 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 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 will no longer be eligible to enroll in the plan until Fall of the following school year.

 Please contact Riggs, Counselman, Michaels & Downes, Inc. (800) 346-4075 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 – Dickinson College

Health Advocate is an added bonus when you enroll in a UnitedHealthcare student medical plan. Your Health Advocate benefit, provided by Dickinson 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 – Dickinson 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

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 – Southwestern 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!

Prescription Drug Information – Southwestern 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.

Need an ID Card – Southwestern University

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.

Health Care 101 – Southwestern University

Welcome to the Health Care 101 Center! We understand the busy schedule of both parents and kids, no matter what the age. With that in mind, here’s a no-frills, easy-access guide to health insurance benefits.

Insurance 101 is not meant to address your policy specifically (each one of these has its own list of exclusions and limitations). However, this is a generic overview of health insurance types and terminology. If you have a specific question about your policy please give us a call at 1-800-505-4160.

Trying to determine if you should purchase the health insurance plan? Download our tools below for a few tips

Healthcare 101

Insurance Glossary of Terms

Find a Doctor, Hospital or Lab – Southwestern University

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 1-800-505-4160 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:

File a Prescription Claim – Southwestern University

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.

Please mail completed form and receipt(s) to:

OptumRx Claims Department

P.O. Box 29044

Hot Springs, AR 71903

File a Prescription Claim – Southwestern University

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.

Please mail completed form and receipt(s) to:

OptumRx Claims Department

P.O. Box 29044

Hot Springs, AR 71903