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File a Prescription Claim – Thomas Jefferson 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

Check Claim Status – Thomas Jefferson University

If you are a student and would like to check on the status of a claim that you or a provider submitted to UnitedHealthcare, you will need to set up a My Account if you have not already done so.

Please visit our My Account center to log in to an existing account or to create a new one.

File a Medical Claim – Thomas Jefferson 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

Waive Your Schools Insurance – Delaware Valley 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.


2016-2017 Waiver Information



Hard Waiver Student Eligibility

  • Full-time Domestic Students taking 12 or more credit hours
  • Full-time International Student taking 12 or more credit hours
Hard waiver students are required to have health insurance to attend Delaware Valley University, both to protect against unexpected high medical costs and provide access to quality care.

You 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.

You may waive coverage under this plan if you have health insurance that meets all of the University plan requirements and is approved by the University. You will need to provide information about your coverage in the waiver section.

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

  • All enrollment or waiver selections must be completed by the deadline.
  • The University reserves the right to audit all waivers in order to ensure compliance with the University insurance requirements. Please be sure to have a copy of your insurance policy as you may be asked to provide this documentation.

Waiver Deadlines

  • Fall Waiver Deadline: 9/20/16
  • Spring Waiver Deadline: 2/12/17 (New Incoming Students Only)

Waive Now

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 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 Annual Enrollment Deadline of *September 20, 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.

*For new dependents or new or renewing students in the Spring semester, your open enrollment deadline is February 12, 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

We are always happy to help in any way.

 

Privacy Policy

Customer Services – Thomas Jefferson 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

 

 

 

Prescription Drug Information – Uniformed Services 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 – Uniformed Services 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 – Uniformed Services 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 – Uniformed Services 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 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: