Welcome to the Policy Information Center! You will find everything you will need to know about your policy in your plan certificate such as eligibility, effective and termination dates, plan benefits, any exclusions or limitations, and instructions on how to file a claim.
2020 – 2021 School Year |Â 2019 – 2020 School Year
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 1-888-251-6253 and/or by asking the provider.
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 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.
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:
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
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
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.
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.
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 1-888-251-6253.
Trying to determine if you should purchase the health insurance plan? Download our tools below for a few tips
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:
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:
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.
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.
Global Emergency Services (GES)
Have some peace of mind while traveling. We’ve heard great stories about GES saving the day for students who are studying or traveling in other states or other countries. When you’re at least 100 miles from home and you’re sick or hurt, GES steps in with immediate assistance and evacuation benefits. They can even help you get home if you need to be medically evacuated.
Some benefits of this service include:
For more information on Global Emergency Services, please review the Assistance and Evacuation Benefits section in your Brochure-Certificate.
Welcome to the Student & Dependent Enrollment Center! Here you will find all the necessary tools to enroll in your school sponsored policy.
We suggest you review the certificate for your rates, effective dates before starting the enrollment process. The plan’s benefits can be found in the certificate within the Schedule of Benefits section with the exclusions towards the back.
2020-2021 Enrollment Information
View your school’s CERTIFICATE
All degree seeking International Students, regardless of credit hours, are required to purchase this insurance plan unless proof of comparable coverage is furnished.Â
Students must actively attend classes for at least the first 31 days after the date for which coverage is purchased. The 31 day requirement is waived for Summer if the applicant was enrolled in this plan in the immediately preceding Spring term. Home study, correspondence and online courses do not fulfill the Eligibility requirements that the student actively attend classes. The Company maintains its right to investigate Eligibility or student status and attendance records to verify that the policy Eligibility requirements have been met. If the Company discovers the Eligibility requirements have not been met, its only obligation is to refund premium.
Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the student’s legal spouse and dependent children under 26 years of age.Â
Dependent Eligibility expires concurrently with that of the Insured student.
U.S. citizens are not eligible for coverage as a student or a Dependent.
Student/Dependent Enrollment Instructions
OPEN ENROLLMENT PERIODS
If you are eligible or have eligible Dependents in the fall and you choose not to enroll before the Fall/Early Arriving RA’s Fall Enrollment Deadline, 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.
*Spring/Summer enrollment periods are for New Incoming and Renewing Students and Dependents only.
TO ENROLL PLEASE CLICK ON THE FOLLOWING LINK:
Please be sure to select I AGREE when you are asked if you wish to share your Insurance Information with your school in order for your school to verify if you are in compliance with their Insurance Requirements.
Students who did not enroll themselves or their dependent(s) during the open enrollment period may be able to enroll in the policy if they experience a Qualifying Life Event.
Qualifying Life Events include:
If you and/or your dependents meet the requirements for a Qualifying Life Event, you will need to provide the following:
All documents and payment must be received within 30 days of the qualifying life event.　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 Us　for cost and enrollment information as a Qualifying Life Event.
If you have any questions about the enrollment process, please call　1-888-251-6253　or　CONTACT US
We are always happy to help in any way.
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:
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:
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.
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.
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:
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
Global Emergency Services (GES)
Have some peace of mind while traveling. We’ve heard great stories about GES saving the day for students who are studying or traveling in other states or other countries. When you’re at least 100 miles from home and you’re sick or hurt, GES steps in with immediate assistance and evacuation benefits. They can even help you get home if you need to be medically evacuated.
Some benefits of this service include:
For more information on Global Emergency Services, please review the Assistance and Evacuation Benefits section in your Brochure-Certificate.
