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Brochures, Flyers & SBC – nib International Student Services

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

 

 

 

 

 

Forms – nib International Student Services

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.

 

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.

 

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.

Customer Service – nib International Student Services

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 1-888-251-6253 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


 

 

 

 

Check Claim Status – nib International Student Services

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 – nib International Student Services

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.

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:Â 1-888-251-6253 or CONTACT US

Health Care 101 – nib International Student Services

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

Health Advocate – nib International Student Services

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

 

Travel Assistance, Evacuation & Repatriation – nib International Student Services

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.

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2017-2018 School Year


2017 – 2018 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:Â Insureds must first call UnitedHealthcare Global directly in order to access and use the services of this benefit. UnitedHealthcare Global does not reimburse monies spent for services not dispatched, arranged 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!

Dental, Vision and Other Discount Services – nib International Student Services

Included with most student health insurance policy is the UnitedHealth Allies discount card. To see if Student Health Allies is included with your plan, please review your brochure or check your permanent ID card. We’re confident that the UnitedHealth Allies program can help you stretch your health care dollar on:

Dental Care

Save from 10% to 35% on a range of dental services including routine cleaning, x-rays, even cosmetic dentistry, such as teeth whitening.

Vision Care

Pay no more than $40 for an annual eye exam, and save 10% to 20% on eyeglasses from participating eye care professionals and retail vision chains and fittings for contact lenses (not included in annual eye exams).

Wellness products and services

Be healthier and save money with discounts of 10% to 50% on weight management, fitness memberships and equipment, relaxation resources, natural products, and vitamins and supplements. For a complete UnitedHealth Allies brochure on Dental Care, Vision Care, and Wellness Products and Services please click on the link below:

UnitedHealth Allies Brochure

UnitedHealth Allies is not insurance. UnitedHealth Allies provides discounts at certain health care providers for medical services. UnitedHealth Allies does not make payments directly to the providers of medical services. The program member is obligated to pay for all health care services, but will receive a discount from those healthcare providers who have contracted with the discount plan organization.

 

File a Prescription Claim – nib International Student Services

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