Welcome to the Review Brochures Center! You will find everything you will need to know about your policy in your plan brochure such as eligibility, effective and termination dates, plan benefits, any exclusions or limitations, and instructions on how to file a claim.
2017 – 2018 School Year | 2016 – 2017 School Year
2016 – 2017 School Year
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
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
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
Are required to purchase this plan unless proof of comparable coverage is furnished.
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.
Please Note: Failure to take action by Deadline will result in your student account being placed on hold.
After you verify that you are required to waive and have other insurance you will need:
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:
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 1-888-251-6253 or CONTACT US
We are always happy to help in any way.
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 brochure for your rates, effective dates and optional coverages before starting the enrollment process. The plan’s benefits can be found in the brochure within the Schedule of Benefits section with the exclusions towards the back.
2016-2017 Enrollment Information
View your school’s BROCHURE
All International Students are required to purchase this plan unless proof of comparable coverage is furnished.
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.
U.S. citizens are not eligible for coverage as a student or a Dependent.
Begin the enrollment process by following the instructions below.
Student/Dependent Enrollment Instructions
Please Note: Failure to take action by Deadline will result in your student account being placed on hold.
IMPORTANT INFORMATION FOR STUDENTS AND DEPENDENTS
Open Enrollment Periods for all Dependents and Students: If you have eligible Dependents in the Annual or, are a student in the fall and eligible to purchase coverage and you choose not to enroll for coverage before the Annual Enrollment Deadline your Dependents or you, will not be eligible to enroll again until the start of the next fall unless you experience a Qualifying Life Event during the year
*The Spring/Summer enrollment period is for new incoming students and their dependents only.
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.Â
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.
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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.
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Welcome to the Review Brochures Center! You will find everything you will need to know about your policy in your plan brochure such as eligibility, effective and termination dates, plan benefits, any exclusions or limitations, and instructions on how to file a claim.
2016 – 2017 School Year  Â
2016 – 2017 School Year
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 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.
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.
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.
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.
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:
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
Access your ID now by visiting My Account. From your My Account, you can print and download your 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.
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.
