Register for Camp

File a Medical Claim – Dyersburg State Community College

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

Need an ID Card – Dyersburg State Community College

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.

Check Claim Status – Dyersburg State Community College

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.

Customer Service – Dyersburg State Community College

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


 

 

 

 

Dental, Vision and Other Discount Services – Dyersburg State Community College

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 – Dyersburg State Community College

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

Travel Assistance, Evacuation & Repatriation – Dyersburg State Community College

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.

 

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!

Prescription Drug Information – Dyersburg State Community College

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:

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.

Dental, Vision and Other Discount Services – Cleveland State Community College

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.