Our prime and elite plans cover preventive care services, including immunizations such as MMR, TDAP, chickenpox, etc and will be paid 100% of preferred allowance. Particularly, HPV vaccines is covered at 100 percent only for people under the age of 27. For patients wishing to receive vaccines in school health center, they need to pay the medical expense first and send the claim to UHCSR by him/herself. For visiting an in network doctors or hospitals, health care claims will be submitted by providers directly. To find an in-network hospitals or doctors, please visit our official website at smcovered.com and then click on find 'find care' under 'visit your doctor' to enter your zip code to find hospitals in network near your school.
2. How can I get vaccines:
We recommend receiving your vaccines from CVS Minuteclinic, Walgreen or your school health care center. CVS clinic do not need an appointment, but please call in to ask if there is any vaccine inventory. To find other in-network doctors, please visit our website at https://www.smcovered.com/page/find-a-doctor, click on the preferred provider lookup link, enter your zip code, click on the services and treatments - > vaccines - > adult vaccines - > click you want a dozen vaccine. (need to schedule an appointment)
Students should call the pharmacy in advance to confirm the vaccine inventory, and show the insurance card to the pharmacy before receiving the vaccine.
3. Provider who cannot find the insured’s information (The pharmacy system showed "it is not covered")
The hospital may have to contacted UnitedHealthcare to get your insurance information. Please let the staff check into the UHCSR system or contact the "For Providers" phone number on your insurance card: 1-888-224-4875 since UnitedHealthcare Student Resources and United Health Care are using two different systems. The insurance company will then instruct the pharmacy staff on the phone and complete the bill on the spot.
4. Prescription Drug
Benefits are available for Prescription Drugs for in-network pharmacies, if you enrolled in one of these plans: Preferred/Prime/Elite. Benefits are subject to supply limits and Co-payments and/or Coinsurance that varies depending on which tier of the Prescription Drugs List the outpatient drug is listed. For example, elite plan have $15 Copay per prescription for Tier 1, $30 Copay per prescription for Tier 2, $50 Copay per prescription for Tier 3 up to a 31 day supply per prescription.
Please find prescription drug list in the attachment.
5. How do I pay for my medical services?
If you bring your insurance ID with you while visiting an in-network doctor or hospital, there is no need for you to file a claim after your visit. Medical care providers will contact the insurance company first, and then send you the rest of the bill that you need to pay. The method of payment will be found on the bill.
If you visit an out-of-network doctor or hospital, you need to pay first, and then file a claim within 90 days after your visit to get a refund.